Nevin Manimala

Brain Behav. 2025 Jul;15(7):e70704. doi: 10.1002/brb3.70704.

ABSTRACT

BACKGROUND: Hemorrhagic stroke remains a major cause of mortality, with hypertension being a key modifiable risk factor. Despite advancements in management, demographic and geographic disparities persist. This study aims to analyze hemorrhagic stroke-related mortality trends among hypertensive adults in the United States from 1999 to 2023, stratified by sex, race, and geographic location.

METHODS: We utilized death certificate data from the CDC WONDER database for individuals aged ≥ 25 years from 1999 to 2023. Crude mortality rates (CMR) and Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and annual percentage change (APC) were determined using Joinpoint regression analysis.

RESULTS: From 1999 to 2023, a total of 372,922 deaths were identified related to hemorrhagic stroke and hypertension. The overall AAMR was 0.45 in 1999 and 6.88 in 2023, with no significant trend observed over the study period. Males consistently exhibited higher AAMRs than females (Males: 7.76 vs. Females: 6.06 in 2023). When stratified by race, the highest AAMR was observed in non-Hispanic (NH) Black or African American populations, followed by NH other, Hispanic or Latino, and NH White populations (AAMR of 10.95, 8.20, 7.83, and 5.86, respectively, in 2023). Regionally, the highest mortality was observed in the West, followed by the South, the Midwest, and lastly, the Northeast (with values of 7.91, 7.76, 5.91, and 4.82, respectively, in 2023). Urban areas (6.79) exhibited consistently higher AAMRs than rural areas (6.13) from 1999 to 2020.

CONCLUSION: Hemorrhagic stroke and hypertension-related mortality remained stable in the United States from 1999 to 2023, with males, NH Black or African American populations, and the Western region exhibiting the highest AAMRs. These findings highlight the importance of improving hypertension management and addressing mortality disparities.

PMID:40686020 | DOI:10.1002/brb3.70704

Prostate. 2025 Jul 21. doi: 10.1002/pros.70018. Online ahead of print.

ABSTRACT

BACKGROUND: We aim to evaluate whether increased lymph node yield at prostatectomy (RP) is associated with improved outcomes in NRG/RTOG 9601, a randomized clinical trial of men who underwent either radiation (RT) alone or RT + bicalutamide for PSA elevation following RP for pT2/T3 prostate cancer.

METHODS: We reviewed available pathology reports for patients in NRG/RTOG 9601 to determine the nodal count at RP. Cox proportional hazards models were used to assess effect of lymph nodes yield, arm (RT alone or RT + bicalutamide), Gleason score, positive margins, and seminal vesicle invasion on the following endpoints: times to local and distant failure and overall and disease-specific survival.

RESULTS: Of 760 patients, 552 (73%, 276 in each arm) had complete data available. Median node count in the entire cohort was 6 (range: 0-33, IQR: 3-9). There were no significant differences between arms in terms of patient demographic or clinical characteristics, including total lymph nodes removed in either arm. There was no significant association between total lymph nodes and overall or disease-specific survival with both arms combined and when adjusting for arm. Notably, interaction analysis revealed that in seminal vesicle invasion, there was a significant association between lymph node yield and OS and DSS (HR = 0.91, 95% CI: 0.83-0.99, p = 0.034; HR = 0.87, 95% CI: 0.77-0.99, p = 0.029, respectively).

CONCLUSIONS: Although lymph node yield in NRG/RTOG 9601 did not show association with adverse outcomes in the entire cohort or either arm alone, there was significant association between lymph node yield and adverse outcomes when seminal vesicle invasion was present. The therapeutic benefit of extensive lymph node dissection remains uncertain but could be more relevant in higher risk patients.

PMID:40686005 | DOI:10.1002/pros.70018

Int Nurs Rev. 2025 Sep;72(3):e70072. doi: 10.1111/inr.70072.

ABSTRACT

INTRODUCTION: Workplace bullying, a widespread phenomenon, significantly impacts interpersonal relationships, mental health, professional performance, and organizational efficiency in healthcare. Defined as repeated behaviors intended to intimidate or degrade, bullying thrives in hierarchical, high-stress environments like hospitals, where nurses face disproportionate risk. Such behaviors harm morale, increase turnover, and jeopardize patient safety through errors and negligence. Understanding its prevalence and contributors is essential for fostering healthier work environments and improving healthcare outcomes.

METHODS: This cross-sectional descriptive study followed the STROBE guidelines. A Slovak adaptation of the Negative Act Questionnaire-Revised, developed as part of this study, was administered to nurses, resulting in a final sample of 244 participants. Spearman’s correlation and Welch’s ANOVA tests analyzed variable relationships using jamovi software.

