Category: Nevin Manimala

J Neurosurg. 2025 Dec 5:1-9. doi: 10.3171/2025.7.JNS25718. Online ahead of print.

ABSTRACT

OBJECTIVE: The US neurosurgical workforce faces growing demand driven by an aging population and rising prevalence of neurological conditions. This study projects workforce supply and demand from 2022 to 2037, highlighting potential shortages and geographic disparities.

METHODS: Workforce projections (2022-2037) were obtained from the Health Resources & Services Administration’s National Center for Health Workforce Analysis Dashboard, using the Health Workforce Simulation Model to estimate supply and demand by specialty, year, and location. Supply, measured in full-time equivalents (FTEs), accounted for new entrants, retirements, and attrition. Demand was projected under two scenarios: 1) status quo and 2) reduced barriers, reflecting improved access for underserved populations. Workforce adequacy (supply-to-demand ratio) was assessed, with descriptive statistics and state-level heat maps generated using Excel and Python in Google Colab.

RESULTS: The neurosurgery workforce is projected to grow slightly from 7060 FTEs in 2022 to 7230 FTEs by 2037 (+2.4%). Under the status quo scenario, demand rises from 7060 to 8310 FTEs (+18%), while the reduced barriers scenario shows an increase from 9280 to 11,830 FTEs (+27%). Workforce adequacy decreases across both scenarios, with national adequacy dropping from 100% to 87% under the status quo and from 72% to 61% under reduced barriers. Metropolitan areas maintain higher adequacy compared with nonmetropolitan areas but still face shortages over time. State-level disparities persist through 2037, with adequacy ranging from 400% in the District of Columbia to 33% in Delaware. By then, neurosurgery ranks 18th under the status quo and 33rd under reduced barriers among 37 specialties.

CONCLUSIONS: Significant neurosurgical workforce shortages are projected through 2037, with growing demand outpacing modest supply increases, particularly under the reduced barriers scenario. Targeted strategies are needed to address geographic disparities and ensure adequate neurosurgical care nationwide.

PMID:41349031 | DOI:10.3171/2025.7.JNS25718

J Med Internet Res. 2025 Dec 5;27:e75313. doi: 10.2196/75313.

ABSTRACT

BACKGROUND: Accurate assessment of voiding patterns before and after surgery for lower urinary tract symptoms is critical in patient care, but it places heavy burdens on both the patient and the clinic. While methods for telemedicine have been devised, no technology for acoustic assessment of urinary patterns has been prospectively evaluated for clinical use.

OBJECTIVE: This study aims to assess the precision of a mobile app-based uroflowmetry and compare it with in-office uroflowmetry measurements for the management of patients undergoing surgical treatment for benign prostatic hyperplasia (BPH).

METHODS: This study was designed as a prospective, multicenter, observational pilot validation study conducted at 3 tertiary centers. A total of 46 patients with BPH who had not received any previous treatment within 4 weeks of their initial outpatient clinic visit were prospectively enrolled. After diagnosis, participants with BPH conducted subsequent uroflowmetry measurements by using a sound-based mobile app, proudP, for at least 4 days during the pretreatment period, followed by transurethral resection of prostate (TURP). Additional measurements were taken at the preoperative visit and 4-day periods after 2, 6, and 12 weeks of treatment initiation, with concurrent in-office measurements. Uroflowmetry parameters, including maximum flow rate (Q_max) and voided volume, were compared. Patient satisfaction was evaluated using a scale ranging from 0 to 10 at the end of the 12-week study.

RESULTS: TURP resulted in a mean Q_max improvement of 7.2 mL/s at conventional uroflowmetry, which correlated with a mean improvement of 5.1 mL/s when measured by the app. A statistically significant correlation (P<.05) was observed between the 2 methods. The app-based uroflowmetry effectively reflected the improvement in voiding symptoms over time after the initiation of medical treatment, with statistically significant improvement in total International Prostate Symptom Scores (IPSS; -4.7), IPSS obstructive (-5.7), IPSS irritative (-2.6), and quality of life (-5.9; all P<.05). Overall, the participants reported a high level of satisfaction, with a mean score of 9.5 (SD 0.8) points at the conclusion of the study.

CONCLUSIONS: The findings of this study demonstrate that app-based uroflowmetry (proudP) measurements serve as an accurate and reliable indicator of perioperative surveillance in patients undergoing TURP for BPH. By enabling personalized and portable uroflowmetry, clinicians can easily monitor treatment response as well as observe the risk of postoperative acute urinary retention.

