Nevin Manimala

Int J Colorectal Dis. 2026 Jan 19;41(1):37. doi: 10.1007/s00384-025-05075-6.

ABSTRACT

BACKGROUND: An enhanced recovery protocol (ERP) comprises a series of elements aimed at optimizing and standardizing perioperative care. Therefore, in this study, we aimed to evaluate the safety and feasibility of a modified enhanced recovery after surgery (ERAS) protocol following colorectal surgery in older adults aged ≥ 65 years.

MATERIALS AND METHODS: Patients aged ≥ 65 years who underwent minimally invasive colorectal cancer surgery at a tertiary referral hospital in Taiwan between 2018 and 2022 were reviewed retrospectively. Patients were divided into ERAS and traditional care groups according to the perioperative care strategy. The primary outcome was the short-term complication rate. However, the secondary outcomes were postoperative hospital stay, reoperation, readmission, and 30-day mortality rates.

RESULTS: Overall, 1392 patients were enrolled, including 550 and 842 in the ERAS and traditional care groups, respectively. Demographic characteristics, including comorbidities, perioperative characteristics, and pathological staging, were not statistically significant. The patients’ short-term complication rate was lower in the ERAS group (aged 65-80 years) than in the traditional care group (29 (7.2%) vs. 75 (11.5%), P = 0.026). However, the short-term complication rate did not differ between patients aged > 80 years (24 (16%) vs. 36 (19%), P = 0.438). In addition, the mean postoperative hospital stay was shorter in the ERAS group (7.5 ± 8.9 days vs 9.7 ± 10.0 days, P < 0.001). However, there were no differences in other secondary outcomes, including reoperation, readmission, and 30-day mortality rates.

CONCLUSION: Minimally invasive colorectal cancer surgery within the ERAS program is safe and effective in patients aged 65-80 years.

PMID:41555061 | DOI:10.1007/s00384-025-05075-6

Nat Med. 2026 Jan 19. doi: 10.1038/s41591-025-04176-7. Online ahead of print.

ABSTRACT

Patient-facing large language models (LLMs) hold potential to streamline inefficient transitions from primary to specialist care. We developed the preassessment (PreA), an LLM chatbot co-designed with local stakeholders, to perform the general medical consultations for history-taking, preliminary diagnoses, and test ordering that would normally be performed by primary care providers and to generate referral reports for specialists. PreA was tested in a randomized controlled trial involving 111 specialists from 24 medical disciplines across two health centers, where 2,069 patients (1,141 women; 928 men) were randomly assigned to use PreA independently (PreA-only), use it with staff support (PreA-human), or not use it (No-PreA) before specialist consultation. The trial met its primary end points with the PreA-only group showing significantly reduced physician consultation duration (28.7% reduction; 3.14 ± 2.25 min) compared to the No-PreA group (4.41 ± 2.77 min; P < 0.001), alongside significant improvements in physician-perceived care coordination (mean scores 113.1% increase; 3.69 ± 0.90 versus 1.73 ± 0.95; P < 0.001) and patient-reported communication ease (mean scores 16.0% increase; 3.99 ± 0.62 versus 3.44 ± 0.97; P < 0.001). Equivalent outcomes between the PreA-only and PreA-human groups confirmed the autonomous operation capability. Co-designed PreA outperformed the same model with additional fine-tuning on local dialogues across clinical decision-making domains. Co-design with local stakeholders, compared to passive local data collecting, represents a more effective strategy for deploying LLMs to strengthen health systems and enhance patient-centered care in resource-limited settings. Chinese Clinical Trial Registry identifier: ChiCTR2400094159 .

PMID:41555035 | DOI:10.1038/s41591-025-04176-7

Eur J Obstet Gynecol Reprod Biol. 2026 Jan 14;318:114967. doi: 10.1016/j.ejogrb.2026.114967. Online ahead of print.

ABSTRACT

BACKGROUND: Long-acting reversible contraceptives (LARCs), including subdermal contraceptive implants (SCIs), are widely used and highly effective. General practitioners (GPs) provide most implant services, but little is known about their confidence, awareness of updated guidelines, and approaches to complications in the Irish setting.

AIM: To assess GPs’ experience, confidence, awareness of guidelines, and management of complications related to SCIs.

METHODS: We conducted a prospective quantitative survey of 100 randomly selected GPs in Ireland. A validated 12-item questionnaire was distributed via Qualtrics, with 74 complete responses analysed in SPSS v29.0. Frequency data and chi-square tests with Cramer’s V were used to assess associations between experience, confidence, and guideline awareness.

