Tag: pubmed

Clin Toxicol (Phila). 2026 May 15:1-8. doi: 10.1080/15563650.2026.2661378. Online ahead of print.

ABSTRACT

INTRODUCTION: Poison information centres advise health professionals on toxic exposures and recommend appropriate responses, preventing transfer where hospital treatment is not required. No study to date has detailed ambulance enquiries for poison information in Great Britain. The aim of this study is to describe ambulance services’ use of the National Poison Information Service through helpline calls and TOXBASE^® accesses.

METHODS: Retrospective records analysis of ambulance calls and TOXBASE^® accesses between 1 April 2022 and 31 March 2023 in England, Scotland, and Wales. The data were analysed descriptively with frequency statistics calculated for patient demographics, characteristics of the poisoning, and advice for transfer to onward care.

RESULTS: There were 4,053 ambulance enquiries, representing 11.0% of calls. The rate of calls per 100,000 population was 6.9 for English, 3.2 for Welsh, and 0.4 for Scottish ambulance services. Conversely, the rate of TOXBASE^® accesses was 369.2 per 100,000 for English, 233.9 for Scottish, and 111.9 for Welsh ambulance services. Phone enquiries were mostly for intentional poisoning (2342/4053 [57.8%]) involving pharmaceuticals (3502/4053 [86.4%]). Most enquiries were benign exposures at the time of the call; Poisoning Severity Score None or asymptomatic (2256/4053[55.7%]) or Minor (1536/4053[37.9%]). Most calls resulted in advice for patient transfer to definitive care (3114/4053, 76.8%). For calls and TOXBASE^® accesses, the most common agent was paracetamol.

DISCUSSION: Ambulance services in Great Britain commonly seek poison information to inform patient management by phone and TOXBASE^®. Calls primarily relate to intentional poisoning with advice to transfer to further care. Yet, for a quarter of cases no further care is advised which likely has a cost-saving effect. Further research is needed to explore how and when paramedics seek poison information.

CONCLUSIONS: These data emphasise the importance of ensuring poisons management advice is tuned to ambulance services’ needs to ensure appropriate management and patient transfer.

PMID:42137929 | DOI:10.1080/15563650.2026.2661378

EuroIntervention. 2026 May 15;22(10):545-554. doi: 10.4244/EIJ-D-26-00032.

ABSTRACT

BACKGROUND: Despite the growing demand for transcatheter aortic valve implantation (TAVI), there is no strategy to prevent its most common complication: cardiac conduction disturbances (CCD). These disturbances often necessitate permanent pacemaker implantation (PPI), leading to high morbidity and costs. Post-TAVI CCD may be transient, resulting from inflammation.

AIMS: We aimed to evaluate the feasibility, safety, and preliminary efficacy of glucocorticoids in preventing PPI in patients undergoing TAVI.

METHODS: This pilot study followed a Prospective Randomised Open-label Blinded Endpoint (PROBE) design. One hundred TAVI patients were randomised 1:1 to standard care or methylprednisolone (7 mg/kg administered 1 hour preprocedure), followed by prednisone (15 mg every 12 hours for 5 days). Electrocardiograms and inflammatory biomarkers were assessed pre- and post-intervention, and at 1 month and 1 year. The primary efficacy endpoint was the 1-month incidence of PPI. Secondary outcomes included 1-year PPI, new left bundle branch block (LBBB), LBBB and PPI, other CCD, mortality, and procedural complications.

RESULTS: The primary efficacy outcome occurred in 16% of the control group and 8% of the intervention group, reflecting a 50% relative risk (RR) reduction in PPI (RR 0.50, 95% confidence interval [CI]: 0.16-1.55; p=0.23). There was no significant difference in 1-year PPI (RR 0.67, 95% CI: 0.26-1.73; p=0.41) or new LBBB (RR 1.12, 95% CI: 0.66-1.89; p=0.66). The intervention was safe, without differences in complications, mortality (4% vs 12%; p=0.27), or adverse events (n=3).

CONCLUSIONS: Glucocorticoids in TAVI are feasible and safe. The observed numerical difference in PPI did not reach statistical significance. Large-scale trials are needed to confirm the results of this pilot study.

PMID:42137921 | DOI:10.4244/EIJ-D-26-00032

EuroIntervention. 2026 May 15;22(10):566-574. doi: 10.4244/EIJ-D-25-01337.

ABSTRACT

BACKGROUND: Dedicated randomised studies on intravascular imaging guidance in unprotected left main coronary artery (LMCA) disease are lacking.

AIMS: We aimed to investigate the clinical feasibility of optical coherence tomography (OCT) guidance in percutaneous coronary intervention (PCI) of true LMCA bifurcation lesions and to evaluate its prognostic impact compared with angiographic guidance.

