Tag: pubmed

Blood Press. 2025 Dec 16:1-19. doi: 10.1080/08037051.2025.2605798. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the effect of acupuncture on 24-hour ambulatory blood pressure (BP) and its circadian rhythm in patients with essential hypertension (EH).

METHODS: A systematic search was conducted across five English databases (PubMed, the Cochrane Library, Embase, Web of Science and The National Library of Medicine) and four Chinese databases (China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database and VIP Chinese Science and Technology Journal Full-Text Database). The search period for each database was from inception to 31 May 2025. A meta-analysis was performed using RevMan 5.4.1 software.

RESULTS: A total of 13 randomised controlled trials, involving 1,080 patients with EH, were included. The meta-analysis results showed that compared with the control group, the experimental (acupuncture) group demonstrated significantly lower values in the following parameters: 24-hour average systolic BP (SBP) (MD = -3.57, 95% confidence interval [CI]: -5.04 to -2.10, p < 0.001), 24-hour average diastolic BP (DBP) (MD = -3.61, 95% CI: -5.12 to -2.10, p < 0.001), 24-hour SBP variability (MD = -1.15, 95% CI: -1.57 to -0.73, p < 0.001), 24-hour DBP variability (MD = -0.96, 95% CI: -1.27 to -0.65, p < 0.001), 24-hour SBP load (MD = -3.47, 95% CI: -5.76 to -1.17, p = 0.003) and 24-hour DBP load (MD = -2.20, 95% CI: -4.08 to -0.31, p = 0.02).

CONCLUSION: Compared with Western medication alone, acupuncture combined with Western medication shows significant advantages in improving ambulatory BP parameters, including 24-hour average BP, 24-hour BP variability, 24-hour BP load and the BP circadian rhythm.

PMID:41400971 | DOI:10.1080/08037051.2025.2605798

JAMA Netw Open. 2025 Dec 1;8(12):e2548028. doi: 10.1001/jamanetworkopen.2025.48028.

ABSTRACT

IMPORTANCE: As Medicare Advantage (MA) continues to expand, an increasing number of MA plans are marketed to specific affinity groups, including Asian Medicare beneficiaries in the US. Little is known about the potential trade-offs of these emerging Asian-oriented affinity plans.

OBJECTIVES: To evaluate the prevalence of MA Asian-oriented affinity plans and the characteristics of their Asian beneficiaries, to understand the differences in plan-benefit design between these affinity plans and other MA plans, and to compare the breadth of MA physician networks of Asian-oriented affinity plans vs other MA plans.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used 2023 national Medicare data to identify Asian-oriented affinity plans. MA plans were identified as Asian-oriented affinity plans if the difference in Asian enrollment between the plan and its service area exceeded the 99th percentile of the Box-Cox-transformed normal distribution. When comparing Asian-oriented affinity plans with other MA plans, the sample was restricted to states where Asian-oriented affinity plans were offered. Data analyses were performed from June 2024 to June 2025.

EXPOSURE: Asian-oriented affinity plan classification.

MAIN OUTCOMES AND MEASURES: Cost-sharing, supplemental benefits, Medicare Star Ratings, and network breadth. Enrollee-weighted, adjusted regression models were used to assess differences in plan-benefit design, Medicare Star Ratings, and network breadth between Asian-oriented affinity plans and other MA plans.

RESULTS: The sample included 4224 MA plans in 2023, of which 27 were identified as Asian-oriented affinity plans. These 27 plans were offered in California, New York, Texas, and Massachusetts and enrolled 16.1% (109 906 of 684 764) of Asian beneficiaries in these states. Asian enrollees in these plans (mean [SD] age, 73.0 [7.19] years; 57 729 females [52.5%]) were more likely to be older, male, without disability, and dually eligible for Medicaid-Medicare benefits. Compared with other MA plans, Asian-oriented affinity plans had a higher likelihood of $0 Part C premiums (adjusted difference, 10.8 [95% CI, 10.8-10.9] percentage points), Part B premium reductions (adjusted difference, 6.7 [95% CI, 6.5-6.9] percentage points), and lower monthly Part D premiums (adjusted difference, -$7.18 [95% CI, -$14.24 to -$0.12]). Asian-oriented affinity plans were more likely than other MA plans to provide culturally relevant benefits, including acupuncture (adjusted difference, 23.2 [95% CI, 23.0-23.4] percentage points) and alternative therapies (adjusted difference, 4.8 [95% CI, 4.7-5.0] percentage points). However, Asian-oriented affinity plans were less likely to cover annual physical examinations (adjusted difference, -41.7 [95% CI, -41.9 to -41.5] percentage points), had lower Medicare Star Ratings, and had narrower physician networks compared with other MA plans.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, while MA Asian-oriented affinity plans offered more culturally relevant benefits and favorable premiums, they came with important trade-offs, including narrower physician networks, lower Medicare Star Ratings, and reduced coverage of certain traditional benefits. Enrollment growth and performance of Asian-oriented affinity plans should be closely monitored to ensure that they address the health care needs of Asian beneficiaries.

