Nevin Manimala

Br J Radiol. 2025 Jul 10:tqaf150. doi: 10.1093/bjr/tqaf150. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the diagnostic yield of thoraco-abdominal-pelvic CT (TAP-CT) in suspected infection of unclear origin in the Emergency Department (ED) and identify predictive factors for normal TAP-CT to optimize its use.

METHODS: We retrospectively categorized 517 TAP-CT studies of adult patients with non-severe infection of unclear origin based on the presence of an infectious focus or significant findings, such as neoplasia or thrombosis. Descriptive analysis, correspondence assessment between CT results and final diagnosis, and statistical modeling were performed to identify predictors of normal TAP-CT.

RESULTS: An infectious focus was identified in 55% TAP-CT scans, mainly pulmonary (46%), bilio-digestive (25%), and genitourinary (23%). Significant noninfectious findings were detected in 20%, including thrombosis (7%) and neoplasia (12%). TAP-CT showed a sensitivity of 73%, specificity of 88%, PPV of 94%, and NPV of 57%, with moderate agreement (Kappa= 0.53) between TAP-CT findings and final diagnosis. Overall, 67% of patients had an identifiable cause for infection-like symptoms. Although C-reactive protein <128 mg/L was associated with normal TAP-CT, no model reliably predicted a normal scan.

CONCLUSIONS: TAP-CT identified a relevant finding in over two-thirds of cases, reinforcing its role in diagnosing both infectious and mimicking conditions. No specific criteria could safely exclude TAP-CT, making it a valuable tool for managing patients with suspected infections of unclear origin.

ADVANCES IN KNOWLEDGE: This study is the first to assess TAP-CT’s value in suspected non-severe infections of unclear origin in the ED, highlighting its role in detecting infectious and noninfectious conditions and optimizing diagnostic strategies.

PMID:40638233 | DOI:10.1093/bjr/tqaf150

Comput Inform Nurs. 2025 Jul 9. doi: 10.1097/CIN.0000000000001358. Online ahead of print.

ABSTRACT

This study aimed to examine the effect of the course on technology use in nursing on students’ readiness for self-directed learning and attitudes toward technology. This was a quasi-experimental study. The study involved 109 first-year nursing students assigned to the intervention group (n = 53) and the control group (n = 56). Whereas the intervention group participated in the course on technology use in nursing, the control group participated in health assessment course. Data were collected with the Student Information Form, the Readiness of Self-directed Learning Scale, and Technology Attitudes Survey between March and May 2024. There was a statistically significant difference between the self-directed learning readiness and attitudes toward technology scores of the intervention and control groups (P < .05). It was found that both the self-directed learning readiness and positive attitudes toward technology scores of the students in the intervention group were significantly higher than the control group (P < .05). The study’s results indicated that course on technology use in nursing improved students’ self-directed learning readiness and positive attitudes toward technology. The integration of technology-based interventions into nursing curriculum is recommended.

PMID:40638231 | DOI:10.1097/CIN.0000000000001358

Interdiscip Cardiovasc Thorac Surg. 2025 Jul 10:ivaf133. doi: 10.1093/icvts/ivaf133. Online ahead of print.

ABSTRACT

OBJECTIVES: Current guidelines recommend concomitant surgical ablation at the time of mitral surgery for patients with atrial fibrillation, however there is a paucity of data on long-term outcomes in this population. We sought to assess long-term clinical outcomes in patients undergoing concomitant surgical ablation at the time of mitral surgery.

METHODS: The United States Centers for Medicare and Medicaid data was used to identify patients undergoing mitral repair or replacement from 2015 to 2019. After excluding prior cardiac surgery, endocarditis, and emergencies, we identified 11,410 patients undergoing isolated mitral repairs or replacement with pre-operative atrial fibrillation. Of these, 3,268(29%) received surgical ablation and 8,142(71%) did not. Propensity score matching was performed on 27 baseline characteristics. The primary outcome was freedom from death or stroke at four years. The secondary outcome was all-cause mortality at four years. Both were assessed using Cox-proportional hazard models.

