Tag: pubmed

Front Med (Lausanne). 2026 May 14;13:1803092. doi: 10.3389/fmed.2026.1803092. eCollection 2026.

ABSTRACT

BACKGROUND: Since their implementation in Spain, adherence of hospitals to Patient Blood Management (PBM) programs has been variable, potentially influencing transfusion practices. This study aimed to evaluate, in a real-world surgical setting, the frequency and appropriateness of red blood cell (RBC) transfusion.

METHODS: A prospective multicenter study in 43 Spanish hospitals including surgical patients. Transfusion appropriateness was evaluated using evidence-based criteria based on hemoglobin thresholds and clinical conditions such as cardiovascular disease, acute hemorrhage, or high comorbidity burden. Statistical analyses identified factors associated with transfusion practices.

RESULTS: The overall perioperative RBC transfusion rate was 9.7%, with the highest rates in cardiac (52.9%), vascular (17.9%), and orthopedic (12.3%) surgeries. RBC transfusion was associated with older patients with comorbidities, lower preoperative hemoglobin, higher ASA score and worse surgical meters and postoperative outcomes. Transfused patients showed significantly lower 60-day survival. Critically, 43% of transfusions were inappropriate, while transfusion omission (1.9%) may represent a clinical concern that warrants further investigation. Inappropriate transfusion was more frequent in older comorbidity patients according to Charlson Comorbidity Index in urgent surgery. In multivariable analysis, age was a factor associated with inappropriate transfusion, by cons, surgical blood loss was the main protective factor against inappropriate transfusion.

CONCLUSION: As far as we know, this is the first Spanish multicenter study evaluating transfusion appropriateness in surgical scenario. Despite a lower overall transfusion rate than international figures, nearly half of transfusions were inappropriate and transfusion omission, also represents a real clinical concern. Implementation of decision-support tools and strengthened PBM protocols are needed to address factors associated with inappropriate transfusion, such as age, and to optimize patient safety and resource use.

PMID:42221112 | PMC:PMC13216454 | DOI:10.3389/fmed.2026.1803092

Front Med (Lausanne). 2026 May 14;13:1848131. doi: 10.3389/fmed.2026.1848131. eCollection 2026.

ABSTRACT

INTRODUCTION: This study aimed to develop and validate a novel formula for calculating intraocular lens (IOL) refractive power based on Gaussian optics and thick-lens imaging.

METHODS: This study was conducted at Ningbo Traditional Chinese Medicine Hospital between October 2021 and October 2023. A total of 54 patients (84 eyes) with age-related cataracts (ARC) undergoing phacoemulsification and IOL implantation were included. The effective lens position was defined as (ACD + W × preoperative LT), where ACD is the anterior chamber depth and LT is the lens thickness. A new IOL power calculation formula was derived using stepwise multiple linear regression, incorporating key ocular parameters including axial length (adjusted for central corneal thickness), keratometry, and the effective lens position. The performance of the new formula was compared with five established formulas: Barrett Universal II, Haigis, Hoffer Q, SRK/T, and Holladay I. For each formula, we compared the mean and median predicted error (PE), the mean and median absolute predicted error (APE), and the proportions of eyes with within ±0.25 D, ±0.50 D, and ±1.00 D.

RESULTS: The newly developed formula demonstrated excellent bias control, with a median prediction error of 0.060 D that was not statistically different from zero (p = 0.480). In contrast, the Barrett Universal II (0.450 D, p = 0.006), Hoffer Q (0.280 D, p = 0.024), and SRK/T (0.515 D, p = 0.0004) showed significant hyperopic shifts. The mean error of the new formula (0.071 D) was significantly lower than that of Barrett Universal II, Hoffer Q, and Holladay I formulas (all p < 0.01) and comparable to that of the Haigis formula (p = 0.226). Its accuracy (mean absolute error, 0.461 D) was comparable to that of all other formulas. The new formula achieved the highest proportion of eyes within ±0.25 D (43.3%), outperforming all other formulas.

DISCUSSION: The proposed IOL calculation formula, which is based on a double-thick-lens imaging model, provides improved control of systematic bias and competitive predictive accuracy. This approach offers a promising framework for clinical applications of personal IOL power calculations.

