Tag: nevin manimala

J Physician Assist Educ. 2025 Oct 14. doi: 10.1097/JPA.0000000000000716. Online ahead of print.

ABSTRACT

INTRODUCTION: Physician associates/assistants (PAs) require extensive clinical training through supervised clinical practice experiences (SCPEs) to meet accreditation standards. While PA programs must document student performance during rotations, there is considerable variability in assessment methods. Many programs use a 2-pronged approach: end-of-rotation (EOR) exams and preceptor evaluations. This study aims to evaluate whether SCPE preceptor evaluations are associated with student performance on EOR exams or Physician Assistant National Certifying Examination (PANCE).

METHODS: This retrospective study analyzed data from 782 students across 3 PA programs over 5 years (2020-2024). The study focused on Family Medicine, Emergency Medicine, and Internal Medicine rotations, comparing preceptor evaluations with EOR and PANCE scores.

RESULTS: Mean PANCE score was 468.2 ± 73.9, with mean EOR scores of 410.6 ± 23.2 for internal medicine, 409.3 ± 22.7 for family medicine, and 410.2 ± 22.1 for emergency medicine. Preceptor evaluations averaged 4.36 ± 0.7 on a 5-point Likert scale. While some statistically significant correlations were identified between preceptor evaluations and standardized exam performance, correlation coefficients were weak (-0.11 to 0.17).

DISCUSSION: Despite some statistically significant correlations, the practical utility of preceptor evaluations in predicting standardized exam performance is negligible. This suggests that preceptor evaluations, although essential to evaluate for clinical competencies beyond standardized evaluations, may not be predictive of academic student success. Preceptor evaluations reveal a weak correlation, when present, with standardized examinations. These findings prompt reflection upon the traditional reliance on preceptor evaluations and suggest that future research is needed at both the programmatic and national levels to capture a comprehensive understanding of student competence as a future clinician.

PMID:41082682 | DOI:10.1097/JPA.0000000000000716

Microsurgery. 2025 Oct;45(7):e70120. doi: 10.1002/micr.70120.

ABSTRACT

BACKGROUND AND OBJECTIVES: The tongue is the most common site of oral malignancy, and surgical treatment may result in impaired feeding, swallowing, and speech. Free tissue transfer is the preferred method for reconstructing complex defects. Evidence remains unclear on whether sensory reinnervation improves function. The objective of this review is to evaluate the outcome of patients undergoing innervated versus noninnervated free flap reconstruction following tongue cancer surgery.

METHODS: A systematic review was performed to determine the role of sensory neurotization in lingual reconstruction. Only studies with comparative designs were eligible for inclusion. Primary outcome measures included static two-point discrimination (S2PD), pinprick sensation, swallowing, and speech. A meta-analysis was performed using key data analysis to calculate weighted effect sizes for reconstruction with or without neurotization using random-effects models. The statistical heterogeneity was determined using the Higgins’ method.

RESULTS: Nine studies were included which produced 107 reinnervated flaps and 117 non-innervated flaps for pooled analysis. Objective measures of sensation were significant, favoring the reinnervation group for pinprick sensation and S2PD (p < 0.05), with the pooled difference in proportions being 0.25 and -13.88 (0.06-0.45, 95% CI, -26.66 mm to -1.11, 95% CI), respectively. Functional outcome measures revealed significantly improved speech in the reinnervated group (p < 0.05, non-weighted means 74.8 vs. 62.5%).

CONCLUSIONS: This study found a strong association favoring the sensory neurotization for tongue reconstruction. Higher quality studies are required to further define the role of reinnervation for the restoration of swallow, relative differences between type of free flap selected, and measure changes in patients’ quality of life.

PMID:41082276 | DOI:10.1002/micr.70120

JAMA Netw Open. 2025 Oct 1;8(10):e2537160. doi: 10.1001/jamanetworkopen.2025.37160.

ABSTRACT

IMPORTANCE: Uncertainty exists about whether women of West African ancestry have increased rates of estrogen receptor (ER)-negative breast tumors, which commonly have earlier age onsets than ER-positive tumors and are aggressive. High-quality population-based studies in Africa with tumor pathology data are generally unavailable, and there is speculation that younger population age structures may explain the increased frequencies of reported ER-negative tumors.