PMID:41349029 | DOI:10.2196/75313

J Neurosurg Spine. 2025 Dec 5:1-10. doi: 10.3171/2025.7.SPINE24939. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to investigate the incidence and postoperative clinical outcomes of lateral interbody cage migration (LCM) in patients undergoing multilevel stand-alone lateral lumbar interbody fusion (LLIF) compared with an aged-matched cohort undergoing LLIF with posterior pedicle screw instrumentation.

METHODS: A retrospective review was conducted of the medical records of patients who underwent multilevel LLIF between 2017 and 2024 at a single institution and had ≥ 1 year of follow-up and postoperative radiographic follow-up. Demographic, operative, and postoperative data were collected and analyzed. Statistical analyses were performed using the chi-square test and independent-sample t-tests to assess the differences between continuous and categorical variables comparing both cohorts (stand-alone vs posterior instrumentation). Age-matched cohort analysis was performed, evaluating the distribution of both cohorts using a frequency matching analysis with the posterior instrumentation cohort as the control group and confirming equal distribution with the chi-square statistical test. Confounding factors were evaluated using logistic regression analyses.

RESULTS: Eighty-seven patients met the inclusion criteria (43 in the stand-alone cohort, 44 in the posterior instrumentation cohort). For the stand-alone cohort, the mean (SD) age was 70.2 (8.2) years (30 [70%] males, 13 [30%] females). For the posterior instrumentation cohort, the mean (SD) age was 69.6 (7.1) years (28 [64%] females, 16 [36%] males). In the stand-alone cohort, 43 surgeries were performed involving the following 110 levels: L1-2 (n = 9), L2-3 (n = 36), L3-4 (n = 42), L4-5 (n = 23), and L5-S1 (n = 0). In the posterior instrumentation cohort, 44 surgeries were performed involving the following 112 levels: L1-2 (n = 6), L2-3 (n = 21), L3-4 (n = 44), L4-5 (n = 41), and L5-S1 (n = 0). The incidence of LCM was 7% in the stand-alone cohort and 5% in the posterior instrumentation cohort, with no statistically significant differences observed between the 2 cohorts. There were no statistically significant confounding factors. Patient-related outcomes, including Oswestry Disability Index and visual analog scale scores, showed postoperative improvement in both cohorts.

CONCLUSIONS: The difference in the incidence of LCM between the stand-alone cohort and the posterior instrumentation cohort was not statistically significant. Although posterior instrumentation has traditionally been used to enhance construct stability, multilevel stand-alone LLIF can be a safe procedure. Prospective study designs are warranted to validate these findings and elucidate factors contributing to cage migration in multilevel stand-alone LLIF versus LLIF with posterior pedicle screw instrumentation procedures.

PMID:41349028 | DOI:10.3171/2025.7.SPINE24939

J Neurosurg. 2025 Dec 5:1-13. doi: 10.3171/2025.7.JNS242821. Online ahead of print.

ABSTRACT

OBJECTIVE: Although dopamine agonist (DA) therapy still represents the standard of care for prolactinomas, a reconsideration of the role of transsphenoidal surgery has been promoted in recent years. The aim of this multicenter retrospective study was to assess the short- and long-term results of the endoscopic endonasal approach (EEA) for prolactinomas, analyzing which factors have a favorable prognostic role.

METHODS: All consecutive prolactinomas operated on in 12 Italian neurosurgical centers between 2013 and 2023 were included. For each case, preoperative clinical and neuroradiological features were considered, as well as surgical complications and short- and long-term results.

RESULTS: The series included 215 patients (44.2% males, mean age 39.7 [SD 16.6] years), accounting for 4.5% of all pituitary surgeries in these centers. The majority of prolactinomas (67.9%) were macroprolactinomas. Radical tumor resection was achieved in 171 patients (79.5%), and 3-month biochemical remission in 154 patients (71.6%). The most common surgical complication was postoperative CSF leak (2.8%). Endocrinological sequelae consisted of new onset of anterior hypopituitarism in 10.7% of cases, transient diabetes insipidus (DI) in 3.3%, and permanent DI in 2.3%. Long-term remission (mean follow-up 33.5 [SD 25.0] months) was achieved in 75.4% of patients, 14 patients (6.5%) presented with tumor recurrence/progression, and 1 (0.5%) demonstrated tumor evolution to carcinoma.

CONCLUSIONS: The EEA is a valid option for the treatment of prolactinomas, with better results for micro tumors and regular macro tumors. This study found that preoperative prolactin values < 184 ng/ml were associated with higher chances of biochemical remission, as was larger pituitary surgery center volume. Currently, the most common surgical indications for prolactinomas are represented by cases that are not responsive or intolerant to DAs. However, interesting future perspectives considering EEA as a possible co-first-line therapy in selected patients have been recently proposed.

