Tag: pubmed

Nurs Crit Care. 2025 Nov;30(6):e70207. doi: 10.1111/nicc.70207.

ABSTRACT

BACKGROUND: Critically ill patients are at an increased risk of constipation due to inadequate nutrition, prolonged immobility and opioid use. Constipation may increase intensive care unit (ICU) and hospital length of stay (LOS) and intra-abdominal infections.

AIM: To determine the impact of a nurse-driven bowel protocol on constipation in ICU patients.

STUDY DESIGN: This is a retrospective before-after cohort study of ICU patients between July 2019 and February 2020 and July 2023 and February 2024. Patients were divided into a bowel protocol and a no bowel protocol group. The primary outcome was constipation for > 72 h at any point during ICU admission. Key secondary outcomes included constipation for > 6 days during ICU admission, ICU and hospital LOS and incidence of diarrhoea.

RESULTS: A total of 116 patients were included, with 58 patients in each group. Patients in the bowel protocol group had a higher Simplified Acute Physiology Score II (SAPS II) score (52 vs. 48, p = 0.05) and lower rates of acute hypoxic respiratory failure (60% vs. 79%, p = 0.03). The primary outcome of constipation for > 72 h during ICU stay did not differ significantly between groups (79% vs. 78%, p = 0.82). Patients in the bowel protocol group had lower rates of constipation for > 6 days, (18% vs. 44%, p = 0.043), which remained significant after adjusting for covariates including morphine milligram equivalents (MMEs), SAPS II score and age (OR 0.30, p = 0.047, 95% CI [0.09-0.98]). No differences were seen in other secondary outcomes.

CONCLUSIONS: Patients receiving the bowel protocol experienced no difference in constipation but were less likely to have prolonged constipation (> 6 days) in the ICU.

RELEVANCE TO CLINICAL PRACTICE: Nurse-driven bowel protocols may decrease constipation in ICU patients.

PMID:41074640 | DOI:10.1111/nicc.70207

J Med Virol. 2025 Oct;97(10):e70639. doi: 10.1002/jmv.70639.

ABSTRACT

Influenza and SARS-CoV-2 are major respiratory pathogens that have impacted global health, sharing similar transmission routes and clinical symptoms. The COVID-19 pandemic brought attention to coinfection with these viruses, which has been associated with worse clinical outcomes, but the full extent of this impact remains underexplored. As both viruses circulate together during seasonal outbreaks, understanding their coinfection dynamics is crucial for public health response. This retrospective observational study analyzed data from over 30 000 hospitalized patients sourced from the Brazilian Epidemiological Surveillance System (SIVEP-Gripe). Patients were classified into two groups: influenza mono-infection and influenza-SARS-CoV-2 coinfection. Descriptive statistics and multivariate logistic regression were performed to evaluate associations with primary (mortality) and secondary (ICU admission) outcomes. Among approximately 3.7 million reported severe acute respiratory syndrome cases, 35 831 were influenza-infected, with 1763 (4.9%) coinfected with SARS-CoV-2. Coinfected patients exhibited nearly double the risk of death (aOR: 1.87, 95% CI: 1.52-2.30) and a significantly higher likelihood of ICU admission (aOR: 1.27, 95% CI: 1.07-1.52), compared to those with influenza alone. Coinfected patients also presented with more severe respiratory symptoms and longer hospital stays. Coinfection with influenza and SARS-CoV-2 is associated with significantly worse clinical outcomes, including higher mortality and increased need for intensive care. Early identification and tailored management strategies for coinfected patients are essential to improving patient outcomes, particularly for those with underlying comorbidities.

PMID:41074627 | DOI:10.1002/jmv.70639

Photodermatol Photoimmunol Photomed. 2025 Nov;41(6):e70059. doi: 10.1111/phpp.70059.

ABSTRACT

INTRODUCTION: Vitiligo, a common depigmentation disorder, is often treated with phototherapy. 308-nm monochromatic excimer lamp/laser (308-nm MEL) is typically administered in hospitals, whereas 308-nm light-emitting diodes (308-nm LED) offer a home-based alternative. This study compared the efficacy and safety of home-based 308-nm LED with hospital-based 308-nm MEL in pediatric vitiligo.

