Nevin Manimala

Asian Pac Isl Nurs J. 2025 Nov 13;9:e75202. doi: 10.2196/75202.

ABSTRACT

BACKGROUND: Preceptorship programs have been implemented in several hospitals across Indonesia to support new nurses during their transition period in the workplace. Many factors influence new nurses successfully transitioning into this new role. However, few studies have examined the factors that affect new nurses’ competency.

OBJECTIVE: This study aimed to identify the factors influencing the competency of new nurses in a preceptorship program.

METHODS: This study used a quantitative approach with a cross-sectional design. Participants were 169 nurses who had been employed for less than 1 year in 2 hospitals. Participants were nurses undergoing an orientation period who were part of a preceptorship program. The study used instruments developed by the researchers and their team, which were tested for validity and reliability. The variables were self-efficacy, new nurses’ adaptation, preceptor commitment, preceptor competency, and mentoring method. Data were analyzed using descriptive statistics, the χ2 test, and multiple logistic regression.

RESULTS: The median age of the 169 participants was 24 years, with the ages ranging from 22 to 30 years. Most of the participants were female (n=136, 80.5%), held a bachelor’s degree (n=164, 97%), and had worked at Hospital X for 0 to 6 months (n=128, 75.7%). In terms of training experience, most participants had completed Basic Cardiac Life Support training (n=142, 84%). The independent variables that influenced new nurses’ competency were gender (P=.02), training (P=.05), mentoring method (P=.001), preceptor commitment (P=.03), and preceptor competency (P=.001). A multiple logistic regression test further indicated that the mentoring method (P=.001; α=.05; OR .198), preceptor commitment (P=.03; α=.05; OR .296), and preceptor competency (P=.001; α=.05; OR .202) were influential variables for new nurses’ competency.

CONCLUSIONS: The mentoring method, preceptor commitment, and preceptor competency were identified as the factors that most strongly influence new nurses’ competency. These results can be used to develop more effective preceptor programs. An effective preceptorship program requires preceptors who demonstrate both professional competence and personal characteristics. Preceptors have to possess adequate knowledge and skills to support the development of new nurses’ competency.

PMID:41231518 | DOI:10.2196/75202

JAMA Otolaryngol Head Neck Surg. 2025 Nov 13. doi: 10.1001/jamaoto.2025.4017. Online ahead of print.

ABSTRACT

IMPORTANCE: Balloon sinus dilation (BSD) is a tool for treating patients with chronic rhinosinusitis or recurrent acute rhinosinusitis. The use of BSD has increased exponentially since its introduction, with concerns for potential misuse. Expert consensus reports that most patients who are candidates for BSD do not need to have all 6 sinuses dilated (bilateral frontal, maxillary, and sphenoid).

OBJECTIVE: To determine the percentage of patients who are undergoing 6-sinus BSD, evaluate factors associated with this practice, and explore outlier practice patterns when performing 6-sinus BSD.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional, retrospective review of a Medicare claims database from January 2022 to December 2023 included otolaryngologists (US Centers for Medicare & Medicaid Services code 04) who performed at least 11 BSDs during the study period, who were defined as high-volume BSD clinicians (>10 BSDs per year). Data were analyzed in July 2024.

MAIN OUTCOMES AND MEASURES: The primary outcome defined before data collection as the percentage of patients billed for 6-sinus BSD. Physician variables were explored for potential association with 6-sinus BSD.

RESULTS: Of the 522 otolaryngologists (mean [SD] age, 52 [9.3] years), most physicians were male (489 [94%]), practiced in a group setting (428 [82%]), and were in an urban environment (474 [91%]). A total of 21 290 unique BSD procedures were performed, and 12 799 procedures (60%) involved all 6 sinuses. Of the 522 otolaryngologists, 40 (8%) performed 6-sinus BSD in 100% of their BSD procedures, while 54 (10%) performed no 6-sinus BSDs. Practice patterns varied substantially, with 8 physicians (2%) responsible for 10% of 6-sinus BSDs (n = 2152).

CONCLUSIONS AND RELEVANCE: The results of this cross-sectional study suggest that the high volume of 6-sinus BSD suggests the potential for overuse of BSD. Substantial variations in care emphasize the need for clear guidelines and indications for multisinus BSD to optimize the utilization and value of BSD.

PMID:41231509 | DOI:10.1001/jamaoto.2025.4017

JAMA Otolaryngol Head Neck Surg. 2025 Nov 13. doi: 10.1001/jamaoto.2025.4030. Online ahead of print.

