Tag: pubmed

Malar J. 2025 Jun 12;24(1):189. doi: 10.1186/s12936-025-05444-0.

ABSTRACT

BACKGROUND: Global malaria control programmes such as approaches to community engagements to deliver malaria control interventions have been successful in controlling malaria. Strategies aimed at accelerating patients’ adherence to prescribed artemisinin-based combination therapy (ACT) are needed in the fight to control and eradicate malaria. Previous studies have shown the power of health education in improving patients’ adherence to ACT. The objective of this study was to establish the impact of a community health education intervention on the patients’ adherence to malaria ACT in Kamuli District, Uganda.

METHODS: A pre-post-test intervention study without a control group was used to understand the impact of community health education training in improving patients’ adherence to ACT. Quantitatively, equal number of 1266 patients were enrolled and assigned into any of the three arms equally (422)-no follow up, follow-up on day 2 and day 4 arm at pre-test and post-test phases. Qualitatively, 24 key informants were enrolled purposively. Mann-Whitney U test was used to establish the impact of the community health education on patients’ adherence to ACT. Statistical significance was established at p < 0.05. Qualitative data was analysed using the thematic analysis technique.

RESULTS: A total of 1688 patients were analysed. At pre-test, the median age was 20 years with majority (64.3%) being females while patients’ adherence was reported to be 588/844 (69.7%). At post-test, the median age was 21 years, majority (62.6%) females, and patients’ adherence 700/844 (82.9%). A Mann-Whitney U test showed a statistically significant difference in the patients’ adherence to ACT of pre-test and post-test after the intervention (U = 308,904, Z = – 6.409, p < 0.0001), with higher adherence at post-test (median = 900.5) than pre-test (median = 788.5) and small effect (0.156). Qualitatively, not all health workers explain clearly how to use the ACT medicines prescribed.

CONCLUSION: Community health education as an intervention was effective in improving patient’s adherence to ACT. Therefore, there is need to avail medical supplies and patient education with adherence support to ensure adequate patients’ adherence to ACT.

PMID:40506709 | DOI:10.1186/s12936-025-05444-0

Ann Surg Oncol. 2025 Jun 12. doi: 10.1245/s10434-025-17640-y. Online ahead of print.

ABSTRACT

BACKGROUND: Neoadjuvant chemotherapy (NAC) has emerged as a potential alternative to upfront surgery (US) followed by adjuvant chemotherapy in locally advanced colon cancer (LACC), offering benefits such as early micrometastases eradication and improved surgical outcomes. However, its efficacy and safety remain uncertain owing to conflicting evidence.

PATIENTS AND METHODS: A systematic review and meta-analysis was conducted evaluating randomized controlled trials (RCTs) comparing NAC with US with adjuvant chemotherapy for LACC. Primary outcomes were 5-year overall survival (OS) and disease-free survival (DFS). Secondary outcomes included positive surgical margin rates and anastomotic leak/abscess. Statistical analyses employed random-effects models, with trial sequential analysis (TSA) assessing the robustness of results.

RESULTS: Eight RCTs with low risk of bias involving 3038 patients were included. NAC improved 5-year OS (81.4% versus 77.8%, hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.64-0.91, p = 0.0028) and DFS (79.2% versus 73.7%, HR 0.80, 95% CI 0.68-0.93, p = 0.0033), with low heterogeneity (I² ≤ 4.4%). NAC significantly reduced positive margin rates (4.1% versus 6.3%, HR 0.49, p = 0.0011) without increasing anastomotic leak/abscess (p = 0.09). The leave-one-out and the TSA analyses confirmed the robustness of OS and DFS findings, with the cumulative Z-curve crossing both the conventional and trial sequential monitoring boundaries for benefit. The GRADE assessments indicated high quality of evidence for the primary outcomes.

CONCLUSIONS: NAC offers superior OS, DFS, and surgical margin outcomes in LACC without heightened surgical risks, supporting its inclusion as a viable and safe treatment option.

PMID:40506679 | DOI:10.1245/s10434-025-17640-y

J Oral Rehabil. 2025 Jun 12. doi: 10.1111/joor.14009. Online ahead of print.

