Category: Nevin Manimala

Accid Anal Prev. 2025 Jul 30;220:108172. doi: 10.1016/j.aap.2025.108172. Online ahead of print.

ABSTRACT

OBJECTIVES: Higher age is often seen as a key factor in the decline of driving skills. Moreover, there is some evidence that overestimation is related to both higher age and poorer on-road performance in older drivers. However, it is unknown how the extent of overestimation or underestimation affects on-road driving performance beyond age.

METHODS: 112 older drivers with and without mild cognitive impairment participated in this prospective on-road study. All participants underwent a standardized on-road driving assessment, neuropsychological testing, collection of driving-related data and different self-assessments. Statistical analyses included a hierarchical regression analysis to predict on-road driving performance by adding age and sex in the first step and the validity of self-assessment (VSA) in the second step. Correlation analyses focused on the association between VSA and cognitive and driving-related behavioral factors.

RESULTS: Results revealed that the combination of age and sex significantly predicted on-road driving skills (R²_adjusted = 0.320). The inclusion of VSA led to a significant increase of explained variance in the criterion (R²_adjusted = 0.639). Moreover, the degree of overestimation correlated with higher age, lower cognitive performance and more risky driving behavior.

DISCUSSION: Our results highlight the importance of the VSA for on-road driving performance beyond the effects of age and sex. Moreover, the VSA appears to decrease towards overestimation with increasing age and decreasing cognition and should thus be a focus of safety research.

PMID:40749272 | DOI:10.1016/j.aap.2025.108172

ESMO Open. 2025 Jul 31;10(8):105516. doi: 10.1016/j.esmoop.2025.105516. Online ahead of print.

ABSTRACT

BACKGROUND: Several studies showed that in mismatch repair-deficient (dMMR)/microsatellite instability (MSI) nonmetastatic colon cancer (CC), neoadjuvant immune checkpoint inhibitors (ICIs) were associated with exceptional rates of pathological major response (pMR) and complete response (pCR). Patients included in these trials, however, were highly selected, and real-life data are now needed to better evaluate the efficacy and tolerability of neoadjuvant ICIs in routine clinical practice.

PATIENTS AND METHODS: This retrospective observational study aimed to describe the clinical practices regarding ICIs in the neoadjuvant setting for patients with dMMR/MSI nonmetastatic CC, and to evaluate their efficacy and safety in real-world conditions. Patients receiving ICIs as part of a therapeutic trial were excluded.

RESULTS: Between 2019 and 2024, 32 patients were included across six French centers [median age 70 years (range 51-76 years), Lynch syndrome 31%]. Twenty-four patients had right-sided CC (85%), including three (9%) with two primary tumor locations. Ten patients (31%) received ipilimumab + nivolumab (NICHE regimen), while 22 (69%) were treated with pembrolizumab monotherapy. Grade ≥3 toxicities were observed in six patients (19%), including one toxic death and three toxicities (9%) leading to treatment discontinuation (one rheumatoid polyarthritis-like syndrome and two tumor fistulizations). Three patients developed bowel obstruction while receiving ICIs, two of whom underwent surgery showing pCR and pMR. Thirty patients were resected and 33 tumors were analyzed histologically with pMR in 21 cases (64%) including pCR in 14 cases (42%). The presence of an independent-cells contingent was statistically associated with poor pathological response.

CONCLUSIONS: This retrospective real-world study confirms the excellent results of neoadjuvant ICIs in dMMR/MSI nonmetastatic CC patients. pMR and pCR rates were, however, lower than those published in previous studies (64% and 42%, respectively), with higher rates of grade ≥3 toxicity, including one potential toxic death and three treatment discontinuations.

PMID:40749247 | DOI:10.1016/j.esmoop.2025.105516

J Neurosurg Pediatr. 2025 Aug 1:1-8. doi: 10.3171/2025.4.PEDS25100. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the effect of intrathecal baclofen (ITB) on BMI over time in a large pediatric cohort of patients with cerebral palsy (CP).

METHODS: The medical records of pediatric patients diagnosed with CP who underwent ITB pump placement at Texas Children’s Hospital between 2007 and 2024 were retrospectively reviewed. Pre- and postoperative BMI, demographic information, and clinical characteristics were collected. Multiple BMI velocities were calculated. A linear mixed-effects model was used to account for interpatient variability.

