Tag: nevin manimala

JAMA Netw Open. 2025 Jun 2;8(6):e2514765. doi: 10.1001/jamanetworkopen.2025.14765.

ABSTRACT

IMPORTANCE: Lymphedema is a common treatment-related adverse effect among breast cancer survivors that can limit activity and mobility. Although exercise is associated with improved outcomes after breast cancer treatment, data are limited on the association of intense physical activity, including strength training, with lymphedema.

OBJECTIVE: To examine the association between resistance training and lymphedema among breast cancer survivors.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study conducted between September 15, 2022, and March 26, 2024, women from 3 prospective studies (EXERT-BC, EXERT-BCN, and EXERT-C) underwent thrice-weekly, dose-escalated resistance training for 3 months to promote strength, mobility, and hypertrophy.

MAIN OUTCOMES AND MEASURES: Lymphedema was assessed at baseline and completion using bioimpedance analysis to evaluate fluid and body composition metrics, distinguishing among intracellular water, extracellular water, and total body water.

RESULTS: A total of 115 women completed the exercise regimen (median age, 54 years; range, 24-71 years). Ninety-six participants (83%) underwent sentinel lymph node biopsy, whereas 14 (12%) underwent axillary lymph node dissection. At baseline, 15 women (13%) had clinical lymphedema: 8 (8%) in the sentinel lymph node biopsy group and 7 (37%) in the axillary lymph node dissection group. No participants experienced subjective or clinical worsening of lymphedema after completing the exercise regimen. Bilateral arm lean mass significantly increased after resistance training (affected arm: median [IQR], 5.64 [4.98-6.20] lb; 95% CI, 5.40-5.84 lb) vs baseline (median [IQR], 5.45 [4.92-6.08] lb; 95% CI, 5.34-5.67 lb) (s = 1789.5; P < .001). The edema index (extracellular water to total body water ratio) significantly improved in all patients, signifying a reduction in lymphedema at the completion of exercise (mean, 0.383; 95% CI, 0.382-0.385) compared with baseline (mean, 0.385; 95% CI, 0.384-0.386) (t110 = 4.05; P < .001).

CONCLUSIONS AND RELEVANCE: In this cohort study of breast cancer survivors, intense resistance training did not exacerbate lymphedema and was associated with improvements in fluid balance and lean mass in the upper extremities. These findings suggest support for the inclusion of structured resistance exercise as part of breast cancer treatment and survivorship care.

PMID:40498485 | DOI:10.1001/jamanetworkopen.2025.14765

JAMA Netw Open. 2025 Jun 2;8(6):e2514857. doi: 10.1001/jamanetworkopen.2025.14857.

ABSTRACT

IMPORTANCE: Alcohol-associated liver disease (ALD) is a major public health concern, accounting for one-quarter of cirrhosis-related deaths and becoming the leading indication for liver transplantation in the US, with concerning increases in mortality during and following the COVID-19 pandemic onset.

OBJECTIVE: To evaluate comprehensive national trends in ALD mortality in the US from 1999 to 2022, with a particular focus on disparities related to sex, race, ethnicity, and age.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional analysis used the Centers for Disease Control and Prevention Wide Ranging Online Data for Epidemiologic Research mortality database from 1999 to 2022, examining death certificates across all 50 states and the District of Columbia. The study included individuals aged 25 years and older. Data analysis was performed from September to November 2024.

EXPOSURE: ALD mortality was identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes (K70.xx) for both alcohol-associated hepatitis (K70.1x) and alcohol-associated cirrhosis (K70.3x).

MAIN OUTCOMES AND MEASURES: Primary outcomes included age-adjusted annual mortality rates per 100 000 population, stratified by sex, age groups (25-44, 45-64, 65-84, and ≥85 years), race and ethnicity, and geographic regions. Joinpoint regression analysis was used to calculate average annual percentage changes (AAPCs) and to identify significant trend changes.

