Nevin Manimala

Pediatrics. 2025 Mar 1;155(3):e2024066367. doi: 10.1542/peds.2024-066367.

ABSTRACT

OBJECTIVE: Antibiotics are the most frequently prescribed pharmacologic agents in the neonatal intensive care unit (NICU). Antibiotic treatment for suspected or culture-negative sepsis surpasses that for culture-proven infection. Therefore, we sought to reduce our overall antibiotic utilization rate (AUR), defined by total antibiotic days per 1000 patient days (DOT/1000-PD), by 20% within a 4-year period (by December 2023).

METHODS: A multidisciplinary team was convened to develop an antibiotic stewardship quality improvement initiative in our 39-bed level IV NICU. Consensus guidelines for antibiotic duration for common indications were developed. Interventions included educational sessions, antibiotic stop dates, and antibiotic necessity documentation in the electronic health record to standardize provider justification for antibiotic prescription and duration.

RESULTS: A total of 552 infants were included in the analysis, 137 in the baseline and 415 in the postintervention period. Overall AUR decreased by 50% from 278 to 140 DOT/1000-PDs. AUR related to culture-negative sepsis diagnoses decreased by 64% from 22 to 8 DOT/1000-PDs. The percent of antibiotic therapy reinitiation within 2 weeks remained unchanged.

CONCLUSION: Implementation of NICU antibiotic consensus guidelines supported by evidence-based education on culture-negative sepsis diagnosis can effectively reduce antibiotic use in a safe manner, despite a heterogenous, high acuity, level IV NICU population. Multidisciplinary team support and standardization of antibiotic justification in the electronic health record can be coupled to reinforce compliance with established guidelines to promote long-lasting antibiotic reduction.

PMID:39999320 | DOI:10.1542/peds.2024-066367

J Eval Clin Pract. 2025 Feb;31(1):e70031. doi: 10.1111/jep.70031.

ABSTRACT

OBJECTIVES: To establish and validate a short scale of critical thinking ability for dental residents based on the Byrnes theory.

MATERIALS AND METHODS: Two hundred and thirty-four dental residents in total from Stomatological Hospital of Chongqing Medical University were divided into development group and validation group randomly. In the development phase, the content validation and the initial reduction was underwent by the modified Delphi method. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and reliability test was used to validate the scale in the evaluation phase.

RESULTS: We developed a 21 items scale after two rounds of expert consultation via Delphi method. In the evaluation phase, no significant sociodemographic difference was found among the 234 participants. Fifteen items extracted three factors and CFA results indicated acceptable goodness-of-fit indices of this scale. The scale was with a good internal consistency and reliability.

CONCLUSIONS: This version of critical thinking scale for the Chinese dental residents was considered to be more feasible for application in the clinical practice and dental education.

PMID:39999223 | DOI:10.1111/jep.70031

Aging Ment Health. 2025 Feb 25:1-10. doi: 10.1080/13607863.2025.2467972. Online ahead of print.

ABSTRACT

OBJECTIVES: Widowhood affects the quality of life and interpersonal relationships of older women. The aim of the study was to determine the effects of a life review program on quality of life and quality of relationships among older rural widows in Iran.

METHOD: A clinical trial was conducted with 128 older adults widowed women who were served by rural health centers in the city of Iran. The intervention was carried out in six sessions over a period of 6 weeks in the form of remote conversations and virtual lessons. Quality of life and relationship quality before and 2 months after the intervention were assessed using the LEIPAD quality of life questionnaire with a score range of 31-124 and the relationship quality questionnaire with a score range of 25-100. The data was analyzed using descriptive and analytical statistical tests with SPSS software version 26.

RESULTS: The results show that after the intervention, the scores for relationship quality and quality of life increased in the intervention group (p < 0.05) compared to the control group.

CONCLUSION: Therefore, the use of this simple, inexpensive, and uncomplicated intervention is recommended for health counseling of the older adults.

TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION: IRCT20111017007816N18.

PMID:39999220 | DOI:10.1080/13607863.2025.2467972

Int J Health Plann Manage. 2025 Feb 25. doi: 10.1002/hpm.3898. Online ahead of print.

ABSTRACT

BACKGROUND: Formal networks are increasingly being used as a strategy to address complex health system issues. This study aimed to understand the organisational performance of a novel network, the Rural Surgical and Obstetrical Networks (RSON) in the Canadian province of British Columbia, as it developed and grew over four years.

METHODS: Between 2019 and 2022, we administrated an annual 37-item survey on network organisational aspects with RSON leaders. We calculated the percentage of favourable ratings (four or five rating out of five) for each survey item and used a two-tailed Wilcoxon Mann-Whitney rank sum test to compare ratings over time. Key themes in respondent comments were described narratively.

