Nevin Manimala

Support Care Cancer. 2025 Dec 8;34(1):15. doi: 10.1007/s00520-025-10226-0.

ABSTRACT

BACKGROUND: Pancreatic cancer is often diagnosed at advanced stages with limited treatment options. Although palliative care (PC) improves symptom control and end-of-life outcomes, referrals are frequently delayed. We evaluated changes in symptom intensity and analyzed survival and place of death among patients referred to PC.

METHODS: We conducted a retrospective study of adults diagnosed with pancreatic cancer between 2011 and 2024 at a tertiary care hospital. Patients were grouped by referral to PC. Data were extracted from electronic records. Symptom intensity was assessed using the Edmonton Symptom Assessment System (ESAS) at the first and second PC visits. Survival was analyzed with Kaplan-Meier curves, and alluvial plots illustrated changes in symptom burden.

RESULTS: Among 489 patients (median age 67), 69.5% were referred to PC. Only 8.8% had resectable tumors, and 49.7% had metastases, more common in the PC group (54.7% vs. 14.8%; p < 0.001). Pain and fatigue were the most intense symptoms at admission. Anxiety, depression, and nausea demonstrated a significant improvement in intensity at the second PC assessment. In locally advanced unresectable cancer, PC referral was associated with longer survival (188 vs. 58 days; p = 0.022). Patients receiving PC more often died at home (80.2% vs. 25.0%; p < 0.001).

CONCLUSION: Our findings demonstrate a reduction in symptom intensity-particularly pain and fatigue-after PC admission. Patients referred to PC were more likely to have advanced, unresectable disease. These results underscore the need to integrate PC earlier in the treatment course to provide more comprehensive, individualized, and compassionate care.

PMID:41359199 | DOI:10.1007/s00520-025-10226-0

Environ Monit Assess. 2025 Dec 8;198(1):24. doi: 10.1007/s10661-025-14880-z.

ABSTRACT

The Vaal River is a vital water source for domestic, industrial, and agricultural use in South Africa’s economic heartland, but its water quality is increasingly threatened by nutrient pollution, resulting in nuisance algal blooms and invasive aquatic plant growth. This study applies an Algal Problem Index (API) to assess biological water quality and identify risks associated with algae and cyanobacteria in the Vaal River’s upper reaches. Water samples were collected over a 12-month hydrological year from 16 sites, including sites in the main stream, major tributaries, and reservoirs. Cyanobacteria and algae were identified, and analyses of physico-chemical parameters and chlorophyll-a concentrations were conducted. Multivariate statistical analysis was used to evaluate relationships between environmental conditions and algal-related problems. Results revealed 16 taxa, including Microcystis aeruginosa and Dolichospermum circinale, responsible for bad tastes, foul odours, and potential toxin production. Tributaries such as the Riet Spruit and Klip River were major sources of nutrient loading, although low light conditions limited algal growth in certain areas. Elevated API scores increased downstream, reflecting degrading water quality from the Vaal Dam to the Vaal River barrage. This study demonstrated the innovative and practical application of the API as a visual tool integrating multiple biological indicators into a single, easily interpretable measure of water quality. By summarising complex algal-related risks, it can provide water managers with a rapid, practical way to assess ecological conditions, and it can be applied in other catchments facing similar challenges.

PMID:41359193 | DOI:10.1007/s10661-025-14880-z

Tech Coloproctol. 2025 Dec 8;30(1):6. doi: 10.1007/s10151-025-03236-x.

ABSTRACT

INTRODUCTION: Limited data exists in literature regarding concomitant ventral rectopexy (VRP) and sacrocolpo/hysteropexy (SCP/SHP), with existing studies being predominantly retrospective. The aim of this meta-analysis is to assess the anatomical and functional outcomes of combined VRP and SCP/SHP for the treatment of multicompartmental pelvic organ prolapse (POP).

METHODS: We performed systematic research and meta-analysis from PubMed/MEDLINE and EMBASE, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, until 15 January 2025. Women submitted to VRP with SCP/SHP were included. Improvement of anorectal symptoms were evaluated. Postoperative anatomical relapse was reported. Re-operation rates were evaluated.

RESULTS: Six articles were included. Constipation/obstructed defecation syndrome (ODS) [odds ratio (OR) 0.26, 95% CI 0.10-0.68; p = 0.006 (I² test 81%, p = 0.56)] and of anal/fecal incontinence (AI/FI) rates [OR 0.09, 95% CI 0.03-0.30; p < 0.0001 (I² test 70%, p = 0.04)] significantly improved after combined VRP and SCP/SHP. The proportion metanalysis of four included studies reported a subjective POP recurrence rate of 7% (95% CI 1-13%; I² test 82.9%, p < 0.001). The proportion metanalysis of five included studies for objective POP recurrence was 5% (95% CI 1-9%; I² test 56.9%, p = 0.041). No serious adverse events were reported.