OBJECTIVE: To estimate age-standardized and age-specific rates of ER-negative breast cancer among Ghanaian women and non-Hispanic Black and non-Hispanic White women in the US.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used 2013 through 2015 data from a population-based case-control study conducted in 2 metropolitan areas of Ghana, Accra and Kumasi, to estimate ER-specific breast cancer incidence rates among women 18 to 74 years of age. Incidence rates were recovered by applying sampling weights for controls calculated by district, 5-year age groups, and nonresponse rates from the 2010 census-based enumeration area listings. US Breast Cancer Registry data were retrieved from 17 registries in the Surveillance, Epidemiology, and End Results (SEER) program for non-Hispanic Black and non-Hispanic White women with breast cancer 20 to 74 years of age. Analyses were conducted January 2020 through May 2025.

EXPOSURES: Age, sex, race and ethnicity, ER tumor status, and country (US and Ghana).

MAIN OUTCOMES AND MEASURES: For each of 3 populations, crude, age-standardized, and age-specific breast cancer incidence rates were calculated overall and by ER status.

RESULTS: Analyses were performed for 1071 women (age range, 18-74 years; 468 [51%] ER-negative) in Ghana and 18 321 non-Hispanic Black women (age range, 20-74 years; 5117 [29%] ER-negative) and 103 227 non-Hispanic White women (age range, 20-74 years; 15 040 [15%] ER-negative) in SEER. From 2013 through 2015, ER-negative age-standardized incidence rates were 42.3 (95% CI, 38.7-46.3) per 100 000 women for Ghanaian participants and 43.1 (95% CI, 42.0-44.3) per 100 000 for US non-Hispanic Black women, both higher rates than that of 24.0 (95% CI, 23.6-24.4) per 100 000 for US non-Hispanic White women. ER-positive age-standardized incidence rates were 42.1 (95% CI, 38.4-46.1) per 100 000 women for Ghanaian participants, 105.4 (95% CI, 103.6-107.3) per 100 000 for non-Hispanic Black women, and 128.5 (95% CI, 127.9-129.7) per 100 000 for non-Hispanic White women.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of Ghanaian and US non-Hispanic Black and non-Hispanic White women with breast cancer, age-standardized tumor incidence rates for women with ER-negative tumors in Ghana were similar to those for US non-Hispanic Black women, and both rates were higher than for US non-Hispanic White women. This finding may suggest increased susceptibility requiring elucidation in US non-Hispanic Black and West African populations.

PMID:41082230 | DOI:10.1001/jamanetworkopen.2025.37160

JAMA Intern Med. 2025 Oct 13. doi: 10.1001/jamainternmed.2025.5263. Online ahead of print.

ABSTRACT

IMPORTANCE: An estimated 70% to 80% of older adults develop delirium in the intensive care unit (ICU).

OBJECTIVE: To determine if a slow-tempo music (60-80 beats/min) listening intervention decreases delirium duration, delirium severity, pain, or anxiety in older adults undergoing mechanical ventilation.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter randomized clinical trial with concealed outcomes assessments was conducted in older adults undergoing mechanical ventilation from February 2020 to December 2023. Patients were enrolled from the ICUs of 2 hospitals affiliated with the Indiana University School of Medicine and from the Mayo Clinic in Rochester, Minnesota.

INTERVENTION: A music intervention comprising classical and contemporary tracks, delivered twice daily through noise-canceling headphones and tablets for up to 7 days, was compared to active control listening to a silence track delivered under identical conditions.

MAIN OUTCOMES AND MEASURES: The primary outcome was delirium/coma-free days during the 7-day intervention period assessed by the Confusion Assessment Method for the ICU (CAM-ICU) and the Richmond Agitation-Sedation Scale. The secondary outcomes were delirium severity assessed by the CAM-ICU-7, pain assessed by the Critical Care Pain Observation Tool, and anxiety assessed by the visual analog scale for anxiety (VAS-A).

