Nevin Manimala

Ir J Med Sci. 2026 Jul 21. doi: 10.1007/s11845-026-04556-z. Online ahead of print.

ABSTRACT

BACKGROUND: Acute Coronary Syndrome (ACS) is a leading cause of morbidity and mortality worldwide. Prognostic stratification is crucial to guide management. Uric acid (UA) and creatinine (Cr) are individually associated with poor outcomes, but their combined value as a ratio (UA/Cr) remains underexplored.

AIMS: Our objective is to evaluate the prognostic significance of UA, Cr, and the UA/Cr ratio in ACS patients for predicting in-hospital severity and complications.

METHODS: A short-term prospective observational cohort study was conducted on 134 patients admitted with ACS (56% NSTEMI, 44% STEMI) between July 2024 and July 2025. Demographic, clinical, and biochemical data were collected. Prognostic value was assessed for severity (Killip, GRACE, CRUSADE) and complications (arrhythmia, hemodynamic instability, mortality) using ROC curves and logistic regression.

RESULTS: The population (mean age 61.8 ± 11.5 years, 89% male) showed significant associations between UA and Cr with severity scores (p = 0.041 and p = 0.006, respectively). The UA/Cr ratio was significantly higher in patients with arrhythmic complications (7.03 ± 2.98 vs. 5.65 ± 2.22, p = 0.024). ROC analysis revealed UA predicted complications (AUC = 0.69, p = 0.006) overall and in NSTEMI (AUC = 0.784, p = 0.004). Multivariate analysis confirmed UA as an independent predictor of severity (OR = 1.138, p = 0.048) and complications (OR = 1.237, p = 0.026) in NSTEMI. UA/Cr ratio predicted complications in NSTEMI patients with preserved renal function (OR = 1.711, p = 0.041).

CONCLUSION: UA is an independent prognostic marker in ACS, especially NSTEMI. The UA/Cr ratio provides incremental prognostic value in patients with preserved renal function and represents a simple, cost-effective tool to improve ACS risk stratification.

PMID:42479402 | DOI:10.1007/s11845-026-04556-z

Infect Dis Ther. 2026 Jul 21. doi: 10.1007/s40121-026-01412-6. Online ahead of print.

ABSTRACT

INTRODUCTION: Tenofovir disoproxil fumarate (TDF) is highly effective for chronic hepatitis B (CHB) but may induce progressive renal impairment and proximal tubular dysfunction. Switching to tenofovir alafenamide (TAF) or entecavir (ETV) may reduce TDF-related nephrotoxicity. This study evaluated renal and metabolic changes before and after switching from TDF to TAF or ETV in a real-world cohort of older patients.

METHODS: This retrospective longitudinal cohort study included adults with CHB who switched from TDF to TAF or ETV at a tertiary center (2012-2023). Eligible patients had ≥ 2 years of TDF treatment and ≥ 2 years of post-switch follow-up. Those with virological failure, major coinfections, or non-HBV-related kidney disease were excluded. Clinical and laboratory data were collected at 6-month intervals from 2 years before to 4 years after switching. Biomarker trajectories were analyzed using linear mixed-effects models with time centered at switch comparing treatments and with multivariable adjustment for key confounders.

RESULTS: A total of 102 patients were included (TAF n = 82; ETV n = 20), mean age 72 ± 10 years, 72% male. All patients had undetectable HBV-DNA at switch. During TDF therapy, serum creatinine showed a non-significant increasing trend (β = + 0.008 mg/dL/year, p = 0.24), which persisted after switching (β = + 0.009 mg/dL/year, p = 0.07), with no significant difference between groups. Serum phosphate declined during TDF in the ETV group (β = – 0.175 mg/dL/year, p = 0.002) and showed a significant increase after switching (β = + 0.111 mg/dL/year, p = 0.031) while the TAF group remained stable throughout. Total cholesterol ishowed a significant immediate increase at the time of switch (+ 18.3 mg/dL, 95% CI 11.0-25.6, p < 0.001), with no significant difference between TAF and ETV.

CONCLUSIONS: Unlike previous studies reporting clear creatinine improvement after switching from TDF, this cohort did not show a statistically significant reduction in creatinine levels after the switch although an attenuation of creatinine progression and recovery of phosphate levels were observed, suggesting mitigation of TDF-related renal and tubular toxicity.

PMID:42479363 | DOI:10.1007/s40121-026-01412-6

Eur J Health Econ. 2026 Jul 21. doi: 10.1007/s10198-026-01956-x. Online ahead of print.

ABSTRACT

OBJECTIVES: This study provides a comprehensive overview of the Italian framework for the appraisal of drug innovativeness, covering all 294 appraisals conducted by AIFA between 2017 and June 2025. It aims to describe the evolution and application of the 2017 criteria, explore the determinants of innovativeness recognition, and discuss the implications of the 2025 revision for value assessment and market access.

