Tag: pubmed

Psychol Med. 2025 Dec 18;55:e384. doi: 10.1017/S0033291725102651.

ABSTRACT

BACKGROUND: Early life adversity (ELA) is common and cross-sectionally associated with brain gray matter structure, including cortical thickness, cortical surface area, and subcortical volumes in childhood. However, to which degree ELA influences the trajectory of gray matter macrostructural and microstructural development during childhood and adolescence remains largely unexplored.

METHODS: We included 6414 participants from the Adolescent Brain Cognitive Development study at ages 9-11, where 1923 were followed to ages 11-13. We used linear mixed-effects models to test for associations between MRI-derived longitudinal measures of gray matter macro- (cortical thickness, surface area, subcortical volume) or microstructure (T1w/T2w ratio) and trauma exposure, parental acceptance, household abuse, and being resilient or susceptible to trauma in terms of developing an internalizing disorder.

RESULTS: At ages 9-11, higher levels of parental acceptance, trauma exposure, and being trauma resilient were associated with lower levels of cortical thickness. In contrast, being trauma susceptible was negatively related to hippocampal volume and cortical surface area. Longitudinally, more parental acceptance at baseline was associated with more cortical thinning between ages 9-11 and 11-13, while more household abuse was associated with less change in T1w/T2w ratio over time.

CONCLUSIONS: Parental acceptance and trauma resilience are linked to accelerated pace of apparent cortical thinning in youth aged 9-13 years, while household abuse is associated with slower microstructural development, as reflected by smaller longitudinal changes in the T1w/T2w ratio. Threat and deprivation may be distinctly associated with gray matter developmental trajectories in late childhood.

PMID:41410108 | DOI:10.1017/S0033291725102651

J Adv Nurs. 2025 Dec 17. doi: 10.1111/jan.70456. Online ahead of print.

ABSTRACT

BACKGROUND: Delirium is a common complication following cardiac surgery and significantly affects patient prognosis and quality of life. Recently, the application of artificial intelligence (AI) has gained prominence in predicting and assessing the risk of postoperative delirium, showing considerable potential in clinical settings.

OBJECTIVE: This scoping review summarises existing research on AI-based prediction models for post-cardiac surgery delirium and provides insights and recommendations for clinical practice and future research.

METHODS: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, eight databases were searched: China National Knowledge Infrastructure, Wanfang Database, China Biomedical Literature Database, Virtual Information Platform, PubMed, Web of Science, Medline, and Embase. Studies meeting the inclusion criteria were screened, and data were extracted on surgery type, delirium assessment tools, predictive factors, and AI-based prediction models. The search covered database inception through January 12, 2025. Two researchers independently conducted the literature review and data analysis.

RESULTS: Ten studies from China, Canada, and Germany involving 11,702 participants were included. The reported incidence of postoperative delirium ranged from 5.56% to 34%. The most commonly used assessment tools were Confusion Assessment Method for the Intensive Care Unit, Diagnostic and Statistical Manual of Mental Disorders-5, and Intensive Care Delirium Screening Checklist. Key predictive factors included age, cardiopulmonary bypass time, cerebrovascular disease, and pain scores. AI-based prediction models were primarily developed using R (6/10, 60%) and Python (4/10, 40%). Model performance, as measured by the area under the curve, ranged from 0.544 to 0.92. Among these models, Random Forest (RF) was the most effective (5/10, 50%), followed by XGBoost (3/10, 30%) and Artificial Neural Networks (2/10, 20%).

CONCLUSION: AI-based models show promise for predicting postoperative delirium in cardiac surgery patients. Future studies should prioritise integrating these models into clinical workflows, conducting rigorous multicenter external validation, and incorporating dynamic, time-varying perioperative variables to enhance generalizability and clinical utility.

REPORTING METHOD: This review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines.

PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct, or reporting.

PMID:41410092 | DOI:10.1111/jan.70456

Clin Teach. 2026 Feb;23(1):e70332. doi: 10.1111/tct.70332.

ABSTRACT

BACKGROUND: Evidence is limited internationally regarding medical students’ perceptions and training needs in patient safety, following the WHO Global Patient Safety Action Plan 2021-2030, the COVID-19 pandemic, and the subsequent acceleration in digitalization. To address this gap, this study explores undergraduate medical students’ knowledge of patient safety, attitudes regarding safety culture, experiences with errors, and their perspectives on improving patient safety through training and digitalization.

METHODS: A mixed-method design was employed, consisting of an online survey with open-ended questions administered at a medical school in Greece. All registered undergraduate students were invited to complete a pretested 46-item study tool, including demographics, the Greek version of the scale ‘What is patient safety?’ and their personal experiences, views on digitalization and educational needs.