RESULTS: Among 237 patients, the average BMI was 17.90 (SD 4.00) kg/m2 preoperatively and 19.13 (SD 4.58) kg/m2 postoperatively, showing a significant difference (p = 0.001, Kruskal-Wallis test) but a small effect size (η2 = 0.02, 95% CI 0.001-0.05). The average BMI velocity was 0.55 (SD 3.5) kg/m2/yr presurgery and 0.46 (SD 3.5) kg/m2/yr postsurgery, showing no significant difference (p = 0.52, t-test). The mixed-effects model found no statistically significant effect of ITB surgery on BMI rate of change by catheter level. Specifically, cervical (p = 0.97), high thoracic (p = 0.41), midthoracic (p = 0.63), and low thoracic (p = 0.84) catheter levels were nonsignificant in effect on BMI.

CONCLUSIONS: Although there was an absolute increase in BMI postoperatively, the small effect size and results of the linear mixed-effects model-accounting for clinical confounders, within-patient variability, and catheter level-demonstrated that ITB surgery does not significantly affect BMI. The authors conclude that improved tone control may not substantially impact BMI, necessitating further nutritional intervention to ensure optimal BMI.

PMID:40749238 | DOI:10.3171/2025.4.PEDS25100

J Neurosurg Spine. 2025 Aug 1:1-9. doi: 10.3171/2025.5.SPINE25304. Online ahead of print.

ABSTRACT

OBJECTIVE: Despite growing interest in using biometric measures as objective tools to monitor recovery after spine surgery, there is sparse guidance on appropriate thresholds to evaluate perioperative changes in these domains. The authors defined thresholds of activity and heart rate (HR) measures that mark improved early recovery and evaluated their association with longer-term surgical outcomes.

METHODS: A prospective observational cohort study recruited patients undergoing elective surgery for lumbar degenerative spine disease at a single institution from February 2021 to June 2023. Patient-reported outcome measures (PROMs) were collected preoperatively and at 1 month and 6 months after surgery. The authors evaluated 50 metrics of physical fitness available on Fitbit fitness trackers that assessed activity amount, activity intensity, and physiological status based on the responsiveness of each after surgery and correlation with clinical metrics. Anchor-based methods were used to calculate Fitbit metric cutoffs that delineated clinical improvement, with Patient-Reported Outcome Measurement Information System physical function (PF) and pain interference scores used as anchors at 1 month postoperatively. The receiver operating characteristic (ROC) analysis was performed to identify optimal thresholds. Six-month clinical outcomes were compared between patient groups based on the newly defined Fitbit metric cutoffs. Multivariable regression, with 6-month PROMs as the dependent variable, were used to control for clinical confounders.

RESULTS: Sixty-two patients (mean age 62 [SD 12] years, 33 [53%] female) were included. PROMs at 6 months were significantly improved for all variables. Among 50 candidate Fitbit metrics, 4 were selected: active time (cutoff: 7.6% decrease, area under the ROC curve [AUC] 0.71), daily steps (cutoff: 1.55 steps/min decrease, AUC 0.70), time spent moving at ≥ 40 steps/min (cutoff: 0.7% decrease, AUC 0.67), and HR stability (cutoff: 15% increase, AUC 0.72). When separating patients into groups based on newly defined Fitbit cutoffs, these Fitbit metrics had at least one significant association with 6-month PROMs. These measures improved predictions of 6-month outcomes based on R2 and, except for daily steps, remained statistically significant on multivariable regression.

CONCLUSIONS: By monitoring the dynamic nature of a patient’s PF through wearable trackers, clinicians can gain valuable insights into functional recovery that can complement traditional PROMs. The cutoffs derived from this study can potentially serve as important benchmarks for future studies examining physiological markers of surgical recovery.

PMID:40749235 | DOI:10.3171/2025.5.SPINE25304

JMIR Form Res. 2025 Aug 1;9:e75120. doi: 10.2196/75120.

ABSTRACT

BACKGROUND: The rise of short-video platforms, such as TikTok (Douyin in China) and Bilibili, has significantly influenced how health information is disseminated to the public. However, the quality, reliability, and effectiveness of health-related content on these platforms, particularly regarding uterine fibroids, remain underexplored. Uterine fibroids are a common medical condition that affects a substantial proportion of women worldwide. While these platforms have become vital sources of health education, misinformation and incomplete content may undermine their efficacy.

