Tag: pubmed

Cancer Nurs. 2025 Apr 2. doi: 10.1097/NCC.0000000000001478. Online ahead of print.

ABSTRACT

BACKGROUND: Pain, anxiety, and stress are the most common symptoms experienced by patients receiving chemotherapy after breast surgery. Virtual reality (VR) can be used as a method to manage these symptoms.

OBJECTIVE: To determine the effect of VR on chemotherapy-associated stress (salivary cortisol value), anxiety, pain, and vital signs of mastectomy patients.

METHODS: A total of 62 participants were enrolled in this randomized, 2-group design. Participants in the experimental group watched videos with VR glasses during their chemotherapy treatments. Saliva samples were collected from participants in both the control and experimental groups before and immediately after their chemotherapy treatments. The Personal Information Form, state anxiety component of the State-Trait Anxiety Inventory, visual analog scale, and the patients’ vital signs were also collected.

RESULTS: The State-Trait Anxiety Inventory state anxiety component and visual analog scale scores and the stress value mean scores differed significantly between the 2 groups at the second data point. There was also a statistically significant decrease in systolic blood pressure and diastolic blood pressure after chemotherapy in the experimental group.

CONCLUSION: The use of VR in women receiving chemotherapy significantly reduced their pain, anxiety, stress and blood pressure from before to immediately following the chemotherapy infusion.

IMPLICATIONS FOR PRACTICE: VR can be an appropriate intervention to reduce pain, anxiety, and stress in patients receiving chemotherapy after mastectomy.

PMID:40179266 | DOI:10.1097/NCC.0000000000001478

Cancer Nurs. 2025 Apr 2. doi: 10.1097/NCC.0000000000001500. Online ahead of print.

ABSTRACT

BACKGROUND: Spiritual care is a crucial component of oncology nursing, addressing patients’ holistic needs. However, limited research has explored spiritual well-being, competence, practices, and barriers among oncology nurses, particularly within specific cultural and religious contexts.

OBJECTIVE: To assess spiritual well-being and its predictors, including perceived competence, practices, and barriers to providing spiritual care among oncology nurses in Oman.

METHODS: A descriptive correlational study was conducted with 422 oncology nurses from 3 cancer care centers in Muscat, Oman. Convenience sampling was used, and data were collected through validated instruments, including the Spiritual Well-being Scale, Spiritual Care Competence Scale, Nurse Spiritual Care Therapeutics Scale, and Spiritual Care Practice Questionnaire. SPSS version 27 was used for data analysis, using descriptive statistics, Pearson correlation, independent t tests, analysis of variance, and multiple linear regression.

RESULTS: Nurses exhibited high spiritual well-being (mean, 102.1 [SD, 14.7]) and moderate spiritual care competence (mean, 96.1 [SD, 19.1]), yet spiritual care practices were infrequent (mean, 37.6 [SD, 13.1]). Major barriers included beliefs about the privacy of patients’ spirituality (59.5%) and lack of time (54.7%). Higher competence and prior oncology training were significantly associated with greater spiritual well-being.

CONCLUSIONS: Although oncology nurses in Oman report high spiritual well-being, barriers such as time constraints and role perceptions hinder spiritual care practices.

IMPLICATIONS FOR PRACTICE: Targeted education and training programs are essential to enhance spiritual care delivery. Addressing systemic challenges, including time management and role clarity, can foster a supportive environment for integrating spiritual care into oncology nursing.

PMID:40179262 | DOI:10.1097/NCC.0000000000001500

Neuropsychol Rehabil. 2025 Apr 3:1-18. doi: 10.1080/09602011.2025.2475544. Online ahead of print.

ABSTRACT

ABSTRACTThe benefits of assistive technology (AT) have been well established to positively support participation within disability. Clinicians have an important role in guiding clients to choose goal-centred AT. This study aims to explore (i) the frequency and types of AT prescribed by clinicians and (ii) real-world implementation of AT by clinicians, employing the ISO 9999 framework, and the challenges involved with AT prescription. An online survey was circulated to brain injury clinicians within New South Wales (NSW). Data were exported into IBM SPSS Statistics v.27 for analysis. Free text responses were analysed using a mixed-methods content analysis. A total of 31 AT products were reported 131 times by clinicians. The most frequently reported AT category was mainstream technology (n = 81), used amongst all professions. Using the ISO 9999 framework, the most reported class use of AT was “communication and information management” (n = 77/131). Challenges around AT implementation were funding acquisition, customizability of AT and time constraints with training. NSW clinicians have demonstrated varied use of AT to support cognitive, physical and communication functions. However, with the rapidly advancing nature of AT, there needs to be quicker approaches to generate high-quality evidence to support its use.