METHODS: A retrospective analysis of 75 pediatric vitiligo patients treated with home-based 308-nm LED or hospital-based 308-nm MEL was conducted. Efficacy (repigmentation > 50%) and adverse events were evaluated after 16, 32, and 48 sessions. Statistical analyses were performed using SPSS 25.0.

RESULTS: After 48 sessions, hospital-based 308-nm MEL showed higher efficacy rates (79.5%) than home-based 308-nm LED (38.9%, p < 0.001). However, efficacy was similar when cumulative doses were comparable (p > 0.05). Adverse events were more frequent in the home-based group (63.9% vs. 30.8%, p = 0.029), likely due to cautious dose adjustments. Shorter disease duration and stable disease correlated with better outcomes (p < 0.05).

CONCLUSION: Home-based 308-nm LED is a viable alternative to hospital-based 308-nm MEL for pediatric vitiligo when cumulative doses are similar. However, higher adverse events in home-based therapy highlight the need for better patient education and professional guidance. AI and digital platforms could enhance the safety and efficacy of home-based phototherapy.

PMID:41074622 | DOI:10.1111/phpp.70059

J Clin Ultrasound. 2025 Oct 11. doi: 10.1002/jcu.70092. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to quantify the O-RADS classification using the ultrasound scoring method (USM) and explore its clinical application value.

METHODS: A retrospective analysis was conducted on 205 patients with adnexal tumors (unilateral or bilateral), corresponding to 244 tumor cases, admitted to our hospital from 2018 to 2023. This cohort included 100 patients with malignant tumors (122 malignant lesions, comprising 34 borderline tumors, and 6 malignant tumors of the fallopian tubes) and 105 patients with benign tumors (122 benign lesions). All cases were confirmed by preoperative ultrasound examination and postoperative pathology. A senior ultrasound physician performed the O-RADS classification, while another ultrasound physician applied the USM. The scores were manually assigned, and the sensitivity, specificity, and area under the curve (AUC) of the USM and O-RADS classification in the differential diagnosis of adnexal tumors were determined through ROC curve analysis. The Delong test was used in R to compare the diagnostic performance of the two diagnostic methods. The optimal range of scores between different categories of O-RADS was calculated using by ROC curve.

RESULTS: The sensitivity, specificity, and AUC of the USM (when the optimal cut-off value was ≥ 14 points) in the differential diagnosis of adnexal tumors were 0.951, 0.877, and 0.975 (95% CI: 0.960-0.990). The sensitivity, specificity, and AUC of O-RADS classification (when the optimal cut-off value was ≥ 4 categories) in the differential diagnosis of adnexal tumors were 0.984, 0.887, and 0.973 (95% CI: 0.955-0.992). The AUC comparison between O-RADS classification and USM revealed no statistically significant difference (p = 0.87, p > 0.05).

CONCLUSIONS: Both the USM and the O-RADS classification exhibit high diagnostic efficacy in the differential diagnosis of adnexal tumors. The quantification of O-RADS categories using the USM provides a more intuitive and convenient approach, suitable for ultrasound physicians at all levels. This method demonstrates strong generalizability and can effectively guide clinical diagnosis and treatment.

PMID:41074610 | DOI:10.1002/jcu.70092

Orthop Surg. 2025 Oct 11. doi: 10.1111/os.70173. Online ahead of print.

ABSTRACT

PURPOSE: Bone void fillers are essential for successful outcomes in opening-wedge high tibial osteotomy (OWHTO), a procedure that corrects varus knee misalignment and alleviates medial compartment pain. However, the best filler for OWHTO is still uncertain. This study compared the clinical and radiographic results of using three-dimensional-printed (3DP) porous tantalum wedges versus allogeneic chip bone as fillers in OWHTO, aiming to provide a reference for clinical decision-making.

