Tag: pubmed

Clin Child Fam Psychol Rev. 2025 May 11. doi: 10.1007/s10567-025-00521-x. Online ahead of print.

ABSTRACT

Emotional and behavioural problems (EBP) are prevalent amongst children, and guided, parent-led digital interventions offer one method of improving access to effective treatments. This systematic review (PROSPERO: CRD42023484098) aimed to examine the evidence base for, and characteristics of, these types of interventions through a narrative synthesis. Systematic searches were conducted using Medline, EMBASE, PsycINFO, Scopus and Web of Science in January 2024 and February 2025, supplemented with hand searching in March/April 2024 and February 2025. Studies were eligible if they reported outcomes related to preadolescent EBP from a guided, fully parent-led, fully digital intervention. Thirteen studies were eligible, including 2643 children and covering eight interventions (addressing anxiety problems, comorbid anxiety and depression, attention deficit hyperactivity disorder, conduct disorder and disruptive behaviour). Studies included randomised controlled trials and pre-post studies. The QualSyst checklist was used to assess study quality; all studies were rated as good quality. All studies showed statistically significant improvements in the child’s symptoms or interference levels, with small to very large effect sizes immediately post-treatment, and at least medium effect sizes by follow-up, suggesting a promising evidence base. A wide range of intervention characteristics were identified, forming a basis for future intervention development for childhood EBP. However, there was a lack of consistency in how information was reported across studies (such as completion rates) and studies lacked information on parent demographics and key intervention details. Further high quality randomised controlled trials for a wider range of EBP are needed to continue building the evidence base.

PMID:40349266 | DOI:10.1007/s10567-025-00521-x

Dermatol Ther (Heidelb). 2025 May 11. doi: 10.1007/s13555-025-01441-y. Online ahead of print.

ABSTRACT

INTRODUCTION: This randomized, prospective study (MATCH) was designed to assess the clinical utility of a machine learning-based tool (Mind.Px) that predicts patient response to the biologic drug classes used in the management of psoriasis.

METHODS: Patients with psoriasis who were biologic naïve or approaching a medication change owing to nonresponse were enrolled into the study (N = 210). At baseline, a dermal biomarker patch was applied to lesional skin, and Mind.Px test results were provided to physicians for patients in the informed arm of the study prior to biologic selection. The choice of biologic was recorded, and, in the case of physician nonconcordance with Mind.Px test results, a questionnaire was completed to determine the reason for nonconcordance. Patients were evaluated at weeks 4 and 12 after baseline using Psoriasis Area and Severity Index (PASI). Statistical analysis between groups was performed using Fisher’s exact test.

RESULTS: Physician prescribing behavior was measured with and without the inclusion of Mind.Px test results in the decision-making process (N = 205). Additional comparisons were made to a previously collected data set identical to the Mind.Px-uninformed arm (N = 429). Statistical analysis of concordance between the Mind.Px-informed and Mind.Px-uninformed groups (92.3% versus 62.9%, respectively) showed that when given access to Mind.Px results, physician behavior was significantly altered (p = 8.08 × 10^-7). Furthermore, analysis of patients whose physicians followed Mind.Px results showed that not only did more patients reach the clinical endpoint (PASI75) at 12 weeks (p = 5.4 × 10^-4), but also more patients reached this endpoint by week 4 than those in the treatment-as-usual arm (p = 0.01).

CONCLUSIONS: These results provide evidence of the clinical utility of Mind.Px by showing that physicians utilize test results in psoriasis biologic decision-making, leading to improved patient outcomes. These improved patient outcomes can also potentially translate into cost savings for healthcare systems. Mind.Px can minimize the trial-and-error approach to psoriasis treatment, and provide physicians, patients, and payers with an effective tool for re-envisioning the management of patients with psoriasis.

GOV LISTING: NCT05036889.

PMID:40349264 | DOI:10.1007/s13555-025-01441-y

Spine Deform. 2025 May 11. doi: 10.1007/s43390-025-01091-2. Online ahead of print.

ABSTRACT

PURPOSE: This article aimed to determine modifiable risk factors to prevent massive blood transfusion of blood products (MTBP) during spinal fusion in patients with cerebral palsy.

METHODS: Patient data were queried from a prospectively collected multicenter database. Perioperative MTBP was defined as the administration of allogenic blood products equaling at least half (50%) of the patients’ preoperative blood volume during the surgical procedure. Univariate and multivariate logistic regression was used for statistical analysis.