PMID:41349017 | DOI:10.3171/2025.7.JNS242821

J Neurosurg. 2025 Dec 5:1-11. doi: 10.3171/2025.8.JNS251211. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the long-term visual outcomes following optic nerve decompression in patients with CSF flow disturbances and to propose a mechanistic framework for surgical qualification based on infusion testing and orbital MRI, independent of idiopathic intracranial hypertension (IIH) diagnostic criteria.

METHODS: This retrospective study analyzed 30 eyes in 26 patients with progressive visual impairment and evidence of CSF flow abnormalities. All patients underwent standardized lumbar infusion testing to quantify CSF outflow resistance, pressure-volume index, and opening pressure. Orbital MRI was used to assess perioptic CSF collections or optic canal narrowing. On the basis of these data, patients underwent either optic nerve sheath fenestration (ONSF) or endoscopic optic nerve sheath decompression (EONSD). Visual function was evaluated using mean deviation of the visual field, visual evoked potentials, and optical coherence tomography of the retinal nerve fiber layer (RNFL) thickness at baseline and 6 and 24 months.

RESULTS: Mean deviation of the visual field improved by a median of +1.89 dB (p < 0.05), and P100 latency (i.e., the time between a visual stimulus and the visual cortex’s response) decreased by -5 msec at 24 months. Papilledema resolved in 87.5% of affected eyes. RNFL thickness remained stable or modestly increased across the cohort, with a trend toward greater thickening following EONSD (+9 µm at both 6 and 24 months) compared with ONSF (minimal change at 6 months [+1 µm] and slight thinning at 24 months [-2 µm]), although the differences were not statistically significant. No significant differences in functional outcomes were observed between the procedures. Patients were stratified into 3 CSF pathophysiological subgroups: 1) IIH with elevated intracranial pressure (ICP), 2) abnormal hydrodynamics without raised ICP, and 3) normal ICP and hydrodynamics with MRI-confirmed perioptic CSF collection. Visual improvement occurred across all subgroups, including groups 2 and 3.

CONCLUSIONS: The authors found that optic nerve decompression guided by CSF infusion testing and orbital MRI effectively stabilizes or improves visual function in patients with CSF-related optic neuropathy, including those without elevated ICP. A mechanism-based classification into three surgical phenotypes enables individualized treatment beyond syndromic definitions. This approach may redefine surgical eligibility and expand access to vision-preserving interventions in CSF-mediated optic nerve dysfunction.

PMID:41349016 | DOI:10.3171/2025.8.JNS251211

Neurology. 2026 Jan 13;106(1):e214449. doi: 10.1212/WNL.0000000000214449. Epub 2025 Dec 5.

ABSTRACT

BACKGROUND AND OBJECTIVES: Growing evidence suggests that the APOE ε4 allele, a genetic risk factor for Alzheimer disease (AD), influences the clinical-pathologic features of Parkinson disease (PD). APOE ε4 promotes brain amyloid accumulation, indicating a PD subtype more susceptible to late copathology. However, the early correlates of APOE ε4 carriers in PD are not known. In this study, we used a multimodal approach to define the clinical, neurochemical, and neurophysiologic profiles of APOE ε4 carriers in PD at onset.

METHODS: We conducted a single-center, cross-sectional study at Tor Vergata Hospital (Rome, Italy), enrolling newly diagnosed, drug-naïve PD participants and age-matched/sex-matched healthy controls (HCs). Patients with PD were stratified by APOE genotype into ε4 and non-ε4 carriers and evaluated through a comprehensive clinical assessment and the measurement of CSF amyloid peptides and tau protein levels. Group differences in high-density EEG-based functional connectivity (FC) were analyzed using network-based statistics to identify APOE ε4-modulated patterns. Clinical and biomarker associations with network metrics were tested using analysis of covariance and correlation analyses.

RESULTS: The study included 66 PD participants (mean age 63.2 [10.1] years, 35% female, 52 ε4 noncarriers, 14 ε4 carriers) and 55 HCs (mean age 62.0 [15.2] years, 42% female). PD ε4, compared with PD non-ε4, demonstrated higher motor impairment, especially in bradykinesia (16.4 [7.6] vs 11.0 [5.6], p = 0.02) and gait disturbances (3.46 [2.23] vs 1.94 [1.46], p = 0.003) Movement Disorder Society-sponsored Unified Parkinson’s Disease Rating Scale part III scores, and reduced CSF amyloid-β42 (Aβ42)/amyloid-β40 (Aβ40) ratio (0.09 [0.03] vs 0.13 [0.03], p < 0.001). Network analyses identified ε4-related FC alterations: decreased α-band connectivity (F = 3.9, p = 0.034) and increased β-band connectivity (F = 9.8, p < 0.001). In ε4 carriers, α-FC correlated inversely with gait disturbances (r = -0.62, p = 0.02) and positively with Montreal Cognitive Assessment (r = 0.57, p = 0.03) and CSF Aβ42/Aβ40 (r = 0.54, p = 0.04). β-FC correlated with bradykinesia in both groups, with stronger associations in ε4 carriers (r = 0.54, p = 0.04) than in non-ε4 (r = 0.28, p = 0.04).

