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

Anxiety as a mediator between symptom distress and quality of life in peritoneal dialysis patients: insights from mediation analysis and nonlinear models

OBJECTIVES

This study investigates anxiety's role as a mediator between symptom burden and quality of life in patients undergoing peritoneal dialysis, emphasizing the potential for targeted interventions to enhance patient outcomes.

METHODS

In a cross-sectional design, 320 peritoneal dialysis patients were recruited, with 305 providing valid responses (response rate: 95.31%). Symptom burden (occurrence and distress), anxiety levels, and quality of life were measured using validated tools. Multiple linear regression and restricted cubic spline models assessed associations, using β with a 95% confidence interval (95% CI), while mediation analysis with 1000 bootstrap samples quantified anxiety's mediating effects.

RESULTS

Participants reported an average of 8.2 ± 2.3 concurrent symptoms, with 'worry,', 'tiredness', and 'dry skin' being the most severe. Both symptom number (β = -0.90; 95%CI: -1.26 to -0.55) and distress (β = -1.20; 95%CI: -1.41 to -0.98) negatively correlated with quality of life. Anxiety mediated these relationships significantly, explaining 38.9% (95%CI: 18%-62%) and 33.3% (95%CI: 19%-49%) of the total effects for symptom number and distress, respectively. Restricted cubic spline models revealed an 'L-shaped' relationship between symptom burden and quality of life.

CONCLUSIONS

Anxiety significantly mediates the relationship between symptom burden and quality of life in peritoneal dialysis patients. These findings underline the importance of integrating psychological interventions and routine symptom screening into patient care to enhance quality of life. Future research should explore longitudinal designs and standardized intervention strategies.

Underground nursing students' experiences in a face-to-face, hybrid, and online escape room model: a comparative analysis in Serbian context

Educational escape rooms (EERs) are gamified teaching and learning tools increasingly used in nursing education. This study aims to compare undergraduate nursing students' gameful experiences (GEs) across three EER models: face-to-face, hybrid, and online. A cross-sectional study was conducted with 136 first-year students in a Serbian undergraduate nursing programme. All models EERs had the same narrative, which included several topics from the Fundamentals of Nursing course. Face-to-face and hybrid EERs were implemented in faculty skills laboratories, while the online model used the Zoom® platform. Face-to-face EERs were conducted in 2021/2022. and hybrid and online in the 2022/2023 school year. Immediately after the EER activity, the Gameful Experience Scale (GAMEX) assessed students' GE across six dimensions (Enjoyment, Absorption, Creative Thinking, Activation, Absence of Negative Effects and Dominance). All students solved the puzzles in the allotted time and 'escaped from the room.' Median escape time from face-to-face EER was 39.2 (IQR = 2.1), from online 37.4 (IQR = 4.1), and hybrid 37.2 (IQR = 3.5) minutes. By comparing GE students in three EER models, significant differences were found in five dimensions of the GAMEX scale. Students in face-to-face EER enjoyed significantly more (p < 0.001) and thought more creatively (p < 0.001), while the GE of online model students indicated significantly higher levels of activation (p < 0.001), dominance (p < 0.001), and negative effect (p < 0.001). In the face-to-face and hybrid models, students' GE were more moderate in these dimensions. All EER models can generate positive emotions with moderate negative effects, aligning with the goals of EERs as educational games. Further research is needed to identify the most effective EER model for different areas of nursing education.

Influenza vaccination hesitancy and related factors among pregnant and breastfeeding women: A cross-sectional study

Achieving safe influenza vaccination coverage among pregnant and breastfeeding women is a global health goal due to the potential risks of serious influenza for both mother and child. However, vaccine hesitancy remains a significant barrier to vaccination uptake. Since anxiety represents a determinant in vaccine decision-making, this study aimed to assess influenza vaccination hesitancy and anxiety levels in this population and to explore the association between women's characteristics, their reluctance, and anxiety levels. A multicentre, cross-sectional study was conducted between February and June 2022 using structured phone interviews to assess: (1) socio-demographics and clinical history; (2) anti-flu vaccination status, previous anti-flu vaccination, and Sars-CoV-2 infection history; (3) insights into influenza vaccination during pregnancy; (4) attitudes toward anti-flu vaccination, using the Vaccination Attitudes Examination (VAX) Scale; (5) anxiety levels, measured by the Self-Rating Anxiety Scale (SAS). Among the 387 participants, 22.8% were already vaccinated or expressed willingness to be vaccinated against influenza, and 54% had an anxiety disorder. While anxiety was not significantly associated with vaccine hesitancy, ongoing pregnancy emerged as an independent predictor of anxiety. Higher educational levels, ongoing pregnancy, already being vaccinated or willingness to get vaccinated, and being employed were associated with reduced vaccine hesitancy, while prior SARS-CoV-2 infection with increased hesitancy. Fear of unpredictable events and lack of healthcare professionals' recommendations emerged as reasons for vaccine reluctance. Given the low coverage rates, these findings highlight the need for health services to enhance vaccination efforts and provide clear recommendations to counter misinformation and ensure accurate vaccine safety information.

Number of medical facilities within driving distance of residence and influenza vaccination status in Japan: A cross-sectional study

Vaccine hesitancy primarily consists of confidence, complacency, and convenience, including geographical accessibility. However, few studies in developed countries have focused on the association between geographical accessibility to vaccination services and vaccination status and previous studies have shown conflicting results. This cross-sectional study aimed to clarify the association between the number of medical facilities within a 15-minute driving distance from the place of residence and influenza vaccination status, using a large nationwide internet survey in Japan (n = 27,440). Postal codes were used to determine participants' place of residence and the number of medical facilities within a 15-minute drive was calculated using geographic information system data. Participants were classified into quartiles based on the number of medical facilities nearby. They reported their influenza vaccination status over the past year. Modified Poisson regression analysis was conducted with influenza vaccination status as the dependent variable and the number of medical facilities nearby as the independent variable, adjusted for covariates stratified by age (under 65 years: or 65 years and older). Among participants aged 65 years and older, those with fewer medical facilities within a 15-minute drive of their place of residence were significantly less likely to have received an influenza vaccination than those with more medical facilities nearby (prevalence ratio in Q1 relative to Q4: 0.93, 95% confidence interval 0.87-0.99). In contrast, no association was observed among participants aged under 65 years. Geographical accessibility to vaccination services may influence vaccine hesitancy among older adults in Japan, a developed country.

Combination of reverse shock index and simplified motor score as a strong discriminator of trauma outcomes

BACKGROUND

The reverse shock index multiplied by simplified motor score (rSI-sMS) is a novel and rapid measure for assessing injury severity in patients with trauma in prehospital settings; however, its discriminant ability requires further validation.

METHODS

A retrospective cohort study was conducted from trauma database of Taipei Tzu Chi Hospital to compare the accuracy of the rSI-sMS with that of the shock index, modified shock index, reverse shock index multiplied by the Glasgow Coma Scale (rSI-GCS), and the reverse shock index multiplied by GCS motor subscale (rSI-GCSM) for discriminating in-hospital mortality, intensive care unit (ICU) admissions, prolonged ICU stays ≥14 days, and prolonged hospital stays ≥30 days in patients with trauma.

RESULTS

A total of 11,760 patients from the trauma database were included. rSI-sMS had significantly better accuracy in discriminating in-hospital mortality, ICU admissions, prolonged ICU stays (≥14 days), and prolonged hospital stays (≥30 days) than the shock index, modified shock index, and rSI-GCSM, whereas its accuracy was similar to that of the rSI-GCS. Furthermore, rSI-sMS had better accuracy for discriminating clinical outcomes in patients with an injury severity score (ISS) ≥16, motor vehicle collisions, falls, no chronic disease, and cardiovascular disease as well as in geriatric and nongeriatric patients. In patients with mixed and isolated brain injuries, rSI-sMS accurately discriminated the four clinical outcomes, similar to rSI-GCS. The optimal cutoff value of rSI-sMS had a discriminant ability of 85.0, 78.6, 75.2, and 81.0% for in-hospital mortality, ICU admissions, ICU stay ≥14 days, and hospital stays of ≥30 days, respectively.

CONCLUSIONS

Compared with the shock index, modified shock index, and rSI-GCSM, rSI-sMS is a more accurate field triage scoring system for discriminating in-hospital mortality, ICU admissions, prolonged ICU stay, and prolonged hospital stays in patients with trauma.

One stage total hip arthroplasty and contralateral hip arthroscopy for bilateral femoroacetabular impingement and osteoarthritis: A clinical trial

Introduction

The management of cam morphology of FAI associated with osteoarthritis (OA) is debated. However, current surgical indications are becoming obsolete, and hip arthroscopy spreads in different settings. The present clinical trial evaluated the outcome of one-stage unilateral hip arthroscopy and contralateral total hip arthroplasty (THA) in patients with bilateral cam deformity associated with labral tears and early and advanced OA stages, respectively. The outcomes of interest were patient-reported outcome measures (PROMs) and the rate of complications.

Methods

All patients who underwent one-stage THA and contralateral hip arthroscopic for symptomatic cam deformity were prospectively invited to participate in the present study. Arthroscopies were performed first with patients in a supine position on a traction bed under fluoroscopic control. Three standard portals were used. The intraarticular joint space was inspected, and the peripheral acetabular labral lesions were selectively debrided. Cam bunectomy was performed, and labral tears were debrided and repaired using bio-resorbable anchors. After arthroscopy, patients were positioned in a lateral position, and THA was performed using a minimally invasive posterolateral approach. All patients received uncemented short stems with ceramic heads and vitamin-E augmented polyethylene (GTS, Zimmer Biomet, United States or 3C, Link, Germany).

Results

All 16 patients were men, with a mean age of 41 years ±7.9. The mean length of the follow-up was 4.2 ± 1.3 years (range, 2 to 6). All patients returned to their normal daily activities within one month. PROMs were statistically significantly increased from baseline to the last follow-up in all patients. No patient experienced minor or major complications. One patient required THA five years after arthroscopy for symptomatic and radiographic progression of osteoarthritis. No other patients progressed to THA. No patient underwent revision surgery for failed arthroscopy.

Conclusion

One-stage arthroscopy and contralateral arthroplasty are effective in managing FAI combined with early and mild to severe OA, respectively.

Causative factors for varus tibial baseplate subsidence in primary total knee arthroplasty: A retrospective analysis

Background

In this retrospective study, the focus was on identifying potential causative factors associated with varus subsidence of the tibial component in primary total knee arthroplasty (TKA). The research aimed to investigate the risk factors contributing to aseptic varus tibial baseplate subsidence (VTBS) leading to revision TKA procedures.

Patients and methods

A total of 120 patients with documented VTBS complications post-TKA were compared with a control group of 52 patients. Factors such as patient demographics, surgical data and comorbidities were included. The study also explored the Coronal Plane Alignment of the Knee (CPAK) classification pre- and post-operatively to understand its implications on varus subsidence.

Results

Significant differences noted in the VTBS group in variables including younger patient age (P=<0.001), increased BMI (P = 0.003), larger proportion of patients with tibial component oversize or undersizing (P=<0.001), less tibial stem extensions used (P < 0.001), higher CCI (P < 0.001) and a higher proportion of patients in CPAK group 2 (P = 0.044).

Conclusion

This investigation provides valuable insights into potential risk factors for VTBS, aiming to optimize patient outcomes and assist in preventing complications associated with TKA procedures.