RESULTS: Propensity matching yielded 3,268 well-matched patient pairs (mean age: 74, 53% female, median CHA2DS2-Vasc score 4). There was no difference in all-cause mortality at 30-days (2.7% with concomitant ablation versus 2.8% without, p = 0.762). Patients undergoing concomitant ablation at the time of surgery had significantly higher freedom from death or stroke at four years (81% vs 77%, HR: 0.84, 95% CI 0.74-0.96). However, overall freedom from death between groups was not statistically significant (84% with concomitant ablation vs 82% without, HR: 1.14, 95% CI 0.76-1.01).

CONCLUSIONS: Surgical ablation at the time of isolated mitral surgery is underutilized but associated with improved long-term outcomes.

PMID:40638230 | DOI:10.1093/icvts/ivaf133

Comput Inform Nurs. 2025 Jul 2. doi: 10.1097/CIN.0000000000001333. Online ahead of print.

ABSTRACT

There is a lack of evidence-based information on the use of technology in first-aid education. For this reason, this study aimed to describe the learning outcomes of three-dimensional technology among practical nursing students in first-aid courses. In this quasi-experimental study, first-year practical nursing students (n = 59) were divided into intervention group (n = 32) and control group (n = 27). For the intervention group, the first-aid course (a total of 16 hours per group) included three-dimensional images, three-dimensional environments, and three-dimensional printing. For the control group, the teaching was implemented using traditional methods. The data of knowledge (pre, post, and follow-up) and skills (post) were collected. The intervention group obtained statistically significantly higher scores in knowledge in follow-up test than the control group (P = .048). They also performed better on the entire resuscitation protocol (P = .0193) and in the following parts of resuscitation: student call for help, student opens the airway correctly, student checks the breathing correctly, and student has a correct depth in the chest compressions. As a conclusion, three-dimensional technology can enhance students’ first-aid knowledge and improve cardiopulmonary resuscitation skills in practical nursing education.

PMID:40638223 | DOI:10.1097/CIN.0000000000001333

Comput Inform Nurs. 2025 Jul 9. doi: 10.1097/CIN.0000000000001355. Online ahead of print.

ABSTRACT

The Internet provides many populations access to virtual health services, social resources, and health education. It is not understood how lack of household Internet adoption impacts the risk of negative health outcomes. Our study aimed to examine the relationship between Internet adoption and self-reported diabetes prevalence in US counties, while controlling for social determinants of health. This cross-sectional, retrospective study used US national county-level data obtained from the 2021 American Communities Survey and the 2021 Behavioral Risk Factors Surveillance System. Analysis included descriptive statistics, two-stage linear regression, and machine learning. A total of 3076 counties were analyzed. The results show that, in 2021, Internet adoption had a significant inverse relationship (β = -.20, P < .001) with diabetes prevalence in US counties while controlling for other social determinants of health. The results suggest that as household Internet adoption rates increase, diabetes prevalence decreases, at the county level. The relationships between social characteristics, Internet adoption, and health behaviors on diabetes prevalence in US counties warrant future research including individual-level validation and integration of health behaviors related to diabetes risk. These findings provide evidence of Internet adoption as a social determinant of health.

PMID:40638222 | DOI:10.1097/CIN.0000000000001355

Comput Inform Nurs. 2025 Jul 3. doi: 10.1097/CIN.0000000000001348. Online ahead of print.

ABSTRACT

This study investigated clinically significant association rules within pressure injury (PI) data from adult hospitalized patients to inform evidence-based prevention and management strategies. A retrospective cohort analysis was performed on a multicenter sample comprising 2386 PI cases (January 2018 to October 2023) across two tertiary hospital districts in Zhejiang Province, China. The analytical framework incorporated five patient-level demographic/clinical variables and six PI-specific characteristics. Association rule mining was conducted using the Apriori algorithm (minimum support = 10%, confidence threshold = 80%, lift >1), yielding 579 preliminary rules. Subsequent validation via χ2 testing retained 540 statistically significant associations (P < .05), of which 11 clinically actionable rules were established through Delphi consensus by a multidisciplinary expert panel. The results corroborate existing epidemiological evidence: advanced age (≥65 years), hypoalbuminemia (<35 g/L), and comorbid respiratory/neurological disorders constitute predominant risk factors for PI development. This study demonstrates the methodological rigor of association rule mining in identifying high-risk patient profiles, facilitating targeted early interventions to reduce PI incidence in inpatient populations.

PMID:40638211 | DOI:10.1097/CIN.0000000000001348

J Zoo Wildl Med. 2025 Jun;56(2):293-302. doi: 10.1638/2023-0124.