DISCUSSION: APOE ε4 defines a PD subtype characterized by greater motor impairment, reduced CSF Aβ42/Aβ40, and distinct FC abnormalities since the onset. An early amyloid-mediated network disruption thus emerges as the potential biological signature of ε4 carriers. Although limited by single-center and cross-sectional design, this study supports APOE ε4 as a stratification marker for early diagnostic and therapeutic strategies in PD.

PMID:41348997 | DOI:10.1212/WNL.0000000000214449

Int Health. 2025 Dec 5:ihaf138. doi: 10.1093/inthealth/ihaf138. Online ahead of print.

ABSTRACT

BACKGROUND: From a public health standpoint, there is merit in determining the levels of Escherichia coli in drinking water, but surveillance datasets often report censored values that may hinder traditional statistical analysis. This study aims to identify sociodemographic factors associated with the presence of E. coli in household drinking water in Bangladesh using Bayesian models for censored data, utilizing data from 6069 households in the Multiple Indicator Cluster Survey 2019.

METHODS: In terms of censoring, we considered two different Bayesian regression strategies: Bayesian Tobit Poisson regression and Bayesian Censored Generalized Poisson regression.

RESULTS: The Bayesian Censored Generalized Poisson regression model was identified as the optimal model for analyzing household fecal contamination. Regression analysis revealed significant associations between household E. coli levels and various factors including division, livestock ownership, location of water sources, treatment of drinking water, household head education, wealth index, source of drinking water, place of handwashing and toilet facility. Households using tube wells had lower E. coli levels than those using other sources. Furthermore, households using pit latrines had 1.03 times higher contamination levels than those using flush latrines.

CONCLUSIONS: Levels of fecal contamination in household water in Bangladesh were alarming. Our findings underscore the need for targeted policy interventions in specific population segments to address household fecal contamination, highlighting the link between sociodemographic and environmental factors with E. coli levels in drinking water.

PMID:41348992 | DOI:10.1093/inthealth/ihaf138

JCO Precis Oncol. 2025 Dec;9:e2500279. doi: 10.1200/PO-25-00279. Epub 2025 Dec 5.

ABSTRACT

PURPOSE: There is growing interest in multicancer detection (MCD) blood tests for diagnosing patients with cancer-related symptoms. However, recent studies suggest that MCD testing may not be sensitive enough to rule out cancer in the symptomatic population without retraining the underlying classifiers. On the basis of clinical guidelines for suspected cancer referral, here we cast these data into a formal diagnostic decision-making perspective to assess clinical utility.

METHODS: Data were extracted from the SYMPLIFY study (ISRCTN10226380), which evaluated the performance of the Galleri test (GRAIL, LLC). The decision threshold for suspected cancer referral was extracted from the National Institute for Health and Care Excellence Guideline 12. Clinical utility was estimated using Bayesian decision curve analysis.

RESULTS: For the guideline-derived decision threshold of 3%, the Galleri MCD test avoided 18,005 unnecessary suspected cancer referrals per 100,000 symptomatic patients, with a 99.4% posterior probability of clinical utility. High probabilities of clinical utility were observed for gynecologic, lower GI, and upper GI referral pathways, avoiding between 25,414 and 62,501 unnecessary referrals per 100,000 symptomatic patients. The rapid diagnostic center and lung referral pathways showed negligible probabilities of clinical utility. The minimum diagnostic performance required for clinical utility varied significantly across referral pathways. The gynecologic pathway showed the lowest sensitivity requirement (under 30% for a highly specific test) and the lung pathway the highest (over 90% for any specificity level).

CONCLUSION: Clinical utility of MCD testing for symptomatic patients in the United Kingdom varies substantially across referral pathways but is favorable for gynecologic and GI cancers. Future pathway-specific optimization of MCD tests must consider clinical utility explicitly and does not require retraining the underlying machine learning classifiers.

PMID:41348983 | DOI:10.1200/PO-25-00279

Health Informatics J. 2025 Oct-Dec;31(4):14604582251401402. doi: 10.1177/14604582251401402. Epub 2025 Dec 5.