Impact of diabetes mellitus on periapical, periodontal, and oral health and the potential confounders: A cross-sectional study

OBJECTIVE

This study aims to assess the impact of diabetes mellitus (DM) on DMFT, periodontal, and periapical conditions, and to analyze potentially significant confounders, including sociodemographic and lifestyle factors.

METHODS

A cross-sectional study was conducted in July 2021 involving patients aged ≥20 years, with available panoramic radiographs and documented DM status. Sociodemographic factors, lifestyle behaviors (alcohol consumption, betel quid chewing, and smoking), oral health indicators (decayed, missing, and filled teeth [DMFT] index, periodontal and periapical conditions), and DM status were collected. Associations between DM, lifestyle behaviors, and oral health indicators were analyzed using independent sample t-test and chi-square tests. Analysis of covariance and sensitivity analysis were conducted using adjusted models, and stepwise multiple linear regression identified the most significant predictors.

RESULTS

A total of 520 patients were included. Patients with DM had a significantly higher DMFT index (p < 0.01), a 2.97 times greater risk (p < 0.01) of developing periodontal disease, and a 1.76 times greater risk (p = 0.04) of having apical periodontitis compared to those without DM. After age adjustment, females had higher filled teeth (FT) (p < 0.01) and DMFT index (p < 0.05), while patients with DM and smokers had fewer FT (p < 0.05). Age, gender, and lifestyle behaviors were identified as confounders impacting the association with DM. Stepwise regression revealed age as the most significant predictor of the DMFT index (R²=0.35; F = 183; p < 0.01).

CONCLUSION

DM affects oral health by increasing the DMFT index and the risk of periodontal disease and apical periodontitis, with age, gender, and lifestyle habits as confounders.

CLINICAL SIGNIFICANCE

Periodontitis, apical periodontitis, oral health status, and demographic and lifestyle factors show a strong association with DM.

Low variability of resting metabolic rate among early, middle, and late achievers of steady state suggests a shortened indirect calorimetry protocol for young children

OBJECTIVE

Standardized protocols for measuring resting metabolic rate (RMR; kJ/d) in children, using indirect calorimetry (IC), are lacking. In this cross-sectional, observational study we aimed to determine, in a diverse group of children, variability of RMR-associated measurements after achieving steady state (SS) with a shortened IC protocol. RMR of 120 conveniently sampled healthy Southern African children 6 to 9 years (60 black [32 girls], 60 white [37 girls]) was measured via IC (Quark RMR, Cosmed).

METHODS

Measurements, without a prior rest period, continued for 15 to 20 minutes. Participants were categorized according to time when machine-generated SS was achieved: early achievers <5 minutes, middle achievers ≥5 and <10 minutes, late achievers ≥10 minutes. Readings before achieving SS were eliminated. Intra-individual percentage coefficient of variation of the mean RMR (kJ/d), VCO2 (mL/min), VO2 (mL/min), and respiratory quotient (VCO2/VO2) was determined for each SS category for the remaining measurement period.

RESULTS

For 113 (94%) participants, usable data were obtained. Mean (min; max) time to reach SS was 5.7 minutes (0.0; 16.2). Nineteen (17%; 6 black; 10 girls [3 black]) did not achieve SS, with no significant difference between sexes (P = 0.290). Significantly (P = 0.048) more white (12%) than black (5%) participants did not achieve SS. Forty-seven (50%) were early, 29 (31%) middle, and 18 (19%) late achievers of SS. There was no significant difference in the sample distribution of SS categories between sexes (P = 0.955) and race/ethnicity categories (P = 9.758).

CONCLUSIONS

After achieving SS, percentage coefficient of variation for all RMR-related variables remained ≤2.89%, well below the recommended <5% to 10% for adults. A shortened IC protocol can be considered for diverse groups of 6- to 9-year-old children.

Comparison of mortality trends in patients with rheumatic mitral valve disease and nonrheumatic mitral valve disease: A retrospective study in US from 1999 to 2020

BACKGROUND

Mitral valve disease (MVD) can have both rheumatic and nonrheumatic etiologies. However, differences in mortality remain unknown.

METHODS

We extracted age-adjusted mortality rates (AAMRs) per 100,000 persons from the CDC WONDER database and stratified them by sex, region, and race. Annual percent change (APC) and average annual percent change (AAPC) were calculated using Joinpoint regression. Pairwise comparison was used to identify significant differences for MVD mortality trends between rheumatic and nonrheumatic patients.

RESULTS

From 1999 to 2020, a total of 72,085 deaths were recorded in patients with rheumatic MVD, while 132,300 occurred in those with nonrheumatic MVD. The AAMR for nonrheumatic patients was twice as high as that for rheumatic patients throughout the study period, and AAPC differed significantly between the groups (p < 0.05). Females with rheumatic MVD were observed to have a higher AAMR (1.1) than their male counterparts (0.8), but those with nonrheumatic MVD exhibited a similar AAMR for both females and males. Among rheumatic patients, NH (non-hispanic) Whites were reported to have the highest AAMR (1.0), followed by NH Black or African Americans (0.8), Hispanic or Latinos (0.7), and NH Asian or Pacific Islanders (0.7). Among nonrheumatic patients, NH Whites exhibited the highest AAMR (1.9), followed by NH Black or African Americans (1.4), NH Asian or Pacific Islanders (1.1), and Hispanic or Latinos (1.0). The AAMR in Rural areas was higher than that in Urban areas for patients with both rheumatic and nonrheumatic MVD.

CONCLUSION

Comprehensive public health strategies are essential to improving survival outcomes.

The association between venous excess ultrasound grading system (VExUS) and major adverse kidney events after 30 days in critically ill patients: A prospective cohort study

BACKGROUND

The Venous Excess Ultrasound grading system (VExUS) can evaluate venous congestion at the bedside. There is conflicting evidence whether VExUS is associated with important clinical outcomes, such as acute kidney injury (AKI), in critically ill patients. The primary aim is to evaluate prevalence of different VExUS grades and its association with AKI and 30 day mortality in critically ill patients. Secondary aims are to investigate the change of VExUS during admission and to assess the feasibility and agreement of VExUS examinations in critically ill patients.

METHOD

A single centre prospective cohort study in a tertiary hospital intensive care unit (ICU) in the Netherlands. Consecutive adult critically ill patients expected to be admitted to the ICU ≥ 24 h in whom ultrasound was feasible were included. VExUS was performed within 48 h of admission and repeated every other day with a maximum of three measurements per patient. Primary outcome was prevalence of VExUS grades and association with major adverse kidney events in the first 30 days after admission (MAKE-30) defined as a rise of ≥200 % in serum creatinine, use of renal replacement therapy or death.

RESULTS

138 patients were included most of whom were male(67 %) with a median age of 67.5[56-75]. Prevalence of VExUS grade 2(8 %) and 3(4 %) was low and VExUS grades showed the most change within the first 72 h after ICU admission. VExUS grade ≥ 2 was strongly associated with MAKE-30 (OR 4.3 [95 % CI 1.2-20.7]), also when corrected for other variables. Lastly, VExUS showed moderate to excellent inter- and intra-rater agreement.

CONCLUSIONS

In critically ill patients the prevalence of VExUS 2 and 3 is low. VExUS is strongly associated with relevant patient outcomes and is a reliable tool in assessing venous congestion.

Examination and testing of structural validity of the Confidence in Dementia Scale with nursing students. An international perspective

BACKGROUND

As the prevalence of dementia continues to rise globally, nurses are increasingly at the forefront of providing care. Effective dementia care relies on not just knowledge, but also the confidence to translate this knowledge into meaningful action. Enhancing nursing education programmes to build both knowledge and confidence is critical. As no studies have explored measuring confidence in dementia care over an extended period (beyond six months), there is a need for a rigorous and robust analysis of the Confidence in Dementia (CODE) Scale, to determine whether it is a psychometrically sound tool for assessing confidence over time.

METHODS

A cross-sectional series design was used to collect longitudinal data from a census of nursing students over a 3-year period. A standardized instrument, the Confidence in Dementia Scale was administered repeatedly to a sample (time 1 n = 247; time 2 n = 239; time 3 = n = 216). Analyses were performed using SPSS for descriptive statistics and JASP for structural equation modelling. An initial exploratory factor analysis was conducted using the first data set to explore the factor structure. A confirmatory factor analysis was performed (on the second and third data sets) to confirm the factor structure and assess the model's overall validity. COSMIN guidelines inform the analysis process, and the findings are reported using STROBE guidelines.

RESULTS

The factor structure replicated and confirmed the one factor structure identified by international findings. The findings confirm its usefulness of the Confidence in Dementia scale to gauge health professionals' confidence in dementia care before going into practice.

CONCLUSIONS

This study highlights the need for psychometrically valid tools that can measure confidence over an extended period, encompassing the three-year degree programme and beyond.

Total adenosine deaminase cases as an inflammatory biomarker of pleural effusion syndrome

BACKGROUND

Although inflammatory diseases commonly affect the pleura and pleural space, their mechanisms of action remain unclear. The presence of several mediators emphasizes the concept of pleural inflammation. Adenosine deaminase (ADA) is an inflammatory mediator detected at increased levels in the pleural fluid.

AIM

To determine the role of total pleural ADA (P-ADA) levels in the diagnosis of pleural inflammatory diseases.

METHODS

157 patients with inflammatory pleural effusion (exudates, n = 124, 79%) and non-inflammatory pleural effusion (transudates, n = 33, 21%) were included in this observational retrospective cohort study. The P-ADA assay was tested using a kinetic technique. The performance of the model was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The ideal cutoff value for P-ADA in pleural inflammation was determined using the Youden index in the ROC curve.

RESULTS

The transudates included congestive heart failure (n = 26), cirrhosis of the liver with ascites (n = 3), chronic renal failure (n = 3), and low total protein levels (n = 1). The exudate cases included tuberculosis (n = 44), adenocarcinoma (n = 37), simple parapneumonic effusions (n = 15), complicated parapneumonic effusions/empyema (n = 8), lymphoma (n = 7), and other diseases (n = 13). The optimal cutoff value of P-ADA was ≥ 9.00 U/L. The diagnostic parameters as sensitivity, specificity, positive and negative predictive values, positive and negative likelihood values, odds ratio, and accuracy were 77.69 (95%CI: 69.22-84.75); 68.75 (95%CI: 49.99-83.88); 90.38 and 44.90 (95%CI: 83.03-95.29; 30.67-59.77); 2.48 and 0.32 (95%CI: 2.21-11.2; 0.27-0.51); 7.65 (95%CI: 0.78-18.34), and 75.82 (95%CI: 68.24-82.37), respectively (χ² = 29.51, P = 0.00001). An AUC value of 0.8107 (95%CI: 0.7174-0.8754; P = 0.0000) was clinically useful. The Hosmer-Lemeshow test showed excellent discrimination.

CONCLUSION

P-ADA biomarker has high diagnostic performance for pleural inflammatory exudates.

Racial and Ethnic Disparities in Failure-to-Rescue After Postoperative Sepsis After Noncardiac Surgery

BACKGROUND

Sepsis disproportionately affects marginalized communities. This study aims to evaluate racial and ethnic disparities in failure-to-rescue (FTR) after postoperative sepsis.

