Nevin Manimala

JAMA Netw Open. 2026 Mar 2;9(3):e260853. doi: 10.1001/jamanetworkopen.2026.0853.

ABSTRACT

IMPORTANCE: Alzheimer disease (AD) pathology may begin decades before symptoms. Genetic factors, such as APOE ε4 carrier status and polygenic risk scores (PRS), influence AD risk, but their roles in cognitive decline among Asian populations remain unclear.

OBJECTIVE: To evaluate whether APOE ε4 carrier status and a non-APOE polygenic risk score (PRS_ADnapoe) are associated with age-related cognitive decline in community-dwelling older adults in Taiwan.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used data from 2 assessment waves of the Healthy Aging Longitudinal Study in Taiwan, spanning 2009 to 2019. Participants were aged 55 years and older and had both genetic data and Mini-Mental State Examination (MMSE) scores. Data analyses were conducted from August to December 2025.

EXPOSURES: APOE ε4 carrier status (noncarrier, heterozygote, homozygote) and PRS_ADnapoe score, derived from genome-wide association summary statistics excluding APOE variants.

MAIN OUTCOMES AND MEASURES: The primary outcome was change in MMSE scores, which were assessed cross-sectionally and longitudinally, modeled with mixed-effects regression accounting for age-related effects and covariates including sex, education, smoking, and population structure.

RESULTS: Among 4392 participants (mean [SD] age, 68.2 [7.8] years; 2359 [53.7%] women), 723 (16.5%) were APOE ε4 heterozygotes and 33 (0.8%) were APOE ε4 homozygotes. Over a mean (SD) follow-up of 6.3 (0.9) years, the mean (SD) annual MMSE decline was -0.2 (0.5). APOE ε4 carriage was associated with a significantly steeper quadratic age-associated decline in MMSE scores compared with noncarriers (estimate, -0.005; SE, 0.001; P = .001). This association was strongest among homozygotes (estimate, -0.017; SE, 0.008; P = .03), with MMSE trajectories diverging after approximately age 70 years. In contrast, PRS_ADnapoe scores were not associated with MMSE decline. Sensitivity analyses restricted to participants with 2-wave data and adjusted with inverse probability of censoring weighting confirmed these findings.

CONCLUSIONS AND RELEVANCE: In this cohort study of middle-aged and older adults in Taiwan, APOE ε4 carriage, particularly homozygosity, was associated with accelerated age-related cognitive decline detectable after age 70 years, whereas non-APOE polygenic risk was not associated with cognitive decline over the current follow-up. These results highlight the potential utility of early genetic risk awareness and support consideration of targeted preventive strategies for APOE ε4 carriers.

PMID:41790466 | DOI:10.1001/jamanetworkopen.2026.0853

Clin Cancer Res. 2026 Mar 6. doi: 10.1158/1078-0432.CCR-25-3726. Online ahead of print.

ABSTRACT

On May 5, 2021 and March 19, 2025, the Food and Drug Administration (FDA) granted accelerated and regular approval for pembrolizumab plus trastuzumab and platinum-based chemotherapy for unresectable or metastatic human epidermal growth factor receptor-2 (HER2) gastric or gastroesophageal junction carcinoma. Both approvals were based on KEYNOTE-811, a randomized, multiregional trial, comparing pembrolizumab plus trastuzumab and chemotherapy versus placebo plus trastuzumab and chemotherapy. Accelerated approval was granted based on overall response rate (ORR) in the first 264 patients randomized, showing a statistically significant improvement with pembrolizumab (74.4% vs. 51.9%, p= 0.00006). The final overall survival (OS) analysis demonstrated a clinically meaningful improvement, with a median OS of 20.0 months (95% CI 17.8, 22.1) and 16.8 months (95% CI 14.9, 18.7) in the pembrolizumab and placebo arms respectively (HR 0.80 [95% CI 0.67, 0.94]; p= 0.004). However, in exploratory subgroup analyses treatment benefit appeared to be driven by the PD-L1 CPS ≥1 population (85% of patients, with an OS HR of 0.79 [95% CI 0.66, 0.95]), whereas in the CPS <1 subgroup (15% of patients) treatment with pembrolizumab did not show improvement (HR 1.10, [95% CI 0.72-1.68]). These results are consistent with analysis of pembrolizumab and other immune checkpoint inhibitors across multiple clinical trials in patients with gastric cancer. KEYNOTE-811 utilized a “one-trial” approach allowing accelerated approval based on response rate with subsequent conversion to regular approval based on survival outcomes. KEYNOTE-811 also provided data for earlier access to therapies in a frontline metastatic setting, following FDA’s Project Frontrunner approach.