METHODS: Patients with true LMCA bifurcation lesions who were randomised to either OCT or angiographic guidance in the OCTOBER Trial were included. The feasibility of OCT guidance was assessed as the proportion of patients with successful and analysable OCT pullbacks before, during, and after stenting. Clinical outcomes between the two groups were compared based on the incidence of a composite of major adverse cardiac events (MACE), comprising cardiac death, any myocardial infarction, or target lesion revascularisation.

RESULTS: In total, 227 patients were included (OCT: 111, angiography: 116). OCT guidance was successful, with 98% of cases having a pre-stenting pullback performed and 96% a final pullback, as per protocol. The proximal LMCA stent edge was analysable in 43% of patients, and in the remaining 57%, only 5% were limited by insufficient image quality. No statistically significant difference in MACE was observed between the two groups (OCT: 14.4% vs angiography: 18.4%, hazard ratio 0.78, 95% confidence interval: 0.39-1.51).

CONCLUSIONS: OCT-guided PCI in true LMCA bifurcation lesions was clinically feasible, but visibility of the LMCA ostium was limited by short pullbacks, insufficient clearance, or guide catheter shadowing. OCT guidance was associated with a non-significant reduction in MACE, consistent with the effect estimate in the main trial.

PMID:42137920 | DOI:10.4244/EIJ-D-25-01337

BJOG. 2026 May 15. doi: 10.1111/1471-0528.70260. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare Vaginal Hysterectomy (VH) with Vaginal Assisted Natural Orifice Transluminal Endoscopic Surgery (NOTES) hysterectomy (VANH) as a day-care procedure.

DESIGN: Single-blind, multicentre randomised controlled trial.

SETTING: Two Dutch non-academic teaching hospitals.

POPULATION: Women aged ≥ 18 years undergoing hysterectomy for benign indications.

METHODS: Women were randomised 1:2 (VH or VANH). Primary outcome was SDD. Secondary outcomes included operative time, rate of elective salpingectomies, intraoperative blood loss, complications (Clavien-Dindo), pain scores (NRS) and analgesic use, post-operative recovery (RI-10), and quality of life (EQ-5D-5L). Analyses were performed on an intention-to-treat basis.

RESULTS: A total of 113 patients were included in the analyses (n = 42 VH, and n = 71 VANH). SDD occurred significantly more frequently in the VANH group (87.3%) than VH group (71.4%; OR 2.76, 95% CI 1.04-7.25; p = 0.04). VANH was associated with a significantly shorter operative time (median 55 min versus 65 min; p = 0.005), less blood loss (median 50 mL vs. 150 mL; p < 0.001) and more often elective opportunistic salpingectomy compared to VH (100% vs. 77.4%; p = 0.008). NRS were significantly lower in the VANH group the first hour post-operative (3 vs. 1, p < 0.001). Post-operative complications (VH 9.5% vs. VANH 15.5%; p = 0.34), readmission (VH 4.8% vs. VANH 8.5%; p = 0.47), analgesic use, recovery, and quality of life were not statistically significant.

CONCLUSIONS: VANH is a safe and effective alternative to VH, offering a higher likelihood of SDD, shorter operative time, reduced blood loss, and more often an elective salpingectomy, without increased complications or differences in pain, recovery, or quality of life.

PMID:42137913 | DOI:10.1111/1471-0528.70260

Nat Ment Health. 2026;4(5):792-805. doi: 10.1038/s44220-026-00623-7. Epub 2026 Apr 21.

ABSTRACT

Autism is a heterogeneous condition, and functional magnetic resonance imaging-based studies have advanced understanding of neurobiological correlates of autistic features. Little work has focused on the optimal brain states to reveal brain-phenotype relationships. Here, using connectome-based predictive modeling, we interrogated four datasets to determine scanning conditions that boost prediction of clinically relevant phenotypes and assess generalizability. In dataset one, a sample of youth with autism and neurotypical participants (n = 63), we found that a sustained attention task resulted in high prediction performance of autistic traits compared with a free-viewing social attention task and a resting-state condition. In dataset two (n = 25), we observed the predictive network model of autistic traits generated from the sustained attention task generalized to predict measures of attention in neurotypical adults. In datasets three and four, we determined the same predictive network model further generalized to predict measures of social responsiveness in the Autism Brain Imaging Data Exchange (n = 229) and the Healthy Brain Network (n = 643). Our data suggest an in-scanner sustained attention challenge can help delineate robust markers of autistic traits.

PMID:42137910 | PMC:PMC13167459 | DOI:10.1038/s44220-026-00623-7

Trials. 2026 May 14. doi: 10.1186/s13063-026-09465-1. Online ahead of print.