PMID:40179258 | DOI:10.1080/09602011.2025.2475544

Ultrasound Obstet Gynecol. 2025 Apr 3. doi: 10.1002/uog.29216. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the accuracy of fetal biparietal diameter (BPD) measurement in comparison with crown-rump length (CRL) measurement for pregnancy dating at 11-13 weeks’ gestation.

METHODS: This was a retrospective multicenter cohort study performed in five maternity units in Spain, the UK, Belgium and Bulgaria between January 2011 and December 2019. We included all women who attended a routine ultrasound examination at 11 + 0 to 13 + 6 weeks who had a singleton pregnancy with a viable non-malformed fetus/neonate and ultrasound-derived measurements for both CRL and BPD, along with a comprehensive record of pregnancy outcomes. We developed a formula for pregnancy dating based on BPD using data from pregnancies conceived via in-vitro fertilization (IVF) by applying a simple linear regression. We validated this formula both internally and externally and compared it with the most commonly used formulae (Robinson’s CRL-based and Kustermann’s BPD-based formulae) through utilization of the Euclidean distance, relative absolute error and mean squared error. We also examined the rate of induction of labor for post-term pregnancy based on dating using each of the formulae.

RESULTS: A total of 49 492 women were included in the study, comprising 47 223 (95.4%) who conceived spontaneously and 2269 (4.6%) who conceived via IVF. In the internal validation performed using data from IVF pregnancies, our newly developed formula showed no significant difference when compared with the true gestational age calculated using conception date, with a mean difference of 0.0006 (95% CI, -0.09 to 0.09) days. In contrast, the mean difference of Kustermann’s BPD-based formula was -0.31 (95% CI, -0.46 to -0.17) days and the mean difference of Robinson’s CRL-based formula was -1.78 (95% CI, -1.88 to -1.68) days. In the external validation using data from spontaneously conceived pregnancies, with dating using Robinson’s formula as the reference for ‘true’ gestational age, both our formula and Kustermann’s formula resulted in underestimation of gestational age, with significant mean differences of -1.25 (95% CI, -1.28 to -1.22) days and -0.96 (95% CI, -0.98 to -0.93) days, respectively. The largest differences compared with Robinson’s formula-based dating results were observed between 11 + 0 and 12 + 0 weeks. Dating the pregnancy using Robinson’s formula led to 8.1% of pregnancies identified as requiring induction after 41 + 3 weeks, compared with 6.8% (P < 0.001) and 7.0% (P < 0.001) when applying our formula and Kustermann’s formula, respectively.

CONCLUSION: Pregnancy dating based on ultrasound measurement of fetal BPD between 11 + 0 and 13 + 6 weeks’ gestation is a reliable alternative to dating based on fetal CRL. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

PMID:40179227 | DOI:10.1002/uog.29216

Sci Prog. 2025 Apr-Jun;108(2):368504251330037. doi: 10.1177/00368504251330037. Epub 2025 Apr 3.

ABSTRACT

ObjectiveTo assess medication appropriateness using the medication appropriateness index (MAI) criteria, the prevalence of potentially inappropriate medication (PIM) prescribing, and factors associated with increased PIM use in elderly ambulatory patients with cirrhosis.MethodsA cross-sectional study of 70 elderly ambulatory patients with cirrhosis (≥65 years old), from January to December 2021. Two clinical pharmacists evaluated medication appropriateness using the MAI tool. Data were analyzed using SPSS version 27.0. Descriptive statistics were used to present patient demographics, clinical characteristics, and MAI responses. Regression analysis was used to identify predictive factors for PIM prescribing. The kappa statistic was used to assess interrater agreement.ResultsAll participants had at least one medication with ≥ 1 inappropriate MAI criterion, with the most common issue being incorrect treatment duration (18%). Of 610 evaluated medications, 44.1% were classified as PIMs. The mean MAI scores per patient and per medication were 15.97 (±10.48) and 1.83 (±3.18), respectively, consistent with other studies. However, the prevalence of PIMs was higher, likely due to the specific disease population studied, as this is the first study to evaluate medication appropriateness in cirrhotic patients. Good interrater agreement was observed (kappa = 0.74), indicating good interrater reliability. Increased inappropriate prescribing was associated with the number of medications, age and severe renal impairment.ConclusionsPIMs are common in elderly patients with cirrhosis, highlighting the need for better prescribing practices to ensure medication safety. Involving clinical pharmacists with geriatrics expertise and using medication appropriateness tools can reduce PIMs and drug-related problems. Further, healthcare team training is essential to improve prescribing practices. Assessing PIMs in this population could enhance clinical outcomes, reduce adverse drug reactions, and lower healthcare costs. Incorporating comprehensive medication management into routine care for elderly cirrhotic patients is a key strategy to improve patient safety and quality of life.