RESULTS: Over four years, we distributed 114 survey invitations to RSON leaders and received 77 responses. From 2019 to 2022, 24 out of 37 survey items (65%) had a statistically significant increase in ratings. Ratings and comments indicated that RSON could have improved its function by (a) including more peripheral network members in decision-making and (b) formalising structures and processes for some network areas. Findings also indicate the presence of three network tensions within RSON: inclusiveness versus efficiency, stability versus flexibility, and network operations versus health system operations.

CONCLUSION: Study findings validate and build on existing network theories and provide practical learnings for other jurisdictions interested in implementing a network like RSON. Among the tensions identified within RSON, the network operations versus health system operations tension, specific to a healthcare delivery setting, has not been well described previously.

PMID:39999218 | DOI:10.1002/hpm.3898

Pediatr Pulmonol. 2025 Feb;60(2):e71018. doi: 10.1002/ppul.71018.

ABSTRACT

BACKGROUND: Patients with primary ciliary dyskinesia (PCD) are commonly treated for pulmonary exacerbations with intravenous tobramycin, but data on tobramycin pharmacokinetics in PCD is lacking. The objective of this study was to compare tobramycin pharmacokinetics in pediatric patients with PCD to those with cystic fibrosis (CF).

METHODS: This retrospective study included pediatric patients hospitalized for a pulmonary exacerbation between January 2018 and June 2023. Included patients were treated with systemic tobramycin and had two concentrations usable to calculate patient-specific pharmacokinetics. Each patient with PCD was matched 1:2 to patients with CF based on age. The primary outcome was tobramycin elimination rate constant.

RESULTS: Seven patients with PCD were matched to 14 patients with CF. Baseline characteristics were similar between groups. The final tobramycin dose was not significantly different between groups (9.3 vs. 11.8 mg/kg, p = 0.192). All doses were infused over 30 min every 24 h. Tobramycin elimination rate constant (0.510 vs. 0.493 h^-1, p = 0.433) and volume of distribution (0.31 vs. 0.23 L/kg, p = 0.640) were not different between groups. No patient experienced acute kidney injury. Additionally, both groups experienced similar duration of tobramycin therapy (12.3 vs. 9.6 days, p = 0.184) and length of stay (12.0 vs. 12.6 days, p = 0.801).

CONCLUSIONS: No difference in tobramycin elimination rate constant was found between patients with PCD and those with CF. Clinical outcomes were not significantly different between groups. Although not statistically significant, a lower tobramycin dose was observed in patients with PCD.

PMID:39998853 | DOI:10.1002/ppul.71018

Cancer. 2025 Mar 1;131(5):e35788. doi: 10.1002/cncr.35788.

ABSTRACT

Transgender and gender-diverse (TGD) populations experience health disparities across all areas of health care due to issues of bias, discrimination, and structural barriers to care. Existing literature on cancer screening in TGD populations demonstrates significant gaps in care; for example, transgender men receive Pap smears at lower rates than cisgender women. Because of known disparities in cancer screening, and gaps in our understanding in terms of diagnosis, treatment, and survivorship, the authors conducted a rapid review of the literature to examine cancer care continuum (screening, treatment, and survivorship) disparities among TGD persons. The results reported disparities across the cancer care continuum. Although there is currently limited research on cancer diagnosis, treatment, and survivorship, the available evidence indicates TGD patients are diagnosed with cancer at later stages than cisgender patients. TGD patients were also less likely than cisgender patients to receive treatment for some types of cancer. The results of this rapid review demonstrate the need for more research across the cancer care continuum for TGD patients with significant gaps in knowledge for cancer treatment and survivorship.

PMID:39998846 | DOI:10.1002/cncr.35788

Ir Med J. 2025 Jan 27;118(1):4.

ABSTRACT

AIM: The social care system is currently under enormous pressure leading to delays in home care provision and unnecessarily prolonged hospital stays for frail, older people. This study examines the rate of hospital-associated complications (HAC) amongst older inpatients who are medically optimised but awaiting home care to facilitate discharge home.

METHODS: Electronic records of patients =65 years with delayed transfer of care (DTOC) awaiting home care provision were examined for incidence of delirium, falls and infection (n=100). A smaller cohort of current inpatients (n=14) awaiting home care were interviewed with focus on quality-of-life (CASP-19), loneliness (UCLA Scale) and depressive symptoms (CES-D).

RESULTS: 59% (57/97) (median 82 years) developed a HAC while medically optimised for discharge. For every additional day awaiting home care, the likelihood of HAC increased by 4% (Adjusted Odds Ratio 1.04 (1.00-1.08; p=0.027). Almost half of interview respondents reported quality-of-life had declined while discharge home was delayed (6/14, 43%), while over one third reported significant depressive symptoms (5/14, 36%).