METHODS: This exploratory-retrospective matched-cohort consecutively enrolled study included 20 patients (10 per group) who were treated between January 2020 and December 2022, with Group A (3DP porous tantalum) selected from a large trial and Group B (allogeneic chip bone) matched by age, gender, and varus severity.

INCLUSION CRITERIA: young, active patients with tibial varus and complete follow-up; exclusions: knee infection, instability, contracture, dislocation, or pan-compartmental osteoarthritis. Postoperatively, early full-weight-bearing rehabilitation was applied, with follow-ups at 6 weeks, 3 months, 6 months, 12 months, and annually.

PRIMARY OUTCOME: bone healing (modified van Hemert score, standing radiographs).

SECONDARY OUTCOMES: hospital for special surgery knee score (HSS), visual analogue scale (VAS), time to full-weight-bearing walking, and radiographic parameters (joint line convergence angle [JLCA], femur-tibia angle [FTA], hip-knee-ankle angle [HKA], mechanical medial proximal tibial angle [mMPTA], mechanical axis deviation [MAD], weight-bearing line [WBL] ratio, posterior tibial slope [PTS]). Postoperative complications were recorded and compared between both groups. Statistical analyses used the Mann-Whitney U test for continuous data and the chi-square test for categorical data.

RESULTS: Mean age was 48.7 ± 3.9 years, with a mean follow-up of 50.0 ± 7.0 months (range: 29.4-59.0). Group A had significantly higher bone healing scores at 6 weeks, 3 and 6 months (3.0 ± 0.8 vs. 1.6 ± 1.0, 3.4 ± 0.5 vs. 2.0 ± 0.9, 4.3 ± 0.5 vs. 2.9 ± 0.9, respectively, all p < 0.01), with no difference at 1 year (4.8 ± 0.4 vs. 4.4 ± 0.5, p = 0.075). Time to full-weight-bearing walking was significantly shorter in Group A (18.7 ± 3.2 vs. 54.4 ± 15.3 days; p < 0.001). Both groups showed significant postoperative improvements in VAS, HSS scores, and radiographic parameters (MAD, WBL ratio, mMPTA, HKA; all p < 0.01 vs. preoperative values), with no intergroup differences in these metrics (preoperative or postoperative). Overall complication rates were similar (20% vs. 60%; p = 0.074), but Group A had a lower incidence of delayed union (0% vs. 40%; p = 0.011). The statistical power for 1-year bone union grades was 0.65 (G*Power, effect size = 0.883).

CONCLUSION: 3DP porous tantalum wedges in OWHTO accelerate bone healing (up to 6 months), reduce time to full-weight-bearing walking, and lower delayed union rates compared to allogeneic chip bone, thereby establishing them as a promising option for future surgical interventions. Further large-scale, long-term trials are needed to confirm these benefits.

PMID:41074606 | DOI:10.1111/os.70173

Augment Altern Commun. 2025 Oct 11:1-12. doi: 10.1080/07434618.2025.2567054. Online ahead of print.

ABSTRACT

This within-groups, repeated measures study examined differences in how accurately people with aphasia (PWA) described themes depicted in AAC displays (theme description accuracy), the types of descriptions they produced (action, naming, or combined action and naming messages), and their display preferences when viewing grids and visual scene displays (VSDs). Nineteen adults with aphasia participated in this study. Each participant viewed grids and VSDs with matched content (e.g., people, objects) presented on a computer monitor and described themes presented in each display. They then completed a display preference task. Results revealed that participants described VSDs themes correctly more often than grid themes; however, grids were described with partial correctness more often than VSDs. Additionally, both display types were described using verbs or verb phrases (action messages), more frequently than nouns or noun phrases (naming messages); however, VSDs were described using action messages more often than grids. Participants also reported greater preference for VSDs than grids. Study results support existing research that both grids and VSDs can effectively support communication for adults with aphasia; however, they may differ in their ability to represent action and naming messages. In addition, results indicate that PWA may prefer VSDs over grids.

