Tag: pubmed

JAMA Netw Open. 2025 Oct 1;8(10):e2535573. doi: 10.1001/jamanetworkopen.2025.35573.

ABSTRACT

IMPORTANCE: Associations of midlife cardiovascular health (CVH), measured once, with incident cardiovascular disease (CVD) are well described. Less is known about patterns of young adulthood CVH, including its changes and associations with later-life CVD outcomes.

OBJECTIVE: To model patterns of change in population-level and individual-level CVH through young adulthood and to assess whether they are associated with incident CVD in later life.

DESIGN, SETTING, AND PARTICIPANTS: The Coronary Artery Risk Development in Young Adults (CARDIA) study is a prospective longitudinal cohort study that enrolled Black and White participants at ages 18 to 30 years in 1985 and 1986 with subsequent follow-up examinations during the next 35 years at 4 urban US centers. Participants with at least 3 CVH measurements in young adulthood and subsequent follow-up with assessment of incident CVD events were included. Analyses were conducted from October 26, 2023, to May 15, 2024.

EXPOSURES: CVH was measured using the American Heart Association Life’s Essential 8 score. Patterns of CVH change in young adulthood (from examinations at years 0 to 20) were modeled with population-level trajectories and assessed by individual-level CVH status changes.

MAIN OUTCOMES AND MEASURES: Incident CVD (myocardial infarction, heart failure, stroke, coronary revascularization, and CVD death) after year 20.

RESULTS: There were 4241 participants in young adulthood (2354 [55.5%] female, 2042 [48.1%] self-identified as Black and 2199 [51.9%] self-identified as White) with a mean (SD) baseline age of 24.9 (3.6) years. In the trajectory analysis, 4 distinct CVH trajectory patterns were identified. Compared with the persistently high CVH trajectory, the moderate-to-low declining and moderate declining CVH trajectories had substantially higher risk for incident CVD. AHRs for incident CVD events ranged from 2.15 (95% CI, 1.04-4.47) in the persistently moderate pattern to 9.96 (95% CI, 4.75-20.86) in the moderate-to-low declining pattern. In the CVH status change analysis (n = 2857), compared with stable moderate CVH in young adulthood, stable high CVH had a lower risk (adjusted hazard ratio [AHR], 0.25 [95% CI, 0.09-0.69]), and stable low CVH had a higher risk (AHR, 5.91 [95% CI, 2.38-14.66]) for incident CVD. Each 10-point decrease in Life’s Essential 8 score between years 0 and 20 was associated with a 53% increase in CVD risk (AHR, 1.53 [95% CI, 1.31-1.78]).

CONCLUSIONS AND RELEVANCE: In this prospective cohort study of young adults, unfavorable patterns of CVH change through young adulthood were associated with marked elevations in risk for incident CVD. These data suggest that achieving and maintaining high CVH throughout young adulthood through strategies of primordial prevention are important for prevention of later-life CVD.

PMID:41051778 | DOI:10.1001/jamanetworkopen.2025.35573

JAMA Netw Open. 2025 Oct 1;8(10):e2535580. doi: 10.1001/jamanetworkopen.2025.35580.

ABSTRACT

IMPORTANCE: A national shortage of blood culture bottles affected approximately half of US hospitals, necessitating changes in blood culture practices.

OBJECTIVE: To determine the association between restrictive blood culture stewardship measures and patient outcomes at a pediatric hospital.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was performed to determine the association between new restrictive stewardship measures and blood culture practices in a quaternary care pediatric medical center from July 1, 2023, to January 31, 2025. All children with blood cultures collected were included.

EXPOSURES: The following restrictive measures were enacted: (1) a 48-hour restriction on all aerobic blood cultures, (2) a 7-day restriction on all anaerobic blood cultures, (3) authorization to order an additional aerobic blood culture every 7 days, and (4) pooling of all central vein catheter lumens in 1 blood culture bottle.

MAIN OUTCOMES AND MEASURES: The primary outcome was the monthly blood culture positivity rate, stratified and normalized per 100 emergency department (ED) visits and per 100 patient-days.

