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The REALITY of MINT: Caution before changing transfusion practice in myocardial infarction based on recent clinical trials
No full textThe Efficacy and Safety of Cardiac Myosin Inhibitors Versus Placebo in Patients With Symptomatic Obstructive Hypertrophic Cardiomyopathy: A Meta-Analysis of Randomized Controlled Trials
No full textIntroduction: Obstructive hypertrophic cardiomyopathy (oHCM) is a genetic disorder characterized by myocardial hypertrophy, which can obstruct left ventricular outflow. Cardiac myosin inhibitors (CMIs) have emerged as a novel therapeutic agent targeting cardiac muscle hypercontractility.
Objective: To compare the efficacy and safety of CMIs mavacamten and aficamten vs. placebo in patients with oHCM.
Methods: We systematically searched PubMed, Scopus, and Cochrane Central databases for randomized controlled trials (RCTs) comparing mavacamten or aficamten to placebo in patients with symptomatic oHCM. Efficacy outcomes included improvement in peak oxygen consumption (pVO2), New York Heart Association functional class (NYHA-FC) improvement of ≥1 class, change in Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS), peak left ventricular outflow tract gradient at rest (rLVOT) and with Valsalva maneuver (vLVOT). Safety outcomes included treatment-emergent adverse events (TEAE), serious adverse events (SAE), and atrial fibrillation (AF). Random effects models generated risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics.
Results: The systematic search identified 5 RCTs including 767 patients (mavacamten 30.4%, aficamten 22.2%, placebo 47.4%) with a median follow-up of 24 weeks. Compared to placebo, CMIs were associated with improvement of ≥1 NYHA-FC (RR 2.33; 95% CI, 1.92-2.82), rLVOT (MD -38.70; 95% CI, [-46.30]-[-31.10]), vLVOT (MD -47.29; 95% CI, [-57.99]-[-36.58]), pVO2 (MD 1.66; 95% CI, 1.14-2.18), and KCCQ-CSS (MD 7.76; 95% CI, 5.63-9.90). Safety outcomes were similar between CMIs and placebo.
Conclusion: CMIs are an effective and safe short-term treatment for symptomatic oHCM. Long-term outcomes require further investigation.
Keywords: Cardiac myosin inhibitors; Hypertrophic cardiomyopathy; Left ventricular outflow tract obstruction; Obstructive HCM
A bridge over troubled water: reverse osmosis to maintain patient care in a boil water notice
No full textA citywide boil water notice necessitated an alternative solution for treating contaminated water. We report our experience using portable reverse osmosis machines to treat the municipal water to provide purified water to patient care areas where non-sterile water was needed, preventing interruptions in services like elective surgeries
Nursing News & Views - July 2025
Full text linkNursing News & Views - July 2025https://scholarlycommons.libraryinfo.bhs.org/nursing_newsletters/1046/thumbnail.jp
Correlation of Bacterial Infections in Women With and Without Intrauterine Devices
No full textIntroduction: The goal of this study is to evaluate the correlation of bacterial infections acquired through sexual transmission, including Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), Mycoplasma hominis (Myc), Ureaplasma urealyticus (Urea), and bacterial vaginosis (BV) in women and those who seek gynecologic care with a history of intrauterine device (IUD) placement versus those without a history of IUD placement.
Methods: A deidentified, retrospective analysis, with 234 test results within a large obstetrics and gynecology (OBGYN) practice in both Monmouth and Ocean County, New Jersey, from 2019 to 2020, was used to determine positivity rates of bacterial infections in both IUD users and non-IUD users. Fisher\u27s exact and chi-squared tests were used to determine any association between the two groups.
Results: The study determined statistical variation among the two groups for BV positivity (p \u3c 0.001), CT/NG (p = 0.03), and concurrent infections (p = 0.002). However, no statistical difference was noted for Myc/Urea infections (p = 0.05, 95% CI: 0.89-20.88, OR: 3.60). Furthermore, no statistical variation was determined by age. However, there was a statistical difference in concurrent infections by IUD types (p = 0.02, 95% CI: 0.00-0.87, OR: 0).
