Tag: nevin manimala

Drug Alcohol Depend. 2025 Jan 29;268:112586. doi: 10.1016/j.drugalcdep.2025.112586. Online ahead of print.

ABSTRACT

PURPOSE: To assess real-world access to buprenorphine treatment in Philadelphia and measure adoption of policies and practices that facilitate buprenorphine access.

METHODS: We used an audit (“secret shopper”) design to survey all programs providing longitudinal, outpatient buprenorphine in Philadelphia from 9/2022-1/2023 (n = 130). After validating eligibility, a research coordinator posing as a case manager called eligible programs to inquire about appointment availability and treatment policies. We used descriptive statistics to analyze the data and compared practices between primary and subspecialty treatment providers.

RESULTS: We reached 107 programs with audit calls (82 % response rate). 56 (52 %) were primary care offices and 51 (48 %) were specialty addiction providers. 96 (90 %) accepted new patients for buprenorphine treatment, and 83 (78 %) accepted insurance. Median time-to-appointment was 3 business days (range 0-120), and 42 % of visits were offered with a single call. Only 42 % of programs could confirm the possibility of a buprenorphine prescription at an initial visit. 48 % of programs could not provide information about requirements for counseling or behavioral health, and few could provide information about policies for patients with ongoing substance use. Specialty models were more likely than primary care programs to provide information about medication availability at the first visit but also were more likely to require counseling and abstinence.

CONCLUSIONS: Our study provides a simulation of real-world experiences accessing buprenorphine, revealing significant variability in treatment access and persistence of practice-level barriers to treatment. These findings can inform efforts to increase engagement and retention in treatment and better align care with evidence.

PMID:39899919 | DOI:10.1016/j.drugalcdep.2025.112586

Clin Exp Optom. 2025 Feb 3:1-6. doi: 10.1080/08164622.2025.2461233. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Since inflammation plays an important role in the pathogenesis of diabetic retinopathy, serum biomarkers and retinal imaging aimed at evaluating the presence of inflammation have emerged as useful tools to monitor the appearance and progression of diabetic retinopathy.

BACKGROUND: This study aims to investigate the value of YKL-40 levels in patients with diabetes mellitus with different stages of diabetic retinopathy and without diabetic retinopathy, and to compare those findings with results from healthy individuals without diabetes mellitus.

METHODS: This prospective cross-sectional study included 67 diabetic patients with or without diabetic retinopathy who underwent cataract surgery and 23 patients (control group) having no ocular and systemic disease other than senile cataract. Participants with diabetes mellitus were separated into three subgroups: the first group consisted of 26 patients without diabetic retinopathy, the second group included 21 patients with non-proliferative diabetic retinopathy and the third group included 20 patients with proliferative diabetic retinopathy. Serum and aqueous humour YKL-40 levels were analysed and compared between the groups.

RESULTS: The mean serum (p < 0.001) and aqueous humour (p < 0.001) YKL-40 levels were statistically significantly lower in control subjects compared to patients with diabetes mellitus. The aqueous humour YKL-40 levels showed statistically significant elevations with the progression of diabetic retinopathy. Duration of diabetes mellitus was significantly correlated with aqueous humour YKL-40 levels (p = 0.001, r = 0.384).

CONCLUSION: Both serum and aqueous humour YKL-40 levels are higher in patients with diabetes mellitus compared to healthy subjects. Levels of YKL-40 in aqueous humour increase with the progression of diabetic retinopathy.

PMID:39899896 | DOI:10.1080/08164622.2025.2461233

Int J Med Educ. 2025 Jan 30;16:11-20. doi: 10.5116/ijme.676f.ce30.

ABSTRACT

OBJECTIVES: This study was aimed at improving clarity regarding the goals underlying motivation for attendance at international meetings to accommodate evolving needs.

METHODS: We performed a case study of a large international medical conference by undertaking (a) semi-structured interviews with 13 multi-disciplinary stakeholders, which underwent thematic analysis, and (b) surveys of 1229 conference attendees, which underwent descriptive statistical analysis and directed content analysis.

RESULTS: Interviews suggested scientific updates and networking are priorities for in-person formats whereas flexibility and reduced travel are priorities for virtual formats. Surveys suggested motivations for attending both in-person and virtual conferences included: scientific updates (81.3% and 85.4%, respectively) and advancements in patient care (76.6%, 78.2%). Social interaction (e.g., to meet experts 80.6% and make/deepen professional connections 69.3%) was highly rated for in-person meetings, but not virtual meetings (51.0% and 30.8%, respectively). 58.9% of attendees prefer future meetings to be hybrid, including both in-person and virtual formats.

