Category: Nevin Manimala

J Med Internet Res. 2026 May 7;28:e98435. doi: 10.2196/98435.

ABSTRACT

This commentary argues that for low-intensity postdischarge interventions, emergency department use may be a more sensitive and appropriate indicator of transitional care quality than readmission. It also positions nurse-led telephone follow-up as interpretive, equity-sensitive transitional care work that helps patients make discharge plans actionable in the home context while highlighting the value of accessible, scalable digital modalities such as telephone outreach.

PMID:42096670 | DOI:10.2196/98435

Phlebology. 2026 May 7:2683555261451569. doi: 10.1177/02683555261451569. Online ahead of print.

ABSTRACT

BackgroundUltrasound-guided foam sclerotherapy (UGFS) is a minimally invasive procedure recommended for the management of chronic venous disease, particularly for varicose veins and saphenous trunk insufficiency, although rare, systemic effects may occur. The study aims to evaluate the impact of UGFS on pulmonary artery pressure and right ventricular function through indirect echocardiographic measurements.Material and MethodsA total of 50 patients with incompetent great saphenous veins underwent UGFS. Preoperative assessments and echocardiographic monitoring of right heart function were conducted at baseline (T0), 5 min (T5), 10 min (T10), and 15 min (T15) after FS injection. Primary endpoint included changes in systolic pulmonary artery pressure (PAPs), while secondary endpoints focused on tricuspid annular plane systolic excursion (TAPSE) and right ventricular diameter (RVD1). Statistical analyses were performed using paired t-tests and linear mixed models.ResultsThe results indicated a significant increase in PAPs from T0 to T10 (mean increase of 8.13 mmHg, p < .01) and T5, with a reduction at T15 that remained above baseline (mean difference of 3.01 mmHg, p < .01). TAPSE showed a significant increase at T15 compared to T0 (mean increase of 1.6 mm, p = .04). No significant changes were observed in RVD1. Importantly, no local or systemic complications occurred, and all patients remained asymptomatic.ConclusionUGFS is a safe and effective treatment for chronic venous disease, with transient and benign alterations in right heart hemodynamic likely attributable to foam degradation products. Further studies with larger cohorts and longer follow-up are warranted to enhance understanding of the long-term effects of UGFS on pulmonary hemodynamic and right ventricular function.

PMID:42096649 | DOI:10.1177/02683555261451569

JMIR Cardio. 2026 May 7;10:e81777. doi: 10.2196/81777.

ABSTRACT

BACKGROUND: Telehealth has shown promise in enhancing care transitions and physical health outcomes in patients with cardiovascular disease. However, limited studies have explored its effect on functional status, psychological health, and rehospitalization, specifically in older patients undergoing coronary artery bypass grafting (CABG).

OBJECTIVE: This study aimed to evaluate the effectiveness of a telehealth intervention in improving functional status, reducing anxiety and depression, and decreasing rehospitalization rates compared with usual care among older patients undergoing CABG.

METHODS: The study was a 2-arm parallel randomized controlled trial. This was conducted in 2 phases. Phase 1 was conducted in the cardiac surgical units at a university hospital in Bangkok, Thailand. Phase 2 involved following up with the participant at home 30 and 90 days after discharge. A total of 84 older adults undergoing CABG were randomly assigned to either the control group (n=42), which received usual care (discharge planning), or the intervention group (n=42), which received a telehealth intervention based on the transitional care model in addition to usual care. The telehealth intervention included home monitoring via the “Zip Heart” app and scheduled video consultations. The primary outcome was functional status, measured using the Thai version of the Enforced Social Dependency Scale. Secondary outcomes included anxiety and depression, assessed using the Thai Hospital Anxiety and Depression Scale, and rates of rehospitalization. Data were collected at baseline, 30, and 90 days after discharge. Analyses were conducted using an intention-to-treat approach, with missing outcome data handled using multiple imputation. Two-way repeated-measures ANOVA was used to evaluate group, time, and group-by-time interaction effects.

