Tag: pubmed

J Adv Nurs. 2025 Sep 11. doi: 10.1111/jan.70216. Online ahead of print.

ABSTRACT

AIMS: To assess self-reported practices and knowledge of nurses and prescribers (i.e., physicians and nurse practitioners) on intravenous fluid therapy, and to evaluate how this is documented through a clinical documentation review.

DESIGN: Multicentre cross-sectional study, between April 2022 and July 2022, across 13 wards from four Dutch hospitals.

METHODS: A survey study was conducted to assess self-reported practices related to intravenous fluid therapy. A 12-item questionnaire evaluated knowledge. To gain insights into documentation practices, a retrospective chart review was performed. Data analysis involved descriptive statistics, with group differences analysed using the chi-squared test or Fisher’s exact test, as appropriate.

RESULTS: Three hundred and four healthcare professionals completed the questionnaire (92% nurses). The majority of prescribers (n = 20/25; 80%) expected that nurses would start, stop or change intravenous fluid therapy. Overall, the median number of correct answers to knowledge questions was eight (IQR 7-9, range 0-12); four participants (1%) answered all knowledge questions correctly. Knowledge about the composition of sodium chloride 0.9% solution was limited. Analysis of patient charts revealed that 54% (196/362) received intravenous fluids, most commonly 0.9% sodium chloride infusion (168/195; 86%), although the indication was described in 3% (6/196). Thirty-one percent (61/196) of patients received intravenous fluids to keep the vein open (< 30 mL/h).

CONCLUSION: The study identified shared responsibility, a knowledge gap, and limited documentation concerning intravenous fluids. Prescribers expect nurses to adjust intravenous fluids without consulting a prescriber, which aligns with what nurses do, although they are not legally authorised. Given the limited documentation of the indication for intravenous fluids, it is plausible that several patients received intravenous fluids unnecessarily.

IMPLICATIONS: The perceived shared responsibility presents an opportunity to develop a protocol engaging both prescribers and nurses, aiming to guide more targeted infusion therapy.

IMPACT: Reducing unnecessary infusions to keep-the-vein-open can help eliminate low-value care.

REPORTING METHOD: CROSS guideline.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:40931896 | DOI:10.1111/jan.70216

Arthritis Care Res (Hoboken). 2025 Sep 11. doi: 10.1002/acr.25633. Online ahead of print.

NO ABSTRACT

PMID:40931879 | DOI:10.1002/acr.25633

Haematologica. 2025 Sep 11. doi: 10.3324/haematol.2025.287910. Online ahead of print.

ABSTRACT

Not available.

PMID:40931858 | DOI:10.3324/haematol.2025.287910

Arthritis Care Res (Hoboken). 2025 Sep 11. doi: 10.1002/acr.25647. Online ahead of print.

ABSTRACT

BACKGROUND: Interstitial lung disease (ILD) is a significant cause of morbidity and mortality in systemic sclerosis (SSc), particularly among Black patients. Pulmonary function tests (PFTs) are critical to screen for and monitor SSc-ILD. We examined whether race-specific and race-neutral PFT reference equations impact classification of restrictive lung disease (RLD) severity in Black and White patients with SSc.

METHODS: Baseline percent predicted forced vital capacity (ppFVC) was calculated for self-identified Black (N=641) and White (N=2909) patients in the Johns Hopkins Scleroderma Center Research Registry using race-specific (Global Lung Initiative 2012 [GLI 2012], National Health and Nutrition Examination Survey III [NHANES]) and race-neutral (GLI Global) equations. The percentage of Black and White individuals who switched RLD severity categories (normal (ppFVC≥80%); mild (70≤ppFVC<80%), moderate (60%≤ppFVC<70%), severe (50%≤ppFVC<60%) or very severe (ppFVC<50%)) when using race-neutral versus race-specific equations was calculated. The percentage who would meet typical ppFVC thresholds for immunosuppression, clinical trial eligibility, and lung transplant referral was compared.

RESULTS: Black individuals had lower absolute FVC values than White individuals. 47% (n=303) of Black individuals were reclassified as having more severe RLD and 17% (n=487) of White individuals were reclassified as having less severe RLD when using the GLI Global versus GLI 2012 equations. Statistically greater proportions of Black individuals met ppFVC thresholds for immunosuppression, clinical trial eligibility and lung transplant referral with race-neutral versus race-specific equations.

CONCLUSIONS: The use of race-specific PFT reference equations may result in systematic misclassification of ILD severity with potential impact on healthcare delivery and clinical trial eligibility.

PMID:40931854 | DOI:10.1002/acr.25647

Ann Otol Rhinol Laryngol. 2025 Sep 11:34894251363745. doi: 10.1177/00034894251363745. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop, implement, and evaluate a novel process used for residency application review that deemphasizes metrics known to create bias with the goal of interviewing and matching a more diverse resident cohort.

