Tag: pubmed

Emerg Med J. 2026 Aug 11:emermed-2026-215992. doi: 10.1136/emermed-2026-215992. Online ahead of print.

ABSTRACT

BACKGROUND: Electric-scooters (e-scooters) are popular worldwide although there are concerns about their regulation and safety. Since 2019, 59 deaths have been reported in the UK involving e-scooters; 10 under 18 years old. In the UK riding privately owned e-scooters is illegal unless on private land. We reviewed e-scooter injuries in patients presenting to Emergency Departments of three UK Paediatric Major Trauma Centres.

METHODS: This was a retrospective observational study of e-scooter-related injuries in patients under 16 years-old from January 2019 to December 2024 at Alder Hey Children’s Hospital (AH), Sheffield Children’s Hospital (SCH) and Royal Manchester Children’s Hospital (RMCH). Patients were identified via electronic triage records and cross-referenced with trauma lists. At RMCH, a change in software limited data collection to 2023-2024. Descriptive statistics were used with 95% CIs for key proportions.

RESULTS: 477 patients presented with increasing incidence over the 6 year period. Median age was 12 years (IQR 10-13), with a male predominance (64.4%). Most injuries occurred to the rider (94.8%) and ≥80% were private e-scooters. 2.5% occurred on private land.Most common injuries were limb (40.6% lower, 36.2% upper), head (24.1%), and facial (18.4%) injuries. 10.4% of head injuries had an Abbreviated Injury Scale (AIS) score of 3 or 4, indicating major trauma necessitating imaging, hospital admission, and surgical intervention. Of the most seriously injured (AIS 3 or 4), 48% were from a collision with a motor vehicle or stationary object. Only 1.8% were wearing a helmet; 13.4% were admitted and 6.9% required surgery. Most injured children (74%) lived in the most deprived areas (Index of Multiple Deprivation (IMD) 1/2).

CONCLUSION: E-scooter related injuries are rising. Limb, head and facial injuries were most common, with head injuries being most severe, this has serious life-changing implications for families and significant impact on healthcare resources. There is a need for greater public awareness, clear public health messaging and review of government legislation to prevent further injuries and deaths.

PMID:42580879 | DOI:10.1136/emermed-2026-215992

Eur J Hosp Pharm. 2026 Aug 11:ejhpharm-2025-004887. doi: 10.1136/ejhpharm-2025-004887. Online ahead of print.

ABSTRACT

OBJECTIVES: Intravenous immunoglobulin (IVIG) is a high-cost therapy that is widely used in paediatric care for its immunomodulatory effects. However, inappropriate prescribing contributes to resource waste and potential harm. This study aimed to evaluate the impact of clinical pharmacist-led supervision on the rational use of IVIG in a paediatric hospital setting.

METHODS: A retrospective cross-sectional study was conducted at a paediatric hospital, comparing two 6 month periods: before and after the implementation of a clinical pharmacist-driven prescribing protocol. A total of 248 paediatric patients were systematically selected and assessed for IVIG indication appropriateness, dosing accuracy, and corticosteroid pre-treatment. Statistical analyses were performed to compare clinical variables across the two periods.

RESULTS: Following clinical pharmacist intervention, the proportion of appropriate IVIG prescriptions significantly increased from 49.2% to 66.9% (p<0.001), and the number of vials used decreased from 837 to 451. Dosing improvements led to the saving of 199 vials, equating to approximately £15,694 in cost savings. Among patients with immune thrombocytopenic purpura (ITP), the rate of corticosteroid use, as the first-line therapy prior to IVIG administration, increased from 10.5 to 33.3%. Although IVIG use increased in certain departments, its administration became more evidence-based and targeted to appropriate indications.

CONCLUSION: Clinical pharmacist-led supervision significantly improved the appropriateness of IVIG use in paediatric patients, reduced unnecessary dosing, and contributed to substantial cost savings, underscoring the critical role of clinical pharmacists in optimising high-cost medication use. Further prospective studies are recommended to assess long-term clinical outcomes of such interventions.

