Nevin Manimala

JAMA Netw Open. 2025 Feb 3;8(2):e2461803. doi: 10.1001/jamanetworkopen.2024.61803.

ABSTRACT

IMPORTANCE: The patient portal has a growing role in health care. Many health systems have implemented shared access functionality in which patients may register a care partner with unique identity credentials to access their portal. Uptake of shared access has been limited.

OBJECTIVE: To examine the outcomes of a multisite demonstration involving organizational strategies associated with registration and use of patient portal shared access.

DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study was conducted in diverse sites within 3 health systems in the US: (1) geriatric oncology, (2) geriatric medicine, and (3) primary care. Patients aged 65 years or older with 1 or more visits during the 12-month demonstration period (July 1, 2022, through July 1, 2023, for sites 1 and 2; site 3 was delayed 3 months) and care partners who used the portal accounts of patients meeting these criteria were included. The 6-month postdemonstration period (August 1, 2023, through January 1, 2024) was compared with the 6-month predemonstration period (January 1 through June 1, 2022).

EXPOSURES: Organizational strategies (brochures, webpages, tip sheets, and implementation toolkits created using a human-centered design) to encourage shared access registration and use.

MAIN OUTCOMES AND MEASURES: Portal registration and use (logins, laboratory results viewed, clinical notes viewed, visits scheduled) by type of access (patient and care partner) from electronic health record data were examined. Patient- and care partner-reported awareness and use of shared access were measured using a postdemonstration survey.

RESULTS: A total of 16 005 patients from the 3 sites met the inclusion criteria (84.8% younger than 85 years and 61.5% women). Most patients had an activated portal account (91.0%) and logged in at least once (84.8%) during the 24 months spanning the demonstration and pre- and postdemonstration periods. New portal registrations were stable, but nonsignificant for shared access (110 of 14 758 [0.7%] vs 91 of 14 016 [0.6%]) and significantly decreased for patient access (677 of 3158 [21.5%] vs 225 of 1520 [13.2%]). Use of shared access before vs after the demonstration increased for number of logins (mean [SD], 5.9 [11.4] vs 6.8 [14.1]), laboratory results viewed (mean [SD], 0.7 [2.7] vs 1.1 [3.7]), clinical notes viewed (mean [SD], 0.2 [1.1] vs 0.6 [3.2]), and visits scheduled (mean [SD], 0.8 [10.8] vs 1.0 [5.4]). Of the 91 care partners reporting portal use in the postdemonstration survey, 48 (52.7%) indicated primarily using patient credentials and 31 (34.1%) indicated primarily using their own credentials. Less than one-half of patients (721 of 1664 [43.3%]) stated being aware of shared access.

CONCLUSIONS AND RELEVANCE: These findings show no association of the multisite demonstration with increased new registrations for shared access and only modest increases in portal use among care partners of older adults. As portal use expands to encompass legal documentation, medical decision-making, and patient education, policies to support proper use of identity credentials are needed.

PMID:39998827 | DOI:10.1001/jamanetworkopen.2024.61803

Ir Med J. 2025 Jan 27;118(1):5.

ABSTRACT

AIM: This study aims to evaluate the impact of increased radiological access for General Practitioners (GPs) on healthcare workflows and patient care outcomes, with a focus on musculoskeletal (MSK) MRIs.

METHODS: A mixed methods approach was used for this study. GPs completed online questionnaires and semi-structured interviews were conducted with orthopaedic and radiology consultants. Doctors were asked to evaluate their experience working within the GP ‘direct access’ to radiology scheme.

RESULTS: Increased GP access to radiology had many positive benefits, including improved efficiencies in healthcare workflow. Of the GPs surveyed 44 (84.5%) found an increased patient satisfaction rate and 46 (88.5%) found improved efficiencies in patient outcomes. However, it may be contributing to downstream inefficiencies and affecting prioritization of more urgent imaging in the system. 52 GPs surveyed and 8 semi structured interviews with radiologist and orthopaedic consultants were analysed.

DISCUSSION: Increased GP access to radiology has led to many important benefits in the Irish healthcare system. There is potential for more efficient healthcare workflows, and improved patient outcomes, pending more appropriate referral pathways and further investment in infrastructure and training.

PMID:39998825

Medicine (Baltimore). 2025 Feb 21;104(8):e41615. doi: 10.1097/MD.0000000000041615.

