Tag: pubmed

Echocardiography. 2026 Apr;43(4):e70437. doi: 10.1111/echo.70437.

ABSTRACT

OBJECTIVE: This study aimed to evaluate right ventricular (RV) function pre and post bone marrow transplantation (BMT) using transthoracic echocardiography (TTE), in order to detect subclinical or clinical RV dysfunction that may occur in the early posttransplant period due to pulmonary vascular changes.

METHODS: A total of 45 patients (aged 18-65 years) who underwent allogeneic or autologous BMT and 45 age- and sex-matched healthy controls were prospectively enrolled. Baseline (pre-BMT) and first-month (post-BMT) data of both groups were compared. Sociodemographic characteristics, laboratory results, and echocardiographic parameters were analyzed.

RESULTS: In the BMT group, RV global longitudinal strain (RVGLS) (-19.24 ± 8.71 vs. -22.33 ± 1.64; p = 0.022) and RV free wall strain (RVFWS) (-25.96 ± 2.83 vs. -28.21 ± 2.10; p < 0.001) were significantly lower than in controls. Four-dimensional echocardiography (4DE) demonstrated lower RV ejection fraction (RVEF) (52.31 ± 2.46 vs. 56.60 ± 5.55; p < 0.001) and RV fractional area change (RVFAC) (46.27 ± 2.57 vs. 51.42 ± 4.56; p < 0.001) in the BMT group compared to controls. Although pulmonary artery stiffness (PAS) (17.09 ± 4.24 vs. 18.56 ± 4.06 Hz/ms; p = 0.098) was higher in the BMT group, the difference did not reach statistical significance.

CONCLUSION: This study indicates that BMT may adversely affect RV systolic and diastolic functions as well as pulmonery artery stiffness (PAS). Advanced echocardiographic assessment in patients at risk of cardiotoxicity during the pre- and posttransplant period may facilitate early detection and implementation of preventive and therapeutic strategies.

PMID:41915363 | DOI:10.1111/echo.70437

J Endocrinol Invest. 2026 Mar 31. doi: 10.1007/s40618-026-02857-9. Online ahead of print.

NO ABSTRACT

PMID:41915358 | DOI:10.1007/s40618-026-02857-9

Clin Rheumatol. 2026 Mar 31. doi: 10.1007/s10067-026-08037-7. Online ahead of print.

ABSTRACT

OBJECTIVES: To systematically evaluate the efficacy and safety of plasma exchange (PE) in adult patients with idiopathic inflammatory myopathies (IIM).

METHODS: A systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO. MEDLINE, Embase and Web of Science were searched from inception to 17 January 2025. Studies involving adult patients with IIM treated with PE were included. Baseline demographics, clinical characteristics, treatment outcomes and adverse events were extracted.

RESULTS: Thirty-five studies involving 473 patients were included, of whom 361 received PE. Most studies were observational, and PE was predominantly used as adjunctive or rescue therapy alongside immunosuppressive treatment. Across included studies, PE was reported to be associated with improvements in organ-specific outcomes, including muscle strength, dysphagia, pulmonary manifestations and biochemical markers such as creatine kinase, ferritin, KL-6 and myositis-specific autoantibody titres. A meta-analysis of seven comparative studies did not demonstrate a statistically significant mortality benefit associated with PE in patients with refractory or rapidly progressive interstitial lung disease (RR 0.41, 95% CI 0.16-1.06, I² = 70%). In immune-mediated necrotising myopathy, PE was frequently associated with clinical improvement and reductions in anti-HMGCR antibody titres. Reported adverse events were generally mild to moderate, with no procedure-related mortality.

CONCLUSION: PE has a biologically plausible but clinically selective role in adult IIM and is most commonly used as an adjunctive therapy in severe or refractory disease. Evidence is heterogeneous and largely observational, limiting causal inference. Prospective studies with standardised outcome measures are required to better define the role of PE in IIM.

PMID:41915329 | DOI:10.1007/s10067-026-08037-7

CJEM. 2026 Mar 31. doi: 10.1007/s43678-026-01137-y. Online ahead of print.

ABSTRACT

OBJECTIVES: Medications for alcohol use disorder, or “anti-craving medications”, are effective yet underutilized treatments for alcohol use disorder. This study examined whether a pre-printed prescription embedded in a printable order set could “nudge” clinicians to increase prescribing for medications for alcohol use disorder.