RESULTS: Nearly one-third of nurses were victims of bullying (32.2%, >45 points), with another third experiencing occasional bullying (32.2%, 33-44 points). The median score per responder was 38 (IQR: 23), with person-related bullying scoring highest (median 19, IQR: 13). Younger nurses with less experience reported higher mobbing levels (p < 0.001). Nurses in frontline roles (operating rooms, intensive care units, and surgical units) experienced significantly more bullying than those in outpatient clinics (p = 0.01). Doctoral degree holders had the lowest mobbing scores (p < 0.001), while nurses in frontline roles reported higher mobbing levels than Ward/Charge Nurses (p < 0.001).

CONCLUSIONS: The study highlights a significant correlation between nurses’ experiences of mobbing and factors such as age, experience, education, position, and workplace type. The high incidence of bullying among Slovak nurses requires immediate attention from healthcare leaders.

IMPLICATIONS: To address workplace bullying, healthcare institutions should implement zero-tolerance policies, provide ongoing education in professional conduct, emotional intelligence, and conflict resolution and integrate these topics into nursing curricula. Leadership should model respectful behavior, while mentorship frameworks and resilience training support novice nurses. Finally, accessible reporting systems must ensure accountability.

PMID:40685991 | DOI:10.1111/inr.70072

J Neuroimaging. 2025 Jul-Aug;35(4):e70064. doi: 10.1111/jon.70064.

ABSTRACT

BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is increasingly performed for distal medium vessel occlusions (DMVOs) of the anterior circulation in acute stroke patients. Although trials have not shown superiority over usual care, selected patients may still benefit from MT. The ideal endovascular technique is debated. We aimed to determine the safety and efficacy of double stent retriever MT (DSR-MT) for DMVOs.

METHODS: We retrospective analyzed demographics, procedure characteristics, and clinical data from consecutive patients with acute primary DMVOs treated with DSR-MT at four comprehensive stroke centers. Reperfusion was defined by the extended Thrombolysis In Cerebral Infarction (eTICI) score. Clinical outcomes were measured by the National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores.

RESULTS: We included 32 patients (median age, 78 years, interquartile range [IQR] 71-82; 16 [50%] female), of whom 26 (81.2%) had primary occlusion of the M2 segment of the middle cerebral artery and six (18.8%) had occlusion of M3. Clinical severity was moderate (median, NIHSS 13; IQR 10-15) in 24 patients (75%). First-pass effect (eTICI 2c/3) was achieved in 20 patients (62.5%). Final eTICI 2b/2c/3 was achieved in 30 patients (93.7%) and final eTICI 2c/3 in 25 (78.1%). Symptomatic intracranial hemorrhage developed in one patient (3.1%). Median NIHSS was 6 at 24 h (IQR 3-12) and 4 at discharge (IQR 1-9). At 90 days, 22 (73.3%) patients were functionally independent (mRS 0-2).

CONCLUSIONS: This preliminary study found good efficacy and safety of DSR-MT for DMVOs in patients with M2 and M3 occlusions.

PMID:40685504 | DOI:10.1111/jon.70064

Nurs Health Sci. 2025 Sep;27(3):e70184. doi: 10.1111/nhs.70184.

ABSTRACT

This randomized controlled pilot study, which involved 176 patients, aimed to evaluate the impact of comedy films on preoperative anxiety levels and postoperative pain in patients undergoing abdominal surgery, as well as the feasibility of this intervention. While the patients in the control group did not undergo any intervention other than routine clinical interventions, the patients in the experimental group watched a comedy movie for 25 min. The pretest anxiety score of the experimental group was found to be 57.48 ± 6.09, while the posttest anxiety score of the same group decreased to 37.35 ± 8.10 after watching a comedy movie. The difference between their pretest and posttest anxiety mean scores was statistically significant (Cohen’s d: 4.20, 95% CI: 27.8124 to 32.4603, p: 0.000). The mean pretest and posttest pain scores of those in the experimental group were 4.99 ± 1.24 and 4.76 ± 1.33, respectively (Cohen’s d: 2.72, 95% CI: -24.6459 to -19.7858, p: 0.003). It was concluded that watching a comedy movie, which is an inexpensive and effective method, reduces preoperative anxiety and postoperative pain in patients undergoing abdominal surgery and provides important information necessary for the design of more precise studies in the future.

PMID:40685496 | DOI:10.1111/nhs.70184

Updates Surg. 2025 Jul 20. doi: 10.1007/s13304-025-02293-z. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) has been linked to several advantages compared to open approach, but the actual benefit of robotic liver resection (RLR) over LLR in HCC needs further investigation.