PMID:41400953 | DOI:10.1001/jamanetworkopen.2025.48028

JAMA Netw Open. 2025 Dec 1;8(12):e2548380. doi: 10.1001/jamanetworkopen.2025.48380.

ABSTRACT

IMPORTANCE: HIV viral load (VL) testing is essential for monitoring responses to antiretroviral therapy (ART) among people with HIV (PWH) and prior to the initiation of HIV preexposure prophylaxis (PrEP). In the US, the potential benefit of implementing HIV VL testing in these scenarios on linkage to care (LTC) has not been evaluated.

OBJECTIVES: To investigate whether providing laboratory-based HIV VL test results changed LTC rates or time to linkage for ART or PrEP across 12 weeks.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted from August 18, 2021, to February 2, 2023, with 12 weeks of follow-up. Participants were a convenience sample of adults with risk factors for HIV acquisition or PWH not taking daily ART, all of whom were recruited from an academic center emergency department in Baltimore, Maryland, and via social media advertising.

INTERVENTIONS: Participants were randomized 1:1 to receive a laboratory-based plasma HIV VL test with next-day results in addition to the standard of care HIV antigen/antibody test result (intervention) or to receive the standard of care HIV antigen/antibody assay alone (control).

MAIN OUTCOMES AND MEASURES: The primary outcome was LTC for ART or PrEP within 12 weeks of enrollment. Secondary outcomes included time to LTC and differences in LTC by HIV status. Analyses were conducted using the intention-to-treat population.

RESULTS: Of 1105 potential participants screened, 195 (17.6%) were enrolled (median [IQR] age 36, [27-47] years; 119 [61.0%) male; 112 [57.4%] Black or African American, 51 (26.2%) White, and 32 (16.4%) other race and ethnicity; and 34 [17.4%] PWH). By week 12, 93 participants (47.7%) completed follow-up, and 69 (35.4%) were linked to care (38 of 69 [55.1%] in the intervention group vs 31 of 69 [44.9%] in the control group). Overall, there was no statistically significant difference in LTC between the intervention and control group (hazard ratio, 1.28 [95% CI, 0.80-2.05]; P = .31]). In a modified intention-to-treat analysis, time to LTC was significantly less for PWH in the intervention group (log-rank P = .03).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial assessing the effects of HIV VL test results on LTC, providing a next-day HIV VL test result did not change LTC overall. More data are required to ascertain whether a rapid point-of-care HIV VL test would improve LTC.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04793750https://clinicaltrials.gov/study/NCT04793750.

PMID:41400951 | DOI:10.1001/jamanetworkopen.2025.48380

JAMA Netw Open. 2025 Dec 1;8(12):e2549815. doi: 10.1001/jamanetworkopen.2025.49815.

ABSTRACT

IMPORTANCE: It is unclear why areas of medicine overrepresented by female physicians receive lower pay. One theory is devaluation-that work done by women is systematically devalued over time.

OBJECTIVE: To assess whether an increase in the proportion of female physicians in a specialty is associated with a decrease in the median annual payments for that specialty.

DESIGN, SETTING, AND PARTICIPANTS: In 2022, a population-based, repeated cross-sectional analysis was conducted using routinely collected data of all active physicians in Ontario, Canada, from 1992-1993 (1993) to 2019-2020 (2020). For each year, the percentage of female physicians and total annual median payments for each specialty were calculated.