METHODS: We conducted a prescription database review comparing prescribing rates at baseline to those at monthly intervals up to 12 months following implementation of a new provincial pre-printed order set for alcohol withdrawal syndrome in Saskatchewan. Patients were included if they had an alcohol-related emergency department (ED) visit, were discharged home, had a prescription for a medication for alcohol use disorder filled within 3 days of ED discharge, and did not have a previous prescription for a medication for alcohol use disorder filled within a washout window prior to the ED visit. The review captured all provincial prescriptions of naltrexone and acamprosate-the two medications available on the pre-printed prescription-for patients who fit the inclusion criteria.

RESULTS: A total of 5740 pre-implementation and 6021 post-implementation patients met inclusion criteria. Baseline demographics and comorbidities were similar across groups. The rate of ED visits with a filled prescription increased from 1.8% pre-implementation to 3.4% post-implementation. Naltrexone prescribing rose from 1.6 to 2.7%, and acamprosate from 0.2 to 0.7%. Interrupted time-series and logistic regression analyses confirmed a statistically significant increase in prescribing post-implementation (adjusted OR 1.9; 95% CI 1.5-2.5).

CONCLUSIONS: Introducing an order set incorporating pre-printed prescriptions for medications for alcohol use disorder effectively increased prescribing rates for physicians treating patients with alcohol-related ED visits, validating use of a “nudge” to effect behavioural change. While promising, sustaining these gains may require reinforcement. In resource-constrained EDs, nudges offer a feasible strategy to improve alignment with evidence-based treatment for alcohol use disorder.

PMID:41915316 | DOI:10.1007/s43678-026-01137-y

Pharmaceut Med. 2026 Mar 31. doi: 10.1007/s40290-026-00606-0. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Survival benefit constitutes the primary pillar of therapeutic efficacy in oncology. However, the survival benefits observed in registrational trials broadly range from significant to marginal, even for US Food and Drug Administration (FDA)-approved drugs. This study explores the association between survival benefits and the likelihood of FDA approval and estimates the boundary effect size that distinguishes FDA-approved from non-approved drugs.

METHODS: We screened 3463 phase 3 trials initiated between 1990 and 2021 on ClinicalTrials.gov. Eligibility was restricted to randomized phase 3 trials for novel anticancer agents with overall survival (OS) as a primary or co-primary endpoint. Included trials required published results, including the OS hazard ratio (HR) and 95% confidence interval (CI). A total of 189 eligible trials were identified, encompassing 208 arm-pairs and 158,250 participants. Clinical data were extracted from published reports, while regulatory outcomes were adjudicated at the trial-and-indication level using US Prescribing Information on Drugs@FDA database. The association between OS benefit and approval status was modeled using logistic regression, with generalized estimating equations (GEE) to account for trial-level clustering. Publication bias was assessed via funnel plots and the trim-and-fill method.

RESULTS: Of the 208 arm-pairs, 79 (38%) supported FDA approval, and 129 (62%) did not. The dataset spanned 27 cancer types, with a mean sample size of 761 participants. The pooled OS HR was 0.70 (95% CI 0.68-0.73) for approved drugs and 0.95 (95% CI 0.93-0.97) for non-approved drugs. Logistic regression revealed a sharp sensitivity of approval probability to the HR for OS. A boundary was observed ranging from 0.74 to 0.86 in the HR for OS, with a 50% probability of FDA approval at HR 0.80. GEE analysis confirmed the robustness of these estimates against trial-level clustering. While funnel plot asymmetry suggested potential publication bias in the non-approved group, trim-and-fill analysis confirmed that the relative disparity in OS HR between approved and non-approved drugs remained consistent.

CONCLUSION: FDA approval for anticancer drugs is characterized by distinct OS HR patterns. While these findings provide a clear efficacy benchmark for OS-driven trials, they should be interpreted cautiously given the evolving therapeutic landscape and potential publication bias in negative trials. Our results underscore the central role of survival benefit in regulatory decisions and provide a quantitative metric to support oncology drug development.

FUNDING: This study was funded by the Ministry of Education, Culture, Sports, Science and Technology (MEXT): Shunsuke Ono KAKEN-HI: 25K10043.

