Nevin Manimala

JMIR Mhealth Uhealth. 2025 May 16;13:e57645. doi: 10.2196/57645.

ABSTRACT

BACKGROUND: Electronic inhaler monitoring devices (EIMDs) can enhance medication adherence in patients with chronic obstructive pulmonary disease (COPD) and asthma, yet patient perceptions and experiences with these devices vary widely. A systematic qualitative synthesis is required to comprehensively understand patient perspectives on EIMDs, to lay the foundation for developing strategies to improve patient compliance.

OBJECTIVE: This study aims to systematically evaluate qualitative studies on the experiences of patients with COPD and asthma using EIMDs, providing insights to support their clinical application and improve patient engagement.

METHODS: This review synthesized qualitative data from reports found through a systematic search of PubMed, Web of Science, CINAHL, Embase, Cochrane Library, and PsycInfo from January 1983 to July 2024. The reports assessed patient experiences with EIMDs for COPD and asthma. The quality of the included reports was appraised using the Critical Appraisal Skills Program criteria developed by the Centre for Evidence-Based Medicine, University of Oxford, UK.

RESULTS: A total of 7 reports were included, encompassing data from 44 patients with COPD and 146 with asthma. Findings were organized into 9 sub-themes and 3 themes: positive experiences with EIMDs (usability and easy acceptance, enhanced self-management); stresses and challenges of using these devices (negative emotional stress, device trust issues, social difficulties, economic burdens, and technical challenges); and patient expectations from these devices (expectations related to device construction and function and external support).

CONCLUSIONS: Patients have positive experiences using electronic monitoring devices for inhalation devices but also face various social, psychological, and technical challenges. Health care workers should consider patient experiences with EIMDs to tailor these devices to patient needs, ultimately enhancing device acceptance and adherence. Further research should focus on increasing EIMDs convenience and usability for patients with COPD and asthma.

PMID:40378281 | DOI:10.2196/57645

Aesthet Surg J. 2025 May 16:sjaf080. doi: 10.1093/asj/sjaf080. Online ahead of print.

ABSTRACT

BACKGROUND: EVOLYSSE FORM (EVLF) and EVOLYSSE SMOOTH (EVLS) are new hyaluronic acid fillers created using an innovative cold crosslinking process.

OBJECTIVES: To collect safety and effectiveness data on new cold-crosslinked fillers to support US approval for the correction of moderate to severe dynamic facial wrinkles and folds.

METHODS: In this randomized, controlled, split-face study, 140 subjects with moderate to severe nasolabial folds received a cold-crosslinked filler in 1 nasolabial fold (EVLF = 70, EVLS = 70) and a traditionally-crosslinked filler, Restylane-L (RESL), in the contralateral fold and were followed through 12 months with an optional retreatment at that timepoint and subsequent 3 months of safety follow-up.

RESULTS: The primary endpoint of mean Wrinkle Severity Rating Scale change from baseline to Month 6 as rated by photographic review panel demonstrated non-inferiority and statistical superiority for the cold-crosslinked fillers. Blinded evaluator Wrinkle Severity Rating Scale assessments showed a mean change from baseline that was statistically significantly better than RESL for EVLF at all visits through 12 months and for EVLS at 6 and 9 months. Most subjects were responders on the Global Aesthetic Improvement Scale throughout the study according to ratings by blinded evaluators, treating investigators, and subjects. The FACE-Q Appraisal of Nasolabial Folds overall mean score showed significant improvement from baseline (p < 0.0001) at all timepoints through Month 12 for all treatment groups. All treatments were well tolerated.

CONCLUSIONS: The new cold-crosslinked fillers were shown to be safe and effective for correction of nasolabial folds, with results lasting for 1 year.

PMID:40378267 | DOI:10.1093/asj/sjaf080

Stat Med. 2025 May;44(10-12):e70077. doi: 10.1002/sim.70077.

ABSTRACT

Precision medicine is accelerating rapidly in the field of health research. This includes fitting predictive models for individual patients based on patient similarity in an attempt to improve model performance. We propose an algorithm which fits a personalized predictive model (PPM) using an optimal size of a similar subpopulation that jointly optimizes model discrimination and calibration, as it is criticized that calibration is not assessed nearly as often as discrimination despite poorly calibrated models being potentially misleading. We define a mixture loss function that considers model discrimination and calibration, and allows for flexibility in emphasizing one performance measure over another. We empirically show that the relationship between the size of subpopulation and calibration is quadratic, which motivates the development of our jointly optimized model. We also investigate the effect of within-population patient weighting on performance and conclude that the size of subpopulation has a larger effect on the predictive performance of the PPM compared to the choice of weight function.

