Tag: nevin manimala

J Am Acad Orthop Surg. 2025 Dec 8. doi: 10.5435/JAAOS-D-25-00380. Online ahead of print.

ABSTRACT

OBJECTIVES: Increased mortality following geriatric hip fractures is well reported. However, population-level analysis of mortality trends over time are not common. This study aimed to evaluate the 3- and 12-month mortality after geriatric hip fractures from 2010 to 2019.

METHODS: The New York Statewide Planning and Research Cooperative System database from 2010 to 2020 was retrospectively queried for patients aged >65 years with a femoral neck or intertrochanteric hip fracture. Kaplan-Meier survival analysis was used to calculate mortality rates for each year. Cox proportional hazard multivariable regression controlling for sex, age, race, obesity, smoking, and Elixhauser comorbidity index was used to compare mortality hazard ratios for each year. Secondary outcomes included length of stay, discharge disposition, and 3-month readmission and emergency department visits.

RESULTS: From 2010 to 2019, 142,540 patients aged ≥65 years had a diagnosis of femoral neck fracture (62%) or intertrochanteric hip fracture (38%). The mean age was 83.29 years (SD 8.22). The mean Elixhauser comorbidity index was 7.35 (SD 7.60). Kaplan-Meier survival analysis revealed that for the complete cohort 3-month mortality rate was 9.82% (95% confidence interval 9.65% to 9.98%) and 12-month mortality rate was 16.06% (95% confidence interval 15.84% to 16.27%). The 3-month mortality rate went from 10.8% in 2010 to 8.6% in 2019 and the 12-month mortality rate went from 17.7% in 2010 to 14.8% in 2018 before rising to 16.9% in 2019. Cox multivariate proportional hazard regression demonstrated statistically significant decreased hazard ratio from 2012 to 2019 compared with reference hazard in 2010 (all P < 0.05). Reductions were also observed for length of stay (7.8 to 6.4 days, P < 0.001), 3-month readmissions rate (34% to 22%, P < 0.001), and 3-month emergency department visit rate (45% to 34%, P < 0.001).

CONCLUSION: Mortality after geriatric hip fractures has demonstrated a reduction in the past decade with 3-month mortality continuously decreasing from 2010 to 2019 and 12-month mortality decreasing from 2010 to 2018 before increasing in 2019.

PMID:41406399 | DOI:10.5435/JAAOS-D-25-00380

J Cardiovasc Pharmacol. 2025 Nov 25. doi: 10.1097/FJC.0000000000001780. Online ahead of print.

ABSTRACT

Colchicine has been studied as an anti-inflammatory treatment for cardiovascular prevention, but findings from randomized trials have been inconsistent. This meta-analysis evaluated the efficacy and safety of colchicine in reducing major adverse cardiovascular events (MACE) and its individual components, using ChatGPT as an assistant throughout the process. Randomized trials of colchicine for cardiovascular prevention were systematically identified, and data extraction, risk of bias assessment, and meta-analyses were performed with ChatGPT under human supervision. The primary outcome was MACE, while secondary outcomes included myocardial infarction (MI), stroke, revascularization, cardiovascular mortality, and all-cause mortality. Eleven trials involving 30,888 patients were included. Colchicine significantly reduced MACE (risk ratio 0.75, 95% CI 0.63-0.88), though no significant effects were observed for MI, stroke, cardiovascular mortality, or all-cause mortality. In addition to its clinical findings, this study illustrates the potential of ChatGPT to assist in systematic reviews and meta-analyses by automating screening, data extraction, bias assessment, and statistical code generation. This integration reduced researcher time by over 70% while maintaining accuracy through human validation. Overall, colchicine appears to lower the risk of MACE but the results of the CLEAR trial have lowered certainty, while the findings highlight the feasibility and efficiency gains of using large language models in evidence synthesis workflows.

PMID:41406368 | DOI:10.1097/FJC.0000000000001780

Can Urol Assoc J. 2025 Dec 15. doi: 10.5489/cuaj.9370. Online ahead of print.

ABSTRACT

INTRODUCTION: Accurate pre-intervention staging of upper tract urothelial carcinoma (UTUC) remains a significant clinical challenge, particularly in identifying muscle-invasive disease (≥pT2), where kidney-sparing surgery may not be appropriate. Current imaging and biopsy approaches are often inadequate. Radiomics, which extracts high-dimensional features from medical imaging, may improve non-invasive staging. This study assessed whether computed tomography (CT)-based radiomic features, alone or combined with clinical data, could predict ≥pT2 UTUC in a multicenter Canadian cohort.