PMID:41915314 | DOI:10.1007/s40290-026-00606-0

Clin Transplant. 2026 Apr;40(4):e70523. doi: 10.1111/ctr.70523.

ABSTRACT

BACKGROUND: In out-of-sequence (OOS) allocation of deceased donor kidney transplants (DDKTs), providers are allowed to choose recipients irrespective of waitlist priority. Whether candidate obesity affects OOS recipient selection is unknown.

METHODS: We examined access to OOS-DDKT by candidate body mass index (BMI) using kidney offers from Organ Procurement and Transplantation Network data (1/2022-12/2023). We compared characteristics of OOS-DDKT versus being last-skipped candidate at the same center using donor-level conditional logistic regression and multilevel modeling among the top-20 OOS-performing centers.

RESULTS: We identified 4970 OOS-placements and 4588 list-skipped candidates. OOS candidates were older and less likely to be Black. We found a dose-response relationship between weight class and odds of OOS-DDKT. Compared to normal weight candidates, candidates with Class 1, 2, and 3 obesity had 32%, 50%, and 69% lower odds of receiving OOS-DDKT. Mediation analysis suggested candidate BMI partially explained higher access among Asian and Hispanic candidates. There was substantial center-level variation; a 10-unit increase in BMI was associated with >50% lower odds of OOS-DDKT at 3/20 centers, 20%-50% lower odds at 12/20 centers, and comparable odds at 5/20 centers.

CONCLUSIONS: DDKT candidates with obesity have lower access to OOS kidney allocation. However, equitable distribution irrespective of candidate obesity was observed at a small number of top-performing centers.

PMID:41915312 | DOI:10.1111/ctr.70523

J Nurs Manag. 2026;2026(1):e1459619. doi: 10.1155/jonm/1459619.

ABSTRACT

BACKGROUND: Medical staff in Chinese tertiary hospitals experience excessive workloads, increasing burnout vulnerability. Traditional cultural resources may influence their job attitudes, but this area remains unexplored.

PURPOSE: Based on the job demands-resources model, this study investigates how Confucian coping, as a personal culture resource, moderates the relationships among job demands, resources, engagement and burnout in Chinese medical staff.

METHODS: Using an online self-administered survey, we collected data from 1653 medical staff members across 14 tertiary hospitals in China. Structural equation modelling was used to test the hypothesised moderating pathways.

RESULTS: Confucian coping demonstrated a significant positive moderating effect on the job resources-job engagement relationship and a significant negative moderating effect on the job demands-job burnout relationship.

CONCLUSION: Confucian coping serves as a significant personal resource for medical staff, mitigating burnout by buffering job demands and enhancing engagement by amplifying job resources.

ORIGINALITY: By employing empirical analysis with the job demands-resources model, this study unravels how medical staff draw on Confucian coping functions and provides a new theoretical perspective for further study of the influence of cultural and psychological factors.

PMID:41915299 | DOI:10.1155/jonm/1459619

Appl Health Econ Health Policy. 2026 Mar 31. doi: 10.1007/s40258-026-01040-8. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Publicly funded healthcare systems that consider a trade-off between efficiency and equity by allowing a higher cost per patient benefit in patients with more severe conditions must somehow assess disease severity. Some countries employ quantitative measures of shortfall, whereas others rely on qualitative assessments. Despite its importance in pharmaceutical reimbursement and pricing, the operationalisation of disease severity in real-world decision making has rarely been scrutinized. The aim of this study was to investigate the relationship and agreement between qualitative disease severity assessments and quantitative measures of disease severity in Swedish pharmaceutical reimbursement.

METHODS: Information from 36 pharmaceutical reimbursement decisions made by the Dental and Pharmaceutical Benefits Agency (TLV) in Sweden from 2018 to 2023 was extracted, including the qualitative assessment of disease severity (moderate, high, or very high). Based on publicly available decision documents from the agency, we calculated absolute QALY shortfall (AS) and proportional QALY shortfall (PS). Linear regression was used to describe the mean shortfall across severity classifications. Ordinal logistic regression was used to analyse the role of AS and PS as predictors of TLV’s qualitative disease-severity assessments and the predictive ability of both measures was compared using the coefficient of discrimination (D’).

