Nevin Manimala

JACC Adv. 2026 Jun 11;5(7):102869. doi: 10.1016/j.jacadv.2026.102869. Online ahead of print.

ABSTRACT

BACKGROUND: Little is known about end-of-life trajectories in survivors of cardiogenic shock complicating acute myocardial infarction (AMI-CS) who die beyond their index admission, or utilization of palliative care services in AMI-CS survivors.

OBJECTIVES: This study aimed to examine long-term palliative and end-of-life care among AMI-CS survivors.

METHODS: This was a population-based, retrospective cohort of AMI-CS survivors in Ontario, Canada, from 2009 to 2020 who died during longitudinal follow-up.

RESULTS: We identified 3,881 AMI-CS survivors (2009-2020) who died after discharge and before March 2024. The median survival time was 1,096 days (IQR: 312-2,139 days). Overall, 2,100 patients (54.1%) died in acute care, with no difference between those who did and did not receive palliative care. Patients who did not receive palliative care were more likely to die in intensive care units (ICU) than those who did (23% vs 17%, absolute standard difference 0.15). Most patients received palliative care in the final year of life (n = 2,485, 64%); 1,057 patients (42.5%) had outpatient visits, 505 patients (20.3%) had inpatient palliative care consultations, and 327 patients (13.2%) had palliative care hospitalizations. Palliative care, however, was most commonly initiated in the last 14 days of life (1,185 patients, 47.7%). Earlier palliative care referrals were associated with reduced rates of dying in hospital (adjusted OR: 0.50; 95% CI: 0.42-0.65) and ICU (adjusted OR: 0.34; 95% CI: 0.26-0.45).

CONCLUSIONS: Early and intermediate term palliative care involvement was associated with reduced risk of death in hospital and ICU. Such consultation may improve end-of-life outcomes in AMI-CS survivors.

PMID:42275681 | DOI:10.1016/j.jacadv.2026.102869

Am J Surg. 2026 May 6;260:117028. doi: 10.1016/j.amjsurg.2026.117028. Online ahead of print.

ABSTRACT

BACKGROUND: Colorectal cancer (CRC) carries a high recurrence risk. Aspirin has been proposed for secondary prevention, but its benefit remains uncertain. This systematic review and meta-analysis evaluated aspirin’s impact on disease-free survival (DFS) and overall survival (OS).

METHODS: A systematic search of four databases (PubMed, Embase, Scopus, the Cochrane Library) was conducted from inception to January 2025 using predefined inclusion and exclusion criteria. Screening and data extraction were performed independently. Study quality was assessed using RoB 2 and the Newcastle-Ottawa Scale. Ten studies were included, comprising retrospective cohorts, population-based cohorts, prospective observational analyses, and Phase III randomized controlled trials (RCTs). A random-effects meta-analysis was conducted to pool effect sizes as odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was quantified using I² and τ², and sensitivity analyses included leave-one-out testing. All analyses followed PRISMA guidelines.

RESULTS: Ten studies were included. Pooled analyses of observational studies showed no statistically significant improvement in OS (OR 0.92, 95% CI 0.78-1.08) or DFS (OR 0.90, 95% CI 0.74-1.08) among aspirin users. Considerable heterogeneity and inconsistency were observed across studies. RCTs likewise demonstrated no clear survival benefit, with effect estimates close to unity. Safety data were limited and variably reported, precluding firm conclusions regarding adverse outcomes.

CONCLUSION: Current evidence does not support aspirin as adjuvant therapy for secondary prevention in CRC. Future research should target biomarker-defined subgroups for potential benefits.

PMID:42275677 | DOI:10.1016/j.amjsurg.2026.117028

Comput Inform Nurs. 2026 Jun 8. doi: 10.1097/CIN.0000000000001582. Online ahead of print.

ABSTRACT

Measuring noninvasive blood pressure (NIBP) is a fundamental skill that nursing students are trained to master, and they are expected to possess comprehensive knowledge and proficiency in this procedure to ensure accurate measurements. The aim of this study was to evaluate the effect of interactive video-based training on noninvasive blood pressure measurement provided to first-year nursing students, focusing on its impact on their knowledge and skills in performing noninvasive blood pressure measurements. Conducted from October 2022 to June 2023, the randomized controlled trial involved 66 students, split into an experimental group (n = 32) and a control group (n = 34). Following theoretical instruction, the experimental group received the video intervention, while the control group did not. No statistically significant difference was found between the mean scores of noninvasive blood pressure measurement knowledge across the participant groups (P = .482; P > .05). A statistically significant difference was found in the noninvasive blood pressure measurement skill scores between the participant groups, with the students in the experimental group scoring higher than those in the control group (P = .000; P < .05). The interactive video application positively influenced noninvasive blood pressure measurement knowledge and skills. It is recommended that technology-supported applications be incorporated into basic skills training.

