Tag: pubmed

J Am Nutr Assoc. 2025 Jul 31:1-8. doi: 10.1080/27697061.2025.2531086. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to assess the effect of probiotic supplementation on multiple dimensions of tuberculosis (TB) care, including clinical, humanistic, and safety outcomes.

METHOD: This study is a prospective cohort study. Data were collected for TB treatment outcome, hematologic inflammatory indices, anti-tuberculosis treatment (ATT)-induced adverse drug reactions (ADRs), and health-related quality of life (HRQoL) using EuroQol 5-Dimension 5-level questionnaire to evaluate the effect of probiotics supplementation.

RESULTS: In all, 177 patients with drug-sensitive pulmonary TB were enrolled. TB treatment success rates in the study group (SG) and the reference group (RG) were 85.1% and 84.6%, respectively (p = 1.000). Among hematologic inflammatory indices, only the systemic inflammation response index (SIRI) showed a statistically significant reduction after probiotic supplementation (p = 0.048). No significant changes were observed in HRQoL scores at various time points. ATT-induced ADRs were significantly lower in the SG than the RG (14.8% vs 61.3%; p < 0.001).

CONCLUSION: Probiotic supplementation did not significantly influence TB treatment success or HRQoL outcomes. However, it showed a favorable impact on systemic inflammation and a significant reduction in the incidence of ATT-induced ADRs, especially gastrointestinal side effects. These findings suggest a potential role for probiotics as a supportive adjunct to ameliorate ATT-induced ADRs. Future studies should focus on assessing long-term supplementation effects to investigate humanistic outcomes.

PMID:40743501 | DOI:10.1080/27697061.2025.2531086

Arch Orthop Trauma Surg. 2025 Jul 31;145(1):394. doi: 10.1007/s00402-025-06011-7.

ABSTRACT

OBJECTIVES: This study aimed to introduce a novel mathematical model for preoperative precalculated pelvic tilt (PT) in patients with thoracolumbar kyphosis due to ankylosing spondylitis (AS) after three-column osteotomy.

METHODS: A total of 20 patients with AS, including 19 men and one woman, who underwent three-column osteotomy from April 2017 to April 2021, in the study hospital were retrospectively reviewed. Spinopelvic parameters, including global kyphosis, pelvic incidence, sacral slope, PT, sagittal vertical axis, horizontal distance between hip axis and hilus pulmonis (HDHH), measured on preoperative, postoperative, and final follow-up radiographs were analyzed. A coordinate diagram was created on the lateral spine radiographs with the hip axis as the origin. The distances and angles between the osteotomy apex, hilus pulmonis, and hip axis were measured, and a mathematical model was established using basic vector functions. The planned osteotomy angle was substituted into the mathematical model to obtain precalculated postoperative PT. Paired sample t-test was performed to determine the differences between planned osteotomy angle and actual osteotomy angle and between predictive postoperative PT and actual postoperative PT.

RESULTS: Seven patients underwent single-level osteotomy, and 13 patients underwent two-level osteotomy. No significant difference was observed between the planned osteotomy angle and the actual osteotomy angle. No statistically significant difference was found between the precalculated postoperative PT and the actual postoperative PT.

CONCLUSIONS: The novel mathematical model was reliable in predicting postoperative PT in patients with AS undergoing three-column osteotomy.

PMID:40742613 | DOI:10.1007/s00402-025-06011-7

J Robot Surg. 2025 Jul 31;19(1):439. doi: 10.1007/s11701-025-02619-4.

ABSTRACT

The use of robotic assistance in colorectal surgery has mainly shown benefit in low rectal resections. The comparisons between robotic and laparoscopic high anterior resections have largely reported similar clinical outcomes at the expense of higher cost and longer operative time in the former. Most of these involve unmatched retrospective studies based on earlier robotic systems. The current study aims to provide contemporary data from a center with an established robotic surgery practice. Patients who underwent elective robotic anterior resections between January 2021 and December 2023 were propensity-score matched with a laparoscopic group. Perioperative management was in accordance with an Enhanced Recovery protocol. Outcomes and histopathological data were compared. One hundred and thirty patients were available for analysis after matching. The use of robotic assistance was associated with significantly less intra-operative blood loss, shorter operative duration, faster recovery of gastrointestinal function, earlier discharge, and lower complication rate. There was no significant difference in tumor characteristics or short-term oncological outcomes. Robotic assistance provides benefits that are clinically significant to both the patient and the healthcare system.