PMID:40378188 | DOI:10.1002/sim.70077

PLoS One. 2025 May 16;20(5):e0323570. doi: 10.1371/journal.pone.0323570. eCollection 2025.

ABSTRACT

BACKGROUND: Bacterial urinary tract infection (UTI) is the second most frequent infection next to respiratory tract infection within the geriatric population both in the community and hospital settings. There is a limited data regarding geriatrics UTI in this study area. Therefore, the current study aimed to assess the status of the community and hospital-acquired urinary tract infections, and antimicrobial susceptibility patterns among UTI suspected geriatrics which is essential to physicians and health care workers to implement appropriate intervention.

METHODS: A comparative cross-sectional study was conducted among 460 UTI suspected geriatrics admitted at the University of Gondar Comprehensive Specialized Hospital and attended in Gondar town (Kallen Bnakafl and Menna Geriatrics Support Center Clinics) from 1st May 2022-14th July 2022. Socio-demographic data were collected using structured questionnaires. Urine culture was performed and isolates were counted for significant growth by a colony counter, and their antibiotic susceptibility was done by the Kirby-Bauer disc diffusion method. Data were entered using Epi Data version 4.0.0 and analyzed by Stata/IC version 14.0. P-value < 0.05 at 95% CI was considered statistically significant.

RESULT: The overall prevalence of UTI in geriatrics was 44.4%. The prevalence of UTI among community and hospitalized suspected patients was 38.7% and 50%, respectively. Escherichia coli (E. coli) (38.6%) predominated across the two groups, followed by Klebsiella spp. (15.8%), S. saprophyticus (12.2%), P. mirabilis (9.1%), S. aureus (5.9%), and Citrobacter spp. (2.8%). Pseudomonas spp. (7.1%), K. rhinoscleromatis (5.1%), and P. vulgaris (2.8%), were isolated from only hospitalized patients. Piperacillin-tazobactam susceptibly was 100% in both study groups. Nalidixic acid resistance was 50% to 87.5% and 50% to 100% in the isolates from community and hospitalized UTI suspects, respectively.

CONCLUSION: This study found a high prevalence of bacterial UTI in geriatrics and a high rate of bacterial resistance was observed to most antimicrobial drugs tested. Piperacillin-tazobactam and meropenem were the most active antimicrobials for UTI. Therefore, expanding routine bacterial culture and antimicrobial susceptibility testing and strengthening regular surveillance systems are essential for appropriate patient care.

PMID:40378179 | DOI:10.1371/journal.pone.0323570

Stat Med. 2025 May;44(10-12):e70060. doi: 10.1002/sim.70060.

ABSTRACT

Rapid and accurate prediction of mortality risk among intensive care unit (ICU) sepsis patients is crucial for timely intervention and improving patient outcomes. However, due to the multimodal and dynamic time-series nature of patient visit information and the limited data samples, it is challenging to obtain discriminative patient representations, leading to suboptimal mortality prediction results. To address this issue, we design a time-aware graph embedding attention model (TGAM) to integrate multimodal data and predict mortality in ICU sepsis patients. Our approach involves modeling and generating patient representations that encompass not only demographic information but also dynamic time-series data reflecting patient health status. Additionally, the graph convolutional network is used to obtain informative concept embeddings from medical ontologies, and an improved transformer is used to capture the temporal information of the patient’s health status and handle missing values, overcoming the limitations of small samples. The experimental results on the MIMIC-III and MIMIC-IV datasets demonstrate that TGAM significantly improves prediction accuracy, with AUROC scores of 87.65% and 87.00% on the MIMIC-III and MIMIC-IV datasets, respectively, outperforming baseline models by over 5 percentage points. TGAM also achieves higher sensitivity, specificity, and AUPRC metrics, and lower Brier Score compared with baseline models, highlighting its effectiveness in identifying high-risk patients. These findings suggest that TGAM has the potential to become a valuable tool for identifying high-risk sepsis patients, enabling clinicians to make more informed and timely intervention decisions.

PMID:40378163 | DOI:10.1002/sim.70060

PLoS One. 2025 May 16;20(5):e0322502. doi: 10.1371/journal.pone.0322502. eCollection 2025.

ABSTRACT

OBJECTIVE: This cohort study estimated the incidence and predictors of cardiovascular disease (CVD) and all-cause mortality among patients with type 2 diabetes mellitus (T2DM) and various stages of peripheral arterial disease (PAD) at the largest tertiary referral hospitals in upper-northern Thailand.

METHODS: This study recruited 278 T2DM and PAD patients for a 7-year cohort study. These patients completed health questionnaires and underwent physical examinations including ankle-brachial index measurements and clinical assessment to determine PAD severity. Mortality endpoints were determined using hospital death registers and national death records. The Cox proportional hazards and subdistribution hazard models were used to estimate PAD’s effect on mortality, quantifying the association with hazard ratios (HR) and subdistribution hazard ratios (SHR).