RESULTS: Three hundred thirty-three patients were included. Ninety-four percent of patients were Gross Motor Classification System IV and V. The incidence of MTBP was 29.7% (99/333). The lack of antifibrinolytic use was significant at univariate analysis. Preoperative low weight, blood volume loss, hybrid system, and unit rod use remained significant after the adjustment in multivariate analysis. Loss of more than 68% of patient blood volume was the threshold for MTBP. Patients receiving MTBP had increased hospital (P = 0.006) and intensive care unit (P < 0.001) stays. However, surgical site complications, deep wound infections, and reoperation rate were not different (P = 0.12, P = 0.46, P = 0.22, respectively). There was a significant decrease in MTBP incidence from 2008 (53%) to 2016 (11%) (P < 0.001) with routine administration of antifibrinolytics.

CONCLUSION: The incidence of MTBP in patients with cerebral palsy undergoing PSF during the study period was 29.7% and this rate has decreased over time, making the surgery safer. Optimization of preoperative nutrition status, use of pedicle screw constructs when possible, and use of antifibrinolytics when not contraindicated is recommended to reduce the risk of perioperative MTBP.

LEVEL OF EVIDENCE: Level III-Retrospective cohort study.

PMID:40349263 | DOI:10.1007/s43390-025-01091-2

J Cancer Res Clin Oncol. 2025 May 11;151(5):160. doi: 10.1007/s00432-025-06221-x.

ABSTRACT

PURPOSE: This study aims to develop an effective machine learning (ML)-based predictive model for the recurrence of borderline ovarian tumor (BOT), and provide the guidelines of accurate clinical diagnosis and precise treatment for patients.

METHOD: A total of 660 patients diagnosed with BOT were included in this study. Statistical testing methods were employed to identify the most influential factors. At the same time, five machine learning-based models-random forest (RF), logistic regression (LR), gradient boosting (GB), multilayer perceptron (MLP), and support vector machine (SVM)-were utilized to construct recurrence prediction models. Model validity was assessed using five metrics: area under the curve (AUC), positive predictive value (PPV), accuracy (ACC), recall (REC), specificity (SPE), and the optimal model was selected based on these performance metrics. The calibration curve further illustrates the reliability of the model. Then, the optimal ML-based model determined the importance of features using SHAP values. Additionally, CIC and DCA, along with recurrence-free survival analysis, were employed to further assess the clinical value of the optimal model.

RESULTS: The RF model demonstrated superior predictive performance. Additionally, the SHAP analysis of the RF-based model provides the key clinical factors associated with the recurrence of BOT. Furthermore, the DCA and CIC shows the clinical application value of the RF-based model. Moreover, random forest-recurrence free survival (rf-RFS) model validate the effectiveness of the proposed method personalized treatment strategies and informed clinical decision-making of the recurrence of BOT.

CONCLUSION: The RF-based model offers an effective tool for predicting BOT recurrence, with a user-friendly web-based calculator developed to aid clinical decision-making.

PMID:40349260 | DOI:10.1007/s00432-025-06221-x

Rheumatol Int. 2025 May 11;45(6):140. doi: 10.1007/s00296-025-05892-6.

ABSTRACT

Behçet’s disease (BD) is a rare multisystem vasculitis. Globally, BD exhibits a unique geographic distribution, with the highest prevalence along the historic Silk Road. To study the demographics, clinical characteristics, and outcomes of BD in the United Arab Emirates (UAE). A multicenter retrospective chart review study was conducted at hospitals in the UAE from 2008 to 2024. All adult and pediatric patients who were diagnosed with BD by a rheumatologist and treated within the timeframe were included in the study while those who received any alternative final diagnosis were excluded. The results were analyzed using descriptive and inferential statistics. One hundred and twenty-three patients were treated and monitored for BD. Most were female (n = 70, 57%). Their median age was 32 years (24-41), and approximately two-thirds were Emirati (n = 82, 67%). Twelve patients (10%) had a family history of BD, including 7 (6%) with first-degree BD. The time from the initial symptoms to diagnosis was 11.9 months (2.3-31.0). The most common clinical manifestations were oral ulcers (n = 99, 81%), arthralgia (n = 63, 51%), genital ulcers (n = 62, 50%), and ocular involvement (n = 37, 30%). Most of the patients were HLA-B51 positive (n = 92, 84%). At diagnosis, 36 (29%) met the ISG criteria, 73 (59%) met the ICBD criteria, and 50 (41%) met neither criteria. The male patients exhibited more major organ involvement (ocular, neurological, vascular, and cardiac), greater use of corticosteroids and anti-TNFa medications, and greater disease activity than the female patients. Among the patients with isolated ocular manifestations (n = 9) who met neither classification criteria, most were female (56%), with a median age of 37 years (26.5-3.5). None had a family history of autoimmune conditions, and all were HLA-B51 positive. Most of these patients (n = 8, 89%) received corticosteroids, 5 (56%) received azathioprine, and 2 (22%) received anti-TNFa therapies. These findings provide insights into the clinical profile of BD in the UAE. Notably, we found a high proportion of patients with positive HLA-B51 and ocular manifestation. Further research with larger sample sizes is needed to better understand these associations.

