Tag: pubmed

J Am Acad Audiol. 2025 May 1;36(3):188-195. doi: 10.3766/jaaa.240020.

ABSTRACT

Background: Although approximately 80 percent of hearing loss cases are treatable with hearing aids (HAs), only one in four individuals who may benefit from them pursue them. Along with audiologists, physicians are integral parts of the hearing-health care team. Whether patients with hearing loss are more likely to pursue HA use based on the physician recommendation is unknown. Purpose: To investigate motivating factors and perceptions of prospective HA users, particularly the role of physician recommendations. Research Design: Patients 18 years and older who underwent an HA evaluation at our practice between January 2018 and December 2022 were identified. Patients were given a 17-question survey to assess their demographic characteristics and factors related to HA adoption via e-mail (n = 2,677) or as a physical copy (n = 487). Study Sample: Our sample (n = 321) included 182 female patients (57 percent) and 139 male patients (43 percent). Most patients identified as White/Caucasian (86 percent), followed by Black/African American (7 percent) and Hispanic/Latino (2 percent). Most patients were older adults (age 60 years and older), and 144 (45 percent) were older than 75 years. Intervention: We assessed the demographics and motivating factors related to HA adoption based on the results of the 17-question survey. Data Collection and Analysis: Data were analyzed using descriptive statistics, chi-square analyses, and multiple logistic regression. An α of 0.05 was set as the threshold of statistical significance. Results: Approximately 80 percent of participants adopted HAs after their evaluation. The most commonly selected factors that influenced their decision were cost, insurance coverage, and physician recommendation. Chi-square analyses were performed to compare these factors between patients who did and those who did not adopt HAs and yielded a significant difference (X² = 177.8; p < 0.0001). Patients’ knowledge of multiple institutional locations that offer HAs (95 percent confidence interval [CI], 0.23-0.98; p = 0.045) and the office where they were evaluated (95 percent CI, 0.12-0.85; p = 0.019) were significant predictors of HA adoption. Conclusions: Our findings align with those of previous studies of motivating factors for HA adoption; however, with the addition of physician recommendation, our study showed higher HA adoption rates. These findings provide audiologists and physicians with insights regarding factors that impact HA adoption, which can help them develop a more individualized care plan during the initial evaluation.

PMID:40913255 | DOI:10.3766/jaaa.240020

JMIR Med Inform. 2025 Sep 5;13:e69216. doi: 10.2196/69216.

ABSTRACT

BACKGROUND: Transportation insecurity is a known barrier to accessing eye care and is associated with poorer visual outcomes for patients. However, its mention is seldom captured in structured data fields in electronic health records, limiting efforts to identify and support affected patients. Free-text clinical documentation may more efficiently capture information on transportation-related challenges than structured data.

OBJECTIVE: In this study, we aimed to identify mention of transportation insecurity in free-text ophthalmology clinic notes using natural language processing (NLP).

METHODS: In this retrospective, cross-sectional study, we examined ophthalmology clinic notes of adult patients with an encounter at a tertiary academic eye center from 2016 to 2023. Demographic information and free text from clinical notes were extracted from electronic health records and deidentified for analysis. Free text was used to develop a rule-based NLP algorithm to identify transportation insecurity. The NLP algorithm was trained and validated using a gold-standard expert review, and precision, recall, and F1-scores were used to evaluate the algorithm’s performance. Logistic regression evaluated associations between demographics and transportation insecurity.

RESULTS: A total of 1,801,572 clinical notes of 118,518 unique patients were examined, and the NLP algorithm identified 726 (0.6%) patients with transportation insecurity. The algorithm’s precision, recall, and F1-score were 0.860, 0.960, and 0.778, respectively, indicating high agreement with the gold-standard expert review. Patients with identified transportation insecurity were more likely to be older (OR 3.01, 95% CI 2.38-3.78 for those aged ≥80 vs 18-60 y) and less likely to identify as Asian (OR 0.04, 95% CI 0-0.18 for Asian patients vs White patients). There was no difference by sex (OR 1.13, 95% CI 0.97-1.31) or between the Black and White races (OR 0.98, 95% CI 0.79-1.22).

CONCLUSIONS: NLP has the potential to identify patients experiencing transportation insecurity from ophthalmology clinic notes, which may help to facilitate referrals to transportation resources.

PMID:40913248 | DOI:10.2196/69216

World J Surg. 2025 Sep 5. doi: 10.1002/wjs.70066. Online ahead of print.