PMID:40179219 | DOI:10.1177/00368504251330037

Science. 2025 Apr 4;388(6742):eadx8687. doi: 10.1126/science.adx8687. Epub 2025 Apr 3.

NO ABSTRACT

PMID:40179204 | DOI:10.1126/science.adx8687

Science. 2025 Apr 4;388(6742):eadt0548. doi: 10.1126/science.adt0548. Epub 2025 Apr 4.

ABSTRACT

Whether a gut-joint axis exists to regulate osteoarthritis is unknown. In two independent cohorts, we identified altered microbial bile acid metabolism with reduced glycoursodeoxycholic acid (GUDCA) in osteoarthritis. Suppressing farnesoid X receptor (FXR)-the receptor of GUDCA-alleviated osteoarthritis through intestine-secreted glucagon-like peptide 1 (GLP-1) in mice. GLP-1 receptor blockade attenuated these effects, whereas GLP-1 receptor activation mitigated osteoarthritis. Osteoarthritis patients exhibited a lower relative abundance of Clostridium bolteae, which promoted the formation of ursodeoxycholic acid (UDCA), a precursor of GUDCA. Treatment with C. bolteae and Food and Drug Administration-approved UDCA alleviated osteoarthritis through the gut FXR-joint GLP-1 axis in mice. UDCA use was associated with lower risk of osteoarthritis-related joint replacement in humans. These findings suggest that orchestrating the gut microbiota-GUDCA-intestinal FXR-GLP-1-joint pathway offers a potential strategy for osteoarthritis treatment.

PMID:40179178 | DOI:10.1126/science.adt0548

Neurologist. 2025 Apr 3. doi: 10.1097/NRL.0000000000000613. Online ahead of print.

ABSTRACT

OBJECTIVE: Our study explores the relationship between fasting triglyceride levels and initial infarct volume in acute ischemic stroke (AIS) patients.

METHODS: We performed a retrospective chart review and cross-sectional analysis of AIS patients admitted to a tertiary care center in Kansas from 2010 to 2023. Inclusion criteria were AIS patients who (1) underwent CTA and CTP within 24 hours of stroke onset, and (2) had fasting triglyceride levels measured within 24 hours of admission. Infarct volume was calculated using RAPID software (iSchemaView Inc.). Statistical analyses were conducted using STATA (Release 16), with T tests, ANOVA, χ2 tests, and multivariable linear regression applied as appropriate.

RESULTS: We included 178 patients, 52% (n=92) of whom were male, and 31% were aged 61 to 70 years. Mean TG levels were 116.91±70.23 mg/dL, and mean infarct volume was 41.64±53.35 mL. Linear regression showed a significant positive association between TG levels and infarct volume (P<0.01, β=0.17, 95% CI: 0.06-0.28), with a 0.17 mL increase in infarct volume per unit increase in TG levels. Patients with Embolic stroke of undetermined source (ESUS) had larger infarct volumes compared with those with large artery atherosclerosis (P<0.05) and the highest mean TG levels (135.61 mg/dL).

CONCLUSION: Hypertriglyceridemia was positively associated with larger infarct volumes, particularly in ESUS patients, who had the highest TG levels and larger infarct sizes. These findings suggest that elevated TG may predict worse stroke outcomes and could be a potential therapeutic target for stroke prevention.

PMID:40178873 | DOI:10.1097/NRL.0000000000000613

JAMA Netw Open. 2025 Apr 1;8(4):e253063. doi: 10.1001/jamanetworkopen.2025.3063.

ABSTRACT

IMPORTANCE: Aspirin (acetylsalicylic acid) and intravenous immunoglobulin (IVIG) are standard treatments for Kawasaki disease (KD) to reduce coronary artery lesions (CALs). However, the optimal duration and dosage of aspirin remain inconsistent across hospitals. The absence of large-scale, multicenter randomized clinical trials hinders a clear understanding of the effectiveness of high-dose aspirin.

OBJECTIVE: To evaluate the effectiveness of IVIG alone compared with IVIG combined with high-dose aspirin as the active interventional therapy for KD and to compare treatment effectiveness across various KD subgroups.