RESULTS: In this study, a total of 436 814 ALD deaths were recorded (308 923 men [70.7%]), with ALD mortality increasing from 6.71 to 12.53 deaths per 100 000 between 1999 and 2022 and significant acceleration during 2018 to 2022 (annual percentage change [APC], 8.94%; 95% CI, 6.27% to 14.51%; P = .001). Women showed more rapid increases than men (AAPC, 4.29% [95% CI, 3.09% to 5.51%] vs 2.50% [95% CI, 1.51% to 3.51%]), whereas young adults (aged 25-44 years) demonstrated concerning trends (AAPC, 4.23%; 95% CI, 3.47% to 4.83%; P = .001). American Indian and Alaska Native populations experienced the highest mortality rates, increasing from 25.21 to 46.75 deaths per 100 000 (AAPC, 4.93%; 95% CI, 3.45% to 5.96%; P = .001). Alcohol-associated hepatitis mortality increased from 0.47 to 0.76 deaths per 100 000 (AAPC, 2.08%; 95% CI, 1.27% to 3.05%; P = .001), with women showing steeper increases than men (AAPC, 3.94% [95% CI, 2.58% to 5.46%] vs 1.56% [95% CI, 0.73% to 2.42%]). Alcohol-associated cirrhosis mortality increased from 4.09 to 9.52 deaths per 100 000 (AAPC, 4.00%; 95% CI, 3.63% to 4.40%; P = .001), with particularly concerning trends among women (APC from 2011 to 2022, 8.32%; 95% CI, 7.40% to 9.82%; P = .01) and adults aged 25 to 44 years (APC from 2018 to 2022, 19.51%; 95% CI, 15.00% to 28.53%; P = .001).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study using data from the Centers for Disease Control and Prevention Wide Ranging Online Data for Epidemiologic Research database, ALD mortality increased significantly across demographic groups, with particularly concerning trends among women, younger adults, and American Indian and Alaska Native populations. These findings highlight the urgent need for targeted public health interventions and enhanced surveillance, especially given the sustained impact of COVID-19 pandemic-related changes in alcohol consumption patterns.

PMID:40498484 | DOI:10.1001/jamanetworkopen.2025.14857

JAMA Netw Open. 2025 Jun 2;8(6):e2514864. doi: 10.1001/jamanetworkopen.2025.14864.

ABSTRACT

IMPORTANCE: Racial and ethnic disparities in pathologic complete response (pCR) and overall survival (OS) have been reported in patients with triple-negative breast cancer (TNBC). In addition to socioeconomic factors and access to care, differences in tumor biology may affect outcomes. The association of ERBB2-low expression with outcomes in patients with TNBC has been minimally explored, including studies evaluating outcomes based on race and ethnicity.

OBJECTIVE: To investigate whether ERBB2-low expression among patients with TNBC varies by race and ethnicity and is associated with pCR and OS.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used the National Cancer Database, a national hospital-based tumor registry, from 2010 to 2019. Participants included adult female patients with stages I to III TNBC treated with neoadjuvant chemotherapy followed by surgery. Tumors with immunohistochemistry scores of 1+ or 2+, in situ hybridization nonamplified, were classified as ERBB2-low; those with immunohistochemistry scores of 0, as ERBB2-zero. Primary analysis was conducted from September 18 to October 18, 2023.

MAIN OUTCOMES AND MEASURES: Rates of ERBB2-low vs ERBB2-zero TNBC by race and ethnicity and pCR and OS by race and ethnicity and by ERBB2 status.

RESULTS: Overall, 31 888 patients with TNBC were identified (median age, 53 [IQR, 44-61] years). Of those, 1078 patients (3.4%) were Asian; 7642 (24.0%), Black; 2578 (8.1%), Hispanic; 20 264 (63.5%), White; and 326 (1.0%), other. Over half of the study population (16 332 [51.2%]) displayed ERBB2-low expression and 15 556 (48.8%), ERBB2-zero expression. Patients with ERBB2-low expression demonstrated lower rates of pCR than those with ERBB2-zero expression (4675 [28.6%] vs 4787 [30.8%]; P < .001); ERBB2-low expression was associated with lower odds of pCR after adjustment for patient, socioeconomic, and tumor variables (odds ratio, 0.93; 95% CI, 0.88-0.99; P = .01). When patients were stratified by race and ethnicity, Hispanic patients had higher rates of ERBB2-zero expression than ERBB2-low expression (1391 of 2578 [54.0%] vs 1187 of 2578 [46.0%]; P < .001); no differences were noted among other racial and ethnic groups. Hispanic patients also had higher rates of pCR among those with ERBB2-low (Hispanic, 30.7%; Asian, 24.6%; Black, 29.5%; White, 27.1%) and ERBB2-zero (Hispanic, 33.2%; Asian, 32.1%; Black, 27.1%; White, 31.7%) TNBC. Non-Hispanic Asian patients had the highest 60-month OS among both those with ERBB2-zero (79%; 95% CI, 75%-83%) and ERBB2-low expression (84%; 95% CI, 80%-87%). Among Asian and White patients, ERBB2-low expression was associated with prolonged OS compared with ERBB2-zero expression (hazard ratios, 0.69 [95% CI, 0.50-0.95] [P = .02] and 0.85 [95% CI, 0.79-0.92] [P < .001], respectively). Black patients had lower pCR and OS rates regardless of ERBB2 status.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with TNBC, ERBB2-low expression and its association with clinical outcomes varied across racial and ethnic groups. These findings highlight the need for further research to understand the biological implications of ERBB2-low expression in diverse populations of patients with TNBC.