OBJECTIVE: This study aims to address these gaps by evaluating the quality and dissemination effectiveness of uterine fibroid-related health information on TikTok and Bilibili.

METHODS: A total of 200 uterine fibroid-related videos (100 from TikTok and 100 from Bilibili) were selected through a keyword search. The videos were evaluated by 2 trained gynecological experts using the Global Quality Score (GQS) and a modified DISCERN (mDISCERN) tool. In addition, the Patient Education Materials Assessment Tool for Audio and Visual Materials was used to assess the understandability and actionability of the videos. Statistical analyses, including the Mann-Whitney U test, Spearman rank correlation, and stepwise regression analysis, were used to assess differences between platforms and identify predictors of video quality.

RESULTS: The results indicated that TikTok outperformed Bilibili in terms of user engagement metrics, such as likes, comments, shares, and followers (all P<.001). However, Bilibili videos were generally longer than those on TikTok (P<.001). The videos on both platforms demonstrated suboptimal overall quality and reliability, reflected by median GQS score of 3 (IQR 3-4) for TikTok and the median GQS score of Bilibili is 3 (IQR 2-4). The median modified DISCERN scores were also low: 2 (IQR 2-2) for TikTok and 2 (IQR 2-2) for Bilibili, with no significant differences between the 2 platforms (P=.62 for GQS; P=.18 for mDISCERN). The videos on both platforms yielded comparable median scores for Patient Education Materials Assessment Tool-Understandability (PEMAT-U) and Patient Education Materials Assessment Tool-Actionability (PEMAT-A). The median score of PEMAT-U was 77% (IQR 69%-83%) for TikTok and 77% (IQR 69%-85%) for Bilibili. The PEMAT-A yielded a median score of 67% (IQR 33%-67%) for TikTok and 67% (IQR 0-67%) for Bilibili. Videos uploaded by medical professionals on TikTok had significantly higher quality scores compared to those uploaded by nonprofessionals. A moderate positive correlation was observed between the GQS and mDISCERN scores (r=0.41, P<.01), indicating an interrelationship between quality and reliability. Stepwise regression analysis identified “completeness score,” “source,” and “PEMAT scores” as significant predictors of video quality.

CONCLUSIONS: This study highlights the generally low quality of uterine fibroid-related health information on short-video platforms, although TikTok showed better performance in terms of engagement and quality. The involvement of medical professionals was found to enhance video quality. These findings underscore the need for improved oversight of health content on social media platforms and greater involvement of health care professionals to ensure the dissemination of accurate and reliable health information.

PMID:40749219 | DOI:10.2196/75120

JMIR Serious Games. 2025 Aug 1;13:e76357. doi: 10.2196/76357.

ABSTRACT

BACKGROUND: Sarcopenia in older adults is associated with reduced muscle mass and function, leading to frailty, increased fall risk, and decreased quality of life (QOL). Mixed reality (MR)-based interventions have emerged as promising tools to enhance physical therapy engagement and effectiveness through immersive, interactive environments.

OBJECTIVE: This study aimed to investigate the effects of a Mixed Reality-Based Physical Therapy (Mr.PT) platform on quadricep muscle thickness, balance confidence, activities of daily living, and QOL in older adults with sarcopenia.

METHODS: A preliminary randomized controlled trial was conducted involving 30 older women (mean age 75.3, SD 9.9 y) diagnosed with sarcopenia based on the Asian Working Group for Sarcopenia criteria. Participants were randomly assigned to either the Mr.PT group or a conventional physical activity (CPA) group. Both groups participated in 30-minute exercise sessions, 3 times per week, over 4 weeks. The Mr.PT program used head-mounted MR devices with gamified, interactive training, while the CPA group received standard therapist-led exercises using resistance bands. Outcome measures included ultrasound imaging of quadricep muscle thickness, the Korean version of the Activities of Daily Living scale (Katz Index of Independence in Activities of Daily Living), the Activities-Specific Balance Confidence (ABC) scale, and the 12-Item Short-Form Health Survey. Statistical analysis was performed using repeated-measures ANOVA and Tukey post hoc tests.

