Nevin Manimala

Aust Health Rev. 2025 Feb 18. doi: 10.1071/AH24329. Online ahead of print.

ABSTRACT

ObjectiveBreast cancer is the most common cancer in Australian women, with rising prevalence and costs. Inefficient care leads to poorer outcomes and strains healthcare systems. This review explores the association between breast cancer management strategies and efficiency in delivering care.MethodsAn exploratory single database review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) guidelines was conducted by searching MEDLINE for studies on patient-centred care, efficiency, and breast cancer published 2014-present. Data extraction and synthesis followed PRISMA extension for Scoping Reviews (PRISMA-ScR) Checklist.ResultsEleven studies were included (one systematic review, one randomised control trial (RCT), four comparative studies, three observational studies, one budget analysis, and one protocol). Seven studies found a positive association between patient-centred care and efficiency; six showed statistical significance. These included reduced diagnostic delays (n=3), improved shared decision-making with decision aids (n=3), need to address ethnic/socioeconomic status disparities (n=2), and survivorship interventions/experience (n=3).ConclusionThis is the first review analysing multiple strategies to improve delivery of care, demonstrating improved efficiency throughout the treatment journey in breast cancer by using patient-centred care. Further implementation studies are needed to understand how to optimise outcomes and healthcare sustainability.

PMID:39961135 | DOI:10.1071/AH24329

Health Informatics J. 2025 Jan-Mar;31(1):14604582241304708. doi: 10.1177/14604582241304708.

ABSTRACT

Introduction: Current discussions surround whether ‘person-first language’ (PFL) such as ‘patient with autism’ and ‘identity-first language’ (IFL) such as ‘autistic patient’ is most sensitive and appropriate. There is language guidance when talking about disability and race, ethnicity, and ancestry in genetics research, but not around PFL and IFL. We applied natural language processing (NLP) methods to PFL and IFL in published in genetics research, focussing on Autism Spectrum Disorders (ASD). Methods: Of the approximately 38,000 abstracts accepted in European Society of Human Genetics (ESHG) conference between 2001 and 2021, almost 5000 contained autism keywords. NLP analysis of these explored PFL and IFL use over time, in combination with specific nouns, and in combination with each other. Results: 262 instances of PFL and 264 instances of IFL showed similar, common and consistent use over time. Straightforward matches (e.g. ‘patient with ASD’ or ‘ASD patient’) accounted for most uses, with subtle differences in the frequently co-occurring nouns. 50 abstracts used both patterns, typically with one example of each. Conclusions: NLP can quantify use, timing and context for PFL and IFL in research articles. Consequently, NLP can support the development of language style guidelines or to evaluate their effectiveness.

PMID:39961131 | DOI:10.1177/14604582241304708

Ann Intern Med. 2025 Feb 18. doi: 10.7326/ANNALS-24-02426. Online ahead of print.

ABSTRACT

BACKGROUND: The Centers for Medicare & Medicaid Services (CMS) Severe Sepsis and Septic Shock Management Bundle (SEP-1) is now included in the Hospital Value-Based Purchasing (VBP) Program.

PURPOSE: To assess the evidence supporting SEP-1 compliance or SEP-1 implementation in improving sepsis mortality.

DATA SOURCES: PubMed, Web of Science, EMBASE, CINAHL Complete, and Cochrane Library from inception to 26 November 2024.

STUDY SELECTION: Studies of adults with sepsis that included 3- or 6-hour sepsis bundles defined by SEP-1 specifications.

DATA EXTRACTION: Article screening, full-text review, data extraction, and risk-of-bias assessment were independently performed by 2 authors. Level of evidence was determined using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria and National Quality Forum criteria.

DATA SYNTHESIS: A total of 4403 unique references were screened, and 17 studies were included. Twelve studies assessed the relationship between SEP-1 compliance and mortality; 5 showed statistically significant benefit, whereas 7 did not. Among studies showing benefit, 1 did not adjust for confounders, 1 found benefit only among patients with severe sepsis, 1 included only patients with septic shock, and 1 included only Medicare beneficiaries. Five studies assessed the relationship between SEP-1 implementation and sepsis mortality; only 1 showed significant benefit, but it did not adjust for mortality trends before SEP-1 implementation. All 17 studies were observational, and none had low risk of bias.

LIMITATIONS: The conclusions are limited by the underlying quality of the available studies, as all were observational. Because there was considerable methodologic heterogeneity among the included studies, a meta-analysis was not performed as the results could have been misleading.

