Tag: nevin manimala

Clinics (Sao Paulo). 2025 Apr 27;80:100636. doi: 10.1016/j.clinsp.2025.100636. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the comparative outcomes of Minimally Invasive Radical Prostatectomy (MIRP) versus Open Radical Prostatectomy (ORP) to treat localized prostate cancer, using only Randomized Controlled Trials (RCTs) to ensure high-quality evidence.

METHOD: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, focusing solely on RCTs comparing MIRP (robot-assisted or laparoscopic surgery) and ORP. Literature searches across multiple databases, including Cochrane Library, Medline, Embase, Lilacs, Scopus, Web of Science, NIH, Clinical Trials, and EU Clinical Trials Register, identified studies meeting predefined PICOT criteria. Four RCTs met inclusion criteria ‒ two representing the same cohort of patients ‒ and were analyzed for perioperative, functional, and oncologic outcomes. Quality assessment utilized the ROB-2 tool to gauge the risk of bias.

RESULTS: Three RCTs encompassing 1051 patients were analyzed. MIRP demonstrated statistically significant benefits over ORP in terms of reduced perioperative blood loss (Standardized Mean Difference [SMD = -3.058], p = 0.006), lower transfusion rates (Odds Ratio [OR = 0.137]; p = 0.009), and fewer overall complications (OR = 0.465; p = 0001). However, no significant differences were found in long-term oncologic and functional outcomes, including urinary continence and erectile function. Positive surgical margins and additional treatments also did not differ significantly between groups.

CONCLUSION: This systematic review and meta-analysis of RCTs indicated that MIRP offers perioperative advantages over ORP, supporting its role as a safe and effective option for localized prostate cancer.

PMID:40294454 | DOI:10.1016/j.clinsp.2025.100636

J Med Internet Res. 2025 Apr 28;27:e60343. doi: 10.2196/60343.

ABSTRACT

BACKGROUND: Patients with long-term health needs are often expected to actively participate in outpatient care, assuming that they have appropriate health literacy and digital health literacy. However, the association between participation in a digital outpatient service and health literacy remain unclear.

OBJECTIVE: This study aims to evaluate whether digital outpatient care for 6 months improved health literacy, health-related quality of life (HRQoL), digital/eHealth literacy, and the use of health care services compared with usual care.

METHODS: We conducted a multicenter nonrandomized trial with 1 intervention arm and 1 control arm. Patients aged ≥18 years receiving outpatient care in the pain, lung, neurology, or cancer departments at 2 Norwegian university hospitals were allocated in a 1:2 ratio, favoring the intervention arm. The intervention arm received digital outpatient care using tailored patient-reported outcome measures, self-monitoring, and chats for timely contact with the outpatient clinic. Patient responses were assessed by health care workers via a dashboard with a traffic light system to draw attention to the most urgent reports. The control arm received usual care. The data were collected at baseline and after 3 and 6 months. The primary outcome was the change in health literacy according to the Health Literacy Questionnaire domain understanding health information well enough to know what to do from baseline to 6 months. The mean difference in change between the 2 treatment arms was the effect measure. The secondary outcomes were additional domains from the Health Literacy Questionnaire, digital/eHealth literacy, HRQoL, acceptability of the digital intervention, and health service use.

RESULTS: Overall, 162 patients were recruited, 55 (34%) in the control arm and 107 (66%) in the intervention arm, with a 17.3% attrition rate after 6 months. There was no statistically significant difference in the primary outcome, “understanding health information well enough to know what to do,” between the arms at 6 months (mean difference -0.05, 95% CI -0.20 to 0.10; P=.53). After 3 months, the health literacy domains actively managing my own health (-0.15, 95% CI -0.30 to -0.00; P=.048) and understanding health information well enough to know what to do (-0.17, 95% CI -0.34 to -0.00; P=.03), as well as both physical (-3.29, 95% CI -5.62 to -0.96; P=.006) and mental HRQoL (-3.08, 95% CI -5.64 to -0.52; P=.02), improved in the digital outpatient intervention arm compared with the control arm.

