Tag: pubmed

Evid Policy. 2023 Jun 12;20(2):184-204. doi: 10.1332/174426421X16843219978173.

ABSTRACT

BACKGROUND: Primary care professions practicing traditional medicine systems, such as naturopathy, may have an increased need to use critical thinking to integrated diverse knowledge sources in response to the complex ‘messiness’ of clinical practice. The degree to which the varied knowledge types used by naturopathic practitioners align with evidence-based practice principles remains unexplored.

AIMS AND OBJECTIVES: To investigate naturopathic practitioners’ behaviours, perceptions and attitudes towards their use of knowledge and information sources.

METHODS: An online cross-sectional survey study administered in five languages to the international naturopathic profession. Descriptive statistics were prepared using Stata 16.1.

FINDINGS: Survey respondents (n=453) represented all world regions. The most common type of knowledge used to inform clinical practice was developed through clinical experience (86.2%) or during initial clinical training (81.2%). The most used information sources were scientific journals (80.4%), conferences or other professional events (78.2%), modern naturopathic clinical textbooks (74.6%), laboratory, pathology or radiology tests (74.0%), or professional journals for clinicians (73.5%). The greatest trust in knowledge acquired from information sources was attributed to information from laboratory, pathology or radiology tests. The greatest importance was placed on information based on the patient’s perspective of living with their health condition.

DISCUSSION AND CONCLUSIONS: Naturopathic practitioners do not appear to have a strong level of trust for any particular information source, despite variations in trust between sources. Further, their philosophies and principles may promote the importance naturopathic practitioners place on non-research information sources such as patient experience and add further complexity to clinical decision-making processes for naturopathic practitioners.

PMID:40557648 | DOI:10.1332/174426421X16843219978173

Int J Epidemiol. 2025 Jun 11;54(4):dyaf096. doi: 10.1093/ije/dyaf096.

NO ABSTRACT

PMID:40557612 | DOI:10.1093/ije/dyaf096

Ann Behav Med. 2025 Jan 4;59(1):kaaf050. doi: 10.1093/abm/kaaf050.

ABSTRACT

BACKGROUND: Emerging statistical methods addressing the multilevel compositional nature of sleep architecture can offer insights into how daily time reallocations between sleep stages (total wake time in bed [TWT], light sleep [Non rapid eye movement stage 1 and 2], slow wave sleep [SWS], and rapid eye movement [REM] sleep) are associated with post-sleep affect.

PURPOSE: This study investigated the daily, prospective association between sleep architecture and affect.

METHODS: In 96 healthy, young adults across 15 consecutive days, sleep architecture was measured at night using electroencephalography (Z-Machine Insight+) and affect was self-reported using the PANAS-X at awakening. Bayesian multilevel compositional data analysis examined how reallocating time between sleep stages was associated with affect.

RESULTS: Various reallocations of sleep stages predicted affect, at both within- and between-person levels. Between-person reallocation of 30 min/night from light or REM sleep to SWS was associated with ≥0.38 points higher high and low arousal positive affect, and from SWS to any other sleep stages was associated with ≥0.21 points higher high arousal negative affect. Within-person reallocation of 30 min/night from REM to any other stages predicted ≥0.05 points higher high arousal negative affect, and 30 min/night from TWT to SWS or REM predicted ≤-0.07 lower low arousal negative affect.

CONCLUSIONS: Findings highlight the distinct constellations of sleep architecture associated with affect in everyday life. Extension of SWS and REM for improving affect, while considering other off-set sleep stages, should be confirmed in experimental research in daily settings, to inform diagnostic and intervention strategies for sleep and affective disorders.

PMID:40557584 | DOI:10.1093/abm/kaaf050

Pharm Stat. 2025 Jul-Aug;24(4):e70021. doi: 10.1002/pst.70021.

ABSTRACT

Covariate-adjusted estimators of average treatment effects in clinical trials are typically more efficient than unadjusted estimators. Recent guidance from the FDA is highly detailed regarding the appropriate use of covariate adjustment for point estimation. Less direction is provided, however, on how to estimate the variance of such estimators. In this paper, we demonstrate that a precise description of the estimand is necessary to avoid ambiguity when comparing variance estimators for average treatment effects involving binary endpoints. When considering the suitability of a proposed estimand, together with a corresponding variance estimator, it is important to consider that the patients enrolled in clinical trials are typically a convenience sample. Since there is no unique way to map this process into formal statistical assumptions, it follows that a range of estimands, and therefore a range of variance estimators, may be acceptable. We aim to highlight through simulation results how the properties of proposed variance estimators differ, as well as the underlying reasons.