ABSTRACT

Both blood and liver samples can be used to evaluate vitamin, mineral, and heavy metal concentrations clinically. In elasmobranchs, it is unknown whether circulating concentrations of these analytes reflect concentrations in storage organs such as the liver. The purpose of this study was to report hepatic concentrations of select heavy metals and to compare concentrations of select vitamins and minerals in paired blood and liver samples in captive elasmobranchs. Blood (serum or lithium heparinized plasma) samples collected perimortem and hepatic tissue samples collected during necropsy from 27 elasmobranchs were included. Taxa (order, species), sex (male, female), and age class (immature, mature) were recorded. Vitamin A, vitamin E, cobalt, copper, iron, manganese, molybdenum, selenium, and zinc were measured in both blood and liver. Arsenic, cadmium, lead, mercury, and thallium concentrations were reported for liver only. Descriptive statistics were calculated for each analyte. Statistical analysis was performed with scatter plots with fitted regression lines, box plots, and a multiple linear regression model for multivariate analysis. Only the correlation between blood and liver concentrations of molybdenum (P < 0.001), cobalt (P = 0.001), iron (P = 0.014), and vitamin A (P = 0.020) were statistically significant. Significant differences in blood manganese and molybdenum, and hepatic vitamin A, manganese, molybdenum, and zinc were found between taxonomic orders. However, no differences based on sex or age class were detected. Future research is needed to elucidate the clinical significance of circulating versus tissue vitamin and mineral concentrations in elasmobranchs.

PMID:40638169 | DOI:10.1638/2023-0124

JAMA Netw Open. 2025 Jul 1;8(7):e2519693. doi: 10.1001/jamanetworkopen.2025.19693.

ABSTRACT

IMPORTANCE: World Health Organization guidelines on azithromycin mass drug administration for child survival target infants aged 1 to 11 months, although prior studies included those aged 1 to 59 months. The AVENIR trial suggested that infants aged 1 to 11 months have lower mortality if children aged 12 to 59 months in the same household are also included.

OBJECTIVE: To assess the possibility of a spillover effect by examining the association of azithromycin and mortality among children aged 1 to 11 months in subgroups defined by the presence of a child aged 12 to 59 months in the same household.

DESIGN, SETTING, AND PARTICIPANTS: This exploratory secondary analysis of the AVENIR (Azithromycine Pour la Vie des Enfants au Niger: Implementation et Recherche) adaptive cluster-randomized clinical trial was performed in 3000 rural and periurban communities in Niger. AVENIR communities were randomized to 3 arms and followed up for 2 years (November 24, 2020, to July 31, 2023). Study arms consisted of children aged 1 to 59 months receiving azithromycin (child arm); infants aged 1 to 11 months receiving azithromycin with placebo to children aged 12 to 59 months (infant arm); and children aged 1 to 59 months receiving placebo (placebo arm). Participants, investigators, data collectors, and data analysts were masked to randomization.

INTERVENTION: A single 20-mg/kg dose of oral azithromycin or placebo administered by study staff biannually.

MAIN OUTCOMES AND MEASURES: All-cause mortality in infants aged 1 to 11 months (deaths per 1000 person-years) measured through biannual census. Subgroups were defined by the presence of a child aged 12 to 59 months in the household recorded during the census.

RESULTS: After exclusions, 2883 communities and 98 969 infants aged 1 to 11 months were included in the analysis. Among the 23 770 infants in allocation 1 at baseline, mean (SD) age was 6.2 (3.1) months and 11 974 (50.4%) were female. Mortality was 18.5 (95% CI, 16.7-20.4) deaths per 1000 person-years in the child arm, 22.3 (95% CI, 20.0-24.7) in the infant arm, and 23.9 (95% CI, 21.6-26.2) in the placebo arm. The incidence rate ratio comparing mortality in the child and infant arms among children with an older sibling was 0.78 (95% CI, 0.65-0.93) compared with 0.91 (95% CI, 0.73-1.15; P = .26 for interaction) among those without. Comparing the infant and placebo arms, the incidence rate ratio among children with an older sibling was 0.96 (95% CI, 0.81-1.14) compared with 0.90 (95% CI, 0.71-1.12; P = .61 for interaction) among those without.