ABSTRACT

BACKGROUND: Although prior studies have estimated the burden of pediatric surgical disease in low- and middle-income countries (LMICs) through statistical modeling and hospital- or household-based surveys, few large-scale descriptions of procedures and outcomes have been published. We aimed to describe the epidemiology and outcomes of children’s surgical care at multiple centers across Africa.

METHODS: Perioperative clinical data were collected prospectively from 2018 to 2023 at 17 hospitals in 11 African countries using a preexisting tool. Data came from children (age < 18 years) who underwent a surgical procedure in facilities equipped by the NGO Kids Operating Room. Data were stored on REDCap and descriptively analyzed.

RESULTS: 16,454 procedures were performed, with a higher frequency of procedures performed in younger children than in older children (mean age 4.5 years). Congenital malformations, acquired genitourinary conditions, and acquired gastrointestinal conditions made up the most common diagnoses. We found a mortality rate of 3.7%, with higher mortality in neonates compared to younger children; conditions associated with the greatest mortality included congenital conditions, intestinal perforation, burns, and intussusception. Emergent operations were associated with much higher rates of mortality than elective operations.

CONCLUSIONS: For the first time at this scale, we have assessed the epidemiology and outcomes of pediatric surgical care in LMICs. Findings were consistent with studies on the burden of disease, with a larger proportion of younger children accessing surgery, comparable mortality to other African studies, and higher mortality than in HICs. Future research and multilevel advocacy are needed to identify gaps in care and to design more effective interventions to reduce global disparities in access to surgical care for children.

PMID:40913246 | DOI:10.1002/wjs.70066

BMC Palliat Care. 2025 Sep 6;24(1):226. doi: 10.1186/s12904-025-01849-5.

ABSTRACT

BACKGROUND/AIMS: The extent to which low- and middle-income countries have implemented Advance Care Planning (ACP) and Advance Directives (AD) remains unclear. We aimed to map the current status of ACP/AD in Latin America.

METHODS: This cross-sectional, mixed-methods survey of ACP/AD in LA comprised interviews with 18 key informants from 18 out of 20 countries, most of whom were appointed by national Palliative Care Associations. Online interviews were conducted with each informant, covering a range of relevant topics from AD regulations to the use of ACP/AD in the context of end-of-life clinical decision making. We performed member checking and data triangulation to confirm our findings.

RESULTS: Only eight (44%) countries have some form of ACP/AD regulations. Most regulatory frameworks tend to adopt a legalistic pattern heavily influenced by the North American model. Despite that characteristic of AD regulations in LA, the leading strategy used by patients to avoid unwanted treatment at the end of life is through conversations with their families, whereas the least common strategy was consulting with a lawyer. In six (33%) countries, informants believed it was common for patients to grant their families permission to modify their previous choices regarding future treatments. The religiosity/spirituality of populations play an important role in the implementation of ACP in the region. Additionally, respecting patients’ preferences of care at the end of life appears to be tied more to aspects related to the characteristics of doctor-patient relationship, and the degree of integration of palliative care into the healthcare system than the existence or content of AD regulations. There was consensus that none of the countries provide sufficient education about ACP/AD to healthcare professionals.

CONCLUSIONS: Our findings encourage rethinking ACP/AD in LA from a decolonial perspective, considering characteristics such as the preference for a relational model of autonomy in several countries and the importance of taking the religiosity/spirituality of individuals into account during ACP conversations. Our data also suggest that honoring patients’ preferences of care at the end of life entails integrating palliative care into health care systems, educating healthcare professionals and the population, and fostering longitudinal trusting relationships between those professionals, patients, and their families.

PMID:40913239 | DOI:10.1186/s12904-025-01849-5

BMC Health Serv Res. 2025 Sep 5;25(1):1191. doi: 10.1186/s12913-025-13396-z.

ABSTRACT

BACKGROUND: Adverse events resulting from medical care continue to be a significant cause of morbidity and mortality globally. Many individuals experience harm due to medical errors, particularly in developing nations. The primary objective of this study was to evaluate the patient safety culture among pharmacy professionals employed in public hospitals within Bahir Dar City, Ethiopia.