PMID:40742611 | DOI:10.1007/s11701-025-02619-4

JAMA Netw Open. 2025 Jul 1;8(7):e2522732. doi: 10.1001/jamanetworkopen.2025.22732.

ABSTRACT

IMPORTANCE: The Parent-Focused Redesign for Encounters, Newborns to Toddlers (PARENT) trial demonstrated increased anticipatory guidance and well child care visit (WCV) attendance but no effect on emergency department (ED) utilization.

OBJECTIVE: To assess whether the PARENT intervention was associated with lower non-WCV costs, and whether the increasing WCV attendance might offset recurring intervention costs.

DESIGN, SETTING, AND PARTICIPANTS: The PARENT cluster-randomized clinical trial was conducted from March 5, 2019, to July 14, 2022. This secondary cost analysis was conducted throughout the trial and continued to November 15, 2024. Participants included 937 enrolled parents with a child younger than 2 years presenting for a WCV at 10 clinics from 2 federally qualified health centers (FQHCs). Data on utilization and estimated cost of care using a unit cost approach were collected. Parents were interviewed at baseline and 6 and 12 months and asked about the number of encounters and the child’s diagnosis for subspecialty referrals, urgent care visits, ED visits, and hospitalizations.

INTERVENTION: PARENT is a team-based approach to health care that uses a trained community health worker as part of the well child care team to provide preventive care services to children aged 0 to 2 years.

MAIN OUTCOMES AND MEASURES: The main outcome of this analysis was 2016 unit cost estimates for subspecialty referrals, urgent care visits, ED visits, and hospitalizations by health condition and child’s age using data from the US Disease Expenditure Study.

RESULTS: Among 937 enrolled PARENT participants, 785 (83.8%) completed the 12-month interview and were included in analyses. Mean (SD) child age at enrollment was 4.4 (4.0) months, and most participants were mothers (868 of 914 with available data [95.4%]) and were Medicaid insured (855 of 914 with available data [93.5%]). The intervention group had statistically significant lower costs than the control group for both subspecialty referrals (-$213; 95% uncertainty interval [UI], -$540 to -$106) and total cost of urgent care visits, ED visits, and hospitalizations (-$70; 95% UI, -$150 to -$13). Based on the mean (SD) volume of newborns across all participating clinics (5.8 [4.1] newborns per week), marginal revenue from increased WCV attendance was greater than annual community health worker salary and benefits costs under select current reimbursements.

CONCLUSIONS AND RELEVANCE: This secondary analysis of a cluster-randomized clinical trial suggests that the cost of the PARENT intervention was offset by savings in non-WCV health care utilization, and revenue for federally qualified health centers from increased WCV attendance could fund ongoing intervention costs.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03797898.

PMID:40742591 | DOI:10.1001/jamanetworkopen.2025.22732

JAMA Netw Open. 2025 Jul 1;8(7):e2524154. doi: 10.1001/jamanetworkopen.2025.24154.

ABSTRACT

IMPORTANCE: Injury is a leading cause of morbidity and mortality among children worldwide. Prevention strategies rely on timely and accurate injury surveillance. Many national programs, including the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), depend on manual review of emergency department (ED) medical records to track injury trends. Rising ED volumes have strained manual processes, delaying data analysis and compromising early detection of public health risks.

OBJECTIVE: To evaluate whether natural language processing (NLP) transformer models can automate injury case detection in ED medical records, improving CHIRPP workflow efficiency while maintaining high sensitivity.