RESULTS: The Mr.PT group showed significantly greater improvement in quadricep muscle thickness than the CPA group (P=.001). Within-group improvements in balance confidence (ABC scale) and daily functioning (Katz Index of Independence in Activities of Daily Living) were observed in both groups (P<.05), though between-group differences were not statistically significant. However, the Mr.PT group demonstrated significantly greater gains in QOL as measured by 12-Item Short-Form Health Survey (P=.02). All participants completed the intervention without dropouts or adverse events.

CONCLUSIONS: MR-based exercise using the Mr.PT platform appears effective in increasing muscle mass and enhancing QOL among older adults with sarcopenia. Its interactive and adaptive features may improve engagement and motivation, suggesting potential advantages over traditional programs. Further research with larger cohorts and longer follow-up is recommended to confirm these preliminary findings and explore long-term outcomes.

PMID:40749218 | DOI:10.2196/76357

J Contin Educ Nurs. 2025 Aug;56(8):322-328. doi: 10.3928/00220124-20250612-02. Epub 2025 Aug 1.

ABSTRACT

BACKGROUND: Early career nurses with 1 to 2 years of experience are offered minimal structured support after onboarding. During this period, nurses often contemplate their next career steps without guidance, sometimes leaving an organization.

METHOD: A quantitative quasi-experimental study was conducted to determine whether career coaching focused on professional development and mentorship would (a) increase retention and (b) improve engagement of pediatric nurses with 1 to 2 years of experience.

RESULTS: Participant retention remained 100% throughout the study. Nonparticipant retention dropped to 96% at 12 weeks postintervention and 94% at 20 weeks postintervention. Engagement scores increased after the career coaching sessions, with no statistically significant difference in mean values for engagement pre- and postintervention (t = -1.06, df = 8.00, p = .320).

CONCLUSION: Engagement improved postintervention. Retention was greater for participants than for nonparticipants. Increasing nurse retention positively impacts professional, financial, and patient care outcomes for nurses and the health care community.

PMID:40749214 | DOI:10.3928/00220124-20250612-02

J Med Internet Res. 2025 Aug 1;27:e60546. doi: 10.2196/60546.

ABSTRACT

BACKGROUND: Internet medical services (IMS) expanded rapidly in China during the COVID-19 pandemic. Unfortunately, disparities in internet medical services utilization (IMSU) have marginalized disadvantaged groups of Chinese patients from digital health benefits. The extent and nature of these disparities remain poorly understood, with no research comprehensively addressing how unfavorable predictors, including demographic, socioeconomic, and health-related factors, shape IMSU status, patterns, and preferences in China after the COVID-19 pandemic.

OBJECTIVE: This study aims to gain a deeper understanding of the disparities and unfavorable predictors that limit IMSU among Chinese adult patients following the COVID-19 pandemic, providing key reference points for advancing equitable IMSU.

METHODS: This cross-sectional study used a triangular approach, combining data from a provincial field survey conducted in July 2023 and a national online survey conducted in March 2024. Participants were Chinese adult outpatients aged 18 years or older. Descriptive and comparative analyses were used to examine disparities in IMSU status, patterns, and preferences across different demographic, socioeconomic, and health status-related factors. Binary logistic regression models were applied to assess the associations between unfavorable predictors (constructed from selected demographic, socioeconomic, and health status-related factors) and IMSU status, patterns, and preferences.

RESULTS: Of the 2011 eligible participants in the Jiangsu provincial field survey, 787 (39.13%) reported using IMS at least once in the previous 12 months. Among the 1611 eligible participants in the national online survey, all reported accessing IMS during the same period; however, only 481 (29.86%) reported high-frequency use (defined as usage in the third quartile or above, ie, ≥6 times). Overall, participants with unfavorable predictors were less likely to engage in IMSU, deep IMS were used less frequently than shallow IMS, and participants with 6 or more cumulative unfavorable predictors had the lowest total of IMSU preference score (mean 48.98 and 57.37 in the provincial field and national online surveys, respectively). Based on combined data from the provincial field and national online surveys, significantly negative associations were observed between unfavorable predictors and IMSU status, patterns, and preferences. In particular, participants aged 60 years or above (odds ratio [OR] 0.40, 95% CI 0.25-0.63, P<.001) and those without everyday internet access (OR 0.54, 95% CI 0.41-0.71, P<.001) were the least likely to use IMS at a medium-to-high frequency. Participants without private health insurance (OR 0.59, 95% CI 0.44-0.79, P<.001) were the least likely to utilize deep IMS. Moreover, participants aged 60 years or above (OR 0.45, 95% CI 0.33-0.63, P<.001) and those with a high school education or less (OR 0.67, 95% CI 0.55-0.82, P<.001) were the least likely to prefer IMS to a moderate-to-strong degree.