PMID:40349258 | DOI:10.1007/s00296-025-05892-6

Eur J Orthop Surg Traumatol. 2025 May 11;35(1):185. doi: 10.1007/s00590-025-04325-1.

ABSTRACT

PURPOSE: The prevalence of obesity and morbid obesity in the U.S. has reached record levels, with over 50% of adults affected. Obese patients undergoing total joint arthroplasty (TJA) face increased post-operative complications, yet studies on optimizing outcomes for this population are limited. The COVID-19 pandemic accelerated the shift towards same-day discharge (SDD) for TJA, but the impact on morbidly obese patients remains understudied. This study aims to fill this gap by examining outcomes and costs for morbidly obese patients undergoing SDD TJA.

METHODS: This study is a retrospective review of the PearlDiver Mariner Database. Based on the procedure and their body mass index (BMI), the patients were divided into 4 SDD groups: Total knee arthroplasty (TKA)-BMI > 40, TKA-BMI < 40, total hip arthroplasty (THA)-BMI > 40, and THA-BMI < 40. The two TKA groups were matched based on age, gender, and the Charlson comorbidity index (CCI). The THA groups were matched similarly. Outcomes at 30 and 90 days post-operatively were compared between the groups.

RESULTS: 5588 patients were included in each TKA group, and 1675 patients in each THA group. When compared to individuals with a BMI of less than 40, patients with morbid obesity receiving SDD TKA had greater incidence of deep vein thrombosis (DVT) (p < 0.05), urinary tract infection (UTI) (p < 0.05), readmissions (p < 0.05), superficial surgical site infection (SSSI) (p < 0.05), and higher costs (p < 0.05). Regarding SDD THA, patients with morbid obesity had greater incidence of DVT (p < 0.05), UTI (p < 0.05), emergency department visits (p < 0.05), readmissions (p < 0.05), intensive care unit admission (p < 0.05), prosthetic joint infection (p < 0.05), SSSI (p < 0.05), and higher costs (p < 0.05).

CONCLUSION: This study highlights the considerable challenges faced by morbidly obese patients undergoing SDD TJA. Patient optimization prior to undergoing total joint replacement may benefit morbidly obese patients undergoing same day discharge. Further research is needed.

PMID:40349255 | DOI:10.1007/s00590-025-04325-1

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2025 May 10;33(2):1611. doi: 10.32687/0869-866X-2025-33-2-301-310.

ABSTRACT

The article presents overview of publications devoted to experience of Russian medical universities in training bachelors in Nurse Business course to provide specialists in medical care of minors in educational organizations. The analysis of data related to provision of general educational organizations with medical personnel was implemented. The survey of graduates and employers was carried out. The ways to solve identified problems were proposed.The Objective was to improve training of specialists providing medical care to minors in educational organizations based on generalization of existed experience of implementing educational program of higher nursing education in Russian universities and Kazan State Medical University.The publications in peer-reviewed scientific journals were analyzed. The data on provision of general educational organizations of the Republic of Tatarstan with medical personnel was considered. The statistical analysis of reporting forms № 30 and № 030-PO / O-17 was implemented. The chief physicians of children clinics and surveying graduates were interviewed.The analysis of publications demonstrated that training of bachelors in Nurse Business course in Russian universities is carried out almost in the same way. The common problems associated with imperfection of legislative sphere, complexity of employment, despite shortage of medical personnel in general education organizations were detected. The analysis of interviews with employers demonstrated that graduates of the bachelor Nurse Business course own necessary professional competencies and are the best suited ones for elaborating effective model of school health care.The generalization of existing experience of training medical personnel under program of higher nursing education made it possible to formulate main ways of improving educational process to train specialists providing medical care to minors in educational organizations.

PMID:40349248 | DOI:10.32687/0869-866X-2025-33-2-301-310

Fam Pract. 2025 Apr 12;42(3):cmaf026. doi: 10.1093/fampra/cmaf026.

ABSTRACT

BACKGROUND: Hospital family physicians are recognized for their excellence in managing complex issues. This study aimed to reveal the level of complexities of patients referred to hospital family physicians by community centers, and the degree of change in these complexities following care provided by a health care team that includes hospital family physicians.

METHODS: A retrospective cohort analysis. Patients introduced by community centers between 2020 and 2023 were identified. The patients received team-based comprehensive care. Complexity was calculated before and after the care, using the patient-centered assessment method (PCAM), which evaluates 12 items across four domains. Each item is rated from 1 to 4, yielding a total score range of 12 to 48. Pre- and post-intervention scores were compared using paired-sample t-tests, with standardized mean difference calculated using Hedges’ g.