PMID:40498483 | DOI:10.1001/jamanetworkopen.2025.14864

JAMA Netw Open. 2025 Jun 2;8(6):e2514989. doi: 10.1001/jamanetworkopen.2025.14989.

ABSTRACT

IMPORTANCE: The Centers for Disease Control and Prevention offers a standardized antimicrobial administration ratio (SAAR) as an evaluation metric for inpatient antibiotic use through rankings and peer comparisons (ie, benchmarking). However, the SAAR model only accounts for facility- and unit-level factors without considering the hierarchical nature of the health care data, and it does not directly reflect patient-level factors or stewardship efforts to avoid overly broad-spectrum therapy.

OBJECTIVE: To examine the use of antimicrobial use risk adjustment methods and choice of basic metrics (eg, days of therapy [DOT] and days of antimicrobial spectrum coverage [DASC], which do not and do consider antimicrobial spectrum, respectively) in hospital benchmarking.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted using data from 117 acute care hospitals within the Veterans Health Administration (VHA) system. All patients admitted between January 1, 2021, and December 31, 2023, were included.

MAIN OUTCOMES AND MEASURES: Monthly antibiotic use was measured with 2 basic metrics and risk adjustment models created using baseline data for 2021 to 2022. Hospitals were benchmarked for 2023 use via 3 methods: (1) unadjusted comparison, (2) risk adjustment with hospital- and unit-level factors with single-level negative binomial regression models (method 1, similar in approach to the SAAR), and (3) risk adjustment with hospital-, unit-, and patient-level factors with hierarchical zero-inflated negative binomial regression models (method 2).

RESULTS: This study included 736 810 patients (median age, 70 [IQR, 61-76] years; 94.7% male). There was wide variability in unadjusted antibiotic use among hospitals (median, 477 [IQR, 420-523] DOT per 1000 days present [DP]; and median, 3115 [IQR, 2739-3602] DASC per 1000 DP). Risk adjustments with methods 1 and 2 resulted in moderate ranking changes, but there were only weak correlations between benchmarking results by the 2 methods (τB = 0.43 for DOT and 0.44 for DASC). The choice of basic metrics with or without consideration of antimicrobial spectrums (DOT vs DASC) had a modest correlation after risk adjustment (τB = 0.84).

CONCLUSIONS AND RELEVANCE: In this cohort study of the nationwide VHA system, there were substantial differences in risk-adjusted benchmarking results between models with only hospital- and unit-level factors and models with hospital-, unit-, and patient-level factors. Future studies should evaluate whether these models with higher content validity also have better construct validity and can inform hospitals and stewardship programs about their objective performance compared with other programs.

PMID:40498481 | DOI:10.1001/jamanetworkopen.2025.14989

Biomed Instrum Technol. 2025;59(1):108-116. doi: 10.2345/0899-8205-59.1.108. Epub 2025 Jun 11.

ABSTRACT

Healthcare staff rely on isolation gowns to provide a degree of protection against cross contamination from blood or body fluids. Gowns that meet standardized liquid barrier penetration test methods provide staff with a presumed assurance of safety. However, these test methods-namely impact penetration and resistance to hydrostatic pressure-were not drafted with personal protective equipment in mind and therefore may be inappropriate for testing products intended for use in a healthcare environment. This study found that adjusting testing parameters to better simulate clinical conditions altered the measured performance outcomes of the gowns. Specifically, increasing the temperature of the gown material’s preconditioning environment or test liquid resulted in statistically significant variations in results. Further, although hydrostatic pressure resistance is measured by the appearance of a third liquid droplet on the inner surface of the gown material, the first two droplets appeared at significantly lower pressures and likely would constitute contamination of healthcare staff. The results indicated that current isolation gown test protocols and regulations should be reevaluated to more accurately reflect healthcare scenarios and improve alignment with expected barrier performance.

PMID:40498446 | DOI:10.2345/0899-8205-59.1.108

Biomed Instrum Technol. 2025;59(1):117-127. doi: 10.2345/0899-8205-59.1.117. Epub 2025 Jun 11.