ABSTRACT

IMPORTANCE: Timely computed tomography (CT) imaging is a requirement before performance of sinus surgery, including balloon sinus dilation (BSD).

OBJECTIVE: To determine adherence to practice guidelines for use of CT imaging before BSD procedures.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used Medicare claims data to identify and include otolaryngologists who each performed at least 11 BSDs from January 1, 2022, to December 31, 2023. Data were analyzed from April 1 to September 9, 2025. using IBM-SPSS statistics version 29 and R 4.3.2.

MAIN OUTCOME(S) AND MEASURE(S): Percentage of physicians performing BSD without CT imaging available within 1 year of the procedure in greater than 10% of procedures (outliers). Physician variables were explored for potential association with outlier status.

RESULTS: The analysis evaluated 490 otolaryngologists (29 female [5.9%] and 460 male [94.1%] individuals) who performed at least 10 BSD procedures annually in a total of 19 692 patients. Preprocedure CT imaging was not available within 1 year prior of BSD for 2905 patients (15%). In all, 156 otolaryngologist-participants (31.8%) were identified as outliers; notably, 30 of these (6.1%) accounted for more than 50% of cases without preprocedure CT imaging, affecting 1880 patients (9.5%) undergoing BSD. Moreover, 42 participants (8.6%) accounted for 47.5% of all missed CTs.

CONCLUSION AND RELEVANCE: This cross-sectional study found that most otolaryngologists adhered to clinical consensus by obtaining CT imaging before performing BSD. However, a substantial portion did not obtain CT imaging before BSD and therefore, did not adhere to standard practice guidelines. These findings demonstrate the need for improved monitoring of adherence to the standard of practice.

PMID:41231495 | DOI:10.1001/jamaoto.2025.4030

JAMA Otolaryngol Head Neck Surg. 2025 Nov 13. doi: 10.1001/jamaoto.2025.4024. Online ahead of print.

NO ABSTRACT

PMID:41231490 | DOI:10.1001/jamaoto.2025.4024

JAMA Netw Open. 2025 Nov 3;8(11):e2543552. doi: 10.1001/jamanetworkopen.2025.43552.

ABSTRACT

IMPORTANCE: Female sex has been identified as a risk factor for mortality in Staphylococcus aureus bloodstream infection (SA-BSI). It is unknown whether this association extends to bloodstream infections with other bacterial species.

OBJECTIVE: To investigate whether female sex is associated with increased mortality risk among patients with gram-negative bloodstream infection (GN-BSI).

DATA SOURCES: MEDLINE, Embase, and Web of Science were searched from inception to January 8, 2025.

STUDY SELECTION: Study inclusion criteria were randomized or observational studies assessing adults with GN-BSI that included at least 100 patients and reported mortality at or before 90 days following GN-BSI, with mortality stratified by sex and, when applicable, by gram-negative bacterial species. Studies with polymicrobial GN-BSI were excluded. For inclusion in the primary analysis, studies must have stratified or statistically adjusted for confounding variables between female and male patients with GN-BSI. A secondary analysis included studies that reported sex-stratified unadjusted mortality.

DATA EXTRACTION AND SYNTHESIS: One reviewer conducted extraction and quality assessment, which was verified by a second reviewer. Risk of bias and quality were assessed with the Newcastle-Ottawa Quality Assessment Scale. Mortality data were combined as odds ratios (ORs). The study followed the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline.

MAIN OUTCOME AND MEASURES: Mortality at or before 90 days following GN-BSI, stratified by sex.

RESULTS: From 9752 studies retrieved, 25 (16 350 patients; 4017 female [25%], 12 333 male [75%]) were included in the primary analysis. Female patients with GN-BSI did not have increased risk of mortality relative to male patients (pooled OR, 0.98 [95% CI, 0.81-1.17]). No publication bias was identified. Subset analyses based on medical comorbidities, timing of mortality end point, bacterial species group, antibiotic resistance phenotype, and publication date did not reveal a set of patients with differences in sex-stratified mortality. A total of 321 studies (147 810 patients) that reported unadjusted mortality were included in a secondary analysis. In this analysis, female sex was associated with decreased risk of mortality (pooled OR, 0.90 [95% CI, 0.86-0.94]).

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, female patients with GN-BSI were not at higher risk than male patients of mortality after statistical adjustment. GN-BSI and SA-BSI thus differ in sex-specific mortality outcomes, highlighting the need for further research into the immunological, pathophysiological, and clinical management factors that may be associated with sex disparities in SA-BSI but not in GN-BSI.

