Nevin Manimala

J Contin Educ Nurs. 2025 Aug;56(8):322-328. doi: 10.3928/00220124-20250612-02. Epub 2025 Aug 1.

ABSTRACT

BACKGROUND: Early career nurses with 1 to 2 years of experience are offered minimal structured support after onboarding. During this period, nurses often contemplate their next career steps without guidance, sometimes leaving an organization.

METHOD: A quantitative quasi-experimental study was conducted to determine whether career coaching focused on professional development and mentorship would (a) increase retention and (b) improve engagement of pediatric nurses with 1 to 2 years of experience.

RESULTS: Participant retention remained 100% throughout the study. Nonparticipant retention dropped to 96% at 12 weeks postintervention and 94% at 20 weeks postintervention. Engagement scores increased after the career coaching sessions, with no statistically significant difference in mean values for engagement pre- and postintervention (t = -1.06, df = 8.00, p = .320).

CONCLUSION: Engagement improved postintervention. Retention was greater for participants than for nonparticipants. Increasing nurse retention positively impacts professional, financial, and patient care outcomes for nurses and the health care community.

PMID:40749214 | DOI:10.3928/00220124-20250612-02

J Med Internet Res. 2025 Aug 1;27:e60546. doi: 10.2196/60546.

ABSTRACT

BACKGROUND: Internet medical services (IMS) expanded rapidly in China during the COVID-19 pandemic. Unfortunately, disparities in internet medical services utilization (IMSU) have marginalized disadvantaged groups of Chinese patients from digital health benefits. The extent and nature of these disparities remain poorly understood, with no research comprehensively addressing how unfavorable predictors, including demographic, socioeconomic, and health-related factors, shape IMSU status, patterns, and preferences in China after the COVID-19 pandemic.

OBJECTIVE: This study aims to gain a deeper understanding of the disparities and unfavorable predictors that limit IMSU among Chinese adult patients following the COVID-19 pandemic, providing key reference points for advancing equitable IMSU.

METHODS: This cross-sectional study used a triangular approach, combining data from a provincial field survey conducted in July 2023 and a national online survey conducted in March 2024. Participants were Chinese adult outpatients aged 18 years or older. Descriptive and comparative analyses were used to examine disparities in IMSU status, patterns, and preferences across different demographic, socioeconomic, and health status-related factors. Binary logistic regression models were applied to assess the associations between unfavorable predictors (constructed from selected demographic, socioeconomic, and health status-related factors) and IMSU status, patterns, and preferences.

RESULTS: Of the 2011 eligible participants in the Jiangsu provincial field survey, 787 (39.13%) reported using IMS at least once in the previous 12 months. Among the 1611 eligible participants in the national online survey, all reported accessing IMS during the same period; however, only 481 (29.86%) reported high-frequency use (defined as usage in the third quartile or above, ie, ≥6 times). Overall, participants with unfavorable predictors were less likely to engage in IMSU, deep IMS were used less frequently than shallow IMS, and participants with 6 or more cumulative unfavorable predictors had the lowest total of IMSU preference score (mean 48.98 and 57.37 in the provincial field and national online surveys, respectively). Based on combined data from the provincial field and national online surveys, significantly negative associations were observed between unfavorable predictors and IMSU status, patterns, and preferences. In particular, participants aged 60 years or above (odds ratio [OR] 0.40, 95% CI 0.25-0.63, P<.001) and those without everyday internet access (OR 0.54, 95% CI 0.41-0.71, P<.001) were the least likely to use IMS at a medium-to-high frequency. Participants without private health insurance (OR 0.59, 95% CI 0.44-0.79, P<.001) were the least likely to utilize deep IMS. Moreover, participants aged 60 years or above (OR 0.45, 95% CI 0.33-0.63, P<.001) and those with a high school education or less (OR 0.67, 95% CI 0.55-0.82, P<.001) were the least likely to prefer IMS to a moderate-to-strong degree.

CONCLUSIONS: Widespread disparities in IMSU status, patterns, and preferences persisted among Chinese adult patients after the COVID-19 pandemic. More pro-disadvantaged patient policies may be warranted to narrow these disparities in IMSU, such as reimbursement for IMSU, to promote digital health equity in China.