ABSTRACT

Objectives: This study sought to investigate whether and to what extent fluid strikethrough for disposable isolation gowns is underreported and to identify areas for improving healthcare worker (HCW) understanding of gown performance. Methods: Researchers developed a confidential, qualitative, online disposable isolation gown user experience survey with an intended audience of HCWs with experience either wearing disposable isolation gowns or selecting them for purchase. The unrestricted survey link was distributed from February to March 2024. Results: A total of 211 individuals completed the survey. When asked about selection, purchasers most frequently chose to purchase level 2 isolation gowns for patient care during nonsurgical applications. More than 40% of wearers stated that they did not have a choice regarding gown protection levels when donning personal protective equipment for patient care, and 34.3% experienced fluid strikethrough (i.e., penetration of fluid through a disposable isolation gown), yet nearly one-half never reported this problem. Discussion and Conclusion: To enhance safety, the healthcare community must work together to improve guidance on gown performance and selection based on fluid exposure risk. Frequent, underreported strikethrough incidents highlighted confusion among HCWs regarding gown classification and appropriate usage. A need exists for a unified, task-based framework that clearly links gown performance with clinical risk. Fostering a culture that normalizes reporting issues-while minimizing staff burden-combined with targeted education and streamlined reporting mechanisms, will enable more informed decision making and reinforce infection prevention efforts.

PMID:40498445 | DOI:10.2345/0899-8205-59.1.117

J Perianesth Nurs. 2025 Jun 11:S1089-9472(25)00048-6. doi: 10.1016/j.jopan.2025.02.010. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the effect of suprazygomatic maxillary nerve block (SMB) in patients undergoing septoplasty surgery.

DESIGN: Randomized controlled trial.

METHODS: A total of 60 patients who met the inclusion criteria were enrolled in this prospective, randomized controlled study. The patients were divided into two groups: group C (control group) and group B (block group). The groups were compared in terms of demographic variables, American Society of Anesthesiologists scores, hemodynamic parameters (mean arterial pressure and heart rate), visual analog scale (VAS) pain scores, postoperative recovery quality (QoR-15 scores) (Quality of recovery-15 (QoR-15)), and the need for rescue analgesics.

FINDINGS: There were no statistically significant differences between the groups regarding age, gender, or American Society of Anesthesiologists scores (P > .05). Baseline hemodynamic parameters were similar between the groups (P > .05). However, mean arterial pressure and heart rate were significantly lower in group B at 15, 30, 45, and 60 minutes postoperatively (P < .05). Visual analog scale scores at 0, 2, 6, and 12 hours were significantly lower in group B (P < .05). QoR-15 scores were also significantly higher in group B (P < .05), while the patients need rescue analgesics was lower in this group (P < .05). There was no significant difference in the total number of postoperative analgesic doses between the two groups (P > .05).

CONCLUSIONS: The application of SMB during septoplasty surgery provides improved perioperative hemodynamic stability, reduced postoperative pain, and enhanced recovery quality. The SMB can be considered a valuable component of a multimodal analgesic approach in septoplasty surgeries.

PMID:40498428 | DOI:10.1016/j.jopan.2025.02.010

J Perianesth Nurs. 2025 Jun 11:S1089-9472(25)00056-5. doi: 10.1016/j.jopan.2025.02.018. Online ahead of print.

ABSTRACT

PURPOSE: This study was conducted to examine the effect of operating room waiting time on surgical fear and preoperative anxiety in patients undergoing urinary system surgery.

DESIGN: This study was conducted as a comparative cross-sectional.

METHODS: This study was conducted with 150 patients undergoing urinary system surgery at a state hospital in Turkey between December 2023 and July 2024. Data were collected using a Descriptive Characteristics Form, the Visual Analog Scale, and the Surgical Fear Questionnaire at two time points: before entering the operating room (T0) and before being placed on the surgical table (T1). Patients were divided into 2 groups based on waiting time: group A (<30 minutes) and group B (≥30 minutes). Statistical analysis was performed with SPSS 27.0 at a significance level of P less than .05.

FINDINGS: Patients in groups A and B were similar in terms of descriptive characteristics and T0 assessment. However, at T1 assessment, patients in group B had significantly higher levels of anxiety (P = .002), short-term fear (P = .001), and total fear (P = .001) compared to group A. Waiting time had a significant effect on anxiety (β = 0.637, P = .001), short-term fear (β = 0.788, P = .001), and total fear (β = 0.536, P = .001).

