Tag: pubmed

Acta Anaesthesiol Scand. 2026 Jan;70(1):e70140. doi: 10.1111/aas.70140.

ABSTRACT

BACKGROUND: Continuous regional anesthesia (CRA) techniques are used for analgesia in patients with acute rib fractures. However, there is a paucity of evidence supporting the initiation of CRA in patients receiving mechanical ventilation (MV). We therefore performed this retrospective study to assess changes in opioid consumption and the rate of liberation from MV in patients with traumatic rib fractures.

METHODS: Patients referred to the Acute Pain Service (January 2022-July 2023) who were mechanically ventilated with acute rib fractures were included in this study. Patients received consultation either with or without CRA. Demographic and severity of injury data were collected. Mechanical ventilator requirements, pain scores, sedation use, opioids, adjunct analgesics, neurological status, and sedation status were collected for the 24 h prior to APS consultation/CRA intervention and for 48 h afterward.

RESULTS: Forty patients were included in the study, with 18 in the non-CRA group and 22 in the CRA group. There was a statistically significant decrease in overall opioid consumption (oral morphine equivalents) for the CRA group compared to the non-CRA group 0-48 h postintervention (0-24 h post-CRA [median 135 mg { 33.1-296.6}]) versus non-CRA 368.3 (121.5-727.9) (p = 0.018), 24-48 h post-CRA (31.5 mg [11.5-131.6] vs. non-CRA 342.8 [99.3-645.8]) (p = 0.001). There was no significant difference in rates of liberation from MV between groups.

CONCLUSIONS: CRA use was associated with a decrease in opioid consumption 24-48 h after CRA intervention compared to baseline. CRA did not facilitate early liberation from MV.

EDITORIAL COMMENT: This retrospective study provides evidence that CRA may reduce opioid requirements in mechanically ventilated patients with rib fractures. Although CRA did not facilitate earlier liberation from ventilation, the opioid-sparing effect is clinically relevant in this population. Larger prospective studies are warranted to define optimal timing, patient selection, and integration of CRA into critical care pathways.

PMID:41144812 | DOI:10.1111/aas.70140

J Appl Clin Med Phys. 2025 Nov;26(11):e70305. doi: 10.1002/acm2.70305.

ABSTRACT

BACKGROUND: Radiation oncology residents report a lack of understanding and confidence in assessing radiotherapy plan quality. A contributing factor is the environment in which plan review is taught during residency, that is, routine clinical practice, which does not provide ample time for self-guided practice in a low-stakes setting. Expertise in plan review requires diverse case presentation and many examples, which are often not achievable in smaller programs and for less common cancer types. As plan quality affects patient outcomes, it is important to address these pitfalls in the education of residents on plan review.

PURPOSE: To address the identified pitfalls of clinic-based training, we have developed techniques to create realistic dose distributions that appear suboptimal in a controllable way. These plans can provide many more case examples in the training curriculum and present a low-stakes technique for safe and effective education of radiation oncology residents.

METHODS: High-quality dose distributions were first generated with a pre-trained deep learning model (trained using only high-quality plans). The dose distributions were then altered directly to create three classes of suboptimal dose distributions: (1) decreased organ-at-risk sparing, (2) decreased target conformality, and (3) hotspots in the target. Experienced clinicians then reviewed a subset of these suboptimal dose distributions to assess realism.

RESULTS: We successfully decreased the quality of radiotherapy dose distributions. The decreased organ-at-risk sparing, decreased target conformality, and increased target hotspots were statistically significant (p < 0.05) when assessed by dose-volume histogram metrics for all parameters evaluated, and the magnitude of dose change was controllable. The resulting dose distributions were overall scored by experienced clinicians as realistic.

CONCLUSION: In this study, we developed techniques to generate realistic but suboptimal dose distributions. The techniques operate directly on existing dose distributions without the need for a treatment planning system and produce dose distributions that appear realistic to experienced clinicians.

PMID:41144809 | DOI:10.1002/acm2.70305

Phys Occup Ther Pediatr. 2025 Oct 27:1-15. doi: 10.1080/01942638.2025.2576746. Online ahead of print.