PMID:42580873 | DOI:10.1136/ejhpharm-2025-004887

AJNR Am J Neuroradiol. 2026 Aug 11:ajnr.A9577. doi: 10.3174/ajnr.A9577. Online ahead of print.

ABSTRACT

PURPOSE: This systematic review and meta-analysis aimed to synthesize evidence on baseline and procedural neuroimaging markers associated with futile recanalization in posterior circulation stroke.

DATA SOURCES: A systematic search was conducted across PubMed, Scopus, Web of Science, and Embase from inception through April 2025.

STUDY SELECTION: Studies evaluating neuroimaging predictors of futile recanalization in patients with posterior circulation stroke who achieved successful recanalization (mTICI ≥2b) after endovascular treatment were included.

DATA ANALYSIS: Risk of bias was assessed using PROBAST. Random-effects meta-analysis was performed for imaging parameters reported in two or more studies. Heterogeneity was assessed using I² statistics, and leave-one-out sensitivity analyses were conducted.

DATA SYNTHESIS: Twelve studies comprising 3,521 patients met the inclusion criteria. Meta-analysis of five studies demonstrated that higher PC-ASPECTS scores were significantly associated with reduced odds of futile recanalization (pooled OR = 0.72, 95% CI: 0.60-0.86; I² = 74.8%). The BATMAN collateral score showed a non-significant general direction toward lower futile recanalization with higher scores (OR = 0.81; 95% CI: 0.57-1.14; I² = 51.8%). Additional imaging predictors identified across studies included PMT score, PC-CS, PComA patency, CBF <35% volume, and cerebral circulation time. Perfusion metrics such as hypoperfusion intensity ratio and core volume did not independently predict futile recanalization.

LIMITATIONS: The current study has several limitations. A small number of included studies (mostly retrospective with limited sample sizes), high heterogeneity (I² = 74.8% for PC-ASPECTS), varying definitions of functional outcome, differing covariates in multivariable models with possible residual confounding, and wide variation in study size/design. Furthermore, we were unable to perform reliable formal subgroup analyses, and publication-bias assessments due to only five eligible studies for PC-ASPECTS and two for BATMAN, necessitating reliance on qualitative assessment and leave-one-out sensitivity analyses while leaving publication bias and small-study effects unexcluded.

CONCLUSION: PC-ASPECTS is a robust imaging predictor of futile recanalization in posterior circulation stroke. Location-based and collateral-based imaging parameters demonstrate greater prognostic value than volumetric thresholds in this territory. Integration of multiple imaging parameters into composite scores may enhance predictive accuracy and guide patient selection.

PMID:42580864 | DOI:10.3174/ajnr.A9577

Open Heart. 2026 Aug 11;13(2):e004250. doi: 10.1136/openhrt-2026-004250.

ABSTRACT

BACKGROUND: Catheter-directed thrombolysis (CDT) has emerged as a reperfusion strategy for intermediate-risk and high-risk pulmonary embolism (PE), potentially improving thrombus resolution while reducing bleeding risk compared with systemic thrombolysis. However, evidence comparing CDT with anticoagulation alone remains inconsistent.

OBJECTIVE: To evaluate the efficacy and safety of CDT compared with anticoagulation alone in intermediate-risk and high-risk PE.

METHODS: A systematic review and meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Cochrane Library, Epistemonikos and ProQuest were searched through 8 May 2026. Randomised and observational studies comparing CDT with anticoagulation alone were included. Primary outcomes were all-cause mortality and major bleeding. Random-effects models were used to calculate pooled risk ratios (RRs) and mean differences with 95% CIs.