PMID:41790455 | DOI:10.1158/1078-0432.CCR-25-3726

JAMA Health Forum. 2026 Mar 6;7(3):e256935. doi: 10.1001/jamahealthforum.2025.6935.

NO ABSTRACT

PMID:41790454 | DOI:10.1001/jamahealthforum.2025.6935

Int J Pharm Pract. 2026 Mar 6:riag031. doi: 10.1093/ijpp/riag031. Online ahead of print.

ABSTRACT

OBJECTIVES: In several countries, pharmacists have gained prescribing authority to enhance the quality and accessibility of healthcare. Elsewhere, pharmacists initiate or modify prescriptions that are subsequently countersigned by a prescriber, potentially serving as a stepping stone toward formal prescribing legislation. This study aimed to investigate current prescription modifications by Dutch pharmacists and their views on introducing prescribing authority.

METHODS: A nationwide cross-sectional survey was conducted among pharmacists in the Netherlands via national professional networks in April and May 2024. The questionnaire assessed current prescription modification practices, pharmacists’ agreement regarding the introduction of formal prescribing authority, and their perceived needs and readiness for prescribing. Data were analysed using descriptive statistics.

KEY FINDINGS: Among the 476 respondents, most worked in community pharmacy (76.7%; n = 365), followed by inpatient hospital pharmacy (14.7%; n = 70). The two most common prescription modifications were adjusting or initiating prescriptions based on clinical decision rules (81.1%; n = 386), and performing therapeutic substitution during drug shortages or according to local formularies (79.6%; n = 379). Almost all respondents favoured formal prescribing authority for at least one prescription modification practice (98.1%; n = 467). Respondents most often indicated clear task division and agreements between physicians and pharmacists (93.9%, n = 447) as a need for implementation. Readiness to use prescribing authority was reported by 92.6% (n = 441) of the respondents.

CONCLUSIONS: The majority of pharmacists frequently initiate or modify prescriptions, and expressed both willingness and readiness to formalize these practices. These findings are valuable for policymakers considering the introduction of formal pharmacist prescribing authority.

PMID:41790438 | DOI:10.1093/ijpp/riag031

Issues Ment Health Nurs. 2026 Mar 6:1-13. doi: 10.1080/01612840.2026.2636099. Online ahead of print.

ABSTRACT

In the context of schizophrenia, it has been previously held that the more insight a patient has about their condition, the more likely they are to adhere to their medication regimen more closely. However, insight alone may not be enough. Metacognitive beliefs (ideas and assumptions about their own cognitive processes, such as thinking, memory, and attention) serve as a critical factor impacting this relationship, given their association with both improved medication adherence and increased insight. Another key component of insight is one’s ability to reminisce. However, no existing studies have explored the link between reminiscence and medication adherence, which could inform the development of appropriate patient interventions. This study aimed to examine the moderating effect of metacognitive beliefs on the relationship between insight and medication adherence and assess the prediction of medication adherence based on reminiscence functions in a sample of patients hospitalized for schizophrenia. This cross-sectional study employed a convenience sampling method to collect data from 224 patients hospitalized for schizophrenia, as administered through interviews with clinical staff. While reminiscence functions were not directly associated with improved medication adherence, this could be due to their relationship with other sociodemographic predictors in the model. It was shown, however, that higher levels of metacognitive beliefs, dominated by dysfunctional metacognitive beliefs, were significantly associated with a reduced effect of insight on medication adherence (p = 0.016). Patients with high levels of dysfunctional metacognitive beliefs struggle with connecting awareness of their condition with the necessity of adhering to medication. Mental health nurses should consider overarching assessments of metacognitive beliefs to further understand medication adherence and its relationship with patient insight.