RESULTS: PAD patients were categorized into three subgroups. Over seven years, the cumulative all-cause mortality rate was 36%, or 6.4 deaths per 100 person-years. Multivariable analysis revealed critical limb ischemia (CLI) patients had significantly higher risks of all-cause (HR 5.26, 95%CI 3.10-8.94) and CVD mortality (SHR 6.20, 95%CI 3.20-12.03) compared to their asymptomatic peers. No statistically significant differences in non-CVD mortality were noted across PAD subgroups.

CONCLUSION: CLI, chronic kidney disease, and underweight (body mass index < 18.5 kg/m2) emerged as independent mortality predictors. Conversely, asymptomatic PAD patients had a similar overall mortality risk as those with intermittent claudication. These findings highlight the need for risk stratification and patient empowerment to optimize management of these complex conditions.

PMID:40378162 | DOI:10.1371/journal.pone.0322502

PLoS One. 2025 May 16;20(5):e0323087. doi: 10.1371/journal.pone.0323087. eCollection 2025.

ABSTRACT

OBJECTIVE: This study examines how weight-adjusted waist index (WWI) correlates with the occurrence of migraine in U.S. adults.

BACKGROUND: Being overweight significantly increases the likelihood of experiencing migraines; nonetheless, conventional metrics like waist circumference (WC) and body mass index (BMI) might not completely capture the level of migraine risk tied to obesity. WWI integrates the strengths of WC while minimizing its correlation with BMI, which might make it a more accurate indicator of central obesity-related migraine susceptibility.

METHODS: This study performed a cross-sectional analysis using data from 9,688 participants obtained from the National Health and Nutrition Examination Survey (NHANES), covering the years 1999-2004. Migraine occurrence was evaluated through questionnaires, and participants’ WWI was computed. Weighted multivariable logistic regression models were used to examine the association between WWI and migraines. Restricted cubic splines (RCS) were applied to evaluate the dose-response relationship between WWI and migraines. Furthermore, interaction tests and subgroup analyses were executed. The receiver operating characteristic (ROC) curve, paired with DeLong et al.’s test, was employed to compare the predictive power of WWI, BMI, and WC for migraines.

RESULTS: The overall prevalence of migraines was found to be 21.50% (weighted population: 31,888,075 out of 148,278,824). In Model 3, the link between WWI and migraines in women showed no statistical significance (OR = 0.94, 95% CI: 0.82-1.07). In this model, each unit increase in WWI among men was linked to a 22% higher risk of migraines (OR = 1.22, 95% CI: 1.05-1.42). When stratified by quintiles, individuals in the third quintile (Q3) displayed a 69% higher likelihood of experiencing migraines compared to those in the first quintile (Q1) (OR = 1.69, 95% CI: 1.19-2.40), with a significant inflection point observed at 10.95 cm/√kg. Significant interactions were noted among various age groups (p for interaction = 0.018). WWI demonstrated a stronger predictive capability for migraine compared to BMI and WC.

CONCLUSION: A U-shaped positive correlation of WWI with migraines was observerd among adult males in the U.S., while no significant correlation was found in females. Within the context of BMI and WC, WWI exhibited a superior predictive capacity for migraines.

PMID:40378149 | DOI:10.1371/journal.pone.0323087

PLoS One. 2025 May 16;20(5):e0323308. doi: 10.1371/journal.pone.0323308. eCollection 2025.

ABSTRACT

BACKGROUND: The mortality risk associated with loss of in-person outpatient visits or transition to virtual care in patients with heart failure (HF) during the COVID-19 pandemic is unknown.

OBJECTIVES: Assess changes in outpatient HF care patterns and associated mortality.

METHODS: Retrospective analysis of HF patients using national Veterans-Health-Administration (VHA) data. Among 509,511 HF patients who received VHA care, we compared mean monthly days-with-an-outpatient-visit from 2/2018-1/2020 (pre-COVID) versus 2/2020-1/2021 (COVID) using T-tests. In a subset of 321,439 patients with ≥1 VHA cardiology or primary-care visit in 2019, we related the presence and type of outpatient visit with mortality using Cox-Regression estimated hazard-ratios (HRs).