CONCLUSIONS: Widespread disparities in IMSU status, patterns, and preferences persisted among Chinese adult patients after the COVID-19 pandemic. More pro-disadvantaged patient policies may be warranted to narrow these disparities in IMSU, such as reimbursement for IMSU, to promote digital health equity in China.

PMID:40749207 | DOI:10.2196/60546

J Am Acad Orthop Surg Glob Res Rev. 2025 Jul 29;9(8). doi: 10.5435/JAAOSGlobal-D-24-00243. eCollection 2025 Aug 1.

ABSTRACT

BACKGROUND: The incidence of metastatic cancer continues to increase, becoming a prevalent condition in oncology orthopaedic practice. The proximal femur is the third most common site of skeletal metastases. Two possible options for endoprosthetic reconstruction of proximal femur metastasis include proximal femur resection and replacement with megaprosthesis and hemiarthroplasty with a long-cemented revision stem.

METHODS: To facilitate better decision making, we conducted a retrospective study comparing these alternatives. This is a single-institution, retrospective, observational study. Patients with metastatic disease of proximal femur who had a reconstruction with either a proximal femoral replacement (group A, 27 patients) or reconstruction using a hemiarthroplasty with long revision cemented stem (group B, 31 patients) were included for analysis.

RESULTS: Group A was associated with higher estimated blood loss than group B (1027.8 vs. 491.9 mL, P = 0.007). Group A was associated with higher surgical time (148.9 vs. 116.6 minutes, P = 0.04). More patients were associated with intense care unit transfer in group A (P = 0.04). Group B was associated with a shorter average time to full weight-bearing (6.2 vs. 11.5 weeks, P = 0.03). Group B was associated with shorter time to discharge (9.4 vs. 17.0 days, P = 0.04). Group A was associated with more postoperative complications (n = 5, 18.5% vs. n = 0, 0%), (P = 0.02).

CONCLUSION: In patients with metastatic disease of the proximal femur, reconstruction with a long revision stem hemiarthroplasty was associated with better performance regarding surgical outcomes (estimated blood loss, surgical time, transfer to intensive care unit vs. regular floor). Furthermore, patients with hemiarthroplasties presented an association with shorter rehabilitation time and less complications.

PMID:40749198 | DOI:10.5435/JAAOSGlobal-D-24-00243

J Am Acad Orthop Surg Glob Res Rev. 2025 Jul 29;9(8). doi: 10.5435/JAAOSGlobal-D-24-00304. eCollection 2025 Aug 1.

ABSTRACT

INTRODUCTION: Perioperative outcomes for patients with cystic fibrosis (CF) have not been previously described following spine surgery. This study used PearlDiver to examine the 90-day postoperative outcomes and 4-year revision rates after posterior lumbar fusion (PLF) for patients with CF compared with matched controls.

METHODS: This study examined a cohort of PLF patients with versus without CF. Patients were matched 1:10 for age, sex, Elixhauser Comorbidity Index, and the number of levels. Ninety-day postoperative outcomes and 4-year revision rates were compared.

RESULTS: One hundred twenty-seven patients with CF were matched with 1263 controls without CF. On multivariable logistic regression, those with CF had statistically significantly increased 90-day odds of the following: venous thromboembolism (odds ratio [OR], 4.2), pleural effusion (OR, 3.4), dyspnea (OR, 3.2), respiratory failure (OR, 2.8), pneumonia (OR, 2.6), acute kidney injury (OR, 2.4), hospital readmissions, (OR, 2.2), and emergency department visits (OR, 2.1). Notably, patients with CF were not at increased odds of 4-year subsequent lumbar surgery.

DISCUSSION: Patients with CF were at significantly increased odds of pulmonary and other defined adverse events. These findings are pertinent in the perioperative risk assessment, patient/family recommendations, and surgical preparations for patients with CF being considered for PLF.

PMID:40749196 | DOI:10.5435/JAAOSGlobal-D-24-00304