PMID:42221106 | PMC:PMC13216231 | DOI:10.3389/fmed.2026.1848131

Front Med (Lausanne). 2026 May 15;13:1801925. doi: 10.3389/fmed.2026.1801925. eCollection 2026.

ABSTRACT

BACKGROUND: Early risk stratification is crucial for improving outcomes in critically ill patients with acute myocardial infarction (AMI). Albumin-derived composite indices hold promise as convenient and effective predictive tools, but their relative efficacy and clinical utility remain unclear.

METHODS: This two-cohort retrospective analysis utilized a derivation cohort from the MIMIC-IV public database and an external validation cohort from the ICU of Guizhou Medical University Affiliated Hospital. Six albumin-derived composite indices were evaluated. Statistical analyses employed Cox proportional hazards regression models to assess their association with mortality. Predictive performance was compared using the area under the receiver operating characteristic curve (AUC) and Delong’s test. A multivariate risk prediction model was developed based on key prognostic variables selected by multiple machine learning algorithms.

RESULTS: The study included 4,850 critically ill AMI patients (4,210 in the derivation cohort, 640 in the validation cohort). Multivariable-adjusted analysis identified the red cell distribution width to Albumin Ratio (RAR), Urea nitrogen to Albumin Ratio (UAR), and Lactate Dehydrogenase to Albumin Ratio (LDAR) as independent predictors of 28-day ICU mortality. Among these, LDAR demonstrated the strongest predictive ability, with an AUC of 0.702 in the derivation cohort, a finding robustly validated externally (AUC = 0.703). Subgroup analysis indicated consistent predictive value across most populations but revealed a significant interaction with hyperlipidemia. Incorporating LDAR into traditional critical illness scores (e.g., APACHE II, SOFA) significantly improved their predictive discrimination (all Delong’s test p < 0.05). A comprehensive model integrating 7 key variables (including LDAR, urea nitrogen, and lactate) selected by machine learning showed good and robust discriminative performance in both internal and external validation (AUCs of 0.767 and 0.735, respectively), significantly outperforming five traditional risk scores (all Delong’s test p < 0.05).

CONCLUSION: Among the six albumin-derived composite indices, LDAR offers the best independent and incremental predictive value for 28-day ICU mortality in critically ill AMI patients. Its interaction with hyperlipidemia suggests potential for targeted risk stratification. The machine learning model incorporating LDAR and other variables demonstrates robust performance, providing a promising tool for the early clinical identification of high-risk patients.

PMID:42221102 | PMC:PMC13219332 | DOI:10.3389/fmed.2026.1801925

Front Med (Lausanne). 2026 May 15;13:1823549. doi: 10.3389/fmed.2026.1823549. eCollection 2026.

ABSTRACT

OBJECTIVE: This study aims to determine the prevalence of uncontrolled asthma and its associated factors among adult asthmatic patients attending hospitals in Burao, Somaliland, in 2025.

METHOD: A cross-sectional study was conducted at four hospitals from May 1 to June 15, 2025, among 363 adult asthma patients selected using systematic random sampling. Data were collected using a structured, interviewer-administered questionnaire. Asthma diagnosis was confirmed by spirometry performed within 3 months before enrollment, demonstrating reversible airflow obstruction. Descriptive statistics summarized the sample characteristics. Variables with p < 0.25 in bivariable analysis were entered into multivariable logistic regression. Model fit was assessed using the Hosmer-Lemeshow test (p = 0.423), and multicollinearity was checked using the variance inflation factor (VIF < 2 for all variables). A p-value < 0.05 was considered statistically significant.

RESULT: Out of 382 adult asthma patients approached, 363 were included in the study, yielding a response rate of 98.4%. The mean age of participants was 47.6 ± 9.98 years, with 56.8% being male. Uncontrolled asthma was identified in 57.9% of the participants. Multivariable analysis revealed significant associations with poor medication adherence (AOR = 27.89; 95% CI: 7.75-100.30; p < 0.001), persistent asthma severity (AOR = 3.42; 95% CI: 1.27-9.23; p = 0.015), a family history of asthma (AOR = 27.51; 95% CI: 2.51-301.60; p < 0.001), biomass fuel use (AOR = 8.56; 95% CI: 3.08-23.78; p < 0.001), and occupational dust exposure (AOR = 68.65; 95% CI: 3.80-1239.19; p = 0.004). Due to small cell counts for dust exposure (n = 40 exposed) and family history (n = 113 with family history, including only 1 well-controlled case), these estimates have wide confidence intervals and should be interpreted cautiously. Exact logistic regression was performed as a sensitivity analysis, which confirmed the direction and statistical significance of these associations. The presence of air conditioning was also associated with increased odds (AOR = 6.26; 95% CI: 1.44-27.21; p = 0.014). Good asthma knowledge approached significance as a protective factor (AOR = 0.45; 95% CI: 0.20-1.04; p = 0.060).