METHODS

This cross-sectional study used data from the American College of Surgeons National Surgical Quality Improvement Program for patients who underwent inpatient noncardiac surgery between 2018 and 2021. Patients were categorized as non-Hispanic White (hereafter, White), non-Hispanic Black (hereafter, Black), Asian, and Hispanic individuals. The association between (1) FTR after sepsis and (2) FTR after septic shock and race and ethnicity was evaluated using multivariable logistic regression. Failure-to-rescue was defined as 30-day mortality among patients who developed postoperative sepsis or postoperative septic shock.

RESULTS

Among the 1388,977 patients (mean [SD] age 60.5 [16]); 783,056 (56.4%) were female, 1017,875 (73%) were White, 171,774 (12%) were Black, 138,457 (10%) were Hispanic, and 60,871 (4%) were Asian. Compared to White individuals, Black (adjusted odds ratio [aOR], 1.29; 95% CI, 1.23-1.35, P < .001) and Hispanic individuals (aOR, 1.15; 95% CI, 1.09-1.21, P < .001) were more likely to develop sepsis; Black individuals were more likely to develop septic shock (aOR, 1.28; 95% CI, 1.21-1.36; P < .001), and Asians were less likely to develop septic shock (aOR 0.84; 95% CI, 0.75-0.93, P = .002). Black individuals experienced lower rates of FTR after sepsis [Black: (aOR, 0.71; 95% CI, 0.54-0.94; P = .017), while Black (aOR, 0.93; 95% CI, 0.80-1.08; P = .35)], Hispanic (aOR, 0.87; 95% CI, 0.72-1.06; P = .16) and Asian Individuals (aOR, 1.06; 95% CI, 0.8-1.37; P = .67) experienced similar rates of FTR after septic shock compared to White individuals.

CONCLUSIONS

Black and Hispanic individuals experienced higher rates of postoperative sepsis but did not experience higher rates of failure-to-rescue. Reducing inequity in surgical care should focus on efforts to prevent postoperative sepsis.

Temporal and demographic disparities in mortality trends for heart failure and COPD-associated heart failure in U.S. Adults: A 1999-2020 analysis of CDC WONDER data

BACKGROUND

Heart failure (HF) carries varying mortality based on demographic distribution. Moreover, the interaction of HF with chronic obstructive pulmonary disease (COPD) raises this mortality. In this study, implementing national databases over a long time could assist in understanding mortality rates in patients suffering from two significant chronic diseases, HF and COPD.

METHODS

This analysis utilized the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) system to assess the mortality trends between HF and COPD-associated HF in US adults aged 25-85+ from 1999 to 2020.

RESULTS

This investigation detected a total of 6,755,700 deaths occurred in patients with HF in ages above 25. Fatalities of 1,141,819 (16.9 %) were associated with HF and comorbid COPD. Age-adjusted mortality Rates (AAMR) of HF-related deaths decreased from 162.7 to 154.4. (Average Annual Percentage Changes (AAPC): -0.49, 95 % CI: -0.63 to -0.34, p < 000001, while the overall AAMR for HF with COPD among adults increased from 24.5 in 1999 to 28.2 in 2020. Men had significantly higher HF-related AAMRs and HF with comorbid COPD-related mortality than women. HF-related AAMRs were highest among NH Black or African Americans, followed by NH Whites. At the same time, on the other side, HF and COPD had the highest mortality in non-Hispanic (NH) White individuals, followed by NH Black individuals, then Hispanic individuals. Mortality in HF with COPD was the highest in the Northeast, then the Midwest, South, and least in the West states.

CONCLUSION

Implementation of a CDC database provided guidance over two decades about the US population mortality attributed to HF with and without the presence of COPD, which contributed to a better understanding of national trends in prevailing diseases with remarkable chronicity.

Cardiovascular health, lifestyle factors, and social determinants among Hispanic or Latino adults in the United States

BACKGROUND

Among Hispanic/Latino subgroups residing in the US, disparities in cardiovascular health status remain largely uncharacterized.

METHODS

This national study used the National Health Interview Survey to assess the burden of cardiometabolic risk factors (hypertension, hyperlipidemia, obesity, diabetes) and cardiovascular diseases (history of heart attack, coronary heart disease, angina, stroke) across Hispanic/Latino subgroups (Mexican, Cuban, Puerto Rican, Central/South American), and the extent to which differences are related to lifestyle factors (physical inactivity, smoking, and alcohol consumption) and/or social determinants of health (income, education, food security, and health insurance status).

RESULTS

The weighted study population included 35,549,841 Hispanic/Latino adults (26,008 respondents). In age- and sex-adjusted models, hypertension was more common among Puerto Rican adults (OR 1.34, 95% CI: 1.12-1.60) but less common among Central/South American adults (OR 0.71, 95% CI: 0.61-0.82) compared to Mexican adults (reference group). Central/South Americans were also less likely to have obesity (OR 0.63, 95% CI: 0.57-0.70) and diabetes (OR 0.50, 95% CI: 0.42-0.61). For cardiovascular diseases, Puerto Rican adults were more likely to have angina (OR 1.69, 95% CI: 1.06-2.71), whereas Central/South Americans were less likely to have angina (OR 0.50, 95% CI: 0.30-0.84), coronary heart disease (OR 0.70, 95% CI: 0.51-0.96), and heart attack (OR 0.49, 95% CI: 0.33-0.72). Moreover, Cuban adults were less likely to have hyperlipidemia (OR 0.73, 95% CI: 0.61-0.88), obesity (OR 0.58, 95% CI: 0.49-0.70), diabetes (OR 0.44. 95% CI: 0.34-0.57) and stroke (OR 0.54, 95% CI: 0.32-0.92) Differences persisted after sequentially adjusting for lifestyle factors and social determinants of health.

CONCLUSION

This study used disaggregated data to demonstrate the complex landscape of cardiovascular health among Hispanic/Latino adults in the US, emphasizing the need for targeted interventions and policy efforts to reduce health inequities in this rapidly growing population.

Incidence and Risk Factors for Accidental Removal of Medical Devices in an Intensive Care Unit: A Retrospective Cohort

BACKGROUND

Accidental removal of medical devices (ARMD) is an important safety risk for critically ill patients admitted to an intensive care unit (ICU), and little is known about the risk factors for its occurrence.

OBJECTIVE

To estimate the incidence and investigate risk factors for ARMD among adult patients admitted to the ICU.

METHODS

This is a retrospective cohort study including data from adult patients admitted to the ICU between 2018 and 2021. The study was carried out in the adult ICU of a hospital accredited by the Joint Commission International, consisting of 54 beds.

RESULTS

A total of 5880 medical records of patients admitted to the ICU were included. Of these, 376 (6.4%) were affected by ARMD; the majority were male (256 [68.1%]), with a mean age of 68.2 (18.9) years. The nasoenteral catheter was the most frequently removed device (44.4%), followed by the central venous catheter (11.4%), the indwelling bladder catheter (9.0%), and the peripheral venous catheter (6.9%). The logistic regression model showed that the diagnosis of kidney disease (odds ratio [OR], 4.09; 95% confidence interval [CI], 1.34-12.44), occurrence of delirium (OR, 2.02; 95% CI, 1.35-3.03), and length of stay in the ICU (OR, 1.02; 95% CI, 1.01-1.02) increased the chance of ARMD occurrence. Patients requiring vasopressor medications had a lower chance of ARMD (OR, 0.32; 95% CI, 0.22-0.46).

CONCLUSIONS

The incidence rate of ARMD is similar to those reported in previous studies. However, the results pointed to new risk factors for the occurrence of ARMD, such as chronic kidney disease and length of stay in the ICU.

Assessment of clinical outcomes in patients with inflammatory arthritis: analysis from the UK Medical Cannabis Registry

The aim of this study was to assess changes in validated patient-reported outcome measures after initiation of cannabis-based medicinal products (CBMPs) and the safety of CBMPs in patients with inflammatory arthritis. A prospective case series from the UK Medical Cannabis Registry was analyzed. The primary outcomes changes were in Brief Pain Inventory, McGill Pain Questionnaire, EuroQol 5-dimension 5-level (EQ-5D-5L), Generalised Anxiety Disorder-7 questionnaire, and Single-Item Sleep Quality Scale at 1, 3, 6, and 12 months of follow-up compared with baseline. Adverse events were analyzed in accordance with Common Terminology Criteria for Adverse Events, v.4.0. Statistical significance was defined as a P -value less than 0.050. Eighty-two patients met the inclusion criteria. Initiation of CBMP treatment was associated with improvements in Brief Pain Inventory, McGill Pain Questionnaire, EQ-5D-5L, Generalised Anxiety Disorder-7 questionnaire, and Single-Item Sleep Quality Scale at 1, 3, 6, and 12 months compared with baseline ( P  < 0.050). There were 102 (44.35%) mild adverse events, 97 (42.17%) moderate adverse events, and 31 (13.48%) severe adverse events recorded by 21 (25.61%) participants. This study suggests that CBMP treatment is associated with pain improvement and increased health-related quality of life for inflammatory arthritis patients. While causality cannot be inferred in this observational study, the results support the development of randomized control trials for inflammatory arthritis pain management with CBMPs.

Drivers of neurosurgeon selection among operative intracranial tumor patients

OBJECTIVE

Despite increased access to online information, little is known about what factors patients consider when selecting a neurosurgeon for intracranial tumor resection. This study aims to identify patient priorities in neurosurgeon selection.

METHODS

Patients who underwent intracranial tumor resection between January 1, 2023, and January 31, 2024, at a single institution were surveyed. They ranked 13 factors on a 5-point Likert scale. Survey data were analyzed alongside demographic and clinical information using ordinal logistic regression.

RESULTS

Fifty patients (mean age 54.15 ± 13.82; 54 % female; 70 % white; 70 % privately insured) completed the survey. Surgeon caseload and procedure-specific experience (mean score 4.64 ± 0.72) were rated as most important, followed by hospital ranking (4.48 ± 0.68), years of experience (4.38 ± 0.75), and surgeon interpersonal skills (4.2 ± 1.14). Least important were social media presence, age, and word of mouth. Subgroup analysis revealed that non-Caucasian patients valued word of mouth more (OR: 1.65), while patients undergoing repeat surgery valued it less (OR: 0.33). Older patients, non-Caucasians, ethnic minorities, and married individuals placed less importance on medical school prestige.

CONCLUSION

Neurosurgical patients prioritize surgeon experience, hospital reputation, and interpersonal qualities. These insights can inform provider transparency, resource allocation, and outreach to underserved groups.

Association between Adherence to Patient Blood Management Recommendations and Postoperative Complications in Hip and Knee Arthroplasty

BACKGROUND

Patient blood management (PBM) is a set of evidence-based practices that reduces the need for blood transfusions. However, its impact on relevant clinical outcomes remains unclear. The authors evaluated the association between adherence to guideline-recommended PBM care and 30-day postoperative complications in patients undergoing primary total knee and hip arthroplasty. Secondary outcomes included the length of hospital stay and erythrocyte utilization.

METHODS

This was a retrospective, multicenter cohort study including patients from 43 hospitals. The PBM clinical pathway comprised nine major guideline-recommended interventions, and adherence was assessed using a composite quality indicator. Multilevel multivariable regression models were used to evaluate the associations between PBM adherence and outcomes at the patient level while accounting for hospital characteristics and hospital variation.