METHODS: We performed a multicentric propensity-score matched (PSM) analysis comparing perioperative and oncologic outcomes of LLR vs. RLR for HCC. The PSM model was estimated using a multivariable logistic regression, with type of surgery as dependent variable and age, BMI, clinically-significant portal hypertension, αFP, size of principal lesion, number of nodules and Kawaguchi difficulty score as covariates. Overall (OS) and recurrence-free (RFS) survivals were estimated using the Kaplan-Meier method.

RESULTS: Six-hundred-forty-seven HCC patients from 12 IGoMILS registry centers treated by LLR (553 patients) or RLR (94 patients) were included. After PSM, RLR resulted in wider surgical margins (median: 10 vs 5 mm; p = 0.002) with higher prevalence of R0 resection (98.9 vs 93.1%; p = 0.037), lower conversion rate (2.1 vs. 8.5%; p = 0.039) and shorter hospital stay (median: 4 vs 5 days; p = 0.025), with no significant difference in postoperative complication rate. We observed similar OS among RLR and LLR cohorts [5-y OS: 68.7 vs 65.0%; univariable HR = 0.95 (95% CI: 0.60-1.49); p = 0.82], with significantly better RFS in RLR cohort [5-y RFS: 46.8 vs 24.0%; univariable HR = 0.71 (95% CI: 0.52-0.98); p = 0.04].

CONCLUSIONS: Perioperative outcomes were significantly better in the RLR cohort, with a lower conversion rate and shorter hospital stay, although the latter may be influenced by the multi-institutional study design. Notably, we observed wider resection margins in the RLR group, which were associated with significantly improved RFS.

PMID:40685493 | DOI:10.1007/s13304-025-02293-z

Pharmacoecon Open. 2025 Jul 20. doi: 10.1007/s41669-025-00593-z. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: Alzheimer’s disease (AD) exerts a considerable economic burden on South Korea’s aging population. Lecanemab, an amyloid-targeting therapy, has demonstrated efficacy in mitigating cognitive decline in early-stage AD but remains non-reimbursed in South Korea due to concerns over its economic feasibility. This study aimed to examine the cost-effectiveness of lecanemab using nationwide claims data for cost estimation within the South Korean healthcare system. Considering the substantial societal burden of AD, we also evaluated the cost-effectiveness of lecanemab from a limited societal perspective.

METHODS: A Markov state transition cohort model was developed to compare costs and outcomes of lecanemab combined with standard of care (SoC) versus SoC alone. The model simulated five stages of AD progression: mild cognitive impairment, mild AD, moderate AD, severe AD, and death. Transition probabilities between health states were derived from data provided by the National Alzheimer’s Coordinating Center. Formal medical costs and long-term care costs were obtained from the national claims database, while drug cost and other medical expenses were derived from previous studies. Additional cost components such as opportunity cost of caregiver time, out-of-pocket expenses, and time and travel costs for hospital visits were included in the limited societal perspective. Korean-specific utilities for patients and caregivers differentiated by states of AD progression and care settings were obtained from the published literature. Effectiveness was measured in quality-adjusted life years (QALYs) over a lifetime horizon. Scenario analyses were conducted by varying compositions of the cohort, age of onset, and drug pricing.

RESULTS: The incremental cost-effectiveness ratio (ICER) of lecanemab combined with SoC was 198,171,820 Korean Won (KRW)/QALY from the healthcare payer perspective and 181,185,820 KRW/QALY from the limited societal perspective, which significantly exceeded South Korea’s willingness-to-pay (WTP) threshold of 30 million KRW/QALY. Sensitivity analyses revealed that the ICER was highly influenced by variations in treatment effect and discount rates. The result of scenario analyses suggested that targeting lecanemab to patients with mild AD or implementing price reductions could substantially improve its cost-effectiveness.

CONCLUSIONS: Lecanemab’s high cost poses a challenge to its inclusion in the National Health Insurance formulary under South Korea’s current WTP thresholds. Strategic price adjustments and patient targeting are essential to enhance its economic viability. These findings provide valuable insights for policymakers and stakeholders in balancing treatment outcomes and resource allocation for AD management.

PMID:40685475 | DOI:10.1007/s41669-025-00593-z

Ann Surg Oncol. 2025 Jul 20. doi: 10.1245/s10434-025-17838-0. Online ahead of print.

ABSTRACT

INTRODUCTION: Breast-conserving oncoplastic surgery (BCOS), in association with radiotherapy, is the state of the art in the surgical treatment of breast cancer. In this study, we aimed to systematize and validate a novel, four-level complexity classification system for BCOS and associate it with surgical morbidity.