METHODS: We retrospectively analyzed clinical, pathologic, and radiographic features of patients with UTUC who underwent extirpative surgery at five academic centers from January 2, 2001, to May 1, 2023. Radiomic features were extracted from machine-learning segmentations of the affected kidney using the excretory phase of CT. Predictive models were developed using clinical only, radiomic only, and combined data to predict stage ≥pT2. Feature selection included univariable logistic regression, correlation filtering, and LASSO. Model performance was assessed via five-fold cross-validation repeated 10 times, with area under the curve (AUC) as the primary metric.

RESULTS: Of 441 patients, 208 (47.2%) were included. Of the 208 patients, 97 (46.6%) had ≥pT2 disease. The clinical model (AUC 0.602) included age, hydronephrosis, and high-grade cytology. The radiomics model, based on two texture features, achieved an AUC of 0.653. The combined model achieved an AUC of 0.647. Radiomics and combined models significantly outperformed the clinical model (p<0.01), but did not differ from each other. For 117 patients with renal pelvis cancers, the combined model’s discrimination performance was statistically better than the clinical model (AUC 0.708 vs. AUC 0.607, p<0.001). Likewise, the radiomics’ AUC discrimination performance was statistically better than the clinical model (AUC 0.694 vs. AUC 0.607, p=0.004). In contrast, we found no significant difference in model performance in the non-renal pelvis subgroup (n=91).

CONCLUSIONS: Conventional radiomics improved the prediction of muscle-invasive UTUC compared to clinical models alone, but overall accuracy remained suboptimal for clinical use. Heterogeneity in CT protocols and challenges with tumor segmentation were the main limitations. Future work should develop more adaptable AI models trained on larger, more diverse datasets to better reflect real-world imaging conditions.

PMID:41406346 | DOI:10.5489/cuaj.9370

Can Urol Assoc J. 2025 Dec 15. doi: 10.5489/cuaj.9451. Online ahead of print.

ABSTRACT

INTRODUCTION: Type and screen testing (T&S) is routinely performed preoperatively for many endoscopic procedures, despite low transfusion rates. While important, T&S can be costly, unnecessary, and burdensome for patients to obtain in a short timeframe due to expiry. We aimed to assess and reduce unnecessary T&S in a safe and collaborative manner through a Transfusion Dashboard. We assessed the effect of reduced testing on patient safety, cost, and the environment.

METHODS: This quality improvement study used the Transfusion Dashboard, a web-based, institutional platform tracking blood transfusion trends. During the observation phase (2016-2019), procedure-specific preoperative T&S recommendations were developed. Following implementation of these recommendations in 2020, the incidence of T&S, perioperative transfusion rates, and rescue transfusion rates were assessed pre- and post-intervention using the Chi-squared test. Cost and environmental savings were also evaluated.

RESULTS: From 2016-2023, outcomes were tracked for 4375 pre-initiative and 2488 post-initiative patients who underwent endoscopic procedures. We found a statistically significant decrease in T&S following initiative implementation for transurethral resection of the prostate (TURP), percutaneous nephrolithotomy (PCNL), holmium e-nucleation of the prostate (HoLEP), and transurethral resection of bladder tumor (TURBT) by as much as 51.2%. There was no change in uncrossed or overall blood transfusions. Since the implementation of the initiative, $45 362.81 in testing materials were saved and an associated reduction of 697 kg CO₂ was observed.

CONCLUSIONS: Institutional- and procedure-specific testing guidelines decreased unnecessary tests, leading to improved resource stewardship, reduced cost, improved patient experience, and environmental savings. Initial modest cost savings and care improvements may be amplified safely in larger organizations and across more procedures.

PMID:41406342 | DOI:10.5489/cuaj.9451

J Med Microbiol. 2025 Dec;74(12). doi: 10.1099/jmm.0.002104.