RESULTS: During the study period, a total of 18 132 blood cultures from 5063 patient visits (median [IQR] age, 5.6 [1.1-12.4] years; 2744 [54.2%] male; 358 [7.15%] Black, 3013 [58.5%] Latino/a/x/Hispanic, and 720 [14.2%] White patients) were collected from August 1, 2023, to July 31, 2024 (preintervention period), and 6449 blood cultures from 2495 patient visits (1391 [55.8%] male, median [IQR] age; 5.5 [1.1-12.5] years; 191 [7.7%] Black, 1452 [58.2%] Latino/a/x/Hispanic, and 375 [15.0%] White patients) were collected from August 1, 2024, to January 31, 2025 (postintervention period). Restrictive stewardship measures were associated with a significant decrease in the blood culture collection rate per 100 ED visits (cumulative change, -24.1%; 95% CI, -38.4% to -8.9%; P = .01) and per 100 patient-days (cumulative change, -45.8%; 95% CI, -64.7% to -26.9%; P < .001). In the ED and inpatient units, the blood culture positivity rate remained stable, with a 14.4% (95% CI, -23.1% to 52.0%) and 27.8% (95% CI, -13.7% to 69.3%) cumulative increase, respectively. There was no significant change in hospital mortality due to septic shock (0.13% vs 0.15%) or mean length of stay (5.4 days vs 6.4 days), but there was a significant decrease in readmissions (3.3 vs 2.7; cumulative change, -27.5%; 95% CI, -7.6% to -47.6%; P = .02).

CONCLUSIONS AND RELEVANCE: The implementation of restrictive blood culture measures, including pooling lumens and decreasing testing cadence, successfully reduced blood cultures collected without decreasing blood culture positivity rates and without an increase in mortality secondary to septic shock, readmission rates, or length of stay.

PMID:41051777 | DOI:10.1001/jamanetworkopen.2025.35580

JAMA Netw Open. 2025 Oct 1;8(10):e2535707. doi: 10.1001/jamanetworkopen.2025.35707.

ABSTRACT

IMPORTANCE: Antiemetics have level 1 evidence supporting their role in improving quality of life and treatment tolerability for patients with cancer; they are an essential part of quality care. Utilization management (prior authorization, step therapy, and quantity limits) is implemented by insurance companies to improve effectiveness and efficiency and to control costs.

OBJECTIVE: To characterize utilization management policies for antiemetics for Patient Protection and Affordable Care Act (ACA) Marketplace and Medicaid plans.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a national sample of all available Medicaid and ACA drug formularies in 2024 linked to the US Food and Drug Administration’s National Drug Codes. Formulations of the 13 most common self-administered (oral, sublingual, transdermal) antiemetics were identified.

EXPOSURE: Plans’ prior authorization, quantity limit, and step therapy policies.

MAIN OUTCOMES AND MEASURES: The share of antiemetics subject to utilization management by coverage type (ACA, Medicaid, Medicaid managed care, state Medicaid), generic vs brand, and geographically by state was calculated.

RESULTS: A total of 561 formularies (301 [53.7%] ACA; 260 [46.3%] Medicaid) were included, amounting to 348 215 unique drug-plan formulations (173 607 [49.9%] ACA; 174 608 [50.1%] Medicaid). Overall, utilization management affected 66 981 covered antiemetic medications in ACA plans (39.7%) and 75 727 in Medicaid plans (43.4%). In ACA plans, a greater proportion of generic formulations faced restrictions than brand-name drugs (40.5% of generic [67 931 of 167 587] vs 17.4% of brand [1050 of 6020]). In Medicaid, this was the opposite: 82.5% of brand drugs (4357 of 5280) vs 42.2% of generic drugs (71 370 of 169 328) faced restrictions. Utilization management policies varied greatly by plan and state; some plans imposed at least 1 coverage restriction on 100% of antiemetic formulations, and others none. Quantity limits were the most prevalent utilization management tool, applying to more than one-third of covered antiemetic formulations in ACA (64 198 [37.0%]) and Medicaid plans (55 585 [38.1%]).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of Medicaid and ACA formularies, there was substantial variation in utilization management requirements for antiemetics across insurance type and state as well as drug type, use, and class. Efforts to increase standardization of utilization management policies may alleviate administrative burden for patients.

PMID:41051776 | DOI:10.1001/jamanetworkopen.2025.35707

JAMA Netw Open. 2025 Oct 1;8(10):e2535759. doi: 10.1001/jamanetworkopen.2025.35759.

ABSTRACT

IMPORTANCE: The association between restless leg syndrome (RLS) and Parkinson disease (PD) remains unclear. Clarifying this association and the role of the dopaminergic pathway may improve understanding of the pathophysiology between these 2 diseases.