ABSTRACT

BACKGROUND: Postoperative delirium (POD) in older adults is associated with high risk of morbidity and mortality. With limited treatment options, prevention is essential. Melatonin has been suggested to prevent delirium through regulating the sleep-wake cycle and serotonin metabolism, which has been shown to be disrupted in patients with POD. However, the evidence regarding the use of melatonin for POD prevention is limited and inconclusive.

METHODS: Our multicenter, 2-arm, parallel-group, feasibility randomized controlled trial evaluated the effect of melatonin on POD incidence after noncardiac surgery in patients >65 years (n = 120). Patients were randomized to 3 mg oral melatonin or placebo once preoperatively and for 7 days postoperatively. Patients were assessed twice daily for delirium and followed at 3 months postoperatively. Feasibility outcomes were recruitment rate, medication adherence, and proportion completing 3-month follow-up. Clinical outcomes were delirium incidence, sleep quality, institutional discharge, and cognitive status at 3 months.

RESULTS: Between September 2021 and June 2023, 85 patients were randomized (~1 patient/wk); of these, 92.9% adhered to study medications and 87.1% completed the 3-month follow-up. POD occurred in 9 patients with no statistical difference between the groups (melatonin group, n = 7; placebo group, n = 2; adjusted odds ratio: 1.12; 95% confidence interval: 0.006-150.1). There were no differences in any other clinical outcomes. Pandemic-related challenges, including interruption of surgeries and restrictions on research procedures impacted feasibility and the study was terminated early due to futility.

CONCLUSIONS: Based on our observations, a sample size of >1000 patients is required for a definitive trial to evaluate the role of melatonin in reducing the incidence of POD. Design changes need to be considered to address feasibility challenges and ongoing post-pandemic modifications to patient care.

PMID:39998812 | DOI:10.1097/MD.0000000000041615

Radiol Phys Technol. 2025 Feb 25. doi: 10.1007/s12194-025-00885-3. Online ahead of print.

ABSTRACT

Lead-based radiation shielding used usually in radiology departments is being replaced by non-lead shields due to concerns over toxicity, high weight, and the impossibility of applying it in the imaging field. New studies refer to the use of nanomaterials and lightweight polymer-based composites as an alternative that can solve the problems caused by lead shields. The study aims to develop a flexible composite shield for CT scan imaging and examine its effectiveness in reducing radiation exposure. This study involved the construction of 1 mm thick composite shields used in chest CT scan imaging. The first type consisted of 10% bismuth oxide, the second type consisted of 10% tungsten, the third type consisted of 5% bismuth oxide and 5% tungsten, and 90% of the rest of the structure of all shields was silicone. This study examined the morphological test, tensile strength test, attenuation efficiency, and image quality assessment of these shields. The radiation transmission coefficient for 10% bismuth, 10% tungsten and 5% bismuth-5%tungsten shields was obtained as 0.86, 0.80, and 0.83, respectively. Also, the noise increasing percentage for mentioned shields were 6, 4, and 6%, respectively, compared to the case without a shield. The study found that the 10% tungsten-90% silicone shield is the most effective in reducing radiation exposure due to its K-edge and attenuation coefficients. According to the noise assessment, using these shields does not significantly affect the quality of images.

PMID:39998795 | DOI:10.1007/s12194-025-00885-3

Curr Med Sci. 2025 Feb 25. doi: 10.1007/s11596-025-00024-4. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the association between insulin resistance and the risk of cardiovascular disease.

METHODS: A cross-sectional study including 2128 participants aged 40-79 years was conducted using data from the National Health and Nutrition Examination Survey from 1999 to 2018. The quantitative insulin sensitivity check index (QUICKI) and homeostasis model assessment of β-cell function (HOMA-β) were used as independent variables. The 10-year risk of a first hard atherosclerotic cardiovascular event was used as the dependent variable, with other potential confounding factors considered. Multivariate linear regression models and smooth curve fitting were used to assess the associations between insulin resistance and 10-year risk.

RESULTS: A total of 2128 patients, comprising 1191 men and 937 women, were included in our analysis. The regression analyses revealed a negative correlation between the QUICKI score and the 10-year risk of a first hard atherosclerotic cardiovascular event [β = – 8.85, CI (- 15.77, – 1.93)] after adjusting for age, race, body mass index, systolic blood pressure, diastolic blood pressure, hypertension treatment, smoking, diabetes, and low-density lipoprotein cholesterol. Conversely, an increase in HOMA-β was associated with 10-year risk [β = 6.84, CI (0.45, 13.23)]. Gender-specific subgroup analysis indicated that the QUICKI had a β value of 0.077 (0.046, 0.108) for men and 0.080 (0.061, 0.094) for women.