ABSTRACT

AIMS: To assess test-retest reliability and concurrent validity of the 1-min sit-to-stand test (1-minSTST) in children and adolescents who are overweight or obese.

METHODS: Thirty-nine overweight and obese children and adolescents were included. The 1-minSTST was administered twice with a one-hour break. Concurrent validity was evaluated by assessing correlations between 1-minSTST repetitions and six-minute walk test (6MWT) distances. The cardiorespiratory measures (blood pressure, heart rate, oxygen saturation, respiratory rate, dyspnea, and perceived fatigue) were recorded before and after each test.

RESULTS: Test-retest reliability was excellent (ICC: 0.90, 95% confidence interval 0.90-0.97). There was no relationship between scores on the 1-minSTST and 6MWT (r = -0.06, p = 0.71). No statistically significant correlation was found between scores on each test and change in cardiorespiratory responses, except for respiratory rate (r = 0.43, p = 0.006). Change in cardiorespiratory responses was similar when performing each test (p > 0.05).

CONCLUSION: While the 1-minSTST seems promising, it is not significantly related to the 6MWT, indicating they may assess different dimensions of fitness in this population. Further investigations are needed to determine the clinical implications of 1-minSTST outcomes in pediatric population.

PMID:41143870 | DOI:10.1080/01942638.2025.2576746

JMIR Res Protoc. 2025 Oct 27;14:e73366. doi: 10.2196/73366.

ABSTRACT

BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide and imposes a significant public health burden. In 2019, HPV was responsible for approximately 620,000 cancer cases in women, 70,000 in men, and more than 300,000 deaths globally. Despite the proven efficacy of the vaccine, vaccination rates remain alarmingly low in certain regions of France. In Réunion Island, only 16% of girls and 9% of boys under 16 years old were fully vaccinated in 2024. This underscores the need for increased awareness, education, and outreach programs. Peer learning is well-established in health education, whereas serious game-style card games are newer and require further research. Both methods have been shown to improve knowledge on specific topics.

OBJECTIVE: The main objective of this study is to assess the impact of 2 awareness-raising strategies on increasing HPV vaccination rates among middle school students by actively involving them in the process.

METHODS: This protocol describes the design of a randomized, open-label, controlled trial aimed at evaluating the effectiveness of 2 awareness-raising interventions-peer learning and a card-based serious game-in improving HPV vaccination rates among middle school students in Réunion Island. The study will span an entire school year, beginning in August. Approximately 3600 students from 24 middle schools in Réunion Island will be included, with schools randomized into 3 groups of 8 each: (1) a control group receiving the existing national vaccination campaign initiated by the French public health institute; (2) ambassador classes, whose students will receive education about the HPV vaccine and later educate other students in the same school; and (3) serious game card group, where students can play and learn about HPV during a science class. The primary outcome will be the proportion of teenagers who initiate the vaccination process, compared across the 3 groups using appropriate statistical methods. Anonymized data will be collected at the end of the school year using social security records. Teenagers’ knowledge of HPV will be assessed both before and 3 months after each intervention, and satisfaction will also be evaluated after the intervention in each group.

RESULTS: As of May 2025, a preliminary result enrolling 124 students showed an increase in vaccination coverage after students played a serious game. We expect higher vaccination rates in the intervention groups compared with the control group, although it is difficult to predict which strategy will be more effective. The estimated target vaccination coverage for groups b and c is 45%.

CONCLUSIONS: This study aims to improve HPV vaccination rates among teenagers in Réunion Island by evaluating the impact of 2 awareness-raising strategies using innovative and engaging tools. If successful, this approach could be adapted and implemented in other regions of France or internationally.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/73366.

PMID:41143859 | DOI:10.2196/73366

Curr Eye Res. 2025 Oct 27:1-8. doi: 10.1080/02713683.2025.2577767. Online ahead of print.

ABSTRACT

PURPOSE: Use of illicit substances such as cocaine is associated with alteration in catecholamine-mediated neurotransmission throughout the CNS, including the eye. One of the most accessible physiologic parameters associated with neuromodulatory features of substance abuse is the pupillary light reflex (PLR). In this study, we examined a domain of the PLR characterized by melanopsin-driven intrinsically photosensitive retinal ganglion cells (ipRGCs) to assess the impact of substance abuse on ipRGC function.