RESULTS: A total of 84 participants were randomized and included in the intention-to-treat analysis (intervention group, n=42; control group, n=42). At baseline, there were no statistically significant differences between the two groups. Significant group-by-time interactions were observed for functional status scores (F2,164=32.09, ηp²=.28; P<.001), anxiety (F2, 164=20.22, ηp²=.2; P<.001), and depression (F2,164=16.81, ηp²=.17; P<.001). The intervention group demonstrated significantly greater improvements in functional status and greater reductions in anxiety and depression at both 30 and 90 days after discharge compared to the control group (all P<.001). Additionally, rehospitalization rates were significantly lower in the intervention group at 30 days (Z=2.77; P=.006) and between 31 and 90 days post discharge (Z=2.31; P=.02).

CONCLUSIONS: The Telehealth intervention is effective in improving functional and psychological outcomes and reducing rehospitalization rates among older patients undergoing CABG. Integrating telehealth into usual care can support recovery and enhance continuity of care.

PMID:42096646 | DOI:10.2196/81777

Prev Chronic Dis. 2026 May 7;23:E11. doi: 10.5888/pcd23.250407.

ABSTRACT

INTRODUCTION: Mobility is a critical determinant of healthy aging. Agility, gait, balance, and fall risk, when left unassessed and unaddressed, may diminish older adults’ ability to age in place, often leading to more restrictive, supervised care environments. This study examined racial and ethnic disparities in a composite mobility/functional measure in Hawai’i and the associations of selected social determinants of health (SDOH) with limitation status.

METHODS: We analyzed data from the Hawai’i Behavioral Risk Factor Surveillance System collected from 2019 through 2021. The study population included community-dwelling adults aged 55 years or older from the 4 largest racial and ethnic groups in Hawai’i: White, Filipino, Japanese, and Native Hawaiian (unweighted n = 10,039; weighted population estimate = 350,922). We used weighted logistic regression to assess associations between mobility limitations and SDOH.

RESULTS: Mobility limitations were reported by 28% of Native Hawaiian people aged 55 years or older, compared with 17% to 19% among other groups. Native Hawaiian adults aged 55 to 64 years also had substantially higher prevalence of mobility limitations than adults of the same age in other racial and ethnic groups. Higher income was protective against mobility limitations for both Native Hawaiian and White adults. In contrast, the associations of education and health insurance with mobility limitations varied across groups, with weaker protective associations of education among Native Hawaiian adults.

CONCLUSION: Findings suggest the importance of considering mobility-focused prevention and assessment for Native Hawaiian adults before the Medicare eligibility age of 65 years. To be effective, these interventions must be culturally grounded and tailored to the unique needs and lived experiences of Native Hawaiian communities.

PMID:42096639 | DOI:10.5888/pcd23.250407

JMIR Med Inform. 2026 May 7;14:e97580. doi: 10.2196/97580.

ABSTRACT

[This corrects the article DOI: 10.2196/68182.].

PMID:42096260 | DOI:10.2196/97580

JAMA. 2026 May 7. doi: 10.1001/jama.2026.5164. Online ahead of print.

ABSTRACT

IMPORTANCE: Despite high recanalization rates with endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion, functional outcomes remain suboptimal. The benefit of adjunctive intra-arterial thrombolysis after successful thrombectomy is uncertain.

OBJECTIVE: To assess whether adjunctive intra-arterial alteplase after successful thrombectomy improves functional outcomes and cerebral reperfusion.

DESIGN, SETTING, AND PARTICIPANTS: Randomized, open-label trial with blinded outcome assessment conducted at 14 stroke centers in Spain from December 11, 2023, through November 26, 2025. A total of 440 patients with acute ischemic stroke due to large vessel occlusion treated with thrombectomy within 24 hours and achieving an expanded Treatment in Cerebral Ischemia score of 2b50 to 3 were randomized.

INTERVENTIONS: Thrombectomy plus intra-arterial alteplase (0.225 mg/kg; maximum dose, 20 mg/kg) infused over 15 minutes (n = 221) or thrombectomy alone (n = 219).

MAIN OUTCOMES AND MEASURES: The primary outcome was an excellent functional outcome at 90 days, which was defined as a modified Rankin Scale score of 0 or 1. There were 6 secondary outcomes, including residual hypoperfusion on follow-up computed tomography perfusion. The safety outcomes included symptomatic intracranial hemorrhage and death.