RESULTS: A total of 638 students from all 6 years of study participated (58% female; 54.2% preclinical students). Findings revealed poor knowledge regarding error management (mean 2.4/5) and the reporting process (mean 1.8/5). Fear of blame culture was reported by 51.2%. Digitalization was expected to advance patient safety in multiple ways. Students advocated strengthening patient safety training (92.8%), emphasizing case-based learning, integrating patient safety principles into the teaching of all clinical courses and watching their professors acting as role models.

CONCLUSIONS: Medical students feel underprepared to manage patient safety issues and request more relevant knowledge and skills. These findings highlight the urgency for appropriate training reforms, tailored to the students’ needs, aiming to optimally prepare them to become key players in improving patient safety in a digitally evolving healthcare system.

PMID:41410090 | DOI:10.1111/tct.70332

Pharmacol Res Perspect. 2026 Feb;14(1):e70206. doi: 10.1002/prp2.70206.

ABSTRACT

Fluoroquinolones (FQs) are widely prescribed antibiotics; however, increasing concerns have arisen over their potential to cause disabling and irreversible adverse effects. Using real-world data from the FDA Adverse Event Reporting System (FAERS) (2011-2024), we performed disproportionality analyses on psychiatric and eye-related adverse events (AEs) using reporting odds ratios (RORs). Of 44 895 FQ-associated adverse event reports, 8518 cases exhibited psychiatric AEs whilst 4367 cases displayed eye-related AEs. Among six FDA-approved FQs, three (ciprofloxacin/levofloxacin/moxifloxacin) showed safety signals for psychiatric disorders and four (ciprofloxacin/levofloxacin/moxifloxacin/ofloxacin) for eye-related disorders. Eight psychiatric and nine eye-related AEs were commonly reported across multiple FQs. Importantly, moxifloxacin exhibited unique safety signals for ocular-related toxicity, including iris transillumination defect [ROR: 6604.89 (4736.76-9209.81)], iris hypopigmentation [1887.66 (1175.44-3031.42)], and pigment dispersion syndrome [2360.62 (1432.71-3889.51)], raising concern for potential progression to pigmentary glaucoma-findings not prominently featured in current safety warnings. Additionally, systematic characterization of suicide cases revealed striking male predominance despite females comprising the majority of psychiatric AEs, identifying middle-aged males as a high-risk demographic. These findings support the need for enhanced pharmacovigilance, particularly regarding moxifloxacin’s ocular toxicity and FQs’ suicide vulnerability in specific patient subgroups. When FQ prescription becomes unavoidable, robust safety monitoring should be implemented to detect early neuropsychiatric and ocular complications.

PMID:41410077 | DOI:10.1002/prp2.70206

Quintessence Int. 2025 Dec 18;0(0):0. doi: 10.3290/j.qi.b6762754. Online ahead of print.

ABSTRACT

Aims to critically analyze the effects of photobiomodulation on recovery of the donor area after free gingival graft (FGG) surgery. A comprehensive literature search was conducted in PubMed, Scopus and Web of Science between May 7th and April 7th, 2025, structured according to the PICO strategy: patients ≥18 years undergoing removal of free gingival grafts from the palatal region (P), intervention with photobiomodulation at the donor site (I), compared with natural healing (C), evaluating wound healing as the primary and pain as the secondary outcome (O). A total of 668 records were identified and 8 randomized clinical trials, in which 284 participants were included. In outcomes, clinical healing parameters and patient-reported pain were analyzed, in which the majority of most studies demonstrated that photobiomodulation positively influenced epithelialization, reduction in wound area, and tissue color during the first two postoperative weeks. However, the effect on pain control was inconsistent among studies, with only two showing statistically significant reductions. The studies included demonstrated clinical and methodological heterogeneity due to different laser parameters, and their designs made statistical pooling of data unfeasible for a meta-analysis. In conclusion, photobiomodulation appears to be a promising adjunctive therapy to accelerate palatal wound healing after FGG, particularly in the early postoperative period. Nevertheless, the clinical benefit in pain management remains uncertain. Future well-designed studies with standardized protocols are needed to strengthen contemporary evidence.

PMID:41410039 | DOI:10.3290/j.qi.b6762754

Biomed Phys Eng Express. 2025 Dec 18. doi: 10.1088/2057-1976/ae2ebb. Online ahead of print.

