Tag: pubmed

Acute Med. 2025;24(3):132-138. doi: 10.52964/AMJA.1018.

ABSTRACT

Acute Internal Medicine (AIM) is a dynamic specialty that addresses the urgent medical needs of adult patients. This study analyses data from the RCP 2023 workforce census to understand for the first time how Acute Physicians allocate their clinical working time across key service areas. Results reveal that the majority of AIM consultants focus on Acute Medical Units (AMU) and Same Day Emergency Care (SDEC), with occasional involvement in newer services such as virtual wards and hospital at home. There is also a significant proportion of time spent performing clinical activity within the Emergency Department, which likely reflects ongoing pressures within the urgent and emergency care system taking Acute Physicians outside of their intended working environments. These findings provide a baseline for future workforce planning and highlight the evolving priorities in AIM.

PMID:42127352 | DOI:10.52964/AMJA.1018

Neurology. 2026 Jun 23;106(12):e218082. doi: 10.1212/WNL.0000000000218082. Epub 2026 May 13.

ABSTRACT

BACKGROUND AND OBJECTIVES: The impact of pregnancy on the clinical course of myasthenia gravis (MG) remains uncertain, with existing evidence mainly derived from small case series. Using nationwide longitudinal register data, we aimed to assess the risk of MG exacerbation during pregnancy and up to 1 year postpartum.

METHODS: In this population-based cohort study, we included women with MG recorded in the Swedish National MG Register who had singleton pregnancies documented in the Medical Birth Register after MG diagnosis (1987-2019). The exposure was pregnancy, and the outcome was MG exacerbation. The primary outcome measure was hospital admissions with MG during pregnancy and the postpartum year, compared with the year preceding pregnancy. Cox proportional hazards models estimated hazard ratios (HRs), adjusting for disease duration and prior thymectomy. The secondary outcome measure was changes in immunosuppressive MG medications during pregnancy and postpartum.

RESULTS: We identified 112 women with MG (median age 30 years) with 176 singleton pregnancies. During pregnancy, women were not more likely to be hospitalized for MG than in the prepregnancy year (HR 0.74, 95% CI 0.39-1.41), and there was no increased risk of longer hospital admissions (HR 0.83, 95% CI 0.36-1.88). The postpartum period was associated with an increased risk of prolonged MG admissions during the first 3 months (HR 5.02, 95% CI 1.66-15.24), with a similar risk observed throughout the first 12 months postpartum (HR 4.52, 95% CI 1.26-16.14). During pregnancy, immunosuppressive MG medications were reduced or discontinued in 13 pregnancies and increased in 6. Postpartum, medications were initiated or escalated in 10 pregnancies and reduced in none. The risk of prolonged MG admissions was higher in periods outside of pregnancy compared with the prepregnancy year (HR 2.95, 95% CI 0.84-10.43), suggesting that women conceive during periods of relative disease stability.

DISCUSSION: Pregnancy was not associated with an increased risk of MG exacerbation. The postpartum period was linked to more severe or prolonged exacerbations in a minority of women, highlighting the importance of close monitoring after delivery. Milder exacerbations not requiring hospitalization or clear medication escalation may have been underestimated, underscoring the need for larger prospective international studies that include detailed clinical data.

PMID:42127347 | DOI:10.1212/WNL.0000000000218082

J Nurs Res. 2026 May 8. doi: 10.1097/jnr.0000000000000744. Online ahead of print.

ABSTRACT

BACKGROUND: With the increasing emphasis on sustainability in health care, it is essential to clarify how work conditions and professional identity influence sustainable behavior in nurses. Decent work environments may contribute to professionalism, which is known to foster sustainable practices.

PURPOSE: This study was designed to investigate the relationship between decent work practices and self-reported sustainable behavior in nurses, with a focus on the mediating role of professionalism.

METHODS: This cross-sectional study was conducted on a sample of 206 clinical nurses. Data were collected using validated Arabic versions of the Decent Work Scale, Nurses’ Professionalism Inventory, and Self-Reported Sustainable Behavior Scale. Statistical analyses included Pearson correlation, t-tests, analysis of variance (ANOVA), and mediation analysis.

RESULTS: The results revealed significantly positive associations between all of the study variables. Decent work practices were shown to correlate strongly with both professionalism (r=.870) and sustainable behavior (r=.897). Also, professionalism was found to correlate positively with sustainable behavior (r=.823). The results of the mediation analysis confirmed professionalism to significantly mediate the relationship between decent work and sustainable behavior (indirect effect β=0.332, 95% CI [0.194, 0.447]).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Decent work conditions enhance professionalism and, as a result, promote sustainable behavior in nurses. These findings underscore the importance of fostering supportive work environments and professionalism to achieve sustainable health care practices. Interventions that enhance decent work and professionalism may play a critical role in advancing sustainability in health care.