PMID:42275671 | DOI:10.1097/CIN.0000000000001582

Obstet Gynecol. 2026 Jun 11. doi: 10.1097/AOG.0000000000006336. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess whether the previously found neonatal survival advantage for Black (vs White) periviable births (20 0/7-25 6/7 weeks of gestation) persists over a 25-year period (1995-2019) in the United States, and to quantify changes in survivability over time. Assessments conceptualize race as a marker of exposure to racialized stressors and barriers to care.

METHODS: This population-based observational study used 1995-2019 U.S. restricted-use, cohort-linked birth and infant death data from the National Center for Health Statistics. The study included all non-Hispanic Black (n=149,601) and non-Hispanic White (n=158,500) periviable births. We used modified Poisson regressions to estimate risks of neonatal death (before age 28 days) based on the birthing person’s race and ethnicity and year of birth (measured in 5-year periods) and their interaction. We also controlled for a set of sociodemographic variables (maternal age, socioeconomic status) and pregnancy characteristics (plurality, neonatal sex) that predict neonatal mortality.

RESULTS: In 1995-1999, Black periviable neonates exhibited a survival advantage compared with their White counterparts (adjusted risk ratio [aRR] 0.86; 95% CI, 0.84-0.87). Over 20 years, White periviable neonates experienced a precipitous decrease in neonatal death risks (2015-2019 aRR 0.82; 95% CI, 0.80-0.83), whereas Black periviable neonates experienced slower improvements (2015-2019 Black×period aRR 1.07; 95% CI, 1.04-1.09). Estimates suggest that risks of neonatal death declined by 18% for White periviable neonates (from predicted probabilities of 53.0 in 1995-1999 to 43.3 in 2015-2019) but by only 13% for their Black counterparts (45.5-39.5). Black-White periviable risk ratios ranged from 4.0 to 3.6 over the study periods.

CONCLUSION: Both Black and White periviable births exhibited declines in neonatal death risks between 1995 and 2019, with White births showing faster declines. Clinically, these findings reveal overall improvements in periviable risks. However, because Black births are disproportionately represented among periviable deliveries, slower improvements in survival sustain a disproportionate burden of periviable deaths among Black neonates.

PMID:42275664 | DOI:10.1097/AOG.0000000000006336

N Z Med J. 2026 Jun 12;139(1636):102-109. doi: 10.26635/6965.7318.

ABSTRACT

Primary healthcare data can be used to conduct cost-effective research that improves understanding of population health and disease, leading to more effective prevention, earlier diagnosis, better-informed health models and improved health equity. However, Aotearoa New Zealand lacks a national primary healthcare data collection and has no national infrastructure to integrate and interrogate routinely collected primary healthcare data. This paper describes new technical approaches used internationally to improve researcher access to healthcare data and considers how this may be applied in the New Zealand context using Māori data governance and ethical data stewardship principles. Data access may be improved through platform-level, algorithm-level and data-level approaches. Māori data governance and ethical data stewardship principles can be applied to these new technical approaches. A governance model requires strict management, administration and oversight. An open-access model could provide easier access for researchers to develop and test models on synthetic data within a trusted research environment. Improving primary healthcare data access for research in New Zealand requires partnership that upholds Māori data governance principles and ethical research standards. Debate of the advantages and disadvantages of these technical approaches and stewardship models including patients and the public is welcomed.

PMID:42275661 | DOI:10.26635/6965.7318

N Z Med J. 2026 Jun 12;139(1636):87-101. doi: 10.26635/6965.7486.

ABSTRACT

AIMS: Life expectancy in Aotearoa New Zealand has increased over recent decades, but these increases have not been distributed equally across population groups. Examining how changes in cause-specific mortality have contributed to changes in life expectancy can improve understanding of evolving mortality patterns and persistent inequities. This study quantified the contribution of major causes of death to changes in life expectancy over approximately two decades.

METHODS: Mortality data from the New Zealand Mortality Collection and population estimates from Statistics New Zealand were used to calculate life expectancy at birth for Māori, Pacific, Asian, and European and Other populations for the periods 2001-2003 and 2020-2022. Changes in life expectancy were decomposed by age and cause of death using the Arriaga method. Deaths were grouped into major disease categories and selected individual causes to estimate their contribution to the change in life expectancy.