RESULTS: Of 3786 patients treated with thrombectomy, 2776 (73%) fulfilled angiographic criteria and 440 (12%) were randomized. There were 433 patients who were treated as randomized (median age, 76 [IQR, 75-78] years; 51% female). At 90 days, 57.5% of patients (123/214) in the thrombectomy plus intra-arterial alteplase group had a modified Rankin Scale score of 0 or 1 vs 42.5% of patients (93/219) in the thrombectomy alone group (adjusted risk difference, 15.0% [95% CI, 5.7% to 24.3%]; P = .002). Of 6 secondary outcomes, 4 showed no significant between-group differences. Residual hypoperfusion occurred in 28.6% (55/192) of patients in the thrombectomy plus intra-arterial alteplase group vs 50.5% (96/190) of patients in the thrombectomy alone group (adjusted risk difference, -22.0% [95% CI, -31.5% to -12.4%]; P < .001) and symptomatic intracranial hemorrhage occurred in 1.4% (3/214) vs 0.5% (1/219), respectively (adjusted odds ratio, 3.10 [95% CI, 0.32 to 30.0]; P = .33). Mortality at 90 days was 12.1% (26/214) in the thrombectomy plus intra-arterial alteplase group vs 6.4% (14/219) in the thrombectomy alone group (adjusted risk difference, 5.9% [95% CI, 0.5% to 11.3%]; P = .03).

CONCLUSIONS AND RELEVANCE: Among patients with acute ischemic stroke and successful thrombectomy, adjunctive intra-arterial alteplase increased the proportion achieving excellent functional outcome at 90 days without a significant increase in symptomatic intracranial hemorrhage. Higher mortality in the thrombectomy plus intra-arterial alteplase group warrants further study.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05797792.

PMID:42096239 | DOI:10.1001/jama.2026.5164

JAMA Oncol. 2026 May 7. doi: 10.1001/jamaoncol.2026.1080. Online ahead of print.

ABSTRACT

IMPORTANCE: Metastatic non-small cell lung cancer (mNSCLC) has very high mortality rates, and comprises approximately half of new cases of lung cancer; however, highly effective and better tolerated treatments have become available in recent decades. Nevertheless, population-level treatment of mNSCLC is poorly characterized in the era of rapid treatment advances.

OBJECTIVE: To characterize treatment rates, trends, and factors associated with treatment of mNSCLC.

DESIGN, SETTING, AND PARTICIPANTS: This population-based study used linked Surveillance Epidemiology and End Results (SEER) and Medicare claims data and the analysis included patients 65 years and older diagnosed with mNSCLC from January 2006 to December 2021. Data were analyzed from October 2025 to February 2026.

EXPOSURES: Sociodemographic variables, comorbidity burden, histologic type, referral to subspecialist, enrollment in Medicare Part D, and biomarker testing.

MAIN OUTCOMES: The primary outcome was receipt of systemic treatment. Statistical analyses included summary statistics and a competing risk proportional hazards model for receipt of systemic treatment.

RESULTS: Of 254 611 patients with mNSCLC, the cohort median (IQR) age was 73 (68-80) years, with 133 635 (52.5%) male individuals; a total of 9512 (3.7%) were Asian, 26 546 (10.4%) were Black, 4553 (1.8%) were Hispanic, 205 381 (80.7%) were White, and 8619 (3.4%) were another or unknown race. A total of 119 197 patients (46.8%) ever received systemic treatment. Of the 100 367 (39.8%) who died within 90 days of diagnosis, 13.2% were treated compared with 69% of those surviving more than 90 days. The treated proportion increased only slightly between 2006 and 2021. In a competing risk model, referral to oncology specialists was associated with treatment (hazard ratio [HR], 2.5; 95% CI, 2.41-2.67; P < .001) which corresponded to a 30.3% greater cumulative incidence of treatment at 180 days (CIF180) compared with those without a referral. Similarly, those with biomarker testing had a 17.8% greater CIF180, whereas those older than 80 years had a 15.4% lower CIF180 compared to those aged 65 to 69 years. Patients with NSCLC not otherwise specified histologic findings had a 12.8% lower CIF180 compared with those with adenocarcinoma histologic findings. Other factors associated with significant but smaller differences in receipt of treatment included comorbidity burden, marital status, Medicare Part C or Part D coverage, rurality, and race and ethnicity.

CONCLUSIONS AND RELEVANCE: In this cohort study of older adults with mNSCLC, despite advances in therapy in recent decades, almost half of patients never received systemic therapy, and the proportion treated only minimally improved over time. Approximately one-fifth of those with the most favorable clinical profiles did not receive systemic therapy.

