Tag: pubmed

BMC Emerg Med. 2025 Apr 20;25(1):69. doi: 10.1186/s12873-025-01191-2.

ABSTRACT

BACKGROUND: Cancer-related emergencies are a significant challenge for healthcare systems globally, including Jordan. Effective triage is critical in ensuring timely and accurate prioritization of care, especially for surgical cancer patients requiring urgent intervention. However, under-triage-misclassification of high-acuity patients into lower urgency categories-can lead to significant delays and worsened outcomes. Despite the recognized importance of accurate triage, limited research has evaluated its impact on cancer patients in Jordan, particularly those requiring surgical care.

OBJECTIVES: This study aimed to evaluate the timeliness and prioritization of care for cancer patients admitted through the emergency department (ED) in Jordan. The specific objectives were to examine the association between under-triage and treatment delays and assess its impact on key outcomes, including time to physician assessment, time to treatment, and hospital length of stay.

METHODS: A retrospective cohort design was used to analyze data from 481 cancer patients admitted through the ED in four governmental hospitals across Jordan. Two cohorts were established: surgical cancer patients requiring emergency interventions and non-surgical cancer patients presenting with other oncological emergencies. Triage accuracy was assessed using the Canadian Triage and Acuity Scale (CTAS), and under-triage was identified when patients requiring high urgency care (CTAS I-III) were misclassified into lower urgency categories (CTAS IV-V). Data were collected from electronic health records and analyzed using multiple linear regression to evaluate the association between under-triage and treatment outcomes.

RESULTS: The majority of patients were elderly, with a mean age of 62.6 years (± 10.7), and a significant proportion presented with advanced-stage cancer (83.4% in stages III and IV). Surgical patients frequently exhibited severe symptoms such as acute pain (51.6%) and respiratory discomfort (41.1%). Under-triage rates were 44.1% for surgical patients and 39.4% for non-surgical patients. Among surgical patients, under-triage significantly delayed time to physician assessment (β = 34.9 min, p < 0.001) and time to treatment (β = 68.0 min, p < 0.001). For non-surgical patients, under-triage delays were even greater, with prolonged physician assessment times (β = 48.6 min, p < 0.001) and ED length of stay (β = 7.3 h, p < 0.001). Both cohorts experienced significant increases in hospital length of stay (surgical: β = 3.2 days, p = 0.008; non-surgical: β = 3.2 days, p < 0.001).

CONCLUSION: Under-triage in Jordanian EDs is strongly associated with significant delays in care for both surgical and non-surgical cancer patients, highlighting systemic gaps in acuity recognition and triage processes. These findings underscore the need for targeted interventions to improve triage accuracy, particularly through oncology-specific training and the integration of evidence-based tools like SIRS criteria. Enhancing ED processes for cancer patients is crucial to reducing delays, optimizing resource allocation, and improving clinical outcomes in this vulnerable population.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40254595 | DOI:10.1186/s12873-025-01191-2

Rehabilitacion (Madr). 2025 Apr 19;59(2):100907. doi: 10.1016/j.rh.2025.100907. Online ahead of print.

ABSTRACT

Virtual reality (VR) is emerging technologies in the field of rehabilitation of post-stroke patients. The aim of this study was to systematically explore the effects of VR rehabilitation program on functional capacity of stroke patients. We conducted a systematic review and meta-analysis. The searches were carried out in the PubMed/Medline, Web of Science, PEDro and OTSeeker to October 2024. Methodological quality was assessed using the Downs and Black scale and the Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess risk of bias. A total of 4 studies met the inclusion criteria. The type of VR intervention varied among studies using Wii Fit, ARMEO Spring 1.1, Rehabilitation Gaming System and ArmAble™. The meta-analysis indicated that the VR group showed statistically significant improvement in functional ability versus control group. The methodological quality mean was moderate quality level. VR interventions seem to be a promising therapeutic system for functional capacity rehabilitation in people with post-stroke.

PMID:40253724 | DOI:10.1016/j.rh.2025.100907

J Community Health Nurs. 2025 Apr 20:1-18. doi: 10.1080/07370016.2025.2487702. Online ahead of print.

ABSTRACT

PURPOSE: To understand the impact of post-acute sequelae of COVID-19 (PASC) on quality of life (QOL) in a Midwestern community sample.

DESIGN: Anonymous online cross-sectional community survey.

METHODS: Survey responses collected July 2023-October 2024 were examined from 1,564 individuals reporting prior COVID-19 positive test or diagnosis. Logistic regressions and sensitivity analyses using subset of data were conducted to identify symptoms significantly associated with perceived Current QOL (determined by “Taking everything in your life into account, please rate your current overall QOL”) and Deteriorated QOL (i.e., Current QOL rated lower than QOL prior to SARS CoV-2 infection).