PMID:42127335 | DOI:10.1097/jnr.0000000000000744

Neurol Neuroimmunol Neuroinflamm. 2026 Jul;13(4):e200573. doi: 10.1212/NXI.0000000000200573. Epub 2026 May 13.

ABSTRACT

BACKGROUND AND OBJECTIVES: Primary CNS vasculitis (PCNSV) is a heterogeneous condition. This study examines a large cohort with long-term follow-up to identify potential disease subsets.

METHODS: We retrospectively analyzed 216 patients with PCNSV (Mayo Clinic, 1983-2023), using standardized diagnostic criteria, classifying by vessel size, histopathology, and outcomes. Subsets and predictors of functional and therapeutic outcomes were evaluated.

RESULTS: Diagnosis was based on cerebral angiography in 142 patients and histologically confirmed in 74. Isolated small vessel involvement was positively associated with mass-lesion presentation (odds ratio [OR] 19.38, p = 0.02), meningeal-enhancing lesions (OR 39.10, p < 0.0001), elevated CSF protein (OR 4.04, p = 0.03), and β-amyloid vascular deposits (OR 23.43, p = 0.0001), but negatively with focal manifestations (OR 0.32, p = 0.04) and cerebral infarcts (OR 0.22, p = 0.003). Lymphocytic vasculitis was linked to younger age at diagnosis (p = 0.006), longer symptom-to-diagnosis interval (p = 0.05), more seizures (p = 0.04), and lower disability (p = 0.003) and mortality (p = 0.008). Necrotizing vasculitis was associated with intracranial hemorrhage (p = 0.008). Two or more relapses occurred in 12.7%, associated with histologic diagnosis (OR 3.15, p = 0.009) and inversely with gadolinium-enhanced lesions (OR 0.33, p = 0.01). Therapy response occurred in 82.9%, long-term remission in 23.6%. Cerebral infarcts, especially multiple, were associated with poor therapy response (OR 0.11, p = 0.03). Histologic diagnosis was inversely associated with long-term remission (OR 0.44, p = 0.03), whereas aspirin use was positively associated (OR 2.8, p = 0.002). A rapidly progressive course occurred in 13.4% of patients and was linked to increasing age (OR 1.34/10 years, p = 0.04), cognitive dysfunction (OR 5.59, p = 0.02), cerebral infarctions (OR 5.02, p = 0.004), and large vessel involvement (OR 3.51, p = 0.02). Gadolinium-enhanced lesions (OR 0.36, p = 0.04) and aspirin (OR 0.42, p = 0.08) were protective. Mortality (21.3%) was associated with older age (HR 1.42, p = 0.002), cognitive dysfunction (HR 3.93, p = 0.006), and cerebral infarctions (HR 1.94, p = 0.03).

DISCUSSION: PCNSV heterogeneity, driven by vessel size and histology, affects presentation and outcomes; our findings offer insights to improve diagnosis and treatment.

PMID:42127334 | DOI:10.1212/NXI.0000000000200573

J Clin Oncol. 2026 May 13:JCO2502719. doi: 10.1200/JCO-25-02719. Online ahead of print.

ABSTRACT

PURPOSE: Limited efficacy of current treatments for chordoma calls for novel therapeutic options. Combination of immune checkpoint inhibitors and antiangiogenic drugs has altered the landscape of cancer treatment but has rarely been investigated in chordoma.

METHODS: An investigator-initiated, single-center, phase II trial was conducted on camrelizumab (a PD-1 inhibitor, 200 mg once every 2 weeks) plus apatinib (an antiangiogenic drug, 250 mg and 500 mg on alternate days, that is, 250 mg one day, 500 mg the next day, alternating) in patients with refractory chordoma for 4-week cycles. The primary end point was the objective response rate (ORR) per RECIST version 1.1. Secondary end points included ORR per Choi criteria, progression-free survival (PFS), overall survival, the disease control rate, median duration of response (mDoR), safety, and quality of life. The trial is registered with Chictr.org.cn (ChiCTR2100042938).

