Nevin Manimala

Medicine (Baltimore). 2026 Mar 20;105(12):e47899. doi: 10.1097/MD.0000000000047899.

ABSTRACT

The value of applying enhanced recovery after surgery (ERAS) pathways in the perioperative management of lung cancer requires further high-level evidence. This study aimed to evaluate the impact of the ERAS nursing pathway on the recovery and prognosis of patients undergoing radical surgery for lung cancer. A retrospective cohort study design was adopted, including patients who underwent radical lung cancer surgery between January 2022 and January 2024. Based on the nursing model, patients were divided into an ERAS group (n = 121) and a conventional care control group (n = 170). Propensity score matching was used to control for confounding factors, resulting in 104 well-matched patients (52 in each group) for analysis. The ERAS group received multidisciplinary, standardized perioperative interventions. Hospital stay, recovery indicators, complications, quality of life (QoL), and patient experience were compared between the 2 groups. After matching, the postoperative hospital stay and total hospital stay in the ERAS group were significantly shorter than those in the control group (median: 5.0 days vs 8.0 days, P < .001; 9.0 days vs 13.0 days, P < .001). The ERAS group showed significantly earlier times to first ambulation, flatus, oral intake, and chest tube removal (all P < .001). Furthermore, the ERAS group had significantly lower overall complication rates (15.4% vs 36.5%, P = .012) and pulmonary complication rates (9.6% vs 25.0%, P = .035). Additionally, the ERAS group exhibited significantly lower postoperative pain scores, lower incidence of nausea and vomiting, while patient satisfaction and early postoperative QoL scores were significantly higher (all P < .05). Subgroup and sensitivity analyses yielded consistent results, confirming the robustness of the conclusions. For lung cancer patients undergoing radical surgery, implementing the ERAS nursing pathway can safely and effectively accelerate postoperative recovery, significantly shorten hospital stay, reduce the risk of complications, and improve patients’ symptom experience and QoL, demonstrating significant clinical value for widespread promotion.

PMID:41861229 | DOI:10.1097/MD.0000000000047899

Medicine (Baltimore). 2026 Mar 20;105(12):e47988. doi: 10.1097/MD.0000000000047988.

ABSTRACT

The role of endothelial injury in worsening congestive heart failure (CHF) remains unquantified. This study evaluates the Endothelial Activation and Stress Index (EASIX) for predicting short-term mortality in patients with critical CHF. This was a retrospective cohort study using the Medical Information Mart for Intensive Care-IV (2008-2022). Adults with CHF admitted to the intensive care unit were stratified by ln(EASIX) quartiles. The primary endpoint was 30-day all-cause mortality. Multivariable Cox regression, restricted cubic splines, and subgroup analyses were performed. Among 4556 patients (median age 72.1 years, 42.8% female), the highest EASIX quartile (Q4) had a 44.2% 30-day mortality rate versus 19.2% in Q1 (adjusted hazard ratio [HR] = 1.6, 95% confidence interval [CI]: 1.27-2.02, P < .001). A nonlinear association was observed (nonlinearity P = .008) with an inflection point at ln(EASIX) = 0.05. Beyond this threshold, each unit increase in ln(EASIX) conferred a 14.2% higher mortality risk (HR = 1.142, 95% CI: 1.062-1.227). Ln(EASIX) remained predictive after full adjustment for severity scores and treatments, with the highest quartile (Q4) exhibiting a 60% increased mortality risk (adjusted HR = 1.60, 95% CI: 1.27-2.02). EASIX is a robust predictor of short-term mortality in patients with critical CHF, particularly valuable in nonsepsis populations. Its simple calculation (lactate dehydrogenase/creatinine/platelets) that refines risk stratification beyond conventional severity scores.

PMID:41861227 | DOI:10.1097/MD.0000000000047988

Medicine (Baltimore). 2026 Mar 20;105(12):e47945. doi: 10.1097/MD.0000000000047945.