PMID:42096214 | DOI:10.1001/jamaoncol.2026.1080

JAMA Netw Open. 2026 May 1;9(5):e2611251. doi: 10.1001/jamanetworkopen.2026.11251.

ABSTRACT

IMPORTANCE: Public health emergency waivers enacted during the COVID-19 pandemic dramatically expanded telemedicine use. Expiration of these waivers would limit access to this convenient care option for older adults, but it is unknown how expiration would affect patients’ burden of care, quantified as health care contact days (days receiving in-person care).

OBJECTIVE: To measure the extent to which telemedicine days experienced by older adults enrolled in traditional Medicare may supplement in-person health care contact days and to estimate how telemedicine waiver expiration could increase the number of health care contact days.

DESIGN, SETTING, AND PARTICIPANTS: This is a cross-sectional study of the 2022 Medicare Current Beneficiary Survey examining a nationally representative sample of community-dwelling adults aged 65 years or older enrolled in traditional Medicare. Data analysis was performed from March 2025 to March 2026.

MAIN OUTCOMES AND MEASURES: The primary outcomes were total telemedicine days (days with any telemedicine service) and additional health care contact days if telemedicine waivers expired (telemedicine days converted to in-person contact days, assuming 100% substitution). Multivariable logistic and Poisson regressions evaluated associations between patient characteristics and the probability and rate of additional health care contact days.

RESULTS: Among 5151 community-dwelling older adults (weighted number, 27 321 585 individuals; mean [SD] age, 74.6 [7.0] years; 2496 female individuals [52.4%]), 1294 (weighted 22.7%) used telemedicine. Telemedicine use varied widely (median [IQR], 1 [1-3] telemedicine day; maximum, 91 days), with 10.5% of telemedicine users (135 respondents) accounting for 50% of all telemedicine days. If telemedicine waivers expired and all affected telemedicine services were substituted with in-person services, 74.1% of older adults (951 respondents) using telemedicine would experience at least 1 additional health care contact day, totaling 8 772 118 additional contact days. Having more chronic conditions (adjusted odds ratio for >10 conditions, 8.42; 95% CI, 5.44-13.00) and difficulty getting places (adjusted odds ratio, 1.29; 95% CI, 1.10-1.53) were associated with higher odds of additional contact days.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of older adults enrolled in traditional Medicare found that most older adults using telemedicine would experience additional health care contact days if telemedicine waivers expired and all affected telemedicine services were substituted with in-person services. The resulting burden would fall disproportionately on adults with multiple chronic conditions and difficulty getting places, potentially exacerbating access barriers for patients most in need of care.

PMID:42096202 | DOI:10.1001/jamanetworkopen.2026.11251

JAMA Netw Open. 2026 May 1;9(5):e2611335. doi: 10.1001/jamanetworkopen.2026.11335.

ABSTRACT

IMPORTANCE: Blood-based neural biomarkers linked to aging may provide insights into the biological end point of the human lifespan. However, the key biomarker associated with cognition and mortality in centenarians remains unclear.

OBJECTIVE: To investigate the associations between 3 neural biomarkers-amyloid-β42 and amyloid-β40 ratio (Aβ42/40), phosphorylated tau 181 (p-tau181), and neurofilament light chain (NfL)-and both cognitive function and all-cause mortality in centenarians.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study included Japanese centenarians aged 100 years or older who were enrolled between September 2000 and January 2021. Participants underwent baseline cognitive assessments and blood sampling and were followed up for 17 years for mortality. Data analysis was performed in February 2026.

EXPOSURES: Baseline plasma levels of Aβ42/40, p-tau181, and NfL measured using ultrasensitive immunoassays.

MAIN OUTCOMES AND MEASURES: Cognitive function at baseline, measured using the Mini-Mental State Examination (MMSE), and all-cause mortality.

