Nevin Manimala

Clin J Oncol Nurs. 2025 Jan 17;29(1):E28-E36. doi: 10.1188/25.CJON.E28-E36.

ABSTRACT

BACKGROUND: Newly diagnosed patients with lung cancer experience significant challenges navigating a fragmented health system. Nurse navigators can use clinical expertise and coordination to address barriers to care.

OBJECTIVES: This quality improvement project aimed to expedite the selection and initiation of first-line treatment for patients with stage III or IV lung cancer. Using a nurse navigator process early on in care, coupled with liquid biopsy, this project focused on reducing the time from tissue biopsy to treatment decision.

METHODS: The team performed a retrospective chart review 12 months preimplementation and 8 months postimplementation.

FINDINGS: Using liquid biopsy, the time to treatment initiation was 21 days compared to 36 days with tissue biopsy only (p = 0.003). Postimplementation, median days to treatment decreased from 34 to 23.5 (p = 0.027), and treatment decisions made during the initial medical oncology visit increased from 38% to 55%.

PMID:39933081 | DOI:10.1188/25.CJON.E28-E36

Pancreas. 2025 Feb 12. doi: 10.1097/MPA.0000000000002476. Online ahead of print.

ABSTRACT

OBJECTIVES: Pancreatitis is common following endoscopic retrograde cholangiopancreatography (ERCP). Despite increased vigilance of post-ERCP pancreatitis (PEP), both its incidence and associated mortality are rising. Risk prediction models may provide more accurate stratification of patient risk and proactive mitigation of PEP incidence and/or severe associated outcomes.

METHODS: We conducted an electronic search of MEDLINE, PubMEd, Cochrane, and CINAHL from inception through April 9, 2024 for studies evaluating the details and performances of available PEP prediction models. Studies were eligible if they used statistical measures to quantify their model’s predictive ability. Risk of bias was determined using the PROBAST tool.

RESULTS: Nineteen studies met eligibility criteria and were included. Logistic regression models were used in 15 studies, with machine learning models representing the second most commonly employed approach. Ten studies reported the performance of their risk prediction models using derivation data, with areas under the receiver operating curve (AUC) ranging from 0.68 to 0.86. Fifteen studies reported the performance of their risk prediction models on internally validated data, with AUCs ranging from 0.66 to 0.97. Eight studies reported on the performance of their risk prediction models on external validation data, with AUCs ranging from 0.67 to 0.98.

DISCUSSION: Numerous PEP clinical prediction models exist with variable performances. The use of PEP prediction tools can support the management of patients following ERCP. Implementation studies assessing the optimal usability of these tools, followed by prospective evaluations, are needed to evaluate their potential impacts on reducing PEP in real-world practice.

PMID:39933053 | DOI:10.1097/MPA.0000000000002476

Pancreas. 2025 Feb 12. doi: 10.1097/MPA.0000000000002478. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the clinical efficacy of laparoscopic peritoneal lavage and drainage (LPLD) in the early stage of severe acute pancreatitis (SAP) and its potential role in reversing organ failure.

METHOD: This study involved 79 patients diagnosed with severe acute pancreatitis with ascites, who were admitted to the Affiliated Hospital of Youjiang Medical University of Nationalities between January 2020 and May 2024. Based on the intervention strategy, the patients were categorized into two groups: the abdominal paracentesis drainage (APD) group (n=42) and the LPLD group (n=37). We conducted a retrospective analysis comparing various parameters including demographic information, trends in inflammatory marker fluctuations, incidence of organ failure, step-up treatment, duration of ICU stay, drainage tube indwelling time, complications, total hospitalization days, total hospitalization cost , and mortality rates.

RESULTS: In addition to the observation that the preoperative volume of ascites was significantly greater in the APD group compared to the LPLD group (P = 0.005), the baseline characteristics of both groups were comparable. Postoperatively, The white blood cell count and C-reactive protein levels in the LPLD group exhibited a significantly faster decline compared to those in the APD group. (P < 0.05 and P < 0.001). There were no statistically significant differences in the rates of hemodialysis, pancreatic pseudocyst, abdominal compartment syndrome (ACS)，and mortality between the two patient groups. (P > 0.05). The LPLD group exhibited significantly reduced durations for mechanical ventilation, step-up treatment, duration of ICU stay, drainage tube indwelling time, duration of systemic inflammatory response syndrome (SIRS), incidence of intra-abdominal infection, new onset organ dysfunctions, total hospitalization days, and total hospitalization cost when compared to the APD group (P < 0.05).