DESIGN, SETTING, AND PARTICIPANTS: Prognostic study of ED visits from January 1, 2017, to December 31, 2023, at The Hospital for Sick Children, a high-volume tertiary pediatric referral center in Toronto, Canada, and a core CHIRPP site. The dataset included pediatric ED visits across all age groups. All medical records were labeled as requiring or not requiring CHIRPP reporting, with no exclusions. Two transformer-based NLP models, DistilBERT-base-uncased (model 1) and BERT-large-uncased (model 2), were fine tuned using supervised learning to classify medical records as CHIRPP-reportable or not.

EXPOSURE: Application of fine-tuned NLP transformer models to routine ED visit data to automate classification of injury-related cases for surveillance reporting.

MAIN OUTCOMES AND MEASURES: Outcomes included true positive rate (TPR), true negative rate (TNR), false positive rate (FPR), false negative rate (FNR), area under the receiver operating characteristic curve (AUROC), and area under the precision-recall curve (AUPRC). Additional outcomes included the proportion of medical records requiring manual review to achieve 90% sensitivity.

RESULTS: Among 217 173 pediatric ED visits across all age groups, model 1 achieved an AUROC of 0.983, AUPRC of 0.932, TPR of 0.90, TNR of 0.99, FPR of 0.014, and FNR of 0.10. Model 2 showed similar performance with an AUROC of 0.983, AUPRC of 0.931, TPR of 0.90, TNR of 0.99, FPR of 0.012, and FNR of 0.09. Both models identified 90% of injury cases while reducing manual medical record review from 100% to 17% of ED visits.

CONCLUSIONS AND RELEVANCE: NLP transformer models accurately automated detecting injury cases in ED patient medical records, with the potential of enabling real-time injury surveillance monitoring.

PMID:40742588 | DOI:10.1001/jamanetworkopen.2025.24154

JAMA Netw Open. 2025 Jul 1;8(7):e2524165. doi: 10.1001/jamanetworkopen.2025.24165.

ABSTRACT

IMPORTANCE: Identification of factors associated with variation in outpatient surgery may further quality improvement efforts to safely reduce postoperative hospital length of stay nationally.

OBJECTIVES: To explore variation in the use of outpatient surgery, incorporating patient, geographic, and hospital factors.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used deidentified administrative claims data from OptumLabs Data Warehouse. Participants included adults who underwent 1 of 10 general, urological, or gynecological operations between January 1, 2015, and June 30, 2021, in the US. Patients who underwent combined procedures or reoperations or had at least 15 Elixhauser comorbidities were excluded. Data were analyzed from July 26 to December 16, 2023.

EXPOSURE: Inpatient or outpatient surgical procedures.

MAIN OUTCOMES AND MEASURES: Multilevel logistic regression assessed variation in the use of outpatient surgery rates by hospital characteristics (bed size, presence of trainees, and rural referral center status) and hospital census division, adjusting for patient factors (age, sex, number of Elixhauser comorbidities, year, and rural-urban commuting area). This multilevel model allowed for the sources of variability to be quantitatively attributed to patient characteristics, geography, and hospital characteristics.