CONCLUSIONS: VRP combined with SCP/SHP has been shown to be safe and effective for women with multicompartment POP, providing optimal anatomical and functional outcomes. Larger, long-term, prospective-controlled studies are needed to confirm these results.

PMID:41359190 | DOI:10.1007/s10151-025-03236-x

Diabetologia. 2025 Dec 8. doi: 10.1007/s00125-025-06613-1. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: The aetiology of type 1 diabetes remains elusive. Family history of type 1 diabetes increases the disease risk but the role of other autoimmune diseases or type 2 diabetes in the family are unclear. Here, we aimed to analyse the effect of family history of diabetes and autoimmune diseases on development of islet autoimmunity and progression to type 1 diabetes.

METHODS: The Environmental Determinants of Diabetes in the Young (TEDDY) study is a prospective observational cohort study of children recruited as newborns in 2004-2010 at clinical centres in Finland, Germany, Sweden and the USA. A total of 8676 children with high-risk HLA-DR-DQ genotype for type 1 diabetes fulfilled the eligibility criteria for regular follow-up. Questionnaire-based family history of all types of diabetes and autoimmune diseases among first- and second-degree relatives (FDRs and SDRs; data available for 8558 and 7479 children, respectively) was collected. The main outcomes were development of islet autoimmunity and progression from autoimmunity to type 1 diabetes. Data until 31 January 2016 were analysed.

RESULTS: Persistent islet autoantibodies were found in 669 children and type 1 diabetes in 233 children (45% and 46% female sex, respectively). The median follow-up time after seroconversion was 6.5 years (IQR 3.3-8.5). Having an FDR with type 1 diabetes increased the child’s risk of islet autoimmunity (HR 2.2 [95% CI 1.8, 2.8]; p<0.001), particularly if the father or sibling had type 1 diabetes. Islet autoimmunity was also associated with family history of type 1 diabetes in an SDR when participants having an FDR with type 1 diabetes were excluded from the analysis (HR 1.4 [95% CI 1.1, 1.8]; p=0.017). Notably, progression from autoantibody positivity to type 1 diabetes was significantly delayed in children having type 2 diabetes in an SDR (HR 0.61 [95% CI 0.44, 0.86]; p=0.004). Islet autoimmunity or progression to type 1 diabetes were not associated with other types of diabetes or autoimmune diseases in the family.

CONCLUSIONS/INTERPRETATION: Family history of diabetes is differentially associated with development of islet autoimmunity and progression to type 1 diabetes. The contribution made by familial, genetic and environmental factors to the two phases of the disease pathogenesis deserves distinct analyses.

DATA AVAILABILITY: Data reported here can be obtained by request at the NIDDK Central Repository website, Resources for Research (R4R), https://repository.niddk.nih.gov/ .

PMID:41359174 | DOI:10.1007/s00125-025-06613-1

Eur Radiol. 2025 Dec 8. doi: 10.1007/s00330-025-12194-9. Online ahead of print.

ABSTRACT

OBJECTIVE: Diagnostic reference levels (DRLs) are essential for optimizing radiation dose in CT examinations. However, current DRLs may not reflect the performance of CT scanners or the background of individual facilities, potentially leading to misleading dose indicators. Furthermore, the factors that influence DRLs remain unclear. This study aims to investigate how facility characteristics and CT scanner performance affect DRLs.

MATERIALS AND METHODS: A dose survey was conducted in 2023 targeting 982 medical facilities in Tokyo. Data were collected from 100 facilities and 176 CT scanners, focusing on adult patients (50-70 kg) undergoing common CT protocols. CTDIvol and DLP were analyzed, and the 75th percentile was defined as the Tokyo-DRL. Factors potentially influencing DRLs, including the presence of radiologists, certified CT technologists, hospital size, CT scanner specifications, and image reconstruction methods, were systematically evaluated.

RESULTS: The Tokyo-DRLs were lower than Japan’s 2020 DRLs across all protocols, likely reflecting advancements in CT technology and staff expertise. Radiation doses were lower in facilities with radiologists and certified CT technologists, more hospital beds, wider scan beam widths, and use of iterative reconstruction or deep learning-based reconstruction. For dual-energy CT, DRLs were established only for the pulmonary artery with contrast due to limited data. Multivariate analysis revealed key dose-influencing factors such as tube current modulation and scan sequence in the head, and beam width in trunk scanning.