CONCLUSIONS: This study explored digital outpatient care. Although no statistical differences were observed in patients’ health literacy after 6 months, our data indicate an improvement in health literacy domains and HRQoL at 3 months. The participants reported high satisfaction with the digital outpatient care intervention, and our findings highlight the potential of digital interventions in outpatient care.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05068869; https://clinicaltrials.gov/ct2/show/NCT05068869.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/46649.

PMID:40294411 | DOI:10.2196/60343

J Med Internet Res. 2025 Apr 28;27:e70703. doi: 10.2196/70703.

ABSTRACT

BACKGROUND: The aging population presents an accomplishment for society but also poses significant challenges for governments, health care systems, and caregivers. Elevated rates of functional limitations among older adults, primarily caused by chronic conditions, necessitate adequate and safe care, including in-home settings. Traditionally, informal caregiver training has relied on verbal and written instructions. However, the advent of digital resources has introduced videos and interactive platforms, offering more accessible and effective training. Large language models (LLMs) have emerged as potential tools for personalized information delivery. While LLMs exhibit the capacity to mimic clinical reasoning and support decision-making, their potential to serve as alternatives to evidence-based professional instruction remains unexplored.

OBJECTIVE: We aimed to evaluate the appropriateness of home care instructions generated by LLMs (including GPTs) in comparison to a professional gold standard. Furthermore, it seeks to identify specific domains where LLMs show the most promise and where improvements are necessary to optimize their reliability for caregiver training.

METHODS: An observational, comparative case study evaluated 3 LLMs-GPT-3.5, GPT-4o, and Microsoft Copilot-in 10 home care scenarios. A rubric assessed the models against a reference standard (gold standard) created by health care professionals. Independent reviewers evaluated variables including specificity, clarity, and self-efficacy. In addition to comparing each LLM to the gold standard, the models were also compared against each other across all study domains to identify relative strengths and weaknesses. Statistical analyses compared LLMs performance to the gold standard to ensure consistency and validity, as well as to analyze differences between LLMs across all evaluated domains.

RESULTS: The study revealed that while no LLM achieved the precision of the professional gold standard, GPT-4o outperformed GPT-3.5, and Copilot in specificity (4.6 vs 3.7 and 3.6), clarity (4.8 vs 4.1 and 3.9), and self-efficacy (4.6 vs 3.8 and 3.4). However, the models exhibited significant limitations, with GPT-4o and Copilot omitting relevant details in 60% (6/10) of the cases, and GPT-3.5 doing so in 80% (8/10). When compared to the gold standard, only 10% (2/20) of GPT-4o responses were rated as equally specific, 20% (4/20) included comparable practical advice, and just 5% (1/20) provided a justification as detailed as professional guidance. Furthermore, error frequency did not differ significantly across models (P=.65), though Copilot had the highest rate of incorrect information (20%, 2/10 vs 10%, 1/10 for GPT-4o and 0%, 0/0 for GPT-3.5).

CONCLUSIONS: LLMs, particularly GPT-4o subscription-based, show potential as tools for training informal caregivers by providing tailored guidance and reducing errors. Although not yet surpassing professional instruction quality, these models offer a flexible and accessible alternative that could enhance home safety and care quality. Further research is necessary to address limitations and optimize their performance. Future implementation of LLMs may alleviate health care system burdens by reducing common caregiver errors.

PMID:40294407 | DOI:10.2196/70703

JAMA. 2025 Apr 28. doi: 10.1001/jama.2025.5791. Online ahead of print.

ABSTRACT

IMPORTANCE: Hospitalization of moderately preterm infants may be prolonged while waiting for apnea of prematurity to resolve after discontinuing caffeine.

OBJECTIVE: To evaluate whether extending caffeine treatment reduces the duration of hospitalization.

DESIGN, SETTING, AND PARTICIPANTS: From February 2019 to December 2022, this randomized clinical trial in 29 US hospitals enrolled infants born at 29 to 33 weeks’ gestation who at 33 to 35 weeks’ postmenstrual age were receiving caffeine treatment with plans to discontinue it plus receiving full feeds (≥120 mL/kg/d). Follow-up was completed on March 20, 2023.

INTERVENTIONS: Infants were randomized to oral caffeine citrate (10 mg/kg/d) or placebo until 28 days after discharge.