ABSTRACT

INTRODUCTION: Dental implant surgery has become a prevalent treatment option for patients with single tooth defects. However, the success of this surgery relies heavily on precise planning and execution. This study investigates the application of artificial intelligence (AI) in assisting the planning process of dental implant surgery for single tooth defects. Single tooth defects in the oral cavity pose a significant challenge in restorative dentistry. Dental implant restoration has emerged as an effective solution for rehabilitating such defects. However, the complexity of the procedure and the need for accurate treatment planning necessitate the integration of advanced technologies. In this study, we propose the utilisation of AI to enhance the precision and efficiency of implant surgery planning for single tooth defects.

MATERIALS AND METHODS: A total of twenty patients with single tooth loss were enrolled. Cone-beam computed tomography (CBCT) and intra-oral scans were obtained and imported into the AI-dentist software for 3D reconstruction. AI assisted in implant selection, tooth position identification, and crown fabrication. Evaluation included subjective verification and objective assessments. A paired samples t-test was used to compare planning times (dentist vs. AI), with a significance level of p < 0.05.

RESULTS: Twenty patients (9 male, 11 female; mean age 59.5 ± 11.86 years) with single missing teeth participated in this study. Implant margins were carefully positioned: 3.05 ± 1.44 mm from adjacent roots, 2.52 ± 0.65 mm from bone plate edges, 3.05 ± 1.44 mm from sinus/canal, and 3.85 ± 1.23 mm from gingival height. Manual planning (21.50 ± 4.87 min) was statistically significantly slower than AI (11.84 ± 3.22 min, p < 0.01). Implant planning met 100% buccolingual/proximal/distal bone volume criteria and 90% sinus/canal distance criteria. Two patients required sinus lifting and bone grafting due to insufficient bone volume.

CONCLUSION: This study highlights the promising role of AI in enhancing the precision and efficiency of dental implant surgery planning for single tooth defects. Further studies are necessary to validate the effectiveness and safety of AI-assisted planning in a larger patient population.

PMID:40506671 | DOI:10.1111/joor.14009

J Relig Health. 2025 Jun 12. doi: 10.1007/s10943-025-02356-w. Online ahead of print.

ABSTRACT

In illnesses such as cancer, which require prolonged and intensive treatment, patients’ spiritual well-being plays a critical role in enhancing their sense of life meaning and may positively influence treatment outcomes. This descriptive study evaluated the spiritual well-being of patients with cancer. The sample consisted of 300 cancer patients receiving care in the medical oncology service and outpatient chemotherapy unit of a training and research hospital in Ankara between February and May 2024. Data were collected using an introductory information form and the Spiritual Well-Being Scale. A statistically significant relationship was found between the subscale scores and patients’ gender, education level, income level, diagnostic status, and time since diagnosis (p < 0.05). In conclusion, the study showed that cancer patients demonstrated moderate levels of meaning and peace and high levels of belief. These findings indicate a potential need for interventions that address the spiritual and religious care needs of cancer patients following diagnosis.

PMID:40506662 | DOI:10.1007/s10943-025-02356-w

Ultrasonics. 2025 Jun 9;155:107725. doi: 10.1016/j.ultras.2025.107725. Online ahead of print.

ABSTRACT

The purpose of this study was to assess eye lesions by analyzing wave speed (WS) of lesions using ultrasound vibro-elastography (UVE) together with a parametric ultrasound imaging approach. Ten subjects with eye lesions (5 nevus (N) vs. 5 melanoma (M)) were recruited and tested using UVE. In addition, the sliding window method was used to reconstruct and analyze horizontal Normalized Shannon Entropy (hNSE) images and Nakagami-m/omega images. Two-way ANOVA statistical analysis was performed to compare mean values of the contrast to noise ratio (CNR), hNSE, and m/omega of these images between the two types of lesions. The results show that there were significant differences in CNR of the m map images (p = 0.0174) and omega map images (p = 0.0128) reconstructed from shear wave velocity (SWV) between the two types of lesions and significant differences in CNR of the m map images (p = 0.0209) and omega map images (p < 0.0001) reconstructed from two dimensional (2D) speed maps between the two lesions Furthermore, the m values of 2D speed maps shows significant differences between N vs. M of all three frequencies (i.e., 100 Hz (p = 0.0052), 150 Hz (p = 0.0100), 200 Hz (p = 0.0174)). The results suggest that CNR, m and omega of Nakagami method are useful biomarkers for assessing eye lesion with UVE technique. Nakagami imaging of SWV and 2D speed maps have better performance than hNSE imaging for analyzing characteristics of eye lesions. UVE based Nakagami imaging is a promising method for evaluating eye lesions.