PMID:41231468 | DOI:10.1001/jamanetworkopen.2025.43552

JAMA Netw Open. 2025 Nov 3;8(11):e2543559. doi: 10.1001/jamanetworkopen.2025.43559.

ABSTRACT

IMPORTANCE: Breast cancer is the most common cancer among women worldwide, yet individuals with disabilities may face substantial barriers affecting their diagnosis and treatment outcomes.

OBJECTIVE: To examine disparities in the diagnosis, treatment, and survival outcomes of patients with breast cancer and disability compared with those without disabilities.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study linked the January 1, 2012, to December 31, 2019, Cancer Public Library Database records with the Korean National Disability Registration System, with follow-up through December 2020. The participants were women age 30 years or older with a diagnosis of breast cancer.

EXPOSURE: Presence and severity of medically verified disabilities, including physical, brain, sensory, and additional impairments.

MAIN OUTCOMES AND MEASURES: The primary outcomes were cancer stage at diagnosis, receipt of standard treatments (surgery, chemotherapy, or radiotherapy), and overall mortality. Multivariate logistic and Cox regression models adjusted for demographic, clinical, and socioeconomic factors. Statistical analyses were conducted in April 2025.

RESULTS: Among 150 412 women with breast cancer, 7443 (4.9%) had disabilities and 142 969 (95.1%) did not. Patients with disabilities were more likely to be aged 65 years or older (3068 patients with disabilities [41.2%] vs 20 182 patients without disabilities [14.1%]). In particular, those with severe disabilities were more likely than patients without disabilities to receive a diagnosis at distant (505 patients with disabilities [6.8%] vs 6601 patients without disabilities [4.6%]) or unknown (308 patients with disabilities [4.1%] vs 3518 patients without disabilities [2.5%]) stage. They were also less likely to undergo surgery (adjusted odds ratio [aOR] 0.91; 95% CI, 0.85-0.98), receive chemotherapy (aOR, 0.77; 95% CI, 0.73-0.81), or receive radiotherapy (aOR, 0.85; 95% CI, 0.79-0.90). The disparity was most pronounced for patients with severe brain impairments. Overall mortality was significantly higher among patients with disabilities (adjusted hazard ratio [aHR], 1.59; 95% CI, 1.50-1.69), particularly among those with severe disabilities (aHR, 2.15; 95% CI, 1.98-2.33).

CONCLUSIONS AND RELEVANCE: In this cohort study of women with breast cancer, those with disabilities experienced significant disparities in stage at diagnosis, treatment access, and survival outcomes compared with those without disabilities. These findings highlight the critical need for targeted interventions to address disability-related barriers and ensure equitable health care.

PMID:41231467 | DOI:10.1001/jamanetworkopen.2025.43559

Pediatr Int. 2025 Jan-Dec;67(1):e70252. doi: 10.1111/ped.70252.

ABSTRACT

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are the most common healthcare-associated infections, leading to increased mortality, hospital stays, and costs. Despite evidence-based prevention bundles, adherence is often suboptimal. This study aimed to evaluate the impact of a multimodal intervention on CLABSI rates in the pediatric intensive care unit (PICU), particularly in tertiary care settings with high infection rates.

METHODS: A quasi-experimental study was conducted from September 2022 to March 2024, involving pediatric patients under 15 years with central venous catheters (CVC). The multimodal intervention included guideline revisions, education, compliance monitoring, feedback, and reward. CLABSI rates during pre-intervention, intervention, and post-intervention phases were compared using a Poisson regression model and Kaplan-Meier survival analysis. Cox proportional hazards models were used to assess risk factors for CLABSIs.

RESULTS: A total of 265 patients across three phases were included, with 3324 CVC days and a mean duration of 8.5 days per central line. The intervention reduced CLABSI rates from 8.3 to 1.0 per 1000 catheter-days during the intervention phase (p = 0.049), with a rebound to 5.9 per 1000 catheter-days post-intervention. Kaplan-Meier analysis demonstrated a statistically significant CLABSI incidence reduction in the intervention group versus the pre-intervention group (p = 0.011). Gram-negative bacteria, predominantly Acinetobacter baumannii, were the leading pathogens (46.1%). Cox regression identified the multimodal intervention as a protective factor, with a hazard ratio of 0.27 (95% CI 0.18-0.39, p < 0.005).

CONCLUSIONS: A multimodal intervention significantly reduced CLABSI rates in the PICU, demonstrating the importance of comprehensive strategies in infection prevention. However, sustained compliance is essential to maintain these improvements.

PMID:41231445 | DOI:10.1111/ped.70252

Int Nurs Rev. 2025 Dec;72(4):e70127. doi: 10.1111/inr.70127.

