Tag: pubmed

J Surg Oncol. 2026 Feb 7. doi: 10.1002/jso.70211. Online ahead of print.

ABSTRACT

Tranexamic acid (TXA) is widely used across surgical specialties to reduce perioperative blood loss, yet its specific role in hepatic resection remains unclear. This meta-analysis, performed according to PRISMA guidelines, evaluated the efficacy and safety of TXA in liver surgery. Outcomes of interest included mean intraoperative blood loss, the proportion of patients receiving transfusion, and mean units of red blood cells transfused intraoperatively and postoperatively. Secondary endpoints included postoperative mortality, thromboembolic events, and hospital length of stay. Of 36 articles assessed, nine studies met eligibility criteria for inclusion. TXA use was associated with a statistically significant reduction in intraoperative blood loss (SMD – 0.18; 95% CI, – 0.28 to – 0.09; p < 0.01), although transfusion requirements did not differ significantly between groups (RR 0.81; 95% CI, 0.47-1.38; p = 0.44). Interpretation of these findings is limited by substantial heterogeneity among included studies (I² = 82%). While TXA appears effective in reducing intraoperative bleeding, its use may confer a higher risk of postoperative thromboembolic complications, suggesting that TXA administration during hepatic resection should be selective and individualized rather than routine.

PMID:41653150 | DOI:10.1002/jso.70211

Global Spine J. 2026 Feb 7:21925682261424528. doi: 10.1177/21925682261424528. Online ahead of print.

ABSTRACT

Study DesignRetrospective study.ObjectiveThis study aimed to investigate the association between preoperative patient expectations and postoperative satisfaction in elderly patients with adult spinal deformity (ASD), with particular emphasis on identifying potential dose-response relationships.MethodsWe conducted a retrospective cohort study of elderly patients (aged ≥65 years) with ASD undergoing thoracolumbar fusion surgery at our institution. Participants were stratified into satisfied and dissatisfied cohorts based on postoperative the North American Spine Society (NASS) satisfaction scores assessed at follow-up. Comprehensive data collection included demographic characteristics, radiological parameters, surgical variables, and perioperative outcomes. Propensity score matching using the nearest-neighbor method was applied to both groups of patients. Conditional logistic regression models adjusted for confounders were employed to assess associations. Nonlinear relationships were investigated through smoothed curve fitting with covariate adjustment. Threshold effects were analyzed using piecewise regression models, with receiver operating characteristic (ROC) curve analysis validating optimal cutoff values.ResultsIn our study involving 234 elderly patients with ASD undergoing thoracolumbar fusion surgery between September 2019 and September 2022, we analyzed statistically significant differences between a case group (patient dissatisfied) and a control group (patient satisfied). We matched 82 patients in each group using nearest-neighbor matching. Despite this matching, there were still significant differences in key variables such as American Society of Anesthesiologists (ASA), Age-adjusted Charlson Comorbidity Index (ACCI), complications, previous spine surgery, perioperative outcomes, and preoperative expectation (P < .05). In our fully adjusted model, we found that higher expectation scores were associated with lower satisfaction levels. Our curve-fitting analysis revealed that the risk of decreased patient satisfaction increased notably when the expectation score exceeded 53 points. Two-piecewise regression confirmed this threshold (OR = 0.29, 95% CI 0.17 ∼ 0.38, P < .001), corroborated by Receiver operating characteristic (ROC) analysis (AUC = 0.808, sensitivity 83.6%, specificity 63.2%).ConclusionOur findings identify 53 points as the critical threshold on preoperative expectation scales where satisfaction risk markedly escalates in elderly spinal deformity patients undergoing thoracolumbar fusion. The demonstrated dose-response relationship underscores the clinical importance of preoperative expectation management in this population.

PMID:41653124 | DOI:10.1177/21925682261424528

Infancy. 2026 Jan;31(1):e70074. doi: 10.1111/infa.70074.