RESULTS

A total of 30,926 patients who underwent primary total knee or hip arthroplasty between 2016 and 2022 at 43 hospitals were included. Of these, 1,335 (4.3%) had 30-day postoperative complications. The median adherence to the PBM clinical pathway was 60.0%. Higher PBM adherence was associated with fewer 30-day postoperative complications (adjusted odds ratio, 0.43; 95% CI, 0.32 to 0.58; P < 0.001), including 65% lower odds of major adverse cardiac events and 45% lower odds of infection. Additionally, higher adherence was associated with shorter hospital stays (adjusted incidence rate ratio, 0.77; 95% CI, 0.76 to 0.79; P < 0.001) and reduced transfusion rates (adjusted odds ratio, 0.11; 95% CI, 0.09 to 0.14; P < 0.001). Sensitivity analyses confirmed these associations.

CONCLUSIONS

Adherence to the PBM clinical pathway was associated with improved outcomes. While causality cannot be established, these findings support the potential effectiveness of PBM in reducing postoperative complications and its efficiency in shortening hospital stays, beyond minimizing blood transfusions, in patients undergoing knee and hip arthroplasty.

Mental health and loneliness in university students: A structural equation modelling comparing Italy and the UK

BACKGROUND

The transition to university often leads to increased demands and changes in lifestyle habits, which may affect mental health. In particular, loneliness could play a key role in the onset of psychological distress. Although many patterns are consistent across countries, cultural differences may influence students' mental health and feelings of loneliness.

AIMS

The aim of this study was thus to examine mental health domains and their relationship with loneliness among students from the University of Milano-Bicocca (Italy) and the University of Surrey (United Kingdom).

METHOD

Data were from the CAMPUS study, a cross-national survey on students' mental health. A structural equation modelling (SEM) approach was carried out to simultaneously test the pathways between loneliness and clinical domains in the two populations.

RESULTS

Anxiety and depressive symptoms were identified as the most common conditions in both the samples. However, Italian students were likely to show a higher degree of anxiety (t = 7.01, p < .001), while UK undergraduates greater depressive symptoms (t = -2.50, p = .013) and a higher prevalence of insomnia (t = -9.55, p < .001). Poor academic performance, along with limited social interactions were associated with worse psychological well-being, despite the likely influence of lifestyle differences among countries. Finally, a significant correlation between loneliness, anxiety and depressive symptoms, as well as insomnia was found both in Italian and UK samples, as confirmed by multivariate analyses.

CONCLUSIONS

Our findings highlight the existence of a cross-nationally, clinically meaningful psychological burden among university students, with a major role played by loneliness. Extensive promotion of healthy social networks, as well as interventions to support academic performance are needed.

Predicting Outcomes in Hospitalized Patients With Acute Severe Ulcerative Colitis in a Prospective Multicenter Cohort

BACKGROUND AND AIMS

Acute severe ulcerative colitis (UC) (ASUC) requiring hospitalization affects up to 1 in 4 patients with UC. There is a paucity of prospective and multicenter clinical cohorts to study treatment trends and predictors of disease outcomes. Here, we conduct a US-based multicenter prospective clinical cohort of ASUC to study predictors of the need for medical rescue therapy and colectomy.

METHODS

A total of 94 patients hospitalized for ASUC were included across 5 academic centers from December 2018 to December 2021. Demographic, clinical, and laboratory data were collected throughout the hospitalization. Patients were followed up to 1-year post-hospitalization to identify predictors of the need for rescue therapy and colectomy.

RESULTS

A total of 21 (22.3%) patients required colectomy within 1 year of admission with 11 (12%) requiring colectomy during the index admission. On multivariate analyses, a BMI < 21.5 kg/m2 (OR = 6.16, P = .02), a simple clinical colitis activity index (SCCAI) greater than 8 (OR = 14.44, P = .01) and an albumin level at admission lower than 2.4 g/dL (OR = 10.61, P = .04) were significant predictors of inpatient colectomy after adjusting for sex, age, and duration of disease.

CONCLUSIONS

In a prospective, multicenter cohort of patients hospitalized with ASUC, BMI, SCCAI, and albumin at admission were important determinants of colectomy risk during the index hospitalization and within 1 year of admission. Colectomy rates remain high-22.3% in this cohort across 5 academic, tertiary care centers-underscoring the need to identify the highest-risk patients, establish novel treatment and care paradigms, and examine opportunities to standardize care.

Comparing robotic ventral transabdominal preperitoneal repair (rvTAPP) and laparoscopic enhanced view totally extraperitoneal repair (eTEP): a multicentre observational study

This study compares two emerging minimally invasive techniques-laparoscopic enhanced-view totally extraperitoneal (eTEP) and robotic ventral transabdominal preperitoneal repair (rvTAPP)-for the repair of small and mid-sized ventral hernias. A prospective observational study was conducted using data from the international CROSSFIRE database with patients treated between January 2023 and December 2024. The inclusion criteria were primary and incisional midline ventral hernias ≤ 4 cm, treated with eTEP or rvTAPP. The group comparisons were conducted using propensity score matching, adjusting for differences in body mass index, sex, and hernia defect. A total of 165 patients from three centers were included (120 eTEP, 45 rvTAPP). After propensity score matching, 100 patients were included (57 eTEP and 43 rvTAPP). The pain scores after eTEP and rvTAPP at 2 days postoperatively (2.9 vs. 3.3, p = 0.385) and at 6 weeks (2.1 vs. 2.1, p = 0.888) were comparable. The mean comprehensive complication index was similar between eTEP and rvTAPP (1.7 vs. 1.5, p = 0.561). The operation time was 88.8 min for eTEP and 110.1 min for rvTAPP (p = 0.003), whereas rvTAPP involved more teaching procedures (32.6% versus 8.8%; p = 0.004). Surgeon workload, as assessed by NASA Task Load Index, was higher in eTEP than rvTAPP (36.3 vs. 17.1; p < 0.001), indicating greater physical and mental strain. Both posterior minimally invasive ventral hernia repair techniques-eTEP and rvTAPP-are safe and show comparable pain levels at 2 days and 6 weeks. Robotically assisted ventral TAPP has a longer operative time than eTEP but imposes less workload on the surgeon.

Longitudinal Financial Toxicity and Quality of Life in Head and Neck Cancer

Importance

Patients with head and neck cancer (HNC) are disproportionately affected by financial toxicity (FT). Most research has evaluated FT at a single point.

Objective

To evaluate longitudinal factors associated with FT and health-related quality of life in patients and caregivers to understand its progression and effect.

Design, Setting, and Participants

This prospective cohort study was conducted at a single tertiary care center from October 2018 to December 2020. Data were analyzed from December 2020 to December 2024. Eligible participants included adult patients with HNC undergoing definitive treatment and their primary caregivers.

Exposures

Surveys conducted at diagnosis, 3 months, and 6 months postdiagnosis. Instruments included the Comprehensive Score for Financial Toxicity, version 1, Financial Distress Questionnaire, University of Washington Quality of Life Scale (UWQOL), version 4 (with physical [PQOL] and social [SQOL] subscales), 19-Item Social Support Survey, and Three-Item Loneliness Scale. Semistructured qualitative interviews were performed at 6 months.

Main Outcomes and Measures

Linear mixed-effects modeling assessed trends in FT (Comprehensive Score for Financial Toxicity), PQOL, and SQOL longitudinally. The McNemar tests compared Financial Distress Questionnaire score among dyads. Qualitative interviews were analyzed using a conventional content analysis.

Results

Of 74 enrolled patients (median [range] age, 60 [32-81] years; 12 female individuals [19%]), 64 (86%) completed at least 1 survey, and 41 (64%) participated in interviews. Patients and caregivers reported similar support and loneliness. FT decreased over time (β = 2.77; 95% CI, 1.60-4.33) and older age (β = 0.37; 95% CI, 0.05-0.68) and higher education (β = 13.43; 95% CI, 7.76-18.43) were associated with lower FT, while not working (β = -6.77; 95% CI, -10.31 to -2.96) was associated with worse FT over time. Mixed-effects logistic modeling showed similar odds of high FT over time for patients and caregivers (odds ratio, 1.66; 95% CI, 0.11-273.14). PQOL declined, while SQOL improved longitudinally. Insurance type was the only sociodemographic variable associated with health-related quality of life at diagnosis. Qualitative findings highlighted gaps in treatment expectations, lack of preparedness for financial demands, and the association of FT with employment and caregiving.

Conclusions and Relevance

The results of this cohort study suggest that age, education level, and employment are associated with FT and its progression. FT is dynamically associated with PQOL and SQOL over time. These findings highlight treatment expectations as a theme contributing to unpreparedness for FT. Interventions to manage physical symptoms, return patients and caregivers to work, and alleviate lower educational attainment and mismatched expectations may serve as mitigation strategies for FT.

Comparing morbidity and mortality in adult patients with acute traumatic cervical spinal cord injury in 2013-2017 and 2018-2022: a retrospective 10-year national trend analysis

OBJECTIVES

While considerable attention has been dedicated to quality improvement in spine surgery, few studies have evaluated progress in spinal cord injury (SCI) outcomes. This study aimed to assess whether morbidity and mortality trends have improved for acute cervical SCI patients in the last decade.

METHODS

The American College of Surgeons Trauma Quality Programs database was retrospectively queried and outcomes for adult patients with acute cervical SCI were compared between two 5-year groups: 2013-2017 and 2018-2022. Patient demographics, comorbidities, type of injury, treatment modality, and adverse events (AEs) were assessed. Multivariable logistic regression was used to identify independent predictors of AEs, non-routine discharge (NRD), and in-hospital mortality.

RESULTS

Compared to patients in the 2013-2017 cohort (n = 41,666), patients in the 2018-2022 cohort (n = 54,755) were significantly older on average (2013-2017: 54.0 ± 18.8 years, 2018-2022: 56.1 ± 18.5 years, p < 0.001) and had a significantly higher baseline comorbidity burden. Mean Injury Severity Score (ISS) was slightly higher in the 2018-2022 cohort than in the 2013-2017 cohort (2013-2017: 21.1 ± 15.3, 2018-2022: 21.3 ± 14.2, p < 0.001). Falls (2013-2017: 19.9 %, 2018-2022: 48.9 %, p < 0.001) were the most common mechanism of injury in the 2018-2022 cohort while "Other" injury was most common in the 2013-2017 cohort (2013-2017: 60.0 %, 2018-2022: 4.5 %, p < 0.001). Patients in the 2018-2022 had a higher frequency of any surgical procedure (2013-2017: 47.7, 2018-2022: 53.7, p < 0.001). The 2018-2022 cohort had a lower frequency of NRD (2013-2017: 75.3 %, 2018-2022: 74.2 %, p < 0.001) and unplanned reoperation (2013-2017: 0.9 %, 2018-2022: 0.5 %, p < 0.001), as well as shorter mean LOS (2013-2017: 12.2 ± 15.7 days, 2018-2022: 12.6 ± 16.2 days, p < 0.001) compared to the 2013-2017 patient cohort. Conversely, the 2018-2022 cohort had a significantly greater rate of in-hospital mortality (2013-2017: 11.3 %, 2018-2022: 12.6 %, p < 0.001) and unplanned ICU admission (2013-2017: 3.0 %, 2018-2022: 4.9 %, p < 0.001)than the 2013-2017 cohort. On multivariable analysis, undergoing treatment for SCI from 2018 to 2022 was significantly associated with decreased odds of NRD (aOR: 0.73, 95 % CI: 0.70-0.76), but increased odds of in-hospital mortality (aOR: 1.18, 95 % CI: 1.11-1.26).

