Category: Nevin Manimala

JAMA Netw Open. 2025 Mar 3;8(3):e251678. doi: 10.1001/jamanetworkopen.2025.1678.

ABSTRACT

IMPORTANCE: Longitudinal changes in functional levels can provide valuable information about disability. However, longitudinal outcomes in aneurysmal subarachnoid hemorrhage (aSAH) have not been well reported, which could provide insight into appropriate management and information for patients experiencing disability.

OBJECTIVE: To investigate the 5-year prognosis and functional outcomes of patients with aSAH.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data of patients with aSAH from the Korean Stroke Cohort for Functioning and Rehabilitation study up to 5 years after onset. Data were collected from August 2012 through May 2015 in 9 different hospitals in Korea. Data were analyzed from September 2023 through January 2024.

EXPOSURE: Patients with aSAH surviving at least 7 days after onset.

MAIN OUTCOMES AND MEASURES: Assessments were performed serially from 7 days to 5 years after onset. Prognosis, measured by the modified Rankin scale (mRS) in terms of positive outcome (mRS score of 0 or 1), and mortality were analyzed. In addition, sequential functional outcomes were assessed using the Functional Independence Measure (FIM) in survivors of aSAH at 5 years after onset. Multiple imputation method was used to handle missing data. Wilcoxon signed-rank test and paired t test were used to analyze differences in functional measurements between each follow-up period. Additionally, a generalized mixed-effects model was used to analyze the longitudinal trajectory of the FIM.

RESULTS: A total of 338 patients with aSAH (mean [SD] age, 56.3 [13.0] years; 207 female [61.2%]) were included. Among survivors of aSAH at 7 days, the 5-year mortality rate was 8.3% (28 participants). The distribution of mRS significantly improved until 4 years and then plateaued, with 180 (53.3%) and 77 (22.8%) patients reporting an mRS score of 0 and 1, respectively. FIM showed a significant improvement up to 4 years (mean [SD] score, 118.9 [18.7]) and then plateaued.

CONCLUSIONS AND RELEVANCE: In this cohort study, the functional outcomes in patients with aSAH continued to improve up to 4 years after onset, with the majority of participants showing favorable outcomes without significant disability, suggesting that proper long-term assessment is needed and appropriate management should be emphasized to maximize potential outcomes of patients with aSAH.

PMID:40131277 | DOI:10.1001/jamanetworkopen.2025.1678

JAMA Netw Open. 2025 Mar 3;8(3):e251705. doi: 10.1001/jamanetworkopen.2025.1705.

ABSTRACT

IMPORTANCE: Recent evidence suggests higher bile duct injury rates for patients undergoing robotic-assisted cholecystectomy compared with laparoscopic cholecystectomy. Proponents of the robotic-assisted approach contend that this may be due to selection of higher-risk and more complex patients being offered robotic-assisted cholecystectomy.

OBJECTIVE: To evaluate the comparative safety of robotic-assisted cholecystectomy and laparoscopic cholecystectomy among patients with varying levels of risk for adverse postoperative outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study assessed fee-for-service Medicare beneficiaries aged 66 to 99 years who underwent cholecystectomy between January 1, 2010, and December 31, 2021. Data analysis was performed between June and August 2024. Medicare beneficiaries were separated into model training and experimental cohorts (60% and 40%, respectively). Random forest modeling and least absolute shrinkage and selection operator techniques were then used in a risk model training cohort to stratify beneficiaries based on their risk of a composite outcome of postoperative adverse events consisting of 90-day postoperative complications, serious complications, reoperations, and rehospitalization in an independent experimental cohort.

EXPOSURES: Robotic-assisted vs laparoscopic cholecystectomy.

MAIN OUTCOMES AND MEASURES: The primary outcome of interest was bile duct injury requiring operative intervention after cholecystectomy. Secondary outcomes were composite outcomes from cholecystectomy composed of any complications, serious complications, reoperations, and readmissions.

RESULTS: A total of 737 908 individuals (mean [SD] age, 74.7 [9.9] years; 387 563 [52.5%] female) were included, with 295 807 in an experimental cohort and 442 101 in a training cohort. Bile duct injury was higher among patients undergoing robotic-assisted compared with laparoscopic cholecystectomy in each subgroup (low-risk group: relative risk [RR], 3.14; 95% CI, 2.35-3.94; medium-risk group: RR, 3.13; 95% CI, 2.35-3.92; and high-risk group: RR, 3.11; 95% CI, 2.34-3.88). Overall, composite outcomes between the 2 groups were similar for robotic-assisted cholecystectomy compared with laparoscopic cholecystectomy (RR, 1.09; 95% CI, 1.07-1.12), aside from reoperation, which was overall higher in the robotic-assisted group compared with the laparoscopic group (RR, 1.47; 95% CI, 1.35-1.59).