ABSTRACT

AIMS: To examine the associations between patient safety silence, culture, competency, and activities among clinical nurses.

BACKGROUND: Patient safety ensures harm prevention and quality of care. Factors such as silence, culture, and competency are widely recognized as significantly associated with patient safety activities, but limited research has examined their interrelationships.

DESIGN: Cross-sectional secondary data analysis.

METHODS: This study used data from a study that investigated the patient safety educational needs of 291 nurses from general hospitals located in the Busan, Ulsan, and Gyeongsangnamdo regions of South Korea. To assess patient safety activities, silence, culture, and competency, the study employed the Patient Safety Activities Questionnaire, Patient Safety Silence Scale, Hospital Survey on Patient Safety Culture, and Patient Safety Competency Self-Evaluation Tool, respectively. The analysis involved descriptive statistics, correlation analysis, and multiple regression using SPSS 27.0.

RESULTS: The factors of silence and receiving patient safety education only once were negatively associated with patient safety activities. Positive associations were found for teamwork within the culture subdomain, skills within the competency subdomain, and hospital size.

CONCLUSIONS: These findings provide a basis for educational programs to improve nursing skills and highlight the need to build an open and collaborative organizational culture.

IMPLICATIONS FOR NURSING: Clinical nurses should develop patient safety skills, report patient safety incidents, and collaborate with team members to foster an open and cooperative organizational culture.

IMPLICATIONS FOR NURSING POLICY: To minimize silence, while strengthening teamwork, organizations actively foster a culture of openness and collaboration. Education should be managed to meet minimum standards, and hospital-specific policies should be tailored according to each institution’s size and characteristics.

PMID:41231440 | DOI:10.1111/inr.70127

Biom J. 2025 Dec;67(6):e70092. doi: 10.1002/bimj.70092.

ABSTRACT

In clinical trials, patients may discontinue treatments prematurely, breaking the initial randomization. In our motivating study, a randomized controlled trial in oncology, patients assigned the investigational treatment may discontinue it due to adverse events. The ICH E9(R1) Addendum provides guidelines for handling such “intercurrent events.” The right strategy to adopt depends on the questions of interest. We propose adopting a principal stratum strategy and decomposing the overall intention-to-treat effect into principal causal effects for groups of patients defined by their potential discontinuation behaviour. We first show how to implement a principal stratum strategy to assess causal effects on a survival outcome in the presence of continuous-time treatment discontinuation, its advantages, and the conclusions that can be drawn. Our strategy allows us to properly handle the time-to-event intermediate variable, which is not defined for patients who would not discontinue, and to account for the fact that the discontinuation time and the primary endpoint are subject to censoring. We employ a flexible model-based Bayesian approach to tackle these complexities, providing easily interpretable results. We apply this Bayesian principal stratification framework to analyze synthetic data of the motivating oncology trial. Supported by a simulation study, we shed light on the role of covariates in this framework. Beyond making structural and parametric assumptions more credible, they lead to more precise inference. Also, they can be used to characterize patients’ discontinuation behavior, which could help inform clinical practice and future protocols.

PMID:41231435 | DOI:10.1002/bimj.70092

Biomarkers. 2025 Nov 13:1-15. doi: 10.1080/1354750X.2025.2589251. Online ahead of print.

ABSTRACT

BACKGROUND: Several studies have identified that HOTAIR polymorphisms were expressed abnormally in a range of cancers, including breast, gastric, liver, and lung cancers. However, the impact of this gene on colorectal cancer (CRC) remains a topic of debate. To obtain the most accurate results, the association of HOTAIR polymorphisms with CRC risk was analyzed in this meta-analysis (MA).

METHODS: The PubMed, Embase, Cochrane, and Web of Science databases were searched to find the correlation of HOTAIR polymorphisms with CRC up to February 2024. The association of HOTAIR polymorphisms with CRC susceptibility was assessed using odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS: Five relevant studies were identified in total. In all HOTAIR polymorphism studies involving CRC, it was found that the subgroup analysis by ethnicity revealed that the rs1899663 G > T codominant and dominant models were positively correlated with CRC development in Asian populations and negatively correlated with CRC development in non-Asian populations (Codominant: OR = 0.70, 95% CI = 0.39 – 1.25; D: Dominant: OR = 0.65, 95% CI = 0.28 – 1.53）.

CONCLUSIONS: This MA indicates that HOTAIR polymorphism-the rs1899663 G > T genotype-might have a racially specific impact on CRC risk.

PMID:41231428 | DOI:10.1080/1354750X.2025.2589251