ABSTRACT

Digital media has become ubiquitous for families, yet little is known about how infants and toddlers are exposed to it across different contexts and demographics. Most existing research focuses narrowly on total screen time, often neglecting critical factors such as media type, user, timing, and background exposure. The current study sought to address this gap by asking 252 socioeconomically diverse caregivers of children 8-25 months about their child’s media exposure, including how much, what kinds, when, by whom, and in what form digital media is used in the home. Consistent with prior work, infants averaged over 2 hours/day of direct media use but were exposed to even higher rates of indirect background TV (over 4.6 hours/day). Such background exposure represents 66%-75% of children’s total TV and handheld device exposure and is significantly more common on weekends. However, there is substantial variability in children’s media environments, with older infants being exposed to greater amounts and more diverse forms of media. Notably, children from lower-SES households experience more background media and caregiver phone use, which may introduce both visual and auditory distractions during key developmental periods. This study highlights that the most prominent source of media exposure early in life is not through children’s personal use of devices, but rather indirect exposure through background media use, which varies widely across families. To truly capture the landscape of young children’s technology exposure and the impact on development, we must consider the broader media environment, not just the screen in front of the child.

PMID:41653108 | DOI:10.1111/infa.70074

Vet Med Sci. 2026 Mar;12(2):e70835. doi: 10.1002/vms3.70835.

ABSTRACT

INTRODUCTION: The public health and economic impact of brucellosis remain a significant concern in Ethiopia. The high seroprevalence rates observed in both camels and humans indicate the potential for cross-species transmission, highlighting the risk of brucellosis spreading. However, there is limited evidence concerning the relationship between brucellosis prevalence in humans and camels in the pastoralist regions of Ethiopia.

METHODS: A cross-sectional study was conducted among 390 camels and 390 camel farmers in the Dire district from November 2023 to March 2024, using multistage sampling. This study aimed to determine the seroprevalence of brucellosis in camel farmers and their camels. During screening and confirming the presence of brucellosis, a modified rose Bengal plate test (MRBPT) and an indirect enzyme-linked immunosorbent assay (I-ELISA) were used, respectively, as a test series.

RESULT: Among 390 camels, 7.17%, 95% CI (4.99-10.22) and 4.36%, 95% CI (2.72-6.91) were seropositive for Brucella using MRPT and I-ELISA, respectively. Among 390 camel farmers, Brucella seroprevalence was 7.69% (95% CI: 5.42-10.81) by MRBPT and 3.08% (95% CI: 1.75-5.35) by I-ELISA. In camels, adult (OR: 5.59, 95% CI: 1.67-44.48), female (OR: 2.83, 95% CI: 1.54-12.81) and large herds (OR: 5.10, 95% CI: 1.27-20.49) were statistically significant risk factors for the seroprevalence of camel brucellosis. In humans, the presence of a positive animal in the household (OR: 5.07, 95% CI: 1.10-23.34) and camel farmers who consume raw milk (OR: 2.75, 95% CI: 1.51-5.21) were also statistically significant risk factors for the seroprevalence of brucellosis.

CONCLUSION: The presence of a Brucella-positive camel in households and the consumption of raw milk highlight shared exposure at the human-animal interface. In marginal areas of Ethiopia, such as the Dire district, camel herders often face challenges accessing public services and information regarding zoonotic diseases. Consequently, promoting preventive strategies and raising awareness about the public health effects of camel brucellosis are encouraged to decrease the impact of this zoonotic disease in pastoral communities.

PMID:41653100 | DOI:10.1002/vms3.70835

Scand J Prim Health Care. 2026 Dec;44(1):2616519. doi: 10.1080/02813432.2026.2616519. Epub 2026 Feb 7.

ABSTRACT

OBJECTIVES: Out-of-hours services (OOHS) worldwide exhibit diverse organisational models, especially within the European Union. This study aims to describe the transformation of OOHS in Region Zealand, Denmark, from a General Practitioner cooperative (GP-OOHS) to a regional organization/service, known as the 1818 Medical Helpline (1818).

STUDY DESIGN: Retrospective cohort study.

METHODS: GP-OOHS data (January 2017-October 2023) during the transition from GP-cooperative to Regional Service (October 2022) were analysed. Coded and timestamped services retrieved from the billing system were used to identify patient pathways, defined as services within a 12-hour window. Descriptive statistics were applied.

RESULTS: A total of 2,572,951 patient pathways were recorded, with 2,258,072 under GP-out-of-hours service and 314,879 under the 1818. Overall, patient pathway volumes declined from 412,116 in 2017 to 314,879 in 2022, and admissions fell from 64,555 to 59,967. The median patient age was 35 years. The GP-out-of-hours service had a higher average monthly volume of patient pathways (32,726 vs. 25,940), while 1818 showed a higher proportion of emergency department admissions within 24 h (19.0% vs. 17.6%), the number of admissions fell from 8.2 per 100,000 inhabitants to 7.1 per 100,000 inhabitants. Interrupted time series analysis showed that the previously increasing tendency in ED admissions flattened following the transition. Although the absolute number of children admitted decreased, the proportion of admissions increased due to overall decline in patient pathways. Face-to-face consultations (31.4% vs. 27.1%) and home visits (9.4% vs. 3.4%) were more frequent in GP-out-of-hours service, both being associated with higher admission rates.