RESULTS: A total of 158 patients were randomized (mean [SD] age, 68 (9.2) years; 72 [45.5%] female and 86 [54.4%] male). In an intention-to-treat analysis, no differences were found in the number of delirium/coma-free days in the music intervention group compared with control (median [IQR] days, 2.5 [0-5] vs 3 [0-5]; P = .66). There were also no statistically significant differences in the mean CAM-ICU-7 scores, mean pain scores, or mean VAS-A scores over the 7-day intervention period. By end of the 7-day period, both music intervention and control groups had similar mean (SD) CAM-ICU-7 scores (2.72 [2.80] vs 2.56 [2.72]), Critical Care Pain Observation Tool scores (0.20 [0.55] vs 0.61 [1.29]), and VAS-A scores (43.6 [24.7] vs 28.8 [38.4]).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial among older adults undergoing mechanical ventilation, a slow-tempo music intervention did not demonstrate a statistically significant decrease in delirium duration, delirium severity, pain, or anxiety symptoms.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04182334.

PMID:41082215 | DOI:10.1001/jamainternmed.2025.5263

Psychooncology. 2025 Oct;34(10):e70306. doi: 10.1002/pon.70306.

ABSTRACT

BACKGROUND: Valid and reliable measurement tools are needed to plan programs that address the stigmatization of adolescents and to monitor the effectiveness of these programs in childhood cancers, where early diagnosis and treatment are decisive for prognosis. In this context, the development of a stigmatization scale for childhood cancers in adolescents will provide an objective tool for health professionals and researchers to assess stigma and evaluate the effectiveness of interventions designed to reduce it.

OBJECTIVES: This study aims to develop a valid and reliable measurement tool to determine adolescents’ stigma of childhood cancer and to examine its psychometric properties.

METHODS: This methodological study was conducted with 500 adolescents in Türkiye between November 2024 and December 2024. Data were collected with the “The Information Form and the Stigmatization Scale for Childhood Cancers for Adolescents (STS-CA)”. IBM SPSS 25.0 and IBM AMOS 25.0 software programs were used for data analysis, and descriptive statistics were used to analyze numeric variables. Exploration and confirmatory factor analyses were performed to determine the scale’s factorial structure.

RESULTS: The factorial analysis was used to test the structural validity of the scale. A three-factor structure consisting of 22 items was developed. The Cronbach’s alpha coefficients for the Avoidance of Friendship and Social Relationships sub-scale, Health Status and Perception of Difference sub-scale, Emotional Burden and Social Isolation sub-scale and total Cronbach’s alpha coefficients were 0.642, 0.744, 0.579 and 0.910, respectively. Fit indices resulting from the study were χ²/sd: 2.725, RMSEA: 0.075, GFI: 0.90, CFI: 0.90, and NFI: 0.90.

CONCLUSIONS: The Stigmatization Scale for Childhood Cancers for Adolescents (STS-CA) is a valid and reliable scale to determine the stigma level of adolescents toward childhood cancers.

IMPLICATIONS FOR PRACTICE: The scale provides a practical tool for health professionals to assess adolescents’ stigmatization levels, plan and implement interventions to reduce stigma, and evaluate their effectiveness. It may also be used to guide educational activities and awareness programs that support psychosocial well-being in adolescents affected by childhood cancer.

PMID:41082211 | DOI:10.1002/pon.70306

JAMA Intern Med. 2025 Oct 13. doi: 10.1001/jamainternmed.2025.4911. Online ahead of print.

NO ABSTRACT

PMID:41082189 | DOI:10.1001/jamainternmed.2025.4911

Anal Methods. 2025 Oct 13. doi: 10.1039/d5ay01147g. Online ahead of print.

ABSTRACT

This study presents a robust, statistically validated analytical method for the quantification of C5-C10 volatile petroleum hydrocarbons (VPHs) in aqueous matrices using headspace gas chromatography with flame ionization detection (HS-GC-FID). A central composite face-centered (CCF) experimental design was employed to optimize critical extraction parameters, including sample volume, temperature, and equilibration time. The response variable, defined as the chromatographic peak area per microgram of analyte (Area per μg), was used to model the extraction efficiency. Analysis of variance (ANOVA) confirmed the global significance of the fitted model (R² = 88.86%, RMSE = 4.997, p < 0.0001), with significant main, quadratic, and interaction effects. Sample volume showed the strongest negative impact, while temperature and interaction terms demonstrated synergistic behavior. The optimized conditions improved both sensitivity and reproducibility. The proposed method aligns with ISO 9377-2 principles and provides a reliable, environmentally relevant protocol for trace-level VPH monitoring in water samples.

