Tag: nevin manimala

Medicine (Baltimore). 2025 Jun 6;104(23):e42691. doi: 10.1097/MD.0000000000042691.

ABSTRACT

This study investigates the incidence and risk factors associated with the reinsertion of urinary catheters in post-cardiac surgery patients. Conducted at the Cardiac Surgery Ward of a university-affiliated hospital in Nanning, China, from July to December 2021, this cross-sectional study included patients aged 18 years and older undergoing cardiac surgery. Excluded were individuals with genitourinary issues, prostate surgery history, urostomy, cognitive impairment, mental illness, chronic indwelling catheter requirements, hemodialysis, or undergoing interventional surgery. Data on demographic and clinical characteristics were collected to perform multivariable logistic regression to identify risk factors for urinary catheter reinsertion. In our study of 254 cardiac surgery patients, 21 (8.26%) required urinary catheter reinsertion. Notable differences were not seen in age, gender, or body mass index between the reinsertion and no reinsertion groups. However, diabetes was significantly more prevalent in the reinsertion group (19%) compared to the no reinsertion group (3%) (P = .001), with diabetic patients also experiencing longer operative times and older age. The median urinary catheter duration was significantly shorter in the reinsertion group (35.03 hours) versus 60.65 hours for those without reinsertion (P = .034). Early catheter removal within the first postoperative day notably increased reinsertion rates, with 52.4% of early removals requiring reinsertion compared to 23.2% of later removals (P = .003). Multivariable logistic regression highlighted key risk factors: each additional year of age increased reinsertion risk by 3.6% (OR = 1.036, P = .023), and diabetic patients were approximately 8.8 times more likely to require reinsertion (OR = 8.755, P = .004). Early catheter removal was associated with an 8.6-fold increase in reinsertion likelihood (OR = 8.570, P = .001). Our findings emphasize the need for personalized management strategies to prevent urinary catheter reinsertion in cardiac surgery patients, particularly among older individuals, those with diabetes, or whose catheters are removed early post-surgery. These insights are crucial for enhancing postoperative care and minimizing complications associated with urinary catheterization.

PMID:40489845 | DOI:10.1097/MD.0000000000042691

Medicine (Baltimore). 2025 Jun 6;104(23):e42804. doi: 10.1097/MD.0000000000042804.

ABSTRACT

This study aimed to investigate the impact of the COVID-19 pandemic on the management and outcomes of adult cardiac arrest patients by assessing the incidence, patient outcomes, and influence of comorbidities during the pandemic. This retrospective cross-sectional study analyzed the clinical data of 500 patients who experienced cardiac arrest in the Emergency Department of Esenyurt Necmi Kadioğlu State Hospital between September 1, 2018, and August 31, 2024. Patient data were obtained from the hospital’s electronic records and included variables such as age, sex, arrest location, etiology, initial rhythm, intervention time, and outcomes. Data analysis was performed using SPSS version 26. Chi-square tests were used for categorical variables, while independent sample t tests and Mann-Whitney U tests were used for continuous data. The incidence of cardiac arrest increased during the pandemic. COVID-19-positive patients had a lower return of spontaneous circulation (ROSC) rates (30%) compared with negative patients (50%) and suspected cases (40%). Mortality was higher in COVID-19-positive patients (70%) and their discharge rates were lower (20%). Ventricular fibrillation as the initial rhythm was associated with better ROSC rates. Comorbidities such as chronic obstructive pulmonary disease, cancer, and heart failure were associated with lower ROSC rates and higher mortality rates. In conclusion, the COVID-19 pandemic has increased the number of cardiac arrest cases and worsened patient outcomes. Comorbidities significantly affected the prognosis. Future preparedness should focus on reducing intervention time, optimizing resource management, and implementing targeted care plans for high-risk patient groups.

PMID:40489834 | DOI:10.1097/MD.0000000000042804

Medicine (Baltimore). 2025 Jun 6;104(23):e41997. doi: 10.1097/MD.0000000000041997.