PMID:40505172 | DOI:10.1016/j.ultras.2025.107725

JACC Heart Fail. 2025 Jun 11;13(8):102497. doi: 10.1016/j.jchf.2025.03.041. Online ahead of print.

ABSTRACT

BACKGROUND: Pooling data from participants with heart failure with mildly reduced ejection fraction (HFmrEF) or heart failure with preserved ejection fraction (HFpEF) from all completed outcomes trials evaluating finerenone to date may enhance understanding of its safety and efficacy in this high-risk and heterogeneous population.

OBJECTIVES: In this prespecified participant-level pooled analysis of the FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF trials (FINE-HEART), we evaluated the safety and efficacy of finerenone in individuals with HFmrEF/HFpEF.

METHODS: The treatment effects of finerenone vs placebo on cardiovascular death or heart failure hospitalization were evaluated using Cox proportional hazards regression models stratified by trial. Additional endpoints included cardiovascular death, HF hospitalization, new-onset atrial fibrillation, and all-cause death.

RESULTS: Among 18,991 pooled trial participants, 7,008 (36.9%) had HFmrEF/HFpEF (mean age, 71 ± 10 years; 44% female). Over a median follow-up of 2.5 years, finerenone reduced cardiovascular death or heart failure hospitalization compared with placebo (HR: 0.87 [95% CI: 0.78-0.96]; P = 0.008). Consistent effects were observed across trials (P_interaction = 0.24), key subgroups, and baseline estimated glomerular filtration rate (P_interaction = 0.47), urine albumin-to-creatinine ratio (P_interaction = 0.62), and glycated hemoglobin (P_interaction = 0.93). Finerenone additionally appeared to reduce heart failure hospitalization (HR: 0.84 [95% CI: 0.74-0.94]; P = 0.003) and new-onset atrial fibrillation (HR: 0.75 [95% CI: 0.58-0.97]; P = 0.030), but did not statistically significantly decrease cardiovascular death or all-cause death. Hyperkalemia was more common, and hypokalemia was less common, with finerenone vs placebo. Serious adverse events were similar between the treatment arms.

CONCLUSIONS: This participant-level pooled analysis of 3 large-scale outcomes trials supports the use of finerenone in individuals with HFmrEF/HFpEF across a broad range of cardiovascular-kidney-metabolic risk. (PROSPERO registration: CRD42024570467).

PMID:40505158 | DOI:10.1016/j.jchf.2025.03.041

J Med Internet Res. 2025 Jun 12;27:e66055. doi: 10.2196/66055.

ABSTRACT

BACKGROUND: Although much progress has been made in artificial intelligence (AI), several challenges remain substantial obstacles to the development and translation of AI systems into clinical practice. Even large language models, which show excellent performance on various tasks, have progressed slowly in clinical practice tasks. Providing precise and explainable treatment plans with personalized details remains a big challenge for AI systems due to both the highly specialized medical knowledge required and patients’ complicated conditions.

OBJECTIVE: This study aimed to develop an explainable and efficient decision support system named H-SYSTEM to assist neurosurgeons in diagnosing and treating patients with hypertensive intracerebral hemorrhage. The system was designed to address the limitations of existing AI systems by integrating a medical domain knowledge graph to enhance decision-making accuracy and explainability.

METHODS: The H-SYSTEM consists of 3 main modules: the key named entity recognition (NER) module, the semantic analysis and representation module, and the reasoning module. Furthermore, we constructed a medical domain knowledge graph for hypertensive intracerebral hemorrhage, named HKG, which served as an external knowledge brain of the H-SYSTEM to enhance its text recognition and automated decision-making capability. The HKG was exploited to guide the training of the semantic analysis and representation module and reasoning module, which makes the output of the H-SYSTEM more explainable., To assess the performance of the H-SYSTEM, we compared it with doctors and different large language models.