RESULTS: 18 studies involving 16 126 patients were included. CDT was associated with a lower risk of all-cause mortality compared with anticoagulation alone (RR 0.41, 95% CI 0.32 to 0.54; p<0.0001; I²=0%). No statistically significant difference was observed in major bleeding (RR 1.78, 95% CI 0.85 to 3.71; p=0.1259; I²=51.3%), and trim-and-fill analysis yielded a similarly non-significant result (adjusted RR 0.84, 95% CI 0.39 to 1.79). CDT and anticoagulation alone showed comparable outcomes for PE-related mortality, intracranial haemorrhage, delta right ventricle (RV)/left ventricle (LV) ratio, delta Thrombus Burden Score or systolic pulmonary artery pressure. Meta-regression identified that a greater baseline RV/LV ratio was associated with attenuation of the observed mortality benefit.

CONCLUSIONS: CDT was associated with lower all-cause mortality compared with anticoagulant alone in intermediate-risk and high-risk PE without a statistically significant increase in intracranial haemorrhage. Larger adequately powered randomised trials are needed to define the role of CDT in acute PE.

PROSPERO REGISTRATION NUMBER: CRD420261373193.

PMID:42580844 | DOI:10.1136/openhrt-2026-004250

BMJ Open. 2026 Aug 11;16(8):e118941. doi: 10.1136/bmjopen-2026-118941.

ABSTRACT

OBJECTIVES: Inappropriate and broad-spectrum antibiotic use contributes to antimicrobial resistance (AMR) and higher healthcare costs. In Saudi Arabia, despite ongoing antimicrobial stewardship efforts, comprehensive real-world evidence on antibiotic prescribing patterns remains limited. This study aimed to evaluate antibiotic prescribing among insured (Daman) beneficiaries in Saudi Arabia and benchmark against international standards.

DESIGN: Retrospective analysis of deidentified health insurance claims from the National Platform for Health and Insurance Exchange Services (NPHIES), covering 1 November 2023-31 October 2024.

SETTING: Antibiotic prescriptions were identified within claims and linked to diagnostic codes using the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) to determine clinical indications for use.

PARTICIPANTS: Among 4.02 million claimants, 8.3 million antibiotic prescriptions were identified.

PRIMARY AND SECONDARY OUTCOME MEASURES: Antibiotic claims were mapped to the Saudi Food and Drug Authority (SFDA) drug list. Hospital antibiotic consumption was expressed as defined daily doses (DDD) per 100 patient-days for five selected inpatient antibiotics, whereas overall antibiotic consumption (in both community and hospital settings) was expressed as DDD per 1000 insured persons per day. Treatment duration, prescriber specialty and patient demographics were measured. Appropriateness of antimicrobial prescribing for respiratory tract infections was assessed using Healthcare Effectiveness Data and Information Set (HEDIS) metrics.

RESULTS: Age-stratified and sex-stratified antibiotic prescription rates showed disproportionately high use in male infants (509.6 prescriptions per 1000) and older males (641.9 prescriptions per 1000). General practitioners accounted for 80% of prescriptions. Broad-spectrum beta-lactams, particularly amoxicillin-clavulanate, predominated. Overall antibiotic consumption was 11.63 DDD per 1000 insured persons per day, comparable to European Surveillance of Antimicrobial Consumption Network (ESAC-Net) outpatient benchmarks. Mean treatment durations ranged 8-14 days, exceeding global stewardship recommendations. HEDIS indicators revealed overprescribing, particularly for upper respiratory tract infections.

CONCLUSIONS: This is the first claim-based analysis of antibiotic prescribing patterns among Daman beneficiaries in Saudi Arabia. Decision support systems, artificial intelligence-driven audits and targeted education could optimise prescribing, reduce AMR and inform policy.

PMID:42580838 | DOI:10.1136/bmjopen-2026-118941

BMJ Open. 2026 Aug 11;16(8):e118613. doi: 10.1136/bmjopen-2026-118613.