CONCLUSIONS: OOHS patient pathways declined over the study period and continued to decline following the organizational change. The absolute number of emergency department admissions also decreased, while the relative proportion of admissions increased. These findings indicate a continued decline in OOHS activity and a slight shift toward more acute cases after the reorganisation.

PMID:41653021 | DOI:10.1080/02813432.2026.2616519

Can J Rural Med. 2026 Jan 1;31(1):15-24. doi: 10.4103/cjrm.cjrm_2_25. Epub 2026 Feb 9.

ABSTRACT

INTRODUCTION: The COVID-19 pandemic imposed an unprecedented strain on the healthcare system, resulting in rising burnout levels among healthcare personnel. The pandemic’s effect on the mental well-being of those working within resource-limited healthcare settings remains unexplored. We assessed the impact of the pandemic on burnout and resilience in healthcare personnel working in rural Northern Ontario.

METHODS: We surveyed healthcare personnel across 15 rural communities in Northern Ontario, gathering demographic, occupational, burnout and resilience data. Chi-square tests (χ2) determined response variations by demographic and occupational factors, whereas ANOVAs assessed mean differences. Pearson correlation coefficient measured the relationship between burnout and resilience, and linear associations were identified using the Mantel-Haenszel test.

RESULTS: Ninety-nine healthcare workers from 15 rural communities were sent the survey. Seventy-six (77%) responded. Fifty-five per cent of respondents experienced burnout, with 81% rating it as moderately severe or worse. Those who grew up in their current community reported higher burnout rates, and 73% of participants reported strong resilience. Childhood community ties correlated with lower resilience, whereas higher resilience was linked to lower burnout severity. Physicians had lower Connor-Davidson-Resilience Scale© (CD-RISC 2) scores compared to hospital CEOs.

CONCLUSION: Despite high burnout, respondents had strong resilience. A correlation between burnout severity and resilience suggests that higher resilience is linked to less severe burnout which suggests that resilience can buffer the impact of burnout. Enhancing resilience could improve the ability to cope with stress and adversity. The data emphasises the need to consider factors, such as occupation and community history, when assessing burnout risk and designing well-being interventions.2-25 L’impact de la pandémie de COVID-19 sur l’épuisement professionnel et la résilience du personnel de la santédans le Nord rural de l’Ontario: Une étude transversale.

INTRODUCTION: La pandémie de COVID-19 a exercé une pression sans précédent sur le système de santé, entraînant une hausse marquée de l’épuisement professionnel chez le personnel soignant. Les répercussions de cette crise sur la santé mentale des professionnels œuvrant dans des milieux où les ressources sont limitées demeurent peu documentées. Cette étude évalue l’impact de la pandémie sur l’épuisement professionnel et la résilience du personnel de la santé travaillant dans des communautés rurales du Nord de l’Ontario.

MTHODES: Une enquête a été menée auprès de membres du personnel de la santé provenant de 15 communautés rurales du Nord ontarien. Nous avons recueilli des données démographiques, professionnelles, ainsi que des mesures d’épuisement professionnel et de résilience. Des tests du khi carré (χ2) ont permis d’examiner les variations selon les caractéristiques sociodémographiques et professionnelles. Des ANOVA ont été utilisées pour comparer les moyennes. Le coefficient de corrélation de Pearson a évalué la relation entre l’épuisement professionnel et la résilience, et des associations linéaires ont été analysées à l’aide du test de Mantel-Haenszel.

RSULTATS: Parmi les 99 membres du personnel de la santé provenant de 15 communautés rurales à qui l’enquête a été envoyée, 76 ont répondu (77%). Cinquante-cinq pour cent des répondants ont indiqué vivre de l’épuisement professionnel, et 81% l’ont qualifié de modérément sévère ou pire. Les personnes ayant grandi dans la communauté où elles travaillent rapportaient des taux d’épuisement plus élevés, tandis que 73% des participants présentaient une forte résilience. Les liens communautaires établis durant l’enfance étaient associés à une résilience plus faible, alors qu’une résilience élevée était liée à une sévérité moindre de l’épuisement professionnel. Les médecins affichaient également des scores inférieurs au Conor-Davidson Resilience Scale© (CD-RISC 2) comparativement aux PDG d’hôpitaux.