PMID:41082185 | DOI:10.1039/d5ay01147g

Ann Indian Acad Neurol. 2025 Oct 13. doi: 10.4103/aian.aian_466_25. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: To compare the clinical features and consequences of self-limited epilepsy with centrotemporal spikes (SeLECTS) between two age groups by the consideration of a pediatric cohort.

METHODS: Patient data and follow-up observations of children with SeLECTS were documented between 2012 and 2023. Clinical profiles, electrocephalogram (EEG) patterns, and treatment details of the children diagnosed with SeLECTS were retrospectively examined and analyzed in two separate groups based on age at diagnosis.

RESULTS: A group of 198 patients with SeLECTS was included. The study group was divided into two subgroups as the group under age 5 (n = 54) and the group over age 5 (n = 144). The number of antiepileptics needed for seizure control (P = 0.041) and the need for more than one antiepileptic (P = 0.02) were found to be higher, with statistical significance, in the group younger than 5 years old. Moreover, the duration of control of seizures (P < 0.001) and recovery of EEG was longer (P < 0.001) in the group younger than 5 years. Electrical status epilepticus in slow-wave sleep emerged in four patients, and findings revealed that all of these patients were in the group over the age of 5.

CONCLUSIONS: SeLECTS patients diagnosed under the age of 5 experience a longer duration to achieve seizure control and EEG normalization. Additionally, these patients often require a greater number of antiepileptic medications for effective seizure management.

PMID:41082184 | DOI:10.4103/aian.aian_466_25

Eur Geriatr Med. 2025 Oct 13. doi: 10.1007/s41999-025-01327-4. Online ahead of print.

ABSTRACT

AIM: To examine the association of muscle strengthening activities with knee extension strength, gait speed, and skeletal muscle index in adultsaged 50-64 and ≥65 years.

FINDINGS: Muscle strengthening activities are linked to better gait speed, knee extension strength, and skeletal muscle index mainly in middle-aged adults (50-64 years), with weaker or no associations in older adults except for higher activity frequency (≥8 sessions/month), benefi tingstrength in those ≥65 years.

MESSAGE: Muscle strengthening activities are linked to better physical function and muscle health in middle-aged compared to older adults,although frequency may be a confounding parameter.

BACKGROUND: This study examined the association of muscle strengthening activities (MSA) with knee extension strength (KES) and gait speed (GS) (n = 2169), and skeletal muscle index (SMI; n = 765) in adults aged 50-64 and ≥ 65 years.

METHODS: Data were drawn from the National Health and Nutrition Examination Survey 1999-2018 cycles. MSA were self-reported based on engagement with weightlifting, push-ups, or sit-ups. MSA frequency was categorized as ≥ 8 or < 8 sessions/month. Linear and logistic regressions were performed, adjusting for demographic and clinical covariates.

RESULTS: MSA were associated with improved GS and KES across adults aged 50-64 years in fully adjusted models (GS: β = -0.24, 95% CI – 0.42 to – 0.07; KES: β = 31.7, 95% CI 18.9 to 44.5) but not in those ≥ 65 years (GS: p = 0.07; KES: p = 0.11). For SMI, a significant positive association emerged only in the 50-64-year old group after adjustments (β = 0.18, 95% CI 0.03 to 0.34; ≥ 65 years → p = 0.53). Age interaction (≥ 65 vs. 50-64 years) showed significant MSA associations with GS and KES, though SMI results were inconsistent. Finally, higher MSA frequency for ≥ 65 versus 50-64 years was linked to higher KES (β = 22.0, p = 0.03), but not GS (p = 0.05) or SMI (p = 0.64).

CONCLUSIONS: MSA are associated with higher KES and GS in middle-aged, but not in older adults. Higher MSA frequency is linked to increased KES in older adults.

PMID:41082171 | DOI:10.1007/s41999-025-01327-4