ABSTRACT

This study aims to evaluate risk factors for readmission within 6 months after acute exacerbation of chronic obstructive pulmonary disease (COPD) and to develop a multifactorial predictive model. A total of 151 patients with acute exacerbation of COPD, admitted to our hospital from October 2021 to December 2023, were included in this retrospective analysis. Data on baseline characteristics, medical history, lung function, lifestyle, comorbidities, inflammatory markers, and treatment adherence were obtained from electronic medical records to identify risk factors associated with readmission. Univariate and multivariate logistic regression analyses were used to identify independent risk factors, construct a predictive model, and assess its predictive efficacy using the receiver operating characteristic (ROC) curve. Patients in the readmission group were older (69.8 ± 9.5 years vs 65.2 ± 8.4 years, P = .048), had a higher proportion of males (76.4% vs 59.5%, P = .032), higher body mass index (25.3 ± 3.8 kg/m2 vs 23.1 ± 3.2 kg/m2, P = .018), more frequent exacerbations (3.2 ± 1.0 episodes vs 1.5 ± 0.8 episodes, P = .009), longer disease duration (12.1 ± 7.3 years vs 8.4 ± 5.7 years, P = .043), and higher GOLD classification (70% in stages III-IV vs 50%, P = .043) and BODE index (5.1 ± 1.4 vs 3.8 ± 1.2, P = .022). Additionally, they had a higher prevalence of cardiovascular comorbidities (55.6% vs 31.6%, P = .015), lower FEV1 levels (45.3 ± 10.1% vs 52.7 ± 8.5%, P = .033), higher levels of C-reactive protein (CRP) (15.2 ± 6.5 mg/L vs 10.4 ± 4.9 mg/L, P = .005), fractional exhaled nitric oxide (FeNO) (32.5 ± 10.4 ppb vs 26.7 ± 8.9 ppb, P = .03), and end-tidal carbon dioxide partial pressure (PetCO2) (40.1 ± 6.3 mm Hg vs 36.2 ± 5.7 mm Hg, P = .028), all of which were significant independent risk factors for readmission. The area under the ROC curve for the multivariate regression model was 0.801, indicating good predictive efficacy. This study evaluates multiple factors affecting readmission risk after acute exacerbation of COPD, highlighting the importance of early identification of high-risk patients and constructing an effective predictive model. Further large-sample, multi-center studies are needed to validate these findings and explore personalized interventions to reduce readmission rates and improve the quality of life for COPD patients.

PMID:40489832 | DOI:10.1097/MD.0000000000041997

Medicine (Baltimore). 2025 Jun 6;104(23):e42639. doi: 10.1097/MD.0000000000042639.

ABSTRACT

This study investigates the characteristics of baseline data and the correlation between autoantibodies and clinical phenotypes in patients with systemic sclerosis (SSc) from Southwest China. A total of 346 patients diagnosed with SSc between 2021 and 2023 were included. Clinical data and laboratory data were collected to analyze the relationship between autoantibodies and clinical phenotypes. The prevalence of hypertension and osteoporosis in female patients with SSc was significantly higher than that in male patients. Anti-Scl-70 antibody was positively correlated with Raynaud phenomenon, facial or acral swelling and interstitial lung disease. Anti-Ro52 antibody is positively correlated with pulmonary hypertension. Anti-Scl-70, anti-U1-nrNP, anti-SSA, and anti-Ro52 were associated with overlap syndrome of SSc and systemic lupus erythematosus. Anti-SSA and anti-Ro52 are associated with overlap syndrome of SSc and Sjogren syndrome. Anti-Scl-70 was found to be statistically different in platelet count (PLT), C3, C4, albumin, and C-reactive protein, as was anti-U1-nRNP in hemoglobin, immunoglobulin G, C3, total triglyceride, high-density lipoprotein and low-density lipoprotein, as was anti-SSA in hemoglobin, immunoglobulin G and erythrocyte sedimentation rate, as was anti-ro52 in white blood cell count (WBC) and IgG, and anti-CENP B in PLT. Our study showed that autoantibodies anti-Scl-70 and anti-Ro52 in SSc patients were associated with the clinical phenotypes of Raynaud phenomenon, facial or acral swelling, interstitial lung disease and pulmonary hypertension.