Conclusion: This study supports a statistically significant association between gonorrhea, chlamydia, and BV in women and those who seek gynecologic care with IUD usage. Our findings also reveal that age and nucleic acid amplification test (NAAT)-confirmed positivity for Mycoplasma/Ureaplasma do not exhibit statistically significant correlations between IUD users and non-IUD users. Given the clinical significance of providing patient education towards appropriate contraception use, our study furthers existing literature by shedding light on the correlation of IUD usage with infection.
Keywords: bacterial vaginosis; intrauterine device; iud; mycoplasma; naat; ureaplasma
Impact of Education for Paramedic-Performed Point-of-Care Ultrasound for Cardiac Function Evaluation: A Pilot Study Assessing Imaging Quality and Interpretation
No full textBackground: Cardiac point-of-care ultrasound (cPoCUS) can detect occlusive myocardial infarction (OMI) in the absence of diagnostic electrocardiogram (ECG) by assessment of left ventricle (LV) function. The feasibility of cPoCUS to assess LV function in the prehospital setting is unknown.
Study objective: To determine image adequacy and interpretation accuracy of paramedics performing cPoCUS for assessment of LV function and wall motion abnormality (WMA).
Methods: This was a prospective observation pilot study of ultrasound-naïve paramedics who participated in a clinical education program to identify OMI and performed cPoCUS during transport of adult patients. Primary outcomes were proportion of patients with 12-lead ECG who received cPoCUS, quality of images obtained, and paramedic interpretations (overall LV function and presence of a WMA). Sensitivity and specificity for LV function and WMA were calculated along with Cohen\u27s kappa (κ) comparing paramedic interpretation to ultrasound fellowship-trained emergency physicians.
Results: Of paramedics who passed a clinical evaluation (n = 14) and written test (n = 10), six opted to participate. Of the 201 eligible cases, 88.6% received cPoCUS during their transport to the hospital. Adequate views for LV function and WMA were obtained among 61.2% and 38.8% of patients, respectively. Accurate paramedic interpretations for LV function and WMA were made among 83/94 (88.3%) and 54/56 (96.4%) patients, respectively. There was moderate agreement between paramedics and physicians on LV function (κ = 0.41), with 41.7% sensitivity and 95.1% specificity. No patients presented with WMA.
Conclusion: With brief training, paramedics were able to acquire adequate cPoCUS images for LV function assessment, and interpretations were largely accurate.
Keywords: echocardiography; emergency medical services; paramedic; point-of-care ultrasound; prehospital medicine
Long-Term Dietary Consumption of Grapes Alters Phenotypic Expression in Skeletal Muscle of Aged Male and Female Mice
No full text(1) Background: Nutrigenomics investigates how diet influences gene expression and how genetic variation impacts dietary responses. Grapes, rich in phytochemicals, exhibit potential disease-preventive properties through nutrigenomic mechanisms rather than direct chemical interactions. This study aimed to explore the modulation of gene expression in muscle tissue resulting from long-term grape consumption. (2) Methods: A mouse model was employed to assess gene expression in the skeletal muscles of males and females fed a grape-enriched diet versus a bland diet over 2.5 years. Heatmaps and principal component analyses were performed to identify patterns, and pathway analyses using KEGG, GO, and Reactome were conducted. (3) Results: Significant sex-specific gene expression changes were observed, with female phenotypes showing greater alterations and converging toward male-like characteristics. Twenty-five differentially expressed genes associated with muscle health were identified. Up-regulated genes such as Ahsg, Alb, Apoa1, and Arg1, and down-regulated genes including Camp, Lcn2, and Irf4, suggest improved muscle function. (4) Conclusions: Long-term grape consumption appears to enhance female muscle traits toward a male-like phenotype, potentially indicating broader health benefits. Further studies and clinical trials are needed to confirm human applicability and the physiological implications of these findings. Nonetheless, this research underscores the role of nutrigenomics in understanding dietary influences on gene expression and sex-specific responses.
Keywords: GO; KEGG; Reactome analytics; genetic metamorphosis; male/female muscle convergence
Hospital Addiction Consultation Service and Opioid Use Disorder Treatment: The START Randomized Clinical Trial
No full textImportance: Medications for opioid use disorder (MOUD) are effective, but hospitalized people with opioid use disorder (OUD) seldom receive MOUD while in the hospital or link with treatment after.