CONCLUSION: Malgré des niveaux élevés d’épuisement professionnel, les participants présentaient une résilience notable. La corrélation entre résilience et sévérité de l’épuisement suggère qu’une meilleure résilience atténue l’impact de l’épuisement, renforçant la capacité à faire face au stress et à l’adversité. Les résultats soulignent l’importance de considérer des facteurs tels que l’occupation et l’ancrage communautaire dans l’évaluation du risque d’épuisement et dans la conception d’interventions pour soutenir le bien-être.

PMID:41652987 | DOI:10.4103/cjrm.cjrm_2_25

Can J Rural Med. 2026 Jan 1;31(1):7-14. doi: 10.4103/cjrm.cjrm_87_24. Epub 2026 Feb 9.

ABSTRACT

INTRODUCTION: The COVID-19 pandemic significantly disrupted primary care delivery, amplifying challenges in resource stewardship. Choosing Wisely Canada (CWC) guidelines aim to reduce unnecessary interventions. However, barriers to their implementation persist, particularly in rural settings where access to resources is limited and patient expectations often conflict with evidence-based care. Our study explored primary care physicians’ awareness of, utilisation of and barriers to implementing CWC guidelines in a post-pandemic context, focusing on challenges, quality improvement opportunities and innovative approaches to reduce low-value care.

METHODS: An online survey of primary care physicians across Canada was used to collect demographic data, practice habits and perspectives on CWC guidelines. Quantitative analysis measured trends, while qualitative analysis of open-ended responses identified recurring themes.

RESULTS: One hundred and twenty-seven primary care physicians responded to the survey. Results revealed high awareness of CWC guidelines (97.6%) but low familiarity with post-pandemic adaptations (36.2%) and patient-facing materials (61.4%). Key barriers included time constraints, fear of missed diagnoses and limited rural resources. Physicians highlighted the need for tailored approaches in rural settings, where deviations from guidelines are often necessary because of challenges related to healthcare access. Participants identified several opportunities for improvement, including integrating guidelines into electronic medical records and developing mobile applications to support decision-making. Enhanced patient education emerged as critical for addressing demands for unnecessary tests, often fuelled by misinformation from social media.

CONCLUSION: Targeted medical and patient education, interprofessional collaboration and technology integration are essential for improving CWC adoption. Tailored solutions that address rural-specific challenges and systemic barriers are pivotal for achieving sustainable resource stewardship in primary care.

INTRODUCTION: La pandémie de COVID-19 a profondément bouleversé l’organisation des soins primaires, accentuant les défis liés à l’utilisation judicieuse des ressources. Les recommandations de Choisir avec soin visent à réduire les interventions inutiles, mais leur mise en œuvre demeure difficile, surtout en milieu rural où l’accès aux services est restreint et où les attentes des patients s’harmonisent parfois mal avec les pratiques fondées sur les données probantes. Notre étude examine la connaissance, l’utilisation et les obstacles à l’intégration des recommandations de Choisir avec soin chez les médecins de famille en contexte postpandémique, en mettant l’accent sur les défis rencontrés, les occasions d’amélioration de la qualité des soins et les approches innovantes pour diminuer les actes à faible valeur.

MTHODES: Une enquête en ligne a été distribuée à des médecins de soins primaires partout au Canada. Le questionnaire recueillait des données démographiques, des informations sur les habitudes de pratique et des perceptions par rapport aux recommandations de Choisir avec soin. L’analyse quantitative a permis d’identifier les tendances, tandis que l’analyse qualitative des réponses ouvertes a fait ressortir des thèmes récurrents.

RSULTATS: Cent vingt-sept médecins y ont répondu. Bien que la grande majorité connaissait les recommandations de Choisir avec soin (97.6%), peu étaient au fait des adaptations postpandémiques (36.2%) ou des outils destinés aux patients (61.4%). Les obstacles principaux mentionnés incluaient le manque de temps, la crainte de passer à côté d’un diagnostic important et le manque de ressources en région. Les médecins ont souligné la nécessité d’approches adaptées aux réalités rurales, où il faut parfois s’éloigner des recommandations en raison de contraintes d’accès aux services. Les participants ont également mis de l’avant plusieurs pistes d’amélioration, comme l’intégration des recommandations dans les dossiers médicaux électroniques et la création d’applications mobiles pour soutenir la prise de décision. Une meilleure éducation des patients a été identifiée comme essentielle pour répondre aux demandes d’examens inutiles, souvent alimentées par la désinformation circulant sur les réseaux sociaux.