METHODS: All AIFA innovativeness reports available up to June 2025 were systematically reviewed and coded across the three appraisal domains – therapeutic need, added therapeutic value, and quality of evidence – together with contextual and regulatory variables (orphan designation, study design, EMA approval type, accelerated assessment, and PRIME designation). Descriptive and multinomial regression analysis were performed to identify predictors of appraisal outcomes and to explore associations with European and national timelines.

RESULTS: Among 294 appraisals, 27% were fully innovative, 29% conditionally innovative, and 44% non-innovative. ATV and quality of evidence were the strongest determinants, while therapeutic need played a secondary role. Orphan designation, pediatric/mixed populations, and the availability of RCT-based evidence increased the likelihood of a positive outcome. Medicines with EMA accelerated assessment were more often granted full innovativeness but did not achieve shorter national reimbursement timelines (median 432 days). Fully innovative medicines followed shorter EMA pathways (median 330 vs. 448 days), though not necessarily implying faster national access.

CONCLUSIONS: AIFA’s framework proved internal coherence, with ATV as the main driver. The 2025 criteria may enhance methodological rigor but reduce flexibility, requiring continuous monitoring to ensure timely and equitable access.

PMID:42479353 | DOI:10.1007/s10198-026-01956-x

J Occup Rehabil. 2026 Jul 21. doi: 10.1007/s10926-026-10436-1. Online ahead of print.

ABSTRACT

PURPOSE: To (1) examine health- and work-related outcomes among partners of cancer survivors and (2) explore associated factors of these outcomes.

METHODS: In the STEPS prospective cohort study 225 employed partners of cancer survivors in the Netherlands completed questionnaires at baseline, and after 6 and 12 months, on work participation, health-related quality of life (HRQoL), and medical, lifestyle, health, and work factors. Generalized estimating equations and time-lagged regression analyses were used to examine changes over time and associations with measured factors.

RESULTS: Partners worked on average 31.1 h/week at baseline, which remained stable over the 12-month follow-up. Employment status (i.e., whether participants were employed versus not) slightly declined from 91 to 86%. Around 30% were sick listed at least once during the 6 months prior to baseline, which did not change over time. Physical HRQoL declined over time (beta [95% confidence interval]: – 1.65 [- 2.96 to – 0.35]). Mental HRQoL remained below population norms (e.g., on average 45.4 (12.6) at baseline), but did not statistically change over time. Multivariate analyses revealed that factors such as income, educational level, financial necessity to work, breadwinner status, work tasks, work ability, need for recovery and survivors’ disease and treatment characteristics were associated with partners’ work and health outcomes.

CONCLUSION: Although work participation remained stable during our study period, partners of cancer survivors experienced a substantial burden regarding their work and health. Interventions should focus on supporting partners at risk, addressing financial strain, helping them balance work and caregiving demands to sustain health and work participation.

PMID:42479346 | DOI:10.1007/s10926-026-10436-1

Radiol Med. 2026 Jul 21. doi: 10.1007/s11547-026-02261-6. Online ahead of print.

ABSTRACT

PURPOSE: To compare qualitative reader-based image quality and anatomical detail of hepato-bilio-pancreatic structures between photon-counting detector CT (PCCT) and third-generation dual-source energy-integrating detector CT (EID-CT) in the same patient cohort.

MATERIALS AND METHODS: This retrospective, single-center qualitative study included 25 patients who underwent contrast-enhanced abdominal CT with both PCCT (Siemens NAEOTOM Alpha pro) and EID-CT (Siemens SOMATOM Force) within a 3-month interval using comparable acquisition protocols, with the exception of reconstructed section thickness (0.4-0.6 mm for PCCT vs 1.0 mm for EID-CT). Four independent radiologists (two with > 10 years and two with < 5 years of experience) evaluated six parameters using a five-point Likert scale: overall image quality, arterial vascular visualization, venous vascular visualization, pancreatic ductal tree, biliary ductal tree, and peripancreatic lymph nodes. All readers were blinded to scanner type. Paired t-tests and non-parametric Wilcoxon signed-rank tests compared mean scores between PCCT and EID-CT. Inter-reader agreement was assessed using intraclass correlation coefficients. Statistical significance was set at p < 0.05. No quantitative image metrics or diagnostic performance outcomes were assessed; analyses were limited to reader-based Likert scale image quality scores.