METHODS: A descriptive institutional-based cross-sectional study was conducted between March 2024 and April 2024. The Pharmacy Survey on Patient Safety Culture (PSOPSC) assessment tool was administered to all pharmacy professionals working at the three public hospitals. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 26, followed by univariable and multivariable logistic regression analyses to identify predictors. Variables with a P value < 0.05 at a 95% Cl in the multivariable analysis were declared statistically significant.

RESULTS: Of the 118 participants, 110 responded, resulting in a response rate of 93.2%. The positive response rates for the 11 patient safety culture dimensions varied from 40.91-70.61%. According to the Agency for Health Research and Quality (AHRQ) guidelines, the average positive response rate was moderate at 59.09%. The lowest positive response rate was for ‘communication about mistakes’ at 40.91%, while ‘teamwork within a unit area’ had the highest positive response rate of 70.61%. The seven dimensions that fell within the AHRQ standard had a moderate positive response rate, ranging from 50.3 to 69.69%, whereas ‘teamwork within a unit area’ (70.61%) and ‘response to mistakes’ (70.45%) had a high positive response rate within the high positive response rate of the AHRQ standard (≥ 70.0%). However, two other dimensions, ‘communication about mistakes’ (40.91%) and ‘communication openness’ (48.47%) had a low positive response rate within the low positive response rate of the AHRQ standards (< 50.0%). Of the participants, 30.9% reported at least one event over the past year, while 37.3% rated the level of patient safety as ‘very good or excellent’. Several factors were found to have a significant association with the level of positive response rate on patient safety culture, including educational level, years of working experience in the hospital and unit area, direct interaction with patients, patient safety training, and five dimensions of patient safety culture: staff training and skills, communication openness, communication about prescriptions across shifts, communication about mistakes, and physical space and environment.

CONCLUSIONS: A moderate level of patient safety culture indicated that targeted interventions are required to address key areas contributing to this moderate positive response rate. To create effective hospital pharmacy settings, teamwork, leadership skills, effective communication, employee counseling, adequate staffing, prompt response procedures, and accurate reporting protocols are essential.

PMID:40913230 | DOI:10.1186/s12913-025-13396-z

J Adv Nurs. 2025 Sep 5. doi: 10.1111/jan.70190. Online ahead of print.

ABSTRACT

BACKGROUND: Research priorities guide research activities, funding and resources within health services. To ensure that research efforts are meaningful and impactful, it is vital that organisational research agendas reflect the priorities of both healthcare consumers and staff, alongside broader national and international research frameworks. This paper outlines a research priority-setting project conducted across two hospitals in Western Australia, aimed at identifying shared research priorities through a collaborative and inclusive approach.

AIM: To identify the top ten nursing and allied health research priorities for two hospitals in Western Australia.

METHODS: A modified James Lind Alliance Priority Setting Partnership approach was used, involving health services users, nurses, allied health professionals, and community members in a co-design approach across three phases. In phase 1, four community conversations were conducted to elicit an initial set of research topics. This data-informed phase 2, a survey to collect diverse views from a wider participant pool. In phase 3, a pre-selected sample of potential research priorities was discussed in a consensus workshop to reach a group consensus of the top ten research priorities. Qualitative data was analysed using multi-step thematic analysis, and quantitative data was analysed using descriptive statistics.

RESULTS: A total of 67, 151 and 18 people participated across study phases 1, 2 and 3, respectively, comprising nurses, allied health professionals, healthcare users, carers, and interested community members. The top ten research priorities reflected three areas: healthcare systems re/design (streamlining care; access to healthcare; patient journey and quality of care), workforce needs (workforce well-being, retention and adequate staffing; workforce training), and specific health issues and needs (dementia and delirium; mental health; caring for carers; Aboriginal and Torres Strait Islander health; palliative care and elderly people).

CONCLUSION: The research priorities identified in this study for two hospitals in Western Australia reflect the strong desire of nurses, allied health professionals, healthcare users and community members to improve structural issues in healthcare systems. This includes how healthcare systems are designed and integrated with each other, how workforce needs affect service delivery, and a greater focus on holistic service provision for specific health issues and needs.

PATIENT OR PUBLIC CONTRIBUTION: Healthcare consumers were an integral part of this study. Healthcare consumers were involved in the design of the study, the conduct of the study, and the review of the data analysis.

PMID:40913226 | DOI:10.1111/jan.70190

Ann Surg Oncol. 2025 Sep 5. doi: 10.1245/s10434-025-18219-3. Online ahead of print.