CONCLUSION: Facility characteristics and scanner performance significantly impact radiation dose. Periodic, detailed surveys are necessary to update DRLs in line with evolving technologies and clinical practice.

KEY POINTS: Question How do facility characteristics and CT scanner performance influence diagnostic reference levels in clinical CT examinations? Findings Radiation doses in CT examinations varied significantly depending on facility size, staff expertise, scanner specifications, and image reconstruction methods. Clinical relevance Identification of facility and scanner characteristics enables more effective radiation dose optimization, enhancing patient safety without compromising diagnostic quality in CT imaging.

PMID:41359161 | DOI:10.1007/s00330-025-12194-9

Nurs Sci Q. 2025 Dec 8:8943184251388292. doi: 10.1177/08943184251388292. Online ahead of print.

ABSTRACT

The purpose of this study is to assess the level of moral development, spiritual intelligence, and critical thinking of nurses, and to see if there is a relationship between these constructs for them. A descriptive correlational design was used, with a sample of 102 nurses in Iran. The descriptive statistics and Pearson’s correlation were done on the survey results using SPSS (Version 24). The moral development level scores of the nurses were 34 ± 2.17, which is considered average, critical thinking was 25 ± 1.23, which is considered relatively high, and spiritual intelligence scores were 41 ± 2.75, which is considered relatively low. Both spiritual intelligence and critical thinking were positively correlated with the nurses’ moral development (R = 0.76, R = 0.48, respectively). The conclusion of the paper is that more attention needs to be paid to raise the level of critical thinking, spiritual intelligence, and moral development in nurses.

PMID:41355780 | DOI:10.1177/08943184251388292

Cutan Ocul Toxicol. 2025 Dec 8:1-8. doi: 10.1080/15569527.2025.2598573. Online ahead of print.

ABSTRACT

INTRODUCTION: The global incidence of skin cancer is rising, emphasizing the need for early detection tools. Artificial intelligence (AI) models, including multimodal systems like ChatGPT-4o, can analyze visual data to assist clinicians in diagnosis. This study evaluated ChatGPT-4o’s diagnostic accuracy in detecting melanoma and non-melanoma skin cancers from macroscopic and dermoscopic images.

METHODS: Ninety patients with histopathologically confirmed lesions were included. For each patient, macroscopic images were first uploaded to ChatGPT-4o, followed by combined upload of macroscopic and dermoscopic images. ChatGPT-4o was instructed to provide a preliminary diagnosis and three differential diagnoses for each lesion. Accuracy was assessed at four levels: Level 1: preliminary diagnosis using macroscopic images; Level 2: preliminary diagnosis using macroscopic and dermoscopic images; Level 3: three differential diagnoses using macroscopic images; Level 4: three differential diagnoses using macroscopic and dermoscopic images.

RESULTS: Overall Level 1 accuracy was 73.3%, with Level 2, Level 3, and Level 4 accuracies of 66.6%, 75%, and 76.6%, respectively. Dermoscopic images improved accuracy for squamous cell carcinoma (72.7% vs 81.8%, p = 1.00), reduced overall and basal cell carcinoma accuracy (73.3% vs 66.6%, p = 0.180 and 79.6% vs 67.8%, p = 0.065, respectively), and did not affect malignant melanoma (84.6% vs 84.6%) or lentigo maligna (0% vs 0%). Statistical analysis revealed that the addition of dermoscopic images did not significantly influence diagnostic accuracy, either overall or within individual diagnostic categories. The model recommended biopsy for all lesions, suggesting potential as a supportive diagnostic tool.

CONCLUSION: ChatGPT-4o showed variable diagnostic accuracy for melanoma and non-melanoma skin cancers. Dermoscopic images reduced performance for certain diagnostic categories. These misclassifications highlight the potential for unnecessary interventions and patient anxiety underscoring that AI-based systems should serve as supportive aids rather than standalone diagnostic tools.

PMID:41355746 | DOI:10.1080/15569527.2025.2598573

Pediatr Int. 2025 Jan-Dec;67(1):e70285. doi: 10.1111/ped.70285.

ABSTRACT

OBJECTIVES: Point-of-care ultrasound (POCUS) requires technical expertise, making quality assurance (QA) a major challenge. We evaluated POCUS utilization and quality in the pediatric emergency department of the National Center for Child Health and Development (NCCHD).

METHODS: We retrospectively reviewed patients aged <18 years who underwent POCUS or radiology-performed ultrasound (RADUS) between June 2023 and May 2024. We mainly evaluated POCUS metrics-image storage, documentation, protocol-specific appropriate storage, and diagnostic delays-and compared them across provider categories and scanning protocols. Diagnostic delay cases were additionally reviewed.