MAIN OUTCOME AND MEASURE: Random-effects linear regression models were constructed to evaluate the association between the percentage of female physicians and median payments overall. Additionally, we conducted a sensitivity analysis of the subgroup of physicians with 1.0 or more full-time equivalency (FTE).

RESULTS: The physician workforce increased from 18 572 in 1993 to 31 374 in 2020 with the number of female physicians increasing from 4151 (22.3%) to 13 205 (42.1%). The mean (SD) age for all physicians in 2020 was 49.6 (12.8) years, and for female physicians in 2020 was 46.2 (11.5) years. Median annual payments increased from $183 033 to $316 570. Regression results found that an absolute 1 percentage point increase in the percentage of female physicians in a specialty over 1 year was associated with a $2183 lower increase in median payments than expected overall (95% CI, -$3932 to -$434; P = .02) and a $3235 lower increase for female physicians (95% CI, -$4888 to -$1583; P < .001), but not for male physicians (-$554; 95% CI, -$2373 to $1264).

CONCLUSION AND RELEVANCE: This repeated cross-sectional study did not find evidence to directly support the theory of devaluation, yet the results underscore that occupational segregation, both across and within specialties, is associated with the gender pay gap. These findings should prompt medical leaders and policymakers to reconsider what activities are monetarily valued in medicine and whether these align with what patients and the public consider most valuable from a care perspective.

PMID:41400950 | DOI:10.1001/jamanetworkopen.2025.49815

JAMA Netw Open. 2025 Dec 1;8(12):e2549822. doi: 10.1001/jamanetworkopen.2025.49822.

ABSTRACT

IMPORTANCE: Low-dose vaginal estrogen (VE) is a safe and effective treatment for genitourinary syndrome of menopause (GSM). The frequency of VE prescribing for GSM is unknown.

OBJECTIVE: To evaluate VE prescriptions among women with GSM and to identify clinical phenotypes associated with VE claims.

DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective, population-based cohort study of a 20% random sample of Medicare fee-for-service beneficiaries enrolled in Parts A, B, and D from 2006 to 2018. Women aged 66 years and older with a diagnosis indicative of GSM were included. Exclusion criteria included diagnoses of breast and/or endometrial cancer within 6 months of GSM diagnosis. Data analysis was performed from October 2023 to June 2024.

EXPOSURE: Diagnosis indicative of GSM.

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of women with a VE prescription claim (cream, ring, or tablet) during the follow-up period, from first GSM diagnosis to the end of Medicare enrollment or the study period. To quantify associations between patient characteristics and the likelihood of VE claims, univariable and multivariable logistic regression analyses were conducted.

RESULTS: A total of 1 838 732 women with at least 1 GSM-related diagnosis were identified (median [IQR] age, 74 [69-81] years; median [IQR] follow-up, 8 [4-10] years). VE prescriptions were filled by 165 530 women (9.0%) at a median (IQR) of 15 (2-46) months after diagnosis. Older women (adjusted odds ratio [aOR] for >86 years vs 66-70 years, 0.59; 95% CI, 0.58-0.60) and those with higher Charlson Comorbidity Index scores (aOR for score ≥5 vs 0, 0.67; 95% CI, 0.66-0.69) were less likely to have a VE claim. When comparing GSM symptom groups, women with recurrent urinary tract infections were least likely to have a VE claim (aOR vs local sexual symptoms, 0.54; 95% CI, 0.46-0.64). Women with vulvovaginal symptoms (aOR, 2.70; 95% CI, 2.45-2.97) and GSM multimorbidity (aOR, 15.91; 95% CI, 14.41-17.57) were most likely to have a VE claim.

CONCLUSIONS AND RELEVANCE: In this large cohort study, 9.0% of female Medicare beneficiaries with a diagnosis indicative of GSM filled a VE prescription. Younger and healthier beneficiaries and those with GSM multimorbidity were more likely to fill a VE prescription. The majority of patients with GSM symptoms, including dyspareunia, vulvovaginal atrophy, and recurrent urinary tract infections, did not fill a VE prescription. Improving patient and practitioner education, revising the diagnostic code schema to capture the full breadth of symptoms, and validating GSM clinical phenotypes will help facilitate care and enhance our understanding of symptoms in research studies.