ABSTRACT

BACKGROUND: Fidelity is defined as the extent to which an intervention is delivered as intended. Without a clear understanding of fidelity to an intervention, variability in implementation may be confounded with observed outcomes, making valid conclusions about the intervention’s efficacy challenging. The MIRROR-TCM (Multisite Replication of a Randomized Controlled Trial – Transitional Care Model) implementation evaluation, discussed here, sought to examine the delivery of the transitional care model (TCM) intervention and factors that influenced fidelity to the implementation of the intervention protocol over time. The TCM includes 10 core components, which aim to support older adults transitioning from the hospital back to the community. The objective of this paper is to describe the operationalization of a fidelity measure for the TCM intervention.

METHODOLOGICAL DEVELOPMENT OF THE FIDELITY SCORE: Fidelity was operationalized at the element, component, and overall intervention levels. The TCM fidelity score examines 38 elements, which are broken into 8 components. Rules to evaluate an element-level, binary (0/1) fidelity scores were established by the study team, which consisted of clinicians and statisticians, and updated through feedback from the advanced practice registered nurses delivering the intervention. Component-level fidelity was assessed as the proportion of total elements completed from each component. Finally, overall fidelity is calculated as the proportion of required elements completed multiplied by 38 or the total possible elements to complete.

CONCLUSION: Proper evaluation of fidelity to the delivery of an intervention is key in evaluating its implementation. This paper provides new methods to calculate fidelity for a complex intervention, which required the incorporation of 38 elements and nuances that did not require all patients to receive all elements, requiring the creation of clear rules for the exclusion of elements for a participant. The fidelity measure was employed throughout implementation and used to give feedback to the study team and improve fidelity. This paper outlines a novel methodology for flexible fidelity scoring in multicomponent interventions, incorporating rule-based exemptions to accommodate variability in real-world implementation. Future work needs to include validation of the metric through evaluation of fidelity at the participant level to examine its association with clinical outcomes in the parent MIRROR-TCM study, overall and by site.

PMID:42135827 | DOI:10.1186/s13063-026-09465-1

J Cardiothorac Surg. 2026 May 14. doi: 10.1186/s13019-026-03994-1. Online ahead of print.

ABSTRACT

BACKGROUND: ECG-gated computed tomography (CT) is not commonly utilized as the primary imaging modality for the diagnosis and management of degenerative mitral valve (MV) disease and preparation for MV intervention typically involves the use of several imaging studies. We hypothesized that CT can accurately identify MV pathology and exclude obstructive coronary artery disease (CAD) in this population potentially obviating the need for routine use of additional imaging modalities.

METHODS: CT was compared to invasive coronary angiography (ICA), transthoracic (TTE) and transesophageal (TEE) echocardiography for identification of coronary artery patency and mitral valve pathology respectively in patients undergoing MV evaluation between January 1, 2019, and December 31, 2023.

RESULTS: 240 patients underwent TTE, TEE, and CT for mitral valve evaluation prior to intervention. Agreement was moderate when CT was compared to TTE for identifying prolapse (71%) and poor for flail segments (51%), with CT being superior. Compared to TEE, CT showed 96% agreement for prolapse (sensitivity 96.5%, CI 92.5-98.7% and specificity 82.3%, CI 71.2-90.5%) and 83% agreement for flail segments (sensitivity 75%, CI 67.8-81.8% and specificity 90.8%, CI 81.9-96.2%). Cohen’s κ statistic was 0.81 and 0.65 for prolapse and flail respectively. 215 patients underwent ICA and CT evaluation followed by valve intervention. CAD prevalence was low at 6.0%. Compared to ICA, CT was 83.3% sensitive (CI 58.6-96.4%) and 97.9% specific (CI 94.9-99.4%) for CAD with excellent agreement (Cohen’s κ = 0.81).

CONCLUSION: As compared to TEE, CT has excellent sensitivity and specificity for diagnosing prolapse and good agreement for flail segments. CT also shows strong agreement with ICA in evaluating CAD. CT provides a non-invasive alternative to TEE and ICA to accurately identify MV pathology and exclude significant CAD.

PMID:42135824 | DOI:10.1186/s13019-026-03994-1

J Cardiothorac Surg. 2026 May 14. doi: 10.1186/s13019-026-04119-4. Online ahead of print.