PMID:41074599 | DOI:10.1080/07434618.2025.2567054

BJOG. 2025 Oct 11. doi: 10.1111/1471-0528.70057. Online ahead of print.

ABSTRACT

OBJECTIVE: To conduct a pilot study evaluating the acceptability of pregnancy loss nomenclature among people with recent lived experience and make recommendations for UK mass communication.

DESIGN: Electronic internet-based questionnaire.

SETTING: UK.

POPULATION OR SAMPLE: Service users who accessed UK healthcare for > 1 experience(s) of pregnancy loss between 2021 and 2024 (n = 391).

METHODS: Descriptive and inferential statistics.

MAIN OUTCOME MEASURES: Acceptability ratings for pregnancy loss nomenclature used diagnostically in UK healthcare settings.

RESULTS: Much nomenclature currently in use in UK pregnancy loss care was rated ‘unacceptable’ by a majority of study participants. Spontaneous abortion, incompetent cervix, and cervical incompetence were among the terminology rated as ‘unacceptable’ by > 80.0% of the respondents rating terms for the process of loss. In contrast, pregnancy loss and ectopic pregnancy were rated ‘acceptable’ by > 80.0% of respondents. As nomenclature for pregnancy loss outcomes, products, contents of the womb/uterus, and tissue were rated ‘unacceptable’ by > 80.0% of respondents. Baby and ‘their given name’ were rated ‘acceptable’ by > 80.0% of respondents across all gestational age brackets. Some terminology elicited mixed acceptability ratings.

CONCLUSIONS: Some pregnancy loss nomenclature attracted consensus acceptability or unacceptability ratings for respondents. The data inform evidence-based recommended alternatives, which should be adopted for mass communications relating to pregnancy loss.

PMID:41074593 | DOI:10.1111/1471-0528.70057

Clin Pharmacol Ther. 2025 Oct 11. doi: 10.1002/cpt.70090. Online ahead of print.

ABSTRACT

Model-informed precision dosing (MIPD) of tacrolimus in renal allograft recipients, evaluated in silico, demonstrated improved (time to and) probability of target concentration attainment and smaller deviations from target range. Using simulated tacrolimus concentration-time profiles, a study of 200 patients was predicted to have sufficient power to demonstrate superior performance of MIPD for these exposure end points compared with physician-based dosing. A fully automated tacrolimus MIPD application integrated in the electronic patient file was tested in 293 de novo recipients in the first 14 days after transplantation in a prospective randomized controlled clinical validation study. More patients dosed with the MIPD application reached the primary study end point of three in-target tacrolimus pre-dose trough concentrations by Day 8, compared with physician-dosed patients: 52.2% (95% CI: 45.3-59.6) vs. 35.7% (95% CI: 27.4-45.6); HR: 1.64 (95% CI: 1.10-2.43) (P = 0.015). The mean fraction of samples per patient in target during the complete study period was higher in the MIPD arm: 0.38 ± 0.14 compared with the physician-dosed arm: 0.28 ± 0.14 (P < 0.001). The mean distance from target window was significantly lower in MIPD-treated patients: 0.022 (95% CI: 0.019-0.024) vs. 0.040 (95% CI: 0.036-0.044) (P < 0.001). On 19 occasions (< 1%), MIPD tacrolimus dose suggestions were actively overruled by physicians. A fully automated MIPD application for tacrolimus in de novo renal recipients, integrated in the electronic patient file, demonstrated superior performance in achieving tacrolimus exposure targets with limited active overruling of MIPD dose executions by physicians. Automated MIPD can be tested in larger trials to evaluate the impact of dosing decision support on clinical outcomes after renal transplantation.

PMID:41074581 | DOI:10.1002/cpt.70090

J Dermatol. 2025 Oct 11. doi: 10.1111/1346-8138.17959. Online ahead of print.