ABSTRACT

This study aims to investigate the positional relationship between the pars interarticularis and the pedicle in lumbar spinal stenosis patients and clarify its guiding significance for individualized decompression strategies in unilateral biportal endoscopy (UBE). All patients received standardized UBE. DLM, laminar abduction angle [LAA], laminar width (LW), and facet joint angle (FJA) differed significantly among groups (all P < .001), with smaller DLM associated with narrower LW, smaller LAA, and higher FJA sagittalization. The small DLM group had lower inferior articular process reservation (24.84 ± 16.71%) and higher grade 2 to 3 destruction (75.0%, P < .001), accompanied by worse postoperative back visual analogue scale (VAS), Oswestry Disability Index, longer hospital stay, and greater drainage volume (all P < .05). No significant differences were found in dural sac area improvement or leg VAS among groups (all P > .05). DLM is closely associated with UBE clinical outcomes and an important anatomical reference. Smaller DLM may increase intraoperative facet joint injury risk, potentially due to compact spinal anatomy, which may worsen postoperative recovery. Preoperative DLM evaluation may help identify high-risk patients and guide individualized strategies, balancing decompression efficacy and spinal stability. A retrospective cohort study included patients with L3-S1 lumbar spinal stenosis who underwent UBE decompression between January 2020 and December 2024. Inclusion criteria: confirmed imaging diagnosis, typical symptoms consistent with imaging, ineffective conservative treatment for ≥3 months, limited surgical segments, complete clinical/imaging data, follow-up ≥3 months. Exclusion criteria: lumbar spondylolisthesis (Meyerding grade ≥ II), prior same-segment spinal surgery, pathological stenosis, severe systemic/mental illnesses, blurred imaging data. Patients were grouped by the distance from the lateral margin of pars interarticularis to medial margin of pedicle (DLM). Evaluated indicators: preoperative imaging parameters (LAA, LW, FJA), surgical indicators, clinical outcomes (preoperative/postoperative VAS, preoperative/3-month postoperative Oswestry Disability Index, 3-month postoperative Macnab score), and postoperative imaging parameters (inferior articular process reserved amount, destruction grade, dural sac area). Statistical analyses used SPSS 26.0: ANOVA/Kruskal-Wallis H test, χ2 test/Fisher’s exact test, Spearman correlation, Jonckheere-Terpstra test, and ICC for consistency; P < .05 was significant.

PMID:41861225 | DOI:10.1097/MD.0000000000047945

Medicine (Baltimore). 2026 Mar 20;105(12):e47572. doi: 10.1097/MD.0000000000047572.

ABSTRACT

This study aims to evaluate the survival rate and short-term clinical outcomes of hybrid unicompartmental knee arthroplasty (UKA). We retrospectively analyzed 155 Oxford phase-3 hybrid UKAs in 155 patients who were followed for more than 3 years. Kaplan-Meier survival curves were generated using revision as an endpoint. Oxford knee score (OKS) and range of motion (ROM) were evaluated for clinical assessment, and radiographs were used to assess implant-related complications. At an average follow-up of 3.6 years (range, 3-6 years), 2 knees required revision. The reasons for revision were bearing dislocation and unexplained pain. The overall survival rate was 98.7% at the 6-year follow-up. The mean OKS decreased from 40.94 ± 4.86 to 14.84 ± 1.39 at the last follow-up (P < .001). The mean OKS showed a significant improvement during the first 2 years. The mean ROM improved from 104.81 ± 10.03° to 114.93 ± 7.51° at the last follow-up (P < .001). The mean ROM increased during the first 3 years. Radiolucent lines were observed in 6 cases at 6 years postoperatively, affecting 4 knees. At 6 years postoperatively, the following complication rates were observed: overall revision rate: 1.33% (2/150); deep vein thrombosis rate: 3.33% (5/150); chronic soft tissue pain rate: 1.33% (2/150); stiffness rate: 0.67% (1/150); prosthesis dislocation rate: 0.67% (1/150); lateral meniscus injury rate: 0.67% (1/150); lateral arthritis progression rate: 2.67% (4/150). Oxford phase-3 hybrid UKA provides good survival rates and clinical outcomes in the short-term follow-up.

PMID:41861224 | DOI:10.1097/MD.0000000000047572

J Am Acad Orthop Surg. 2026 Apr 1;34(7):e970-e984. doi: 10.5435/JAAOS-D-25-00057. Epub 2025 Sep 8.