MAIN OUTCOMES AND MEASURES: The primary outcome was days to discharge after randomization. Secondary outcomes included days to physiological maturity (apnea free for 5 consecutive days, receiving full oral feeds, and out of the incubator for at least 48 hours), postmenstrual age at discharge, all-cause hospital readmissions, all-cause sick and emergency department visits, safety outcomes, and death.

RESULTS: A total of 827 infants (median gestational age, 31 weeks; 414 female [51%]) were randomized (416, caffeine; 411, placebo) out of the 878 planned before reaching the prespecified futility threshold. Days of hospitalization after randomization did not differ between groups (18.0 days [IQR, 10 to 30 days] for caffeine vs 16.5 [IQR, 10 to 27 days] for placebo; adjusted median difference, 0 days [95% CI, -1.7 to 1.7 days]), nor did days to physiological maturity differ (14.0 vs 15.0 days, adjusted median difference, -1 day [95% CI, -2.4 to 0.4 days]). Infants receiving caffeine were apnea free sooner (6.0 vs 10.0 days; adjusted median difference, -2.7 days [95% CI, -3.4 to -2.0 days ]) but had similar days to full oral feeding (7.5 vs 6.0 days, adjusted median difference, 0 days [95% CI, -0.1 to 0.1]). Rates of readmissions and sick visits did not differ between groups. There was no statistically significant difference in adverse events between the 2 groups.

CONCLUSIONS AND RELEVANCE: In moderately preterm infants, continuation of caffeine treatment compared with placebo did not shorten hospitalization.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03340727.

PMID:40294395 | DOI:10.1001/jama.2025.5791

J Comput Assist Tomogr. 2025 Apr 28. doi: 10.1097/RCT.0000000000001761. Online ahead of print.

ABSTRACT

OBJECTIVES: At present, the study of bronchiolar adenoma (BA) mainly focuses on its pathologic characteristics, but there is limited understanding of its clinical manifestations and imaging signs. This article aims to summarize the clinical manifestations and imaging features of 80 cases of BA, with the goal of achieving a comprehensive and systematic understanding of BA.

MATERIALS AND METHODS: We retrospectively analyzed 80 patients with BA confirmed by surgical pathology in our hospital. All subjects underwent thin-slice CT examination. The basic information, tumor history, clinical manifestations, and CT imaging features of the lesions were collected. The subjects’ age, maximum diameter of BA, and shortest distance from the pleura were analyzed by t-test or 1-way ANOVA, while other clinical and radiologic characteristics were compared for differences among different BA types by the χ2 test or Fisher exact probability method.

RESULTS: The majority of the 80 patients were female, with an average age of 59.08±10.16 years. The majority of them do not manifest any clinical symptoms. All lesions are located in the subpleural area, including 63 cases in the lower lobe of the lungs. The average size of the tumors was 10.31±5.01 mm. The majority of the lesions exhibited irregular morphology (53 cases, 66.25%) and predominantly comprised solid nodules (46 cases, 57.50%). There were statistically significant differences in lesion morphology, boundary, and pseudocavity among pure ground-glass nodular BA, mixed ground-glass nodular BA, and solid density nodular BA. Compared with pure ground-glass density BA (1 case, 1.25%) and mixed ground-glass density BA (7 cases, 8.75%), the boundary of solid nodules BA (42 cases, 52.50%) was significantly clearer (P<0.001). The presence of pseudocavity was found to be significantly higher in individuals with solid nodules compared with those with pure ground-glass nodules (P<0.0167). Compared with BA without pseudocavity, BA with pseudocavity exhibited a clearer lung interface (P<0.001), more abnormal vessel signs (P=0.007), and a higher incidence of malignant preoperative diagnosis (P=0.020).

CONCLUSIONS: BA mostly occurs in middle-aged and elderly women without any clinical symptoms. The imaging manifestations of BA are diverse, mainly presenting as irregular solid nodules. The interface between the tumor and lung is clear, and pseudocavity formation is common. In addition, BA with pseudocavity often exhibits abnormal vascular signs, which can lead to misdiagnosis as malignancy before surgery.

PMID:40294372 | DOI:10.1097/RCT.0000000000001761

JCO Glob Oncol. 2025 Apr;11:e2400589. doi: 10.1200/GO-24-00589. Epub 2025 Apr 28.