ABSTRACT

BACKGROUND: This systematic review and meta-analysis compared the intraoperative and postoperative outcomes of minimally invasive versus open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC), which is a highly aggressive tumor with a high mortality rate. Surgical resection remains the only potentially curative treatment. Minimally invasive distal pancreatectomy (MIDP), including laparoscopic and robotic approaches, has gained popularity, although the evidence of its efficacy is limited.

MATERIALS AND METHODS: PubMed, Scopus, and Web of Science databases were searched for studies that compared MIDP and ODP. Randomized clinical trials (RCTs) and observational studies were included. Risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CI) were used to analyze the outcomes. Heterogeneity was assessed using the I² test, and statistical significance was set at p < 0.05. Analyses were conducted using the RStudio version 4.4.1.

RESULTS: A total of 20 studies with 9339 patients were included, of which 2219 (23.76%) underwent MIDP and 7120 (76.24%) ODP. MIDP was associated with reduced hospital stay (MD – 1.99; p < 0.000001), infections (RR 0.58; p = 0.001855), delayed gastric emptying (RR 0.48; p = 0.003677), blood loss (MD – 55.55; p = 0.000005), transfusions (RR 0.36; p < 0.000001), and 90-day mortality (RR 0.43; p = 0.001092). Other outcomes, including pancreatic fistula, complications according to the Clavien-Dindo classification, operative time, and reoperation, showed insignificant differences.

CONCLUSIONS: MIDP for PDAC offers better clinical outcomes than ODP, including reduced infections and transfusions. Further RCTs are needed to validate these findings and update the guidelines.

PMID:40913221 | DOI:10.1245/s10434-025-18219-3

Behav Res Methods. 2025 Sep 5;57(10):277. doi: 10.3758/s13428-025-02694-3.

ABSTRACT

The study of time-dependent within-person dynamics has gained popularity in recent years through the use of multilevel (latent) time-series models. However, due to the complexity of the models, model applications are usually limited with respect to the inclusion of time-varying moderating factors on the longitudinal within-person relations between variables. That is, in common applications of multilevel time-series models, the within-person dynamics of constructs over time are regarded as being insensitive to changes in other time-varying factors or changes in contexts. We illustrate an extension of multilevel latent time-series models that incorporate latent interaction effects at the dynamic within-person level. We build on previous work that incorporated time-varying observed or latent moderator variables for the dynamic parameters in vector autoregressive models and provide a tutorial for the application of the models, implemented and estimated using Bayesian estimation via Markov chain Monte Carlo techniques. The models are illustrated by two empirical applications that investigate the temporal dynamics of negative affect, rumination, and mindful attention. The performance of different models with varying complexity is investigated via several simulation studies to provide recommendations regarding the models’ applicability for applied researchers. Required sample sizes range between at least 25 time points for around 50 persons in the simplest fixed-effects models and at least 100 time points for at least 100 persons in random-effects factor models, depending on the expected effect sizes of the dynamic parameters.

PMID:40913220 | DOI:10.3758/s13428-025-02694-3

Eur Spine J. 2025 Sep 6. doi: 10.1007/s00586-025-09329-3. Online ahead of print.

ABSTRACT

PURPOSE: To compare the long-term clinical outcomes and radiographic findings between hybrid surgery (HS) and anterior cervical discectomy and fusion (ACDF) for three-level cervical degenerative disc disease (CDDD). And the incidence, prognosis, and potential risk factors of heterotopic ossification (HO) more than 10 years after Bryan prosthesis replacement in HS has been explored.

METHODS: From January 2007 to December 2014, a total of 46 patients who underwent either HS (n = 26) or ACDF (n = 20) for consecutive three-level CDDD were retrospectively analyzed. Clinical outcomes were assessed using the Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) score, and Neck Disability Index (NDI). Radiographic evaluations included cervical lordosis (CL), C2-7 range of motion (C2-7 ROM), ROM of surgical segments (SROM), and adjacent segment degeneration (ASD). Potential risk factors for HO development at the 10-year follow-up after HS, including age, sex, ossification of the anterior longitudinal ligament (OALL), and anterior vertebral osteophytes (AVO), were evaluated. Univariate analysis was followed by multivariate logistic regression to identify independent predictors. Receiver operating characteristic (ROC) curve analysis was performed to determine the predictive value of AVO for HO, including the area under the curve (AUC) and cutoff value. Spearman correlation was used to assess the relationship between ROM and ASD. Postoperative complications were also recorded.