ABSTRACT

INTRODUCTION: Suicide is a major public health concern and one of the leading causes of death among young people globally. Unemployment has been associated with an increased risk of suicide and suicidal behaviour through its effects on mental health, financial security and social well-being. In sub-Saharan Africa (SSA), high levels of youth unemployment, poverty and limited access to mental healthcare may further increase vulnerability to suicidal behaviour. This systematic review aims to synthesise evidence on the prevalence, associated factors and methods of suicide and suicidal behaviours among unemployed youth in SSA.

METHODS AND ANALYSIS: The review will be conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Eligible studies will focus on unemployed youth aged 15-35 years residing in SSA countries and report on suicide, suicidal ideation, suicide attempts or completed suicide. Electronic databases, including PubMed, Web of Science, EBSCOhost, Scopus, ProQuest and Sabinet African Journals, will be searched using a comprehensive search strategy supplemented by backward and forward citation searching. Three reviewers will independently screen studies, extract data and assess methodological quality using appropriate critical appraisal tools. Prevalence estimates will be pooled using random-effects meta-analysis where appropriate. Associated factors will be synthesised narratively and organised according to the socioecological framework.

ETHICS AND DISSEMINATION: Ethical approval is not required as the review will use data from published studies and publicly available sources. Findings will be disseminated through publication in a peer-reviewed journal, conference presentations and engagement with relevant stakeholders. The review is expected to provide evidence to inform suicide prevention strategies, mental health interventions and employment-related policies targeting unemployed youth in SSA.

PROSPERO REGISTRATION NUMBER: CRD42025642679.

PMID:42580836 | DOI:10.1136/bmjopen-2026-118613

J Clin Psychol. 2026 Aug 11. doi: 10.1002/jclp.70207. Online ahead of print.

ABSTRACT

OBJECTIVES: While some research suggests that increases in anxiety symptoms drive changes in insomnia and depression symptoms, other studies support that these relations may be bidirectional. The present study therefore aimed to further examine how anxiety, insomnia and depression symptoms predict changes in these symptoms over time.

METHODS: Participants were recruited via an online participant database, social media advertisements, and other online sites, resulting in a large sample (N = 2,666) of adults from across the United States. Well validated instruments were used to measure symptoms of depression (CES-D), anxiety (STAI), and insomnia (ISI). Data were collected via a series of Qualtrics surveys administered online at two time points: March-June 2020 (baseline) and January-March 2021 (follow-up).

RESULTS: Insomnia symptoms (β = 0.142, p < 0.001) but not anxiety symptoms (β = 0.019, p = 0.445) significantly predicted depression symptoms. Depression symptoms (β = 0.077, p = 0.001) but not anxiety symptoms (β = 0.039, p = 0.075) significantly predicted insomnia symptoms. Both insomnia (β = 0.060, p = 0.001) and depression symptoms (β = 0.281, p < 0.001) significantly predicted anxiety symptoms. Although multiple cross-lagged paths were statistically significant, effect sizes were generally small, and no single pathway was meaningfully stronger than others. Additionally, secondary exploratory mediation models revealed significant indirect effects between anxiety and depression through insomnia (model 1 indirect β = 0.027, p = 0.007; model 2 indirect β = 0.008, p = 0.036).

CONCLUSIONS: Findings suggest that insomnia symptoms were prospectively associated with subsequent depressive and anxiety symptoms. Depression symptoms also predicted later anxiety symptoms, highlighting the complex longitudinal associations among these symptom domains. However, results did not support a temporal pathway in which anxiety precedes the development of comorbid insomnia. Future studies should assess temporal order more closely, using high density longitudinal sampling strategies (i.e., more than two data collection points) to further clarify the temporal ordering of these symptom domains.

PMID:42579862 | DOI:10.1002/jclp.70207

Genetics. 2026 Aug 11:iyag204. doi: 10.1093/genetics/iyag204. Online ahead of print.