CONCLUSIONS: We found a disconnect between attendees’ preferences and recommendations currently put forward as socially responsible in terms of climate, equity and diversity. Meeting organisers may need to educate others about the value and costs involved in hybrid formats. When hybrid formats are possible, our data provide guidance on what to prioritize during in-person components and how to combine those with the benefits of global accessibility and flexibility enabled by virtual technology.

PMID:39899888 | DOI:10.5116/ijme.676f.ce30

J Med Internet Res. 2025 Feb 3;27:e53306. doi: 10.2196/53306.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has shifted health care toward virtual and online models, impacting both users and providers. Numerous user concerns and perceived risks related to telemedicine are continually evolving and adjusting in response to the pandemic. In many countries, there has been a substantial increase in the use of virtual health care visits, which offers a unique opportunity for researchers to explore these user concerns.

OBJECTIVE: This study aimed to first reconstruct the risk dimensions associated with telemedicine, then identify the risk factors affecting users’ adoption, and finally propose effective solutions to mitigate these concerns. By integrating the newly constructed perceived risk with the technology acceptance model (TAM), we scrutinized various dimensions of perceived risk and their influence on users’ perceptions of ease of use, perceived usefulness, and use intention (UI).

METHODS: Our target population consists of adults aged ≥18 years who have used or may use telemedicine services, recruited through an anonymous, voluntary, open, web-based survey. We collected responses and used part of them to reconstruct risk dimensions using exploratory factor analysis. Subsequently, we analyzed the intricate relationship between perceived risk, the TAM, and the acceptance of telemedicine using structural equation modeling with another part of the responses.

RESULTS: A total of 1600 valid responses were collected. Eight distinct risk dimensions were reconstructed, revealing a substantial negative impact of performance risk on UI. The psychological and social risk was the strongest barrier to the ease of using telemedicine. Time risk, provider risk, and privacy risk were not statistically significant to the TAM. The resulting model elucidates a remarkable 66% variance in UI for telemedicine services.

CONCLUSIONS: This study substantially advances the field of telemedicine research by reconstructing and redefining 8 risk dimensions and confirming the statistical significance of 5 perceived risks on the adoption of telemedicine services. These insights are poised to facilitate the promotion and enhancement of telemedicine services in the health care sector.

PMID:39899842 | DOI:10.2196/53306

J Med Internet Res. 2025 Feb 3;27:e63864. doi: 10.2196/63864.

ABSTRACT

BACKGROUND: Racial inequity in health outcomes, particularly in colorectal cancer (CRC), remains one of the most pressing issues in cancer communication and public health. Social media platforms like Twitter (now X) provide opportunities to disseminate health equity information widely, yet little is known about the availability, content, and reach of racial health equity information related to CRC on these platforms. Addressing this gap is essential to leveraging social media for equitable health communication.

OBJECTIVE: This study aims to analyze the volume, content, and exposure of CRC racial health equity tweets from identified CRC equity disseminator accounts on Twitter. These accounts were defined as those actively sharing information related to racial equity in CRC outcomes. By examining the behavior and impact of these disseminators, this study provides insights into how health equity content is shared and received on social media.

METHODS: We identified accounts that posted CRC-related content on Twitter between 2019 and 2021. Accounts were classified as CRC equity disseminators (n=798) if they followed at least 2 CRC racial equity organization accounts. We analyzed the volume and content of racial equity-related CRC tweets (n=1134) from these accounts and categorized them by account type (experts vs nonexperts). Additionally, we evaluated exposure by analyzing follower reach (n=6,266,269) and the role of broker accounts-accounts serving as unique sources of CRC racial equity information to their followers.

RESULTS: Among 19,559 tweets posted by 798 CRC equity disseminators, only 5.8% (n=1134) mentioned racially and ethnically minoritized groups. Most of these tweets (641/1134, 57%) addressed disparities in outcomes, while fewer emphasized actionable content, such as symptoms (11/1134, 1%) or screening procedures (159/1134, 14%). Expert accounts (n=479; 716 tweets) were more likely to post CRC equity tweets compared with nonexpert accounts (n=319; 418 tweets). Broker accounts (n=500), or those with a substantial portion of followers relying on them for equity-related information, demonstrated the highest capacity for exposing followers to CRC equity content, thereby extending the reach of these critical messages to underserved communities.

CONCLUSIONS: This study emphasizes the critical roles played by expert and broker accounts in disseminating CRC racial equity information on social media. Despite the limited volume of equity-focused content, broker accounts were crucial in reaching otherwise unexposed audiences. Public health practitioners should focus on encouraging equity disseminators to share more actionable information, such as symptoms and screening benefits, and implement measures to amplify the reach of such content on social media. Strengthening these efforts could help bridge disparities in cancer outcomes among racially minoritized groups.

