Tag: pubmed

JAMA Netw Open. 2025 Jun 2;8(6):e2513906. doi: 10.1001/jamanetworkopen.2025.13906.

ABSTRACT

IMPORTANCE: Patients with language barriers may experience difficulties accessing virtual care.

OBJECTIVES: To synthesize the literature on the association between language barriers and use of and satisfaction with virtual care among adult patients and among caregivers of pediatric patients in high-income countries.

DATA SOURCES: Four electronic databases, MEDLINE, Embase, PsycINFO, and Web of Science, were searched from inception to March 2023 using a combination of language and virtual care terms.

STUDY SELECTION: Eligible studies compared quantitative data on use of or satisfaction with virtual care among adult patients or caregivers of pediatric patients with or without language barriers in high-income countries.

DATA EXTRACTION AND SYNTHESIS: Data were extracted by 2 independent reviewers using a piloted data extraction form. Risk of bias assessments were performed using the ROBINS-E tool. Data were synthesized by outcome type using random-effects meta-analyses stratified by primary vs specialist care and narrative synthesis. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guideline.

MAIN OUTCOMES AND MEASURES: The primary outcomes were use of virtual care and satisfaction with virtual care among adult patients and among caregivers of pediatric patients with vs without language barriers.

RESULTS: In total, 41 studies were included, 35 with adult patients (N = 4 543 906) and 6 with caregivers of pediatric patients (N = 7921). Most studies (n = 38) were set in the US, and examined use of virtual care (n = 35). Adult patients facing language barriers had no significant difference in adjusted pooled odds of virtual vs in-person primary or specialist care use (adjusted OR [AOR], 0.91 [95% CI, 0.61-1.35]; n = 5; I2 = 95.0%) and significantly lower adjusted pooled odds of video vs telephone primary or specialist care use (AOR, 0.66 [95% CI, 0.52-0.85]; n = 5, I2 = 93.5%), with high heterogeneity. Restricting to specialist care, adult patients facing language barriers had significantly lower adjusted pooled odds of using virtual vs in-person (AOR, 0.78 [95% CI, 0.70-0.87]; n = 4; I2 = 0.0%) and video vs telephone (AOR, 0.62 [95% CI, 0.53-0.73]; n = 3; I2 = 0.0%) care, with low heterogeneity. Results for caregivers of pediatric patients were limited and showed no significant difference in odds of virtual vs in-person specialist care, with a wide confidence interval and high heterogeneity (OR, 0.62 [95% CI, 0.38-1.02]; n = 3; I2 = 91.2%). Results specific to primary care and results on other use of virtual care outcomes (eg, visit noncompletion) were inconclusive due to limited numbers of studies (eg, n = 2 studies reporting AOR of visit noncompletion for primary and specialist care, with I2 = 75.5% and 89.6%, respectively, for the corresponding meta-analyses). Results on satisfaction with virtual care, synthesized narratively, were limited and mixed. In studies of adult patients and caregivers of pediatric patients (n = 3 each), 2 of the 3 studies found no statistically significant difference in satisfaction, while 1 study found significantly lower satisfaction.

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, adult patients facing language barriers had no significant difference in pooled odds of using virtual compared with in-person care overall, and significantly lower pooled odds of using video compared to telephone care overall. Restricting to specialist care, pooled odds of using virtual care and video care were significantly lower among adult patients facing language barriers, with low heterogeneity. Further research on virtual care among individuals facing language barriers is needed, focusing on virtual primary care, patient satisfaction, and caregivers of pediatric patients.

PMID:40471580 | DOI:10.1001/jamanetworkopen.2025.13906

JAMA Netw Open. 2025 Jun 2;8(6):e2513931. doi: 10.1001/jamanetworkopen.2025.13931.

ABSTRACT

IMPORTANCE: Alzheimer disease and related dementias (ADRD) have substantial clinical and public health consequences for individuals, families, employers, and government.

OBJECTIVE: To assess ADRD’s economic burden on non-Latino African American, Latino, and non-Latino White adults and their caregivers, employers, and the government between 2020 and 2060.