CONCLUSIONS AND RELEVANCE: In this cohort study of Medicare beneficiaries, bile duct injury rates were higher among low-, medium-, and high-risk surgical candidates after robotic-assisted cholecystectomy. These findings suggest that patient selection may not be the cause of differences in bile duct injury rates among patients undergoing robotic-assisted vs laparoscopic cholecystectomy.

PMID:40131276 | DOI:10.1001/jamanetworkopen.2025.1705

JAMA Netw Open. 2025 Mar 3;8(3):e251714. doi: 10.1001/jamanetworkopen.2025.1714.

ABSTRACT

IMPORTANCE: Understanding the relationship between patients’ clinical characteristics and outcomes is fundamental to medicine. When critically ill patients die after withdrawal of life-sustaining therapy (WLST), the inability to observe the potential for recovery with continued aggressive care could bias future clinical decisions and research.

OBJECTIVE: To quantify the frequency with which experts consider patients who died after WLST following resuscitated cardiac arrest to have had recovery potential if life-sustaining therapy had been continued.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included comatose adult patients (aged ≥18 years) treated following resuscitation from cardiac arrest at a single academic medical center between January 1, 2010, and July 31, 2022. Patients with advanced directives limiting critical care or who experienced cardiac arrest of traumatic or neurologic etiology were excluded. An international cohort of experts in post-arrest care based on clinical experience and academic productivity was identified. Experts reviewed the cases between August 24, 2022, and February 11, 2024.

EXPOSURE: Patients who died after WLST.

MAIN OUTCOME AND MEASURES: Three or more experts independently estimated recovery potential for each patient had life-sustaining treatment been continued, using a 7-point numerical ordinal scale. In the primary analysis, which involved the patient cases with death after WLST, a 1% or greater estimated recovery potential was considered to be clinically meaningful. In secondary analyses, thresholds of 5% and 10% estimated recovery probability were explored.

RESULTS: A total of 2391 patients (median [IQR] age, 59 [48-69] years; 1455 men [60.9%]) were included, of whom 714 (29.9%) survived to discharge. Cases of uncertain outcome (1431 patients [59.8%]) in which WLST preceded death were reviewed by 38 experts who rendered 4381 estimates of recovery potential. In 518 cases (36.2%; 95% CI, 33.7%-38.7%), all experts believed that recovery potential was less than 1% if life-sustaining therapies had been continued. In the remaining 913 cases (63.8%; 95% CI, 61.3%-66.3%), at least 1 expert believed that recovery potential was at least 1%. In 227 cases (15.9%; 95% CI, 14.0%-17.9%), all experts agreed that recovery potential was at least 1%, and in 686 cases (47.9%; 95% CI, 45.3%-50.6%), expert estimates differed at this threshold.

CONCLUSIONS AND RELEVANCE: In this cohort study of comatose patients resuscitated from cardiac arrest, most who died after WLST were considered by experts to have had recovery potential. These findings suggest that novel solutions to avoiding deaths based on biased prognostication or incomplete information are needed.

PMID:40131275 | DOI:10.1001/jamanetworkopen.2025.1714

JAMA Netw Open. 2025 Mar 3;8(3):e251759. doi: 10.1001/jamanetworkopen.2025.1759.

ABSTRACT

IMPORTANCE: Disparities in organ supply and demand led to geographic inequities in the score-based liver transplant (LT) allocation system, prompting a change to allocation based on acuity circles (AC) defined by fixed distances. However, fixed distances do not ensure equivalent population size, potentially creating new sources of disparity.

OBJECTIVE: To estimate the association between population size around LT centers and waiting list outcomes for critically ill patients with chronic end-stage liver disease and high Model for End-stage Liver Disease (MELD) scores or acute liver failure (ALF).

DESIGN, SETTING, AND PARTICIPANTS: This US nationwide retrospective cohort study included adult (aged ≥18 years) candidates for deceased donor LT wait-listed between June 18, 2013, and May 31, 2023. Follow-up was completed June 30, 2023. Participants were divided into pre-AC and post-AC groups.

EXPOSURE: Population size within defined radii around each LT center (150 nautical miles [nm] for participants with high MELD scores and 500 nm for those with ALF) based on AC allocation policy.