RESULTS: A total of n = 74 full responses were collected. Results showed that while a majority (94.6 %) have inserted subdermal contraceptive implants, confidence levels varied, with 37.3 % feeling confident in insertion and removal procedures. Notably, 39.2 % were unaware of updated guidelines from January 2020. Statistical analyses revealed significant associations between general practitioners’ reported experience in subdermal contraceptive implant procedures and confidence in these skills (p < 0.001), as well as awareness of guidelines (p = 0.011). General practitioners with greater experience tended to refer complicated cases to specialist services, contrasting with less experienced peers managing cases independently.

CONCLUSION: This study underscores the need for enhanced General Practitioners’ training on subdermal contraceptive implant procedures and guideline updates to optimise service delivery. Given the increasing popularity of subdermal contraceptive implants, addressing these gaps is crucial for ensuring safe and effective contraceptive care in primary care settings.

PMID:41554227 | DOI:10.1016/j.ejogrb.2026.114967

Public Health. 2026 Jan 18;252:106146. doi: 10.1016/j.puhe.2026.106146. Online ahead of print.

ABSTRACT

OBJECTIVES: To protect workers and individuals from second-hand smoke exposure, Japan’s national indoor smoking ban was enforced on April 1, 2020. However, certain exemptions were made for eating and drinking establishments. Local ordinances restricted these exemptions to increase their effectiveness. We aimed to evaluate the 2-year impact of the national ban and local ordinances on indoor smoking policies in eating and drinking establishments over a 2-year period.

STUDY DESIGN: Panel data analysis.

METHODS: From a commercial database of eating and drinking establishments, we used area-level summary data of 320,693 establishments for August 2016 and individual establishment data extracted biannually between January 2020 and December 2022 (n = 329,322 to 403,133). We calculated the category-specific and weighted proportions of smoke-free establishments. We analysed the short-term and trend changes using an interrupted time-series analysis.

RESULTS: The proportion of smoke-free establishments increased after the national ban (+5.7 % points). Local ordinances restricting the exemption for the establishments with non-family employees enhanced the impact of the national ban (+7.8 % points). In December 2022, the proportions of smoke-free establishments were 68.3 % in restaurants, 70.2 % in cafés, 32.8 % in izakaya, and 25.0 % in bars.

CONCLUSIONS: The indoor smoking ban has promoted indoor smoke-free policies in eating and drinking establishments in Japan. However, many establishments, nearly two-thirds of izakaya and bars, remain smoking-allowed, probably owing to exemptions and non-compliance. To effectively reduce second-hand smoke exposure in eating and drinking establishments, it is necessary to minimise exemptions by revising laws or enforcing additional ordinances and promoting compliance with these legislations.

PMID:41554192 | DOI:10.1016/j.puhe.2026.106146

Conscious Cogn. 2026 Jan 18;139:103979. doi: 10.1016/j.concog.2025.103979. Online ahead of print.

ABSTRACT

This study presents the first comprehensive psychometric comparison of Greyson’s (1983) 16-item Near-Death Experience Scale (NDE Scale) and Martial et al.’s (2020) 20-item Near-Death Experience Content Scale (NDE-C) using Rasch modeling and differential item functioning (or response bias) analyses. A total of 705 self-identified “near-death experiencers” (64% women) completed both measures, which were randomly intermingled and rated for experiential relevance. Results confirmed that the two scales measure the same underlying construct of NDE phenomenology, as evidenced by a near-perfect disattenuated Pearson correlation (r = 0.98, p < 0.001). However, Rasch analysis revealed limitations in the category structures of both scales-particularly the NDE-C-and identified psychometric and conceptual weaknesses in its five novel items. Critically, the core Rasch item hierarchy derived from the original NDE Scale was replicated both in this sample and a previously simulated dataset based on the NDE-C’s development research, confirming its long-term structural stability. Based on the present evidence and the principle of parsimony, we recommend the original NDE Scale supported by Rasch scoring and a validated cut-off of 7 (out of 32), as it is conceptually coherent and psychometrically robust, while maintaining historical comparison with previous research. These findings reinforce the value of Rasch modeling for cumulative theory-building and underscore the Rasch NDE hierarchy’s foundational role in operationalizing legitimate near-death experiences.

PMID:41554189 | DOI:10.1016/j.concog.2025.103979

West J Emerg Med. 2025 Dec 19;27(1):25-32. doi: 10.5811/westjem.47392.

ABSTRACT

INTRODUCTION: Free Open Access Medical Education (FOAMed) has emerged as a prominent component of online medical communication, with X (formerly Twitter) serving as an active hub for professional exchange among clinicians. Despite its reach and influence, few longitudinal studies have examined how FOAMed content and engagement patterns evolve over time. In this study we aimed to analyze thematic shifts and user interaction trends in #FOAMed tweets over a five-year period.

METHODS: We conducted a retrospective bibliometric and natural language processing (NLP) study of 6,000 high-engagement, English-language tweets tagged with #FOAMed, posted between January 1, 2020-December 31, 2024. Each month, the 100 tweets were selected from Twitter’s “Top” tab and manually curated. We used latent Dirichlet allocation (LDA) to identify thematic clusters. Hashtag usage and engagement metrics were assessed using descriptive statistics and linear regression.