PMID:40489831 | DOI:10.1097/MD.0000000000042639

Medicine (Baltimore). 2025 Jun 6;104(23):e42745. doi: 10.1097/MD.0000000000042745.

ABSTRACT

This study aimed to describe the incidence of abnormal liver function tests (LFTs) in pregnant women post-2019 coronavirus disease (COVID-19) and investigate the characteristics of pregnant women with abnormal LFTs and its impact on pregnancy outcomes. The data for 168 pregnant women who were infected with COVID-19 in the late stages of pregnancy were collected in Hefei Maternal and Child Health Hospital from December 2022 to January 2023, and 86 pregnant women with abnormal liver function were divided into the research group and 82 pregnant women with normal liver function into the control group for retrospective analysis. Population and laboratory data were collected and statistical analysis was conducted. Among the 168 pregnant women with COVID-19, 86 (51.2%) had elevated liver enzymes. In the control group, 4 (4.5%) had elevated liver enzymes. Differences between the 2 groups were statistically significant (P < .05). Single-factor analysis revealed that age, gestational week, and body mass index (BMI) exhibited statistically significant differences (P < .001) as potential factors influencing abnormal LFTs. Logistic regression analysis demonstrated that age (OR: 1.526), gestational week (OR: 1.321), and BMI (OR: 1.159) remained independent risk factors for liver injury (P < .05). Furthermore, the cesarean section rate, postpartum hemorrhage rate, rupture of membranes rate, and fetal intrauterine distress rate in the observation group were all significantly higher than those in the control group (P < .05). Additionally, the incidence of neonatal asphyxia, preterm birth, and low birth weight in the observation group were all significantly higher than those in the control group (P < .05). Pregnant individuals are at an elevated risk of hepatic injury following severe acute respiratory syndrome coronavirus 2 infection. Furthermore, the likelihood of hepatic injury escalates with advancing maternal age, gestational age, and BMI. Hepatic functional aberrations in the latter stages of pregnancy may precipitate adverse pregnancy outcomes.

PMID:40489829 | DOI:10.1097/MD.0000000000042745

Medicine (Baltimore). 2025 Jun 6;104(23):e42622. doi: 10.1097/MD.0000000000042622.

ABSTRACT

Accurate information on pregnancy outcomes in women with prosthetic heart valves (PHVs) is essential for preconception counseling and prenatal care. This study aims to determine the maternal and fetal outcomes in women with PHVs. A total of 138 pregnant women with PHVs admitted into a tertiary center between November 2007 and February 2020 were included in the study, and the data were analyzed retrospectively. Patients were divided into the mechanical heart valves (MHVs) group, 118 patients with MHVs, and the tissue heart valves (THVs) group, 20 patients with THVs. The 2 groups were compared. There was 1 maternal death in the MHV group patients (0.8%). There was no difference between the 2 groups regarding maternal mortality (P = 1.000), valve thrombosis (P = .376), and hemorrhagic events (P = .692). Only 66.9% of patients in the MHV group had a live birth compared to the live birth rate of 100% in the THV (P = .002). Mechanical valve thrombosis (MVT) occurred in 3.2% of patients who used warfarin only; no MVT occurred in patients using a regimen called “sequential therapy”, which utilizes low-molecular-weight heparin (LMWH) during the 1st trimester and warfarin during the 2nd and 3rd trimesters. MVT occurred in 33.3% of patients using LMWH throughout gestation (P < .001). The difference was statistically significant. Compared to patients using other regimens, the patients using the regimen of “warfarin only ” was correlated with the highest rate of miscarriage (38.1%, 3.4%, and 16.7%, P < .001). Women with MHVs have a lower rate of live birth. The anticoagulation regimen of “sequential therapy” was superior to other regimens in terms of the weighted effects of regimens on maternal MVTs and fetal loss.