CONCLUSION: Le renforcement de la formation clinique et de l’éducation du public, la collaboration interprofessionnelle et l’intégration de solutions technologiques sont essentiels pour augmenter l’adoption des recommandations de Choisir avec soin. Des stratégies adaptées aux réalités des milieux ruraux et aux obstacles systémiques sont indispensables pour assurer une gestion durable et responsable des ressources en soins primaires.

PMID:41652986 | DOI:10.4103/cjrm.cjrm_87_24

J Perioper Pract. 2026 Feb 7:17504589251413465. doi: 10.1177/17504589251413465. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to evaluate the occurrence of postoperative sore throat, hoarseness, and cough after inflating the cuff using a manometer versus the traditional syringe-assisted cuff inflation method.

METHODS: This study involved 56 patients of the American Society of Anesthesiologists (ASA) physical status (PS) classification system I and II undergoing elective laparoscopic surgeries under general anaesthesia. After obtaining ethics committee approval and informed consent, the patients were divided into two groups. In group A, cuff pressure was set to 25 cmH₂O using a Portex^® cuff inflator. In group B, the cuff was inflated with room air using a 10-ml syringe; adequacy was assessed by palpation and auscultation. Postoperatively, the patients were monitored for sore throat, hoarseness, and cough, graded using the Harding and McVey scoring system.

RESULTS: The incidence of sore throat in the cuff manometer group was higher than in the syringe group at zero hour, possibly due to various factors. However, over time, the manometer group had more patients reporting no sore throat. A notable statistical and clinical difference was found between groups in sore throat and hoarseness. No statistical difference in cough was observed.

CONCLUSION: Continuous cuff pressure monitoring during surgery reduces postoperative sore throat and hoarseness.

PMID:41652922 | DOI:10.1177/17504589251413465

New Phytol. 2026 Feb 6. doi: 10.1111/nph.70977. Online ahead of print.

ABSTRACT

Rapid environmental change reshapes both abiotic stress and biotic interactions, yet it remains unclear how these combined forces structure plants’ genomic adaptation. In particular, the joint influence of temperature and pollinator identity, two ecological axes undergoing simultaneous global shifts, has rarely been quantified at genomic resolution. We resequenced Brassica rapa L. plants after a six-generation evolution experiment, combining two temperature regimes (ambient vs hot) with three pollination treatments (bumblebee, butterfly, and mixed bumblebee-butterfly), and glasshouse control, to assess how these factors shape genomic responses. Using multiple complementary statistics (allele-frequency trajectories, F_ST outliers, Cochran-Mantel-Haenszel tests, and local score analyses), we found that adaptive genomic responses differed sharply among pollinators and temperatures: warming strengthened selection in community-level pollination, yielding the clearest signals in the hot-generalised treatment; bumblebee pollination showed strong but drift-obscured genomic change; and butterfly treatments exhibited minimal genomic response. Our findings demonstrate that pollinator identity and temperature interact nonadditively to produce distinct, highly context-dependent adaptive trajectories. This work highlights the importance of accounting for demographic variation and ecological complexity when predicting evolutionary responses to climate-driven shifts in species interactions.

PMID:41652900 | DOI:10.1111/nph.70977

J Natl Cancer Inst. 2026 Feb 6:djag028. doi: 10.1093/jnci/djag028. Online ahead of print.

ABSTRACT

Surveillance, Epidemiology, and End Results (SEER) multiple myeloma (MM) survival statistics (https://seer.cancer.gov/statfacts/html/mulmy.html) that have been used to guide MM management and control have been systematically overestimated due to the inclusion of smoldering multiple myeloma (SMM), a premalignant condition of MM. Using the latest SEER release, we estimated the extent of such overestimation in the survival statistics. In 2016, 77.9% out of 5,495 patients reported as overall MM were symptomatic MM and 10.9% were SMM. Median survival was 65.8 months for overall MM versus 56.8 months for symptomatic MM (p < .001). Inclusion of SMM overestimated MM survival by 9 months. Five-year relative survival estimates from 2015-2021 were 61.6% for overall MM, 57.9% for symptomatic MM, and 88.3% for SMM, versus SEER’s reported 62.4%. Survival statistics for symptomatic MM and SMM should be reported separately to guide MM management and prevention at the population level.

PMID:41652897 | DOI:10.1093/jnci/djag028