PMID:41790431 | DOI:10.1080/01612840.2026.2636099

Int Urol Nephrol. 2026 Mar 6. doi: 10.1007/s11255-026-05082-8. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the feasibility and safety of omitting postoperative urinary catheter placement in patients undergoing percutaneous nephrolithotomy (PCNL) under paravertebral block (PVB) anesthesia without retrograde catheterization.

METHODS: This retrospective study analyzed 197 eligible patients selected from an initial cohort of 248. All patients received PCNL under PVB. They were divided into two groups based on postoperative catheterization: Group 1 (without urinary catheter, n = 97) and Group 2 (with urinary catheter, n = 100). To minimize confounding factors, propensity score matching was performed based on the number of access tracts, resulting in two groups: Group A (without urinary catheter, n = 90) and Group B (with urinary catheter, n = 90). Preoperative baseline characteristics, perioperative parameters, and postoperative complications were compared between the groups.

RESULTS: No significant differences were observed in age, gender, body mass index (BMI), comorbidities, stone characteristics, or preoperative laboratory findings between the two groups (P > 0.05), indicating comparability. Regarding surgical efficacy and safety, there were no statistically significant differences in operative time, blood loss, number of access tracts, postoperative hemoglobin drop, inflammatory marker changes, or initial stone-free rate (P > 0.05). Group A showed superior outcomes in several aspects: lower visual analog scale (VAS) pain scores (P < 0.001), shorter postoperative hospital stay [3.00 (3.00, 4.00) vs. 4.00 (3.00, 4.00) days, P < 0.001], lower incidence of postoperative urinary tract infection (2/90 vs. 10/90, P = 0.017), and lower overall postoperative complication rate (9/90 vs. 25/90, P < 0.002).

CONCLUSION: For appropriately selected patients undergoing PCNL under PVB without retrograde catheterization, omitting the postoperative urinary catheter is a safe practice. This approach is associated with reduced postoperative pain, shorter hospitalization, and merits clinical consideration under standardized perioperative management.

PMID:41790419 | DOI:10.1007/s11255-026-05082-8

Doc Ophthalmol. 2026 Mar 6. doi: 10.1007/s10633-026-10091-0. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the agreement between Snellen visual acuity (VA) and sweep visual evoked potential (sVEP) VA in individuals with normal vision and assess sVEP variability and reproducibility across multiple test sessions.

METHODS: Thirty-nine healthy participants (78 eyes) underwent Snellen and sVEP VA testing. Ten participants (20 eyes) also underwent sVEP testing twice daily (morning and afternoon) on three separate days (120 total recordings). and Snellen VA measurements showed strong agreement, with a mean absolute difference of 0.03 LogMAR (less than one Snellen line). Forty of 78 eyes had differences within one Snellen line, while the largest discrepancy reached four lines. Statistical analysis (P = 0.201) indicated no significant difference between the two methods. sVEP reproducibility was also high, with no significant variation between morning and afternoon recordings (P = 0.67), confirming its stability as a clinical tool.

CONCLUSION: sVEP provides objective and reproducible VA measurements comparable to Snellen VA, suggesting its potential as an alternative clinical assessment tool, particularly for patients with communication challenges, cognitive impairments, or suspected malingering vision loss.

PMID:41790402 | DOI:10.1007/s10633-026-10091-0

Cogn Res Princ Implic. 2026 Mar 6;11(1):20. doi: 10.1186/s41235-026-00708-y.