CONCLUSIONS: In patients with SAP complicated by ascites, early-stage LPLD can effectively alleviate systemic inflammatory response, expedite organ failure reversal, delay disease progression, avoid step-up treatment, reduce postoperative complications and shorten hospitalization duration. This minimally invasive therapeutic approach represents a promising strategy for early intervention in SAP.

PMID:39933051 | DOI:10.1097/MPA.0000000000002478

Cancer. 2025 Feb 15;131(4):e35759. doi: 10.1002/cncr.35759.

ABSTRACT

BACKGROUND: Chemotherapy is required to improve the overall survival (OS) of patients with resectable pancreatic ductal adenocarcinoma (PDAC). Assessing the impact of chemotherapy dose density (DD) on survival is difficult as a result of confounding. The objective of this study was to determine the impact of chemotherapy DD on OS in patients with resectable PDAC.

METHODS: This was a secondary analysis of SWOG 1505, a randomized phase 2 trial of perioperative chemotherapy in resectable PDAC. DD was defined as the percentage of chemotherapy dose received of the total planned. Two landmark time points for OS were used: after surgery and at 40 weeks (which encompassed the entire treatment period).

RESULTS: Of the 102 eligible patients enrolled, 73 (71%) underwent surgery, and median preoperative chemotherapy DD was 89%. Patients with ≥85% DD had higher OS compared to those with <85% DD (median, 38.1 vs. 17.2 months; p = .039). Of the 82 patients who survived to 40 weeks postrandomization, 67 underwent surgery, and median DD for all perioperative chemotherapy was 67%. In this cohort, DD ≥70% was associated with better OS (median, 32.2 vs. 14.0 months; p = .017). Perioperative DD was not significantly associated with pathologic response, margin status, or lymph node negativity.

CONCLUSIONS: This is the first study to identify a prognostic association of chemotherapy DD with OS in patients undergoing perioperative chemotherapy and surgery for resectable PDAC. Patients who received ≥85% DD preoperatively and/or ≥70% DD perioperatively survived longer than those receiving a smaller proportion of protocol therapy.

PMID:39932777 | DOI:10.1002/cncr.35759

J Med Internet Res. 2025 Feb 11;27:e48775. doi: 10.2196/48775.

ABSTRACT

BACKGROUND: Social determinants of health (SDoH), such as financial resources and housing stability, account for between 30% and 55% of people’s health outcomes. While many studies have identified strong associations between specific SDoH and health outcomes, little is known about how SDoH co-occur to form subtypes critical for designing targeted interventions. Such analysis has only now become possible through the All of Us program.

OBJECTIVE: This study aims to analyze the All of Us dataset for addressing two research questions: (1) What are the range of and responses to survey questions related to SDoH? and (2) How do SDoH co-occur to form subtypes, and what are their risks for adverse health outcomes?

METHODS: For question 1, an expert panel analyzed the range of and responses to SDoH questions across 6 surveys in the full All of Us dataset (N=372,397; version 6). For question 2, due to systematic missingness and uneven granularity of questions across the surveys, we selected all participants with valid and complete SDoH data and used inverse probability weighting to adjust their imbalance in demographics. Next, an expert panel grouped the SDoH questions into SDoH factors to enable more consistent granularity. To identify the subtypes, we used bipartite modularity maximization for identifying SDoH biclusters and measured their significance and replicability. Next, we measured their association with 3 outcomes (depression, delayed medical care, and emergency room visits in the last year). Finally, the expert panel inferred the subtype labels, potential mechanisms, and targeted interventions.