OBJECTIVES: To assess whether RLS is a risk factor for developing PD and whether the dopamine pathway is meaningfully associated with RLS and PD.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the Korean National Health Insurance Service Sample Cohort from 2002 to 2019. Statistical analyses were performed between September 2024 and March 2025. Patients with RLS and PD were identified based on codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision and matched to individuals without RLS. For the secondary analysis, the dopamine agonist (DA)-treated group was operationally defined as patients with RLS who received DA during 2 or more distinct clinical visits, while those who did not meet this criterion were classified as the DA-nontreated group.

EXPOSURES: Diagnosis of RLS and treatment with DAs.

MAIN OUTCOMES AND MEASURES: Development of PD. To compare the time to PD diagnosis across groups, a restricted mean survival time (RMST) analysis was conducted.

RESULTS: A total of 9919 patients with RLS and 9919 matched controls were included. The mean (SD) age at enrollment was 50.1 (16.3) years in the control group (6225 women [62.8%]) and 50.3 (16.0) years in the RLS group (6225 women [62.8%]). The incidence of PD was 1.0% (99 of 9919) in the control group and 1.6% (158 of 9919) in the RLS group. At the prespecified time horizon of 15 years (τ = 15), the RMST to PD diagnosis was 14.93 years in the control group and 14.88 years in the RLS group, resulting in a difference of -0.05 years (95% CI, -0.07 to -0.03 years). Compared with the control group, the DA-nontreated RLS group (n = 6842) showed a significantly shorter RMST to PD diagnosis (difference, -0.09 years [95% CI, -0.12 to -0.06 years]) and a higher incidence rate (143 of 6842 [2.1%]). The DA-treated RLS group (n = 3077) showed a significantly longer RMST to PD diagnosis (difference, 0.03 years [95% CI, 0.01-0.06 years]) and a lower incidence rate (15 of 3077 [0.5%]).

CONCLUSIONS AND RELEVANCE: In this cohort study, RLS was associated with an increased risk of developing PD. Furthermore, patients with RLS who were not treated with DAs tended to be at increased risk of developing PD, whereas those who were treated with DAs tended to be at decreased risk compared with the control group. These findings suggest that the pathophysiological connection between RLS and PD may involve mechanisms beyond the dopaminergic pathway.

PMID:41051773 | DOI:10.1001/jamanetworkopen.2025.35759

JAMA Pediatr. 2025 Oct 6. doi: 10.1001/jamapediatrics.2025.3798. Online ahead of print.

NO ABSTRACT

PMID:41051768 | DOI:10.1001/jamapediatrics.2025.3798

JAMA Pediatr. 2025 Oct 6. doi: 10.1001/jamapediatrics.2025.3636. Online ahead of print.

NO ABSTRACT

PMID:41051764 | DOI:10.1001/jamapediatrics.2025.3636

J Pediatr Orthop. 2025 Oct 6. doi: 10.1097/BPO.0000000000003123. Online ahead of print.

ABSTRACT

BACKGROUND: Our aim is to investigate the association between soft tissue infection in the popliteal fossa and hamstring muscles to determine the risk of DVT formation in children with infections in the knee and posterior thigh.

METHODS: This prospective cohort study (the Peterborough Paediatric Musculoskeletal Infection Study) has gathered data for 181 children aged 0 to 15 years with infection of their limbs or spine. Those with MRI evidence for infection of the popliteal fossa of the knee were identified, as well as those with thrombosis in the venous system.

RESULTS: Popliteal fossa infection was present in 15 children (8% of the 181 in the entire study). Most were associated with septic arthritis of the knee (80%), but some were due to pyomyositis of the hamstrings or calf (20%). Venous thrombosis was noted in 1.1% of the entire 181 study group, but 13% of those with popliteal fossa infection, a 12-fold difference (Fisher exact test statistic 0.0064, P<0.01). One of those with a DVT died from pulmonary embolism a few hours after their MRI scan had been performed.

CONCLUSION: Thirteen percent of children with popliteal fossa infection had an associated DVT, so it may be an independent risk factor for thrombosis. To minimize the risk of DVT and its serious complications, we recommend that children presenting to the Emergency Department with pain in the knee, thigh or calf and raised inflammatory markers (CRP/ESR) suspicious for musculoskeletal infection should have their popliteal fossa examined, and if tender, an urgent Doppler ultrasound should be organised. On MRI, attention should be paid to the popliteal fossa on axial STIR images, and if oedema is present around the popliteal vessels, then prophylactic dose anticoagulation should be started, while those with a dilated popliteal vein on MRI should receive treatment dose anticoagulation.