METHODS: An exploratory PLR examination on ten subjects with a documented history of substance use (HSU) without preexisting ocular disease was conducted with a comparator control cohort. Cases included assessment of cognitive function, depression, insomnia, and retinal nerve fiber thickness. IpRGC functionality was demonstrated by the PLR using a pedagogical-based methodology centered on response parameters with the introduction of a complementary analysis employing pseudo-one-phase modeling. Discriminant analysis employing the area under the receiver operating characteristic curve (AUC of ROC) categorized normal vs. abnormal ipRGC response.

RESULTS: There was no statistical association between ipRGC function and insomnia; however, insomnia was more prevalent among those with ipRGC abnormality. Indication of clinical depression was seen in 70% of study participants and was unrelated to ipRGC function. Pseudo-one-phase modeling demonstrated a significantly higher plateau in the HSU group as well as a slower initial rate of pupil recovery consistent with abnormal PIPR dynamics and complementary to AUC metrics. Discriminant analysis identified that 60% of HSU demonstrated ipRGC abnormality.

CONCLUSION: Abnormal ipRGC functionality was demonstrated among those with HSU in this small exploratory study utilizing both AUC-ROC analysis as well as assessment of PLR waveform characteristics using features of a pseudo-first-order model.

PMID:41143850 | DOI:10.1080/02713683.2025.2577767

JAMA Netw Open. 2025 Oct 1;8(10):e2539451. doi: 10.1001/jamanetworkopen.2025.39451.

ABSTRACT

IMPORTANCE: The Defense Health Agency Procedural Instruction (DHA-PI) 6200.02, introduced in May 2019, aimed to improve contraception access and knowledge among eligible beneficiaries. However, the policy’s association with contraception prescribing and dispensing practices has not been fully evaluated.

OBJECTIVE: To evaluate changes in contraceptive prescribing and dispensing practices associated with DHA-PI 6200.02, focusing on extended day supply of long-acting reversible contraception (LARC), short-acting reversible contraception (SARC), and permanent contraception.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted utilizing interrupted time-series analysis to examine changes in contraception care practices before and after policy implementation. The study period was between January 1, 2016, and September 30, 2022. Participants were active-duty servicewomen (ADSW) aged 18 to 55 years, with an assigned sex of female in medical records who were enrolled in TRICARE.

EXPOSURE: The implementation of the DHA-PI 6200.02 policy in May 2019.

MAIN OUTCOMES AND MEASURES: The primary outcomes included rates of extended contraceptive supply and utilization of LARC, SARC, and permanent contraception. Five performance measures were employed to assess the associations between DHA-PI 6200.02 and changes in contraceptive supply. Segmented regression models were unadjusted and used to estimate level and trend changes in monthly MOPs.

RESULTS: Among 429 194 ADSWs (mean [SD] age 24.5 [7.0] years; 148 104 [34.5%] Army, 101 299 [32.6%] Navy, 115 288 [26.86%] Air Force, and 35 352 [8.24%] Marine Corps), the proportion of SARC users receiving extended supply increased from 1.1% prepolicy to 5.3% postpolicy. Extended SARC use increased from 16.3% (95% CI, 16.0%-16.7%) at baseline to 19.7% (95% CI, 17.9%-21.6%) at the end of follow-up, and dispensed extended SARC rose from 8.2% (95% CI, 7.9%-8.5%) to 9.3% (95% CI, 7.4%-11.1%), both reflecting significant post-policy upward trends. The overall proportion of ADSW with any extended contraceptive supply showed no meaningful change and declined significantly in trend. Prescriber provision of extended supply rose modestly without sustained trend change, and among contraceptive users extended supply increased but without significant policy-related effects.

CONCLUSIONS AND RELEVANCE: In this cohort study of ADSWs, DHA-PI 6200.02 was associated with increased access to extended day supply for SARC but no corresponding increases were observed in overall extended contraceptive supply across all methods (SARC, LARC placement, and permanent contraception). These findings underscore challenges in policy uptake and highlight the need for enhanced efforts to ensure comprehensive implementation of DHA-PI 6200.02.

