Tag: nevin manimala

Health Rep. 2025 Mar 19;36(3):17-28. doi: 10.25318/82-003-x202500200002-eng.

ABSTRACT

BACKGROUND: Ambulatory care sensitive conditions (ACSCs) are illnesses that can be effectively treated and managed in primary care settings. Hospitalizations for ACSCs are therefore considered avoidable and may indicate poor access to quality primary care. This study examined trends in avoidable hospitalizations in Canada among racialized groups.

DATA AND METHODS: The 2016 Canadian Census Health and Environment Cohort was used to estimate annual age-standardized hospitalization rates (ASHRs) for ACSCs among people aged 10 to 74 from 2016/2017 to 2021/2022. ASHRs were disaggregated by sex and racialized group. Rate ratios (RRs) and 95% confidence intervals (CIs) were calculated to assess relative inequality. Logistic regression models were run, adjusting for age, sex, immigrant status, household income, and education.

RESULTS: Across all study years, the odds of avoidable hospitalizations were significantly higher among males, Black people, and non-immigrants, and significantly lower among Chinese people and people in the category “other racialized groups not included elsewhere.” In 2020/2021, during the COVID-19 pandemic, RRs for Black females compared with non-racialized females decreased (2019/2020: RR=1.12, 95% CI=1.07 to 1.61; 2020/2021: RR=0.99, 95% CI=0.94 to 1.04), while they significantly increased for Black males compared with non-racialized males (2019/2020: RR=1.30, 95% CI=1.25 to 1.35; 2020/2021: RR=1.63, 95% CI=1.41 to 1.88).

INTERPRETATION: This study reveals inequalities in avoidable hospitalizations in Canada, pronounced for the Black population compared with the non-racialized population, especially during the pandemic (2020/2021 and 2021/2022). Future studies examining the factors driving these inequalities (e.g., access to primary care, most prevalent conditions, geography) may inform targeted interventions.

PMID:40121621 | DOI:10.25318/82-003-x202500200002-eng

Clin Pharmacokinet. 2025 Mar 23. doi: 10.1007/s40262-025-01500-9. Online ahead of print.

ABSTRACT

OBJECTIVES: The volume kinetics of a commercially available colloid fluid, Gelofusine, have not been studied previously.

METHODS: Intravenous Gelofusine 10 mL/kg was infused over 30 min in 15 patients undergoing vascular surgery. Of the 15 patients, 14 were classified as American Society of Anesthesiologists (ASA) class III status. The distribution and elimination of the infused volume was calculated with mixed-model kinetics based on 280 measurements of the hemoglobin-derived plasma dilution (19 per patient) collected over 180 min.

RESULTS: The expanded central fluid space volume (V_c, the plasma) amounted to 2.16 L (95% confidence interval [CI] 1.06-2.35) at baseline. The maximum volume expansion of V_c was 706 mL (95% CI 599-812) after infusing Gelofusine 800 mL. Elimination occurred with a half-life of 115 min (95% CI 110-124). Noradrenaline was infused in eight of the 15 patients, leading to a dose-dependent reduction in elimination half-life. For example, an infusion rate of 3 µg/min decreased the half-life to 60 min (- 48%). Distribution of the infused volume to the extravascular space was small (15%), and redistribution to the plasma was accelerated by noradrenaline. Mean arterial pressure and urinary creatinine were not statistically significant covariates, and the model was not strengthened by considering the urine output. Infusion protocols aiming to achieve steady state plasma volume expansion during surgery can begin with a fast infusion over 20 min, then decreasing the rate by 80%.

CONCLUSION: The kinetics of Gelofusine was predictable in patients of American Society of Anesthesiologists class III status undergoing vascular surgery, with the fluid expanding the vascular space and the half-life shortened by noradrenaline.

TRIAL REGISTRATION: Retrospectively registered with ClinicalTrials.gov NCT06474052, June 24, 2024.

PMID:40121598 | DOI:10.1007/s40262-025-01500-9

Epilepsia Open. 2025 Mar 22. doi: 10.1002/epi4.70021. Online ahead of print.

ABSTRACT

OBJECTIVE: Investigate real-world outcomes in drug-resistant epilepsy (DRE) patients treated with cenobamate as adjunctive treatment to other antiseizure medications (ASMs) within the Early Access Programs (EAP) in Germany, France, and the United Kingdom.

METHODS: DRE adults with uncontrolled focal-onset seizures were included from 19 hospitals participating in the EAP in this retrospective study. Data were sourced from clinical records. Participants were evaluated at baseline, 1 months, and 3 months from cenobamate start, and 3, 6, and 12 months after maintenance. The primary effectiveness endpoint was the 50% responder rate, defined as the reduction in seizure frequency ≥50%.