RESULTS: Life expectancy increased for all ethnic groups, with the largest absolute increases observed among Māori. Improvements were driven primarily by reductions in mortality at adult and older ages. Across all ethnic and sex groups, declines in cardiovascular disease and cancer mortality accounted for more than half of the total change in life expectancy. Reductions in mortality from diabetes and smoking-related conditions also contributed to increases among Māori and Pacific peoples. Despite these improvements, substantial ethnic inequities in life expectancy remain.

CONCLUSION: Increases in life expectancy in Aotearoa New Zealand between 2001-2003 and 2020-2022 were driven largely by reductions in mortality from major non-communicable diseases, primarily cardiovascular disease and cancer. Māori experienced some narrowing of the life expectancy gap relative to European and Other populations, whereas the gap for Pacific peoples remained largely unchanged. Despite overall improvement, substantial inequities persist. Further increases are likely to depend on strengthening primary prevention, particularly reductions in smoking and cardiovascular risk factors, alongside improved participation in screening and early detection programmes, including the potential role of lung cancer screening, and ensuring equitable access across care pathways.

PMID:42275660 | DOI:10.26635/6965.7486

N Z Med J. 2026 Jun 12;139(1636):36-43. doi: 10.26635/6965.7377.

ABSTRACT

AIM: The aim of this article was to examine clinical and demographic factors associated with receipt of rhythm control procedures (electrical cardioversion [ECV] or ablation) in patients with atrial fibrillation or flutter (AF/AFL) in Auckland, Aotearoa New Zealand.

METHOD: We conducted a retrospective cross-sectional study of patients with AF/AFL, collecting data up to 31 August 2021. Descriptive statistics were used to characterise procedural use, and associations between patient factors and rhythm control procedures were assessed using multivariable logistic regression.

RESULTS: We identified 1,908 patients with AF/AFL (46.8% female), of whom 292 (15.3%) underwent rhythm control procedures (ablation in 109, ECV only 183). In adjusted analysis, increasing age (adjusted odds ratio [aOR] per year 0.96 [95% confidence interval (CI) 0.95-0.97]) and female sex (aOR 0.46 [95% CI 0.34-0.63]) were associated with lower odds of receiving rhythm control procedures. Compared with European patients (New Zealand/other European), Māori (aOR 0.52 [95% CI 0.36-0.77]), Pacific peoples (aOR 0.41 [95% CI 0.28-0.60]) and other ethnicities (aOR 0.47 95% CI 0.28-0.79]) were less likely to undergo rhythm control procedures. The most common indication for rhythm control procedures was symptomatic relief (76.7%) followed by heart failure optimisation (13.7%).

CONCLUSION: Rhythm control procedures are selectively applied and vary by demographic and clinical factors. Female sex and ethnicity-based differences highlight the need to understand decision-making and access to rhythm control pathways.

PMID:42275654 | DOI:10.26635/6965.7377

J Speech Lang Hear Res. 2026 Jun 11:1-13. doi: 10.1044/2026_JSLHR-25-00593. Online ahead of print.

ABSTRACT

PURPOSE: Oral narrative abilities are essential for social participation, academic success, and the development of literacy. While children with Down syndrome (DS) often show relative strengths in narrative macrostructure, little is known about how these skills develop over time and how they respond to targeted intervention, particularly in Spanish-speaking contexts.

METHOD: This cross-case study explored macrostructural narrative development in four Chilean children with DS aged 8-12 years over a 6-month period and evaluated the effects of a brief one-on-one narrative intervention. Participants’ narrative competence was assessed, using the Frog Goes to Dinner story in retelling modality, at three points: 6 months earlier, 1 week before the intervention, and 1 week after. Macrostructural elements were scored using the Narrative Scoring Scheme (NSS), complemented by special coding for targeted elements.

RESULTS: Children showed modest improvement over the 6-month period without intervention but greater and more consistent gains following the 3-week intervention. Statistically significant increases were observed in overall macrostructure (NSS total score), character development, conflict-resolution, mental states, and use of emotional vocabulary and temporal markers. Microstructural measures remained stable, suggesting that macrostructural changes were not confounded by general linguistic development.