DISCUSSION: Almost 60% of frail, older inpatients have a HAC while awaiting home care provision, with the likelihood increasing significantly for every additional day in hospital awaiting care. Interventions to address this deficit in home care are required urgently.

PMID:39998843

JAMA Netw Open. 2025 Feb 3;8(2):e2461031. doi: 10.1001/jamanetworkopen.2024.61031.

ABSTRACT

IMPORTANCE: Adherence to the Mediterranean Diet (MedDiet) has been associated with a lower incidence of cancer and reduced weight gain. These associations suggest a potential role for the MedDiet in lowering the risk of obesity-related cancers (ORCs). Obesity is a known risk factor for various cancers and shows an inverse association with MedDiet adherence.

OBJECTIVE: To examine the association between adherence to the MedDiet and the risk of ORCs, considering the possible mediating role of adiposity.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study analyzed data from the European Prospective Investigation Into Cancer and Nutrition (EPIC) study, which enrolled participants aged 35 to 70 years from 1992 to 2000 across 23 centers in 10 countries. The data analysis was conducted from March 1 to May 31, 2023.

EXPOSURES: Dietary intake before baseline was evaluated using country-specific, validated questionnaires administered at recruitment. Adherence to the MedDiet was scored on a 9-point scale and categorized as low (0-3 points), medium (4-6 points), or high (7-9 points).

MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of ORCs, classified according to the 2015 International Agency for Research on Cancer criteria. Multivariable Cox proportional hazards regression models were used to assess the association between MedDiet adherence and ORC incidence. Mediation analyses were conducted to evaluate the role of waist to hip ratio and body mass index in this association.

RESULTS: A total of 450 111 participants were included in the study (mean [SD] age, 51.1 [9.8] years; 70.8% women) and followed up during a median (IQR) time of 14.9 (4.1) years. Among participants, 4.9% experienced an ORC (rates, 0.053, 0.049, and 0.043 per person-year in the low, medium, and high MedDiet adherence groups, respectively). Participants with high adherence to the MedDiet (7-9 points) had a lower risk of ORC compared with those with low adherence (0-3 points) (hazard ratio [HR], 0.94; 95% CI, 0.90-0.98). A similar inverse association was observed for participants with medium adherence (4-6 points vs 0-3 points). However, mediation analyses did not show associations of waist to hip ratio or body mass index between MedDiet adherence and ORC risk.

CONCLUSIONS AND RELEVANCE: These findings indicate that higher adherence to the MedDiet is associated with a modest reduction in the risk of ORCs, independent of adiposity measures. Further research is needed to clarify the mechanisms by which the MedDiet may contribute to cancer prevention.

PMID:39998833 | DOI:10.1001/jamanetworkopen.2024.61031

JAMA Netw Open. 2025 Feb 3;8(2):e2461559. doi: 10.1001/jamanetworkopen.2024.61559.

ABSTRACT

IMPORTANCE: The Veterans Health Administration (VHA) implemented the Comprehensive Suicide Risk Evaluation (CSRE) in 2019 to standardize suicide risk assessment across the health care system. Identifying CSRE responses associated with suicide could inform risk management and prevent suicide.

OBJECTIVE: To identify CSRE responses associated with subsequent suicide.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study examines acute (within 30 days) and chronic (within 365 days) suicide risk after 269 374 CSREs were administered. Participants included US VHA patients undergoing CSRE evaluation between November 1, 2019, and December 31, 2020. Data collection and analysis were performed from April 5 to August 20, 2024.

EXPOSURES: CSRE responses, including suicidal ideation, behaviors, warning signs, risk factors, and protective factors.

MAIN OUTCOME AND MEASURE: Suicide per death certificate data from the Department of Veterans Affairs and Department of Defense Mortality Data Repository. Outcomes were analyzed using multivariable Cox proportional hazards regression.