CONCLUSIONS AND RELEVANCE: In this secondary analysis of a cluster-randomized clinical trial, interaction for the presence of a older sibling was not statistically significant, but results were consistent with lower mortality among infants aged 1 to 11 months living with older, treated children.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04224987.

PMID:40638118 | DOI:10.1001/jamanetworkopen.2025.19693

JAMA Otolaryngol Head Neck Surg. 2025 Jul 10. doi: 10.1001/jamaoto.2025.1833. Online ahead of print.

ABSTRACT

IMPORTANCE: The palatine tonsil is the most common subsite of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (SCC). There is debate on how to manage the contralateral clinically uninvolved tonsil in patients undergoing a primary surgical approach via transoral robotic surgery (TORS).

OBJECTIVE: To assess postoperative complications, functional outcomes, contralateral tonsil second primary rates, and survival in patients undergoing unilateral vs bilateral TORS with pathology-guided adjuvant treatment.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was carried out in a quaternary care academic medical center. All consecutive unilateral tonsillar patients with SCC undergoing TORS as primary treatment from June 2016 to July 2023 were included. Analysis was conducted between October 1, 2024, and January 1, 2025.

EXPOSURE: Unilateral TORS (ipsilateral radical tonsillectomy) vs bilateral TORS (ipsilateral radical tonsillectomy and contralateral extracapsular tonsillectomy).

MAIN OUTCOMES: The primary outcome measure was rate of postoperative oropharyngeal hemorrhage. Secondary outcome measures included postoperative emergency department (ED) visit/hospitalization rate, time to nasogastric tube (NGT) removal, rate of discharge with an NGT tube, G-tube dependence rates, second primary rates in the contralateral tonsil, length of stay, and 2-year and 5-year disease-free survival (DFS) and overall survival (OS).

RESULTS: A total of 158 (106 unilateral, 52 bilateral TORS) patients with HPV-associated tonsillar SCC were evaluated, including 18 women and 139 men with a mean (SD) age of 60 (10) years. There were clinically meaningful differences in oropharyngeal hemorrhage rates (7% vs 15%; percent difference, -7.8; 95% CI, -18.8% to 3.2%), 30-day ED visit/hospitalization rates (9% vs 21%; percent difference, -11.7%; 95% CI, -24.1 to 0.7), and median length of stay (2 vs 3 days) for unilateral and bilateral TORS, respectively. Swallowing outcomes, DFS, and OS were not significantly different between the 2 groups. A total of 3 patients (1.9%) had a second primary tumor in the contralateral tonsil, including 2 metachronous primary tumors in the unilateral group (1.8%) and 1 synchronous primary tumor incidentally removed at the time of surgery in the bilateral group (1.9%).

CONCLUSIONS AND RELEVANCE: This cohort study found that omission of contralateral elective extracapsular tonsillectomy in HPV-positive SCC was safe and associated with a trend toward lower posttonsillectomy hemorrhage, postoperative ED visits for pain control, and hospital length of stay without compromising survival. Prophylactically resecting the contralateral tonsil may add patient harm without any clear benefits.

PMID:40638110 | DOI:10.1001/jamaoto.2025.1833

J Craniofac Surg. 2025 Jul 10. doi: 10.1097/SCS.0000000000011116. Online ahead of print.

ABSTRACT

The authors conducted a retrospective analysis of the patients who underwent himi-lengthening genioplasty (HLG) in our department since 2020, using digital technology for a comprehensive comparative analysis of bone stability, facial symmetry, and neurosensory evaluation, aiming to evaluate the effectiveness and potential risks of HLG and provide a reference for oral and maxillofacial surgeons. A total of 23 patients were included in our study. Among them, 13 patients underwent HLG, while 10 patients underwent conventional genioplasty. The follow-up period was 1 year postoperatively. The measurements the authors recorded included 2-point discrimination (TPD) test values of lip and chin, the mandibular similarity index, the volumes of chin segments, and the absorption rates. All these measurements were compared by statistical method. The TPD values increased 1 day and 4 days postoperatively and were statistically significant (P<0.05), but when 1 month and 3 months postoperatively, the differences in TPD values were not statistically significant. The mandibular similarity index of the HLG group is better at 1 year after surgery (P=0.005). The difference in the stability of the chin segments was not statistically significant between the 2 groups.

PMID:40638093 | DOI:10.1097/SCS.0000000000011116