PMID:40489827 | DOI:10.1097/MD.0000000000042622

Medicine (Baltimore). 2025 Jun 6;104(23):e42664. doi: 10.1097/MD.0000000000042664.

ABSTRACT

Most previous studies on dislocation after total hip arthroplasty (THA) have focused on patient- and surgery-related factors without detailing the specific circumstances of dislocation events. Therefore, this study aimed to analyze dislocation cases and compare these relevant factors between patients who experienced dislocation and those who did not to inform targeted prevention measures during acute care hospitalization. This retrospective study examined the electronic medical records of 420 patients (445 joints) who underwent THA and rehabilitation at our hospital between April 1, 2018, and August 31, 2023. A total of 9 cases of dislocation in 6 patients were reported. Dislocation occurred most frequently in bed within the patient’s room (5 cases; 55.6%), followed by in the rehabilitation room and the toilet (1 case each; 11.1%), and unknown locations (2 cases; 22.2%). Bed-related dislocations were associated with trunk rotation or external rotation of the hip joint; in 2 cases, the dislocation was already present when the patient awoke. The revision THA and THA indication rates, preoperative Functional Independence Measure scores, and locomotion status differed significantly between the patients who showed dislocation and those who did not. Revision THA, THA indications other than osteoarthritis, low Functional Independence Measure score at admission, and low locomotion status may increase the risk of dislocation. Furthermore, the findings suggest that dislocation prevention strategies during acute hospitalization should prioritize safe bed use and sleep positions.

PMID:40489815 | DOI:10.1097/MD.0000000000042664

Medicine (Baltimore). 2025 Jun 6;104(23):e42504. doi: 10.1097/MD.0000000000042504.

ABSTRACT

This study evaluates the effectiveness of a current training program for new nurses over a period of time, identify any existing issues in the program, and put forward recommendations to alleviate these issues, towards improving the structure and management of the training program. A total of 201 newly recruited nurses and 52 head nurses in a Grade-A tertiary hospital (Wuhan, China) were included in this longitudinal study with a 6-month duration. Using the Kirkpatrick model, we evaluated the effectiveness of the training against 4 levels of criteria: reaction, learning, behavior, and results. Cluster sampling was used to select participants, and data were analyzed using SPSS 19.0, including descriptive statistics, u tests, and 1-way analysis of variance to assess theoretical scores, operational scores, and behavioral evaluations. The reaction level responses were that the new nurses were generally satisfied with the training. The learning level responses showed that there was a significant difference in exam scores between new nurses after 3 months of training and after 6 months of training. The behavioral level responses indicated that the clinical nursing abilities and interpersonal skills of new nurses improved after 6 months of training. In the self-evaluation, new nurses gave themselves higher scores than the scores given by head nurses, and the difference between the 2 scores was statistically significant. According to the quality check data from the nursing department, the results level responses showed that the complaint rate against new nurses was 0, the accident rate was 0, and new nurses accounted for 20% of all the commendation letters. The systematic and comprehensive evaluation of new nurse training programs based on the 4 levels of the Kirkpatrick model provides valuable insights for nursing managers.

PMID:40489814 | DOI:10.1097/MD.0000000000042504

JMIR Res Protoc. 2025 Jun 9;14:e75368. doi: 10.2196/75368.

ABSTRACT

BACKGROUND: Postoperative delirium of cardiovascular surgery (PODOCVS) is an acute brain dysfunction characterized by inattention, impaired consciousness, and cognitive disorders, and the severity and presence of these symptoms fluctuate over time. PODOCVS occurs during the early postoperative period and is associated with adverse outcomes, including prolonged mechanical ventilation, premature mortality, and so on. Advances in its early diagnosis and treatment have mitigated some of the initial adverse effects of PODOCVS, but models for predicting risk in patients who have already developed PODOCVS remain inadequate for effective secondary prevention. Developing multivariable prediction models for stratifying PODOCVS risk would enable early, personalized interventions.