CONCLUSION: This review found no moderate- or high-level evidence to support that compliance with or implementation of SEP-1 was associated with sepsis mortality. CMS should reconsider the addition of SEP-1 to the Hospital VBP Program.

PRIMARY FUNDING SOURCE: None. (PROSPERO: CRD42023482787).

PMID:39961104 | DOI:10.7326/ANNALS-24-02426

Tree Physiol. 2025 Feb 17:tpaf023. doi: 10.1093/treephys/tpaf023. Online ahead of print.

ABSTRACT

Droughts during dry seasons may pose a greater threat to Mediterranean forests under climate change. Effective desiccation avoidance strategies include reduced water loss rates, enhanced tissue water storage capacity, and greater root water access, which can avoid or delay dehydration damage. However, resource allocation competition may lead to trade-offs among these strategies that are not yet fully understood. In this study, six woody species from a Mediterranean forest were selected. We measured their twig hydraulic capacitance, ranging from 0.32-2.81 mmol m-2 MPa-1, to assess tissue water storage capacity, and twig residual conductance (gres) at 25 °C, ranging from 1.23-7.73 mmol m-2 s-1, to evaluate water loss rate. We found that the leaves of all four evergreen Mediterranean species featured sunken or hidden stomata, which may contribute to their low gres. The gres was also measured across a 25 °C-30 °C-40 °C temperature gradient, revealing species-specific response patterns. Predawn water potential (ΨPD) and the difference between predawn and midday water potential (∆Ψ) at the end of the dry summer season were used to estimate root water access. Significant trade-offs in plant desiccation avoidance strategies were observed as gres positively correlated with ∆Ψ (R2 = 0.78, P = 0.02) and twig hydraulic capacitance negatively correlated with ΨPD (R2 = 0.68, P = 0.04). Consequently, species with greater root water access exhibited lower tissue water storage capacity and higher gres, potentially increasing their mortality risk during extreme droughts when soil moisture is unavailable. By inverting a plant desiccation model, we demonstrated that both the calculated minimum hydraulic capacitance required for daily plant survival and a novel risk index positively correlated with ΨPD, supporting this conclusion. Notably, these findings align with historical statistics of tree mortality. Additionally, the risk index increased under scenarios of elevated temperature.

PMID:39961024 | DOI:10.1093/treephys/tpaf023

Medicine (Baltimore). 2025 Feb 14;104(7):e41355. doi: 10.1097/MD.0000000000041355.

ABSTRACT

This research aims to investigate the relationship between virus seropositivity and the occurrence of erectile dysfunction (ED). We obtained data from the U.S. Centers for Disease Control and Prevention’s National health and nutrition examination survey regarding ED, hepatitis A, herpes simplex virus type 1, herpes simplex virus type 2, and cytomegalovirus, along with sociodemographic variables. We then evaluated the associations between ED and viral exposure using adjusted multivariable models. A total of 3184 participants were included in the subsequent analysis. In this study, males with ED were found to have lower levels of education, were married or living with partner, belonged to a lower socio-economic status, had a less physically active lifestyle, were smokers, and also had diabetes (all with a significance of P < .05). Our study investigating the relationship between Hepatitis A seropositivity and ED found that patients with Hepatitis A seropositivity had a higher likelihood of experiencing ED. This link remained statistically significant even when accounting for various other factors (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.65-2.36; P < .0001). Additionally, we found that exposure to cytomegalovirus (CMV), determined by the presence of anti-CMV IgG antibodies, was also associated with ED (OR = 1.47; 95% CI = 1.14-2.25; P = .0329). This relationship remained significant after accounting for various covariates. In contrast, no associations were found between ED and seropositivity for herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2) in the sample (all P values < 0.05). This study found that seropositivity for Hepatitis A or CMV is associated with ED.

PMID:39960971 | DOI:10.1097/MD.0000000000041355

Medicine (Baltimore). 2025 Feb 14;104(7):e41529. doi: 10.1097/MD.0000000000041529.