FINDINGS: Current QOL was predicted by pre-infection QOL and more frequent experiences of work/school difficulties, challenges with shopping/cleaning/driving/meal-prep, anxiety, depression, fatigue/tiredness, light headedness/fainting/rapid heartbeat episodes, and diminished activity/exercise tolerance (C-statistic = 0.84). Compared to the full dataset’s primary analyses, sensitivity analysis revealed all identified predictors except three physical symptoms remained significant Current QOL predictors. Deteriorated QOL after SARS-CoV-2 infection was predicted by pre-infection QOL, and more frequent experiences of work/school difficulties, diminished activity/exercise tolerance, anxiety, depression, trouble completing daily activities, fatigue/tiredness, and slow mental processing (C-statistic = 0.85). In contrast, sensitivity analysis revealed frequency of SARS-CoV-2 infection, pre-infection QOL, and more frequent challenges with shopping/cleaning/driving/meal-prep were the only significant predictors of Deteriorated QOL.

CONCLUSIONS: PASC negatively impacted QOL. Pre-infection QOL may influence perceived post-infection QOL.

CLINICAL EVIDENCE: Results make a compelling case for community nurses to identify PASC, rule-out underlying medical causes, and refer patients for interdisciplinary post-COVID rehabilitation to improve health outcomes and QOL.

PMID:40253714 | DOI:10.1080/07370016.2025.2487702

Scand J Clin Lab Invest. 2025 Apr 20:1-6. doi: 10.1080/00365513.2025.2494261. Online ahead of print.

ABSTRACT

This study evaluates the utility of leftover EDTA whole blood from a diagnostic biobank for determining concentrations of ferritin, cobalamin, homocysteine, hCG, and thyroid-related hormones and antibodies (TSH, fT4, fT3, TRAb, and anti-TPO). Twenty participants were included. Pre-analytical bias in their blood samples was assessed as per European Federation of Clinical Chemistry and Laboratory Medicine Milano performance specifications. We evaluated the stability of EDTA whole blood stored at various intervals (days 0, 1, 6, and 13), and compared plasma derived from these samples with serum samples. Bland Altman plots and Paired t-test were used to identify statistically significant differences. We found good quantitative agreement, with biases within set performance specifications for cobalamin (14%), fT4 (3.5%), fT3 (3.6%), TSH (15%), and ferritin (7.4%). The calculated biases for serum vs. EDTA plasma day 6 were as follows: cobalamin 1.9%, fT4 2.6%, fT3 0.4%, TSH -2.1%, and ferritin -4.5%. The biases for homocysteine exceeded limits in all comparisons, except serum vs. EDTA plasma on day 0 and between EDTA plasma from day 0 and day 1. The calculated bias of 41% exceeded the set limit of 13% when comparing serum with EDTA plasma day 6. For hCG, anti-TPO, and TRAb, limited measurable levels restricted bias calculations. As per the diagnostic biobank protocols, EDTA blood stored for up to 6 days provides plasma suitable for analyzing cobalamin, fT4, fT3, TSH, and ferritin. Our study confirms previous findings that homocysteine has poor stability in whole blood.

PMID:40253713 | DOI:10.1080/00365513.2025.2494261

Aging Ment Health. 2025 Apr 20:1-9. doi: 10.1080/13607863.2025.2468893. Online ahead of print.

ABSTRACT

OBJECTIVES: This study presents findings from IDEA Café, for older adults aged 50 and older living with early dementia, dementia, Alzheimer’s Disease or cognitive impairment (ED/CI) with no informal caregiver or care partner. IDEA Café is a group adaptation of Innovations in Dementia Empowerment and Action (IDEA) (built upon the foundation of RDAD). It was tested with sexual and gender minority (SGM) older adults, as an underserved population.

METHOD: Employing a two-group randomized controlled pilot trial, thirty participants were randomly assigned to IDEA Café (n = 15) or routine medical care (RMC; n = 15). Feasibility and acceptability were assessed. We conducted pre- and post-treatment assessments of primary and secondary outcomes.

RESULTS: IDEA Café was feasible (attendance, participation), acceptable (helpfulness of the program), and met enrollment goals, with 85% of participants reporting treatment as helpful. The treatment group showed significant improvement in physical functioning (p = 0.04), depressive symptomology (p = 0.03), quality of life (p = 0.04), and a reduction in microaggressions (p = 0.05) and social exclusion (p = 0.03). The RMC showed no statistical change from pretest to posttest.