RESULTS: PCCT demonstrated statistically significant superiority across all six parameters compared with EID-CT (overall image quality 4.82 vs 3.80, arterial vascular visualization 4.87 vs 3.98, venous vascular visualization 4.84 vs 3.91, pancreatic ductal tree 4.83 vs 3.51, biliary ductal tree 4.87 vs 3.63, peripancreatic lymph nodes 4.86 vs 3.81; all p < 0.0001). Mean score improvements with PCCT ranged from 0.89 to 1.32 points across all parameters. Inter-reader agreement was good to excellent for PCCT (ICC 0.70-0.92) and poor to moderate for EID-CT (ICC 0.43-0.70). Reader experience level did not significantly influence assessments (p = 0.94). These findings derive from a qualitative head-to-head comparison of image quality scores and were consistent across all four readers.

CONCLUSION: In this preliminary intra-patient comparison, photon-counting CT provided significantly superior image quality and anatomical detail in the hepato-bilio-pancreatic region compared to third-generation dual-source EID-CT. Enhanced visualization of ductal structures, distal vessels, and lymph nodes may support improved diagnostic confidence and more precise staging, although diagnostic performance was not assessed in this study. Because reconstructed section thickness differed between systems, these qualitative advantages cannot be attributed to detector technology alone and require confirmation in larger studies with matched protocols and diagnostic-accuracy endpoints.

PMID:42479320 | DOI:10.1007/s11547-026-02261-6

Musculoskelet Surg. 2026 Jul 21. doi: 10.1007/s12306-026-00965-6. Online ahead of print.

ABSTRACT

PURPOSE: Spondylodesis is performed to stabilize and immobilize spinal regions impacted by conditions such as degenerative disorders, deformities, trauma, tumors, or infections. To improve the accuracy of pedicle screw placement, computer-assisted navigation systems were introduced in spine surgery. The objective of this study was to compare the accuracy of pedicle screw placement and the patient outcomes in robotic-guided versus intraoperative 3D navigation techniques for thoraco-lumbar spine surgery.

METHODS: The search was conducted on 30 September 2025 on Scopus, Cochrane Central Library and PubMed. Prospective and retrospective studies that compared pedicle screw placement, clinical outcomes and complications using robotic versus intraoperative 3D navigation technique in the thoracolumbar segment were included. Hospital stay, operative time and blood loss were evaluated as continuous outcomes with mean difference. Screw accuracy, FJV, intraoperative and postoperative screw revisions, complications and complications were evaluated as dichotomous outcomes with odds ratio. Statistical significance was set at p < 0.05.

RESULTS: Among the 14 studies included in the meta-analysis, statistically significant results in favor of robotic group were described for hospital stay (p = 0.003) and pedicle screw accuracy (p < 0.00001). However, no significant differences were observed in terms of intraoperative or postoperative screw revisions, facet joint violations, operative time and blood loss.

CONCLUSION: Robotic-guided pedicle screw fixation represents a safe and highly effective technique, showing statistically significant superiority in screw placement accuracy compared to CT-guided navigation.

PMID:42479318 | DOI:10.1007/s12306-026-00965-6

Adm Policy Ment Health. 2026 Jul 21. doi: 10.1007/s10488-026-01515-9. Online ahead of print.

ABSTRACT

Despite policy efforts to expand integrated behavioral health care in the United States, substantial gaps remain in service delivery for people with co-occurring mental health (MH) and substance use disorders (SUD). Certified Community Behavioral Health Clinics (CCBHCs) are intended to close these gaps through enhanced financing and certification standards that mandate comprehensive, integrated MH-SUD services. Using the 2023 National Survey of Substance Use and Mental Health Services (N-SUMHSS) data for 1,480 facilities (198 CCBHCs, 448 community mental health centers [CMHCs], and 834 other outpatient MH facilities), this study compared service availability across three domains: engagement services, outpatient SUD treatment, and recovery support. Descriptive statistics characterized service provision, and multivariable logistic regressions estimated adjusted odds of service availability by facility type, controlling for ownership, government funding, and being a part of a multisite organization. Relative to other outpatient MH facilities, CCBHCs had significantly higher odds of providing engagement services, including interim services, outreach, and transportation, as well as outpatient SUD services, including outpatient detoxification and medication-assisted treatment. CCBHCs also exhibited greater availability of recovery-oriented support, including employment counseling, assistance obtaining social services, and housing supports. These findings provide some of the first national evidence that the CCBHC model is associated with substantially broader SUD-related service offerings than traditional CMHCs and other outpatient MH settings. By expanding both clinical SUD care and enabling services that reduce access barriers and address social determinants, CCBHCs appear well positioned to improve care continuity and recovery for individuals with co-occurring MH and SUD conditions.

PMID:42479310 | DOI:10.1007/s10488-026-01515-9

Psicol Reflex Crit. 2026 Jul 21. doi: 10.1186/s41155-026-00406-0. Online ahead of print.