RESULTS: Of the 38 patients initially screened between September 2021 and October 2024, 33 were enrolled. Median follow-up duration was 20.8 months (IQR, 13.35-26.55). ORR was 24.2% (8/33 [95% CI, 11.0 to 38.9]) per RECIST 1.1 and 48.5% (16/33 [95% CI, 30.8 to 66.5]) per Choi criteria. The median PFS was 28.4 months (95% CI, 13.53 to 43.28). The mDoR was not reached per RECIST 1.1 and was 22.2 months (95% CI, 12.5 to not reached) per Choi criteria. CDKN2A copy-number deletion or homozygous deletion was found to associate with worse prognosis. The most common grade 3 or 4 treatment-related adverse events included increased aspartate aminotransferase (13 [39.4%]) and increased alanine aminotransferase (11 [33.3%]). No treatment-related deaths occurred.

CONCLUSION: Combination of camrelizumab and apatinib offered encouraging efficacy with manageable toxicity in chordoma treatment. CDKN2A alterations are associated with worse prognosis and may prove to be a potential biomarker for treatment selection.

PMID:42127327 | DOI:10.1200/JCO-25-02719

J Ultrasound Med. 2026 May 13. doi: 10.1002/jum.70295. Online ahead of print.

NO ABSTRACT

PMID:42126885 | DOI:10.1002/jum.70295

JAMA Netw Open. 2026 May 1;9(5):e2612199. doi: 10.1001/jamanetworkopen.2026.12199.

ABSTRACT

IMPORTANCE: Information regarding risk factors among service member families for different child maltreatment types is needed to improve prevention efforts.

OBJECTIVE: To identify factors associated with first occurrences of 4 child maltreatment types and examine child age-related changes in risk for each type among active duty service member families.

DESIGN, SETTING, AND PARTICIPANTS: This population-based retrospective cohort study used data from the Child Maltreatment in Military Families Life Course Study on active duty service member families with a first occurrence of child maltreatment in fiscal years 2009 through 2018 and a representative sample of active duty families without child maltreatment incidents. Data were analyzed from August 2023 to February 2026.

EXPOSURE: One or more parents serving as an active duty service member.

MAIN OUTCOMES AND MEASURES: First documented occurrences of neglect, physical abuse, emotional abuse, and sexual abuse, identified using Family Advocacy Program data. Associations between sociodemographic, family, and military-related characteristics and first occurrences of maltreatment types were examined in univariable and multivariable logistic regressions.

RESULTS: The study included 618 101 active duty service member families (28 684 [4.64%] with a first occurrence of child maltreatment and 589 417 [95.36%] without child maltreatment incidents), consisting of 1 070 510 family-months (FM); the total weighted sample was 65 142 809 FM (59 031 293 male service member FM [90.62%]; mean [SD] age, 32.74 [6.97] years). Crude rates of child maltreatment were highest for child neglect (22.16 per 100 000 FM) followed by physical abuse (10.97 per 100 000 FM), emotional abuse (4.23 per 100 000 FM), and sexual abuse (2.66 per 100 000 FM). Factors associated with higher odds of all child maltreatment types in multivariable models were female service member families (eg, sexual abuse: odds ratio [OR], 1.39 [95% CI, 1.18-1.64]; physical abuse: OR, 1.82 [95% CI, 1.70-1.95]), early parenting (age <21 years) (eg, neglect: OR, 1.32 [95% CI, 1.22-1.41]; sexual abuse: OR, 2.12 [95% CI, 1.75-2.56]), larger number of dependent children (≥3) (eg, emotional abuse: OR, 1.63 [95% CI, 1.48-1.79]; sexual abuse: OR, 2.32 [95% CI, 2.06-2.61]), and never-deployed status (eg, sexual abuse: OR, 1.90 [95% CI, 1.55-2.32]; emotional abuse: OR, 3.76 [95% CI, 3.09-4.57]). Risk rates peaked at 3 months of age for neglect (48.61 per 100 000 FM) and physical abuse (25.49 per 100 000 FM). Risk of emotional and sexual abuse peaked in middle childhood (age 5-12 years) and adolescence but was generally lower (<6 per 100 000 FM) than risk of other child maltreatment types across all ages.

CONCLUSIONS AND RELEVANCE: In this cohort study, families with female service members, never-deployed service members, 3 or more children, and young parents had higher risk of child maltreatment. Dynamic prevention approaches appear to be needed to address evolving risk factors across the family life course.

PMID:42126881 | DOI:10.1001/jamanetworkopen.2026.12199

JAMA Netw Open. 2026 May 1;9(5):e2612232. doi: 10.1001/jamanetworkopen.2026.12232.