ABSTRACT

Respiratory phase mismatch between single-photon emission computed tomography (SPECT) and computed tomography (CT) acquisition phases presents a challenge in lung perfusion scintigraphy using SPECT/CT. This study simulated lung volume and SPECT counts changes under free-breathing and breath-hold CT conditions compared to respiratory-synchronized acquisition. Chest 4D-CT images, divided into 10 respiratory phases, were used to generate lung, soft tissue, liver, and bone regions for each phase. A digital phantom was constructed via image processing using ImageJ. SPECT images were generated from these phantoms by employing the Prominence Processor to simulate projection data and reconstruct images. Simulations included a “synchronized image,” where both SPECT and μMAP for attenuation correction were created in the same phase; a “free-breathing image,” combining a free-breathing SPECT and μMAP; and a “CT breath-hold image,” using phase-specific μMAPs with the free-breathing SPECT image for attenuation correction. Lung volumes and SPECT counts in the free-breathing and CT breath-hold images were compared with those in the synchronized image. By analyzing the relative errors caused by differences in the μMAPs, the study evaluated the impact of mismatch between SPECT and CT phases. Results indicated that lung volumes appeared reduced during inspiration and increased during expiration compared with synchronized images. No significant difference in the relative error was observed between the free-breathing and CT breath-hold images. Our findings revealed that in the quantitative evaluation of lung perfusion SPECT, varying the μ-map phase during free-breathing acquisition did not result in a significant improvement, suggesting that the mismatch between SPECT and CT had no statistically significant effect on quantitative accuracy. Compared with respiratory-gated SPECT, free-breathing acquisitions introduced potential errors of approximately 2.5% in lung volume measurement and 1.2% in SPECT counts. However, these errors were within acceptable tolerance limits for clinical diagnosis, indicating that free-breathing acquisition had minimal effects on diagnostic capability.

PMID:41410023 | DOI:10.1088/2057-1976/ae2ebb

Pharm Stat. 2026 Jan-Feb;25(1):e70066. doi: 10.1002/pst.70066.

ABSTRACT

The introduction of checkpoint inhibitors in immuno-oncology has raised questions about the suitability of the log-rank test as the default primary analysis method in confirmatory studies, particularly when survival curves exhibit non-proportional hazards. The log-rank test, while effective in controlling false positive rates, may lose power in scenarios where survival curves remain similar for extended periods before diverging. To address this, various weighted versions of the log-rank test have been proposed, including the “MaxCombo” test, which combines multiple weighted log-rank statistics to enhance power across a range of alternative hypotheses. Despite its potential, the MaxCombo test has seen limited adoption, possibly owing to its proneness to produce counterintuitive results in situations where the hazard functions on the two arms cross. In response, the modestly weighted log-rank test was developed to provide a balanced approach, giving greater weight to later event times while avoiding undue influence from early detrimental effects. However, this test also faces limitations, particularly if the possibility of early separation of survival curves cannot be ruled out a priori. We propose a novel test statistic that integrates the strengths of the standard log-rank test, the modestly weighted log-rank test, and the MaxCombo test. By considering the maximum of the standard log-rank statistic and a modestly weighted log-rank statistic, the new test aims to maintain power under delayed effect scenarios while minimizing power loss relative to the log-rank test in worst-case scenarios. Simulation studies and a case study demonstrate the efficiency and robustness of this approach, highlighting its potential as a robust alternative for primary analysis in immuno-oncology trials.

PMID:41410010 | DOI:10.1002/pst.70066

Glob Health Action. 2025 Dec;18(1):2602116. doi: 10.1080/16549716.2025.2602116. Epub 2025 Dec 18.

ABSTRACT

BACKGROUND: Since the establishment of national health insurance in Ghana, the government’s health policy has focused on reducing out-of-pocket expenditure (OOP) to ensure that people do not become poorer while accessing healthcare services. However, studies show that OOP expenditure remains high, and a substantial portion of the population experiences catastrophic health expenditure (CHE).

OBJECTIVE(S): We estimated the level and determinants of catastrophic health expenditures for hypertension management among adults in the Greater Accra Region of Ghana.

METHODS: We conducted a cross-sectional CHE survey at two randomly selected district primary health facilities in the Greater Accra Region. Data collection took place between December 2023 and February 2024. A questionnaire was used to collect data on direct and indirect medical expenditures related to hypertension care from 382 participants. CHE was defined at thresholds of 10% and 40% of the household’s capacity for direct and indirect medical expenditures, respectively. Multivariate logistic regression was used to assess the determinants of CHE.