RESULTS: The mean follow-up duration was 141.85 ± 17.20 months. Both groups demonstrated significant improvements in VAS, JOA, and NDI scores at 3 days postoperatively and at the final follow-up compared to preoperative values (P < 0.05). However, there were no statistically significant differences in these scores between the groups at any time point (P > 0.05). At the final follow-up, the HS group exhibited significantly greater C2-7 ROM and SROM compared to the ACDF group (P < 0.05). Both groups showed significant improvement in CL at postoperative day 3 compared to preoperative measurements (P < 0.05). At the 10-year follow-up, the incidence of ASD was lower in the HS group (53.85%) than in the ACDF group (75.00%), with a significant reduction in ASD severity (P < 0.05). A negative correlation between ROM and ASD was observed (P < 0.05). The rate of secondary surgeries was lower in the HS group (0% vs. 5.0%), though the difference was not statistically significant (P > 0.05). The overall prevalence of HO in the HS group was 26.92% (grades I-IV). Both sex and AVO were significantly associated with HO development, and multivariate analysis identified AVO as an independent risk factor (P < 0.05, β = 3.137). ROC curve analysis revealed that AVO had an AUC of 0.85 in predicting HO, with a cutoff value of 1.5.

CONCLUSIONS: Both HS and ACDF demonstrated favorable long-term clinical outcomes and effective reconstruction of cervical physiological curvature. However, HS better preserved cervical ROM. At the 10-year follow-up, HS demonstrated a trend toward a lower incidence of ASD compared to ACDF, and reduced the severity of progression of ASD. There was a trend toward fewer reoperation rates in HS. AVO proliferation was identified as a significant independent risk factor for HO after HS, whereas island-type OALL was not significantly associated with HO development. In clinical practice, preoperative evaluation of AVO in ACDR segments is essential to mitigate the risk of postoperative HO formation.

PMID:40913198 | DOI:10.1007/s00586-025-09329-3

Environ Sci Pollut Res Int. 2025 Sep 6. doi: 10.1007/s11356-025-36917-z. Online ahead of print.

ABSTRACT

Per- and poly-fluoroalkyl substances (PFAS) are fluorinated organic compounds known as forever chemicals that are used in many materials, from cooking appliances to industrial detergents. Given their high chemical stability due to their lipophilic properties and widespread use, PFAS tend to bioaccumulate in the cardiac, hepatic, renal, gastrointestinal, and neural tissues, resulting in a variety of malignant and non-malignant diseases. Depression is a prevalent mental health condition that affects an individual’s activities of daily living. Depression is associated with numerous other chronic diseases, as well as the exacerbation of those conditions. With the increasing exposure to PFAS, this study set out to further examine the toxic correlation of nine subtypes of PFAS with depression outcomes in the U.S. adult population. PFAS exposure was analyzed from serum laboratory samples from the National Health and Nutrition Examination Survey (NHANES) datasets from 2015 to 2018 and was analyzed via multiple linear regression and multiple logit regression approaches. Depression ratings were based on individual responses to the Patient Health Questionnaire (PHQ9) and then characterized as none (score of 0-4), mild (score of 5-9), moderate (score of 10-14), moderately severe (score of 15-19), and severe (score of 20-27). All statistical analyses are conducted with R software version 4.4.0. The observed correlation was significant for a subset of PFAS subtypes. The findings suggest a medium concentration exposure to branch perfluorooctanoic acid isomers (BFOA) (odds ratio (OR) 2.010; [95% confidence interval (CI), 1.013, 3.988]), a medium concentration exposure to n-perfluorooctanoic acid (NFOA) (OR 6.073; [95% CI, 1.069, 34.498]), and medium concentration exposure to perfluorononanoic acid (PFNA) (OR 3.992; [95% CI, 1.261, 12.632]) were positively correlated with depression occurrence in adults aged 20 years and older who were not incarcerated. Analyzed covariates that were most common among depressed individuals included being female; widowed, divorced, separated, or never married; having a BMI of obese; and a current smoker. Given the documented negative health effects and current research gaps, researchers should continue to analyze the effects of PFAS exposure while healthcare and governmental institutions disseminate education, encourage laboratory testing, and fund elimination efforts of PFAS exposure. More investigation is required to support or reject these findings.

PMID:40913187 | DOI:10.1007/s11356-025-36917-z