ABSTRACT

IMPORTANCE: Medicare home health is a critical postacute care source for individuals with Alzheimer disease and related dementias (ADRD). The Home Health Value-Based Purchasing (HHVBP) program has substantially reshaped financial incentives in home health, but its implications for patients with ADRD are unclear.

OBJECTIVE: To assess the association between residence in a state with an HHVBP program and home health service volume within 30 days of home health initiation among Medicare beneficiaries with ADRD, and how this varies by patient race and/or ethnicity, dual eligibility, and home health agency (HHA) racial composition.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study linked 2021 to 2022 Medicare claims data with Home Health Focus and Provider of Services files for Medicare fee-for-service beneficiaries with ADRD older than 65 years who initiated home health care within 14 days of hospital discharge in the 9 states in which an HHVBP program was piloted compared with non-HHVBP states. The analysis was conducted from November 2024 to June 2025.

EXPOSURE: Residence in an HHVBP pilot state vs a non-HHVBP state.

MAIN OUTCOMES AND MEASURES: Number of nursing and therapy visits received within 30 days (main analysis) and 14 days (sensitivity analysis) of home health initiation. Negative binomial regression models with HHA random effects were estimated, and average marginal effects were reported.

RESULTS: The analytic cohort included 264 601 Medicare beneficiaries with ADRD (median [IQR] age, 83 [77-89] years; 160 947 males [60.8%]), of whom 68 765 (26.0%) resided in HHVBP states. The overall racial and ethnic composition included Asian (3.1%; n = 8099), non-Hispanic Black (8.9%; n = 23 634), Hispanic (6.3%; n = 16 562), and non-Hispanic White (81.7%; n = 216 306) individuals, as determined by Research Triangle Institute race codes from the Master Beneficiary Summary File. Adjusted 30-day outcomes showed HHVBP state residence vs non-HHVBP state residence was associated with 0.46 fewer nursing visits (3.94 vs 4.40 visits; average marginal effect [AME] = -0.46; 95% CI, -0.52 to -0.41; P < .001) and 0.32 more therapy visits (6.37 vs 6.05 visits; AME = 0.32; 95% CI, 0.24-0.39; P < .001). In non-HHVBP states, dual-eligible beneficiaries and those receiving care from HHAs primarily serving a racial and ethnic minority population received more nursing but fewer therapy visits compared with non-dual-eligible beneficiaries and those receiving care from HHAs serving a predominantly White population. These differences became smaller in HHVBP states. For example, therapy visit gaps between patients receiving care from HHAs primarily serving a racial and ethnic minority population and those receiving care from HHAs serving a predominantly White patient population narrowed from -0.81 (95% CI, -0.90 to -0.73) to -0.27 (95% CI, -0.44 to -0.09) visits in non-HHVBP vs HHVBP states (P < .001). The findings of increasing use of therapy visits and smaller group differences were consistent within a 14-day window.

CONCLUSIONS AND RELEVANCE: In this cohort study of Medicare beneficiaries with ADRD, residence in an HHVBP state was associated with increased therapy use and smaller differences in home health service patterns between racial and/or ethnic minority and White patients, dual-eligible and non-dual-eligible beneficiaries, and patients receiving care from minority-serving HHAs and those receiving care from HHAs serving a predominantly White patient population compared with residence in a non-HHVBP state. These findings suggest that VBP models could reduce differences in postacute care.

PMID:42126880 | DOI:10.1001/jamanetworkopen.2026.12232

JAMA Netw Open. 2026 May 1;9(5):e2612319. doi: 10.1001/jamanetworkopen.2026.12319.

ABSTRACT

BACKGROUND: Unhealthy alcohol and drug use have significant health-related sequelae. Given racial and ethnic disparities in complications of substance use, successful screening and medication prescribing for addictions are important in community health settings serving diverse populations.

OBJECTIVE: To evaluate alcohol and drug use screening and prescribing of medications for addiction treatment in adults by race, ethnicity, and language preference.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included US adults seen between 2012 and 2020 in a multistate electronic health record (EHR) network (1394 primary care clinics). Analyses were completed October 2024.

EXPOSURE: Race and ethnicity with language preference groups: non-Hispanic White, non-Hispanic Black, Latino with Spanish language preferred, and Latino with English language preferred.

MAIN OUTCOME(S) AND MEASURES: Multivariable logistic regression estimated covariate-adjusted odds ratios (aOR) of receipt of alcohol and drug screening and EHR-documented prescription of medication for alcohol (AUD) or opioid use disorders (OUD).