ABSTRACT

Introduction. Biofilms have been implicated as a potential cause of chronic rhinosinusitis (CRS), with patients showing an increased prevalence of biofilms, likely contributing to antibiotic ineffectiveness in these individuals. In many environments, biofilms are polymicrobial, with interspecies interactions promoting bacterial survival and encouraging robust growth. Improvements in visualization techniques for biofilms have enabled species-specific identification, leading to a growing body of literature using these techniques and examining severity in different phenotypes of CRS.Gap Statement. It is unclear whether sinus biofilms are typically poly- or monomicrobial, and if they are correlated with clinical severity in CRS.Aim. We conducted a scoping review to determine how prevalent biofilms were in sinus tissue of patients with CRS. Furthermore, we correlated disease severity with the presence of biofilms.Methodology. We searched PubMed, Scopus, Medline and Web of Science databases for all studies which directly visualized biofilms on tissue from patients with CRS. After screening 1,853 search results, 39 studies were included for analysis in this review.Results. Patients with CRS had a higher prevalence of biofilms compared with controls. We found no significant difference in the proportion of biofilms detected across visualization techniques or based on CRS phenotyping. Fifteen studies reported disease severity by biofilm status; most reported greater severity in patients with biofilms, although only some were statistically significant. Nine studies used techniques capable of detecting polymicrobial biofilms, all of which found a subset of polymicrobial biofilms.Conclusion. Our findings demonstrate an increased prevalence of biofilms in patients with CRS, which may correspond to increased disease severity. The evidence for biofilms being polymicrobial is compelling, although it is based on a small number of studies.

PMID:41405936 | DOI:10.1099/jmm.0.002104

JAMA. 2025 Dec 17. doi: 10.1001/jama.2025.20541. Online ahead of print.

NO ABSTRACT

PMID:41405908 | DOI:10.1001/jama.2025.20541

JAMA Psychiatry. 2025 Dec 17. doi: 10.1001/jamapsychiatry.2025.3828. Online ahead of print.

ABSTRACT

IMPORTANCE: Veterans with serious mental illness (SMI) experience a higher prevalence of obesity than the general veteran population; weight loss programs are needed that are tailored to this population.

OBJECTIVE: To evaluate a weight loss program, CoachToFit (CTF), which includes weekly calls from a Veteran Health Administration peer specialist, a Bluetooth-enabled scale and fitness tracker, and a smartphone application that provides health education and tracks steps, goals, and weight.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted within the Pittsburgh Veteran Affairs health care system and presents pre-post (6 months) analysis comparing CTF and usual care. Veterans with body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 30 or higher and diagnosis of major depressive disorder, bipolar disorder, or schizophrenia were eligible for inclusion. Exclusion criteria included history of bariatric surgery or recent psychiatric hospitalization. The study was conducted from October 1, 2020, to September 30, 2025, and data analysis was conducted from January to October 2025.

EXPOSURE: Random assignment to CTF.

MAIN OUTCOMES AND MEASURES: The primary outcomes were weight (in kg), BMI, and cardiorespiratory fitness (meters walked in 6 minutes).

RESULTS: Among the sample (n = 256), mean (SD) age was 53.5 (13.1) years, 80 participants (31.3%) were female, and 199 (77.7%) were diagnosed with major depressive disorder. Mean (SD) weight loss at 6 months was -3.2 (6.2) kg in the CTF group (n = 128) compared to -1.6 (4.9) kg in the usual care group (P = .05). After adjustment, participants in CTF experienced greater, nonsignificant weight loss compared to usual care, with an adjusted mean difference (AMD) of -1.62 kg (95% CI, -3.38 to 0.14; P = .07). For BMI, the AMD in change between groups at 6 months was -0.56 (95% CI, -1.15 to 0.03; P = .06). Change in meters walked was not statistically significant between groups, with an AMD of 3.53 m (95% CI, -12.87 to 19.92; P = .67). At 6 months, 34 participants (36.6%) from the CTF group lost 5% or more of their body weight compared to 19 (22.4%) in usual care, representing a 1.93-fold greater likelihood in adjusted analyses (95% CI, 0.96-3.91; P = .07). More participants in CTF (n = 21 [22.6%]) lost 7% or more of their body weight compared to usual care (n = 7 [8.2%]), representing a 3.9-fold greater likelihood in adjusted analyses (95% CI, 1.45-10.36; P = .007).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, a weight loss program tailored to veterans with SMI using remote technologies and paraprofessionals demonstrated the potential to help this population lose weight.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04560335.

PMID:41405896 | DOI:10.1001/jamapsychiatry.2025.3828

JAMA Netw Open. 2025 Dec 1;8(12):e2544153. doi: 10.1001/jamanetworkopen.2025.44153.