RESULTS: The question 1 analysis identified 110 SDoH questions across 4 surveys covering all 5 domains in Healthy People 2030. As the SDoH questions varied in granularity, they were categorized by an expert panel into 18 SDoH factors. The question 2 analysis (n=12,913; d=18) identified 4 biclusters with significant biclusteredness (Q=0.13; random-Q=0.11; z=7.5; P<.001) and significant replication (real Rand index=0.88; random Rand index=0.62; P<.001). Each subtype had significant associations with specific outcomes and had meaningful interpretations and potential targeted interventions. For example, the Socioeconomic barriers subtype included 6 SDoH factors (eg, not employed and food insecurity) and had a significantly higher odds ratio (4.2, 95% CI 3.5-5.1; P<.001) for depression when compared to other subtypes. The expert panel inferred implications of the results for designing interventions and health care policies based on SDoH subtypes.

CONCLUSIONS: This study identified SDoH subtypes that had statistically significant biclusteredness and replicability, each of which had significant associations with specific adverse health outcomes and with translational implications for targeted SDoH interventions and health care policies. However, the high degree of systematic missingness requires repeating the analysis as the data become more complete by using our generalizable and scalable machine learning code available on the All of Us workbench.

PMID:39932771 | DOI:10.2196/48775

J Nurs Educ. 2025 Feb 12:1-4. doi: 10.3928/01484834-20241029-04. Online ahead of print.

ABSTRACT

BACKGROUND: This quality improvement project evaluated the effectiveness, barriers, and perceived student effects of an accessibility initiative, including Universal Design for Learning, from faculty perspectives across a school of nursing’s five campuses in the Pacific Northwest.

METHOD: A descriptive cross-sectional design was used for this study. Eighty faculty completed a survey with quantitative and qualitative components. Data were analyzed using descriptive statistics and thematic analysis.

RESULTS: Faculty found the training and resources useful, improving their knowledge and confidence in designing accessible online and hybrid courses. Barriers often were time-related, with faculty struggling to allocate time to attend training sessions and create digitally accessible content. Student feedback and faculty perceptions illustrated how accessible design supports the diverse needs of students with disabilities and fosters better learning experiences.

CONCLUSION: These findings highlight the effectiveness of accessible design to support the success of all nursing students to promote diversity, equity, and inclusion in nursing practice. [J Nurs Educ. 2025;64(X):XXX-XXX.].

PMID:39932726 | DOI:10.3928/01484834-20241029-04

JAMA Netw Open. 2025 Feb 3;8(2):e2458834. doi: 10.1001/jamanetworkopen.2024.58834.

ABSTRACT

IMPORTANCE: Information about longitudinal associations of attention-deficit/hyperactivity disorder (ADHD) diagnosis, symptom severity, pharmacotherapy, and incident nicotine and tobacco use, including e-cigarettes, among US youths is limited.

OBJECTIVE: To evaluate whether ADHD diagnosis, symptom severity, and pharmacotherapy are associated with incident e-cigarette and tobacco use over a 9-year period.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study followed up a nationally representative sample of US youths and their parents in the Population Assessment of Tobacco and Study via questionnaires from wave 1 (September 2013 to December 2014) to waves 2 to 7 (October 2014 to April 2023). Participants were representative of the US civilian noninstitutionalized population. Youths aged 12 to 17 years at wave 1 (N = 13 572) and their parents were interviewed.

EXPOSURES: Time in years and history of ADHD diagnosis, symptom severity, and pharmacotherapy at wave 1 were used to construct 9 mutually exclusive subgroups of US youths, including those with ADHD diagnosis and pharmacotherapy, ADHD diagnosis without pharmacotherapy, and population controls without ADHD diagnosis; within each of these 3 subgroups, ADHD symptom severity was categorized as none, 1 to 2, or 3 to 4 symptoms.

MAIN OUTCOMES AND MEASURES: Incident e-cigarette use, cigarette smoking, other tobacco use, and dual use (e-cigarette and cigarette and/or other tobacco use) in weighted percentages with 95% CIs.