CONCLUSION: A future randomized controlled trial is needed to test the efficacy and sustainability of the intervention and to bring the intervention to scale.

PMID:40253707 | DOI:10.1080/13607863.2025.2468893

Age Ageing. 2025 Mar 28;54(4):afaf106. doi: 10.1093/ageing/afaf106.

ABSTRACT

BACKGROUND: Orthogeriatric care has been shown to effectively reduce mortality and morbidity and has a potential impact on health-related quality of life (HRQoL). This systematic review and meta-analysis summarises the effects of orthogeriatric care on HRQoL in hip fracture patients.

METHODS: The review protocol was registered in International Prospective Register of Systematic Reviews (PROSPERO): CRD42021206280. We searched Medline and EMBASE from inception to January 2024 without language restrictions. We included randomised and non-randomised controlled trials comparing HRQoL in older hip fracture patients receiving orthogeriatric care to other fracture care. Study quality was evaluated using the Revised Cochrane Risk-of-Bias (RoB) tool or the Newcastle-Ottawa Scale (NOS). Pooled standardised mean differences (SMDs) were calculated using random-effects models. We reported according to the Preferred Reporting Items of Systematic reviews and Meta-Analyses guidelines.

RESULTS: Eight studies involving 2411 patients were included, all employing various orthogeriatric care models with moderate to good methodological quality, based on the RoB tool and NOS. However, substantial clinical heterogeneity was present due to variations in study design, number and execution of intervention components, outcome measures and patient populations. Despite this variability, meta-analysis showed that in-hospital orthogeriatric care, compared to usual care, led to a small but statistically significant improvement in overall HRQoL (SMD 0.18, 95% CI 0.06-0.30) with moderate heterogeneity (I2 = 47%).

CONCLUSION: In-hospital orthogeriatric care has a small but significant effect on HRQoL. This study highlights the need for clear descriptions of orthogeriatric care models, their implementation, fidelity and contextual factors. High-quality future research is essential to advance clinical practice, refine care models, address methodological limitations and prioritise patient-centred short- and long-term HRQoL outcomes.

PMID:40253688 | DOI:10.1093/ageing/afaf106

Age Ageing. 2025 Mar 28;54(4):afaf096. doi: 10.1093/ageing/afaf096.

ABSTRACT

BACKGROUND: Hospital-based Special Care Units (SCU) for dementia show promise as effective models of care. However, limited research describes hospital-wide benefits.

OBJECTIVE: To describe patient-level outcomes and hospital service-level outcomes of a SCU.

DESIGN: Pre-post analyses of SCU-patient data and hospital service-unit incident report data.

SETTING, PARTICIPANTS: 2-years of SCU-patient admissions and 4-years of hospital incident-reports from four medical wards (2-years pre-post SCU).

METHODS: Admission and discharge severity of SCU-patients’ behaviour was prospectively measured by specialist SCU nurses. One-year hospitalisation rates, length-of-stay, diagnosis and patient demographics were retrospectively obtained from medical records. Hospital service-unit data included 4 years of monthly incident report rates for falls, pressure injury and occupational violence (OV) across four medical wards. Analysis of count data used Poisson and Negative Binomial Regression models.

RESULTS: 121 SCU admissions involved 107 unique patients. Median SCU LoS was 23 days (interquartile range [IQR], 13-50), and stabilisation of behaviour severity took 11 days (IQR 6-12). Barriers to discharge related to substitute decision-making and care facility availability. After SCU discharge, yearly hospitalisation rates for ‘all-reasons’ decreased by 68% (Incident Rate Ratio [IRR], 0.32, 95% CI, 0.23-0.43), and 83% for behaviour-related admissions (IRR 0.17, 95% CI, 0.11-0.28). For hospital service-unit outcomes, falls-per-month decreased by 21% (IRR 0.79, 95% CI 0.64-0.99) after SCU implementation and OV by 26% (IRR, 0.74, 95% CI 0.59-0.94).

CONCLUSIONS: A hospital-based SCU reduced hospital health service demand through decreased SCU-patient readmissions and was associated with decreased falls and OV rates across hospital medical wards.

PMID:40253685 | DOI:10.1093/ageing/afaf096

Age Ageing. 2025 Mar 28;54(4):afaf093. doi: 10.1093/ageing/afaf093.

ABSTRACT

BACKGROUND: Emergency departments (EDs) in England are under significant strain, with increasing attendances and extended wait times, affecting frail older adults. The clinical frailty scale (CFS) has been implemented as a tool to assess frailty in ED settings, but its reliability and predictive accuracy as a screening tool remain debated.