RESULTS: Data were collected from 298 patients who received at least one dose of cenobamate; efficacy was evaluated on 216 patients with seizure data available. At baseline, the median epilepsy duration was 22.2 years, and 41.9% of patients had previous epilepsy surgery, including vagus nerve stimulation, with a median of nine previously failed ASMs. The median number of seizures/month was 8.8. After 3 months of maintenance, the 50% responder rate (primary endpoint) was 49.3%; the median percentage seizure reduction from baseline was 49.1%. A total of 100%, ≥90%, and ≥75% seizures reduction were reported in 13.6%, 20.0%, and 33.6% of patients, respectively. Both the responder rate and the median percentage seizure reduction steadily increased during the observation period. At 6-month maintenance, the seizure-free rate was 24.2%. The retention rate assessed by Kaplan-Meier decreased from 96.6% at 1-month cenobamate start to 69.7% at 12-month maintenance. Adverse Drug Reactions (ADRs) to cenobamate occurred in 30.9% of patients, with asthenia, dizziness, and somnolence being the most frequent; the majority were mild-to-moderate and resolved during the observation period; three patients (1.0%) experienced a total of seven serious ADRs, all during titration.

SIGNIFICANCE: In this study, cenobamate demonstrated to be an effective option for people with uncontrolled epilepsy even after multiple failed ASMs or failure of epilepsy surgery.

PLAIN LANGUAGE SUMMARY: This study involved patients with drug-resistant epilepsy, who had continued seizures despite using at least two antiseizure medications (ASMs). Patients received cenobamate (Ontozry) as epilepsy treatment during the Early Access Program (EAP) in France, Germany, and the United Kingdom. An EAP allows patients to receive promising new drugs under clinical supervision before they are commercially available. After 6 months from cenobamate start, 49.3% of patients had their seizures cut by half or more, and 13.6% became seizure-free. A total of 30.9% of patients had an undesirable reaction to cenobamate, mostly mild-to-moderate and resolved; the most frequent were asthenia, dizziness, and somnolence.

PMID:40119878 | DOI:10.1002/epi4.70021

Epilepsia. 2025 Mar 22. doi: 10.1111/epi.18380. Online ahead of print.

ABSTRACT

We compared the efficacy of lacosamide to other frequently used second-line anti-seizure medications (ASMs) for adult status epilepticus (SE) by conducting a retrospective analysis of an institutional SE registry between January 2013 and December 2022. Clinical outcomes assessed at discharge were categorized as return to baseline, new disability, or death; we also considered SE termination after the second-line ASM and the need for mechanical ventilation. Potential confounders included the Status Epilepticus Severity Score (STESS), sex, adequacy of initial SE treatment, treatment delay, and potentially fatal etiology. Over 10 years, 961 adult SE episodes were analyzed; 868 were treated with the following second-line ASMs: 413 levetiracetam (47.6%), 110 valproate (12.7%), and 75 lacosamide (8.6%), as well as lower rates of 18 other ASMs including benzodiazepines (not further analyzed). Univariable analysis identified STESS, treatment delay, and adequacy of initial SE treatment as potential confounders. On multivariable analysis adjusting for these variables, patients with episodes treated with second-line lacosamide, levetiracetam, or valproate demonstrated statistically equivalent rates of seizure cessation, need for mechanical ventilation, and clinical outcomes at hospital discharge. We conclude that lacosamide appears to represent a reasonable alternative to levetiracetam and valproate, and warrants consideration for inclusion in future randomized controlled trials for control of SE.

PMID:40119876 | DOI:10.1111/epi.18380

Am J Orthod Dentofacial Orthop. 2025 Mar 22:S0889-5406(25)00100-3. doi: 10.1016/j.ajodo.2025.02.013. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to compare changes in maxillary anterior alveolar bone remodeling and complication rates in adult patients with different periodontal conditions after maxillary anterior tooth retraction using fixed appliances. In addition, this study analyzed potential factors affecting alveolar bone thickness in patients with periodontitis.

METHODS: A total of 55 adult patients (mean age, 23.53 ± 4.55 years) with Angle Class I or II Division 1 malocclusion with maxillary protrusion were recruited and categorized into the healthy control group (n = 23), stage I periodontitis (P-I) group (n = 17), and stage II periodontitis (P-II) group (n = 15). The maxillary anterior teeth were retracted using a fixed appliance. Cone-beam computed tomography was used to measure the thickness, height, and density of the alveolar bone in the maxillary anterior region before (T1) and after (T2) treatment. The incidences of bone dehiscence and fenestration were documented. Statistical analysis was conducted to evaluate intergroup and intragroup differences. Clinical and cephalometric data were collected to identify factors affecting the changes in alveolar bone thickness using multivariate linear regression analysis.