PMID:41400949 | DOI:10.1001/jamanetworkopen.2025.49822

Interdiscip Cardiovasc Thorac Surg. 2025 Dec 16:ivaf300. doi: 10.1093/icvts/ivaf300. Online ahead of print.

ABSTRACT

OBJECTIVES: This study develops a visual scoring system based on Chest Computed Tomography(CT) findings to assess donor lung function and explores its use for brain-dead donors.

METHODS: We conducted a retrospective cohort study of 151 donors after brain death managed by our local Organ Procurement Organization from January 1 to June 30 2024. A multidisciplinary team developed a chest CT evaluation protocol based on Fleischner Society guidelines. Lung lesions were scored lobe-by-lobe for statistical analysis.

RESULTS: Of 151 potential donors, 56 (37.09%) underwent lung transplantation. Transplanted lungs had a higher proportion of blood type O, better oxygenation index, lower C-reactive protein and procalcitonin level, and lower CT scores compared to non-transplanted lungs. A higher total lung score (TLS) was strongly and negatively associated with lung utilization (OR 0.643, p < 0.001). ROC curve analysis indicated good discriminative ability for the TLS alone (AUC = 0.803). Our findings establish that chest CT visual scoring is a valuable univariable tool for assessing lungs from brain-dead donors. Based on the CT scoring results, the overall utilization rate of potential lung lobes reached 79.22%.

CONCLUSIONS: In the evaluation of donor lungs, a high TLS demonstrates a significant negative univariable association with lung utilization rates and exhibits good univariable diagnostic accuracy. The TLS has the potential to serve as a powerful and practical screening tool for donor lung assessment. Our findings suggest that chest CT visual scoring holds potential importance in assessing lungs from brain-dead donors and provides meaningful insights into the evaluation of donor lung lobes. However, further studies with larger sample sizes are required to explore these findings in greater depth.

PMID:41400936 | DOI:10.1093/icvts/ivaf300

Int J Qual Health Care. 2025 Dec 16:mzaf123. doi: 10.1093/intqhc/mzaf123. Online ahead of print.

ABSTRACT

BACKGROUND: The specific impact of anticholinergic load on quality of life is understudied. We aimed to investigate relationships between anticholinergic load and quality of life in residential aged care facilities and differences between residents with and without dementia.

METHODS: A retrospective cohort study of 21 residential aged care facilities in New South Wales, Australia. Residents aged ≥65 years for permanent care. Residents had their quality of life measured using the Quality of Life Aged Care Consumers tool in 2023 at baseline (July-September) and follow-up (October-December, the study outcome). Higher scores indicate better quality of life. Anticholinergic load of administered medications between two quality of life measures was evaluated using five existing scales: Anticholinergic Cognitive Burden, Anticholinergic Drug Scale, Anticholinergic Loading Scale, Anticholinergic Risk Scale, and Clinician-rated Anticholinergic Score. Associations between anticholinergic load from each scale and follow-up quality of life scores were examined using linear regression, controlling for age, sex, baseline quality of life scores, and other potential confounders. Interactions between anticholinergic load and dementia were tested. Analyses were conducted for overall cohort and a subgroup analysis was performed for residents with and without dementia.

RESULTS: A total of 927 residents (69.7% female) were included. One-point higher anticholinergic load measured on each of the Anticholinergic Loading Scale, Anticholinergic Risk Scale, and Clinician-rated Anticholinergic Score, was associated with lower quality of life scores at follow-up: -0.24 (95% confidence interval -0.47, -0.01), -0.26 (95% confidence interval -0.46, -0.05), and -0.25 (95% confidence interval -0.49, -0.01), respectively. Associations did not differ by dementia status. In a subgroup analysis, the associations remained statistically significant in residents without dementia (n = 501), but not in those with dementia (n = 426).

CONCLUSION: Our results indicate that, controlling for baseline quality of life, anticholinergic load was associated with lower quality of life at follow-up over a short period (up to six months).

PMID:41400935 | DOI:10.1093/intqhc/mzaf123

Pharmacoecon Open. 2025 Dec 16. doi: 10.1007/s41669-025-00621-y. Online ahead of print.

ABSTRACT

BACKGROUND: Health state utility values (HSUVs) are vital in cost-utility analyses (CUAs) that inform policymaking. However, suboptimal selection and application of HSUVs have been reported in areas such as cardiovascular disease and cancer. This study reviewed the methodological quality and appropriateness of HSUV in CUA use for interventions targeting infectious diseases in aging populations.