RESULTS: A total of 153 736 patients with 269 374 valid CSREs (86.26% male; mean [SD] age, 50.48 [15.26] years) were included in the multivariable-adjusted analyses of suicide. Suicidal ideation (hazard ratio [HR], 3.14; 95% CI, 1.51-6.54), firearm access (HR, 2.62; 95% CI, 1.49-4.61), making preparations for a suicide attempt (HR, 2.15; 95% CI, 1.27-3.62), seeking access to lethal means (HR, 2.04; 95% CI, 1.11-3.75), anxiety (HR, 1.80; 95% CI, 1.16-2.81), and psychiatric hospitalization history (HR, 1.63; 95% CI, 1.02-2.61) were associated with increased suicide risk within 30 days, whereas anger (HR, 0.50; 95% CI, 0.30-0.85) was associated with decreased risk. Suicidal ideation (HR, 1.63; 95% CI, 1.20-2.21), firearm access (HR, 1.55; 95% CI, 1.13-2.13), making preparations for a suicide attempt (HR, 1.56; 95% CI, 1.09-2.23), reckless behaviors (HR, 1.40; 95% CI, 1.00-1.95), and history of psychiatric hospitalization (HR, 1.68; 95% CI, 1.32-2.13) were associated with increased suicide risk within 365 days, whereas anger (HR, 0.56; 95% CI, 0.44-0.71), preexisting risk factors (eg, trauma; HR, 0.77; 95% CI, 0.62-0.96), and recent transition from the military (HR, 0.39; 95% CI, 0.22-0.70) were associated with decreased risk in multivariable-adjusted analyses. Suicide risk within 365 days was elevated among patients identified by clinicians to be at intermediate acute risk (HR, 1.39; 95% CI, 1.13-1.71), intermediate chronic risk (HR, 1.34; 95% CI, 1.01-1.77), and high chronic risk (HR, 1.74; 95% CI, 1.22-2.47) of suicide compared with patients at low risk in multivariable-adjusted analyses.

CONCLUSIONS AND RELEVANCE: In this cohort study of suicide following risk assessments, findings suggest that only a few constructs are associated with subsequent suicide, particularly suicidal ideation, firearm access, and preparatory behaviors. Developing risk prediction algorithms including CSRE responses may enhance clinical evaluation.

PMID:39998832 | DOI:10.1001/jamanetworkopen.2024.61559

JAMA Netw Open. 2025 Feb 3;8(2):e2461735. doi: 10.1001/jamanetworkopen.2024.61735.

ABSTRACT

IMPORTANCE: Immunotherapies are the preferred frontline treatment for most hepatocellular carcinomas (HCCs), but only a small subset of patients attain complete responses to immunotherapies, resulting in an absence of radiographic apparent disease. The clinical importance of these complete responses is unclear, and whether clinical or molecular features may define HCCs that are exquisitely sensitive to immunotherapies is ambiguous.

OBJECTIVE: To describe the long-term survival outcomes of complete responders to immunotherapies, and to examine whether clinical and genomic characteristics are associated with complete response.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study includes a post hoc analysis of the IMbrave150 trial (which enrolled patients across 17 countries in North America, Europe, Asia, and Australia) and a multicenter cohort analysis of patients with advanced HCC treated with frontline immunotherapies across 3 institutions (2 in the US and 1 in Asia). Complete responders were defined as patients with a complete response according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 or modified RECIST. Statistical analyses were conducted from January to May 2024.

MAIN OUTCOMES AND MEASURES: The main outcome was overall survival measured as the time from start of immunotherapy to the date of death. Kaplan-Meier curves were used to estimate progression-free and overall survival, and differences in survival outcomes were assessed using the log-rank test.

RESULTS: The analytical sample included 279 patients (mean [SD] age, 64.7 [11.1] years; 228 male patients [81.7%]) treated with atezolizumab and bevacizumab in the IMbrave150 trial and 194 patients (mean [SD] age, 64.3 [11.4] years; 155 male patients [78.7%]) with frontline anti-programmed cell death 1 ligand 1 (PD-1/L1) therapies in a multicenter patient cohort. Complete responders had high disease-free survival rates at 2 years in the IMbrave150 (58.0%; 95% CI, 36.2%-74.7%) and multicenter (87.4%; 95% CI, 58.2%-96.7%) cohorts. Overall survival rates at 2 years for complete responders were 81.1% (95% CI, 64.4%-90.5%) in the IMbrave150 cohort and 93.3% (95% CI, 61.2%-99.0%) in the multicenter cohort. Among complete responders who discontinued treatment for reasons other than disease progression after a median duration of treatment of 24 months, disease recurrence was rare. Molecular profiling of HCC among complete responders did not reveal unique genetic alterations in these patients. However, cancers with complete responses had higher PD-L1 protein expression in the immune cell compartment and lower circulating tumor DNA levels.

CONCLUSIONS AND RELEVANCE: In this post hoc trial and multicenter cohort analysis of patients with HCC treated with immunotherapy, complete responders demonstrated prolonged survival and durable disease control even after discontinuation of therapy. Biological features of complete responders were also distinct, and further evaluation of immune cell PD-L1 protein expression and circulating tumor DNA as potential biomarkers is warranted.

PMID:39998829 | DOI:10.1001/jamanetworkopen.2024.61735