RESULTS: Of 495 participants (398 [80.4%] women; mean [SD] age 104.1 [3.0] years), 419 completed a cognitive assessment (mean [SD] MMSE, 14.9 [6.9]). During 17 years of follow-up, 466 participants (95.5%) died. Lower Aβ42/40 (β = 0.99; 95% CI, 0.46 to 1.52) and higher NfL levels (β = -0.92; 95% CI, -1.62 to -0.23) were significantly associated with lower MMSE scores after adjusting for confounders. Higher NfL levels were also associated with increased mortality (hazard ratio, 1.36; 95% CI, 1.17 to 1.57), showing the greatest point estimate among the biomarkers, all of which were standardized and statistically significant (change in Akaike Information Criterion, likelihood ratio test, χ2 = 30.16; P < .001). Aβ42/40 and p-tau181 were not statistically significant after full adjustment.

CONCLUSIONS AND RELEVANCE: In this cohort study of centenarians, higher plasma NfL levels were associated with lower cognitive function and increased all-cause mortality, whereas Aβ42/40 and p-tau181 showed no associations. These findings suggest that plasma NfL was associated with neurodegeneration in extreme aging. Further studies are needed to confirm its clinical utility before routine implementation.

PMID:42096201 | DOI:10.1001/jamanetworkopen.2026.11335

JAMA Netw Open. 2026 May 1;9(5):e2611440. doi: 10.1001/jamanetworkopen.2026.11440.

ABSTRACT

IMPORTANCE: There is conflicting evidence for associations between maternal SARS-CoV-2 infection and neonatal congenital anomalies. Population-based studies evaluating confirmed maternal infection during pregnancy and at specific gestational time periods are needed.

OBJECTIVE: To evaluate associations between laboratory-confirmed maternal SARS-CoV-2 infection in pregnancy and neonatal congenital anomalies, overall during pregnancy and by specific trimester of exposure.

DESIGN, SETTING, AND PARTICIPANTS: This population-based, matched cohort study of live births with maternal SARS-CoV-2 infection in pregnancy matched 1:4 to live births without maternal infection in Ontario, Canada, was conducted from December 14, 2020, to December 31, 2021. Matching was performed on maternal age, delivery date, gestational age at birth, neonatal sex, and prepregnancy diabetes. Analyses were conducted from May to August 2025.

EXPOSURE: Maternal SARS-CoV-2 infection in pregnancy confirmed by positive real-time polymerase chain reaction (RT-PCR) test. Pregnancies with no positive RT-PCR test were considered SARS-CoV-2 negative.

MAIN OUTCOMES AND MEASURES: The primary outcome was any neonatal congenital anomaly. The secondary outcome was any neonatal cardiac anomaly. Crude incidence rates of congenital anomalies per 1000 live births by maternal SARS-CoV-2 infection status with 95% CI were determined with a Poisson distribution for the study sample overall, and by each trimester of exposure.

RESULTS: A total of 5049 live births with corresponding maternal SARS-CoV-2 infection in pregnancy (mean [SD] maternal age, 31.0 [4.9] years) were matched 1:4 to 20 196 live births without maternal infection (mean [SD] maternal age, 31.1 [4.7] years). Compared with patients without infection, those with infection were more likely to be immigrants and to have high levels of material deprivation and were less likely to receive COVID-19 vaccination and live in rural areas. The crude incidence rate of any congenital anomaly was 32.5 anomalies per 1000 live births (95% CI, 27.9-37.9 anomalies per 1000 live births) with maternal SARS-CoV-2 infection and 31.1 anomalies per 1000 live births (95% CI, 28.8-33.6 anomalies per 1000 live births) without maternal SARS-CoV-2 infection (unadjusted rate ratio, 1.04; 95% CI, 0.87-1.24; P = .65). Multivariable logistic regression adjusting for maternal socioeconomic variables and prepregnancy COVID-19 vaccination did not alter these findings. Infection separately by trimester was not statistically significantly associated with the outcome. There were no statistically significant associations between maternal SARS-CoV-2 infection and cardiac anomalies in pregnancy overall or by trimester.

CONCLUSIONS AND RELEVANCE: In this Ontario population-based study of 5049 live births with maternal SARS-CoV-2 infection matched to 20 196 live births without maternal infection, there was no association between laboratory-confirmed maternal SARS-CoV-2 infection and neonatal congenital anomalies in pregnancy overall, or by trimester of infection. These findings may provide reassurance to pregnant patients and their health care professionals, although further studies evaluating first trimester infection and risks of specific anomalies are warranted.

PMID:42096200 | DOI:10.1001/jamanetworkopen.2026.11440