CONCLUSION: The burden of uncontrolled asthma in Burao City is high, with modifiable factors such as medication adherence and follow-up care playing a vital role. Targeted interventions addressing these factors are crucial to improving asthma control in this setting.

PMID:42221096 | PMC:PMC13219360 | DOI:10.3389/fmed.2026.1823549

Front Med (Lausanne). 2026 May 15;13:1807805. doi: 10.3389/fmed.2026.1807805. eCollection 2026.

ABSTRACT

BACKGROUND: Vascular calcification (VC), characterized by calcium deposition in arterial walls, is a major risk factor for cardiovascular morbidity and mortality. While genome-wide association studies (GWAS) have identified susceptibility loci for specific vascular beds, such as coronary artery calcification (CAC) and abdominal aortic calcification (AAC), single-phenotype studies may overlook pleiotropic variants. This study aims to elucidate the shared genetic architecture of CAC and AAC and translate these findings into biological insights and potential therapeutic targets.

METHODS: We performed a multivariate genome-wide analysis integrating summary statistics for CAC and AAC from individuals of European ancestry. To prioritize candidate genes, we applied four complementary mapping strategies, including positional mapping, multivariate set-based association test, transcriptome-wide association study, and multi-marker analysis of genomic annotation. Findings were further characterized using tissue-specific expression profiling, Gene Ontology enrichment, and cell-type specificity analysis. Therapeutic potential and safety were subsequently evaluated using OpenTargets for druggability assessment and phenome-wide association studies (PheWAS) to assess horizontal pleiotropy. Finally, experimental validation was conducted to verify the genetic findings.

RESULTS: The multivariate analysis identified seven genome-wide significant loci. Cross-referencing the four gene-mapping strategies highlighted a consensus set of robust candidate genes, with CDKN2B supported by all methods, and strong multi-method support for ADAMTS7, PHACTR1, and MORF4L1. Pathway analysis identified lipid homeostasis and cell cycle regulation as key functional modules. Cell-type specificity analysis demonstrated that candidate genes were enriched in endothelial cells. Druggability assessments identified HDAC9 as a target for approved drugs potentially repurposed for VC, while PheWAS results suggested a predicted lack of severe genetic pleiotropy for most candidates, with the notable exception of CDKN2A, which showed associations with neoplasms. Quantitative real-time PCR confirmed significantly altered expression of most candidate genes, including ADAMTS7, CDKN2A, CDKN2B, CXCL12, FHL5, HDAC9, MORF4L1, PDGFD, and PHACTR1, in the experimental group.

CONCLUSION: This study demonstrates that CAC and AAC share a substantial genetic basis, reinforcing the concept of VC as a systemic pathological process driven by common mechanisms. By rigorously prioritizing candidate genes and mapping them to specific cell types, we provide a comprehensive genetic map of VC and highlight potentially safe targets for future therapeutic development.

PMID:42221083 | PMC:PMC13218890 | DOI:10.3389/fmed.2026.1807805

Front Med (Lausanne). 2026 May 15;13:1793058. doi: 10.3389/fmed.2026.1793058. eCollection 2026.

ABSTRACT

INTRODUCTION: The clinical-epidemiological profile of Chagas disease (CD) has changed over the past decades, leading to decreased levels of physical activity (PA), which may be associated with changes in markers of subclinical atherosclerosis. This study aimed to investigate the association between PA levels and carotid intima-media thickness (CIMT), the presence of carotid atherosclerotic plaque (CAP), and the amount of epicardial adipose tissue (EAT) in patients with chronic CD.

METHODS: This cross-sectional study included patients with chronic CD. The PA level was determined using the short version of the International Physical Activity Questionnaire (IPAQ-short). CIMT and CAP were assessed using Doppler ultrasound of the carotid arteries. The amount of EAT was assessed using transthoracic echocardiography. Linear and binomial logistic regression models were used.