MAIN OUTCOMES AND MEASURES: LT candidate waiting list mortality and dropout rate were analyzed using generalized linear mixed-effect models with random intercepts for center and listing date before and after AC implementation. Fine-Gray competing risk regression, accounting for clustering, was used as a secondary model.

RESULTS: The study analyzed 6142 LT candidates (1581 with ALF and 4561 with high MELD scores) during the pre-AC era and 4344 candidates (749 with ALF and 3595 with high- MELD scores) in the post-AC era, for a total of 10 486 participants (6331 male [60.5%]; mean [SD] age, 48.5 [7.1] years). In the high-MELD cohort, being listed at a center in the lowest tertile of population size was associated with increased waiting list mortality in the AC era (adjusted odds ratio [AOR], 1.68; 95% CI, 1.14-2.46). Doubling of the population size was associated with a 34% reduction in the odds of mortality or dropout (AOR, 0.66; 95% CI, 0.49-0.90). These results were consistent with those of the extended Fine-Gray models and were also corroborated by multiple sensitivity analyses. However, there were no significant population density-associated disparities in the ALF cohort.

CONCLUSIONS AND RELEVANCE: In this retrospective nationwide cohort study, being wait-listed in less populated regions was associated with greater mortality among critically ill LT candidates with high MELD scores, underscoring the limitations of allocation systems based purely on fixed distances.

PMID:40131274 | DOI:10.1001/jamanetworkopen.2025.1759

JAMA Netw Open. 2025 Mar 3;8(3):e251765. doi: 10.1001/jamanetworkopen.2025.1765.

ABSTRACT

IMPORTANCE: Despite emphasis on the establishment of inclusive hospital policies, the impact of these policies on employees and organizations remains unknown.

OBJECTIVE: To evaluate the association between inclusive policies for lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender minority (LGBTQ+) and nurse job outcomes as well as nurse-reported quality of care.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed 4 survey datasets from 2021: the RN4CAST-NY/IL, including registered nurses from New York and Illinois, and the Healthcare Equality Index (HEI) data. The HEI evaluates and scores US health care facilities that voluntarily participate based on their LGBTQ+ inclusivity in policies, such as nondiscrimination policies and LGBTQ+ inclusive clinical services. The study used American Hospital Association Annual Survey data for hospital characteristics and Magnet organization data to classify hospitals by Magnet status. Data analyses were performed in December 2024.

MAIN OUTCOMES AND MEASURES: Nurse job outcomes included burnout and job dissatisfaction. Quality of care outcomes included nurses’ perceptions of care quality and their likelihood of recommending their hospital. The independent variable was LGBTQ+ Healthcare Equality Leader (HEI Leader) status, which signified hospitals with the highest levels of LGBTQ+ inclusion. Multilevel logistic regression models included nurse-level (age, race and ethnicity, gender, and years of experience at the current hospital) and hospital-level (Magnet status, size, teaching status, specialized service capability, and ownership) covariates.

RESULTS: A total of 7343 nurses (mean [SD] age, 44.9 [13.4] years; 6584 [89.6%] women) from 111 hospitals were included in the study. Nurses in hospitals with HEI Leader status had lower odds of high burnout (adjusted odds ratio [AOR], 0.69; 95% CI, 0.52-0.92) and lower odds of job dissatisfaction (AOR, 0.62; 95% CI, 0.45-0.86) compared with those in hospitals without the status. They also had higher odds of reporting excellent or good quality of care (AOR, 1.83; 95% CI, 1.23-2.73) and higher odds of recommending their hospital (AOR, 1.72; 95% CI, 1.19-2.50).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, nurses in hospitals with high LGBTQ+ inclusion reported more favorable job outcomes and care quality. Hospitals should understand that implementing LGBTQ+ inclusive policies goes beyond compliance or diversity; it is essential for improving the work climate, enhancing staff well-being, and optimizing care delivery.

PMID:40131273 | DOI:10.1001/jamanetworkopen.2025.1765

JAMA Netw Open. 2025 Mar 3;8(3):e251807. doi: 10.1001/jamanetworkopen.2025.1807.

ABSTRACT

IMPORTANCE: Copy number variants (CNVs) and single-nucleotide variations (SNVs) or insertions and deletions are key genetic contributors to neurodevelopmental disorders (NDDs). Traditionally, chromosome microarray and exome sequencing (ES) have been used to detect CNVs and single gene variants, respectively.

OBJECTIVE: To identify genetic variants causing NDDs and evaluate the diagnostic yield and clinical utility of ES by simultaneously analyzing CNVs and SNVs in patients with NDDs and their biologic parents (trios).