ABSTRACT

IMPORTANCE: The Planetary Health Diet (PHD), introduced by the EAT-Lancet Commission in 2019, emphasizes a plant-based diet. Several cohorts have assessed adherence using the PHD Index (PHDI), but evidence is limited on whether maternal periconceptional and early pregnancy adherence is associated with fetal growth.

OBJECTIVE: To examine the association of maternal PHDI adherence in early pregnancy with longitudinal 2-dimensional and 3-dimensional fetal biometric measures.

DESIGN, SETTING, AND PARTICIPANTS: Secondary analysis of a prospective cohort of pregnant women with singletons (July 2009 to January 2013) at 12 US clinical sites. Women with preexisting health conditions were excluded. Participants had data on fetal body composition and organ volumes (April 2016 to September 2019). Analyses were conducted June 2024 to August 2025.

EXPOSURE: PHDI adherence categorized as low, moderate, or high, assessed by the Food Frequency Questionnaire between 8 to 13 weeks’ gestation.

MAIN OUTCOMES AND MEASURES: Estimated fetal weight (EFW), head circumference (HC), humerus and femur lengths, abdominal circumference and area, abdominal subcutaneous tissue thickness, fractional thigh and arm volumes (total, lean, and fat), midthigh areas, ratio of fractional fat thigh volume to fractional thigh volume, and ratio of midthigh fat area to midthigh area, measured up to 5 times between 15 to 42 weeks’ gestation. Trajectories were modeled using linear mixed-effects models.

RESULTS: Analyses included 1464 women. Mean (SD) maternal age was 28.1 (5.6) years, and mean (SD) gestational age at delivery was 39.2 (1.7) weeks. High vs low PHDI adherence was associated with larger EFW at 32 to 40 weeks (32 weeks: difference, 35 g; 95% CI, 22 to 49 g; 40 weeks: difference, 165 g; 95% CI, 108 to 223 g), larger HC at 37 to 39 weeks (37 weeks: difference, 1.89 mm; 95% CI, 1.10 to 2.69 mm; 39 weeks: difference, 2.44 mm; 95% CI, 1.47 to 3.42 mm), smaller fractional lean arm volume at 34 to 37 weeks; (34 weeks: difference, -0.40 cm3; 95% CI, -0.56 to -0.25 cm3), larger fractional fat arm volume at 28 to 29 weeks; (28 weeks: difference, 0.23 cm3; 95% CI, 0.13 to 0.34 cm3), and larger abdominal area at 25 to 26 weeks (25 weeks: difference, 62.2 mm2; 95% CI, 34.4 to 90.0 cm3). Moderate adherence showed similar patterns.

CONCLUSIONS AND RELEVANCE: In this cohort study of pregnant women, higher maternal PHDI adherence in early pregnancy was associated with greater fetal adiposity and reduced lean tissue, suggesting potential implications for offspring metabolic health.

PMID:41405886 | DOI:10.1001/jamanetworkopen.2025.44153

JAMA Netw Open. 2025 Dec 1;8(12):e2550044. doi: 10.1001/jamanetworkopen.2025.50044.

ABSTRACT

IMPORTANCE: Little is known about food insecurity (FI) among graduate medical education (GME) trainees or how FI might relate to well-being outcomes in this population.

OBJECTIVES: To assess the prevalence of and factors associated with FI among GME trainees and to investigate the associations of FI with well-being outcomes such as burnout and social isolation in this population.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, a survey was distributed among 3408 resident and fellow physicians at 4 geographically distinct sites within 2 US academic institutions from May 2 to June 21, 2023. All resident and fellow physicians appointed at both institutions were eligible and were invited by email to participate.

MAIN OUTCOMES AND MEASURES: The primary outcome was prevalence of FI. Measurement instruments included a 2-item FI screening tool, a 2-item measure of burnout, items addressing intent to stay at one’s institution, social isolation, and demographic characteristics. Univariable analysis and multivariable Poisson and linear regression were used to characterize prevalence and factors associated with FI and associations with well-being outcomes and intent to stay at the institution.