RESULTS: Of the 13 572 youths included in the analysis, 6967 (51.3%; 95% CI, 51.2%-51.5%) were male. An estimated 1881 participants (14.1%; 95% CI, 13.2%-15.0%) were diagnosed with ADHD. Multivariable logistic regression analyses indicated that the adjusted odds of incident e-cigarette use, cigarette smoking, other tobacco use, and dual use did not significantly differ between those with asymptomatic ADHD (with or without pharmacotherapy) compared with population controls. In contrast, all subgroups who had 3 or more ADHD symptoms (with or without pharmacotherapy) had significantly higher adjusted odds of e-cigarette use (adjusted odds ratio [AOR], 1.60; 95% CI, 1.34-2.04), cigarette smoking (AOR, 1.52; 95% CI, 1.22-1.89), other tobacco use (AOR, 1.61; 95% CI, 1.27-2.02), and dual use (AOR, 1.72; 95% CI, 1.38-2.14) compared with youths with asymptomatic ADHD or population controls. Among youths with ADHD, those with highly symptomatic ADHD were significantly more likely to initiate e-cigarette (AOR, 1.68; 95% CI, 1.16-2.44) and dual use (AOR, 1.82; 95% CI, 1.17-2.83) than youths without symptoms.

CONCLUSIONS AND RELEVANCE: In this cohort study of US youths, ADHD symptoms were associated with the onset of nicotine and tobacco use. Findings highlight the importance of early diagnosis and effective treatment of ADHD to alleviate symptoms and reduce the risk of later nicotine and tobacco use.

PMID:39932711 | DOI:10.1001/jamanetworkopen.2024.58834

JAMA Netw Open. 2025 Feb 3;8(2):e2459342. doi: 10.1001/jamanetworkopen.2024.59342.

ABSTRACT

IMPORTANCE: Despite growing national concern about high and increasing rates of pregnancy-associated mortality due to homicide, suicide, and drug overdose, state-level incidence has previously not been available.

OBJECTIVE: To identify cases of pregnancy-associated homicide, suicide, drug overdose, and deaths involving firearms in the US from calendar year 2018 to 2022 and estimate 5-year proportionate mortality and mortality ratios per 100 000 live births by state and cause of death.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study is a population-based analysis of the 2018-2022 restricted-use mortality files provided by the National Center for Health Statistics. These data include all deaths occurring in the US, with geographic identifiers for state of residence. All records in which the decedent was female aged 10 to 44 years and pregnant at the time of death or up to 1 year earlier were included in the analysis. Data were analyzed from July 1 to December 1, 2024.

MAIN OUTCOMES AND MEASURES: International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for underlying cause of death were used to identify cases of homicide, suicide, drug overdose, and deaths involving firearms occurring in each state from 2018 to 2022. Proportionate mortality was estimated as the count of cases divided by the total count of deaths of pregnant and postpartum women in each state. Cause-specific mortality ratios were estimated as the count of cases divided by the total count of live births in each state from 2018 to 2022.

RESULTS: Nationally, there were 10 715 deaths of people who were pregnant or within 1 year post partum from 2018 to 2022, including 837 homicides, 579 suicides, 2083 drug overdoses, and 851 that involved firearms. Proportionate mortality and mortality ratios for homicide, suicide, and drug overdose varied across the US. Of states with more than 9 cases, pregnancy-associated homicide mortality was highest in Mississippi (12.86 per 100 000 live births), pregnancy-associated suicide mortality was highest in Montana (21.55 deaths per 100 000 live births), and pregnancy-associated drug overdose was highest in Delaware (36.03 deaths per 100 000 live births). Firearms accounted for as many as 15.56% of pregnancy-associated deaths in Colorado, and pregnancy-associated firearm mortality was highest in Mississippi (13.42 deaths per 100 000 live births).

CONCLUSIONS AND RELEVANCE: The information in this study may provide relevant guidance for state and local intervention strategies to advance the health, safety, and well-being of women during pregnancy and beyond.

PMID:39932710 | DOI:10.1001/jamanetworkopen.2024.59342

Minerva Urol Nephrol. 2025 Feb 11. doi: 10.23736/S2724-6051.24.05871-3. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to compare the efficacy and safety of Aquablation^® with those of holmium laser enucleation of the prostate (HoLEP) for the treatment of patients with benign prostatic hyperplasia (BPH).

METHODS: Prospective comparative non-randomized multicenter study conducted between July 2021 and July 2023, consecutive patients undergoing BPH surgery were enrolled to each group. Patients had moderate to severe lower urinary tract symptoms (LUTS), International Prostate Symptom Score (IPSS) ≥8, maximum urinary flow rate (Qmax) ≤15 mL/s, prostate volume ≥30 mL ≤120 mL, and BPH medical therapy failure. Primary outcome was short-term efficacy measured by IPSS, IPSS-QoL, Qmax, post-void residual volume (PVR), prostate-specific antigen (PSA); secondary outcome was safety (intra and post-operative complications, ejaculatory dysfunction, continence, blood transfusions). A six-month follow-up was performed.