ABSTRACT

INTRODUCTION: Existing literature lacks clarity on how geography may affect gender disparities among pediatric orthopaedic surgeons. This study compares the academic productivity of pediatric orthopaedic attendings based on their sex and region.

METHODS: Faculty lists from the 45 Pediatric Orthopaedic Society of North America fellowship programs were accessed in February 2024. Data on sex, training history, fellowship director status, institution, publication counts, and H-indices were collected from program websites and Scopus. The attending publication rate was calculated by dividing the total number of publications completed as an attending by the number of years in practice. Results were displayed using (mean ± SD). Categorical variables were analyzed using Pearson chi square. Mann-Whitney U and one-way analysis of variance were used for nonparametric and parametric data, respectively. Analyses were done using GraphPad Prism 10, with significance set at P < 0.05.

RESULTS: Four hundred one pediatric orthopaedic surgeons (302 male, 99 female) from 45 fellowship programs were analyzed. Female surgeons had fewer publications, lower H-indices, and lower publication rates than male surgeons. In the Northeast, male attendings had higher publication counts, rates, and H-indices. Men also had higher H-indices than women in the Midwest and Southwest. Among male pediatric orthopaedic attendings, those in the Northeast exhibited the highest publication counts, rates, and H-indices. However, no regional differences were observed among female pediatric orthopaedic surgeons.

CONCLUSION: Notable gender disparities persist among pediatric orthopaedic surgeons in the United States, reflecting systemic barriers that limit women’s research opportunities. Male faculty outnumber female faculty across fellowship programs and have higher publication counts, rates, and H-indices. Regional differences were most notable in the Northeast, where male attendings had markedly higher publication counts, rates, and H-indices. H-index disparities were also present in the Midwest and Southwest. Targeted strategies are needed to improve research access and support for women trainees and faculty.

PMID:41860572 | DOI:10.5435/JAAOS-D-25-00057

JAMA Netw Open. 2026 Mar 2;9(3):e262645. doi: 10.1001/jamanetworkopen.2026.2645.

ABSTRACT

IMPORTANCE: Health care systems can help protect patients from the increasing threat of extreme heat-driven morbidity and mortality. Electronic health records (EHRs) provide insight into trends and local variation in thresholds above which extreme heat is associated with emergency department (ED) use among at-risk patient populations.

OBJECTIVE: To examine associations between extreme heat exposure and all-cause ED visits among patients aged 65 years and older.

DESIGN, SETTING, AND PARTICIPANTS: This matched case-control study of patients seeking emergency care at an urban health care system during the summer (May 1 to September 30) from 2022 to 2024. Two New York City (NYC) EDs were included: (1) ED-1, predominantly serving Medicaid-enrolled patients from minoritized racial and ethnic groups, and (2) ED-2, predominantly serving White, privately insured patients. Included patients were aged 65 years or older and presented to ED-1 and ED-2 during the study period. Data were analyzed from April to August 2025.

EXPOSURES: Daily maximum heat index (HImax) values during the summer were calculated from the National Centers for Environmental Information monitor-derived recordings.

MAIN OUTCOMES AND MEASURES: Daily all-cause ED use counts were derived from EHRs, and extreme heat exposure-outcome curves were calculated. Daily HImax anomalies were calculated based on a 30-year baseline average. The cumulative odds ratio (OR) and 95% CIs were calculated.

RESULTS: This study included 55 200 ED encounters and represented 15 092 unique patients at ED-1 and 19 559 at ED-2 with a mean (SD) age of 74.9 (8.92) years at ED-1 and 74.9 (8.72) years at ED-2. Compared with ED-2, more ED-1 patients were female (8589 [56.9%] vs 10 767 [55.0%]), Hispanic (3544 [23.5%] vs 2576 [13.2%]), and Medicaid-enrolled (1321 [8.8%] vs 824 [4.2%]). At ED-1, daily HImax associations increased after 66 °F (OR, 1.10 [95% CI, 1.01-1.21]), peaking at 101 °F (OR, 1.24 [95% CI, 1.11-1.39]), and were higher on days with HImax anomalies between 15 °F (OR, 1.07 [95% CI, 1.01-1.13]) and 18 °F (OR, 1.10 [95% CI, 1.01-1.20]) warmer than average. At ED-2, daily HImax ED use associations were not significant and were significantly negative for days with HImax anomalies above 16 °F, nadiring at 21 °F (0.84, 95% CI [0.73, 0.95]) warmer than average.