CONCLUSION

Our study suggests patients undergoing treatment from 2018 to 2022 were at decreased risk of NRD, but increased risk of in-hospital mortality compared to patients undergoing treatment from 2013 to 2017.

Comparison of treatment times for repair and replacement: a cross-sectional study

OBJECTIVE

This cross-sectional study analyzed and compared the treatment time for dental students to perform different restorative procedures (repair or replacement).

MATERIAL AND METHODS

This study used secondary data from patients treated in a randomized controlled trial (CaCIA). The time (in minutes) was monitored by the operators/assistants, performed between 2016 and 2022. The operator's level during the procedures was categorized into third, fourth, and fifth years. Since procedure times were not normally distributed, non-parametric tests were applied: Mann-Whitney U for two-group comparisons (repair × replacement) and Kruskal-Wallis for comparisons across student years, followed by Bonferroni-adjusted pairwise Mann-Whitney tests when p < 0.05; 95 % confidence intervals for means were also calculated.

RESULTS

A total of 117 procedures were analyzed: 76 repairs (mean 110.2 ± 29.4 min) and 41 replacements (mean 128.4 ± 30.9 min). Repairs in molars averaged 109.2 ± 32.0 min, while replacements in molars averaged 130.9 ± 34.4 min, showing a significant difference (p = 0.015). Repairs averaged 112.2 ± 23.8 min for premolars, while replacements averaged 122.5 ± 20.1 min, with no significant difference observed (p = 0.248). Comparisons between third, fourth, and fifth student groups demonstrated significant differences in repair (p = 0.001) and replacement (p = 0.012) times, with final year students completing procedures faster.

CONCLUSION

Repairs require significantly less time than replacements, particularly for molars. Additionally, the variation in time required by students from different academic levels underscores the relevance of technical skills and experience in reducing procedural duration.

CLINICAL RELEVANCE

This study highlights the clinical advantages of repair over replacement in restorative dentistry, particularly regarding time efficiency. Repairs not only require less time than replacements, especially for molars, but also align with the principles of minimally invasive dentistry by preserving tooth structure.

Hospital-based violence intervention programs may positively influence mental health outcomes

BACKGROUND

Hospital-based violence intervention programs (HVIPs) are interdisciplinary teams and interventions designed to improve outcomes for violently injured patients. There is a lack of literature showing longitudinal assessment of mental health outcomes among survivors of violence who use HVIPs. This study examines whether HVIP engagement by survivors of community violence improves long-term mental health-related quality of life. We hypothesize that victims of violence who engaged with HVIP programming will show better mental health-related quality of life scores 6 to 12 months following their injury.

METHODS

In this prospective nested cohort study, adult survivors of community violence with moderate to severe injuries (Injury Severity Score, ≥9) admitted to two level I trauma centers between December 2015 and July 2020 were interviewed 6 to 12 months after injury. Short Form-12 mental and physical health component score data were collected. Multivariable linear regression was used to estimate the adjusted mean difference in component scores given HVIP engagement.

RESULTS

Of 98 patients with a violent injury, 17 (17.3%) had true HVIP use. Using an as-treated approach, patients who engage with an HVIP have a greater mean mental health component score compared with patients who do not engage with an HVIP (54 [95% confidence interval, 49-75] vs. 41 [95% confidence interval, 32-52]; p = 0.002). There is no significant difference in physical health component score, all-cause, and trauma-related readmission between patients who do and do not engage with an HVIP following violent injury.

CONCLUSION

This study demonstrates that HVIPs may be associated better long-term mental health outcomes among patients who suffer violent injuries. These findings should encourage further implementation, funding, and evaluation of HVIPs that may help mitigate the sequelae of violent injury.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.

Behavioral determinants of dental and facial esthetic self-perception among an academic population: a cross-sectional study

BACKGROUND

Facial attractiveness is a relevant feature in many societies, and self-perceived attraction has been shown to affect a wide range of aspects in human lives, including quality of life. The present study assessed the mediating effects of behavioral determinants on self-reported dental and facial esthetics in an academic population.

METHODS

A cross-sectional observational study on 1,232 students from Universidad Cooperativa de Colombia, Pasto, Colombia was conducted. Socio-demographic variables such as age, sex, residency, place of birth, living zone, socioeconomic status, and type of faculty (Dentistry, Medicine, Nursing, Engineering and Law) were included. Moreover, clinical characteristics related to oral rehabilitations of anterior teeth (composites and crowns) were recorded. Behavioral determinants such as self-esteem, self-compassion, social achievements, and social anxiety were evaluated through Rosenberg's Self-Esteem Scale (RSE), Self-compassion Scale (SCS), Social Achievement Goal Scale (SAG) and Social Anxiety Questionnaire for Adults (SAQ-A30). The Orofacial Esthetic Scale (OES) was employed to determine self-rated dental and facial esthetics. A paper-and-pencil self-administered survey was utilized. Descriptive statistics (frequencies, means and standard deviations) were calculated to determine the levels of personal factors. Structural Equation Modeling (SEM) was performed with robust unweighted least squares estimation method to assess the mediating effects of the behavioral variables on dental and facial esthetics. Analyses were conducted using SPSS 28.0 and EQS 6.2 statistical package. Statistical significance was set at P < 0.05.

RESULTS

The sample comprised 496 (40.3%) males and 736 (59.7%) females. 1,068 (86.7%) participants were 18-25 years old, and 164 (13.3%) > 25 years old. The mean and standard deviations (SD) of scales were: RSE = 24.24, SD ± 1.91; SCS = 3.16, SD ± 0.54; SAG = 32.55, SD ± 7.97; SAQ-A30 = 74.61, SD ± 21.33; and OES = 58.12, SD ± 13.12. SEM found self-compassion (β = 0.38, P = 0.03), social goals achievement (β = 0.34, P = 0.02) and self-esteem (β = 0.25, P = 0.02) had moderate and direct effects on dental and facial esthetics, while social anxiety (β = -0.19, P = 0.02) displayed a moderate indirect effect.

CONCLUSIONS

Behavioral factors predicted dental and facial esthetics self-perception in college students. Clinicians and educators should be aware of the identified effects which may, in turn, affect overall quality of life of patients and students.

Prevalence and Risk Factors of Post-Extraction Complications in a Western Australian Tertiary Dental Hospital: A Retrospective Cross-Sectional Study

OBJECTIVES

Dental extractions are routine procedures, yet they carry a risk of post-operative complications that can negatively affect patients' quality of life. This study aimed to identify patient-, tooth- and clinician-related risk factors associated with post-extraction complications at Western Australia's only tertiary dental hospital, to inform clinical decision-making and improve outcomes by identifying high-risk groups.

METHODS

A retrospective audit of patient records was conducted using data from individuals who underwent dental extractions during the audit period. Extracted variables included demographic details, medical history (e.g., smoking status, diabetes, hypertension), extraction characteristics (e.g., simple vs. surgical, tooth location) and clinician factors (e.g., level of training, anaesthesia type). Post-operative complications were identified through clinical follow-up notes. Descriptive and inferential statistical analyses were used to determine significant associations.

RESULTS

The overall post-extraction complication rate was 11.0%. The most common complications were persistent post-operative pain (4.1%) and alveolar osteitis (3.4%). Statistically significant patient-related risk factors included smoking, uncontrolled diabetes and hypertension. Surgical extractions and mandibular tooth removals were associated with higher complication risks. Extractions performed by students and those conducted under general anaesthesia were also linked to increased complications.

CONCLUSIONS

Approximately 1 in 10 patients experienced post-operative complications. Identifying modifiable risk factors and minimising surgical complexity may reduce adverse outcomes. Operator experience and anaesthesia choice should be considered during preoperative planning.

CLINICAL RELEVANCE

This study highlights the importance of structured preoperative risk assessment that integrates medical comorbidities, extraction complexity and operator training level. Tailoring surgical planning and post-operative monitoring based on individual risk profiles may improve clinical outcomes, reduce avoidable complications and support safer, more effective delivery of care in tertiary and teaching settings.

Research in hybrid coursework nursing Master degrees: A content analysis of university websites

AIM

To map the research project component of nursing hybrid Master degrees in Australia and New Zealand, as documented in university websites.

BACKGROUND

Master degrees are completed by many nurses internationally. These degrees take many formats, one of which combines coursework and research. Little is known about the components, structures and intended outcomes of the research project component of these hybrid Master degrees.

METHODS

Websites of members of the Council of Deans of Nursing and Midwifery of Australia and New Zealand were systematically searched for details of the research project components of hybrid Master degrees. All content was downloaded and hyperlinks searched for information about the research component. A preset template was used to guide the extraction of the website content related to the structure and components of the research pathways. Descriptive statistics and content analysis were used to generate the findings.

RESULTS

Twenty-seven university websites contained content of hybrid nursing Master degrees. The volume and format of the website information varied greatly. There was variation in the proportion of the research component in the degree (range 8 %-50 %; median 33.3 %), the type of research undertaken (primary, secondary or both), the final output (thesis, report or manuscript) and its size (range 2000-25,000 words). Learning outcomes (n = 178), where included, varied in focus and content.

CONCLUSION

Findings indicate the research pathway components of hybrid nursing master degrees across Australasia vary widely. Information provided on many university websites was insufficient for nurses to confidently choose a program that would align with their career goals.

Evaluating evidence-based health information from generative AI using a cross-sectional study with laypeople seeking screening information

Large language models (LLMs) are used to seek health information. Guidelines for evidence-based health communication require the presentation of the best available evidence to support informed decision-making. We investigate the prompt-dependent guideline compliance of LLMs and evaluate a minimal behavioural intervention for boosting laypeople's prompting. Study 1 systematically varied prompt informedness, topic, and LLMs to evaluate compliance. Study 2 randomized 300 participants to three LLMs under standard or boosted prompting conditions. Blinded raters assessed LLM response with two instruments. Study 1 found that LLMs failed evidence-based health communication standards. The quality of responses was found to be contingent upon prompt informedness. Study 2 revealed that laypeople frequently generated poor-quality responses. The simple boost improved response quality, though it remained below required standards. These findings underscore the inadequacy of LLMs as a standalone health communication tool. Integrating LLMs with evidence-based frameworks, enhancing their reasoning and interfaces, and teaching prompting are essential. Study Registration: German Clinical Trials Register (DRKS) (Reg. No.: DRKS00035228, registered on 15 October 2024).

The use of FD-HPC in Ruptured and Unruptured Aneurysms, the Italian Dataset (RUAID): Preliminary results on feasibility and safety

BackgroundThe introduction of flow diverters (FDs) has revolutionized the treatment of complex intracranial aneurysms; subsequent surface modifications have extended their indications to ruptured, bifurcation, and distal aneurysms. The aim of this study is to assess the real-world feasibility and safety of HPC surface-modified devices in the treatment of ruptured and unruptured aneurysms.MethodsThis independent, multicenter, prospective observational study evaluated the outcomes of patients treated with implanted Phenox p64 or p48 MW-HPC-FDs between 2020 and 2022. The sub-analysis of the procedures, complications (clinical and technical), and additional treatment requirements assessed the devices' feasibility and safety in the peri-procedural period.ResultsOne hundred and forty aneurysms (35% ruptured and 65% unruptured) were treated in 140 patients (37 females and 103 males) using 153 HPC-FDs (111 p64 and 42 p48): 100 aneurysms were saccular (71%), 22 dissecting (16%), 13 fusiform (9%), and five blister-like (3.6%). The successful deployment rate was 97.9%. The overall peri-procedural mortality rate was 9%, including three device-related deaths (2.2%); the overall morbidity rate was 12.1% (6.4% severe, 3.6% mild, and 2.1% asymptomatic adverse events); 4.4% of the clinical adverse events were certainly device related, and 2.2% were probably device related.ConclusionsThe use of p64 and p48 HPC-FDs is highly feasible and acceptably safe, although further data are needed to assess the impact of the coating on safety in emergency and elective procedures.