CONCLUSION: This study demonstrated that increased insulin resistance is linked to an increased risk of cardiovascular disease.

PMID:39998770 | DOI:10.1007/s11596-025-00024-4

J Med Syst. 2025 Feb 25;49(1):31. doi: 10.1007/s10916-025-02164-5.

ABSTRACT

When the hospital census is near-capacity, either from insufficient physical beds or nurse staffing, discharge delays can result in postanesthesia care unit (PACU) congestion that backs up the operating rooms. Hospital administrators often promote increasing morning discharges as mitigation. Before the COVID-19 pandemic, most hospitalized Florida patients were discharged after 3 PM, without change from 2010 through 2018. The current study extended the observation period through 2022 to determine if discharge pressure during the COVID-19 pandemic from persistent high census resulted in overall earlier hospital discharges. Results showed the percentages of patients discharged by 12 noon or 3 PM remained unchanged. Among 1,034,515 discharges at 197 hospitals during the last 2 quarters of 2022, most discharges (P < 0.0001 versus 50%) occurred after 3 PM. The pooled incidence of discharges by noon was 13.2%, while the estimate of the incidence inverse weighted by the hospitals’ counts of discharges was 13.3% (97.5% 12.6% to 14.1%). The corresponding pooled incidences of discharges by 3 PM was 42.5%, and 43.7% (97.5% confidence interval 42.3% to 45.2%). All 136,924 combinations of hospital and Medicare severity diagnosis-related groups were evaluated to examine why discharges did not occur earlier. Among the 1377 such combinations (1% of the total) with a significant change in median length of stay, 95% (1313) were decreases in lengths of stay. The implication is that the pandemic had no salutatory effect on earlier discharges. Therefore, post-anesthesia care unit managers should continue to plan for most hospital beds to be unavailable until late afternoon.

PMID:39998727 | DOI:10.1007/s10916-025-02164-5

J Robot Surg. 2025 Feb 25;19(1):81. doi: 10.1007/s11701-025-02252-1.

ABSTRACT

Ventral hernia repairs (VHR) are commonly performed surgical procedures in the United States, with over 300,000 cases treated annually. Robotic surgery has gained traction for its safety and efficacy in VHR, particularly with techniques such as myofascial release. However, the extensive dissection involved in these procedures may lead to postoperative complications like seromas and hematomas. This study aims to assess the effectiveness of Arista™, an FDA-approved hemostatic agent, in reducing these complications during robotic-assisted laparoscopic VHR involving mesh placement in the retrorectus space. This single-institution single-blind prospective randomized controlled trial involved 100 patients undergoing elective robotic-assisted laparoscopic VHR at a tertiary referral hernia center. Participants were randomized to receive either 5 g of Arista™ or standard of care intraoperatively, with no hemostat applied in the control group. All patients had drains placed in the retrorectus space. Primary outcomes included drain output on the first postoperative day (POD), total drain output, and duration of drain placement. Secondary outcomes included estimated blood loss (EBL), number of drains used, operative time, and length of stay (LOS). This study was funded by Becton, Dickinson and Company (BD). The mean total drain output was significantly higher in the Arista™ group (592.8 ml) compared to the control group (407.9 ml; p = 0.01), with a 39.6% increase noted. However, no significant difference in drain output on the first postoperative day or drain duration was observed. Secondary outcomes revealed no statistically significant differences in EBL, number of drains, operative time, or LOS between the groups. While the application of Arista™ during robotic-assisted laparoscopic VHR resulted in increased total drain output, it did not significantly affect other postoperative metrics, including LOS and complications. Further research is warranted to explore the potential benefits of Arista™ in specific patient populations and surgical contexts.

PMID:39998726 | DOI:10.1007/s11701-025-02252-1

J Patient Rep Outcomes. 2025 Feb 25;9(1):25. doi: 10.1186/s41687-025-00854-9.