RESULTS: The outputs based on HKG showed reliable performance as compared with neurosurgical doctors, with an overall accuracy of 94.87%. The bidirectional encoder representations from transformers, inflated dilated convolutional neural network, bidirectional long short-term memory, and conditional random fields (BERT-IDCNN-BiLSTM-CRF) model was used as the key NER module of the H-SYSTEM due to its fast convergence and efficient extraction of key named entities, achieved the highest performance among 7 key NER models (precision=92.03, recall=90.22, and F1-score=91.11), significantly outperforming the others. The H-SYSTEM achieved an overall accuracy of 91.74% in treatment plans, showing significant consistency with the gold standard (P<.05), with diagnostic measures achieving 88.18% accuracy, 97.03% area under the curve (AUC), and a κ of 0.874; surgical therapy achieving 98.53% accuracy, 98.53% AUC, and a κ of 0.971; and rescue therapies achieving 89.50% accuracy, 94.67% AUC, and a κ of 0.923 (all P<.05). Furthermore, the H-SYSTEM showed high reliability and efficiency when compared to doctors and ChatGPT, achieving statistically higher accuracy (95.26% vs 91.48%, P<.05). Additionally, the H-SYSTEM achieved a total accuracy of 92.22% (ranging from 91.14% to 95.35%) in treatment plans for 605 additional patients from 6 different medical centers.

CONCLUSIONS: The H-SYSTEM showed significantly high efficiency and generalization capacity in processing electronic medical records, and it provided explainable and elaborate treatment plans. Therefore, it has the potential to provide neurosurgeons with rapid and reliable decision support, especially in emergency conditions. The knowledge graph-enhanced deep-learning model exhibited excellent performance in the clinical practice tasks.

PMID:40505141 | DOI:10.2196/66055

J Am Acad Orthop Surg Glob Res Rev. 2025 Jun 11;9(6). doi: 10.5435/JAAOSGlobal-D-24-00287. eCollection 2025 Jun 1.

ABSTRACT

INTRODUCTION: Although increased treatment of pediatric anterior cruciate ligament (ACL) injury is well-documented, surrounding trends remain unknown. We evaluated national trends over 21 years using data from pediatric ACL reconstructions (ACLR) submitted to the American Board of Orthopaedic Surgeons (ABOS) Part II Oral Examination and compared fellowship training, geographic variation, and case volume trends.

METHODS: The ABOS SCRIBE database was queried for ACLR in pediatric (<19) patients between 2000 and 2021. Data included geographic region, fellowship training, and patient demographics. ACLRs per capita was estimated using census data. Data were stratified by age and sex. Multiple linear regression assessed whether year, sex, and age/sex category predicted surgery number.

RESULTS: From 2000 to 2021, ABOS Part II candidates reported 12,124 pediatric ACLR. Nearly 2/3 were in patients 16 years or older. Most were in the Midwest (22.8%) and South (22.2%). Each region decreased in ACLR. Overall, pediatric ACLR decreased 31.3% and contributing surgeons decreased 40.4%. Female ACLR increased 39.5% from 2009 to 2014, with 11.9% more than male patients in 2014. After 2014, sex differences and total ACLR decreased. 81.3% were reported by surgeons with sports medicine training and 6.0% with dual sports medicine and pediatric orthopaedics fellowships. Dual training increased in 2009 and declined after 2013. Surgeries in male patients compared with female patients (B = -6.777, 95% confidence interval, -9.534 to -4.279) and male patients 16 to 18 years compared with male patients younger than 16 years (B = -4.935, 95% confidence interval, -6.596 to -3.273) decreased.

CONCLUSION: Pediatric ACLR performed by ABOS Part II candidates decreased overall, but a concern for increased ACLR in female patients persists. More surgeries were done in the Midwest and South.

STUDY DESIGN: Cross-sectional Study Level of Evidence: III.

PMID:40505137 | DOI:10.5435/JAAOSGlobal-D-24-00287

JMIR Hum Factors. 2025 Jun 12;12:e66658. doi: 10.2196/66658.