PMID:40749207 | DOI:10.2196/60546

J Am Acad Orthop Surg Glob Res Rev. 2025 Jul 29;9(8). doi: 10.5435/JAAOSGlobal-D-24-00243. eCollection 2025 Aug 1.

ABSTRACT

BACKGROUND: The incidence of metastatic cancer continues to increase, becoming a prevalent condition in oncology orthopaedic practice. The proximal femur is the third most common site of skeletal metastases. Two possible options for endoprosthetic reconstruction of proximal femur metastasis include proximal femur resection and replacement with megaprosthesis and hemiarthroplasty with a long-cemented revision stem.

METHODS: To facilitate better decision making, we conducted a retrospective study comparing these alternatives. This is a single-institution, retrospective, observational study. Patients with metastatic disease of proximal femur who had a reconstruction with either a proximal femoral replacement (group A, 27 patients) or reconstruction using a hemiarthroplasty with long revision cemented stem (group B, 31 patients) were included for analysis.

RESULTS: Group A was associated with higher estimated blood loss than group B (1027.8 vs. 491.9 mL, P = 0.007). Group A was associated with higher surgical time (148.9 vs. 116.6 minutes, P = 0.04). More patients were associated with intense care unit transfer in group A (P = 0.04). Group B was associated with a shorter average time to full weight-bearing (6.2 vs. 11.5 weeks, P = 0.03). Group B was associated with shorter time to discharge (9.4 vs. 17.0 days, P = 0.04). Group A was associated with more postoperative complications (n = 5, 18.5% vs. n = 0, 0%), (P = 0.02).

CONCLUSION: In patients with metastatic disease of the proximal femur, reconstruction with a long revision stem hemiarthroplasty was associated with better performance regarding surgical outcomes (estimated blood loss, surgical time, transfer to intensive care unit vs. regular floor). Furthermore, patients with hemiarthroplasties presented an association with shorter rehabilitation time and less complications.

PMID:40749198 | DOI:10.5435/JAAOSGlobal-D-24-00243

J Am Acad Orthop Surg Glob Res Rev. 2025 Jul 29;9(8). doi: 10.5435/JAAOSGlobal-D-24-00304. eCollection 2025 Aug 1.

ABSTRACT

INTRODUCTION: Perioperative outcomes for patients with cystic fibrosis (CF) have not been previously described following spine surgery. This study used PearlDiver to examine the 90-day postoperative outcomes and 4-year revision rates after posterior lumbar fusion (PLF) for patients with CF compared with matched controls.

METHODS: This study examined a cohort of PLF patients with versus without CF. Patients were matched 1:10 for age, sex, Elixhauser Comorbidity Index, and the number of levels. Ninety-day postoperative outcomes and 4-year revision rates were compared.

RESULTS: One hundred twenty-seven patients with CF were matched with 1263 controls without CF. On multivariable logistic regression, those with CF had statistically significantly increased 90-day odds of the following: venous thromboembolism (odds ratio [OR], 4.2), pleural effusion (OR, 3.4), dyspnea (OR, 3.2), respiratory failure (OR, 2.8), pneumonia (OR, 2.6), acute kidney injury (OR, 2.4), hospital readmissions, (OR, 2.2), and emergency department visits (OR, 2.1). Notably, patients with CF were not at increased odds of 4-year subsequent lumbar surgery.

DISCUSSION: Patients with CF were at significantly increased odds of pulmonary and other defined adverse events. These findings are pertinent in the perioperative risk assessment, patient/family recommendations, and surgical preparations for patients with CF being considered for PLF.

PMID:40749196 | DOI:10.5435/JAAOSGlobal-D-24-00304

Crit Rev Biomed Eng. 2025;53(3):47-76. doi: 10.1615/CritRevBiomedEng.2025058842.