CONCLUSIONS AND RELEVANCE: In this case-control study of the association between heat exposure and ED use in adults aged 65 years and older, positive associations were only observed at ED-1, which served a predominantly lower-income population from minoritized racial and ethnic groups. These association thresholds were not fully captured by NYC heat advisories, which were triggered by 2 days above HImax 95 °F or any time above 100 °F, highlighting an opportunity for future research to develop targeted, risk-informed health care system-based heat warning strategies.

PMID:41860548 | DOI:10.1001/jamanetworkopen.2026.2645

JAMA Health Forum. 2026 Mar 6;7(3):e260034. doi: 10.1001/jamahealthforum.2026.0034.

NO ABSTRACT

PMID:41860540 | DOI:10.1001/jamahealthforum.2026.0034

JAMA Health Forum. 2026 Mar 6;7(3):e260041. doi: 10.1001/jamahealthforum.2026.0041.

ABSTRACT

IMPORTANCE: The US has faced a nationwide shortage of attention-deficit/hyperactivity disorder (ADHD) medications since 2022, yet the underlying causes remain unclear. Public debate has largely centered on prescribing trends and Drug Enforcement Administration (DEA) quotas, although evidence suggests that quotas were not binding. A sound policy response requires a clear understanding of the drivers behind the shortage.

OBJECTIVE: To examine descriptive evidence on the potential causes of the shortage.

SETTING AND DESIGN: In this economic evaluation, we use time series data (2015-2025) from multiple sources, such as Symphony Health and the DEA’s Automation of Reports and Consolidated Orders System (ARCOS) summary reports, to characterize US production, consumption, and trade of amphetamine-based and other stimulants, including manufacturer-level production volumes, before and during the shortage period.

FINDINGS: The sharp, simultaneous production cutbacks across several medium-sized and smaller manufacturers in late 2022 and early 2023 coincided with a steep contraction in US imports of raw amphetamines and more modest declines in phenylacetone, a key precursor.

CONCLUSIONS AND RELEVANCE: These patterns align with manufacturers’ reports to the US Food and Drug Administration citing a shortage of the active ingredient as the cause of backorders. More broadly, this economic evaluation reframes the discussion of ADHD medication shortages beyond DEA quotas, highlighting the vulnerability of US pharmaceutical manufacturing to international supply chain disruptions and underscoring the need for policies that strengthen supply chain resilience.

PMID:41860539 | DOI:10.1001/jamahealthforum.2026.0041

JAMA Health Forum. 2026 Mar 6;7(3):e260123. doi: 10.1001/jamahealthforum.2026.0123.

ABSTRACT

IMPORTANCE: Rates of congenital syphilis in the US have surged over the past decade, despite most states having long-standing mandates requiring clinicians to offer syphilis screening early in pregnancy. Gaps in screening coverage remain, and first-trimester screening alone may miss cases. Several professional bodies now recommend repeat screening in the third trimester and at delivery. Evidence on the impact of expanded prenatal syphilis screening mandates on case detection is limited.

OBJECTIVE: To evaluate the effectiveness of expanding prenatal syphilis screening mandates on syphilis case detection during pregnancy.

DESIGN, SETTING, AND PARTICIPANTS: Birth certificate data from 33 US states between 2012 and 2022 were analyzed using a staggered difference-in-differences design. Maternal syphilis case detection in 4 states that enacted mandates for third-trimester and delivery screening (Arizona, Georgia, Louisiana, and Michigan) were compared with 29 control states without such mandates during this period. The new mandates required all pregnant people be offered third-trimester screening. Three of the states further required that individuals at high risk of syphilis infection be offered screening again at delivery, and 1 state required universal delivery screening. To ascertain whether expanded mandates were associated with changes in screening coverage, inpatient discharge records from 1 mandate expansion state (Georgia) were analyzed. Data were analyzed from December 2024 to September 2025.

EXPOSURES: Passage of a universal syphilis screening mandate in the third trimester and a high-risk or universal mandate at delivery between 2012 and 2022.