RESULTS: We identified 10 distinct topics were identified through LDA modeling: point-of-care ultrasound (POCUS) education; neuro-radiology, cardiology-electrocardiogram (ECG); nephrology; and intensive care unit; ultrasound; prehospital/policy; webinars and learning; resuscitation scenarios; pediatric imaging; medical student education; and critical care and publications. Topic prevalence shifted over time: Early tweets focused on COVID-19 and critical care, while later years showed increasing attention to prehospital care, diagnostics, and POCUS. Mean tweet engagement peaked in 2023 (236.9 ± 914.6). Notably, hashtags such as #POCUS and #MedEd showed substantial increases in both usage and engagement, with #MedEd reaching a peak mean engagement of 287.7. In contrast, COVID-19 declined steadily, both in frequency (from 126 tweets in 2020 to just six in 2023) and in engagement (mean: 67.1 → 18.5). Spearman correlation analysis revealed that hashtag count had a weak but statistically significant correlation with engagement (ρ = 0.047, P < .001), suggesting that content quality, rather than volume, was the primary driver of visibility.

CONCLUSION: FOAMed discourse on Twitter/X remains dynamic, responsive to clinical priorities and shaped by peer interaction. Natural language processing and topic modeling are valuable tools to uncover longitudinal trends in digital medical education, reinforcing Twitter/X’s role in informal, real-time learning communities.

PMID:41554176 | DOI:10.5811/westjem.47392

West J Emerg Med. 2025 Dec 23;27(1):67-77. doi: 10.5811/westjem.48357.

ABSTRACT

INTRODUCTION: Prior research demonstrates that emergency department (ED) patients with suicidal ideation (SI), substance use (SUD), and/or intimate partner violence (IPV) have disproportionate adverse outcomes for both women and infants. The 2013 Hague Protocol suggested that children with caregivers with the above characteristics are also more likely to suffer from child maltreatment. Of all pregnancies in this group, as many as 90% are unintended. We hypothesized that women with SI/SUD/IPV have gaps in care access, high levels of unscheduled care use, and reduced ED contraceptive inquiry, which if addressed could potentially improve outcomes.

METHODS: We conducted a chart review of 62,284 ED visits from 2018-2021 from a suburban four-hospital system in the Southern United States. We compared women of reproductive age (15-44) with SI/SUD/IPV (4,776) against controls (57,508). The exposures were defined as women with SI, SUD, and/or IPV. We analyzed results using the chi-square test (χ²) with Bonferroni adjustment to test for independence and logistic regression.

RESULTS: Women suffering from SI/SUD/IPV who present to the ED have contraceptive status less frequently documented compared to controls without these factors (39.5 vs 51.7%, RR 0.77, CI, 0.74-0.79, P < .001). They also have reduced access to care, with higher rates of uninsurance (32.7 vs 26.1%, P < .001), more care in the acute care environment, longer ED length of stay (LOS) (mean was 10.38 vs 3.87 hours, P < .001), higher hospitalization rates (61.0 vs 8.7%, P < .001), and higher 30-day ED revisits (11.8 vs 8.8%, P < .001), even after adjusting for the Social Vulnerability Index, acuity, age, and obesity (adjusted odds ratio 1.52 95% CI 1.36-1.70 P < .001).

CONCLUSION: Despite significant morbidity coupled with reduced access to ambulatory care and disproportionately increased ED use, little ED contraceptive documentation exists. This practice contributes to inequity, given the increased number of unintended pregnancies and greater need of contraceptives in women with suicidal ideation/substance use disorder/intimate partner violence.

PMID:41554174 | DOI:10.5811/westjem.48357

West J Emerg Med. 2026 Jan 9;27(1):159-162. doi: 10.5811/westjem.47187.

ABSTRACT

INTRODUCTION: Viewing a solar eclipse without proper eye protection can lead to ocular injuries such as solar retinopathy or photokeratitis. The April 8, 2024, solar eclipse in the southern and eastern United States presented a rare opportunity to assess the public health impact of such events on eye-related emergency department (ED) visits.

METHODS: We identified a total of 1,774 ED visits for eye injuries across both periods. There were 853 visits before the eclipse and 921 visits after, showing no statistically significant difference (X² = 1.432, P > .05) between the two time periods.

RESULTS: We identified a total of 1,774 ED visits for eye injuries across both periods. There were 853 visits before the eclipse and 921 visits after. The chi-square statistic (X² = 1.432, degree of freedom = 1, P > .05) indicated no statistically significant difference in the incidence of eye injuries between the two time periods.