PMID:40557557 | DOI:10.1002/pst.70021

Int J Surg. 2025 Jun 25. doi: 10.1097/JS9.0000000000002673. Online ahead of print.

ABSTRACT

BACKGROUND: The 2015 American Thyroid Association guidelines recommend total thyroidectomy (TT) followed by radioactive iodine (RAI) therapy as the primary treatment modality for intermediate-risk papillary thyroid carcinoma (PTC) patients with lateral lymph node metastasis (LLNM). However, the supporting evidence remains insufficient. The clinical superiority of TT versus lobectomy (LT) in this patient population remains unclear, and the optimal surgical approach for intermediate-risk PTC with LLNM continues to be debated.

AIM: This meta-analysis examined the clinical superiority of TT versus LT for intermediate-risk PTC with unilateral LLNM.

METHODS: This PRISMA/AMSTAR-compliant meta-analysis (PROSPERO: CRDXXX) evaluated recurrence-free survival (RFS) in intermediate-risk PTC with unilateral LLNM. Systematic searches of PubMed, Web of Science, and Cochrane Library (2004-2024) combined MeSH terms and title/abstract: (“papillary thyroid carcinoma” OR “papillary thyroid cancer” OR “PTC”) AND (“lateral cervical lymph node metastasis” OR “lateral neck lymph node metastasis” OR “lateral lymph node metastasis” OR “lateral cervical nodal metastasis” OR “N1b”) AND (“thyroidectomy” OR “total thyroidectomy” OR “lobectomy”). Two investigators independently extracted data on surgical outcomes, adjuvant RAI therapy, and RFS metrics, with quality assessed via Newcastle-Ottawa Scale. Prespecified subgroup analyses examined RAI utilization and surgical extent impacts. Pooled hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Review Manager 5.3, prioritizing adjusted HR. Heterogeneity was assessed via I2 statistics.

RESULTS: Among 609 initially identified references, 8 studies met the inclusion and exclusion criteria, comprising 2,462 intermediate-risk PTC patients with unilateral LLNM. Of these, 53.3% (1,313/2,462) underwent TT, and 46.7% (1,149/2,462) underwent LT. Compared with the TT group, LT showed no statistically significant difference on RFS (HR = 1.08, 95% CI 0.83-1.40, p = 0.56). In subgroup analyses: Compared with TT + RAI, LT showed no significant difference in RFS (HR = 0.66, 95% CI 0.40-1.08, p = 0.10); Compared with TT + RAI, LT or TT alone showed no significant difference in RFS (HR = 0.65, 95% CI 0.41-1.03, p = 0.07); Compared with TT alone, LT showed no significant difference in RFS (HR = 1.16, 95% CI 0.63-2.12, p = 0.64); Compared with TT + RAI, TT alone showed no significant difference in RFS (HR = 0.87, 95% CI 0.42-1.81, p = 0.37).

CONCLUSION: For intermediate-risk PTC patients with isolated unilateral LLNM, TT and LT demonstrate comparable oncological outcomes in terms of RFS. Unilateral LLNM alone should not constitute an absolute indication for TT. When no additional high-risk features are present, LT may serve as a preferable alternative to optimize quality of life while maintaining oncological safety.

PMID:40557546 | DOI:10.1097/JS9.0000000000002673

Eur J Emerg Med. 2025 Aug 1;32(4):278-287. doi: 10.1097/MEJ.0000000000001229. Epub 2025 Jun 24.

ABSTRACT

BACKGROUND: Undiagnosed HIV-infected patients are mainly responsible for viral transmission in Western countries. Emergency departments (EDs) could represent a strategic point in healthcare systems to uncover HIV infection.

OBJECTIVE: This study aimed to analyze the time trends of HIV testing in EDs in Barcelona (Spain) and investigate if EDs have changed HIV screening patterns after the implementation of a targeted opt-in strategy for HIV testing.

DESIGN: This is a quasiexperimental (pre/post) study.