ABSTRACT

BACKGROUND: The perinatal period is one of the most vulnerable times a woman experiences. Multidimensional, interprofessional, and personalized support is needed to improve outcomes in women’s and children’s health while strengthening partner relationships at the same time. Although a vast amount of support services already exist in Germany for psychosocial counseling during the perinatal period, groups who are especially at risk do not take advantage of them.

OBJECTIVE: Family eNav is an app-based intervention developed by experts in the field of medical and psychosocial support to help young parents navigate through primary and secondary care services in Germany according to their needs. It also empowers patient and parenting perspectives through self-education and symptom monitoring for different settings, for example, mental health and preterm birth. While the intervention will be evaluated in a multicenter, randomized, controlled trial, the focus here lies on the conception of the app, demand among patients, and preuse acceptance.

METHODS: During the conception phase, we conducted an explorative study with prospective users and experts in the perinatal psychosocial field to understand the need and preuse acceptance of the intervention. We interviewed 20 participants with a semistructured guide, analyzing their responses using systematic text condensation. Additionally, we conducted a short survey on general questions concerning digitalization within the health care system among the participants.

RESULTS: We established two main themes: (1) access and barriers to health care and psychosocial services and (2) high preuse acceptance of app-based intervention. Health care and psychosocial providers indicated that there is a high demand for their services, which cannot always be met immediately, and at the same time, they are doubtful of reaching those individuals most in need. Prospective users and health and social care providers alike showed great interest in the perinatal navigator and suggested a variety of needs and content requirements to be included. Regionality, availability, and individualized content were underlined as success factors for high user acceptance. Barriers consisted of data protection concerns, as well as denial of their own needs.

CONCLUSIONS: Our findings show great acceptance for an app-based intervention on the part of both prospective users and service providers. Feedback on requirements and content, as well as possible barriers, was taken into consideration while developing the app.

PMID:40505134 | DOI:10.2196/66658

J Am Acad Orthop Surg Glob Res Rev. 2025 Jun 11;9(6). doi: 10.5435/JAAOSGlobal-D-25-00143. eCollection 2025 Jun 1.

ABSTRACT

INTRODUCTION: Socioeconomic status has been correlated with clinical and functional outcomes in elective orthopaedic surgery; however, there has been limited application in orthopaedic trauma. The Area Deprivation Index (ADI) uses 17 different metrics to assess disadvantages at the neighborhood level by zip code. The purpose of this study was to examine the relationship between ADI and unplanned return to the operating room (UROR) in the orthopaedic trauma patient population.

METHODS: A retrospective review of adult orthopaedic trauma patients from 2014 to 2019 at a level 1 trauma center was done. Patient demographics, injury characteristics, and ADI were recorded. ADI was used to describe survival to UROR, and logistic regressions were used to identify factors that increased the odds of UROR.

RESULTS: In total, 1,031 patients were included in the study, with a UROR incidence of 14.3%. The average ADI score fell in the minimally deprived category (second quartile). Univariate analysis demonstrated a significant association between UROR and younger age (P < 0.001), higher Injury Severity Score (P < 0.001), ADI > 75 (P< 0.05), osteoporosis (P < 0.001), open fracture (P< 0.05), number of fractures (P < 0.05), and higher fracture complexity (P < 0.001). Multivariate analysis revealed that ADI > 75 (OR 3.486, P = 0.029), younger age (OR 0.982, P = 0.004), Injury Severity Score (OR 1.069, P < 0.001), and osteoporosis (OR 5.086, P < 0.001) was associated with UROR. Kaplan-Meier confirmed increased rates of UROR for the third and fourth ADI quartiles for all cases (P < 0.001) and when controlling for symptomatic implant (P < 0.001).

CONCLUSION: Defined by ADI, patients from severely deprived communities undergoing orthopaedic trauma interventions were found to have a 3.5-fold increased rate of UROR. This study shows outcome disparities in the orthopaedic trauma population when using a comprehensive measure for socioeconomic status even after controlling for other contributing factors. Understanding and addressing the unique challenges facing socioeconomically deprived patient populations has the potential to markedly improve outcomes for orthopaedic trauma patients.

PMID:40505132 | DOI:10.5435/JAAOSGlobal-D-25-00143