RESULTS: A total of 330 424 (72.3%) of 456 954 included patients underwent outpatient surgery. The median age was 54 (IQR, 41-67) years, and of those with data available, most patients were female (268 692 of 414 193 [64.9%]). The likelihood of outpatient surgery varied significantly by hospital census division for all 10 operations (eg, MIS salpingo-oophorectomy range, 29.6%-58.8%; P < .001). Variation in hospital census division contributed most to outpatient surgery for 8 of 10 operations compared with other patient and hospital characteristics. Hospital census division contributed the greatest degree to the variation in outpatient simple mastectomy (20.6%) and the least to outpatient open ventral hernia repair (0.7%). Multivariable analysis showed that the odds of outpatient surgery for patients from metropolitan areas were higher for minimally invasive salpingo-oophorectomy (odds ratio [OR], 1.62; 95% CI, 1.34-1.95) and open ventral hernia repair (OR, 1.16; 95% CI, 1.09-1.24). Hospitals with 400 or more beds were independently associated with decreased odds of outpatient surgery compared with hospitals with 50 to 199 beds for 4 of 7 operations (MIS paraesophageal hernia repair [OR, 0.58; 95% CI, 0.47-0.71; P < .001]; MIS cholecystectomy [OR, 0.73; 95% CI, 0.68-0.78; P < .001]; open ventral hernia [OR, 0.51; 95% CI, 0.46-0.57; P < .001]; MIS ventral hernia repair [OR, 0.66; 95% CI, 0.56-0.77; P < .001]). The presence of a residency training program was independently associated with increased odds of outpatient surgery for simple mastectomy (OR, 1.35; 95% CI, 1.16-1.58; P < .001) and mastectomy with reconstruction (OR, 1.50; 95% CI, 1.27-1.77; P < .001) and decreased odds of outpatient surgery for minimally invasive cholecystectomy (OR, 0.96; 95% CI, 0.92-1.00; P = .04), open ventral hernia repair (OR, 0.93; 95% CI, 0.86-1.00; P = .04), and total thyroidectomy (OR, 0.84; 95% CI, 0.71-1.00; P = .04).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, significant variation existed in the use of outpatient surgery in the US and appeared to be driven primarily by hospital geography. Addressing these variations may improve the use of resources.

PMID:40742587 | DOI:10.1001/jamanetworkopen.2025.24165

JAMA Netw Open. 2025 Jul 1;8(7):e2524201. doi: 10.1001/jamanetworkopen.2025.24201.

ABSTRACT

IMPORTANCE: Legal barriers during cancer care contribute to longstanding disparities and lead to adverse health outcomes in vulnerable populations, yet their prevalence remains unknown.

OBJECTIVE: To identify and characterize legal barriers for patients with cancer who reached out to a legal navigation program.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the Legal & Financial Navigation (LFN) database of Triage Cancer, a nationwide nonprofit organization providing free education on legal issues faced by individuals with cancer, between March 1, 2021, and December 31, 2024. Participants included patients with cancer and caregivers and health care professionals calling on a patient’s behalf.

EXPOSURES: Sociodemographic, financial, and disease-site characteristics of patients.

MAIN OUTCOMES AND MEASURES: The main outcome was the primary legal issue prompting use of Triage Cancer’s LFN. Sociodemographic, financial, and disease-site factors of patients were characterized, and the associations of these factors with the primary legal issue were explored with logistic regression models.

RESULTS: A total of 5810 calls (3883 [66.8%] by patients, 1091 [18.8%] by caregivers, and 597 [10.3%] by health care professionals) were investigated in reference to patients from 50 US states (3710 [63.9%] female; 3293 [56.7%] aged 40 to 64 years). Patients were primarily insured (4436 [76.4%]), 2533 (43.6%) had annual household income below $50 000, and 2808 (48.3%) were in active cancer treatment. Almost half of patients (2807 [48.3%]) had 2 or more legal barriers. The most common primary barriers were health insurance (1648 [28.4%] requested help navigating claim denials, appeals, or health insurance), followed by finances (1194 [20.6%] needed help with financial assistance and housing), employment (1095 [18.8%] needed help navigating wrongful termination, working through treatment, taking time off, or unemployment benefits), and disability insurance (1082 [18.6%] needed help navigating claim denials or applying for and transitioning off disability insurance). Black or African American compared with White patients had lower odds of needing assistance with health insurance (odds ratio [OR], 0.66; 95% CI, 0.50-0.87); Black or African American compared with White patients (OR, 1.52; 95% CI, 1.12-2.05) and patients living in the South compared with the Northeast (OR, 1.32; 95% CI, 1.04-1.67) more often sought assistance for financial barriers; and patients with household income below $20 000 compared with over $100 000 (OR, 0.34; 95% CI, 0.14-0.87) and those with Medicaid (OR, 0.36; 95% CI, 0.13-0.99) or marketplace insurance (OR, 0.37; 95% CI, 0.23-0.60) vs employer-sponsored insurance less often sought assistance for employment.