Sensitive periods for the association between smoking initiation and later oral health-related quality of life

AIM

To examine the association between the age of smoking initiation (SI) and oral health-related quality of life (OHRQoL) in individuals aged 50 and older.

METHODS

This secondary analysis utilised data from never and current smokers (N = 7153 complete cases) participating in the second wave of the Brazilian Longitudinal Study of Ageing (ELSI-Brazil 2019-2021), a nationally representative cohort of community-dwelling individuals aged 50 years and over. OHRQoL was assessed using the Oral Impacts on Daily Performance (OIDP) questionnaire. Adjusted zero-inflated negative binomial regression models were employed to estimate mean ratios (MRs) for the association between the age of SI and overall OIDP scores.

RESULTS

Compared to never smokers, individuals who initiated smoking at ages 15-19, 10-14, and 5-9 years exhibited 29 % (95 % CI: 1.10, 1.51), 28 % (95 % CI: 1.06, 1.55), and 46 % (95 % CI: 1.12, 1.90) higher OIDP mean scores, respectively. After adjusting for pack-year smoking history, only the association for those who started smoking at ages 5-9 years remained significant (MR = 1.44; 95 % CI: 1.06, 1.96).

CONCLUSION

SI at childhood and adolescence is associated with poorer OHRQoL later in life. The association observed in individuals who started smoking between ages 5 and 9 appears to be independent of the cumulative smoking exposure.

CLINICAL SIGNIFICANCE

Early childhood represents a sensitive period during which SI has enduring adverse effects on oral health in later life. Tobacco control policies should prioritise early-life interventions to mitigate long-term oral and systemic health risks.

Heart failure and co-morbidities confer a negative prognosis in COVID-19 infection

BACKGROUND

Since early reports, it has been shown that cardiovascular (CV) diseases, including heart failure (HF), represent a risk factor for infection, hospital admissions and mortality from COVID-19. The COVID-19 pandemics has been of major importance in Italy and in the Lombardy Region. Aims of this study were to compare COVID-19 infection in HF and No-HF subjects, and to quantify among HF patients the risk for COVID-19 infection and all-cause mortality.

METHODS

All consecutive patients (98,549) with at least one hospital discharge of HF (primary diagnosis) during January 1st, 2015, to December 31st, 2019, were identified in the Lombardy Region Database (>10 million inhabitants), and compared with No-HF subjects (394,104 with a lower age limit 40 years), randomly chosen in a 4:1 proportion among hospitalized patients. The whole cohort of cases of COVID-19 infection, laboratory-confirmed by RT-PCR, aged >40 years, diagnosed from the beginning of the epidemic on 21 February 2020 to 1 October 2020 was studied. The study outcomes were: occurrence, hospitalization, and death in COVID-19 cases.

RESULTS

Incidence of COVID-19 increased with age in both HF (p < 0.001) and No-HF patients (p < 0.001); cases (and incidence rates, IR) were 8648 (IR = 29.653 × 100.000) in HF and 14,256 (IR = 10.195) and in No-HF (p < 0.001); hospital admissions were 4974 (IR = 14.970) and 4943 (IR = 3.484), respectively (p 〈0001); deaths were 7650 (IR = 5.368) and 18,368 (IR = 56.921), respectively (p < 0.001); the incidence rate ratio (IRR) was 2.909 (95 % C.I. 2.908-2.909) for infection (p < 0.001), 4.297 (95 % C.I. 4.296-4.297) for hospital admission (p < 0.001), and 10.603 (95 % C.I.10.602-10.604) for mortality (p < 0.001). The excess IRR for mortality varied from 25.001 (95 % C.I. 24.971-25.032) for the age decade 40-49 to 1.925 (95 % C.I. 1.923-1.926) for the age decade 100-109. Among HF patients, age (OR = 1.087, 95 % C.I.1.05-1.088), male sex (OR = 1.27, 95 % C.I. 1.23-1.31), number of hospital admissions for HF during the period 2015-2019 (OR = 2.22, 95 % C.I. 2.11-2.33), co-morbidities (OR = 1.33, 95 % C.I. 1.32-1.35), or Charlson Index (OR = 1.21, 95 % C.I. 1.20-1.22), were risk factors for both infection and all-cause mortality at univariable and at multivariable analysis.

CONCLUSION

Infections, hospital admissions, and mortality for COVID-19 increased with age and male sex were more frequent in HF than in No-HF patients. Among HF patients, age and sex, number of hospital admissions for HF, co-morbidities, were risk factors for both infection and mortality. These data are of relevance for prioritizing interventions for prevention of infection, and for assistance to patients with COVID-19, and to inform management of future pandemics.

Micronanoplastic exposure due to cardiopulmonary bypass in children: A prospective observational study

Cardiopulmonary bypass (CPB) is widely used in cardiac operations. However, it remains unclear whether a CPB circuit, which is mainly made of plastics, can release micronanoplastics (MNPs) into the bloodstream. We conducted a prospective observational study involving children undergoing congenital heart disease repair with CPB support. Blood samples were collected before and after CPB and analyzed using pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS) and laser direct infrared spectroscopy (LDIR) in combination with scanning electron microscopy. A total of 22 patients were involved in this study. The Py-GC/MS analysis revealed a significant increase in total MNPs after CPB support (p < 0.0001). Notably, CPB support significantly increased the levels of polystyrene (p = 0.046), polyethylene (p = 0.038), polypropylene (p < 0.0001), polyvinyl chloride (p < 0.0001), and polyamide 6 (p = 0.027). CPB time was positively correlated to MNP exposure (r = 0.43, p = 0.047). Increases in MNP exposure were positively correlated to an increase in white blood cells (r = 0.52, p = 0.013) and neutrophils (r = 0.46, p = 0.029). The LDIR analysis found that the post-CPB count of MNPs was significantly higher than the pre-CPB count (p = 0.015). In conclusion, CPB support significantly increases exposure to MNP in children undergoing cardiac operations. Further investigations are warranted to clarify the long-term health risks of MNP exposure caused by CPB support.

Contact activation of coagulation in newly inserted indwelling catheters

The aim of this this cross-sectional observational study was to investigate coagulation and platelet activation in blood collected from newly inserted catheters. Blood samples were collected from newly inserted central venous, peripheral venous and arterial catheters in adult patients. Sample 1 was collected within seconds after insertion. Sample 2 was collected directly after Sample 1 but after proper flush and discard. A selected set of haemostatic assays were performed and the results for Sample 1 and 2 compared per catheter type. In total 10 patients per catheter type were included between December 2021 and June 2022. For central venous catheters, there was a difference in ROTEM NATEM clotting time, clot formation time, α-angle, prothrombin time international normalised ratio, factor VII and thrombin-antithrombin complex, supporting strongly enhanced activation in Sample 1 compared to Sample 2. Peripheral venous catheters and arterial catheters were less prone to activate coagulation. In conclusion, our results support flush and discard ahead of haemostatic assay blood sampling in newly inserted catheters. Furthermore, the results enhance the understanding of central venous catheter-related thrombosis formation.

County-Level Factors and Mortality Among Pacific Islander Compared With Asian American Adults

Importance

Interactions between race and county-level factors associated with mortality, such as employment, education, income, and population density, are understudied among Asian American and Pacific Islander populations.

Objective

To compare all-cause, cancer, and heart disease mortality rates between Pacific Islander and Asian American adults across county-level factors.

Design, Setting, and Participants

This cross-sectional study examined National Center for Health Statistics death certificate data on non-Hispanic Asian American and Pacific Islander adults (aged 20-84 years) between January 1, 2018, and December 31, 2020. County-level socioeconomic data were obtained from the American Community Survey, and population density was determined using Rural-Urban Continuum Codes. Analyses were conducted between August 1, 2023, and September 4, 2024.

Exposures

County-level unemployment, educational attainment, median household income, and population density.

Main Outcomes and Measures

Age-standardized all-cause, cancer, and heart disease mortality rates and mortality rate ratios (MRRs), comparing Pacific Islander with Asian American individuals by sex and age. Interactions between race and county-level factors associated with MRRs were evaluated using P value for trend across county-level factors.

Results

During 2018 to 2020, 43 221 696 Asian American and 1 281 221 Pacific Islander adults resided in the US. A total of 148 939 Asian American individuals (16.7% aged 20-54 years, 17.2% aged 55-64 years, and 66.1% aged ≥65 years; 57.5% male) and 9628 Pacific Islander individuals (29.9% aged 20-54 years, 23.0% aged 55-64 years, and 47.1% aged ≥65 years; 57.2% male) died of any cause. Across all county-level factors, Pacific Islander adults had elevated all-cause, cancer, and heart disease mortality rates compared with Asian American adults (female: MRR range from 1.82 [95% CI, 1.67-1.98] for population <250 000 to 2.93 [95% CI, 2.73-3.14] for lowest unemployment tertile; male: MRR range from 1.64 [95% CI, 1.50-1.78] for lowest income tertile to 2.47 [95% CI, 2.31-2.63] for lowest unemployment tertile). Across all county-level factors, the largest relative all-cause mortality differences between Pacific Islander and Asian American adults occurred in counties with the lowest unemployment (female: MRR, 2.93 [95% CI, 2.73-3.14]; male: MRR, 2.47 [95% CI, 2.31-2.63]), highest educational attainment (female: MRR, 2.71 [95% CI, 2.53-2.90]; male: MRR, 2.39 [95% CI, 2.25-2.54]), highest median household income (female: MRR, 2.67 [95% CI, 2.56-2.79]; male: MRR, 2.25 [95% CI, 2.17-2.33]), and highest population density (female: MRR, 2.79 [95% CI, 2.67-2.92]; male: MRR, 2.37 [95% CI, 2.28-2.47]). No trends in relative cancer mortality differences between Pacific Islander and Asian American adults across county-level factors were observed overall except for greater population density among women (<250 000 population: MRR, 1.49 [95% CI, 1.25-1.76; >1 000 000 population, 2.13 [95% CI, 1.95-2.32]). The largest heart disease MRRs for Pacific Islander compared with Asian American individuals occurred among those younger than 65 years, with the greatest relative mortality among those aged 20 to 54 years in counties with the lowest unemployment (female: MRR, 14.21 [95% CI, 9.89-20.04]; male: MRR, 5.75 [95% CI, 4.58-7.15]) and highest educational attainment (female: MRR, 13.69 [95% CI, 9.68-18.94]; male: MRR, 6.17 [95% CI, 5.00-7.54]), median household income (female: MRR, 11.97 [95% CI, 9.55-14.91]; male: MRR, 5.16 [95% CI, 4.49-5.91]), and population density (female: MRR, 11.77 [95% CI, 9.39-14.62]; male: MRR, 5.48 [95% CI, 4.76-6.29]).