ABSTRACT

Work status in later life has been linked to psychological resilience, social engagement, and overall well-being, all of which may shape how individuals experience and manage stress as they ageObjective This study examined the moderating effects of resilience and work status on the relationship between perceived stress and successful aging among older adults.Methods Participants were N = 538 brazilian community-dwelling older adults (≥ 60 years) of both sexes. Measures included a sociodemographic questionnaire, the Brief Resilience Scale, the Perceived Stress Scale (independent variable), and the Successful Aging Scale (dependent variable). Resilience and current work status (employed vs. not employed) were tested as moderators using a cross-sectional, quantitative design. Data were analyzed through descriptive and inferential statistics, followed by a moderated moderation analysis. Results The three-way interaction among perceived stress, resilience, and work status was statistically significant (p < .05). Among non-working older adults, perceived stress was negatively associated with successful aging at all levels of resilience, with this association being attenuated at higher levels of resilience. In contrast, among working older adults, perceived stress was not significantly associated with successful aging at any level of resilience.Conclusion Perceived stress is negatively associated with successful aging, moderated by resilience and work status. Resilience buffered this association among non-working older adults, whereas no significant association was observed among those employed. These findings suggest that employment may alter stress processes and highlight the importance of supporting adaptive transitions into retirement and access to psychosocial resources.

PMID:42479275 | DOI:10.1186/s41155-026-00406-0

Neurol Sci. 2026 Jul 21;47(8):649. doi: 10.1007/s10072-026-09201-2.

ABSTRACT

BACKGROUND: This study validated the Italian version of the In-Person Telephone Interview for Cognitive Status (IP-TICS).

METHODS: 468 healthy Italian individuals (176 males; age: 57.5 ± 15.4, education: 13.2 ± 3.7) completed the TICS, IP-TICS, MMSE and MoCA. Correlational analyses explored the construct validity of the IP-TICS against the TICS, MMSE and MoCA. Hierarchical Confirmatory Factor Analyses tested the configural, metric and scalar invariance between the TICS and IP-TICS. Statistical equivalence was assessed via a two one-sided test (TOST) procedure. Equating norms were derived via log-linear smoothing equipercentile equating (LSEE) analyses, with TOST procedures assessing equivalence between empirical and LSEE-derived scores.

RESULTS: The IP-TICS converged with the TICS, MMSE and MoCA, showing configural and metric invariance and equivalence with the TICS. Empirical and LSEE-derived scores were statistically equivalent.

DISCUSSION: Findings support the convergence, equivalence and invariance between the TICS and the IP-TICS. The IP-TICS converges with established in-person screeners.

PMID:42479254 | DOI:10.1007/s10072-026-09201-2

J Patient Rep Outcomes. 2026 Jul 21. doi: 10.1186/s41687-026-01144-8. Online ahead of print.

ABSTRACT

BACKGROUND: Systematic collection of patient-reported outcomes via electronic health records can improve symptom assessment and supportive care delivery in oncology, yet implementation is often hindered by inadequate attention to end-user needs and organizational context. Guided by an implementation science framework, we conducted a formative evaluation to inform design and implementation planning of an electronic patient-reported outcome supportive care screening system in ambulatory oncology care, using head and neck cancer as a use case.

METHODS: A prospective mixed-methods observational study was conducted using semi-structured interviews as part of a pre-implementation formative evaluation. Eligible participants were target users of the proposed supportive care screening system, including (1) clinical staff and (2) patients with head and neck cancer from a single health care system. Using the Consolidated Framework for Implementation Research as a guiding framework, we elicited user feedback through interview and prototype engagement. Quantitative measures included patient symptom burden and validated pre-implementation measures of acceptability, appropriateness, feasibility, and usability. For data analyses, we used directed content analysis and matrix analysis for qualitative data, and descriptive and comparative statistics for quantitative assessments.

RESULTS: Forty-six target users (20 clinical staff, 26 patients) participated. Both groups expressed strong tension for change, recognizing many inadequacies of the current approach to symptom assessment. Clinical staff described current practices as “haphazard,” while patients recounted missed opportunities for support and preventable harm. Electronic health record integration enhanced perceived compatibility, though time constraints and alert fatigue emerged as potential barriers. Clinical staff emphasized the need for clear symptom thresholds and actionable referral criteria; patients emphasized that their sustained engagement depended on evidence of clinicians using the data in their care. Pre-implementation scores indicated strong readiness across both groups: acceptability (clinical staff 4.47/5, patients 4.21/5), appropriateness (4.46/5, 4.24/5), feasibility (4.41/5, 4.35/5), and usability (82.2/100, 85.6/100). Findings informed key design priorities and implementation strategies.

CONCLUSIONS: Systematic pre-implementation formative evaluation revealed important barriers, facilitators, and contextual insights that shaped both intervention design and implementation approach. High scores on leading indicators suggest strong organizational readiness and perceived value. This user-informed development process provides a replicable model for optimizing electronic patient-reported outcome systems before deployment.

PMID:42479244 | DOI:10.1186/s41687-026-01144-8