ABSTRACT

Speckle noise in ultrasound images compromises image quality and hinders diagnostic accuracy. Traditional ultrasound denoising methods often struggle to preserve anatomical details while effectively reducing noise, especially under high-noise conditions. In this study, we propose an innovative approach that integrates a lightweight channel attention mechanism (LCAM) within a convolutional variational autoencoder (CVAE) framework to enhance ultrasound image denoising. The proposed approach efficiently reduces speckle noise while maintaining essential anatomical features. Comprehensive evaluations across six diverse ultrasound datasets demonstrate that the LCAM-CVAE outperforms conventional denoising techniques in both subjective image quality and objective performance metrics, including peak signal-to-noise ratio (PSNR), structural similarity index measure (SSIM), standard deviation in PSNR (SD-PSNR), standard deviation in SSIM (SD-SSIM), PSNR statistical relevance tests, and computational efficiency (CE). The LCAM-CVAE approach demonstrates exceptional performance, particularly under high-noise conditions, ensuring the preservation of key anatomical structures for accurate diagnosis. These results highlight the LCAM-CVAE approach as a robust and promising solution for ultrasound image denoising, with significant clinical potential to improve diagnostic quality in noisy environments.

PMID:40749195 | DOI:10.1615/CritRevBiomedEng.2025058842

Crit Rev Biomed Eng. 2025;53(3):13-21. doi: 10.1615/CritRevBiomedEng.2025055055.

ABSTRACT

In this paper, we gave the numerical solution of the various population categories of susceptible, exposed, infected, and recovered (SEIR) mathematical models by using homotopy perturbation method, which is a technique that combines the perturbation and homotopy methods to solve nonlinear problems. Also, we discuss the susceptible population category and explore the graphical solution of all populations (SEIR) using the parameters α and β for both fractional and integer order. In the end, the stability analysis is also shown in the population graphs.

PMID:40749193 | DOI:10.1615/CritRevBiomedEng.2025055055

Crit Rev Biomed Eng. 2025;53(3):v-vi. doi: 10.1615/CritRevBiomedEng.v53.i3.10.

NO ABSTRACT

PMID:40749191 | DOI:10.1615/CritRevBiomedEng.v53.i3.10

ATS Sch. 2025 Aug 1:1-13. doi: 10.34197/ats-scholar.2024-0136OC. Online ahead of print.

ABSTRACT

Background: The gold standard for interstitial lung disease (ILD) diagnosis is multidisciplinary discussion (MDD); however, access is often limited by geographic barriers, time constraints, and the number of centers with ILD expertise. Objective: To assess the educational and clinical impact of a novel videoconferencing MDD program for the diagnosis and management of ILD. Methods: We performed a retrospective observational study of the Multidisciplinary Interstitial Lung Disease Discussion with Experts Remotely (MILDDER) program, a videoconferencing MDD platform initiated by the Toronto General Hospital in Toronto, Canada. We used anonymized survey data from attendees (trainees and practicing physicians) and referring physicians who attended MILDDER between 2018 and 2023. Self-reported ILD confidence before and after MILDDER participation and general program satisfaction were assessed using a 10-point Likert scale. ILD confidence questions were stratified by clinical practice experience. Wilcoxon signed-rank testing for paired data was used to determine statistical significance in the subgroup that completed a MILDDER semester (bimonthly sessions for 6 mo). Written survey responses were assessed qualitatively and grouped by theme. Clinical outcomes, including patient characteristics, new or changed ILD diagnoses, new investigations requests, and new treatment suggestions, were assessed. Results: Three hundred seventeen attendees and referring physicians completed pre-MILDDER questionnaires. Overall, they reported low confidence in their ability to diagnose and manage ILD. After they attended a MILDDER semester ILD, their confidence increased by a median of 3 to 4 points in the overall group. Among respondents with ⩾5 years of clinical practice experience, there was no change in ILD diagnostic confidence after MILDDER; however, management confidence increased by a median of 2 points. A statistically significant increase in all areas of ILD confidence assessed was noted in the subgroup of 70 participants with complete pre- and post-MILDDER semester surveys. Respondents were generally very satisfied with MILDDER. New or changed ILD diagnoses occurred in 86 (50.6%) presented cases, new investigation requests occurred in 40 (22.7%) cases, and new medications were recommended for 30 (17%) cases. Conclusion: Videoconferencing MDD platforms such as MILDDER are feasible and can be used as a tool for physician education and remote management of ILD.