RESULTS: The median age of the 349 participants was 62 years (54.0-69.0), 56.5% were women, and 79.5% were non-white, with 67.6% having <9 years of schooling. The most common clinical form of CD was the cardiac form without heart failure (HF) (53.9%). Median CIMT values were 0.65 mm (left) and 0.66 mm (right). CAP was present in 46.4% of participants, and the median EAT was 5.0 mm. No statistically significant association was observed between PA levels and CIMT, the presence of CAP, or the amount of EAT.

CONCLUSION: PA levels were not associated with the markers of subclinical atherosclerosis in individuals with chronic CD.

PMID:42221074 | PMC:PMC13219020 | DOI:10.3389/fmed.2026.1793058

Front Med (Lausanne). 2026 May 14;13:1786137. doi: 10.3389/fmed.2026.1786137. eCollection 2026.

ABSTRACT

OBJECTIVE: Fentanyl-induced cough (FIC) is a common adverse event during anesthesia induction with a high incidence and may result in serious clinical complications. Although our clinical observations suggest that oliceridine attenuates FIC, the available evidence remains limited. This study was designed to assess the prophylactic efficacy of oliceridine against FIC and to characterize its peri-induction safety profile.

METHODS: A total of 168 adult surgical patients with American Society of Anesthesiologists physical status I-III scheduled for general anesthesia were randomized to receive either oliceridine 2 mg (OF group) or normal saline (SF group) prior to fentanyl administration. The primary outcome was the incidence of cough within 1 min following fentanyl injection. Secondary outcomes included cough severity, vital sign changes, and the incidence of adverse events.

RESULTS: No patients in the OF group experienced FIC, compared to 58.33% in the SF group (p < 0.001). Cough severity in the SF group was classified as mild (17.86%), moderate (20.24%), and severe (20.24%). Vital signs did not show statistically significant changes from before to after oliceridine injection within each group, and no significant between-group differences were identified. The incidence of adverse events was low in both groups, with no significant between-group differences.

CONCLUSION: Pretreatment with 2 mg oliceridine effectively reduces the incidence of FIC without increasing significant additional risks, providing a rationale and safe approach for anesthetic induction.

CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn/showproj.html?proj=272947, identifier ChiCTR2500105221.

PMID:42221070 | PMC:PMC13215988 | DOI:10.3389/fmed.2026.1786137

Front Med (Lausanne). 2026 May 14;13:1829842. doi: 10.3389/fmed.2026.1829842. eCollection 2026.

ABSTRACT

INTRODUCTION: The comparative impact of Minimally Invasive Cardiac Surgery versus median sternotomy on the interplay between peripheral muscle strength, kinesiophobia, and functional capacity remains unclear. This study compared these parameters in the early postoperative period.

METHODS: Forty-six patients (30 Sternotomy, 16 Minimally Invasive Cardiac Surgery) were included in this prospective study. Peripheral muscle strength (handgrip and knee extension), functional capacity (30-Second Sit-to-Stand test), and kinesiophobia (Tampa Kinesiophobia Scale) were assessed preoperatively and on the postoperative 5th day.

RESULTS: Both groups experienced a significant decline in postoperative muscle strength from baseline; however, there was no statistically significant difference between the groups regarding the magnitude of this decline (e.g., right handgrip p = 0.366, right knee extension p = 0.294). However, the Minimally Invasive Cardiac Surgery group demonstrated superior functional performance in the 30-Second Sit-to-Stand test (p = 0.008) and significantly lower increases in kinesiophobia scores compared to the sternotomy group (p = 0.008). A significant negative correlation was found between kinesiophobia and functional capacity (r = -0.311, p = 0.035).

CONCLUSION: Although Minimally Invasive Cardiac Surgery does not mitigate surgery-associated muscle strength decline, it offers a distinct advantage in preserving functional capacity by minimizing kinesiophobia. Functional limitations after sternotomy appear driven more by movement-related fear than muscle weakness. Consequently, rehabilitation strategies should integrate kinesiophobia management to optimize early mobilization and functional independence.

CLINICAL TRAIL REGISTRATION: ClinicalTrials.gov, identifier (NCT07172529).