SETTING AND PARTICIPANTS: Monthly HIV tests performed by Microbiology Departments of four hospitals in Barcelona were recorded over 78 months, classified as ordered by ED or at other healthcare levels. Monthly ED attendances were compiled, along with new HIV diagnoses.

INTERVENTION: Implementation of an opt-in strategy to test every ED patient with targeted conditions (community-acquired pneumonia, herpes zoster, mononucleosis syndrome, chemsex, postexposure prophylaxis, sexually transmitted diseases) in addition to other classical reasons for HIV testing.

OUTCOME MEASURES AND ANALYSIS: Determination of trends over time in HIV screening and new diagnoses in EDs during the 60-month preintervention and 18-month postimplementation periods, and estimation of the impact of intervention using interrupted time series analyses.

MAIN RESULTS: A total of 659 885 HIV tests were performed, with 11 442 (1.7%) being ordered by EDs (0.29% of ED comers were tested), and 287 new HIV diagnoses made (positivity rate: 2.8%). During the preintervention period, HIV testing increased over time (overall and in EDs), new HIV diagnoses in EDs remained stable, and the rate of positive HIV tests decreased. The intervention increased the monthly average of HIV tests ordered in the ED by 106 (95% CI = 86-125), proportion of ED comers screened by 0.075% (95% CI = 0.032-0.118), and proportion of HIV tests made in Barcelona performed by EDs by 0.728% (95% CI = 0.424-1.032), but had no impact on new HIV diagnoses and rate of positive HIV tests in the EDs.

CONCLUSION: In the last years, HIV screening in Barcelona increased, with EDs having a significant and increasing role in the overall HIV testing in Barcelona. The implementation of a targeted opt-in strategy for HIV screening in EDs increased the number of HIV tests performed, but not the number of HIV diagnoses made in EDs.

PMID:40557507 | DOI:10.1097/MEJ.0000000000001229

Pest Manag Sci. 2025 Jun 25. doi: 10.1002/ps.70017. Online ahead of print.

ABSTRACT

BACKGROUND: Plant Protection Products (PPPs) consist not solely of active ingredients. Some of the other ingredients of the finished formulations are intended to enhance the efficacy of the main active ingredient. The PPPs’ effects impact honeybees that pollinate crops by exposing them to a complex of numerous chemical compounds. Depending on their composition, PPPs affect these insects in various ways. The present study estimated the effect of sublethal doses of insecticide (Active Ingredient (AI): indoxacarb) and commercial adjuvant (AI: alkylbenzene sulphonic acid sodium salt) applied individually and as a combination of these two formulations, on thermal preference and CO₂ emission rate of bees, and expression of the genes CYP9Q1, CYP9Q2, and CYP9Q3 involved in detoxification processes of these insects.

RESULTS: Aqueous solutions of adjuvant and a mixture of both formulations statistically significantly altered honeybee thermal preferences (a decrease in the selected ambient temperature by 1.4 and 0.9°C, respectively). CO₂ emissions levels also changed (a drop of 1.7% for the insecticide-treated group, 10% for those treated with adjuvant and 15.4% for those treated with both formulations applied together). The levels of the transcripts of the genes CYP9Q1, CYP9Q2, and CYP9Q3 were significantly elevated only in the head of the honeybee, but not in its abdomen.

CONCLUSION: Our results indicate that ready-made PPP formulations, their adjuvants, and their mixtures determine the physiological status of honeybees, although the direction of changes might vary depending on the analyzed parameter. © 2025 Society of Chemical Industry.

PMID:40557483 | DOI:10.1002/ps.70017

Vet Ophthalmol. 2025 Jun 25. doi: 10.1111/vop.70045. Online ahead of print.

ABSTRACT

BACKGROUND: Keratoconjunctivitis sicca (KCS) results from a deficiency in the pre-corneal tear film, causing persistent ocular discomfort and a predisposition to ocular surface diseases. Current treatments, including topical lacrimostimulants and lacrimomimetics, primarily offer symptomatic relief without restoring lacrimal gland function. Mesenchymal stem cell (MSC) therapy, with its regenerative and immunomodulatory properties, has been investigated in preclinical and veterinary studies but remains critically underexplored for its clinical relevance in treating KCS.