CONCLUSION: Despite concerns regarding eclipse-related eye injuries, we found no statistically significant increase in ED visits for ocular pain or photokeratitis following the April 8, 2024, solar eclipse. These results suggest that public education campaigns promoting safe eclipse viewing may have been effective. Ongoing efforts are warranted to continue promoting ocular safety during future eclipses.

PMID:41554171 | DOI:10.5811/westjem.47187

West J Emerg Med. 2025 Dec 24;27(1):214-218. doi: 10.5811/westjem.47475.

ABSTRACT

INTRODUCTION: Maricopa County, Arizona, experienced its largest West Nile virus outbreak in 2021, with 1,487 cases and 101 deaths, in the midst of the COVID-19 pandemic. We sought to describe initial presentations of emergency department (ED) patients ultimately diagnosed with West Nile virus and determine how often patients presented to the ED before their diagnosis. To assist with disease recognition during future outbreaks, we examined in detail cases where emergency physicians initially did not suspect West Nile virus.

METHODS: We reviewed records from May-December 2021 for patients with a positive West Nile virus result and at least one ED visit within 15 days. Data included age, sex, race, Emergency Severity Index (ESI) score, number of ED visits, chief complaint, vital signs, blood or cerebrospinal fluid (CSF) testing, diagnosis, and disposition. We excluded cases with only immoglobulin G-positive results or outpatient tests, leaving 147 cases.

RESULTS: Among 147 ED West Nile virus cases, the median patient age was 67 years, with patients being predominantly male (66.7%) and White (97.3%). The most common presenting chief complaints included fever (23.8%), headache (17.7%), and generalized weakness (11.6%). Emergency physicians initiated testing for the virus in 63 cases (42.9%). Patients dispositioned (n = 84, either discharged or admitted) from the ED without initiation of testing tended to be older (median 73 vs 62 years, P < .001), with higher triage respiratory rate (mean 19.4 vs 18.3 breaths per minute, P = .05) and lower triage oxygen saturation (median 96% vs 97%; P =.02). Emergency physicians predominantly performed CSF testing (n = 42 patients) over serum testing (n = 21 patients). Patients tested via CSF had lower ESI scores than those tested via serum (ESI score of 1-2 45.3% vs 14.3%, P = .03).

CONCLUSION: Emergency physicians did not initiate testing in 57.1% of initial ED encounters of patients ultimately found to have West Nile virus. During West Nile virus outbreaks, emergency physicians should stay vigilant for less acute presentations, such as generalized weakness in elderly patients, along with typical presentations including fever and headache, to avoid delayed diagnosis.

PMID:41554170 | DOI:10.5811/westjem.47475

West J Emerg Med. 2025 Dec 19;27(1):177-183. doi: 10.5811/westjem.47216.

ABSTRACT

INTRODUCTION: Mass shooting incidents (MSI) are single events injuring four or more victims, and they occur in the United States on average every 12.5 days. Studies have examined the psychological impact of MSIs on witnesses and surviving victims. However, the mental health of healthcare workers involved in the care of MSI victims requires further examination. We explored the association between work-related stress and symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) in healthcare workers involved in the 2017 Las Vegas mass shooting.

METHODS: Surveys were distributed to 170 healthcare workers involved in the care of victims of the largest MSI in US history, the 2017 Las Vegas Route 91 Harvest Festival (58 people killed, 413 wounded bv gunshot or shrapnel). Fifty healthcare workers (29.4% response rate; 68% female), 29-71 years of age, responded to demographic questions followed by the Beck Anxiety Inventory, Beck Depression Inventory-II (BDI-II), Patient Health Questionnaire-9 (PHQ-9), PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, 5^th Ed, and the Health & Safety Executive Management Standards Indicator Tool, between October 15, 2022-March 15, 2023.

RESULTS: Results showed that work-related stress was significantly associated with symptoms of depression (BDI-II: P < .001, 22.9% variance; PHQ-9: P < .05, 20.5% variance) and PTSD (P < .001, 26.8% variance). No significant differences in symptom severity (work-related stress, anxiety, depression, and PTSD) were found between participants involved in critical care and non-critical care (P > .05). In addition, healthcare workers reported higher symptoms of depression (5.18 vs 2.91, P < .001), and lower symptoms of anxiety (8.84 vs 22.35, P < .05) than normative data of the general population.

CONCLUSION: Healthcare workers reporting a higher risk of work-related stress were more likely to report more symptoms of depression and PTSD. Healthcare workers involved in critical and non-critical care reported similar symptoms of anxiety, depression, PTSD, and work-related stress. Moreover, healthcare workers involved in the care of the Las Vegas mass shooting victims were more likely to report more symptoms of depression and fewer symptoms of anxiety than samples of the general population. Given the novelty of this study, the unpredictability of MSIs, and the current limitations, we offer recommendations for future studies.

PMID:41554169 | DOI:10.5811/westjem.47216