ABSTRACT

At present, there is a lack of research on the correlation between cumFPG and digestive malignancies, and previous cohort studies have not considered the competitive risk between death and digestive malignancies, which may overestimate the impact of related risk factors. To explore the correlation between cumFPG and malignant tumors of the digestive system. In this study, 53,747 participants who had undergone 3 consecutive physical examinations since 2006 were collected. Finally, a total of 53,747 participants were included in this study. According to the grouping method of previous studies, cumFPG was divided into 4 groups according to the quartile. Cox regression model and competitive risk model were used to assess the risk of new digestive system malignancy. In sensitivity analyses, participants with cancer within 5 years of follow-up were excluded to eliminate the possibility of reverse causation. Subjects taking hypoglycemic drugs were excluded to eliminate the effect of the drug on blood glucose. Restricted cubic splineregresion (RCS) was then used to calculate the relationship between cumFPG and GI cancers. The mean age of participants was 49.02 ± 11.78 years. During a mean follow-up of 10.58 years, 817 new Gastrointestinal cases were identified, and the Cox proportional hazards model suggested that the risk of incidence in the Q2 to Q4 group increased sequentially compared with the lowest Q1 group, even after excluding the diagnosis of digestive malignancy within 5 years, the participants taking hypoglycemic drugs, and the death competition risk model analysis. In site-specific analysis, we observed that this risk was more pronounced in colorectal cancer, liver cancer, and pancreatic cancer, while gastric cancer, small bowel cancer, and bile duct cancer all had a similar trend to the main model but were not statistically significant, while esophageal cancer was U-shaped but not statistically significant. RCS results showed that cumFPG was associated with a similar risk of digestive system tumors, showing an inverted “√” type relationship. High levels of cumFPG are an independent factor in malignancy of the digestive system. cumFPG can provide a new idea for the prevention of Gastrointestinal cancers.

PMID:39960953 | DOI:10.1097/MD.0000000000041529

Medicine (Baltimore). 2025 Feb 14;104(7):e41554. doi: 10.1097/MD.0000000000041554.

ABSTRACT

High-flow nasal cannula (HFNC) therapy has emerged as an important method of respiratory support in the pediatric emergency department (ED), but its optimal use and factors affecting success require further investigation. The aim of this study was to evaluate the diagnosis and treatment response of patients receiving HFNC therapy in the pediatric ED and to investigate the factors affecting the success of HFNC therapy. This retrospective, cross-sectional study analyzed the data of 415 patients admitted to the Pediatric ED of the Istanbul Medical Faculty from 2021 to 2022 who received HFNC therapy. Treatment failure was defined as the required noninvasive ventilation (NIV) or intubation. Diagnoses were confirmed by examination findings, radiological imaging, laboratory tests and other hospital admissions. Respiratory disease was diagnosed in 88.2% of patients. The most common diagnoses were bronchiolitis (48%), pneumonia (23.6%), asthma (9.6%), reactive airway disease (5.8%), and heart failure (4.8%). Among the patients, 55.4% were admitted to the pediatric service, 28% were admitted to the intensive care unit, 8.7% were discharged, and 7.7% left the ED with a referral to an external center. HFNC therapy ended with symptom regression in 63.9% of patients, transition to NIV in 25.8%, and intubation in 4.3%. Although patients did not respond to HFNC therapy at 0 to 1 hour, a HFNC response was observed in almost half of the patients in the following periods. The presence of chronic disease and abnormal chest radiography findings were found to be independent risk factors for treatment failure, whereas the presence of allergic disease and the duration of HFNC therapy were found to be protective factors. HFNC therapy was effective in most pediatric patients with respiratory distress. Clinicians should consider extending HFNC therapy beyond the first hour in initial nonresponders, as significant improvement may occur in the following hours. Chronic disease and abnormal chest radiography findings were independent risk factors for failure of HFNC therapy. Conversely, allergic disease and longer HFNC duration were protective. Clinical and laboratory parameters should be considered when evaluating the efficacy of HFNC therapy. Therefore, patients should be evaluated individually, and treatment should be planned.

PMID:39960951 | DOI:10.1097/MD.0000000000041554

Medicine (Baltimore). 2025 Feb 14;104(7):e41517. doi: 10.1097/MD.0000000000041517.

ABSTRACT

BACKGROUND: This study investigated the link between arterial tortuosity and cervical artery dissection, focusing on carotid and vertebral tortuosity indices, as well as carotid tortuosity classifications (kinking, looping, and coiling).

METHODS: We searched PubMed, SCOPUS, Web of Science, and Google Scholar from database inception to January 2024. The inclusion criteria encompassed human studies on tortuosity and cervical, carotid, or vertebral artery dissection. Exclusion criteria included case reports, non-English studies, and studies solely on connective tissue disorders and diseases. Quality and risk of bias were assessed using the Newcastle-Ottawa Scale. Random-effects model was employed for mean differences and odds ratios. When meta-analysis was not feasible, we summarized and integrated the results narratively.