CONCLUSIONS: These findings underscore the value of brief structured narrative interventions for children with DS and highlight the importance of addressing specific macrostructural components, such as character detail and event sequencing. This is the first known study to explore narrative macrostructure development and intervention in Chilean children with DS, contributing culturally relevant insights to a growing field.

PMID:42275646 | DOI:10.1044/2026_JSLHR-25-00593

JMIR Serious Games. 2026 Jun 11;14:e86092. doi: 10.2196/86092.

ABSTRACT

BACKGROUND: Serious games (SGs) have emerged as a promising tool in nursing education, providing interactive learning environments for clinical simulation, skill development, and feedback. These games enhance knowledge, clinical reasoning, and psychomotor skills. However, evidence on their effectiveness is dispersed across various platforms and outcome measures, making it difficult to derive clear guidelines for their integration into nursing curricula.

OBJECTIVE: This scoping review aimed to systematically identify and map existing evidence on the use of SGs in nursing education, analyze game characteristics, and identify critical gaps to inform future research and practice development.

METHODS: This scoping review followed the JBI framework and the PRISMA-ScR checklist. Nine databases (PubMed, Web of Science, Embase, CINAHL, the Cochrane Library, CBM, Wanfang Data, CNKI, and VIP) were searched from inception to January 15, 2026. Eligible studies were those reporting on original research on SGs in nursing education. Two reviewers screened titles, abstracts, and full texts. Risk of bias was assessed using a standardized checklist. The extracted data encompassed study characteristics, study design, participant information, sample sizes, application context, teaching content, and SG characteristics. Data were extracted and synthesized with descriptive statistics and content analysis. An evidence gap map was created to show the study distribution across course categories and outcome domains.

RESULTS: We screened 6078 records and included 24 studies. Publications were from 2021 to 2025 (n=13, 54%), with the majority conducted in Europe (n=13, 54%). Quasi-experimental designs (n=10, 42%) and randomized controlled trials (n=8, 33%) were predominant. SGs were mainly used in fundamental or skills training and adult nursing courses. Scenario-based decision points (n=20, 83%) and points, badges, or leaderboards (n=20, 83%) were the most common game mechanics, while progression or unlocking and collaborative elements were less frequent. Outcomes most often assessed were knowledge (n=16, 67%), skills (n=10, 42%), and engagement or usability (n=13, 54%). Objective use metrics were rarely reported (n=1, 4%), indicating limited data on in-platform learning behaviors. Most SGs were delivered as digital non-virtual reality applications or computer-based simulation games. Follow-up assessment beyond immediate postintervention outcomes was infrequent. An evidence gap map showed studies concentrated in skills-based training and adult nursing, with fewer studies in maternity or neonatal nursing, critical care, and foundational sciences.

CONCLUSIONS: This review extends earlier work on SGs in nursing education by mapping evidence across curricular areas, intervention reporting, and outcome assessment, rather than focusing mainly on effectiveness or specific formats. It shows where evidence is concentrated and where important gaps remain, particularly in underrepresented course areas, intervention descriptions, follow-up assessments, and objective use data. These findings provide a clearer picture of the evidence base and can inform curriculum planning; the use of SGs in skills-based and clinical training; and future decisions about their design, implementation, and evaluation.

PMID:42275629 | DOI:10.2196/86092

Am J Public Health. 2026 Jun 11:e1-e5. doi: 10.2105/AJPH.2026.308558. Online ahead of print.

ABSTRACT

Objectives. To examine how men’s characteristics and traditional masculine attitudes are associated with vasectomy utilization in the United States. Methods. Using 2022-2023 National Survey of Family Growth data on men aged 30 to 49 years (n = 2278), we conducted descriptive statistics and multivariable logistic regression to assess how sociodemographic characteristics and traditional masculine attitudes are associated with undergoing vasectomy. Results. Approximately 1 in 9 men (11.9%) reported undergoing vasectomy. Men who agreed that men have greater sexual needs than women were more likely to report having ever had a vasectomy (adjusted odds ratio = 1.86; 95% confidence interval = 1.24, 2.80). Other masculine attitudes were not significantly associated with vasectomy utilization. Conclusions. Gender beliefs are an important and overlooked component of male contraceptive behavior. Men may view vasectomies as a means to maintain sexual continuity by reducing reliance on female-controlled contraception, suggesting opportunities to reframe vasectomy utilization within public health messaging. (Am J Public Health. Published online ahead of print June 11, 2026:e1-e5. https://doi.org/10.2105/AJPH.2026.308558).

PMID:42275620 | DOI:10.2105/AJPH.2026.308558