Objective: To test whether an addiction-focused consultation service, the Substance Use Treatment and Recovery Team (START), increases MOUD initiation during hospitalization and linkage to follow-up care after discharge.
Design, setting, and participants: This 1:1 randomized clinical trial grouped participants into the START intervention or usual care. The study was conducted between November 2021 and September 2023 at 3 hospitals in the following cities: Los Angeles, California; Albuquerque, New Mexico; and Springfield, Massachusetts. The last follow-up was in December 2023. Eligible individuals were 18 years and older and met criteria for OUD.
Intervention: START consists of an addiction medicine specialist and a care manager delivering a motivational and addiction-focused discharge planning intervention and follow-up calls.
Main outcomes and measures: Primary outcomes were the proportions of patients (1) initiating MOUD (naltrexone, buprenorphine, or methadone) during hospitalization (per electronic medical record data) and (2) successfully linking to OUD treatment within 30 days after discharge (per patient self-report).
Results: A total of 325 were consented and randomized to START (n = 164) or usual care (n = 161). Median (IQR) age was 41.0 (32.0-50.0) years. A total of 213 participants (65.5%) were male at birth, 28 (8.6%) were American Indian or Alaska Native, 21 (6.5%) were Black, 156 (48.0%) were Hispanic, and 125 (38.5%) were White. More than half, 175 (53.8%), were unhoused in the past year, and 163 (50.2%) were unemployed. START participants were more likely than usual care participants to initiate MOUD during hospitalization (94/164 [57.3%] vs 43/161 [26.7%], respectively; adjusted risk ratio [aRR], 2.10 [97.5% CI, 1.51-2.91]) and to link to OUD care after discharge (90/125 [72.0%] vs 50/104 [48.1%], respectively; aRR, 1.49 [97.5% CI, 1.15-1.93]).
Conclusions and relevance: By addressing gaps in inpatient care, the hospital-based addiction-focused consultation service presented in this randomized clinical trial improved receipt of evidence-based treatment for people with OUD in the hospital and linkage to treatment after discharge.
Trial registration: ClinicalTrials.gov Identifier: NCT05086796
Barriers to Universal Availability of Medications for Opioid Use Disorder in US Jails
No full textImportance: Many of the approximately 2 million people being held in US correctional facilities are experiencing an opioid use disorder (OUD). Providing medications for OUD (MOUD) to this population is, therefore, essential to curb the opioid crisis.
Objective: To examine the types of MOUD jails are making available, factors associated with availability, and additional supports needed for jails to address implementation challenges.
Design, setting, and participants: This survey study used a cross-sectional survey of jails conducted between February 2 and July 1, 2023, to explore how they administer MOUD. Publicly available county-level data were connected with the survey responses to assess how variables in the surrounding community were associated with MOUD availability. The survey was administered to jails via mail, telephone, and online survey link. Participants included jails with MOUD available that completed the survey.
Exposures: Urbanization, average daily population, availability of a health care professional to administer MOUD, whether the state expanded Medicaid, average drive time to MOUD in the county, county overdose rate, and county social vulnerability were assessed.
Main outcomes and measures: The primary outcome was the type of MOUD available in the jail, including buprenorphine, methadone, or naltrexone, or all 3 medications. Binary logistic regressions were conducted to identify the characteristics of jails and county-level factors associated with offering the medications.
Results: A total of 462 jails were invited to complete the survey based on responses to a previous nationally representative survey of jails, in which they indicated that MOUD was available to individuals in their facility. A total of 265 US jails with MOUD available were included in the analysis, representative of 1243 jails nationwide with MOUD available after weighting (812 jails [65.3%] provided buprenorphine, 646 jails [52.0%] provided naltrexone, 560 jails [45.0%] provided methadone, and 343 jails [27.6%] provided all 3 medications). Availability was associated with urbanicity, location in a Medicaid expansion state, county opioid overdose rate, and county social vulnerability. Common challenges included jail policies and procedures and the logistical accessibility of the medication.
Conclusions and relevance: The findings of this survey study of US jails demonstrate that jails with MOUD available still experience challenges with making all 3 types of medication available to anyone held within their facility. Policy, regulatory, financing, staffing, and educational solutions are needed to ensure that all detainees with OUD have access to treatment while incarcerated