RESULTS: Of 150 patients (75:75) enrolled, both groups showed improvements (P<0.05) in IPSS, IPSS-QoL, Qmax, and PVR at six months. No significant differences were observed between HoLEP and Aquablation^® in IPSS (7.6±6.9 vs. 5.05±4.9 points, P=0.11), IPSS-QoL (1.7±1.6 vs. 1.3±1.6 points, P=0.16), Qmax (28.6±8.8 vs. 23.8±9.3 mL/sec, P=0.12), and PVR (7.2±8.2 vs. 20.3±22.6 mL, P=0.19) at six months. No intraoperative complications occurred. Postoperative hemoglobin drop was higher in Aquablation^® group (2.6±1.33 vs. 0.4±0.67 g/dL, P<0.001), with no statistically significant differences in transfusion rate (1.3 vs. 1.3%, P=0.31). Ejaculatory dysfunction rate was significantly lower in Aquablation^® (6,6%) than HoLEP (89.3%, P<0.001). Mean prostate volume was (mean±SD) 81.8±37.4 and 71.9±34.8 mL (P=0.08) in HoLEP and Aquablation^® groups, respectively. Holep demonstrated a smaller prostate volume after treatment (18.1±6.5 vs. 46.5±25.02 mL P<0.001) as well as a significantly greater reduction and lower levels of PSA (1.2±1.4 vs. 2.65±2.8 ng/mL, P<0.001). Aquablation^® demonstrated significantly shorter tissue removal time (5.5±2.4 vs. 22.4±9.8 min, P<0.001), but no difference in total operative time (49.1±15 vs. 43.9±26.8 min, P=0.052).

CONCLUSIONS: HoLEP and Aquablation^® show similar effectiveness and safety for BPH-related-LUTS at 6 months. Aquablation^® has lower ejaculatory dysfunction rates. Larger randomized trials and with longer follow-up time are needed for validation.

PMID:39932697 | DOI:10.23736/S2724-6051.24.05871-3

J Phys Ther Educ. 2025 Feb 7. doi: 10.1097/JTE.0000000000000397. Online ahead of print.

ABSTRACT

INTRODUCTION: Physical therapy clinical education experiences (CEE) typically involve a 1:1 or 2:1 student:instructor ratio. Students may also be supervised by more than 1 clinical instructor (CI), referred to as shared clinical instruction. The purpose of this study was to examine the incidence and implementation of shared clinical instruction in the United States.

REVIEW OF LITERATURE: Burnout and moral distress, along with the growing number of physical therapist (PT) education programs, contribute to limitations in clinical education capacity. Shared clinical instruction may benefit both educators and students, warranting further investigation.

SUBJECTS: Deidentified data were extracted from 178 PT education programs using Exxat in September 2023.

METHODS: This study analyzed CEE data between January 2014 and September 2023 (placement setting, state, dates, length of the CEE, number of assigned CIs, CI years of clinical experience and as a CI, credentialed instructor status, and specialization status) using descriptive and inferential statistics.

RESULTS: Almost all, 175 (98.3%) of the 178 programs, and 16,356 (12.5%) of the 131,184 CEEs in the data set had students who participated in shared clinical instruction, representing all 50 states, and every clinical setting. Shared clinical instruction occurred in longer CEEs compared with 1:1 experiences; binary logistic regression indicated that longer CEEs predicted higher rates of shared clinical instruction. Independent t-tests indicate that primary CIs in shared clinical instruction had slightly more years of clinical and instructional experience.

DISCUSSION AND CONCLUSION: Shared clinical instruction is occurring in most PT education programs and clinical settings in the United States. Further investigation should explore the rationale behind the use of shared clinical instruction in various practice settings, and the selection and pairing of CIs in this model, along with the efficacy of shared clinical instruction, including benefits, challenges, and best practices.

PMID:39932684 | DOI:10.1097/JTE.0000000000000397