DESIGN, SETTING, AND PARTICIPANTS: Population-based cross-sectional study using nationally representative data on African American, Latino, and White adults aged 50 years and older with ADRD and their unpaid caregivers from the 2014 to 2020 Medical Expenditure Panel Survey (MEPS) alongside the 2011 to 2017 National Study of Caregiving (NSOC) and 2013 Panel Study of Income Dynamics. These data were augmented with information from the US Census Bureau, Bureau of Labor Statistics, Internal Revenue Service, and other sources to estimate current and future economic burden. Two-part regression models were used to estimate medical and work-related costs for older adults, and multivariate-distance matching was used to estimate the value of unpaid care, lost wages and productivity, loss of federal income tax revenue, and financial transfers for caregivers. Data were analyzed from March 2023 to February 2025.

EXPOSURE: Older adults with ADRD and their family caregivers.

MAIN OUTCOMES AND MEASURES: Projected medical costs and work-related losses for persons with ADRD, and unpaid care value, forgone earnings, and lost federal income tax payments and labor productivity for caregivers.

RESULTS: Of 31 028 older adults in MEPS, 5184 (10%) were African American; 146 (<1%) American Indian or Alaska Native; 1043 (3%) Asian (Indian, Chinese, or Filipino); 5346 (10%) Latino; 690 (2%) Other Asian, Native Hawaiian, and Pacific Islander; and 18 617 (75%) were White. In the NSOC sample of 1929 older adults, there were 644 (33%) African American, 169 (9%) Latino, and 1116 (58%) White adults. The total estimated economic burden of ADRD was close to $344 billion in 2020 and was projected to increase to over $3 trillion in 2060. African American and Latino adults bore one-third ($113 billion) of it in 2020, with projections rising to $1.7 trillion by 2060, surpassing the economic burden for White adults, which was projected to grow from $231 billion to $1.4 trillion.

CONCLUSIONS AND RELEVANCE: The findings of this study suggest that African American and Latino older adults with ADRD and their families are likely to face disproportionately high burdens, primarily associated with unpaid caregiving. Understanding ADRD prevalence, comorbidity, inadequate care, and support policies may attenuate economic burdens for all US residents.

PMID:40471578 | DOI:10.1001/jamanetworkopen.2025.13931

Prehosp Emerg Care. 2025 Jun 5:1-6. doi: 10.1080/10903127.2025.2504521. Online ahead of print.

ABSTRACT

OBJECTIVES: Adenosine is a common prehospital treatment for paroxysmal supraventricular tachycardia (PSVT); however initial dosing varies and the optimal first dose is unknown. To evaluate the association of the two common initial adenosine dosing regimens (6 mg and 12 mg) with prehospital patient improvement, hospital admission, complications, and death.

METHODS: This retrospective observational study included all 9-1-1 responses with prehospital adenosine administration between 1/1/2022 and 12/31/2022 from the ESO Data Collaborative. Outcomes included EMS clinician documented patient response (improved v. unchanged/worse) to the initial dose, emergency department (ED) dispositions, compressions/cardioversion/pacing after adenosine administration, and death. Descriptive statistics and adjusted odds ratios (OR) were used to compare outcomes for patients who received an initial adenosine dose of 6 mg versus 12 mg.

RESULTS: We analyzed 11,245 patients that received adenosine from 1,350 EMS agencies. Most received an initial dose of 6 mg (70%, n = 7,825), while 30% (n = 3,314) received an initial dose of 12 mg. Initial pulse rate and systolic blood pressure were similar between groups. Nearly half in the 6 mg group (48%, n = 3,746) received additional doses, compared to 25% (n = 815) in the 12 mg group. An initial dose of 12 mg was associated with 65% increased odds of prehospital improvement (OR: 1.65, 95%CI: 1.49-1.82). Complications including cardioversion (5%, n = 481), pacing (<1%, n = 2), and cardiopulmonary resuscitation (CPR) (<1%, n = 20) were rare. There was no difference in the need for cardioversion, pacing, or CPR between groups (p > 0.05). Amongst EMS transported patients, 25% (n = 2,732) had available ED dispositions. An initial dose of 12 mg was associated with a 28% reduction in odds of admission (OR: 0.72, 95%CI: 0.59-0.87). In total, 2% (n = 48) who received prehospital adenosine and had available outcome data died. Of those, 70% (n = 32) were in the 6 mg group and 30% (n = 14) were in the 12 mg group.

CONCLUSIONS: An initial prehospital adenosine dose of 12 mg was associated with less re-dosing, greater rates of patient improvement, and lower rates of hospital admission compared to an initial dose of 6 mg. Complications requiring interventions and death were rare and similar across dosing regimens.