METHODS: A systematic search of the MEDLINE database was conducted to identify CUAs that evaluated interventions against six major infectious diseases from January 2000 to July 2025. Two reviewers independently screened the identified studies based on eligibility criteria. The two reviewers then assessed the included studies using a modified checklist that covered how HSUVs were selected, elicited, and applied. Findings are summarized by descriptive statistics across the entire period (January 2000 to July 2025) and three sub-periods (2000-2009, 2010-2019, and 2020 to July 2025).

RESULTS: Among the 146 included CUA studies, only 10 (7%) relied exclusively on original sources for HSUVs, while 78% used economic data, either alone or in combination with other secondary sources or assumptions. Most studies (78-91%) did not provide sufficient rationale or descriptions for the population or how HSUVs were elicited, and 42% failed to report all utility components. Complete comparability between the CUAs and reference data for the diagnosis, severity, and country was observed in only 51-60% of studies. Notably, fewer than half of CUAs reported HSUVs that were consistent with their cited sources, and 80% did not discuss the limitations associated with HSUV use. Most criteria showed limited improvements, and in some cases declines, between January 2000 and July 2025.

CONCLUSION: CUAs of infectious diseases in aging populations are frequently associated with suboptimal practices in how HSUVs are selected, elicited, and applied. These shortcomings highlight the need for cautious interpretation of CUA data and for greater methodological transparency. Improving the quality of economic evaluations will require systematic approaches to how HSUVs are selected and elicited, with increased investment in primary data collection and the creation of accessible utility databases.

PMID:41400916 | DOI:10.1007/s41669-025-00621-y

J Neurooncol. 2025 Dec 16;176(2):125. doi: 10.1007/s11060-025-05312-6.

ABSTRACT

PURPOSE: Meningiomas are common, mostly benign, and often asymptomatic. Minimizing surgical adverse events (AE) is essential to maintain a favorable risk-benefit balance. Traditional AE grading systems often failed to account for disabling complications like neurologic deficits, which led to the development of the multidimensional therapy-disability-neurology grade (TDN). This study evaluates risk factors and consequences of AE in meningioma patients using TDN.

METHODS: Pre- and perioperative factors associated with the occurrence and severity of AE at discharge and follow-up were retrospectively identified in a monocentric cohort of consecutive patients undergoing surgery between 2013 and 2022. Significant variables of the univariable analysis were consequently tested in a multivariable analysis. Statistical analysis to detect the relationship between TDN and clinical outcomes was performed.

RESULTS: 367 patients were included with a mean age at surgery of 60.8 years. A total of 95 AE at discharge and 144 AE at follow-up were recorded. Generalized linear models showed a relationship between the modified Rankin Scale on admission, tumor complexity as measured by the Milan Complexity Scale, and preoperative embolization with the frequency of AE at discharge and follow-up. A correlation between TDN, Karnofsky Performance Scale at discharge, and length of hospital stay was observed.

CONCLUSION: The severity of AE as classified according to TDN correlated with the length of hospital stay and functional outcome following meningioma resection in our cohort and may be predicted by specific pre- and perioperative factors.

PMID:41400878 | DOI:10.1007/s11060-025-05312-6

J Robot Surg. 2025 Dec 16;20(1):90. doi: 10.1007/s11701-025-03071-0.

ABSTRACT

Robotic surgery has become an integral part of minimally invasive surgical practice across a variety of disciplines. However, training structures, access, and perceptions of its clinical value vary significantly among surgeons worldwide. To assess global trends in robotic and laparoscopic/thoracoscopic surgery training, practice patterns, and surgeon-perceived clinical outcomes across a range of procedures. A cross-sectional, web-based survey will be conducted among surgical professionals worldwide. The survey includes structured quantitative items using Likert scales and multiple-choice formats comparing the conventional laparoscopic/thoracoscopic approaches. Data will be analyzed using descriptive statistics, subgroup comparisons, and regression models where appropriate. The study aims to identify variability in training pathways, perceived clinical benefits, and barriers to robotic surgery adoption, possibly informing curriculum development and policy changes to enhance equitable access and training.

PMID:41400869 | DOI:10.1007/s11701-025-03071-0