ABSTRACT

Contemporary language learning applications such as Duolingo and Rosetta Stone often introduce vocabulary through guessing-with-feedback exercises in which learners match words and pictures. We investigated whether that process might yield a pretesting effect-that is, the phenomenon where guessing with correct answer feedback (pretesting) enhances memory. Across four experiments, adult online learners engaged in multiple-choice pretesting to learn Spanish word translations shown in word-image (Experiments 1-2) or image-word (Experiments 3-4) format. Relative to a read-only condition, pretesting yielded statistically significant performance improvements on subsequent cued recall (Cohen’s d = 0.18-0.40) and, in most cases, multiple-choice tests (d = 0.25-0.67), regardless of whether test formats were separately presented or intermixed. Participants also reported preferring pretesting over reading for learning second-language vocabulary, especially for word-image learning. Together, these findings extend the pretesting effect to visual and verbal materials, offering theoretical insights and substantiating word-image and image-word guessing-based approaches of language learning.

PMID:41790401 | DOI:10.1186/s41235-026-00708-y

Eur Arch Paediatr Dent. 2026 Mar 6. doi: 10.1007/s40368-026-01188-w. Online ahead of print.

ABSTRACT

BACKGROUND: Refugee families often arrive in Europe full of hope after facing many challenges. It is known that a significant proportion of them suffer from post-traumatic stress disorder (PTSD) and that this is associated with bad health status, including oral health in adults. While it is known that refugee children have poor dental health, it remains unclear if this is related to their mental health. We aimed to find out if children’s PTSD status was associated with their dental health. We further examined if parental mental health is associated with children’s dental health.

METHODS: The study is part of the German INterCuLtUral Child DevelopmEnt Studies (INCLUDE). Dental and psychological examination of n = 44 children between 1.5 and 6 years was conducted. Dental health was assessed with dmft value and O’Leary Plaque Index (PI). The Child and Adolescent Trauma Screening was applied to test for PTSD symptoms in children. Parental mental health was assessed with the refugee health screener (RHS). Descriptive analyses and multiple linear regression were performed to test the association between child’s PTSD and dental health with parental mental health.

RESULTS: Mean dmft value was 4.98 (± 3.69), mean PI was 40.92 (± 14.76). PTSD was detected in 30% of the children. There were no statistically significant differences between children with and without PTSD symptoms pertaining dental health. Linear regression yielded child’s age and parental RHS score to be positively associated with child’s dmft value.

CONCLUSIONS: Children’ had poor dental health status, regardless of the presence of PTSD. Parental mental health was associated with child dental health. Interventions and programs for refugee children should consider parental mental health as well.

PMID:41790396 | DOI:10.1007/s40368-026-01188-w

Wien Med Wochenschr. 2026 Mar 6. doi: 10.1007/s10354-026-01134-x. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Inpatient acute geriatric wards provide care for older patients with multiple morbidities who require treatment due to acute events, with a focus on maintaining or restoring independence. Geriatric patients need treatment that takes into account medical, functional, psychological, and social aspects. In 2005, the Association for Quality in Geriatrics and Gerontology (QiGG) developed a uniform documentation standard for process control and quality assurance in acute geriatric inpatient care, which is used by many acute geriatric wards in Austria. Aim of this study was to conduct a reliable, systematic analysis of data collected in 2024 from acute geriatric wards in Austria, taking into account gender-specific differences, in order to provide transparency on the geriatric care situation and thereby generate a basis for scientific analysis, evidence-based planning, and managing of future care structures.

METHODS: Patient characteristics, therapeutic services, length of stay, and geriatric assessment parameters (self-care ability, mobility, social history, polypharmacy) were analyzed from data of 7545 patients from 15 acute geriatric wards in Austria in 2024. Data were collected using the digital Benchmarking and Reporting System CDS-BARS, and analyzed using descriptive statistics.

RESULTS: More than 50% of the patients were admitted to acute geriatric wards within 2 weeks of the acute event. Overall, almost twice as many women as men were admitted. On average, patients had around 7.6 functional impairments upon admission. Most patients remained in the acute geriatric ward for 15 to 21 days and achieved a demonstrable and quantifiable improvement in their self-care abilities and mobility during their stay. A total of 90.5% of patients who lived at home before their stay returned home afterwards.

CONCLUSION: This study underscores the importance of acute geriatric wards in an aging society and the need for continuous development of acute geriatric structures.

PMID:41790386 | DOI:10.1007/s10354-026-01134-x