ABSTRACT

Systemic Janus kinase inhibitors (JAKIs) have markedly advanced the therapeutic landscape for alopecia areata (AA). Although baricitinib and ritlecitinib are approved in the United States (US) and Europe, and deuruxolitinib in the US for severe AA, the lack of head-to-head randomized controlled trials (RCTs) limits evidence-based prescribing decisions. Moreover, prior meta-analyses excluded data on certain oral JAKIs or incorporated findings from agents and dosing regimens that were abandoned, investigational, clinically ineffective, or associated with unacceptable safety profiles. To compare the efficacy of oral JAKIs, limited to FDA, EMA, or MHRA approved drugs and doses-baricitinib (2 and 4 mg QD), ritlecitinib (50 mg QD), and deuruxolitinib (8 mg BID)-for severe AA, using advanced indirect comparison methodologies. A systematic review was performed following PRISMA 2020 guidelines (CRD420251116775). Bayesian network meta-analysis (NMA) synthesized data from RCTs reporting Week 24 outcomes on Severity of Alopecia Tool (SALT) ≤ 10 and SALT ≤ 20 thresholds. Multilevel network meta-regression (ML-NMR) evaluated heterogeneity and adjusted for baseline imbalances. Additionally, unanchored matching-adjusted indirect comparisons (MAIC) were conducted using individual patient-level data from THRIVE trials. Surface under the cumulative ranking (SUCRA) values were calculated to rank treatments. Seven RCTs (n = 4560 participants) were included. Deuruxolitinib 8 mg significantly outperformed baricitinib 2 and 4 mg on both SALT endpoints. Differences with ritlecitinib 50 mg were directionally favorable for deuruxolitinib but not statistically significant in NMA and ML-NMR models. MAICs confirmed superior odds for deuruxolitinib versus baricitinib 2 mg (OR = 71.55) and ritlecitinib (OR = 18.27) for SALT ≤ 20. SUCRA rankings also consistently favored deuruxolitinib. Among approved oral JAKIs, deuruxolitinib 8 mg shows the highest short-term efficacy for severe AA. These findings provide preliminary evidence to guide treatment decisions but should be interpreted as exploratory pending confirmation.

PMID:41074562 | DOI:10.1111/1346-8138.17959

J Esthet Restor Dent. 2025 Oct 11. doi: 10.1111/jerd.70045. Online ahead of print.

ABSTRACT

BACKGROUND: The integration of thermal imaging with artificial intelligence (AI) offers a novel, non-invasive approach for assessing gingival inflammation. While thermal imaging has been widely applied in other medical fields, its use in evaluating gingival health remains largely unexplored. This study is the first to utilize AI-supported analysis of thermal gingival images in patients with mouth breathing habits, aiming to detect and classify gingival inflammation severity. This research establishes specific thermal thresholds for gingival health and disease in this unique population.

METHODS: Forty participants were included, stratified according to periodontal status and clinically confirmed breathing pattern (mouth or nasal breathing), under standardized imaging conditions. From these participants, 160 images were annotated, producing 1734 labeled data points categorized according to bleeding on probing (BoP) for diagnosis, with Gingival Index (GI) applied only for secondary stratification of inflammation severity. Preprocessing included image resizing, outlier removal, and calculation of mean RGB values. The XGBoost algorithm was used for classification, with hyperparameters optimized via grid search and 5-fold cross-validation to ensure robust model performance.

RESULTS: The XGBoost Achieved Outstanding Classification Results, With an Accuracy of 92.74%, Precision of 92.95%, Sensitivity of 92.74%, and an F1 Score of 92.78%. Cross-Validation Confirmed the Model’s Reliability, With Mean-Test and Validation-Scores of 88.28% and 89.43%, Respectively.

CONCLUSIONS: This study represents the first application of AI-supported thermal imaging for evaluating gingival inflammation in mouth breathers, marking a significant step forward in periodontal diagnostics. By establishing specific thermal thresholds in this unique population, it highlights the potential of this innovative approach as a non-invasive, real-time, and scalable diagnostic tool. Future research should focus on refining AI algorithms and expanding datasets to enhance clinical applicability, paving the way for advanced diagnostics and personalized care in periodontology.

PMID:41074551 | DOI:10.1111/jerd.70045