PMID:41143794 | DOI:10.1001/jamanetworkopen.2025.39451

AIDS. 2025 Oct 27. doi: 10.1097/QAD.0000000000004380. Online ahead of print.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitor (ICI) therapy has demonstrated safety and efficacy in a variety of malignancies, including cancers affecting patients with human immunodeficiency virus (PWH). However, there is limited data directly comparing efficacy of ICI use between cancer patients with versus without HIV.

METHODS: Real-world retrospective data were used to compare clinical outcomes between 24 PWH and cancer 24 matched cancer patients without HIV, all treated with ICI therapy.

RESULTS: Adverse event rates did not differ by HIV status. Overall response (complete or partial response) to ICI therapy was observed in 29% of PWH compared to 38% of people without HIV (PWoH), but this difference was not statistically significant. The overall survival at end of study follow-up by HIV status was similar between both groups (63% in PWH and 67% in PWoH).

CONCLUSIONS: These findings suggest that HIV status alone should not preclude use of ICI therapy to improve prognosis among PWH and cancer.

PMID:41143744 | DOI:10.1097/QAD.0000000000004380

Health Technol Assess. 2025 Oct;29(51):1-28. doi: 10.3310/JHGD7339.

ABSTRACT

BACKGROUND: Motor neuron disease is a progressive, fatal neurodegenerative disease for which there is no cure. Formal psychological therapies are not routinely part of United Kingdom standard motor neuron disease care due to a lack of evidence-based guidance resulting from a paucity of clinical trials. We aimed to evaluate the clinical and cost-effectiveness of Acceptance and Commitment Therapy plus usual care compared to usual care alone for improving psychological health in people living with motor neuron disease.

METHODS: We conducted qualitative interviews with 15 people living with motor neuron disease, 10 caregivers and 12 healthcare professionals. Findings were used to develop an Acceptance and Commitment Therapy intervention specifically for people living with motor neuron disease. Next, we examined its acceptability and feasibility in an uncontrolled feasibility study with 29 people living with motor neuron disease. Findings from qualitative interviews with 14 people living with motor neuron disease and 11 therapists were used to revise the intervention. Finally, we conducted a multicentre, parallel, two-arm randomised controlled trial in 16 United Kingdom motor neuron disease care centres/clinics. Eligible participants were aged ≥ 18 years with motor neuron disease. Participants were randomly assigned (1 : 1) to receive up to eight sessions of Acceptance and Commitment Therapy plus usual care or usual care alone and followed up at 6 and 9 months post randomisation by blinded outcome assessors. The primary outcome was total score on the McGill Quality of Life Questionnaire-Revised at 6 months. Secondary outcomes included health status using the EuroQol-5 Dimensions, five-level version. Primary analyses were by intention to treat.

RESULTS: Acceptance and Commitment Therapy was acceptable to people living with motor neuron disease, and it was feasible to recruit participants, hence trial progression criteria were met. From September 2019 to August 2022, 191 participants were recruited: 97 were allocated to Acceptance and Commitment Therapy plus usual care and 94 to usual care alone. Mean age was 61.9 years (standard deviation 11.4), 58% were male and 95% were White/White British. Acceptance and Commitment Therapy plus usual care was superior to usual care alone on the McGill Quality of Life Questionnaire-Revised at 6 months [adjusted mean difference 0.66 (95% confidence interval 0.22 to 1.10); Cohen’s d = 0.46 (95% confidence interval 0.16 to 0.77); p = 0.003] and 9 months [adjusted mean difference 0.76 (95% confidence interval 0.30 to 1.22); Cohen’s d = 0.53 (95% confidence interval 0.21 to 0.85); p = 0.001]. Mean differences in total costs and quality-adjusted life-years at 9 months between Acceptance and Commitment Therapy plus usual care versus usual care alone were not statistically significant [costs: £1019 (95% confidence interval -£34 to £2074); quality-adjusted life-years: 0.019 (95% confidence interval -0.07 to 0.05)]. The incremental cost-effectiveness ratio was £88,507/quality-adjusted life-year: this decreased to £13,817/quality-adjusted life-year in those with medium disease-related deterioration in subgroup analyses.