CONCLUSIONS: Prolonged waiting time in the operating room significantly increases psychological burden by significantly increasing anxiety, short-term fear, and total fear levels in patients.

PMID:40498427 | DOI:10.1016/j.jopan.2025.02.018

Dig Dis Sci. 2025 Jun 11. doi: 10.1007/s10620-025-09111-x. Online ahead of print.

ABSTRACT

BACKGROUND: The Viral Hepatitis National Strategic Plan documents the value of a collaborative provider workforce trained in the provision of hepatitis treatment and prevention to facilitate the United States’ 2030 viral hepatitis elimination efforts.

AIMS: This study aims to characterize the amount and type of viral hepatitis education topics provided to Doctor of Medicine students during the preclinical phase of medical school.

METHODS: Investigators developed a 19-item Qualtrics survey and sent survey links to curricula content experts at 157 accredited medical colleges/schools in April-May 2023, and allotted 28 days for survey completion. Survey questions assessed the type, amount, and topics of viral hepatitis instruction provided to Doctor of Medicine students, and the hepatitis instructors’ training/experience. We used descriptive statistics for analysis.

RESULTS: 51 medical institutions across 22 jurisdictions responded; 90% of programs presented hepatitis education as a required part of the curriculum. All education topic respondents confirmed that their institutions provided instruction on viral hepatitis epidemiology, diagnostics, and HBV vaccination. Screening and linkage to care for HBV, HCV, and HDV were included in 69%, 78%, and 33% of curricula, respectively, while 11% of curricula discussed national efforts to eliminate hepatitis by 2030.

CONCLUSIONS: Survey results show similarities, variability, and gaps in topics devoted to viral hepatitis education across United States medicine curricula. Most programs required hepatitis education in their curricula, many discussed HBV and HCV screening, and few discussed hepatitis elimination. To support national viral hepatitis elimination efforts, ideally, all medical schools should provide education on (1) screening, (2) linkage to care, and (3) national elimination strategies to better equip all future physicians to work toward viral hepatitis elimination.

PMID:40498408 | DOI:10.1007/s10620-025-09111-x

Dermatol Ther (Heidelb). 2025 Jun 11. doi: 10.1007/s13555-025-01456-5. Online ahead of print.

ABSTRACT

INTRODUCTION: Psoriasis body surface area (BSA) of 10% or more has been a major criterion for determining systemic therapy eligibility. However, patients with BSA < 10% and even ≤ 3% may have high disease burden and difficulties accessing biologics. To assess psoriasis burden among patients with BSA ≤ 10%, this study characterized patient-reported outcomes (PROs) across BSA categories among systemic treatment-naïve patients initiating biologic therapy.

METHODS: Patients from the CorEvitas Psoriasis Registry initiating biologics between April 2015 and September 2023 were categorized according to low (< 3%), medium (3-10%), or high (> 10%) BSA involvement. Measures assessed at initiation of biologic therapy included health-related quality of life, itch, pain, fatigue, psoriatic arthritis, psoriasis disease characteristics, and medical history. Overlap between BSA groups for each outcome was calculated via non-parametric Mann-Whitney statistic transformation (range 0.0-1.0; 0.5 indicates complete similarity [i.e., for a comparison between low and high BSA groups, overlap of 0.5 means there is 50% probability that a randomly selected patient with low BSA would have the same or greater PRO burden as one with high BSA]; 0 or 1 indicates complete dissimilarity) to determine whether each measure differed in randomly selected patients with low or medium versus high BSA.

RESULTS: Of 1640 patients who initiated biologics, 7.0% had low BSA, 46.9% had medium BSA, and 46.2% had high BSA involvement. PRO overlap statistics ranged from 0.52 to 0.59 and from 0.60 to 0.70 for randomly selected patients with high versus medium and low BSA, respectively, indicating patients with high and medium BSA are likely to have similar levels of disease burden, and patients with high BSA are slightly more likely to have higher disease burden than those with low BSA. Near complete overlap (range 0.44-0.58) was observed for psoriasis disease characteristics and medical history in the low versus high and medium BSA groups.

CONCLUSION: Observed overlap in PROs across BSA categories shows that patients with low BSA can experience similarly poor quality of life and high symptom burden to those with higher BSA. These findings support the appropriateness of considering biologic therapies for patients with low BSA and indicators of high disease burden.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT02707341.

PMID:40498388 | DOI:10.1007/s13555-025-01456-5