RESULTS: Of 41 referred patients, three died shortly after the initial consultation. Among the 38 remaining patients, 24 were admitted, and 14 were treated as outpatients. The mean PCAM score significantly decreased from 36.9 to 23.7 after interventions (P < .001, Hedges’ g = 2.54). Scores improved significantly across all domains: health and well-being (2.96 vs 1.95; P < .001, g = 2.00), social environment (3.09 vs 1.96; P < .001, g = 2.38), health literacy and communication (2.78 vs 2.46; P < .001, g = 0.67), and service coordination (3.61 vs 1.57; P < .001, g = 4.68).

CONCLUSION: Hospital family physicians in Japan often manage patients with exceptionally complex problems and improve patient outcomes across multiple domains.

PMID:40347438 | DOI:10.1093/fampra/cmaf026

Epilepsia Open. 2025 May 10. doi: 10.1002/epi4.70055. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effects of personalized multichannel tDCS on seizure frequency, severity, quality of life, and psychiatric comorbidities in patients with drug-resistant focal epilepsy. Secondary goals include assessing the safety and feasibility of this approach.

METHODS: This open-label pilot study involved 16 patients with drug-resistant focal epilepsy. Patients underwent 3 cycles of personalized multichannel tDCS over 6 months, targeting the EZ defined by stereoelectroencephalography (SEEG). Each cycle consisted of five consecutive days of tDCS, with two daily sessions of 20 min each. The primary endpoint was a reduction in seizure frequency, with secondary endpoints addressing quality of life (QOLIE-31 scores), seizure severity (NHS3 scores), and psychiatric comorbidities (NDDI-E and GAD-7 scales).

RESULTS: Across all participants, a statistically significant 20% reduction in seizure frequency was observed (p = 0.044). Six patients (37%) were identified as responders (≥50% seizure reduction), with one achieving seizure freedom. The mean seizure reduction among responders was 68%. Significant improvements were noted in overall quality of life (QOLIE-31, p = 0.009), with greater benefits for patients with poorer baseline scores. No overall significant changes were observed in depression, anxiety, and seizure severity scores, though individual variability was noted. The treatment was well tolerated, with mild adverse events, primarily skin-related.

SIGNIFICANCE: Personalized multichannel tDCS shows promise as a noninvasive therapeutic option for drug-resistant focal epilepsy, with benefits in seizure reduction and quality of life. Although results were variable, the method’s safety and feasibility support further exploration through randomized controlled trials to refine protocols, better select potential responders’ patients, and validate findings.

PLAIN LANGUAGE SUMMARY: This study tested a personalized brain stimulation technique called tDCS in people with difficult-to-treat epilepsy. The treatment led to fewer seizures in some patients and improved their quality of life. The approach was safe and caused only mild side effects. These results suggest that this type of noninvasive brain stimulation may be a helpful new option for people who do not benefit from medication or surgery.

PMID:40347434 | DOI:10.1002/epi4.70055

Int J Clin Oncol. 2025 May 10. doi: 10.1007/s10147-025-02778-2. Online ahead of print.

ABSTRACT

BACKGROUND: There is no definitive consensus on the necessity and impact of lymph-node dissection during radical cystectomy for non-muscle-invasive bladder cancer (NMIBC). This study aimed to evaluate the prognostic significance of lymph-node dissection in NMIBC and identify preoperative factors influencing non-urinary tract recurrence-free survival (NUTRFS).

METHODS: We retrospectively analyzed data for 2674 cases of bladder cancer treated with radical cystectomy between January 2013 and December 2019 from a multicenter Japanese database; 410 patients were preoperatively diagnosed with NMIBC. Patients were divided into lymph-node dissection and non-lymph-node dissection groups, and NUTRFS and overall survival were compared as endpoints. Univariate and multivariate analyses were performed to determine NUTRFS prognostic factors.

RESULTS: Lymph-node dissection was performed in 374/410 patients and not in 36/410. Compared with the lymph-node dissection group, the non-lymph-node dissection group was older, and had a lower proportion of a performance status of 0 and a higher proportion of clinical stage < T1 disease. The pathological lymph-node positivity rate in the lymph-node dissection group was 6.9%. However, lymph-node dissection did not provide a statistically significant prolonged survival. Results remained consistent after propensity score matching. Multivariate analysis revealed poor performance status and bladder neck tumors as independent risk factors for NUTRFS. Lymph-node dissection was not a significant prognostic factor in preoperatively diagnosed NMIBC.

CONCLUSIONS: Routine lymph-node dissection may be unnecessary for all NMIBC cases; however, our findings suggest that this should be considered for NMIBC involving the bladder neck.

PMID:40347426 | DOI:10.1007/s10147-025-02778-2