RESULTS: Seven studies, involving 507 dissected patients and 582 non-dissected patients, were included. In a meta-analysis of 3 studies, vertebral tortuosity favored the dissection cases [MD = 3.58, 95% CI: 2.21-4.95]. The mean carotid tortuosity difference was not statistically significant in a meta-analysis of 2 studies [MD = 2.27, 95% CI: -0.16-4.70]. In the classification analysis, 2 studies indicated no conclusive association between kinking, coiling, and cervical arteries dissection. Regarding carotid classification and internal carotid artery dissection, meta-analyses only showed a significant association with kinking, but the result was inconclusive.

CONCLUSION: Tortuosity index screenings may help prevent cervical artery dissection among at-risk individuals. However, the association with specific tortuosity classifications remains inconclusive, and further research is needed to validate these findings. Standardized measurement criteria are crucial for future studies.

PMID:39960948 | DOI:10.1097/MD.0000000000041517

Medicine (Baltimore). 2025 Feb 14;104(7):e41540. doi: 10.1097/MD.0000000000041540.

ABSTRACT

This retrospective study aimed to examine hospitalization costs and associated factors for Parkinson disease (PD) patients. A total of 848 PD patients were extracted from the National Neurological and Brain Center in Xinjiang, and basic demographic information, medical insurance payment, and hospital expenses were collected. SPSS 26.0 was used and univariate analysis was performed on the number of days of hospitalization, times of hospitalizations, gender, payment method, and total hospitalization costs. Correlation analysis was performed using multiple linear regression to explore the influencing factors of hospitalization expenses. The average hospitalization cost of PD patients was 15,515.78 ± 29,667.49 yuan. Diagnosis fees accounted for the highest proportion (29.50%), followed by material costs (25.50%) and drug costs (21.20%). PD patients with less than 5 hospitalizations were the main source of disease, but 2.83% of them had more than 10 hospitalizations (P = .025). Female patients were significantly more than male patients, but the total hospitalization costs of male patients were much higher than those of female patients (P < .001). The number of PD patients increased significantly when they were over 60 years old, but the hospitalization costs were much lower than those of patients under 60 years old (P = .007). The effect of the payment method on total hospitalization cost did not show a statistical difference (P = .213). There was a positive correlation between hospitalization days and total hospitalization cost (P < .001). In conclusion, the results of the regression model suggested that age, length of hospital stay, gender, and number of hospitalizations could be used as predictive variables for hospitalization costs in PD patients.

PMID:39960945 | DOI:10.1097/MD.0000000000041540

Medicine (Baltimore). 2025 Feb 14;104(7):e41568. doi: 10.1097/MD.0000000000041568.

ABSTRACT

This study aimed to investigate the predictive effect of static lung compliance (SLC) and airway resistance (AR) in patients undergoing minimally invasive cardiac surgery (MICS) with unilateral pulmonary edema (UPE). A total of 245 patients who underwent MICS via cardiopulmonary bypass and minimal right lateral thoracic incision port access were enrolled, with immediate postoperative SLC and AR data collected upon intensive care unit (ICU) admission. Cutoff values for grouping patients into high (H-) and low (L-) compliance/resistance categories were determined using receiver-operating characteristic curves and Youden indexes. The primary outcome was the incidence of radiographically and clinically defined UPE within the first 24 hours postoperatively, while the secondary outcomes included duration of mechanical ventilation, length of ICU stay, total hospitalization days, in-hospital mortality, and the highest sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE-II) scores within the first 24 hours post-surgery. Results showed that patients in the L-compliance group (SLC < 40 mL/cmH2O) had longer durations of mechanical ventilation, length of ICU stay, and total hospitalization days, along with higher SOFA and APACHE-II scores compared to those in the H-compliance group (SLC ≥ 40 mL/cmH2O) (P < .05), although there was no significant difference in in-hospital mortality. Conversely, patients in the H-resistance group (AR ≥ 11 cm H2O/[L·s]) exhibited longer durations of mechanical ventilation, length of ICU stay, and total hospitalization days, as well as significantly higher SOFA, APACHE-II scores, but lower in-hospital mortality rates than those in the L-resistance group (AR < 11 cm H2O/[L·s]) (P < .05). In summary, immediate postoperative SLC < 40 mL/cm H2O and AR > 11 cm H2O/(L·s) are potentially valuable indicators for predicting postoperative UPE in patients undergoing MICS.

PMID:39960940 | DOI:10.1097/MD.0000000000041568