METHODS: A systematic review was conducted on April 24, 2024, using Medline, Embase, Web of Science, and CABI databases. Studies evaluating MSC therapy in dogs and cats with KCS were included. Data collected included demographic information, baseline and post-treatment Schirmer tear test (STT) values, and ocular symptoms such as discharge, conjunctival hyperemia, and corneal changes. The risk of bias was assessed using validated tools, and the quality of evidence was graded using the Oxford Centre for Evidence-Based Medicine (OCEBM). Statistical analyses were performed with STATA to compare STT values at baseline and after 1- and 6-month follow-ups.

RESULTS: Six studies involving 151 eyes from 98 dogs were included. Studies demonstrated low to moderate risk of bias, and evidence quality was graded as level C. MSC therapy significantly increased tear production and improved ocular comfort, with mean STT increases of 0.68 mm/min at 1 month and 1.51 mm/min at 6 months.

CONCLUSION: MSC therapy offers statistically significant improvements in tear production in dogs with KCS and is considered a safe treatment option. However, the modest clinical significance highlights the need for further research to confirm its efficacy.

PMID:40557470 | DOI:10.1111/vop.70045

Anat Rec (Hoboken). 2025 Jun 25. doi: 10.1002/ar.70010. Online ahead of print.

ABSTRACT

Repair of volumetric muscle loss (VML) lesions tends to be poor, leading to fibrosis and functional loss. Here we investigated the effectiveness of fresh versus cryopreserved autologous adipose tissue transplantation to facilitate repair. Wistar rats were distributed into four experimental groups: normal control, VML lesions, VML lesions treated with a fresh autologous adipose tissue graft, and VML treated with a cryopreserved autologous adipose tissue graft. At 60 days post-intervention, a histological, histochemical, and immunohistochemical analysis was performed to assess changes related to the degree of fibrosis, vascularization, and innervation. These changes were quantified and statistically analyzed. The changes generated by the two types of adipose tissue implanted in the VML lesion were highly similar, with some significant differences favoring the use of cryopreserved adipose tissue. Compared with the VML group, the following outcomes were observed: (1) significant presence of regenerated muscle fibers; (2) significant reduction of fibrosis, albeit with a higher proportion of type III collagen; (3) significant increase in the microvascular pattern; and (4) significant reduction in the number of angulated atrophic muscle fibers and increase in cytoarchitectural changes indicative of reinnervation. This study suggests that autologous adipose tissue transplantation in VML lesions promotes reintegrative processes, facilitating the regeneration and formation of new muscle fibers. Furthermore, the freezing did not diminish outcomes in the CAAT group, highlighting its potential for preservation in tissue banks and applications in regenerative medicine.

PMID:40557468 | DOI:10.1002/ar.70010

Fam Pract. 2025 Jun 4;42(4):cmaf033. doi: 10.1093/fampra/cmaf033.

ABSTRACT

BACKGROUND: The 2024 Final Rule for physician fee schedule under the Medicare Prospective Centers for Medicare & Medicaid Services (CMS) has sunset and combined seven screening and quality measures for traditional Medicare Merit-Based Incentive Payment System (MIPS) reporting with a single composite clinical quality process measure, Preventive Care and Wellness (PCW). While composites offer benefits including statistical efficiency and increased stability over time, the contextless nature of composite scores may result in disadvantaging low-resource primary care health centers (“health centers”) serving medically underserved communities that face healthcare access and outcome challenges.

OBJECTIVE: Evaluate the CMS composite score metric in health centers to identify characteristics that are associated with higher versus lower composite scores.

METHODS: We conducted a 4-year (2019-2022) retrospective data analysis with more than 1.5 million patients from 191 primary care health centers within the OCHIN national network of community health organizations (CHOs). The primary outcome is a modified version of the PCW. Generalized linear mixed models assessed clinic factors associated with score variation, accounting for repeated measures.

RESULTS: Our analysis demonstrated that prepandemic scores started to recover by the end of 2022 (0.6644 vs. 0.6153) and that five factors (pediatric or 65+ patients, Hispanic adults, uninsured patients, and clinic encounter volumes in Q2 and Q4) significantly affected clinic score variation over time.

CONCLUSIONS: Our analyses show that preventive service delivery in health centers has nearly recovered from pandemic declines. Differences in subpopulations highlight the importance of context in interpreting health centers’ score variation.

PMID:40557464 | DOI:10.1093/fampra/cmaf033