ABSTRACT

Introduction: Pediatric restraint orders require frequent renewal to ensure patient safety. Previously, providers depended on nurses paging them upon order expiration, leading to lapses. Methods: In April 2023, we implemented an alerting system in our 38-bed pediatric intensive care unit (PICU) that sent automated text messages to providers upon order expiration. Pediatric wards and adult ICU served as controls. We analyzed 2 years of restraint order data. An unpaired t-test compared pre- and post-intervention. Results: A total of 1394 orders were included (133 PICU, 628 pediatric wards, 633 adult ICU). In the PICU, time without an active order decreased by 39% (2 h 23 min to 1 h 27 min, p = .24) though this result did not reach statistical significance. Conclusion: Despite not reaching statistical significance, this exploratory case study demonstrated that automated EHR alerts may reduce time without an active restraint order. This pilot led the institution’s informatics team to system-wide adoption. While promising, such systems must be balanced against risks like provider alarm fatigue.

PMID:41348972 | DOI:10.1177/14604582251401402

JMIR Public Health Surveill. 2025 Dec 5;11:e83323. doi: 10.2196/83323.

ABSTRACT

BACKGROUND: Long COVID affects millions worldwide, straining health systems and workforce stability. This first nationwide survey among French civil servants combines epidemiological assessment with a Knowledge, Attitudes, and Behaviors approach. Long COVID remains a diagnostic and epidemiological challenge with evolving symptoms and uncertain categorization, particularly among self-suspected cases. Beyond prevalence and risk factors, understanding behavioral dimensions is essential to developing prevention strategies and maintaining workforce resilience.

OBJECTIVE: This study aimed to (1) assess the prevalence of long COVID among French civil servants; (2) identify associated sociodemographic, occupational, and health-related factors; (3) assess disease-related knowledge of long COVID and (4) examine attitudes and behaviors regarding COVID-19 vaccination.

METHODS: This cross-sectional survey was conducted in 2024 among active or retired civil servants in France. A Knowledge, Attitudes, and Behaviors-validated questionnaire, based on World Health Organization guidelines, was used. Responses were compared across 4 COVID-19 status groups (no COVID, COVID-19 without long COVID, diagnosed long COVID, and suspected long COVID). Statistical analyses included univariate tests and multivariable logistic regressions to identify factors associated with diagnosed or suspected long COVID.

RESULTS: Among 3962 eligible respondents, 61 (1.54%; 95% CI 1.20-1.97) reported a formal diagnosis of long COVID and 241 (6.08%; 95% CI 5.38-6.87) without diagnosis. Diagnosed long COVID was significantly associated with long-term sick leave (odds ratio [OR] 1.15, 95% CI 1.03-6.28; P=.04) and long-term illness coverage (OR 0.72, 95% CI 0.27-0.92; P=.03). Suspected long COVID was associated with being in a relationship (OR 1.65, 95% CI 1.08-2.52; P=.02), widowed (OR 2.25, 95% CI 1.18-4.31; P=.01), and uncertain (OR 1.90, 95% CI 1.32-2.74; P<.001) or incomplete COVID-19 vaccination status (OR 1.67, 95% CI 1.16-2.42; P=.01). Knowledge scores differed significantly across groups (ANOVA F3,3476=24.31, P<.001; χ²6=54.92, P<.001), with diagnosed cases showing the highest proportion of high knowledge (13/61, 21%) compared to 12.4% in the non-COVID group. Among 61 diagnosed cases, 36 (59%; 95% CI 46.4-70.5) were vaccinated, 13 (21%; 95% CI 12.9-33.2) intended to get vaccinated, and 12 (20%; 95% CI 11.6-31.3) remained unvaccinated; among suspected cases, these proportions were 173 (71.8%; 95% CI 65.9-77.1), 30 (12.4%; 95% CI 8.8-17.3), and 38 (15.8%; 95% CI 11.6-21.0), respectively.

CONCLUSIONS: Unlike previous studies that examined the clinical or behavioral factors separately, this nationwide analysis linked epidemiological data with knowledge and vaccination behaviors. Among French civil servants, long COVID remains underdiagnosed, where absenteeism and sick leave threaten essential services. The study highlights disparities in disease-related knowledge, vaccination attitudes, and behaviors, underlining the importance of workplace health education and systematic screening. Vaccination is associated with lower odds of long COVID, reinforcing its preventive value. Thus, findings reveal organizational implications and support workplace-based prevention strategies integrating vaccination promotion, early detection, and health literacy to sustain the resilience of public services.

PMID:41348962 | DOI:10.2196/83323