ABSTRACT

PURPOSE: This study aimed to identify the concerns and needs of radiation oncology residents in Turkey regarding their efforts to stay current with advancements in this highly competitive discipline.

MATERIALS AND METHODS: A cross-sectional anonymous survey of 20 questions was designed by the Turkish Society for Radiation Oncology (TROD)-Young Radiation Oncologists Group (GROG) and distributed to radiation oncology residents across Turkey. Data were collected and analyzed using descriptive analyses to identify common themes and specific needs and stratified according to junior and senior residents. Statistical analysis was performed using the Statistical Package for Social Sciences Statistics 21.0 (SPSS Inc, Chicago, IL).

RESULTS: Sixty-four residents participated in the survey, with an overall response rate of 20%. The majority of participants, 55 (85.9%), had a regular training program in their clinic. However, only 28 (51%) felt that this program was sufficient to stay up to date. Consequently, almost all participants (98.4%) reported making individual efforts to stay current, with 87.3% encountering difficulties. Notably, junior residents experienced a higher rate of difficulty than senior residents did (93.1% v 70%, respectively). All the participants expressed the need for a new platform to easily access the results of significant new studies.

CONCLUSION: The traditional radiation oncology curriculum needs to be updated to include modern methods of obtaining information in the current Internet era. In addition, new platforms should be provided to residents for easier access to information. As TROD/GROG, we have planned to address this issue with the GROG News project. Further efforts should be made to develop solutions to alleviate residents’ concerns.

PMID:40294365 | DOI:10.1200/GO-24-00589

JCO Precis Oncol. 2025 Apr;9:e2400459. doi: 10.1200/PO-24-00459. Epub 2025 Apr 28.

ABSTRACT

PURPOSE: Although estrogen receptor is well studied in breast cancer (BC), the role of androgen receptor (AR) in prognosis and therapy response is less understood. Here, we characterized the clinicopathologic and molecular features of AR gene expression in BC subtypes.

METHODS: Ten thousand seven hundred twenty-eight BC samples were tested by next-generation DNA sequencing, whole-transcriptome sequencing, and immunohistochemistry at Caris Life Sciences (Phoenix, AZ). Tumors with AR-high and AR-low RNA expression were stratified by top and bottom quartiles, respectively. Treatment-associated survival was obtained from insurance claims and calculated from treatment start to last contact using Kaplan-Meier estimates. Statistical significance was determined by chi-square and Mann-Whitney U test with P values adjusted for multiple comparisons (q < .05).

RESULTS: AR-low was associated with basal-like tumors. AR-high tumors were associated with increased mutation rates in several genes-namely PIK3CA and CDH1-across all subtypes, while other associations such as RB1 and MAP3K1 were subtype-dependent. The immune landscape was differentially affected by AR expression in each subtype, but these differences did not correspond to differential responses to immune checkpoint blockade. Patients with AR-high tumors had a longer therapy response for most subtypes, but those with AR-high tumors that were human epidermal growth factor receptor 2-enriched and luminal B trended toward worse chemotherapy or hormone therapy response, respectively.

CONCLUSION: Our data suggest a unique molecular profile of AR-high BC that is subtype-specific and generally associated with improved outcomes. Exploration of specific mutations and immune-oncology markers associated with AR-high may aid in molecularly selected clinical trial design for patients with advanced BC.

PMID:40294352 | DOI:10.1200/PO-24-00459

Pediatr Infect Dis J. 2025 Apr 28. doi: 10.1097/INF.0000000000004835. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to develop and validate a clinical score for the prediction of critical care entrance in children with dengue.

METHODS: We conducted a retrospective cohort study using admissions from January 2019 to August 2021, at Hospital Infantil Napoleón Franco Pareja, in Cartagena, Colombia. We included all children 18 years or younger, with a positive immunoglobulin M or nonstructural protein 1 laboratory test and admitted for follow-up at the emergency department. We selected variables retrospectively collected on emergency admission for feature selection. We assessed discrimination and calibration in the development dataset, using 1000 bootstrap replications for internal validation. Data from 2019 to 2020 were used for development and 2021 for temporal validation. We report the c-statistic for discrimination with 95% confidence intervals (CIs), as well as the calibration intercept and slope.