MAIN OUTCOMES AND MEASURES: Maternal syphilis case detection (cases per 100 000 live births) and the share of deliveries receiving syphilis screening.

RESULTS: The study sample included 16.3 million live births and 20 961 reported syphilis cases between 2012 and 2022 in 4 mandate expansion states and 29 control states. Expanded screening mandates were associated with a 26% (95% CI, 3-53) increase in maternal syphilis case detection in the first quarter after enactment. The increase in case detection attenuated thereafter and was no longer significant within 1 year (11%; 95% CI, -17 to 48; P = .48).

CONCLUSIONS AND RELEVANCE: In this study, expanded prenatal syphilis screening mandates may improve syphilis case detection in the near-term but are unlikely to have sustained impact without complementary efforts, such as those that facilitate clinician adherence and ensure patient access to and completion of treatment.

PMID:41860538 | DOI:10.1001/jamahealthforum.2026.0123

JAMA Health Forum. 2026 Mar 6;7(3):e260136. doi: 10.1001/jamahealthforum.2026.0136.

ABSTRACT

IMPORTANCE: Income is a key social determinant of health, yet its influence on health system performance may differ across settings. Cross-national comparisons can help identify where income-related disparities are most pronounced and inform targeted policy responses; the US and South Korea are 2 members of the Organisation for Economic Co-operation and Development with high poverty rates but different health systems.

OBJECTIVE: To compare health system performance and income-related inequalities in health system performance between the US and South Korea.

DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study including nationally representative samples of noninstitutionalized adults from the US and South Korea used data from the Medical Expenditure Panel Survey (MEPS; 2010-2019), National Health and Nutrition Examination Survey (NHANES; 2009-2018), Korean Health Panel Study (KHPS; 2010-2019), and Korean National Health and Nutrition Examination Survey (KNHANES; 2010-2019). Data were analyzed from March 2024 to March 2025.

EXPOSURES: Annual household income, categorized into country-specific deciles.

MAIN OUTCOMES AND MEASURES: The main outcomes were 30 indicators across 6 domains: health care spending, health care utilization, access to care, health status, behavioral risk factors, and clinical outcomes. To evaluate income-related inequalities in outcomes, adjusted mean values across income deciles were estimated using regression models.

RESULTS: The sample included 224 168 US adults (female: 51.1% in MEPS, 51.7% in NHANES) and 179 452 South Korean adults (female: 52.4% in KHPS, 56.1% in KNHANES). Mean (SD) age was 46.6 (18.0) years in MEPS, 46.5 (17.4) years in NHANES, 47.7 (16.2) years in KHPS, and 50.5 (17.1) years in KNHANES. US adults had higher mean total health care spending (lowest income decile: $7852 [95% CI, $7456-$8247]; highest decile: $6510 [95% CI, $6218-$6802]) than South Korean adults (lowest decile: $1184 [95% CI, $1105-$1263]; highest decile: $1025 [95% CI, $950-$1100]) despite similar levels of self-reported good health. A 1-decile increase in income was associated with a difference of -$142 (95% CI, -$179 to -$104) in total health care spending in the US compared with -$33 (95% CI, -$41 to -$25) in South Korea. A 1-decile increase in income was associated with an increase of 2.4 (95% CI, 2.3-2.5) percentage points (pp) in self-reported good health in the US compared with 1.5 (95% CI, 1.4-1.6) pp in South Korea. Income-related disparities in preventive service use were also larger in the US, ranging from 0.2 (95% CI, 0.2-0.2) pp for cervical cancer screening to 4.0 (95% CI, 3.9-4.1) pp for dental checkups. In South Korea, disparities ranged from 0.6 (95% CI, 0.4-0.8) pp for dental checkups to 2.0 (1.8-2.2) pp for routine checkups. Similar income gradients were observed in access to care and behavioral risk factors. Differences in clinical outcomes were modest in both countries.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, income was associated with disparities in health system performance in both the US and South Korea, with larger differences by income in the US. The findings suggest that structural and systemic policy efforts are needed to address income-based health inequalities, particularly in the US.

PMID:41860537 | DOI:10.1001/jamahealthforum.2026.0136