CONCLUSIONS AND RELEVANCE: This cohort study examining legal barriers to cancer care access faced by patients with cancer and their caregivers found that certain populations may have greater need for legal navigation. In light of recent federal policies supporting reimbursement for complex care coordination and unmet social services needs in patients with cancer, these findings suggest a need for health care teams to better understand cancer-related legal issues and design more accessible legal navigation services.

PMID:40742586 | DOI:10.1001/jamanetworkopen.2025.24201

JAMA Netw Open. 2025 Jul 1;8(7):e2524302. doi: 10.1001/jamanetworkopen.2025.24302.

ABSTRACT

IMPORTANCE: Homelessness is an important risk factor for premature death, with individuals experiencing homelessness having substantially higher mortality rates than the general population.

OBJECTIVE: To assess the association of housing and support interventions with mortality among individuals experiencing homelessness and mental illnesses.

DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of a randomized clinical trial included 2255 homeless adults with mental illnesses. The study was conducted in 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montreal, and Moncton). Recruitment took place from October 2009 to July 2011; mortality data were collected until March 30, 2019. Due to the complexity of accessing health administrative data, analyses were conducted and completed between February 2021 and December 2023.

EXPOSURE: Participants were randomized to receive either the Housing First (HF) intervention, which provided immediate permanent, scattered-site housing and support through intensive case management or assertive community treatment to chronically homeless individuals, or treatment as usual (TAU).

MAIN OUTCOMES AND MEASURES: Mortality rate ratios were ascertained at each site using health administrative databases. Adjusted hazard ratios were computed using Cox proportional hazard survival models. Random-effects meta-analysis was used to calculate pooled effect sizes across sites.

RESULTS: Of the 2255 total participants, 2108 (93.5%) were successfully linked with health administrative data; among them, 1434 (68.0%) were male, with a mean (SD) age of 40.6 (11.5) years. Mortality rates were not different in the HF compared with TAU groups (pooled log mortality rate ratio, -0.07; 95% CI, -0.36 to 0.22). The pooled adjusted hazard ratio comparing mortality in the HF and TAU groups was 0.83 (95% CI, 0.43-1.22).

CONCLUSIONS AND RELEVANCE: In this secondary analysis of a randomized clinical trial, the HF intervention was not directly associated with mortality risk. Research is needed to determine whether adjunctive interventions could reduce mortality among homeless individuals with mental illnesses.

TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN42520374.

PMID:40742585 | DOI:10.1001/jamanetworkopen.2025.24302

JAMA Netw Open. 2025 Jul 1;8(7):e2524368. doi: 10.1001/jamanetworkopen.2025.24368.

ABSTRACT

IMPORTANCE: Prehospital transfusion (PHT) of blood products by emergency medical services (EMS) has become common in civilian settings. However, variability exists in practices across the US. There are few large-scale data describing US civilian PHT with regard to blood products administered, potential exposure of females of childbearing potential to D-positive blood, or the proportion of PHT cases occurring in EMS transports of short duration.

OBJECTIVE: To evaluate nationwide PHT trends, regional differences, and potential risks, particularly for D-positive blood administration in females of childbearing potential.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study, Characteristics, Regional Evaluation, and D-Antigen in Transfusions by EMS (CREDIT-EMS), assessed data collected from January 1, 2020, to October 31, 2024 (before hypothesis generation), in trauma and nontrauma patients of all ages treated in 48 states in the US.

EXPOSURE: Prehospital-initiated transfusion of blood products.

MAIN OUTCOMES AND MEASURES: Age, sex, blood product characteristics (including blood type), and transport time. Comparative analyses were conducted using Pearson χ2, Wilcoxon rank sum, and nonparametric trend tests. Proportions were reported with binomial exact 95% CIs.