RESULTS: Of 2004 patients, 1683 underwent POCUS and 384 RADUS. For POCUS, the rates of overall image storage, documentation, protocol-specific appropriate image storage, and diagnostic delay were 97.4%, 83.6%, 90.8%, and 0.4%, respectively. Documentation rates were significantly lower among nondedicated physicians than among pediatric emergency medicine (PEM) physicians and fellows (both p < 0.01); their protocol-specific appropriate image storage rate was also significantly lower than that of PEM fellows (p = 0.03). Across scanning protocols, the rates of documentation and protocol-specific appropriate image storage differed significantly (both p < 0.01). Among six diagnostic delays, two resulted from acquisition errors, two from interpretation errors, and two from early scans in the disease course; four of these six delays involved the abdominal emergency screening protocol.

CONCLUSION: This study identified challenges in POCUS implementation at NCCHD, including quality gaps among nondedicated physicians, the need for clearer follow-up in early presentations, and the importance of protocol design aligned with clinical indications. Sharing QA practices may help refine POCUS strategies for diverse pediatric emergency settings.

PMID:41355727 | DOI:10.1111/ped.70285

Pharmacoepidemiol Drug Saf. 2025 Dec;34(12):e70280. doi: 10.1002/pds.70280.

ABSTRACT

PURPOSE: The ongoing global increase in opioid use necessitates studies examining long-term health impacts. Prospective cohorts frequently rely on self-reported medication use data which may be subject to several types of bias compared to more objective measurements. We evaluated the agreement between two opioid exposure measures in the UK Biobank (UKBB)-self-reported regular use and prescription-based indicators using linked general practitioner (GP) records.

METHODS: Our analysis included 171 813 UKBB participants with linked prescription records. At baseline, participants reported medications taken regularly (weekly, monthly, every 3 months). We assessed agreement between self-reported regular opioid use and opioid prescription records prior to enrollment across various look-back periods and prescription counts. Logistic regressions assessed factors associated with omission and commission.

RESULTS: Agreement was moderate to substantial between self-reported opioid use and prescription records. The strongest agreement was observed for ≥ 3 prescriptions in the past 365 days (Cohen’s Kappa = 0.66). Subgroup analysis showed better agreement for analgesic opioids (Kappa = 0.43-0.63) than for non-analgesic opioids (Kappa = 0.25-0.34). Omission odds were highest with increasing months since the last record and lowest for individuals with chronic pain. Commission odds were highest for individuals with chronic pain and lowest in married/partnered individuals.

CONCLUSIONS: This analysis indicates that self-reported regular opioid use in the UKBB could be a valid indicator for identifying individuals with repeated prescriptions for analgesic opioids in the past year, while also capturing opioid use from non-linked sources. However, agreement was low for non-analgesic opioids, suggesting limited utility of self-report for capturing use of these medications.

PMID:41355709 | DOI:10.1002/pds.70280

J Prim Care Community Health. 2025 Jan-Dec;16:21501319251403839. doi: 10.1177/21501319251403839. Epub 2025 Dec 8.

ABSTRACT

BACKGROUND: Health disparities in the United States (US) are closely linked to income inequality. While many studies have reported associations between income and health, causal evidence remains limited.

OBJECTIVE: To estimate the causal effect of income-equalizing state policies, such as minimum wage increases, Medicaid expansion, and Earned Income Tax Credit (EITC) adjustments, on adult self-rated health using a difference-in-differences (DiD) framework.

METHODS: Using the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) data from 2018 to 2023, a 2-way fixed-effects DiD model was employed to compare changes in the proportion of adults reporting fair or poor health between states that implemented income-related policies and those that did not. The covariates included the demographic and economic characteristics of the American Community Survey. Robustness checks included event study analyses, placebo tests, and models with state-specific linear trends.

RESULTS: In baseline difference-in-differences models, policy adoption was linked to a -0.00403 (SE = 0.00141, P = .006) change in the likelihood of reporting fair or poor health, representing a 0.4 percentage-point decrease compared to control states; however, place-study diagnostics showed a significant pre-policy trend violation (F = 47.24, P < .001), which challenged the parallel-trends assumption. After adjusting for state-specific linear time trends, the estimated effects were both statistically and practically null. Placebo models with randomized policy dates produced null estimates, confirming robustness.

CONCLUSIONS: The observed improvements in self-reported health in baseline models were not robust to trend-adjusted specifications and likely reflected the underlying pre-policy trends. These findings underscore the importance of rigorous diagnostic testing in quasi-experimental evaluations of policy effects.

PMID:41355670 | DOI:10.1177/21501319251403839