PMID:40749108 | DOI:10.34197/ats-scholar.2024-0136OC

Evolution. 2025 Aug 1:qpaf160. doi: 10.1093/evolut/qpaf160. Online ahead of print.

ABSTRACT

The distribution of pleiotropic mutational effects impacts phenotypic adaptation. However, small effect sizes and high sampling error of covariances hinder investigations of the factors influencing this distribution. Here, we explored the potential for shared information across traits affected by the same mutations to counter sampling error, allowing robust characterisation of patterns of mutational input. Exploiting a published dataset representing 12 samples of the same mutation accumulation experiment in Drosophila serrata, we inferred robust signals of mutational effects from the concordance across samples. Krzanowski common subspace analysis identified a multivariate wing trait with statistically supported mutational variance in all samples. Importantly, this multivariate trait was aligned with the major axis of among-line (mutational) variance within most population samples. That is, despite considerable heterogeneity among samples in individual (co)variance parameter estimates, the predominant pattern of correlated mutational effects was identified in each dataset. Two other multivariate traits were statistically supported across most samples. Smaller effect sizes (lower mutational variance) with concomitant larger sampling error or other factors (e.g., microenvironmental dependence of effects) may reduce the robustness of estimated mutational input for these traits. Overall, our results suggest that multivariate analyses of mutation accumulation experiments can detect the true signal of pleiotropic mutation, and that sampling error does not preclude such studies from extending our knowledge of pleiotropic mutational effects.

PMID:40748662 | DOI:10.1093/evolut/qpaf160

JAMA Netw Open. 2025 Aug 1;8(8):e2524557. doi: 10.1001/jamanetworkopen.2025.24557.

ABSTRACT

IMPORTANCE: Epilepsy is a common complication of brain abscess. However, the effectiveness of antiseizure medications (ASMs) in preventing epilepsy in brain abscess survivors is unknown.

OBJECTIVE: To assess whether the initiation of ASMs is associated with a reduced risk of epilepsy.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study conducted a target trial emulation using US commercial insurance claims data from October 1, 2016, to June 30, 2022, and followed up patients for 180 days. The study population was restricted to those with a diagnosis of brain abscess using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes associated with an acute care visit. Only patients aged 18 years or older at the time of the brain abscess with at least 1 year of prior enrollment were included. Statistical analysis was performed from May to December 2024.

EXPOSURE: A priori selected study ASMs were levetiracetam, valproate, and phenytoin. A clone-censor-weight approach was used to compare the initiation of ASMs within a 45-day grace period (treatment arm) with no initiation of ASMs (control arm). Inverse probability weights were used to control for treatment selection.

MAIN OUTCOMES AND MEASURES: Study outcome was a diagnosis of epilepsy or seizure (with ICD-10-CM code) occurring 15 days or more after the index date. Weighted Kaplan-Meier models were fitted to estimate risk differences (RDs) at 90, 135, and 180 days accompanied by nonparametric bootstrapped 95% CIs. Sensitivity analyses were conducted to assess internal threats to validity.

RESULTS: Among the 572 patients included, the mean (SD) age was 61.5 (16.6) years and 353 (61.7%) were male. Of those in the treatment arm, 83 (88.3%) initiated ASMs within the first 30 days. Overall, 129 patients (22.5%) developed epilepsy during follow-up. There was no statistically significant risk difference in the probability of epilepsy incidence at each follow-up time point (RD at 90 days, -0.02% [95% CI, -4.9% to 4.8%]; RD at 135 days, 1.9% [95% CI, -5.0% to 8.5%]; RD at 180 days, 3.5% [95% CI, -4.4% to 10.8%]). Sensitivity analyses agreed with the primary findings.

CONCLUSIONS AND RELEVANCE: In this cohort study of brain abscess survivors, initiation of ASMs was not associated with a reduced risk of epilepsy. Future studies should replicate the findings and consider alternative treatment protocols.

PMID:40748638 | DOI:10.1001/jamanetworkopen.2025.24557