PMID:40471550 | DOI:10.1080/10903127.2025.2504521

Oral Radiol. 2025 Jun 5. doi: 10.1007/s11282-025-00833-2. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to investigate the relationship between masseter muscle thickness and variables such as age, gender, dental occlusion, and parafunctional habits in adolescents aged 11-15 years using ultrasonographic measurements.

METHODS: A total of 168 adolescents aged 11-15 years who were referred to the Department of Oral and Maxillofacial Radiology at Van Yuzuncu Yil University for routine dental examinations participated in this cross-sectional study. Data on parafunctional habits, age, height, and weight were collected. Dental occlusion and tooth loss were documented during clinical examinations. Masseter muscle thickness was measured bilaterally at rest and during contraction using ultrasonography. Statistical analyses included Kolmogorov-Smirnov, Wilcoxon, and Mann-Whitney U tests, with a significance level of p < 0.05.

RESULTS: No significant differences in masseter muscle thickness were observed between genders, either at rest or during contraction (p > 0.05). Similarly, muscle thickness did not significantly differ according to dental occlusion or parafunctional habits such as mouth breathing and swallowing (p > 0.05). However, a positive correlation was found between the number of premolar and molar teeth and masseter muscle thickness on the left side during contraction (p = 0.006, r = 0.213).

CONCLUSION: Dental occlusion and parafunctional habits appear to have minimal impact on masseter muscle thickness in adolescents. Ultrasonography provides a reliable and non-invasive method for assessing masseter muscle thickness, supporting its utility in clinical practice.

PMID:40471539 | DOI:10.1007/s11282-025-00833-2

Probiotics Antimicrob Proteins. 2025 Jun 5. doi: 10.1007/s12602-025-10611-5. Online ahead of print.

ABSTRACT

Necrotizing enterocolitis (NEC) is a commonly encountered disease of the gastrointestinal tract in premature infants. The aim of the study was to evaluate the therapeutic role of probiotics on NEC in a preterm rat model. NEC model was induced in preterm formula-fed rats, exposed daily to hypoxia, hypothermia, and administered pathogenic bacteria. Then rats were randomly divided into four different groups: control group, NEC group, NEC-antibiotic group, and NEC-probiotic group. All rats were sacrificed at the end of the experiment. Histological examination of ileal wall under light and electron microscopes was done, and TNF-α and IL-18 staining was also assessed. Statistical analysis of data was performed. Histological examination of the ileal mucosa of NEC group showed inflammatory infiltration, various degrees of separation of the submucosa, thinning of the wall, sloughing, and loss of the intestinal villi. The villus heights significantly decreased (p ≤ 0.05) in the NEC group. Electron micrographs demonstrated signs of enterocytic death, lost microvilli, abnormal nuclei, vacuolated cytoplasm, swollen mitochondria, and loss of junctional complexes. These findings were almost reversed in the probiotic group that regained the normal villous height, and to a lesser extent in the antibiotic group which was still significant compared to the CG (p ≤ 0.05). Immunohistochemical staining showed significantly increased expression of proinflammatory cytokines TNF-α and IL-18 (p ≤ 0.05) in the intestinal mucosa of the NEC group and NEC-antibiotic group as compared to the control group and the NEC-probiotic group. Probiotics could hold therapeutic potential for NEC in preterm neonatal rats.

PMID:40471534 | DOI:10.1007/s12602-025-10611-5

Int J Implant Dent. 2025 Jun 5;11(1):42. doi: 10.1186/s40729-025-00623-9.

ABSTRACT

PURPOSE: This retrospective study aimed to evaluate the incidence of dehiscence following bone augmentation with patient-specific titanium meshes and to identify factors associated with its occurrence.

MATERIAL AND METHODS: Patients who underwent bone grafting with patient-specific titanium mesh between December 2014 and October 2021 were included. The primary outcome was the occurrence of dehiscence. The occurrence of dehiscences was recorded during the following time phases, enabling the determination of whether dehiscences occur early (< 2 weeks), in the mid-term (2-9 weeks), or later in the healing phase (> 9 weeks).

RESULTS: A total of 78 patients undergoing 85 titanium mesh augmentations were included, with a mean follow-up period of 1.2 years. Dehiscence occurred in 33 meshes (38.8%), with 51.5% of these events arising during the early healing phase. In no case was premature removal of the titanium mesh required due to dehiscence. A statistically significant association was observed between dehiscence and both smoking behavior (p < 0.001) and the anatomical location of the maxillary defect (p = 0.029). No significant associations were found between dehiscence and gender (p = 0.160), periodontitis (p = 0.512), gingival phenotype (p = 0.495), defect type (p = 0.490), augmented bone volume (p = 0.373), or incision type (p = 0.354). Logistic regression analysis further identified smoking (odds ratio: 7.07; 95% CI: 2.19-22.80) and maxillary defect alveolar (odds ratio: 11.86; 95% CI: 0.34-4.60) as significant predictors of dehiscence.