Conclusions and Relevance

In this cross-sectional study, all-cause mortality disparities between Asian American and Pacific Islander populations worsened in counties with higher socioeconomic status and greater population density. Historical aggregation of Pacific Islander with Asian American individuals may have misled health improvement efforts, especially for Pacific Islander adults who lived in high socioeconomic and more populated areas.

Assessing the Impact of Post-COVID Clinics on 6-Month Health Care Utilization for Patients With Long COVID: A Single-Center Experience

Objective

To assess the impact of post-COVID clinics by examining the association between their early usage and downstream health care utilization.

Patients and Methods

In a case-control study spanning data from March 11, 2020 to June 1, 2023, patients with Long COVID were identified from a major health system using diagnosis codes. The Fast, Large-Scale Almost Matching Exactly algorithm was used to match patients who presented early to post-COVID clinics with patients with Long COVID who did not attend such clinics. Matching was performed on demographic characteristics, acute COVID severity, comorbidities, diagnosis date, and vaccination, to reduce confounders for the comparison of the health care utilization and mortality between cohorts.

Results

When exactly matching on all 46 features, the algorithm yielded 2814 matched patients, of whom 692 (24.6%; 66.6% females; mean [SD] age, 48.8 [14.5] years) were seen in post-COVID clinics within the first 6 months and 2122 (75.4%; 64.1% females; mean [SD] age, 49.7 [15.2] years) who were not. The average treatment effect (95% CI) of early post-COVID clinic usage was -0.60 (-0.83 to -0.39) on inpatient visits, -0.19 (-0.26 to -0.11) on emergency department visits, 7.62 (6.96-8.56) on outpatient visits, -$3467 (-$6267 to -$754) on estimated costs, and -0.006 (-0.010 to -0.003) on mortality.

Conclusion

Early usage of post-COVID clinics by patients with Long COVID is associated with not only fewer downstream inpatient stays, emergency department visits, estimated costs, and reduced mortality within the first 6 months but also greater outpatient utilization. Results suggest early post-COVID clinic involvement shifts care to outpatient settings, potentially reducing costs and mortality.

Trends in mortality due to ischemic heart diseases among patients with Alzheimer's disease in the United States from 1999 to 2020

Background

Ischemic heart diseases (IHD) and Alzheimer's Disease (AD) significantly contribute to mortality in aging population. Understanding mortality trends where these conditions overlap is crucial for developing targeted interventions for vulnerable populations.

Methods

We analyzed CDC WONDER mortality data from 1999 to 2020 for individuals aged ≥45 years. IHD and AD mortality were identified using ICD-10 codes I20-I25 and G30, respectively. Age-adjusted mortality rates (AAMR) per 100,000 were calculated, and trends were analyzed by gender, race, region, place of death and state. Joinpoint regression was used to calculate annual percentage changes (APC) with 95 % confidence intervals (CI).

Results

A total of 171,080 deaths were attributed to IHD in individuals with AD from 1999 to 2020. The AAMR decreased from 10.6 in 1999 to 4.1 in 2020, with a significant decline between 2004 and 2014 (APC: -7.73; 95 % CI: -8.42 to -7.24). Females exhibited higher overall AAMR compared to males (Females: 6.8 vs. Males: 6.4). Individuals of Non-Hispanic (NH) White ancestry had the highest AAMR (6.8), followed by those of NH Black (6.5) and Hispanic ancestry (5.9). The West region reported the highest AAMR at 7.9, while the Midwest had the lowest at 6.3. Oklahoma recorded the highest state-level AAMR (10.9), while Utah had the lowest (3.2).

Conclusions

IHD mortality in individuals with AD declined significantly, with disparities by gender, race, and geography. These findings underscore the need for tailored public health approaches to address the evolving burden of IHD in AD patients.

Demographic and regional mortality trends in patients with asthma in the United States (1999-2020): a CDC WONDER analysis

OBJECTIVE

Around 7.7% of Americans have asthma, including 20.2 million adults and 4.6 million children. This study examines asthma mortality trends and disparities across U.S. demographic and geographic groups from 1999 to 2020.

METHODS

A retrospective analysis was conducted using the CDC WONDER database to examine asthma-related deaths in the U.S. from 1999 to 2020. Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 100,000 were calculated. Trends and annual percent changes (APCs) were assessed overall and stratified by sex, race, region, and age.

RESULTS

From 1999 to 2020, the U.S. recorded 221 161 asthma-related deaths (AAMR: 3.07), mostly in medical facilities. Mortality declined from 1999 to 2018 (APC: -1.53%) but surged from 2018 to 2020 (APC: 28.63%). Females, NH Blacks, and NH American Indians had the highest mortality rates. Older adults (≥65) had the greatest burden, with younger groups showing notable increases post-2018. Rural areas and the West reported slightly higher rates than urban and other regions. Hawaii and the District of Columbia had the highest AAMRs, while Florida and Nevada had the lowest.

CONCLUSION

Asthma-related mortality in the U.S. declined until 2018 but sharply increased from 2018 to 2020, with rises across all demographic groups, regions, and settings. Females, NH Blacks, and older adults consistently had higher mortality rates, while younger age groups showed recent alarming increases. Targeted interventions are urgently needed to address inequities and recent mortality surges.

Paratesticular Sarcoma: Analysis of Oncological Outcomes and Prognostic Factors

INTRODUCTION AND OBJECTIVES

Paratesticular sarcomas are a rare subtype of genitourinary sarcoma. Incomplete excision results in high recurrence rates. The aim of this study was to report oncological outcomes following surgery and characterize risk factors associated with poor survival.

MATERIALS AND METHODS

Paratesticular sarcomas managed at a tertiary sarcoma referral center were identified. Kaplan-Meier survival curves were calculated for local recurrence-free survival (LRFS), metastasis-free survival (MFS) and disease-specific survival (DSS). Univariate analysis was used to identify predictive factors for these outcomes.

RESULTS

A total of 56 cases were identified between 2002 and 2023. The median age at tumor resection was 63 years. Dedifferentiated liposarcoma (DDLPS) was the most common histological subtype with n = 23 (42%) patients. Of the 51 patients with localized disease at presentation, 9 (18%) developed local recurrence, 10 (20%) developed metastatic disease and 10 (20%) have died from the disease at a median follow up of 48 months (IQR 16-93). The 5-year LRFS, MFS and DSS rate was 54.4%, 60.8% and 90.8% respectively. Positive surgical margin was significantly associated with reduced LRFS (HR 3.92, P = .005). T3 stage was associated with reduced LRFS (HR 5.78, P = .022). Tumor Grade 3 was significantly associated with reduced DSS (HR 12.0, P = .038). Patients who underwent wide re-resection (WRR) due to suboptimal primary resection had equivalent LRFS (P = .5) and DSS (P = .75) compared to patients who did not require WRR.

CONCLUSION

Positive surgical margin status is the single most important parameter for locoregional treatment failure. In these cases, wide re-resection including hemiscrotectomy is required to achieve negative surgical margins. With better awareness, prompt referral to a specialist center which provides a multidisciplinary approach will ensure individualized treatment, risk stratification and optimal oncological outcomes.

Safety and efficacy of simultaneous liver transplantation and sleeve gastrectomy in morbid obese patients with end-stage liver disease: The LT-SG study

In obese patients, metabolic dysfunction-associated steatotic liver disease is becoming a leading etiology of end-stage liver disease and HCC. Simultaneous liver transplantation and sleeve gastrectomy (LT-SG) have been proposed in the United States, but the safety and efficacy of the procedure have not been widely explored in Europe. Between January 2016 and December 2022, morbidly obese patients listed for liver transplantation at Tor Vergata University were enrolled in the LT-SG study. Primary outcomes were (1) safety expressed as 30- and 90-day overall survival and (2) major postoperative complications (Clavien-Dindo >IIIa). The secondary outcome was efficacy expressed as a 3-year %excess body mass index (BMI) loss. Eleven patients were enrolled in the study. The median BMI at transplantation was 42 (IQR 38-48). Indications of LT-SG were HCC (63.6%) and cirrhosis (36.4%). In 54% of cases, donors had high-risk characteristics (eurotransplant donor risk index >1.6). The 30- and 90-day overall survival were 63.6% and 54.5%, respectively. All deaths occurred in patients with P-SOFT >15 or in patients who had at least 3 of the following characteristics: >60 years, BMI >45, metabolic syndrome, MELD >25 or eurotransplant donor risk index >1.6. The 6 months, 1, 2, and 3 years %excess BMI loss was 73%, 60%, 50%, and 43%, respectively. LT-SG is a complex procedure that may carry excess risk in an unselected population. It should be considered only in highly selected patients. Standard donors are recommended, and prioritization of severely obese patients on the waiting list should be considered.

Therapeutic Sequences of Systemic Therapy After Atezolizumab Plus Bevacizumab for Hepatocellular Carcinoma: Real-World Analysis of the IMMUreal Cohort

BACKGROUND

The introduction of several new systemic therapies in recent years has significantly altered the treatment landscape for advanced hepatocellular carcinoma. However, while the approval of the combination of atezolizumab and bevacizumab as the preferred first-line therapy over sorafenib represents progress, it has also raised uncertainties regarding optimal treatment sequencing for advanced disease.

AIMS

This study evaluates the sequential treatment of hepatocellular carcinoma following therapy with atezolizumab and bevacizumab, providing evidence from a prospective real-world cohort.

METHODS

Data were derived from the ongoing IMMUreal cohort, which investigates immunotherapy in hepatocellular carcinoma across two tertiary centres in Bavaria. A total of 124 patients treated with atezolizumab and bevacizumab as first-line therapy between June 2020 and December 2023 were analysed. Feasibility, treatment patterns, and outcomes of sequential therapy were assessed, with a focus on defined prognostic subgroups.

RESULTS

The median overall survival under real-world conditions was 19.8 months. Less than half of the patients (41.2%) proceeded to second-line therapy, and only 19.2% were eligible for third-line treatment. This decline in treatment eligibility corresponded to a marked reduction in therapy duration and progressive deterioration in liver function, as indicated by Albumin-Bilirubin and Child-Pugh scores. While patients with worse baseline liver function, such as patients with Child-Pugh B or ALBI > 1, had a significantly lower probability of transitioning to 2nd line therapy, no significant association was found between the number of treatment lines and factors such as liver cirrhosis, poor physical condition, extrahepatic disease, or macrovascular invasion.

CONCLUSIONS

Sequential therapy following atezolizumab and bevacizumab is feasible only for selected patients. However, preserving liver function seems crucial to optimising multi-line therapy and improving outcomes in advanced hepatocellular carcinoma.

Stroke-heart syndrome and early mortality in patients with acute ischaemic stroke using hierarchical cluster analysis: An individual patient data pooled analysis from the VISTA database

BACKGROUND

The patient clinical phenotypes at particularly high risk for early cardiac complications after a recent acute ischaemic stroke (AIS), that is, stroke-heart syndrome (SHS), remain poorly defined. We utilised hierarchical cluster analysis to identify specific phenotypic profiles associated with this risk.

METHODS

We gathered data on patients with AIS from the Virtual International Stroke Trials Archive, a global repository of clinical trial data. We examined cardiac complications within 30 days post-stroke, including acute coronary syndrome, heart failure, arrhythmias and cardiorespiratory arrest. We employed hierarchical cluster analysis to define distinct phenotypic risk profiles. The incidence/risk of SHS and 90-day mortality were compared across these profiles.