METHODS: Between 2020 and 2023, a novel standardized rubric and application review process were developed and implemented at the authors’ academic training program. The rubric deemphasized USMLE scores, honor society membership, and number of publications while utilizing an AI-driven pre-sort of applications, facilitating holistic review. This weighted applicant attributes identified in personal statements, life experiences, achievements in community, leadership roles, otolaryngology-specific impressions highlighted in letters of recommendation, and otolaryngology-specific research and publications similarly to academic metrics (clerkship grades and standardized test scores). Demographics of applicants interviewed and matched into our program were compared pre- and post-implementation using descriptive statistics.

RESULTS: Using a standardized rubric to review residency applications that deemphasizes traditional metrics, the authors’ otolaryngology residency program has interviewed, ranked, and matched more diverse candidates. As a result, from 2019 to 2022, the overall resident cohort has diversified from 4% historically marginalized residents to 24%, from 28% female residents to 44%, and from 33% of residents outside our geographic region to 66%.

CONCLUSION: There is significant underrepresentation among otolaryngology residents. Selection based upon USMLE Step 1 scores, honor society membership, and number of publications have been shown to restrict diversity. Purposeful holistic review increases diversity in interviewed and matched resident cohort.

PMID:40931850 | DOI:10.1177/00034894251363745

Hypertension. 2025 Sep 11. doi: 10.1161/HYPERTENSIONAHA.125.25157. Online ahead of print.

ABSTRACT

BACKGROUND: The association between season of screening blood pressure (BP) measurement and adverse outcomes has not been examined among populations without prior physician-diagnosed hypertension. We aimed to investigate the association between the season of screening clinic BP measurement and the risk of all-cause mortality.

METHODS: This was a prospective cohort study, and data were analyzed from an ongoing community hypertension screening program in Shanghai between 2018 and 2024. In this study, 166 670 participants aged 35 to 89 years who were free of prior physician-diagnosed hypertension were included and had their BP measured with an automated office BP platform in Shanghai community health centers. Participants were categorized into 4 groups by season of screening BP measurement: spring, summer, autumn, and winter. Deaths were ascertained from linkage to the Shanghai Vital Statistics Registry with follow-up until September 30, 2024. Cox regression models were used to examine the association between seasons of BP measurement and risk of all-cause mortality.

RESULTS: During a median follow-up of 1.6 years, 1850 (1.1% of participants) all-cause deaths occurred. The incidence rate of all-cause mortality was 5.0 per 1000 person-years and was higher in participants with screening BP measured in summer (5.4 per 1000 person-years) than in other seasons (4.4, 5.3, and 4.9 per 1000 person-years in spring, autumn, and winter, respectively). After adjustment for age, sex, residential region, and systolic and diastolic BP, the hazard ratio for the risk of all-cause mortality in participants with screening BP measured in summer relative to the overall population was 1.14 (95% CI, 1.05-1.24). There was no any significant interaction between the season of screening BP measurement and sex, age, and hypertension status in relation to the risk of all-cause mortality (all P≥0.05).

CONCLUSIONS: Screening for raised BP in summer was associated with significantly higher risks of all-cause mortality, though the mean systolic/diastolic BP was lowest in summer. The findings imply that if only clinic BP is measured for hypertension screening in 4-season countries and regions, repeated BP measurements, preferably in different seasons, might be needed.

PMID:40931832 | DOI:10.1161/HYPERTENSIONAHA.125.25157

Emerg Med Australas. 2025 Oct;37(5):e70130. doi: 10.1111/1742-6723.70130.

ABSTRACT

OBJECTIVES: Acute pyelonephritis (APN) is a common diagnosis among patients presenting to the Emergency Department (ED). It is treated by empiric antibiotics within the ED. With a rise in antimicrobial resistance globally, it is unknown whether patients are being managed with empiric antibiotics that are appropriate for the causative organisms of APN. The aim of this study was to describe the pathogens causing APN and to assess whether the current choice of empirical antibiotics is appropriate.

METHODS: A single-centre retrospective review of patients with a discharge diagnosis of APN at an adult tertiary referral hospital in metropolitan Melbourne over a 5-year period (2018-2022) was conducted. Eligible cases were identified from ICD-10 discharge diagnoses. Demographics, cultured organisms and antibiotic regimens were extracted using explicit chart review.

RESULTS: There were 557 patients included with APN with 569 urine samples cultured after initial assessment. The most common pathogen cultured was E. coli, identified in 232 (40.8%) culture results. There were 26 (4.7%; 95% CI: 3.1-6.6) patients managed in the ED with inappropriate antibiotics. This occurred most frequently when ampicillin or amoxicillin monotherapy was prescribed. Patients were discharged with inappropriate antibiotics in 76 (13.6%) cases. This occurred most commonly when no antibiotic was prescribed on discharge.

CONCLUSION: Most empiric antibiotic prescribing for APN was appropriate and sensitive against the cultured organism. E. Coli in urine samples was commonly resistant to amoxicillin, ampicillin or trimethoprim. Strict adherence to national clinical guidelines can further reduce the rates of inappropriate antibiotic prescriptions.

PMID:40931827 | DOI:10.1111/1742-6723.70130

Emerg Med Australas. 2025 Oct;37(5):e70140. doi: 10.1111/1742-6723.70140.