RESULTS: There were 2 191 945 patients across 25 states (mean (SD) age, 41.3 [15.2] years; 1 236 818 female [56.4%]); 416 607 identified as non-Hispanic Black (19.0%), 1 015 066 non-Hispanic White (46.3%), 474 389 Latino with Spanish-language preference (21.6%), and 285 883 Latino with English-language preference (13.0%). Over the study period, 869 609 (39.7%) had documented completed alcohol screening, and 862 263 (39.3%) completed drug screening-113 629 (5.2%) had a diagnosis of AUD and 247 530 (11.3%) had an OUD diagnosis. Spanish-preferring Latino patients had 59% increased odds of screening compared with non-Hispanic White patients (aOR, 1.59; 95% CI, 1.31-1.93). All minoritized race and ethnicity with language preference groups had lower odds of prescribed medications for addictions treatment compared with non-Hispanic White patients; non-Hispanic Black patients had the lowest odds of any group (AUD: aOR, 0.55; 95% CI, 0.43-0.69; OUD: aOR, 0.38; 95% CI, 0.31-0.46).

CONCLUSIONS AND RELEVANCE: In this cohort study, there was an overall low likelihood of completed screening for alcohol and drug use among all minoritized race and ethnicity with language preference groups. All minoritized groups had lower odds of receipt of medications for addiction treatment compared with the non-Hispanic White group. Improving screening and addressing this emerging treatment inequity should be prioritized.

PMID:42126879 | DOI:10.1001/jamanetworkopen.2026.12319

JAMA Netw Open. 2026 May 1;9(5):e2612323. doi: 10.1001/jamanetworkopen.2026.12323.

ABSTRACT

IMPORTANCE: Although hepatocellular carcinoma (HCC) incidence has decreased in the US, it is unclear if rural residents have experienced similar trends.

OBJECTIVE: To examine rural-urban differences in HCC incidence and incidence-based mortality trends by sex, race and ethnicity, and stage at diagnosis.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed HCC diagnoses from 2001 to 2022 and deaths from 2007 to 2022 using data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results (SEER) programs for incidence and the SEER-21 program for incidence-based mortality. Rurality was classified using the 2013 Rural-Urban Continuum Codes. All analyses were performed from October 2025 to February 2026.

MAIN OUTCOMES AND MEASURES: Annual incidence and incidence-based mortality rates per 100 000 people were calculated and age standardized to the 2000 US standard population. The annual percentage change (APC) and the average APC in incidence and incidence-based mortality rates were then estimated using Joinpoint regression.

RESULTS: The study analyzed 264 633 HCC cases (77.0% among men and 86.6% in urban areas). Among men, HCC incidence was 4.5 (95% CI, 4.4-4.5) per 100 000 people in rural counties and 5.8 (95% CI, 5.8-5.8) per 100 000 people in urban counties; among women, HCC incidence was 1.2 (95% CI, 1.2-1.2) per 100 000 people in rural counties and 1.5 (95% CI, 1.5-1.5) per 100 000 people in urban counties. In rural counties, HCC incidence increased by 1.1% (95% CI, 0.6%-1.6%) per year among men from 2007 to 2022 and 1.7% (95% CI, 1.2%-2.3%) per year among women from 2001 to 2022, whereas in urban counties, HCC rates decreased by 1.4% (95% CI, -1.7% to -1.1%) per year among men from 2008 to 2022 and by 1.0% (95% CI, -1.4% to -0.6%) per year among women from 2009 to 2022. Among men, incidence-based mortality rates were 2.7 (95% CI, 2.3-3.0) per 100 000 people in rural counties and 3.8 (95% CI, 3.6-3.9) per 100 000 people in urban counties; among women, the incidence-based mortality rates were 0.8 (95% CI, 0.6-0.9) per 100 000 people in rural counties and 0.9 (95% CI, 0.8-1.0) per 100 000 people in urban counties. In rural counties, incidence-based mortality rates increased by 1.2% (95% CI, 0.3%-2.1%) per year among men and remained stable among women (APC, 0.3% [95% CI, -1.1% to 1.7%]), whereas in urban counties, incidence-based mortality rates decreased by 1.4% per year (95% CI, -1.7% to -1.1%) among men and 1.0% (95% CI, -1.7% to -0.4%) per year among women.

CONCLUSIONS AND RELEVANCE: This cohort study revealed rural-urban disparities in HCC incidence and incidence-based mortality trends. These findings highlight the need for targeted prevention strategies and improved access to early detection and specialty care for rural populations.

PMID:42126878 | DOI:10.1001/jamanetworkopen.2026.12323