PMID:39899839 | DOI:10.2196/63864

JMIR Form Res. 2025 Feb 3;9:e54147. doi: 10.2196/54147.

ABSTRACT

BACKGROUND: Future Health Today (FHT) is a program integrated with electronic medical record (EMR) systems in general practice and comprises (1) a practice dashboard to identify people at risk of, or with, chronic disease who may benefit from intervention; (2) active clinical decision support (CDS) at the point of care; and (3) quality improvement activities. One module within FHT aims to facilitate cardiovascular disease (CVD) risk reduction in people with chronic kidney disease (CKD) through the recommendation of angiotensin-converting enzyme inhibitor inhibitors (ACEI), angiotensin receptor blockers (ARB), or statins according to Australian guidelines (defined as appropriate pharmacological therapy).

OBJECTIVE: This study aimed to determine if the FHT program increases the proportion of general practice patients with CKD receiving appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) to reduce CVD risk at 12 months postrandomization compared with active control (primary outcome).

METHODS: General practices recruited through practice-based research networks in Victoria and Tasmania were randomly allocated 1:1 to the FHT CKD module or active control. The intervention was delivered to practices between October 4, 2021, and September 30, 2022. Data extracted from EMRs for eligible patients identified at baseline were used to evaluate the trial outcomes at the completion of the intervention period. The primary analysis used an intention-to-treat approach. The intervention effect for the primary outcome was estimated with a marginal logistic model using generalized estimating equations with robust SE.

RESULTS: Overall, of the 734 eligible patients from 19 intervention practices and 715 from 21 control practices, 82 (11.2%) and 70 (9.8%), respectively, had received appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) at 12 months postintervention to reduce CVD risk, with an estimated between-trial group difference (Diff) of 2.0% (95% CI -1.6% to 5.7%) and odds ratio of 1.24 (95% CI 0.85 to 1.81; P=.26). Of the 470 intervention patients and 425 control patients that received a recommendation for statins, 61 (13%) and 38 (9%) were prescribed statins at follow-up (Diff 4.3%, 95% CI 0 to 8.6%; odds ratio 1.55, 95% CI 1.02 to 2.35; P=.04). There was no statistical evidence to support between-group differences in other secondary outcomes and general practice health care use.

CONCLUSIONS: FHT harnesses the data stored within EMRs to translate guidelines into practice through quality improvement activities and active clinical decision support. In this instance, it did not result in a difference in prescribing or clinical outcomes except for small changes in statin prescribing. This may relate to COVID-19-related disruptions, technical implementation challenges, and recruiting higher performing practices to the trial. A separate process evaluation will further explore factors impacting implementation and engagement with FHT.

TRIAL REGISTRATION: ACTRN12620000993998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380119.

PMID:39899838 | DOI:10.2196/54147

J Craniofac Surg. 2025 Feb 3. doi: 10.1097/SCS.0000000000011132. Online ahead of print.

ABSTRACT

Lower-third facial feminization procedures have been associated with the development of postoperative jowling, yet quantitative evaluations of this outcome remain limited. This study evaluated the relationship between patient risk factors and bony volume reduction with postoperative jowling. Chin and gonial angle bony measurements were obtained from preoperative and postoperative computed tomography imaging, whereas changes in jowling were assessed using a validated photonumeric jowling scale on preoperative and postoperative patient images. Associations between skeletal changes, demographic variables, and soft tissue outcomes were statistically analyzed. The study included 35 patients with a mean age of 36 ± 12 years. The average time between surgery and postoperative photographs was 10.0 ± 7.5 months. Gonial angle volume decreased by 9.48% (P < 0.001), whereas chin volume decreased by 3.06% (P = 0.051). Average jowling grade increased significantly from 2.3 to 2.6 postoperatively (P = 0.03), with higher age correlating to a greater increase in jowling (r = 0.35, P = 0.037). Postoperatively, only body mass index was significantly correlated with absolute jowling score (r = 0.51, P = 0.0018). However, no significant associations were found between changes in bony measurements and changes in jowling scores. These findings underscore the importance of further investigating the interplay between patient risk factors and bony and soft tissue changes in facial feminization surgery. Future studies will focus on expanded cohorts and more sensitive assessment tools to better define risk factors and optimize surgical strategies for minimizing jowling.

PMID:39899802 | DOI:10.1097/SCS.0000000000011132

Retina. 2025 Jan 29. doi: 10.1097/IAE.0000000000004418. Online ahead of print.

ABSTRACT

PURPOSE: To determine the pathoanatomical alteration of ectopic inner foveal layers (EIFL) and its relationship to visual recovery after epiretinal membrane (ERM) peeling surgery.