RESULTS: The mean AS and PS was 12.2 and 0.796, respectively, in the very high disease severity category, which was approximately twice the mean shortfall observed in the moderate and high severity categories (Moderate: AS = 6.0, PS = 0.340; High: AS = 6.2, PS = 0.405). When the quantitative measures of severity were used as predictors of the qualitative assessments, PS was better able to discriminate between TLV’s severity classifications than was AS (D’ = 34.6% vs 22.3%). However, both measures frequently predicted low probabilities of the qualitative assessments that were observed and there was both substantial variation in shortfall for diseases with the same qualitative assessment (AS, R² = 35.8%; PS, R² = 61.0%) and overlaps in observed shortfall across different severity classifications.

CONCLUSION: Proportional QALY shortfall agrees more closely than AS with qualitatively assessed disease severity applied in the Swedish reimbursement system but there are large variations in the qualitative assessments that cannot be explained by either measure. Further investigation is warranted to understand if this is an intended and desired outcome.

PMID:41915293 | DOI:10.1007/s40258-026-01040-8

Environ Monit Assess. 2026 Mar 31;198(4):390. doi: 10.1007/s10661-026-15214-3.

ABSTRACT

Heavy metal pollution in groundwater poses global environmental and public health risks, particularly in agricultural regions relying on groundwater for irrigation and drinking. Here we quantify 11 heavy metals (Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Sr, Cd, Ba) in the Fengpei Plain, China, and apportion their sources and health impacts using the APCS-MLR receptor model coupled with health risk assessment. Mean concentrations ranked as: Sr (521.5 μg/L) > Ba (50.45 μg/L) > Fe (15.37 μg/L) > As (1.080 μg/L) > Zn (0.887 μg/L) > Cu (0.294 μg/L) > Cr (0.083 μg/L) > Ni (0.064 μg/L) > Co (0.032 μg/L) > Mn (0.027 μg/L) > Cd (0.011 μg/L). Source apportionment using the APCS-MLR model revealed five major sources of heavy metals in the study area, with their respective contributions as follows: iron ore mining (22.8%), traffic emissions (24.4%), agricultural activities (18.9%), industrial activities (6.4%), and unidentified sources (27.5%). The health risks associated with heavy metals in groundwater were mainly attributed to As ingestion through drinking water. At approximately 6.7% of sampling sites, the non-carcinogenic hazard index (HI) for children exceeded 1 (maximum 1.31), while adult carcinogenic risk (TCR) exceeded the acceptable threshold, reaching 1.39 × 10⁻4 for females and 1.13 × 10⁻4 for males. This study provides a comprehensive understanding of the distribution, sources, and health risks of groundwater heavy metals, offering valuable guidance for groundwater management and contributing to the protection of drinking water safety for residents in agriculture-dominated regions.

PMID:41915285 | DOI:10.1007/s10661-026-15214-3

Environ Monit Assess. 2026 Mar 31;198(4):388. doi: 10.1007/s10661-026-15261-w.

ABSTRACT

Pit latrines are widely used sanitation systems in underdeveloped countries. However, poor construction and maintenance often allow pathogenic bacteria to contaminate surrounding soil and water, facilitating the spread of enteric diseases. Young children are particularly vulnerable because geophagy (soil ingestion) increases exposure to fecal pathogens, leading to higher incidences of diarrhea, growth impairment, and mortality. This review investigates the association between pit latrine-derived contamination of water (surface and groundwater) and soil (including sludge) and its impacts on child health. Relevant studies were systematically collected, summarized, and compared. The health effects of pathogens, particularly among children aged 6-24 months, are discussed, along with reported child mortality rates linked to fecal contaminated soil and water. Common pathogens identified in contaminated soils include Escherichia coli, Salmonella, Bacteroides (HF183), and rotavirus, with several studies reporting multidrug-resistant strains. High child mortality from diarrhea and pneumonia has been consistently associated with poor sanitation and open defecation. Pit latrines promote aerobic decomposition at the sludge surface and anaerobic decomposition at depth, enabling pathogen survival, greenhouse gas emissions, and soil contamination. Improved latrine designs incorporating impermeable linings, along with phytoremediation strategies, may offer effective solutions to mitigate pathogen persistence and environmental contamination.

PMID:41915284 | DOI:10.1007/s10661-026-15261-w