ABSTRACT

Reliably defining the risk of adverse in-flight events in aeromedical trauma patients could enable more informed pre-departure treatment and guide central asset allocation to achieve better system-level outcomes. Unfortunately, the current literature base specifically examining the in-flight period is sparse. Flight duration is often considered a proxy for the risk of in-flight deterioration; however, there is limited data to support this commonly held assumption. This paper examines the association between flight duration and the risk of in-flight deterioration in aeromedical trauma patients. A total of 2927 cases of aeromedical transport for acute trauma were retrospectively examined, and the time to first hypotension was recorded. Cases were categorised as either primary or inter-hospital transfer retrievals. Cases were also subclassified as being a primary Traumatic Brain Injury or not based on several criteria, including initial GCS. The median time to hypotension was 11.5 min overall, 10 min in primary retrieval cases, and 15 min in inter-hospital transfer cases (p = 0.049). Notably, after approximately 50 min, a significant plateau in cumulative risk was observed. Isolated TBI cases had a significantly higher overall rate of in-flight hypotension, at 39.5% compared to 9.2%. Overall, this paper supports the physiologically plausible assumption that longer aeromedical transfer times are associated with an increased risk of deterioration during flight. It also demonstrates that deterioration tends to occur early in flight, raising questions as to why this might occur.

PMID:40931825 | DOI:10.1111/1742-6723.70140

Hypertension. 2025 Sep 11. doi: 10.1161/HYPERTENSIONAHA.125.25259. Online ahead of print.

ABSTRACT

BACKGROUND: Aortic structural degeneration occurs with aging; however, 3-dimensional geometric remodeling has not been well characterized in large populations.

METHODS: We segmented the thoracic aorta from magnetic resonance images of 56 164 UKB (UK Biobank) participants and computed tomography images of 9417 PMBB (Penn Medicine Biobank) participants. We quantified structural measurements of elongation, dilation, tortuosity, and curvature across the thoracic aorta. Multivariate linear regression models estimated the associations between age and aortic structure in a subset of normative healthy participants from the UKB (n=3532), and in the overall cohorts.

RESULTS: Patterns of aging were highly consistent between the UKB and PMBB. In the UKB normative subset, aging was associated with profound geometric changes, including elongation (β per decade of age, 1.001 cm [95% CI, 0.893-1.110]; P<0.0001), luminal dilation (β per decade of age, 0.870 mm [95% CI, 0.794-0.947]; P<0.0001), and decreased curvature (β per decade of age, -0.060 mm^-1 [95% CI, -0.067 to -0.053]; P<0.0001). The strongest relationship with age was observed for aortic volume (β per decade of age, 17.124 mL [95% CI, 15.124-18.386]; P<0.0001). No age-sex interactions were observed in the healthy normative subset, whereas in the overall UKB and PMBB cohorts, females exhibited less pronounced luminal dilation (particularly after menopause) and more pronounced changes in curvature.

CONCLUSIONS: Aging is associated with profound 3-dimensional geometric changes in the thoracic aorta, including elongation, luminal dilation, and decreased curvature. Females demonstrate less eccentric aortic remodeling and more pronounced changes in curvature, likely contributing to unfavorable pulsatile arterial hemodynamics that are present in older females.

PMID:40931824 | DOI:10.1161/HYPERTENSIONAHA.125.25259

Stroke. 2025 Sep 11. doi: 10.1161/STROKEAHA.125.052056. Online ahead of print.

ABSTRACT

Preclinical stroke research faces a critical translational gap, with animal studies failing to reliably predict clinical efficacy. To address this, the field is moving toward rigorous, multicenter preclinical randomized controlled trials (mpRCTs) that mimic phase 3 clinical trials in several key components. This collective statement, derived from experts involved in mpRCTs, outlines considerations for designing and executing such trials. mpRCTs offer advantages such as increased sample sizes, robust statistical design, incorporation of heterogeneity, and standardized protocols, but they face challenges in finding the right balance between standardization and heterogeneity, appropriate stroke model selection, and outcome measures, as well as the implementation of complex network infrastructure. We discuss the importance of rigorous study design, including appropriate stroke models, representation of biological variables and comorbidities, functional outcome readouts, and handling of attrition and mortality. Statistical considerations such as adaptive sequential designs, covariate adjustments, and appropriate handling of missing data are also addressed. The integration of machine learning, the implementation of common data elements, and the selection of appropriate therapeutic candidates are crucial for maximizing the efficiency and utility of mpRCTs. Furthermore, the transition toward mpRCT platforms, akin to clinical trial platforms, holds promise for facilitating continuous evaluation of therapies. Finally, we discuss data-sharing practices and the collateral benefits of mpRCTs, emphasizing their potential to improve preclinical stroke research and bridge the translational gap. Altogether, we hope that this article will serve as a starting point for a lasting debate on the future of stroke mpRCTs and their evolution toward a universally accepted set of principles.

PMID:40931817 | DOI:10.1161/STROKEAHA.125.052056