CONCLUSION: Dehiscence following customized titanium mesh augmentation was significantly associated with smoking and the location of the maxillary defect, underscoring the importance of early detection and timely intervention.

PMID:40471513 | DOI:10.1186/s40729-025-00623-9

Emerg Radiol. 2025 Jun 5. doi: 10.1007/s10140-025-02349-y. Online ahead of print.

ABSTRACT

PURPOSE: MRI is the preferred imaging modality for patients with acute dizziness when a central etiology is possible. Abbreviated protocols may improve access in urgent settings. This study assesses the diagnostic yield and utility of an abbreviated MRI protocol for patients presenting with dizziness to the emergency department (ED).

METHOD: This retrospective study included 613 adult patients presenting to the ED with dizziness from August 1, 2019 to August 31, 2023. The protocol included 3 mm coronal and axial DWI, axial FLAIR, and SWI sequences, with a duration of approximately 11 min. MRI findings were categorized as negative or positive for intracranial pathology; etiology and location were recorded. Charts were reviewed for concurrent CTA during the ED visit, and findings were assessed for correlation with MRI results.

RESULTS: Of the 613 patients, clinically significant intracranial pathology was identified in 52 cases (8%), including 42 (7%) acute infarcts. Of these infarcts, 19 (45%) were infratentorial, 16 (38%) supratentorial, and 7 (17%) involved both regions. The cerebellum was the most common infratentorial site (38%), followed by the brainstem (24%). Infarcts ranged from 1-84 mm, with 48% measuring less than 1 cm. TOAST classification revealed strokes as cardioembolic (36%), large vessel (26%), cryptogenic (19%), and lacunar (19%). Statistical analysis showed no significant relationship between vertigo and infarct characteristics (P > 0.05).

CONCLUSION: Abbreviated protocol MRI demonstrated a 8% diagnostic yield for detecting intracranial pathology and more often positive than concurrent CT/CTA in identifying acute findings. Supratentorial pathology can present with symptoms of dizziness as well. The abbreviated protocol offers a rapid, efficient diagnostic tool for urgent care settings and MRI identifies more acute findings than concurrent CT/CTA.

PMID:40471503 | DOI:10.1007/s10140-025-02349-y

Endocrine. 2025 Jun 5. doi: 10.1007/s12020-025-04287-8. Online ahead of print.

ABSTRACT

PURPOSE: Thyroid nodules are commonly evaluated using ultrasound-based risk stratification systems, which rely on subjective descriptors. Artificial intelligence (AI) may improve assessment, but its effectiveness in non-subspecialist settings is unclear. This study evaluated the impact of an AI-based decision support system (AI-DSS) on thyroid nodule ultrasound assessments by general endocrinologists (GE) without subspecialty thyroid imaging training.

METHODS: A prospective cohort study was conducted on 80 patients undergoing thyroid ultrasound in GE outpatient clinics. Thyroid ultrasound was performed based on clinical judgment as part of routine care by GE. Images were retrospectively analyzed using an AI-DSS (Koios DS), independently of clinician assessments. AI-DSS results were compared with initial GE evaluations and, when referred, with expert evaluations at a subspecialized thyroid nodule clinic (TNC). Agreement in ultrasound features, risk classification by the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) and American Thyroid Association guidelines, and referral recommendations was assessed.

RESULTS: AI-DSS differed notably from GE, particularly assessing nodule composition (solid: 80%vs.36%,p < 0.01), echogenicity (hypoechoic:52%vs.16%,p < 0.01), and echogenic foci (microcalcifications:10.7%vs.1.3%,p < 0.05). AI-DSS classification led to a higher referral rate compared to GE (37.3%vs.30.7%, not statistically significant). Agreement between AI-DSS and GE in ACR TI-RADS scoring was moderate (r = 0.337;p < 0.001), but improved when comparing GE to AI-DSS and TNC subspecialist (r = 0.465;p < 0.05 and r = 0.607;p < 0.05, respectively).