ABSTRACT

This study aims to compare the early and mid-term follow-up results of total thoracoscopic mitral valve repair versus median sternotomy mitral valve repair. Data from patients with mitral regurgitation treated in our hospital from January 2020 to December 2024 were collected, including 165 cases of total thoracoscopic mitral valve repair and 160 cases of median sternotomy mitral valve repair. Demographic characteristics, technical indicators, complications, and follow-up results were compared between the two groups. The results showed that the total thoracoscopic mitral valve repair group had a shorter ICU stay (30.2 ± 6.1 h vs. 75.3 ± 15.6 h, P < 0.001), shorter postoperative mechanical ventilation time (12.5 ± 4.2 h vs. 28.1 ± 4.6 h, P < 0.001), shorter hospital stay (8.6 ± 4.5d vs. 13.8 ± 7.6d, P < 0.001), and less postoperative drainage (157.2 ± 47.1 ml vs. 382.5 ± 181.5 ml, P < 0.001). There was no perioperative mortality in either group. Cardiac ultrasound follow-up results at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years post-surgery showed no statistically significant difference in the recurrence rate of mitral regurgitation (Grade IV) between the two groups (1.21% vs. 1.25%, P = 0.536). Total thoracoscopic mitral valve repair is reliable, minimally invasive, with fewer complications, faster recovery, and satisfactory perioperative outcomes.

PMID:42135819 | DOI:10.1186/s13019-026-04119-4

Crit Care. 2026 May 14. doi: 10.1186/s13054-026-06037-2. Online ahead of print.

ABSTRACT

PURPOSE: In comatose patients at risk of death by neurologic criteria (DNC), spinal-mediated movements (SMM) and movements of unclear neuroanatomic origin (MUO) are occasionally challenging to discriminate from cerebral-mediated movements. Our objectives were to assess the respective prevalence and semiology of SMM and of MUO in this population and to estimate the associations between these movements with cerebral blood flow and perfusion.

METHODS: In this prospective cohort study conducted in 15 intensive care units across Canada, we enrolled consecutive, brain-injured adults with an unconfounded Glasgow Coma Scale score of 3. Physicians conducted standardized DNC clinical evaluation, and participants underwent a brain CT-perfusion scan with CT-angiography reconstructions within a 2-h delay. We assessed the prevalence and semiology of SMM and MUO with descriptive statistics. We estimated the associations between SMM and MUO with cerebral blood flow and brain perfusion using generalized linear mixed models with a logit link function, age and sex as covariates, and random intercepts for study sites.

RESULTS: We included 282 participants with a median [IQR] age of 60 [47-69] years. The respective prevalence of SMM and MUO were 27% (95% CI: 22-32%) and 12% (95% CI: 9-16%). SMM and MUO were not associated with the presence of cerebral blood flow on CT-angiography (aOR for SMM: 1.14, 95% CI: 0.63-2.05; aOR for MUO: 1.36, 95% CI: 0.61-3.01) or brain perfusion on CT-perfusion (aOR for SMM: 1.44, 95% CI: 0.77-2.68; aOR for MUO: 1.75, 95% CI: 0.77-3.97). Findings were similar in the subgroup of 204 patients fulfilling clinical criteria for DNC.

CONCLUSIONS: SMM and MUO are common among comatose patients at risk of DNC. Their prevalence is similar among alive comatose patients and patients fulfilling clinical criteria for DNC. These movements are not associated with cerebral blood flow on CT-angiography or brain perfusion on CT-perfusion.

TRIAL REGISTRATION: Registered on ClinicalTrials.gov: NCT03098511 on March 27, 2017.

PMID:42135815 | DOI:10.1186/s13054-026-06037-2

Arch Public Health. 2026 May 14. doi: 10.1186/s13690-026-01958-4. Online ahead of print.

ABSTRACT

BACKGROUND: Extensive population testing played a crucial role in mitigating the COVID-19 pandemic. However, scaling up testing capacity requires a considerable workforce and infrastructure. Furthermore, sampling and testing delays can hinder timely interventions. We therefore sought to improve pre-test triage through an ensemble model based on self-reported information.

METHODS: We trained an XGBoost classifier to predict individual risk of COVID-19 infection for higher education students in Leuven (Belgium) from real-world social and health data related to 38,180 test results. The model could recommend isolation, testing, or release of individuals at high, moderate, or low risk of infection, respectively, based on two parametrizable probability thresholds. We then studied the epidemiological impact of the ensemble triage tool in silico, by simulating its implementation in our context to control an epidemic over time.

RESULTS: The predictive model achieved a ROC AUC of [Formula: see text], but its performance varied across rolling retraining windows. The epidemiological simulations highlight the potential of the ensemble-enhanced triage system to control a surge of infections in the student population of Leuven. Given a rapid implementation at the onset of an infection surge, it could reduce the effective reproduction number below 1.0 while reducing the testing requirements by [Formula: see text]. The predictions of the ensemble model were strongly influenced by the number of contacts which individuals reported, the reason for testing, and the onset of symptoms.

CONCLUSIONS: Our study suggests that pre-test triage guided by ensemble models could play an important role in allocating testing resources efficiently. Given timely implementation and isolation compliance within the population, it could also help rapidly control a surge of infections. Future research could validate this approach for other pathogens, in other settings, and with deep learning models.

PMID:42135808 | DOI:10.1186/s13690-026-01958-4