CONCLUSION: Acceptance and Commitment Therapy plus usual care is clinically effective at maintaining or improving psychological health, as measured by the McGill Quality of Life Questionnaire-Revised, in people living with motor neuron disease compared to usual care alone. It was not cost-effective overall when calculated using a standard health status measure (EuroQol-5 Dimensions, five-level version). However, it was cost-effective in a subgroup of people experiencing a medium rate of disease-related deterioration.

LIMITATIONS: Participants from ethnic minorities were under-represented, despite recruiting from sites with diverse communities. Between-group differences in outcomes may have been partly attributable to expectancy or non-specific therapeutic effects due to the lack of an active control. Cost-effectiveness analyses may have been underpowered to detect significant between-group differences.

FUTURE WORK: Studies should examine the effectiveness of Acceptance and Commitment Therapy in diverse populations, compared to an active control, using a more appropriate measure to assess cost-effectiveness, and in those with different rates of disease-related deterioration.

FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/81/01.

PMID:41143590 | DOI:10.3310/JHGD7339

Ann Behav Med. 2025 Jan 4;59(1):kaaf082. doi: 10.1093/abm/kaaf082.

ABSTRACT

BACKGROUND: While intergenerational caregiving is increasingly prevalent among older individuals, longitudinal evidence on its associations with multidimensional health outcomes remains limited.

PURPOSE: This study examined the associations between childcare engagement in older adults and various health and behavioral outcomes at follow-up.

METHODS: We analyzed data from a cohort of >12 000 (range: 12 124-12 896) community-dwelling adults aged 70+ years, categorizing childcare engagement as never, <weekly, and ≥weekly. Using an outcome-wide approach, we assessed 42 outcomes across physical, cognitive/major health events, psychological, social, and behavioral domains. Follow-up assessments occurred at ∼2 years for most outcomes, with extended follow-up (median 6-9 years) for time-to-event outcomes. We performed gender-disaggregated regressions, adjusting for multiple covariates.

RESULTS: Participants were aged 70-95 years (mean: 75.2 ± 4.3) at baseline, and 54.5% were women. Childcare engagement was more common among women (46% vs. 40%). Key findings included: (1) social domain: both genders showed increased social contacts and community participation, with women additionally demonstrating reduced social isolation; (2) mortality: lower mortality was observed in men with a dose-response pattern, while only <weekly childminding was associated with lower mortality in women; (3) physical domain: men showed increased moderate-to-vigorous physical activity while women had higher pain reports and slower gait speed; and (4) null associations: most psychological outcomes, as well as certain physical and health events, showed no significant relationships.

CONCLUSION: Childcare engagement during older adulthood was linked to not only selected health outcomes, including notable social benefits and lower mortality, but also some physical trade-offs in women. These findings support considering intergenerational engagement in healthy ageing initiatives.

PMID:41143543 | DOI:10.1093/abm/kaaf082

J Chem Phys. 2025 Oct 28;163(16):164509. doi: 10.1063/5.0292952.

ABSTRACT

It is experimentally well-established that non-equilibrium long-range correlations of concentration fluctuations appear in free diffusion of a solute in a solvent, but it remains unknown how such correlations are established dynamically. We address this problem in a model of Donev, Fai, and Vanden-Eijnden (DFV), obtained from the high-Schmidt limit of the Landau-Lifshitz fluctuating hydrodynamic equations for a binary mixture. We consider an initial planar interface of the mean concentration field in an infinite space domain, idealizing prior experiments. Using methods borrowed from turbulence theory, we show both analytically and numerically that a quasi-steady regime with self-similar time decay of concentration correlations appears at long time. In addition to the expected “giant concentration fluctuations” with correlations ∝r for r ≲ L(t) = (Dt)1/2, with diffusivity D, a new regime with spatial decay ∝1/r appears for r ≳ L(t). The quasi-steady regime arises from an initial stage of transient growth ∝t, confirming the prediction of DFV for r ≳ L(t) and discovering an analogous result for r ≲ L(t). Our results give new insight into the emergence of non-equilibrium long-range correlations and provide novel predictions that may be investigated experimentally.

PMID:41143499 | DOI:10.1063/5.0292952