CONCLUSION: In a non-subspecialist setting, non-adjunct AI-DSS use did not significantly improve risk stratification or reduce hypothetical referrals. The system tended to overestimate risk, potentially leading to unnecessary procedures. Further optimization is required for AI to function effectively in low-prevalence environment.

PMID:40471487 | DOI:10.1007/s12020-025-04287-8

Ann Intensive Care. 2025 Jun 5;15(1):78. doi: 10.1186/s13613-025-01492-6.

ABSTRACT

BACKGROUND: Ventilator-associated pneumonia (VAP) is a significant complication in mechanically ventilated patients. Paradoxically, it lacks precise diagnostic criteria, making the identification of a reliable diagnostic indicator an unmet medical need. Lipids are critical regulators of innate lung defense. The aim of the study was to identify lipid alterations specific to VAP in tracheal aspirates of patients with ARDS.

METHODS: Tracheal aspirates samples from ventilated patients were collected longitudinally from patients with COVID-19-related ARDS. Tracheal aspirates sampled at the day of VAP diagnosis were used to assess VAP specific lipidome and were compared with matched controls (patients without VAP). Lipid detection was performed using ultra-high-performance liquid chromatography with high resolution mass spectrometry. The statistical analysis included: unsupervised multivariate methods, partial least squares discriminant analysis (PLS-DA), orthogonal partial least squares discriminant analysis (OPLS-DA), and the area under the receiver operating characteristic (AUROC) curve to assess classification performance. The Benjamini-Hochberg adjusted p-value was used to control the false discovery rate.

RESULTS: We studied 39 patients (26 VAP and 13 control patients). The characteristics of VAP and control patients were similar, including biological markers such as neutrophils, CRP, and PCT. The lipid signature, composed of 272 lipids, differed between VAP and control patients (p = 0.003). Phosphatidylcholines were the most represented with 17 significantly upregulated and 6 downregulated lipids. OPLSDA identified 8 best candidates as VAP biomarkers with sphingomyelin (34:1) and phosphatidylcholine (O-34:1) presenting the best scores (AUROC = 0.85 [0.71-0.95] and 0.83 [0.66-0.94], respectively). Combinations of several lipid biomarkers did not improve the prediction accuracy. During ARDS, lung lipidome mostly resulted in breakdown product of host-pathogen interactions (surfactant and pulmonary cells).

CONCLUSION: We investigated VAP-specific lipids in tracheal aspirate and identified significant alterations in lipidomic profiles, likely driven by active infection dynamic and the breakdown of surfactant and pulmonary cells. Among the potential VAP biomarker candidates in COVID-19 ARDS, sphingomyelin (34:1) and phosphatidylcholine (O-34:1) demonstrated predictive performance for VAP that surpassed all previously tested biomarkers.

PMID:40471479 | DOI:10.1186/s13613-025-01492-6

Eur J Health Econ. 2025 Jun 5. doi: 10.1007/s10198-025-01797-0. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the psychometric performance of the Child Health Utility (CHU9D) proxy version compared with the Pediatric Quality of Life Inventory (PedsQL) in Australian children aged 0-7 years with anorectal malformations (ARM) or Hirschsprung disease (HD).

METHODS: Parents of children with ARM or HD were identified from a patient database managed by a tertiary paediatric hospital in Australia over the past 20 years. Since 2020, CHU9D and PedsQL proxy report versions were administered to parents via telephone interview. Using data collected between 2020 and 2022, we assessed the feasibility, ceiling and floor effects, known-group validity and convergent validity for both instruments in the total sample, by conditions and child age.

RESULTS: The study included 145 children with ARM or HD, among which, 13.1% had missing values on the CHU9D schoolwork dimension, and 20.7% had missing values on the PedsQL school functioning domain (2-4 year old version). The CHU9D and PedsQL did not demonstrate ceiling effects. The CHU9D showed stronger effect size (ES) in differentiating children with ARM (ES = 0.32) or HD (ES = 0.90) with healthy children compared to the PedsQL. We did not find statistically significant differences in CHU9D or PedsQL scores between ARM and HD. There were moderate to strong correlations in most theoretically related dimensions of the CHU9D and PedsQL.

CONCLUSION: The CHU9D and PedsQL demonstrated comparable and acceptable psychometric properties in Australian children aged 2 years and above with ARM or HD. However, the validity of the CHU9D in children under 2 years old needs to be further explored and modification may be needed.

PMID:40471476 | DOI:10.1007/s10198-025-01797-0