RESULTS: The study analyzed 10 444 patients (median [IQR] age, 45 [29-63] years; 7302 of 10 439 [70.0%] male) who received 18 177 units of blood products. The proportion of transfused units that were whole blood (WB) increased from 10.0% in 2020 to 30.8% in 2024 (P < .001). Regional variations in PHT were identified, with the Northeast having the highest proportion of WB use (33.2% of PHT). A total of 1589 (15.2%; 95% CI, 14.5%-15.9%) of the study patients were females of childbearing potential (aged 12-50 years), with an increasing number receiving D-positive blood products over time (73 of 169 [43.2%] in 2020 to 372 of 497 [74.9%] in 2024) (P < .001). Prehospital times were 20 minutes or less in only 255 of 10 343 cases (2.5%; 95% CI, 2.2%-2.8%).

CONCLUSIONS AND RELEVANCE: This cohort study of civilian PHT practices in the US found geographic and temporal variability. There was increasing adoption of WB and significant implications for females of childbearing potential who are increasingly likely to receive D-positive PHT. Cases of PHT uncommonly involved short prehospital duration. These findings highlight the need for standardized protocols and further evaluation of risk-benefit considerations.

PMID:40742584 | DOI:10.1001/jamanetworkopen.2025.24368

JAMA. 2025 Jul 31. doi: 10.1001/jama.2025.11661. Online ahead of print.

ABSTRACT

IMPORTANCE: The Department of Veterans Affairs (VA) Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act expanded opportunities for veterans to obtain care outside the VA. However, the impact on health care outcomes is uncertain.

OBJECTIVE: To measure the MISSION Act’s impact on travel times and outcomes of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and aortic valve replacement (AVR).

DESIGN, SETTING, AND PARTICIPANTS: This retrospective difference-in-differences cohort study included veterans receiving nonemergent/nonurgent PCI, CABG, or AVR between October 2016 and September 2022 in non-VA hospitals under MISSION Act coverage or in VA hospitals in the 48 contiguous US states or the District of Columbia. Analyses were conducted in 2023-2024.

EXPOSURES: Veterans eligible for non-VA care under the MISSION Act by living far from ( >60 minutes) the nearest VA medical center vs veterans living near (≤60 minutes) a VA medical center.

MAIN OUTCOMES AND MEASURES): Major adverse cardiovascular events (MACE), defined as rehospitalization for cardiovascular cause or mortality within 30 days of the procedure, and travel times for care were the primary outcomes.

RESULTS: The cohort comprised veterans receiving PCI (n = 43 000; 42 066 [98%] male; mean [SD] age, 69 [8.8] years), CABG (n = 23 301; 22 197 [98%] male; mean [SD] age, 69 [7.7] years), or AVR (n = 14 682; 14 336 [98%] male; mean [SD] age, 74 [9.6] years). After MISSION implementation, mean PCI travel times increased by 1.3 minutes for near patients and decreased by 29.2 minutes for far patients (difference in differences, -30.5 minutes; P < .001). Mean CABG travel times increased by 9.4 minutes for near patients and decreased by 18.1 minutes for far patients (difference in differences, -27.4 minutes; P < .001). Mean travel times for AVR increased by 10.0 minutes for near patients and decreased by 23.0 minutes for far patients (difference in differences, -33.1 minutes; P < .001). After MISSION implementation, mean PCI MACE rates decreased by 0.5 percentage points for near patients and increased by 2.3 percentage points for far patients (difference in differences, 2.8 percentage points; P <.001). Mean CABG MACE rates decreased by 6.5 percentage points for near patients and increased by 1.6 percentage points for far patients (difference in differences, 8.1 percentage points; P < .001). AVR MACE rates were not statistically different between the groups (P = .45).

CONCLUSIONS AND RELEVANCE: MISSION Act implementation was associated with substantial decreases in travel times among veterans who became geographically eligible for non-VA care. For these patients undergoing PCI or CABG, MISSION Act implementation was also associated with worsened 30-day MACE rates.

PMID:40742582 | DOI:10.1001/jama.2025.11661