LEVEL OF EVIDENCE: Level II. A lesser quality prospective study with patients enrolled at different points in their disease.

PMID:41051763 | DOI:10.1097/BPO.0000000000003123

Int J Clin Pharm. 2025 Oct 6. doi: 10.1007/s11096-025-02017-8. Online ahead of print.

ABSTRACT

INTRODUCTION: Bariatric surgery may induce changes in the effects of oral medication, which may result in medication related problems. Therefore, tailored pharmacotherapy is necessary for individual patients following surgery. In case pharmacotherapy is not adjusted, adverse drug events and even unplanned hospital readmissions may occur. The prevalence of these medication-related readmissions is not known.

AIM: The primary objective of this study was to determine the prevalence of medication-related readmissions within two years after bariatric surgery. Secondary objectives were to determine the percentage of potentially preventable medication-related readmissions. The reasons for readmission, the associated medication, and medication errors involved in the potentially preventable readmissions were also determined.

METHOD: A retrospective, observational study in a large Dutch teaching hospital was performed. Unplanned readmissions of patients who underwent primary bariatric surgery between January 1, 2018 and August 31, 2020 were included with a follow-up of two years. Records were screened to identify potential medication-related reasons for readmissions. Identified records were independently assessed using adjusted versions of the algorithms of Kramer, Schumock & Thornton for causality and preventability by a doctor and pharmacist. All readmissions assessed as possibly (Kamer scores 0 through 3) or probably (Kramer score 4) related to medication were included. In addition, reasons for readmission, associated medication and medication errors were recorded. Descriptive statistics were used to analyze the data.

RESULTS: In total, 606 unplanned readmissions of 356 individual patients were included. Eighty-three of 606 (13.7%, 95% CI 11.1-16.7%) readmissions were identified as medication-related with a median time between index hospitalization and readmission of 152 days (IQR 16-438). Of these readmissions 36 (43.3%) from 32 unique patients were potentially preventable. The most frequently occurring reasons for readmissions were abdominal pain and infections. Medication most frequently associated with readmissions were Proton Pump Inhibitors, opioids and antibiotics. Medication errors involved in the preventable readmissions were most often prescribing errors followed by non-adherence.

CONCLUSION: Medication-related readmissions frequently occur after bariatric surgery. More attention is needed for correct pharmacotherapy and patient education in this population.

PMID:41051716 | DOI:10.1007/s11096-025-02017-8

Neurol Sci. 2025 Oct 6. doi: 10.1007/s10072-025-08579-9. Online ahead of print.

NO ABSTRACT

PMID:41051688 | DOI:10.1007/s10072-025-08579-9

Sleep Breath. 2025 Oct 6;29(5):307. doi: 10.1007/s11325-025-03494-x.

ABSTRACT

PURPOSE: This observational study aimed to compare the effectiveness of mandibular advancement devices (MAD) and continuous positive airway pressure (CPAP) therapy in patients diagnosed with obstructive sleep apnea (OSA), with a specific focus on changes in heart rate parameters.

METHODS: Fifty-two patients treated with MAD were compared with fifty-two patients treated with CPAP. All participants underwent sleep study prior to the initiation of therapy (T0), followed by a control sleep study after a (3-month) predefined treatment period (T1). Changes in cardiac parameters between baseline (T0) and post-treatment (T1) were analyzed both within each group (MAD and CPAP) and between groups. To enhance comparability between patients treated with MAD and those treated with CPAP, a propensity score matching approach was applied based on pre-treatment variables, in order to minimize selection bias and optimize the validity of the between-group comparison.

RESULTS: For intragroup comparisons, both the MAD and C-PAP groups demonstrated statistically significant reductions in AHI and ODI following treatment (p < 0.001). Additionally, a modest but significant decrease in mean heart rate was noted in both groups (MAD: p = 0.033; CPAP: p = 0.002). For intergroup comparisons, both treatment modalities resulted in a significant reduction in AHI and ODI values. Regarding heart rate parameters, no statistically significant differences were observed between the two groups after treatment for mean HR (p = 0.350), minimum HR (p = 0.602), or maximum HR (p = 0.942).

CONCLUSION: The use of MAD and CPAP leads to significant improvements in heart rate in patients with OSA. However, no significant differences were found between the two treatment modalities in terms of heart rate reduction.

PMID:41051681 | DOI:10.1007/s11325-025-03494-x