METHODS: We conducted a retrospective, observational study of consecutive female patients who underwent breast-conserving surgery between August 2022 and January 2024 at our breast center. Descriptive statistics were used to summarize the main sample characteristics. The primary outcome was surgical morbidity associated with the novel four-level complexity classification category of surgery performed, computed through a logistic regression model.

RESULTS: Overall, 304 patients underwent the procedures of interest in this study. Surgery complexity levels 1, 2, 3, and 4 were performed in 28, 121, 114, and 41 patients, respectively. A total of 95 patients had complications, including infection, seroma, hematoma, dehiscence, or other complications. A total of 28 patients required re-interventions after definitive diagnosis. The odds of complications increased according to the surgery complexity level, independently of risk factors for complications and factors linked to the surgery type selection, even when considering only clinically relevant complications.

CONCLUSIONS: We concluded that there is an association between morbidity and the complexity level of the surgery performed, with the most complex techniques being associated with higher rates of overall complications and the need for re-intervention, validating the need for a new stratification system for surgeries to improve patients’ quality of life.

PMID:40685460 | DOI:10.1245/s10434-025-17838-0

Sci Rep. 2025 Jul 20;15(1):26327. doi: 10.1038/s41598-025-12163-8.

ABSTRACT

Snow water equivalent (SWE) is a critical variable for understanding water availability and snowmelt-driven streamflow in mountainous regions. Yet, its spatial and temporal estimation is constrained by scarce in situ measurements and the inherent challenges of deriving SWE directly from satellite observations. Thus, accurate SWE assessment is essential for predicting the spatial distribution of snowpack and its temporal contributions to downstream outflow, particularly in semi-arid snow-fed basins like Morocco’s High Atlas regions. In this study, we simulate the local and spatial distribution of SWE and outflow at 500 m using Snow17 model, ERA5-Land and satellite-derived fractional Snow Cover Area (fSCA) from Moderate Resolution Imaging Spectroradiometer (MODIS) for the period 2000-2022. The reanalysis data was downscaled and bias corrected using machine learning models (e.g. random forest). To validate results, we compared simulated snow cover area (fSCA) (transformed from SWE simulation) with fSCA issued from MODIS. The methodology was tested in the Rheraya sub-basin (Tensift basin) and applied in Ait Ouchene and Tillouguite sub-basins (Oum Er Rbia basin) in Morocco’s High Atlas Mountains. Statistical analysis shows strong model performance, with Nash-Sutcliffe Efficiency (NSE) values exceeding 0.84 for snow depth (SD) simulations. Moreover, spatio-temporal analysis revealed that SWE and snow depth are significantly higher above 2,500 m elevation, with SWE exceeding 300 mm and SD surpassing 60 cm in Tillouguite and Rheraya sub-basins. Findings also demonstrated that snowmelt contributions to outflow varied significantly with elevation, accounting for 40-46% of annual outflow above 2,500 m and playing a dominant role during spring (55-57% of seasonal outflow). Our research provides a framework for enhancing SWE/outflow estimation and understanding snowpack dynamics in semi-arid mountainous regions, highlighting the vital role of high-altitude snowpacks in water resource sustainability and management under climate change.

PMID:40685453 | DOI:10.1038/s41598-025-12163-8

Sci Rep. 2025 Jul 20;15(1):26322. doi: 10.1038/s41598-025-11610-w.

ABSTRACT

Investigation of antibiotic use in the pediatric population is crucial, in particular in the hospital setting. Measures of antibiotic consumption, such as Duration-Of-Therapy (DOT) and Length-Of-Therapy (LOT) are recommended as indicators of use in pediatrics. This study is aimed to estimate DOT and LOT in hospitalized children using data from electronic medical records (EMRs). We included all patients hospitalized in a tertiary care children’s hospital in Italy, from January to December 2022. Measures DOT and LOT were derived from data recorded in patient EMRs. DOT/1000 patient-days was estimated by patient characteristics, antibiotic molecule prescribed and type of inpatient ward. The time trend of antimicrobial consumption in hospitalized children was also estimated. At least one antibiotic was prescribed in 8,518 out of 21,787 children (39.1%). Overall, DOT and LOT/1000 patient-days were 539 and 354, with a DOT/LOT ratio of 1.5. The molecule with the highest DOT/1000 patient-days was piperacillin/tazobactam followed by meropenem (81.3 and 59.6 DOT/1000 patient-days). Oncohematology and Intensive Care Units were the type of wards with highest DOT/1000 patient-days (1112 and 944, respectively) and LOT/1000 patient-days (591 and 547, respectively). EMRs enhances data accessibility to measure antibiotic use in hospitalized children and their integration into pediatric antibiotic stewardship programs.

PMID:40685445 | DOI:10.1038/s41598-025-11610-w