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included pediatric patients with suspected NDDs who visited Shanghai Children’s Hospital between January 1, 2018, and December 31, 2023. ES was used to investigate trios (trio-ES) including patients with NDDs who remained undiagnosed after phenotype identification and underwent gene panel testing, multiplex ligation-dependent probe amplification, or karyotyping. Comprehensive clinical and laboratory data were collected. Data were analyzed from July 2022 to December 2023.

EXPOSURE: NDDs, characterized by global developmental delay or intellectual disability.

MAIN OUTCOMES AND MEASURES: The study measured the overall diagnostic yield of SNVs and CNVs in the NDD cohort as well as within NDD syndromic subtypes.

RESULTS: Of the 1106 patients with NDDs, 731 (66.1%) were male. The mean (SD) age of patients at diagnosis was 3.80 (2.82) years. The overall diagnostic yield of trio-ES was 46.1% (510 diagnoses among 1106 patients), with 149 CNVs (13.5%), 355 SNVs (32.1%), and 4 cases of uniparental disomy (0.4%). Codiagnosis of SNVs and CNVs occurred in 2 cases (0.2%). Among the trios, 812 candidate germline variants were identified, including 634 SNVs (78.1%), 174 CNVs (21.4%), and 4 cases of uniparental disomy (0.5%). Of these, 423 SNVs (66.7%) and 157 CNVs (90.2%) were diagnostic variants, while 211 SNVs (33.3%) and 17 CNVs (9.8%) were variants of uncertain significance. Sixteen CNVs smaller than 20 kilobase were detected using ES.

CONCLUSIONS AND RELEVANCE: In this cohort study, trio-ES, by simultaneously detecting SNVs and CNVs, achieved a diagnostic yield of 46.1%. Trio-ES may be particularly applicable for identifying small CNVs and recessive genetic diseases involving both SNVs and CNVs. These findings suggest that in clinical practice, simultaneously analyzing SNVs and CNVs using trio-ES data has a favorable genetic diagnostic yield for children with NDDs.

PMID:40131272 | DOI:10.1001/jamanetworkopen.2025.1807

JAMA Netw Open. 2025 Mar 3;8(3):e251821. doi: 10.1001/jamanetworkopen.2025.1821.

ABSTRACT

IMPORTANCE: Neonates requiring intensive care are at high risk of health care-associated infections. In neonatal intensive care units (NICUs) in low-resource settings, the identification of modifiable risk factors can inform targeted prevention strategies to reduce the global burden of neonatal morbidity and mortality.

OBJECTIVE: To describe the incidence of and the risk factors associated with health care-associated bloodstream infections (BSIs) in NICUs in Pune, India.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter prospective cohort study enrolled all neonates admitted to 3 NICUs in Pune, India, from May 1, 2017, to July 31, 2019. Neonates were followed up from admission until discharge, transfer, or death. This secondary data analysis included neonates admitted for 3 days or more and was completed on January 31, 2024.

MAIN OUTCOMES AND MEASURES: The primary outcome was health care-associated BSIs, defined as a positive blood culture on or after admission day 3. Summary statistics, incidence of health care-associated BSIs, and hazard rate by characteristics of interest were generated. Among neonates admitted for 7 days or longer, the association between antibiotic exposure and infection risk was assessed.

RESULTS: A total of 6410 neonates were admitted for 3 days or longer. The median gestational age was 34 weeks (IQR, 32-37 weeks), and 3560 (55.5%) were male. The incidence of health care-associated BSIs was 6.09 per 1000 patient-days. Most isolates were gram-negative organisms (n = 273 [66.3%]), of which 85.5% (202 of 236 isolates tested) were resistant to third- or fourth-generation cephalosporins and 44.8% (117 of 261 isolates tested) were resistant to carbapenems. The hazard rate of health care-associated BSIs was higher among neonates with central venous catheters, respiratory support, or urinary catheters within 3 days preceding infection. Of 3229 neonates admitted for 7 days or longer, 190 (5.8%) had health care-associated BSIs on or after hospital day 7, with an incidence of 3.22 per 1000 patient-days. Antibiotic exposure during the first week of admission was associated with a nearly 3-fold increase in the risk of health care-associated BSIs (adjusted hazard ratio, 2.82 [95% CI, 1.26-6.32]).