RESULTS: One thousand three hundred eighty-five patients were included for development and internal validation. In temporal validation with 519 additional patients, the c-statistic was 0.82 (95% CI: 0.77-0.87), with a calibration slope of 0.98 (95% CI: 0.77-1.18). We selected the 50th percentile of the distribution of predicted probability of critical care entrance (5%) as a threshold value for increased alert at emergency admission, missing 10% of all cases that need to enter critical care (sensitivity of 90% with 95% CI of 82-95, and specificity of 48% with 95% CI of 41-50).

CONCLUSIONS: Our validated model can be useful to predict critical care entrance in children with dengue. We recommend the validation and potential recalibration of our score in other clinical settings.

PMID:40294334 | DOI:10.1097/INF.0000000000004835

ASAIO J. 2025 Apr 28. doi: 10.1097/MAT.0000000000002450. Online ahead of print.

ABSTRACT

Extracorporeal cardiopulmonary resuscitation (ECPR) requires advanced skills for induction and management. This study evaluated whether the outcomes of ECPR differ by institutional volume. Using the Japanese Association for Acute Medicine-Out-of-Hospital Cardiac Arrest (JAAM-OHCA) registry, we analyzed adult patients (aged ≥18 years) who received ECPR between 2014 and 2020, focusing on 30 day in-hospital survival and favorable neurologic prognosis at 30 days defined as Cerebral Performance Category (CPC) 1-2. Facilities were categorized into tertiles by annual ECPR volume. Multivariable logistic regression examined outcomes across low (≤4.7 cases/year), medium (4.8-7.8 cases/year), and high (≥7.9 cases/year) volume groups. A total of 1,759 patients from 83 centers were included, with an overall 30 day survival of 21.1% and CPC 1-2 rate of 10.1%. We observed no statistically significant differences in the respective rates of 30 day survival and neurologic outcomes in the medium ECPR volume group (adjusted odds ratios 1.09 [95% confidence interval {CI}, 0.82-1.47] and 0.85 [0.56-1.26]) and higher ECPR volume group (adjusted odds ratios 1.27 [95% CI, 0.95-1.70] and 1.11 [0.75-1.63]) compared with the lower ECPR volume group. These findings suggest that ECPR outcomes for out-of-hospital cardiac arrest are not significantly affected by institutional ECPR volume.

PMID:40294333 | DOI:10.1097/MAT.0000000000002450

Pediatr Infect Dis J. 2025 Apr 29. doi: 10.1097/INF.0000000000004836. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to determine the incidence and clinical characteristics of infants evaluated and treated with a prolonged course of antibiotics for culture-negative sepsis in a quaternary Neonatal Intensive Care Unit (NICU) over a 4-year period.

STUDY DESIGN: Retrospective chart review of patients in the NICU at Children’s Hospital of Philadelphia who had negative blood cultures and received ≥5 days of antibiotics. Data collection included demographics, clinical and laboratory data, and underlying diagnoses. Statistical analysis included Mann-Whitney and chi-square tests, and multivariable logistic regression.

RESULTS: We identified 774 culture-negative sepsis evaluations where antibiotic treatment was continued ≥5 days. While the majority were attributed to a focal etiology, 146 had negative blood cultures and no focal source. Infants with no focal source were younger at the time of sepsis evaluation, of greater gestational age, and more frequently required extracorporeal membrane oxygenation (P < 0.001). In multivariable analysis, evaluations for early-onset disease and need for extracorporeal membrane oxygenation were increased among infants with no focal source (P < 0.01). Although rates of invasive ventilation, and central venous catheters were similar, length of stay and mortality were significantly higher in late-onset episodes (P < 0.001 and P = 0.029, respectively). Consultation with the infectious disease team increased during the study period (P = 0.002).

CONCLUSIONS: Although it is challenging to limit the initiation of antibiotics in infants with complex underlying disease processes with concern for sepsis, minimizing antibiotic use can be achieved by timely discontinuation when cultures are negative. A robust antimicrobial stewardship program can identify valid reasons for prolonged antibiotic administration and suggest approaches to minimize antibiotic exposure.

PMID:40294328 | DOI:10.1097/INF.0000000000004836