OBJECTIVE: To evaluate the use and variability of the CFS in EDs and its association with patient outcomes, including discharge rates, length of stay, readmission and mortality.

METHODS: A retrospective cohort study of ED attendances at two London (UK) hospitals from 2017 to 2021. Data included CFS scores, demographics, clinical observations and outcomes. Comparative statistics, logistic regression, Cox proportional hazards models and competing risk regression were applied to examine CFS predictive validity.

RESULTS: In a sample of 123 324 ED visits, CFS scores strongly correlated with adverse outcomes: e.g. for long-term mortality (n = 33 475, events = 8871), each CFS single-point increase was associated with a 25% increase in mortality risk (95% CI 1.23-1.26). CFS scores varied significantly between raters and across visits, median difference two levels (interquartile range 1-3). Intraclass correlation coefficient analysis showed that 33.1% of CFS score differences was attributable to between-patient differences, 15.4% to inter-rater differences, with 51.5% residual variance from non-frailty factors, such as acute illness severity.

CONCLUSION: The CFS is associated with crucial patient outcomes in the ED. Inter-rater variability and potentially confounding factors can limit its consistency. Automation to enhance CFS score reliability should be explored as a means to support proactive management.

PMID:40253684 | DOI:10.1093/ageing/afaf093

World J Urol. 2025 Apr 20;43(1):236. doi: 10.1007/s00345-025-05608-2.

ABSTRACT

BACKGROUND: Hugo RAS is a novel robotic platform gaining global adoption. Most reported outcomes come from centers with prior Da Vinci experience, with limited data from robotic-naïve settings or comparisons based on prior robotic expertise.

OBJECTIVE: To compare outcomes of Hugo RAS robot-assisted radical prostatectomy (RARP) performed by Da Vinci-experienced (DVE) versus non-Da Vinci-experienced (NDVE) surgeons.

DESIGN, SETTING, AND PARTICIPANTS: Prospective data from patients undergoing Hugo-RARP (July 2022-November 2024) were analyzed. Patients were grouped based on whether their surgeon had prior Da Vinci experience. None had prior Hugo-RAS experience.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcomes were positive surgical margin (PSM) and complication rates. Secondary outcomes included operative time (OT), estimated blood loss (EBL), length of stay (LOS), continence, and potency. Propensity score matching adjusted for baseline differences.

RESULTS AND LIMITATIONS: After matching, 117 patients per group were analyzed. PSM rates (17% vs. 21%; p = 0.40) and complications (p = 0.63) were similar. DVE surgeons had shorter OT (179 vs. 206 min; p < 0.001) and lower EBL (127 vs. 161 ml; p = 0.008). LOS did not differ (p = 0.84), and 12-month functional and oncological outcomes were comparable. Limitations include the non-randomized, single-center design.

CONCLUSIONS: Hugo RAS enables safe and effective RARP with comparable outcomes regardless of prior robotic experience. Prior Da Vinci experience, however, improves intraoperative efficiency.

PMID:40253671 | DOI:10.1007/s00345-025-05608-2

Cancer Control. 2025 Jan-Dec;32:10732748251335365. doi: 10.1177/10732748251335365. Epub 2025 Apr 20.

ABSTRACT

Introduction: Male breast cancer is an uncommon disease, representing a fraction of all breast cancer diagnoses. This study examines the characteristics, treatment, and outcomes of males with breast cancer at a community academic institute in central Illinois.Methods: We retrospectively reviewed the medical records of male patients with breast cancer treated between 2000 and 2021. This review focuses on patient demographics, tumor characteristics, treatment modalities, and recurrence and survival rates. We evaluated the association of epidemiological factors and clinical outcomes with patient age, tumor stage, and grade, as well as tumor hormone receptor status.Results: Our study included 81 male patients, predominantly white, with a median age of 67 years. Most cases presented estrogen receptor-positive (96.1%) and progesterone receptor-positive (93.5%) tumors, while only 13.5% had HER-2 neu receptor-positive expression. Staging distribution was 34.6% at Stage I, 47.4% at Stage II, and 17.9% at Stages III/IV among 78 patients. Recurrence occurred in 20.8% of 77 patients, with a 5-year recurrence-free survival rate of 76.2%. The 5-year overall survival rate of all 81 patients was 63.4%. Age and disease stage were significantly associated with mortality (P = .041 and P = .0028, respectively).Conclusion: Our findings align with national trends in male breast cancer demographics and outcomes, with comparable survival statistics. Increased awareness and targeted research are critical to improving management and prognosis for this patient population. Further studies are necessary to elucidate the molecular basis of male breast cancer and to refine treatment guidelines.

PMID:40253653 | DOI:10.1177/10732748251335365