RESULTS

We included 12,482 patients (mean age 69 ± 12 years; 55% male), yielding five phenotypes: Profile 1 ('elderly and AF'), Profile 2 ('young and smoker'), Profile 3 ('young'), Profile 4 ('cardiac comorbidities') and Profile 5 ('hypertension with atherosclerotic comorbidities'). Profiles 4 and 1 exhibited the highest risk for SHS (adjusted HR (95% CI): 2.01 (1.70-2.38) and 1.26 (1.05-1.51), respectively, compared to Profile 3), while Profiles 5 and 2 showed moderate risk and Profile 3 had the lowest risk. Although Profiles 1 and 4 were at the highest risk for most SHS presentations, Profile 5 had the highest risk for cardiorespiratory arrest (adjusted HR (95% CI): 2.99 (1.22-7.34)). The 90-day mortality risk was stratified by phenotype, with the highest risk observed in Profiles 5, and 4.

CONCLUSIONS

Hierarchical cluster analysis effectively identified phenotypes with the highest risk of SHS and early mortality in patients with AIS.

Initial blood pressure and adverse cardiac events following acute ischaemic stroke: An individual patient data pooled analysis from the VISTA database

BACKGROUND

Adverse cardiac events following ischaemic stroke (stroke-heart syndrome, SHS) pose a clinical challenge. We investigated the association between initial blood pressure at stroke presentation and the risk of SHS.

METHODS

We utilised data from the Virtual International Stroke Trials Archive (VISTA). We defined SHS as the incidence of cardiac complications within 30 days post-ischaemic stroke. These presentations included acute coronary syndrome encompassing myocardial injury, heart failure/left ventricular dysfunction, atrial fibrillation/flutter, other arrhythmia/electrocardiogram abnormalities, and cardiorespiratory arrest. Using Cox proportional hazards models, we assessed the risk trajectories for developing SHS and its presentations associated with initial blood pressure. We also explored the risk trajectories for 90-day mortality related to initial blood pressure.

RESULTS

From 16,095 patients with acute ischaemic stroke, 14,965 (mean age 69 ± 12 years; 55% male) were analysed. Of these, 1774 (11.8%) developed SHS. The risk of SHS and initial blood pressure showed a U-shaped relationship. The lowest blood pressures (⩽130 mmHg systolic and ⩽55 mmHg diastolic) were associated with the highest risks (adjusted hazard ratio [95%confidence interval]: 1.40 [1.21-1.63]; p < 0.001, 1.71 [1.39-2.10]; p < 0.001, respectively, compared to referential blood pressure range).Cardiorespiratory arrest posed the greatest risk at higher blood pressure levels (2.34 [1.16-4.73]; p = 0.017 for systolic blood pressure >190 mmHg), whereas other presentations exhibited the highest risk at lower pressures. The 90-day mortality risk also followed a U-shaped distribution, with greater risks observed at high blood pressure thresholds.

CONCLUSIONS

There is a U-shaped relationship between initial blood pressure at ischaemic stroke presentation and the risk of subsequent SHS.

Continuity of care across sectors in patients with type 2 diabetes: A nationwide register study in Denmark

AIMS

Our aims were to describe health care utilisation patterns across sectors in patients with type 2 diabetes(T2D), and to identify patient characteristics associated with low continuity of care.

METHODS

A nationwide register-based cohort study including all Danish citizens recorded with a diagnosis of T2 diabetes in 2017. The outcome was continuity of care as measured by three different indices: the Continuity of Care Index (COCI), the Usual Provider of Care Index (UPC), and the Sequential Continuity Index (SECON).

RESULTS

The median of patients with T2D had 75 % of their contacts to their usual health care provider. The strongest association with low continuity of care was the number of comorbidities, showing a dose response trend. Other patient characteristics associated with low continuity of care were duration of T2 diabetes (>10.3 years), lower age group (40-49 years), having a high education level (>15 years) and having a cancer comorbidity.

CONCLUSIONS

Our study was the first step to flag patients at potential risk of fragmented care due to many transitions between providers. This is of importance for the general practitioners, who are the coordinators of the patients with T2D and their various health conditions and contacts.

Cannabis use and psychotic-like experiences: A systematic review of biological vulnerability, potency effects, and clinical trajectories

Epidemiological data have provided evidence that psychotic-like experiences (PLEs) occur in the general population without clinical impairment. According to the psychosis continuum hypothesis, PLEs are subject to multiple risk factors. This review synthesizes current research on biological, substance use-related, and environmental risk factors for PLEs in non-clinical populations. PubMed/Medline and Scopus databases were searched for peer-reviewed studies published until January 2024 investigating risk factors for PLEs in non-clinical samples. Following PRISMA guidelines, 38 full-text articles were analyzed after title/abstract and full-text screening (PROSPERO registration ID: N 1001,807). Four main risk factor categories emerged. Biological vulnerabilities included specific metabolic profiles, genetic predisposition, and neurobiological alterations. Substance use patterns, particularly high-potency cannabis, showed significant associations with PLEs, with evidence for bidirectional relationships. Socio-demographic factors revealed influences of digital media use, ethnic density, and gender differences. Outcome studies demonstrated associations between PLEs and consequences including suicidal behavior and cognitive impairments. Findings suggest a complex interplay between multiple risk factors in PLE development. More attention should be paid to the interaction between biological vulnerabilities and environmental factors, as these experiences may represent important markers for mental health outcomes. A comprehensive assessment approach and proactive early intervention strategies are essential for the timely identification and management of at-risk individuals. Our findings support a multifactorial model where genetic vulnerabilities, cannabis use patterns, and socio-environmental factors influence PLE trajectories. The bidirectional cannabis-PLE relationship suggests self-regulatory mechanisms that could inform preventive interventions. Early identification of PLEs in young cannabis users represents a crucial opportunity for targeted clinical interventions.

Sociodemographic disparities in incidence and survival for pediatric out-of-hospital cardiac arrest in the United States

BACKGROUND

Sociodemographic disparities in pediatric out-of-hospital cardiac arrest (OHCA) outcomes exist; differences in pediatric OHCA incidence remain unknown. This study investigated the association between race, ethnicity, and socioeconomic status (SES) with pediatric OHCA incidence and survival. We hypothesized that children who are Black, Hispanic/Latino, or of lower SES would have higher incidence and lower survival rates compared to children who are White or of higher SES.

METHODS

This is a retrospective cohort study (2015-2019) of the Cardiac Arrest Registry to Enhance Survival database. We included OHCAs among children < 18 years. The exposures were race, ethnicity, or SES index score. The SES index score incorporated race or ethnicity, household income, high school graduation rates, and unemployment rates on a scale from 0 to 4, with 4 indicating the highest-risk neighborhoods. The primary outcome was incidence (measured per 100,000 children of a particular group). Secondary outcomes included survival to hospital discharge and survival with a favorable neurologic outcome.

RESULTS

Among 6945 OHCAs, 2320 (33.4%) occurred in Black children, 739 (10.6%) in Hispanic/Latino children, 2161 (31.1%) in White children, 188 (2.7%) in children of Other race, and 2855 (41.2%) in highest-risk neighborhoods. Black children had the highest OHCA incidence (15.5) as compared to Hispanic/Latino children (3.3) and White children (3.8), p < 0.001. OHCA incidence was higher in highest-risk neighborhoods (11.6) compared to lowest-risk neighborhoods (4.3), p < 0.001. Black children had lower odds of survival to hospital discharge (adjusted odds ratio [aOR] 0.73, 95% CI 0.59-0.91) and neurologically favorable survival (aOR 0.64, 95% CI 0.50-0.82) compared to White children. Hispanic/Latino children did not have significantly worse survival outcomes compared to White children. Children from the highest-risk neighborhoods had lower odds of survival to hospital discharge (aOR 0.64, 95% CI 0.50-0.81) and neurologically favorable survival (aOR 0.54, 95% CI 0.41-0.71) compared to children from the lowest-risk neighborhoods.

CONCLUSIONS

Black children have over four times the OHCA incidence compared to White and Hispanic/Latino children. Children from the highest-risk neighborhoods have more than twice the OHCA incidence compared to children from the lowest-risk neighborhoods. Black children and children from the highest-risk neighborhoods have significantly lower OHCA survival rates.

Heart Rate Variability Does Not Predict Recurrence of Apnoea of Prematurity After Ceasing Caffeine Therapy: A Prospective Cohort Study

AIM

We evaluated whether sample entropy of heart rate time series could serve as a biomarker for guiding caffeine cessation in preterm infants treated for apnoea of prematurity (AOP). We also assessed associations of sample entropy with weeks of gestation, clinical morbidity, AOP frequency and caffeine reinitiation.

METHODS

We conducted a prospective single-centre study at the University Children's Hospital Basel, Switzerland, from July 2019 to June 2020. We included 61 hospitalised preterm infants born before 32 weeks of gestation. Heart rate was derived from the clinical standard monitoring system at caffeine cessation, 3 days later, and at discharge. Sample entropy was calculated from 90-min recordings using custom-written analytical software.

RESULTS

We obtained valid data from 44/61 infants (72%) with a mean of 28.4 weeks of gestation (range: 24.0-31.7). Twenty-eight (64%) were male. Sample entropy at caffeine cessation was positively associated with weeks of gestation (R2 = 0.15, p = 0.01) and negatively with bronchopulmonary dysplasia (R2 = 0.18, p = 0.01). It did not predict AOP frequency or caffeine reinitiation.

CONCLUSION

Sample entropy at caffeine cessation is associated with maturation at birth and bronchopulmonary dysplasia but does not predict AOP within 3 days of cessation. Further studies should assess longitudinal measurements to predict respiratory control in preterm infants.

TRIAL REGISTRATION

clinicaltrials.gov: NCT04303494.

Penetrating trauma in Spain: analysis of the Spanish trauma registry (RETRAUCI)

OBJECTIVE

To describe the epidemiology of penetrating trauma, mortality associated factors and its management in Spanish intensive care units.

DESIGN

Multicenter, prospective registry. A comparison is established between two cohorts defined by the type of trauma (blunt and penetrating).

PATIENTS

Patients with traumatic injury admitted to the participating ICUs from June 2015 to June 2022.

INTERVENTIONS

None.

MAIN VARIABLE OF INTEREST

Epidemiology, injury pattern, prehospital and hospital care, resource utilization, and clinical outcomes.

RESULTS

12,806 patients were eligible, of whom 821 (6.4%) suffered penetrating trauma; 418 patients (50.9%) from stab wounds, 93 (11.3%) from gunshot wounds, and 310 (37.8%) from other objects. The most common intent was assault (47.7%). The mean ISS was 15.2 ± 10.6 in penetrating trauma and 19.8 ± 11.9 in blunt trauma (p < 0.001). ICU mortality was 7.8% compared to 11.7% in blunt trauma, with deaths more frequently occurring within the first 24 hours (64% vs. 39%). Factors associated with mortality included female sex, prior use of antithrombotic agents, older age, higher NISS score, and the presence of cranial trauma or shock.

CONCLUSIONS

Penetrating trauma is an emergent pathology in our context with high complexity, highlighting the need for focused study and documentation, protocol development, and resource optimization to provide quality care.