RESULTS: The labial alveolar bone thickness increased significantly after treatment in all groups, but no differences were observed among the groups. In contrast, the palatal alveolar bone thickness decreased, particularly in the P-I and P-II groups, at the midroot and apical levels (P <0.05). A significant decrease in alveolar bone height was observed in the P-I and P-II groups (P <0.05). The incidence of palatal bone dehiscence was higher in the P-II (84.44%) and P-I (69.61%) groups. Multivariate linear regression analyses revealed that sex, treatment duration, periodontal treatment, changes in tooth inclination, and initial thickness significantly affected palatal alveolar bone thickness changes in patients with periodontitis.

CONCLUSIONS: After retraction of the maxillary anterior teeth with a fixed appliance, the labial alveolar bone of the maxillary anterior teeth thickened, whereas the palatal bone exhibited thinning in adults with periodontitis. The reduction in palatal bone height was more significant in this population than in healthy subjects, along with a higher incidence of palatal bone dehiscence. Bone morphology must be carefully assessed, considering these relevant factors before and during orthodontic treatment.

PMID:40119866 | DOI:10.1016/j.ajodo.2025.02.013

J Perianesth Nurs. 2025 Mar 21:S1089-9472(24)00554-9. doi: 10.1016/j.jopan.2024.11.010. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the incidence and causes of cancellation of day surgery.

DESIGN: This study was a retrospective, observational study and the clinical data were obtained from electronic medical records.

METHODS: Data of day surgery from March 1, 2023 to February 29, 2024 were collected in the major operating room in Xiangya Hospital of Central South University, including patients’ general conditions, diagnoses, anesthesia methods, and whether surgery was performed. The incidence of surgery cancellation in different ages, genders, departments, and anesthesia methods was analyzed comprehensively.

FINDINGS: A total of 6,397 cases were scheduled, 211 cases were canceled after scheduling; the cancellation rate was 3.3%. The cancellation rate among different age groups (P < .01) was statistically significant with 6 to 17 years old as the lowest 1.30% (11/844), and over 65 years old as the highest 3.74% (20/535). The cancellation rate among different departments was statistically significant (P < .01) with plastic surgery as the lowest 2.06% (2/97) and neurosurgery as the highest 10.13% (8/79). The cancellation rate between different anesthesia methods was statistically significant (P < .05) with general anesthesia as 3.01% (140/4,654) and local anesthesia as 4.07% (71/1743). There was no statistically significant difference between different genders (P > .05). Medical reasons were the main reason for cancellation 65.2% (138/211).

CONCLUSIONS: The rate of cancellation is higher in elderly patients and local anesthesia patients and neurosurgery patients with day surgery. Medical reasons were the main cause of these cancellations, most of which could be avoided.

PMID:40119865 | DOI:10.1016/j.jopan.2024.11.010

J Perianesth Nurs. 2025 Mar 21:S1089-9472(24)00535-5. doi: 10.1016/j.jopan.2024.11.005. Online ahead of print.

ABSTRACT

PURPOSE: To reduce fasting time before anesthesia for pediatric bronchoscopy through a quality improvement project.

DESIGN: A quality improvement project design was used.

METHODS: This quality improvement project was conducted between May 2022 and April 2023. The project team adopted the Intergrated Promoting Action on Reasearch Implementation in Health Services (i-PARIHS) theoretical framework, combined with Specific, Measurable, Achievable, Relevant, Time-bound (SMART) objectives and the Plan-Do-Check-Act (PDCA) cycle, to implement a series of improvement measures at a large women and children’s hospital in Southwest China. Barrier analysis for fasting times and relevant balancing measures were identified. Data were analyzed using control charts and statistical process control methods.

FINDINGS: A total of 830 children were involved in this project. The results showed that the new fasting policy did not reduce the preoperative fasting time (8.11 ± 1.98 hours vs 8.41 ± 2.11 hours). Subgroup analysis showed that fasting time for fluid diet such as breastfed and formula patients decreased (P = .019, 95%CI: [-0.48, 0.83]). Correlation analysis indicated that fasting time was related to the number of surgeries (r = 0.342, P = .013), patient weight (r = 0.280, P = .044), and general anesthesia (r = 0.732, P < .001).