RESULTS: Of those eligible, 1656 residents and fellows participated in the survey (a response rate of 48.6%). Of these respondents, 735 of 1458 (50.4%) who indicated their gender identified as men and 365 of 1402 (26.0%) who indicated their parental status reported having children. Of the 1551 respondents who reported their age, 519 (33.5%) were younger than 30 years, 770 (49.6%) were aged 31 to 35 years, 169 (10.9%) were aged 36 to 40 years, and 53 (3.4%) were older than 40 years. Among 1457 respondents indicating their race and ethnicity, the majority were Asian (310 [21.3%]) or White (654 [44.9%]). The overall prevalence of FI was 13.7%. FI proportions differed across training sites, with higher levels in large metropolitan locations (15.6%, 17.0%, and 21.3% for the 3 sites in large metropolitan areas vs 4.5% for the site in a small metropolitan area; P < .001). There were also differences by postgraduate year (16.9% for postgraduate year 1 vs 10.1% for postgraduate year ≥5; P = .003) and race and ethnicity (22.4% for Black or African American trainees compared with 8.4% for White trainees; P = .04). Those with FI were more likely to experience burnout (adjusted relative risk, 1.37 [95% CI, 1.18-1.60]; P < .001), were less likely to consider remaining at their institution after training (adjusted relative risk, 0.81 [95% CI, 0.68-0.98]; P = .02), and had higher social isolation scores (T-score parameter estimate 2.37 [95% CI, 0.89-3.86]; P = .002).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, nearly 1 in 7 GME trainees screened positive for FI. FI was associated with important well-being outcomes including burnout. These findings suggest that academic medical institutions should pursue systemic solutions to address FI among resident and fellow physicians as a means of supporting their well-being.

PMID:41405884 | DOI:10.1001/jamanetworkopen.2025.50044

JAMA Netw Open. 2025 Dec 1;8(12):e2550195. doi: 10.1001/jamanetworkopen.2025.50195.

ABSTRACT

IMPORTANCE: Standard preoperative radiotherapy (RT) for high-risk soft tissue sarcoma (STS) is delivered over 5 weeks, which can be a logistical challenge for patients.

OBJECTIVE: To evaluate the long-term toxic effects and clinical outcomes associated with a shorter 5-day, dose-equivalent preoperative RT regimen.

DESIGN, SETTING, AND PARTICIPANTS: Phase 2, single-group nonrandomized trial with an initial cohort (April 2016 to May 2018) and expansion cohort (October 2018 to May 2023) at a single academic center in the US. Participants were patients with histologically confirmed extremity or trunk STS recommended to undergo standard preoperative RT and surgery. Patients with planned neoadjuvant systemic therapy who were enrolled in the expansion group were excluded from this analysis. Analysis was conducted September 2024 to August 2025.

INTERVENTION: A total of 30 Gy in 5 fractions were delivered preoperatively.

MAIN OUTCOMES AND MEASURES: The primary end point was 2-year grade 2 or higher radiation toxic effects. Secondary end points included major wound complications (MWC), local failure, distant progression, and overall survival.

RESULTS: A total of 110 patients were treated with preoperative RT and surgery (42 patients [38%] were aged 65-79 years; 64 [58%] were male; 75 had tumors of the lower extremity [68%], and 64 patients [58%] had high-grade disease). The initial cohort accrued 50 patients who underwent surgery. The expansion cohort accrued 83 patients; 60 of 83 were treated without neoadjuvant chemotherapy and were included. Median (IQR) follow-up was 37.3 (20.1-60.6) months, including 64.2 (36.3-74.1) months for the initial cohort and 30.0 (13.5-40.2) months for the expansion cohort. At 2 years, 14 of 74 evaluable patients (18.9%) developed grade 2 or higher toxic effects (10 patients [25.0%] for the initial cohort and 4 patients [11.8%] for the expansion cohort). MWCs occurred in 33 of 110 patients (30.0%); (17 [34.0%] for the initial cohort and 16 [26.7%] for the expansion cohort). Time to wound closure exceeded 6 months for 15 patients (13.6%), including 12 of 29 patients (41.4%) who underwent local tissue advancement flaps. Two-year local control adjusting for competing risk of death was 92.4% (95% CI, 86.3%-96.5%). There were 3 (2.7%) bone fractures and 5 (4.5%) amputations.

CONCLUSIONS AND RELEVANCE: This nonrandomized clinical trial of ultrahypofractionated preoperative RT identified durable local control with MWC and favorable late grade 2 or higher toxic effects rates. Randomized data are necessary to differentiate the safety profiles of various fractionation regimens, especially duration of wound healing.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02701153.

PMID:41405883 | DOI:10.1001/jamanetworkopen.2025.50195