RESULTS: Despite a 2-3-fold increase in video-only visits and use of telephone visits to maintain access, the overall days with outpatient visits decreased from a monthly-average of 81.4 ± 6.1 in 2018-2019 and 81.0 ± 5.6 in 2019-2020, to 57.8 ± 11 days in 2020-2021 (P < 0.01 for both), per 100 Veterans. When compared to patients with no-visits during the study period, the adjusted-mortality risk was lowest for patients with at least one in-person (HR 0.42, 95%CI: 0.41-0.44), followed by video-only (HR 0.52, 95%CI: 0.50-0.55) and then telephone-only (HR 0.57, 95%CI: 0.54-0.60) visits (p = 0.14 for trend). Results remained similar when the analysis was repeated (without including telephone visits) for pre-COVID (2/2018-1/2020) periods.

CONCLUSIONS: Despite an increase in video and use of telephone visits during the COVID-19 pandemic, there was still a decrease in total outpatient visits for patients with HF. The presence and type of outpatient encounter was associated with the adjusted risk of mortality.

PMID:40378140 | DOI:10.1371/journal.pone.0323308

PLoS One. 2025 May 16;20(5):e0318853. doi: 10.1371/journal.pone.0318853. eCollection 2025.

ABSTRACT

BACKGROUND: Bronchiolitis exerts a high burden on children, their families and the healthcare system. The Canadian Bronchiolitis Epinephrine Steroid Trial (CanBEST) assessed whether administering epinephrine alone, dexamethasone alone, or in combination (EpiDex) could reduce bronchiolitis-related hospitalizations among children less than 12 months of age compared to placebo. CanBEST demonstrated a statistically significant reduction in 7-day hospitalization risk with EpiDex in an unadjusted analysis but not after adjustment.

OBJECTIVE: To explore the probability that EpiDex results in a reduction in hospitalizations using Bayesian methods.

STUDY DESIGN: Using prior distributions that represent varying levels of preexisting enthusiasm or skepticism, i.e., how confident or doubtful one is that EpiDex may reduce hospitalizations, and information about the treatment effect before data were collected, the posterior distribution of the relative risk of hospitalization compared to placebo was determined. The probability that the treatment effect is less than 1, 0.9, 0.8 and 0.6, indicating increasing reductions in hospitalization risk, are computed alongside 95% credible intervals.

RESULTS: Combining a minimally informative prior distribution with the data from CanBEST provides comparable results to the original analysis. Unless strongly skeptical views about the effectiveness of EpiDex were considered, the 95% credible interval for the treatment effect lies below 1, indicating a reduction in hospitalizations. There is a 90% probability that EpiDex results in a clinically meaningful reduction in hospitalization of 10% even when incorporating skeptical views, with a 67% probability when considering strongly skeptical views.

CONCLUSION: A Bayesian analysis demonstrates a high chance that EpiDex reduces hospitalization rates for bronchiolitis, although strongly skeptical individuals may require additional evidence to change practice.

TRIAL REGISTRATION: Clinical Trial registry name, registration number: Current Controlled Trials number, ISRCTN56745572.

PMID:40378135 | DOI:10.1371/journal.pone.0318853

PLoS One. 2025 May 16;20(5):e0323866. doi: 10.1371/journal.pone.0323866. eCollection 2025.

ABSTRACT

PURPOSE: This study aimed to examine perceived family functioning among individuals with depression, then compare these perceptions with those of the general population.

MATERIALS AND METHODS: A cross-sectional study was conducted among individuals with depression at Songklanagarind Hospital and individuals from the general population; from May to July 2024. Participants completed three questionnaires: 1) Personal and demographic inquiry, 2) the Family State and Functioning Assessment Scale (FSFAS-25), and 3) the Patient Health Questionnaire (PHQ-9). Data analysis involved descriptive statistics, Chi-square or Fisher’s exact test, Wilcoxon rank sum test and Student’s t-test.

RESULTS: The study compared 41 individuals with depression with 41 from the general population; revealing significant differences in family functioning scores. The depression group reported lower median family functioning scores (76 [IQR 64-84]) compared with the general population (87 [IQR 77-93]). Fewer individuals in the depression group reported high total family functioning scores (56.1% vs. 82.9%, p = 0.016). They also showed lower percentages in family support (61.0% vs. 95.1%, p < 0.001) and discipline dimensions (46.3% vs. 78.0%, p = 0.006). Furthermore, those with residual depression symptoms (PHQ-9 having a score of nine or higher) showed significant differences in family support (37.5% vs. 76.0%, p = 0.033) and emotional status (18.8% vs. 60.0%, p = 0.023) compared with those without residual depression symptoms.

CONCLUSION: Individuals with depression demonstrated lower levels of family functioning compared with the general population. Acknowledging and addressing the influence of family dynamics on the development and persistence of the disorder may be essential for improving treatment outcomes. Integrating these factors into person-centered mental health interventions can lead to more comprehensive, individualized, and effective care.

PMID:40378133 | DOI:10.1371/journal.pone.0323866