METHODS: Clinical charts and tracked spectral-domain optical coherence tomography images of patients diagnosed with stage 3 and 4 ERM were reviewed and analyzed preoperatively and at 3 and 6 months postoperatively. Central macular thickness (CMT) and EIFL thickness were measured at these time points. Wilcoxon signed-rank test was used for analysis and P < 0.05 was considered statistically significant.

RESULTS: The study cohort consisted of 54 eyes of 54 patients, 27 of whom were female. The mean age was 69.2 years. The mean Snellen VA improved from 20/50 preoperatively to 20/35 at 3 months (P<0.001) and remained 20/35 at 6 months, significantly better than preoperative levels (P=0.002). The mean preoperative EIFL thickness was 169.15 µm and decreased to 95.70 µm at 3 months (P = 0.001) and 90.95 µm at 6 months (P = 0.02). Similarly, CMT reduced from 510.00 µm preoperatively to 444.56 µm at 3 months (P < 0.001) and 415.50 µm at 6 months (P < 0.001). Reduction in EIFL thickness was significantly correlated with improvement in log-MAR VA (P =0.02) 6 months after surgery.

CONCLUSION: ERM peeling results in reduced EIFL thickness, restoration of the normal foveal pit structure, and a corresponding improvement in visual acuity. Reduction in EIFL thickness is correlated with visual improvement.

PMID:39899800 | DOI:10.1097/IAE.0000000000004418

Neurology. 2025 Feb 25;104(4):e210229. doi: 10.1212/WNL.0000000000210229. Epub 2025 Feb 3.

ABSTRACT

BACKGROUND AND OBJECTIVES: Ordinal scales are widely adopted as outcome measures in neurologic randomized controlled trials (RCTs). We aimed to evaluate which statistical methods have been used to test and estimate treatment effects from ordinal outcomes in recent RCTs across a range of acute neurologic diseases.

METHODS: We searched PubMed for RCTs in 5 acute monophasic neurologic diseases (stroke, traumatic brain injury [TBI], subarachnoid hemorrhage [SAH], meningitis, and Guillain-Barré syndrome [GBS]) published in high-impact journals between January 1, 2015, and November 1, 2023. Trials had to report on an ordinal scale as the primary or secondary efficacy outcome. Two independent reviewers performed study screening and data extraction. We evaluated the results to determine how investigators (1) addressed the ordinal nature of outcomes, (2) assessed and reported key assumptions, (3) used longitudinal measurements, and (4) adjusted for prognostic covariates.

RESULTS: We reviewed 70 RCTs for treatment evaluations in stroke (n = 36), TBI (n = 13), SAH (n = 10), meningitis (n = 7), and GBS (n = 4). In 46 of 70 trials (66%), investigators retained the full ordering information, commonly analyzed using a proportional odds model (33/46 trials, 72%). The proportional odds assumption was not addressed in 23 of 33 trials (62%). In 22 of 70 trials (31%), the ordinal outcome was dichotomized, with notable variation in the cut-point for each ordinal scale. In 41 of 70 trials (59%), the ordinal outcome was assessed at multiple time points while some form of longitudinal data analysis was performed in only 3 of these 41 studies (7%). The time point chosen for analysis varied within neurologic conditions. Covariate adjustment was reported in 48 of 70 studies (69%).

DISCUSSION: There is a large variation in the current practice of analyzing ordinal outcomes in neurologic trials. Dichotomization and focus on a single time point are common; therefore, information contained in the rank ordering of the outcome and repeated measurements is not fully used. Further research needs to clarify the balance between maximizing the statistical power, making assumptions, and allowing for straightforward interpretations in approaches that make more effective use of the outcome data.

PMID:39899785 | DOI:10.1212/WNL.0000000000210229

Health Aff (Millwood). 2025 Feb;44(2):215-223. doi: 10.1377/hlthaff.2024.00190.

ABSTRACT

Consolidation of physician practices, largely driven by health systems, has motivated policy efforts to move care toward lower-price, non-health system settings. At the same time, however, private equity (PE) firms are increasingly acquiring those non-health system practices, potentially negating the prior price advantages of those practices. We used novel ownership data on gastroenterology practices linked to commercial claims for the period 2015-20 to study how PE acquisitions affect the prices and volume of care relative to both health system-affiliated practices and independent practices. We examined both professional fees and facility fees. After PE acquisition, prices increased by $92 per claim, or 28.4 percent, driven by a 78.1 percent increase in professional fees. Facility fees did not exhibit a statistically significant change. Meanwhile, utilization also increased. These findings suggest that PE firms have multiple avenues for raising prices-in this case, primarily via professional fees. For policy makers, although moving care out of higher-price health system settings remains a key strategy to lower spending, unchecked growth in professional fees in PE-acquired outpatient settings may nullify some of the intended effects.

PMID:39899779 | DOI:10.1377/hlthaff.2024.00190