CONCLUSIONS AND RELEVANCE: In this cohort study of 6410 neonates admitted to 3 NICUs in Pune, India, the risk of health care-associated BSIs was associated with the presence of indwelling devices and prior antibiotic exposure. Future efforts should focus on mitigating the risks associated with indwelling devices and strengthening infection prevention and control and antimicrobial stewardship programs to prevent health care-associated infections.

PMID:40131271 | DOI:10.1001/jamanetworkopen.2025.1821

J Perianesth Nurs. 2025 Mar 25:S1089-9472(24)00559-8. doi: 10.1016/j.jopan.2024.11.015. Online ahead of print.

ABSTRACT

PURPOSE: This study was conducted to determine the methods used to evaluate and prevent preoperative deep vein thrombosis (DVT) risk in urological surgery patients.

DESIGN: A descriptive and cross-sectional study.

METHODS: The study population consisted of patients treated at the urology clinic of a university hospital in the Mediterranean region between February 2024 and June 2024. The sample consisted of 120 patients who met the inclusion criteria. The data of the study were collected using the Personal Information Form, Autar DVT Risk Diagnosis Scale and Patient Follow-up Form. In addition to linear regression analysis, descriptive statistics were also used to analyze the data.

FINDINGS: According to the Autar DVT risk diagnostic scores of the patients participating in the study, 82.5% were in the low-risk group, 15.8% were in the intermediate-risk group, and 1.7% were in the high-risk group. Additionally, the study determined that sex, body mass index, and age significantly predicted the risk of DVT (P < .05).

CONCLUSIONS: As a result of the study, it is noteworthy that although the risk of DVT is low in the majority of urological surgery patients, there are also patients at medium and high risk. In line with these results, more effective strategies should be developed, accompanied by guidelines, in evaluating and preventing DVT risk in clinical practice.

PMID:40131255 | DOI:10.1016/j.jopan.2024.11.015

Afr J Reprod Health. 2025 Mar 25;29(3):76-84. doi: 10.29063/ajrh2025/v29i3.10.

ABSTRACT

For both individual and community health, women’s health is vital. In particular, gynecological cancers can be prevented or treated by adopting healthy lifestyles, raising awareness, and detecting them early. This study aimed to identify levels of gynecological cancer awareness and healthy lifestyle behaviors among women aged 20-65 years. There were 251 women in the descriptive cross sectional study. The Gynecological Cancers Awareness Scale (GCAS), the Descriptive Characteristics Form, and the Healthy Lifestyle Behavior Scale-II (HLBS-II) were used to gather data. The data was analyzed using the Pearson’s correlation test, multiple linear regression, and descriptive statistics. The average HLBS-II score was 123.53±20.75, while the average GCAS score was 149.64±21.30. The HLBS-II and GCAS scores showed a statistically significant positive correlation. Women knowledgeable about early diagnosis methods scored 10.758 times higher on the GCAS, while women familiar with vulvar self-examination scored 11.016 times higher. Employed women had a mean HLBS-II score 6.124 times higher than non-employed women (p<0.05). Women’s awareness of gynecological cancer was high, but they also had moderately good lifestyle choices. To raise awareness and promote healthy lifestyle choices, healthcare professionals are advised to take part in health-promoting initiatives.

PMID:40131246 | DOI:10.29063/ajrh2025/v29i3.10

Expert Rev Neurother. 2025 Mar 25. doi: 10.1080/14737175.2025.2484439. Online ahead of print.

ABSTRACT

INTRODUCTION: Cenobamate (CNB) is an anti-seizure medication (ASM)utilized for drug-resistant focal-onset seizures, which are difficult to managewith usual agents. Previous studies demonstrated that it can be effective inpatients with refractory epilepsy.

METHODS: The MEDLINE, Cochrane, and Scopus databases weresystematically searched up to 24 October 2024. A Random-effects model wasemployed to compute the Mean Difference (MD) and the Risk Ratio (RR) with 95%Confidence Intervals (CI). Statistical Analyses were performed utilizingRStudio 4.4.2.

RESULTS: Four studies were included, comprising 906 patients; 527(59%) received CNB as add-on therapy. The results indicated that the 50%responder rate (RR 1.77; 95% CI: 1.28 to 2.44, p = 0.000551, I² = 70.3%) andseizure freedom (RR of 3.09; 95% CI: 1.91 to 5.00, p = 0.000004, I² = 8.7%)were significantly higher in this group.

CONCLUSIONS: In this meta-analysis of four studies, CNB as an add-ontherapy significantly reduced seizure frequency in patients with uncontrolledfocal seizures, making it a promising option for improved seizure control andquality of life.

PMID:40131227 | DOI:10.1080/14737175.2025.2484439