ABSTRACT

Predicting phenotypes from genetics and environmental inputs is a long-standing challenge in genetics and plant breeding. Deep neural networks are a promising approach due to their capacity to approximate nonlinear biological processes. Despite initial expectations, recent studies have found that deep neural networks under-perform compared to linear methods, even on continent-scale datasets. We attribute this to several failure modes of deep learning, including greedy learning, the tendency to over-emphasize a single type of input data. As a solution, we present the Structured Interaction Neural Network (SINN), which combines statistical decomposition of genetic, environmental and interaction effects with deep neural networks. SINN dissects phenotype prediction into isolated component modeling tasks, revealing poor generalization of learned representations to new environments as the main limitation for prediction of genotype-by-environment interactions and overall yield. We reach competitive performance on yield prediction in the next cycle of 2 maize multi-environment trial datasets, including new genotypes and environments. In the Genomes to Fields (United States) dataset, SINN achieved higher overall accuracy (0.63) than BLUP-based methods (0.43) and a neural network from previous literature (0.48), and surpassed previous top-performing models with a lower RMSE (2.40 vs. 2.46 Mg/ha, mean yield 9.51 Mg/ha). Similar gains were observed in a secondary dataset consisting of Chinese national maize variety trials (MaizeGEP). SINN achieved higher overall accuracy (0.79) than BLUP-based methods (0.49) and a neural network from previous literature (0.76). By combining statistical genetics and modern deep learning, SINN enables accurate, modular and scalable genomic prediction in new environments.

PMID:42579860 | DOI:10.1093/genetics/iyag204

J Occup Environ Med. 2026 Aug 11. doi: 10.1097/JOM.0000000000003850. Online ahead of print.

ABSTRACT

OBJECTIVE: : Our aim was to determine the association between exposure to chromium compounds and the respiratory health of workers in ferrochromium and stainless steel production.

METHODS: : The study included 333 workers occupationally exposed/non-exposed to chromium compounds. Respiratory health was assessed using a questionnaire and spirometry. Bronchial and alveolar nitric oxide (NO) production, inflammatory markers in exhaled breath condensate, and serum samples were analyzed.

RESULTS: : There were no differences in symptoms or lung function between the study groups. Alveolar NO, 8-isprostane in exhaled breath and interleukin-8 in serum were higher in the study groups than in the controls. However, no consistent associations were found between inflammatory markers and exposure levels of air impurities.

CONCLUSIONS: : Although the differences in some inflammatory markers were statistically significant, further research is needed to ascertain the clinical significance of the finding.

PMID:42579848 | DOI:10.1097/JOM.0000000000003850

J Clin Oncol. 2026 Aug 11:JCO2600852. doi: 10.1200/JCO-26-00852. Online ahead of print.

ABSTRACT

Daromun (L19IL2/L19TNF) was investigated as a neoadjuvant, intralesional therapy for patients with fully resectable stage III melanoma in the phase III PIVOTAL trial (ClinicalTrials.gov identifier: NCT02938299). The trial enrolled 256 patients in the European Union and met its primary end point, demonstrating a statistically significant improvement in recurrence-free survival (RFS; hazard ratio, 0.59; P = .005) for daromun followed by surgery versus up-front surgery, at a median follow-up (FU) of 21 months from random assignment. PIVOTAL included two clinically distinct subgroups, namely, patients with de novo diagnosed metastatic disease (n = 34; 13%) and patients with recurrence(s) after surgery with or without radiotherapy and/or adjuvant systemic therapies (n = 222; 87%). Here, we present an updated analysis of the primary and secondary end points, including safety data, at a median FU of 36.8 months from random assignment (database cutoff: November 28, 2025), alongside new sensitivity analyses of event-free survival (EFS). The updated analysis confirms the clinically and statistically meaningful improvements in RFS and distant metastasis-free survival recorded in the neoadjuvant daromun versus control arm. The EFS post hoc analysis, conducted in both the overall population and the recurrent patient subgroups (with or without prior systemic therapies), provides consistency and robustness to the benefit of neoadjuvant daromun observed for the primary efficacy end point. No new safety signals of concern were recorded.

PMID:42579833 | DOI:10.1200/JCO-26-00852