ABSTRACT

BACKGROUND: The important roles of well-being as realization of one’s true potential for healthy aging have been highlighted by literature of the recent decades. The Scales of Psychological Well-being (SPWB) are an internationally recognized measurement tool for psychological well-being. Yet, sound validation of the German SPWB 18-item version has been lacking to date. Therefore, the present study aims to (1) test the psychometric properties of the German SPWB 18-item version in terms of factorial validity and (2) determine construct validity by investigating its correlations with psychosocial variables, mental and physical health. (3) Sociodemographic characteristics of the SPWB in a middle to old age German population was explored.

METHODOLOGY: Data of N = 3,374 participants 45-85 years old of the 10-year follow-up (2017-2022) of the Gutenberg Health Study (GHS) were analyzed. Descriptive analyses and inference statistical analyses were performed to assess construct validity. In order to determine the psychometric properties, item characteristics and reliability coefficients were analyzed. Confirmatory factor analyses tested the proposed theoretical factorial structure.

RESULTS: Construct validity of the SPWB was established with respect to sociodemographic, psychosocial (social support and resilient coping), and health variables (sleeping problems, depression and anxiety symptoms, stress, loneliness, and somatic diseases). Analysis of the psychometric properties of the German SPWB 18-item version rendered support for the theoretically proposed multidimensional structure of psychological well-being in our sample rather than a one factorial structure. Bi-factor models that take the method effects of positively and negatively formulated items into account are highly recommended.

CONCLUSIONS: The German SPWB 18-item version shows comparable psychometric properties to previous large-scale studies from other countries. The SPWB provides psychological indicators for healthy aging.

PMID:39998720 | DOI:10.1186/s41687-025-00854-9

Lasers Med Sci. 2025 Feb 25;40(1):118. doi: 10.1007/s10103-025-04375-1.

ABSTRACT

There is a lack of clinical consensus on the parameter settings of the pulsed-wave thulium fiber laser for soft tissue resection. The aim of this study was to explore the optimal parameter settings of the pulsed-wave thulium fiber laser for soft tissue resection, with a view to providing a reference for future clinical applications. Two different thulium fiber lasers, prototype thulium fiber lasers and Urolase, were used to explore the optimal parameters of thulium fiber laser for soft tissue cutting by evaluating the depth of tissue vaporization and depth of thermal damage in an isolated pig kidney model, and then the optimal parameters of in vitro screening were statistically validated by operation time, coagulation time, intraoperative hemorrhage, smoke level, and depth of thermal damage in an in vivo model using rabbit kidney. In ex vivo animal experiments the depth of tissue vaporization and thermal damage increased with increasing average power, and tissue carbonization occurred at 30 W. In animal use we used 1 J, 25 W for surgery, and there was no statistical difference between the two thulium fiber lasers in terms of surgery time, coagulation time, bleeding, smoke level, and depth of thermal damage. Thulium fiber laser for soft tissue resection is safe and feasible, and we believe that 1 J, 25 W is the optimal laser setting parameter for soft tissue resection, but it needs to be adjusted according to the actual situation.

PMID:39998717 | DOI:10.1007/s10103-025-04375-1

Psychiatr Q. 2025 Feb 25. doi: 10.1007/s11126-025-10123-z. Online ahead of print.

ABSTRACT

Psychological suffering of healthcare professionals, during War times, is ignored in literature. While struggling to provide ultimate care, HCP need support and psychological counseling. The purpose of this study was to examine the moderation effect of resilience on the relationship between life satisfaction, depression, and PTSD controlling for the sociodemographic and personal characteristics among on-duty healthcare professionals in Gaza. A convenience sample of 150 on-duty healthcare professionals filled out an online survey. The sample targeted a convenience sample of HCWs who are currently on duty in Gaza. Data collected regrading satisfaction with life, PTSD, depression, and resilience. Data collected from August to end of Sept 2024. Of the sample, 94.7% (n = 146) met criteria of PTSD, 85.3% (n = 128) reported a severe form of depression, 59.3% (n = 89) have a low level of resilience, and 74.7% (n = 112) reported that they are dissatisfied with their life. The analysis showed that resilience has no significant moderation effect on the relationship between psychological factors and PTSD controlling for demographic and personal characteristics as the R² change of 0.011 in the model was not statistically significant (p = 0.09). Years of experience, age and having mental illness were significant risk factors to develop PTSD. There is a need to provide an urgent psychological counselling to healthcare professionals in Gaza. Online and face-to-face help groups and peer to peer support need to be established.

PMID:39998710 | DOI:10.1007/s11126-025-10123-z