DESIGN, SETTING, AND PARTICIPANTS: In this prospective, evaluator-blinded, multicenter noninferiority randomized clinical trial, children (aged <6 years) who had been diagnosed with KD according to American Heart Association criteria were recruited from 5 medical centers in Taiwan and were enrolled between September 1, 2016, and August 31, 2018, with follow-up assessments at 6 weeks and 6 months after treatment. Data were analyzed between January 23, 2023, and January 29, 2024.

INTERVENTION: The standard group received IVIG (2 g/kg) plus high-dose aspirin (80-100 mg/kg per day) until fever subsided for 48 hours. The intervention group received IVIG (2 g/kg) alone.

MAIN OUTCOMES AND MEASURES: The primary outcome was the occurrence of CALs at 6 weeks. The noninferiority margin was set at 10%. Data analysis was performed using χ2 tests for categorical variables; independent t tests for continuous, normally distributed variables; generalized estimating equations for variables without specific distributions at multiple time points; and repeated-measures analysis of variance for continuous variables at multiple time points.

RESULTS: The final cohort consisted of 134 patients with KD (mean [SD] age, 1.8 [1.3] years; 82 males [61.2%]), with matched age, weight, height, and sex distributions in 2 groups. Overall, in the IVIG plus aspirin group, among 69 patients, CAL occurrence decreased from 9 (13.0%) at baseline to 2 (2.9%) at 6 weeks and to 1 (1.4%) at 6 months. In the IVIG-only group, among 65 patients, CAL occurrence decreased from 7 (10.8%) at diagnosis to 1 (1.5%) at 6 weeks and to 2 (3.1%) at 6 months. No statistically significant differences in CAL frequency were observed between the 2 groups (0.7 percentage points [95% CI, -4.5 to 5.8 percentage points]; P = .65). There were also no significant differences in the treatment or prophylactic effect.

CONCLUSIONS AND RELEVANCE: This randomized clinical trial demonstrated the noninferiority of IVIG alone compared with IVIG plus aspirin, with a noninferiority margin set at 10%. The findings suggest that addition of high-dose aspirin during initial IVIG treatment is not clinically meaningful for CAL reduction in children with KD. Future studies on IVIG treatment alone for CAL reduction in KD across diverse racial and ethnic groups, beyond the Asian population, may be necessary to confirm minimal racial and ethnic variability and the broad applicability of these findings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02951234.

PMID:40178858 | DOI:10.1001/jamanetworkopen.2025.3063

Plast Reconstr Surg. 2025 Apr 1. doi: 10.1097/PRS.0000000000012135. Online ahead of print.

ABSTRACT

BACKGROUND: Hyaluronic acid (HA) facial fillers are a non-surgical treatment for age-related changes. Literature on long-term volumetric results and patient-reported outcomes (PROs) is limited. This prospective study aims to precisely define and measure objective tissue metrics and PROs of HA fillers in different facial regions over 12 weeks.

METHODS: Females aged 40 to 65 received injections in facial regions using HA fillers: Restylane-L® in nasolabial folds and marionette lines, Restylane-L Lyft® in the malars, and Restylane Silk® in the lip border. Patients completed FACE-Q® questionnaires, were photographed with 3D Vectra® M3 Imaging Software pre-injection, immediately post-injection, and at 2-, 4-, and 12-weeks post-injection. Volumes were analyzed from eight regions: left, right malars and extended midface (MEM), upper perioral (UP), lower perioral and jawline (LPJ), and lips. Tissue displacement factor (TDF) and effective volume (EV) were calculated. Statistical analyses included Mann Whitney U tests and risk-adjusted linear regression.

RESULTS: 101 women participated. Restylane-L Lyft® had the highest TDF, 1.25, followed by Restylane-L®, 1.14, and Restylane Silk®, 0.56. EV for Restylane-L Lyft® was highest, 89.8%, followed by Restylane-L®, 89.7%, and Restylane Silk®, 70%. Volume maintenance was 65.5% (whole face), 79.2% (MEM), 62.7% (UP), and 37.2% (lips) over 12 weeks. PROs demonstrated improvements in facial appearance, treated regions, psychological and social function.

CONCLUSIONS: We define the novel tissue metrics, TDF and EV, relative to HA treatments, with greatest volume maintenance in the midface and greatest loss around the mimetic areas throughout 12 weeks. Significantly improved PROs were observed for patients undergoing large volume HA filler injections.

PMID:40178806 | DOI:10.1097/PRS.0000000000012135