RESULTS: A total of 382 patients were included in the analysis; the majority were females (76%), and Christians (95%). Based on the 10% and 40% thresholds of household income capacity to pay, 65% and 58% of the total sample experienced CHE, respectively. The regression model revealed that being widowed (OR = 0.32, 95% CI: 0.09-1.10, p = 0.07), unemployed (OR = 0.26, 95% CI: 0.08-0.09, p = 0.03), and having a large household size (OR = 1.32, 95% CI: 0.95-1.84, p = 0.09) correlate with CHE for hypertension management and care.

CONCLUSION: The study demonstrates that hypertension care imposes a considerable financial burden on households.

PMID:41410004 | DOI:10.1080/16549716.2025.2602116

J Arrhythm. 2025 Dec 15;41(6):e70247. doi: 10.1002/joa3.70247. eCollection 2025 Dec.

ABSTRACT

INTRODUCTION: Antiarrhythmic effects of sacubitril/valsartan in heart failure (HF) have been previously reported; however, its impact among individuals with ventricular arrhythmias with cardiac defibrillators remains unclear. Therefore, we performed this systematic review and meta-analysis to address this lack of evidence.

METHOD: A systematic search of PubMed, Embase, and Cochrane Library was conducted from inception until February 26, 2025. Binary and continuous variables were analyzed by odds ratio (OR) and mean differences, respectively. All analyses were performed using a random-effects model by RevMan.

RESULTS: Four paired observational cohort studies, including 397 patients with HF and implanted cardiac defibrillators (ICDs) were enrolled. This study showed that sacubitril/valsartan could significantly reduce the incidence of ICD shocks (OR, 0.33; 95% CI, 0.19 to 0.60; p = 0.0003; I ² = 13%), appropriate ICD shocks (OR, 0.21; 95% CI, 0.10 to 0.47; p = 0.0001; I ² = 0%), NSVT duration (OR, -1.86; 95% CI, -3.43 to -0.30; p = 0.02; I² = 86%), and biventricular (Biv) pacing < 90% (OR, 0.15; 95% CI, 0.03 to 0.83; p = 0.03; I ² = 0%). However, the mata-analysis didn’t reveal a significant association between sacubitril/valsartan and a lower rate of ventricular arrhythmia, sustained ventricular tachycardia (SVT), non-sustained ventricular tachycardia (NSVT), inappropriate ICD shocks, premature ventricular contractions per hour (PVC/h), and left ventricular ejection fraction (LVEF).

CONCLUSION: Sacubitril/valsartan may have a potential benefit among HF patients with cardiac defibrillators; future investigations are warranted to confirm the antiarrhythmic effects of sacubitril/valsartan in this setting.

PMID:41409992 | PMC:PMC12705482 | DOI:10.1002/joa3.70247

JAC Antimicrob Resist. 2025 Dec 16;7(6):dlaf246. doi: 10.1093/jacamr/dlaf246. eCollection 2025 Dec.

ABSTRACT

BACKGROUND: Although adjunctive rifampicin and/or gentamicin have been recommended for Staphylococcus aureus prosthetic valve endocarditis, evidence regarding the evaluation of their clinical effectiveness is limited.

OBJECTIVES: To compare the clinical impact of adjunctive rifampicin without gentamicin, and adjunctive gentamicin without rifampicin therapies for S. aureus prosthetic valve endocarditis.

METHODS: This retrospective study used TriNetX to evaluate multicentre electronic medical records of patients aged 18 years or older in the USA between 2016 and 2024. After propensity score matching, HRs were estimated with 95% CIs. Covariates included age, sex, ethnicity and medical comorbidities.

RESULTS: A total of 353 and 369 patients were identified in the rifampicin and gentamicin groups, respectively. One-year all-cause mortality was observed in 87 (31.3%) and 111 (39.9%) patients in the rifampicin and gentamicin groups after propensity score matching, respectively, leading to an HR of 0.71 (95% CI, 0.54-0.94; P = 0.016). The HRs were not statistically significant for ICU admission (HR 0.93; 95% CI, 0.74-1.18; P = 0.540), recurrent endocarditis (HR 0.76; 95% CI, 0.42-1.40; P = 0.381), kidney failure (HR 0.93; 95% CI, 0.74-1.18; P = 0.540) or hepatic failure (HR 0.96; 95% CI, 0.66-1.39; P = 0.822).

CONCLUSIONS: The rifampicin-containing regimen without gentamicin was associated with reduced 1 year mortality compared with the gentamicin-containing regimen without rifampicin. Although the results should be interpreted with caution because of potential residual unmeasured confounders, including duration of antimicrobial treatment and biases, our findings provide further evidence that adjunctive gentamicin may not be routinely needed for S. aureus prosthetic valve endocarditis.

PMID:41409990 | PMC:PMC12706467 | DOI:10.1093/jacamr/dlaf246