OBJECTIVE: This study aims to systematically review and critically evaluate the development, performance, and applicability of existing prediction models for PODOCVS.

METHODS: An extensive systematic search will be performed across multiple databases, including Embase, PubMed, the Web of Science, and so on, to identify studies related to multivariate predictive models for PODOCVS. A manual search of the included studies’ reference lists will also be conducted to identify any additional relevant publications. This systematic review will include studies that meet the following criteria: (1) studies with subject populations comprising adult cardiovascular surgery patients aged ≥18 years, (2) studies involving the development and internal or external validation of predictive models for PODOCVS via multivariate analysis, and (3) studies with outcome measures focused on postoperative delirium. Two researchers (ZXL and WYK) will independently extract the data and assess the included studies’ model quality using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist and the Predictive Model Bias Risk Assessment Tool (PROBAST). Since this study will not involve patient data, ethics approval is not required. Our findings will be published in a peer-reviewed scientific journal and the dataset will be made freely available.

RESULTS: Literature searches were conducted from the inception of the database to May 20, 2024 (updated up to January 31, 2025), and data extraction and analysis are expected to be complete by the end of May 2025. We currently have a preliminary plan to publish the complete study results by August 2025, subject to any unforeseen delays or changes in the research timeline.

CONCLUSIONS: We present a protocol for the systematic review of prediction models for postoperative delirium in cardiac surgery patients. Aiming to identify, summarize, and critically appraise existing risk models globally, this review seeks to provide an up-to-date reference for stakeholders involved in patients with cardiac surgery care, policy making, and research. In addition, we aim to investigate whether machine learning models for PODOCVS offer more accurate predictions than traditional statistical models.

TRIAL REGISTRATION: PROSPERO CRD42024578957; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024578957.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/75368.

PMID:40489772 | DOI:10.2196/75368

Hepatol Commun. 2025 Jun 9;9(7):e0735. doi: 10.1097/HC9.0000000000000735. eCollection 2025 Jul 1.

ABSTRACT

BACKGROUND: Racial and ethnic minority populations are disproportionately impacted by HCC due to more advanced tumor burden and underuse of treatments. We explored racial and ethnic differences in medical mistrust, barriers to treatment, and health literacy among patients with HCC.

METHODS: We conducted a multicenter survey among patients with newly diagnosed HCC between September 2018 and July 2023 at 4 large U.S. health systems. The survey assessed medical mistrust [Group-Based Medical Mistrust Scale (GBMMS)], health literacy (CHEW Assessment of Health Literacy), and barriers to HCC treatment. We performed multivariable logistic regression to evaluate associations between race and ethnicity and survey measures.

RESULTS: Of 1245 eligible patients, 833 (66.9%) completed the survey (45.9% Hispanic, 35.9% White, and 14.2% Black). A higher proportion of Black and Hispanic patients had high medical mistrust than White patients (14.2% and 3.3% vs. 0.7%, respectively; p<0.001). In multivariable analysis, Black race (OR: 19.2, 95% CI: 4.2-87.7) but not Hispanic ethnicity (OR: 3.72, 95% CI: 0.80-17.2) was significantly associated with high mistrust. Compared to White patients, Black and Hispanic patients both reported greater barriers to HCC treatment, with the most common barriers being concerns about pain (41.6%), financial burden (37.6%), and time commitment (31.1%). Limited health literacy was reported by 38.1% of patients (46.8% Hispanic, 41.0% Black, 26.2% White; p<0.001).

CONCLUSIONS: Medical mistrust, barriers to treatment, and limited health literacy are prevalent among Black and Hispanic patients with HCC. Understanding the interplay between race, ethnicity, and these factors is essential to address HCC disparities.

PMID:40489762 | DOI:10.1097/HC9.0000000000000735