CONCLUSIONS: Due to cultural differences, education levels, medical resources, operational difficulties, parental cooperation, and policy management issues, this quality improvement project revealed the complexity of reducing preprocedural fasting times for pediatric bronchoscopy, making the localization of fasting guidelines difficult to implement in Southwest China. It emphasized the importance of understanding various factors influencing fasting durations and highlighted the need for further targeted interventions to address these factors effectively. These insights will inform future efforts to optimize fasting policies and improve patient and family experiences.

PMID:40119864 | DOI:10.1016/j.jopan.2024.11.005

Am J Primatol. 2025 Mar;87(3):e70024. doi: 10.1002/ajp.70024.

ABSTRACT

Kinship is a major determinant of affiliative and mating behavior in primates. In field studies, identifying kin typically relies in part on genetic analysis, especially for discriminating paternal relationships. Such analyses assume knowledge of Mendelian inheritance, genotyping technologies, and basic statistical inference. Consequently, they can be difficult for students to grasp, particularly through traditional lecture formats. Here, we investigate whether integrating an additional active learning approach-interaction with DadApp, an application built using the R package Shiny that implements a popular paternity inference approach in an accessible graphical user interface-improves student understanding of genetic kinship analysis in molecular primatology. We do so in the context of a nontraditional learning environment in Kenya, a developing nation in which students have limited access to technology, and where the efficacy of educational Shiny apps has never been assessed. Twenty-eight (28) participants with diverse educational backgrounds attended an introductory lecture on genetics and paternity inference, completed a pre-test, interacted with DadApp via a structured set of exercises and questions, and then completed a post-test and survey about their experience and subjective understanding. Post-test scores significantly improved relative to pre-test scores (p = 3.75 × 10^{– 6}), indicating enhanced learning outcomes. Further, student interest and confidence in the subject matter significantly increased after the practical session with DadApp. Our results suggest that Shiny web app-based active learning approaches have potential benefits in communicating complex topics in molecular primatology, including in resource-limited settings where such methods have not yet experienced high penetrance.

PMID:40119860 | DOI:10.1002/ajp.70024

Am J Primatol. 2025 Mar;87(3):e70028. doi: 10.1002/ajp.70028.

ABSTRACT

Ultrasound-guided intrauterine insemination (IUI) has been successfully employed in cynomolgus macaques, yet its effectiveness in large-scale, multi-age cohorts has not been fully explored. Here, we implemented IUI within large breeding colonies to boost pregnancy rates in cynomolgus macaques. Ovulation timing was estimated by monitoring menstrual bleeding, after which IUI was performed. We then compared single menstrual cycle (SMC) pregnancy rates between IUI groups and harem-style mating groups. Our findings revealed that the overall pregnancy rate in the IUI group was significantly higher than in the harem-style breeding group across all ages. Notably, this advantage was mainly attributable to monkeys over 10 years old; in contrast, no significant difference was observed among 4-5-year-old and 6-10-year-old monkeys. Although pregnant females in the IUI group exhibited a higher birth rate compared to those in harem-style breeding, this difference was not statistically significant. Collectively, these results establish a basis for refining reproductive technologies in older cynomolgus macaque breeding programs and highlight potential improvements in managing large-scale colonies.

PMID:40119859 | DOI:10.1002/ajp.70028

J Gerontol B Psychol Sci Soc Sci. 2025 Mar 22:gbaf057. doi: 10.1093/geronb/gbaf057. Online ahead of print.

ABSTRACT

OBJECTIVE: Higher schooling attainment is associated with better cognitive function at older ages, but it remains unclear whether the relationship is causal. We estimated causal effects of schooling on performances on the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) word-recall (memory) test at older ages in China, Ghana, India, Mexico, Russia, and South Africa.

METHODS: We used harmonized data (n = 30,896) on older adults (≥50 years) from the World Health Organization Study on Global Ageing and Adult Health. We applied an established nonparametric partial-identification approach that bounds causal effects of increasing schooling attainment at different parts of the schooling distributions under relatively weak assumptions.

RESULTS: An additional year of schooling increased word-recall scores by between 0.01-0.13 standard deviations (SDs) in China, 0.01-0.06 SDs in Ghana, 0.02-0.09 SDs in India, 0.02-0.12 SDs in Mexico, and 0-0.07 SDs in South Africa when increasing schooling from never attended to primary. No results were obtained for Russia at this margin due to the low proportion of older adults with primary schooling or lower. At higher parts of the schooling distributions (e.g., high school or university completion) the bounds cannot statistically reject null effects.

DISCUSSION: Our results indicate that increasing schooling from never attended to primary had long-lasting effects on memory decades later in life for older adults in five diverse low-and-middle-income countries.

PMID:40119841 | DOI:10.1093/geronb/gbaf057