PMID:42221065 | PMC:PMC13216003 | DOI:10.3389/fmed.2026.1829842

Front Big Data. 2026 May 15;9:1799073. doi: 10.3389/fdata.2026.1799073. eCollection 2026.

ABSTRACT

Inventory management is a critical business process that affects the operational efficiency and competitiveness of manufacturing companies. Inaccurate inventory decisions can result in significant financial losses for companies. Demand variability poses a challenge in determining inventory levels, requiring more sophisticated, flexible forecasting methods. This study was conducted to examine the roles of statistical methods and Artificial Intelligence (AI) in inventory decision-making in the manufacturing industry, analyze the conditions under which each method is suitable, and evaluate the potential of a hybrid approach integrating statistical methods and AI. This study uses the Systematic Literature Review method with the PRISMA 2020 framework to ensure research transparency and accuracy. This study identifies articles from reputable databases indexed in Scopus. The findings show a significant shift in inventory management research. In the last decade, AI technology has dominated the literature at 62.5%, while statistical methods account for 25%, and hybrid methods have begun to emerge but remain limited to 12.5%. Based on the review of selected papers, statistical methods have proven to remain effective for consistent historical data and stable demand patterns. Conversely, in dynamic operational environments with large-scale data and complex nonlinear patterns, AI technology is superior. This study also found that the hybrid approach has great potential to balance accuracy, interpretability, and decision support, although the relevant literature remains limited. The implementation of technology in the manufacturing industry faces several obstacles, including limited data quality, a skills gap in technology, and the black-box nature of complex AI. This review provides a systematic and critical synthesis of methodological patterns and operational fit in the use of statistical, AI, and hybrid methods for manufacturing inventory management. Future research is recommended to focus on the development of interpretable AI, modular hybrid frameworks, and the use of real industry data to ensure that academic innovations can be applied in the manufacturing industry.

PMID:42221062 | PMC:PMC13218985 | DOI:10.3389/fdata.2026.1799073

J Med Educ Curric Dev. 2026 May 29;13:23821205261450082. doi: 10.1177/23821205261450082. eCollection 2026 Jan-Dec.

ABSTRACT

BACKGROUND: Clear communication and cohesive teamwork are critical for ensuring safe, high-quality patient care, especially within the demanding environment of the labor ward. Pakistan faces some of the worst pregnancy outcomes globally. The TeamSTEPPS® is a validated curriculum for teaching interprofessional communication to healthcare professionals. Given the unique contexts of maternity care in Pakistan, there is a need to test the effectiveness of the TeamSTEPPS® program in interprofessional team involved in provision of care.

METHODS: This quasi experimental study was conducted at Services Institute Medical Sciences/Services hospital Lahore, Pakistan. All the nursing students, pharmacist, obstetric, anesthesia and pediatric residents posted in labour room for two months were included. A core team of faculty taught the participants using TeamSTEPPS® framework. Participants knowledge, perceptions and attitudes were checked pre-training, one week and one month post-training using TeamSTEPPS® questionnaire of Teamwork Attitudes Questionnaire, Teamwork Perceptions Questionnaire and learning benchmarks. Team performance using Team Performance Observation Tool was also assessed after a month by simulation scenarios. Data were entered and analyzed using SPSS version 25. Descriptive statistics were used to summarize demographic characteristics and Chi-square test was applied to evaluate the association between pre- and post-intervention scores related to attitude, perception, benchmark and team performance. P-value of less than 0.05 was considered statistically significant.

RESULTS: Total of 25 participants were imparted training. Significant improvements in team knowledge were seen in understanding the role of a team leader, shared mental model identifying the best method for conflict resolution at one week and one month post training (P<0.05). Changes in attitudes was observed in Team Structure, leadership and communication after one month (p<0.05). The intervention was effective in enhancing perceptions of team structure, situation monitoring, mutual support, and communication (p<0.05). The team performance assessment showed that all teams scored from acceptable to excellent implying that training had positive impact on their ability to work as interprofessional team.

CONCLUSION: The study demonstrated improvements in knowledge, attitudes, perceptions, and observed behaviors of healthcare professionals, affirming the relevance and effectiveness of structured teamwork training in a maternity care setting. This advocates for integration of TeamSTEPPS® into medical curricula, institutional policy, and national health programs.

PMID:42221058 | PMC:PMC13221585 | DOI:10.1177/23821205261450082