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COVID-19 Factors Associated With Medication Changes Among Nursing Home Residents With Dementia
No full textThis study examined associations of COVID-19 mortality rates, staffing, and resident behavior with changes in antidementia and psychotropic medication initiation among nursing home (NH) residents with dementia. A nationally representative survey of Directors of Nursing was analyzed to assess changes in medication initiation at the peak of the pandemic. NHs with higher COVID-19 mortality rates were less likely to report increases in antidementia medication initiation. COVID-19 mortality rates were not associated with significant increases or decreases in psychotropic initiation. NH's that reported increased resident behavioral problems during the pandemic had higher odds of psychotropic initiation. In summary, NHs most affected by COVID-19 deaths were less likely than NHs with a milder pandemic experience to increase initiation of antidementia medications. Increased behavioral symptoms, possibly due to consequences of COVID-19, were associated with more psychotropic drug use. More research is needed to understand factors influencing prescribing practices during public health emergencies.No embarg
Hypoperfusion intensity ratio is associated with follow-up infarct volume in medium vessel occlusions: A multicenter multinational study
Get PDFMedium vessel occlusion (MeVO) contributes significantly to acute ischemic stroke (AIS). The hypoperfusion intensity ratio (HIR), reflecting collateral circulation via the ratio of Tmax >10s to Tmax >6s volumes, predicts infarct progression in large-vessel occlusions but is unstudied in MeVOs. In this multicenter, multinational retrospective study, we evaluated consecutive patients with MeVO who underwent mechanical thrombectomy with or without intravenous thrombolysis. Inclusion required available follow-up imaging and pretreatment CT perfusion. Follow-up infarct volume (FIV) was measured on CT or MRI 12-36 h post-procedure. Univariable and multivariable linear regression models were used to identify predictors of FIV, with HIR as the primary variable of interest. Among 147 patients (median age 75 years, 57 % female), univariable analysis showed HIR was significantly associated with larger FIV (β = 80 mL; p 10 s showed the strongest correlation with FIV (r = 0.56; p < 0.001). These findings suggest that higher HIR correlates with larger infarct volumes, underscoring the prognostic role of collateral failure in MeVO and highlighting HIR as a potential imaging marker to guide treatment and outcome prediction.1 year2026/08/1
Complete Heart Block Triggered by Nirmatrelvir-Ritonavir and Verapamil
Get PDFRitonavir-boosted nirmatrelvir (Paxlovid) is a treatment for COVID-19. However, ritonavir, a cytochrome P450 (CYP) CYP3A4 inhibitor, poses a risk of significant drug-drug interactions. In our case, coprescribed nirmatrelvir-ritonavir and verapamil, with concomitant acute kidney injury, resulted in complete heart block and shock. Following fluid resuscitation, blood pressure support with norepinephrine, and calcium therapy for verapamil toxicity, the patient recovered and was discharged home in normal sinus rhythm. To our knowledge, only 2 cases with this drug-drug interaction have been documented, making this a rare, but serious interaction poorly described in the literature. Understanding the pharmacokinetic relationship between these 2 medications and the risks of coprescribing them is crucial for both diagnosing toxicity and reducing preventable morbidity and mortality.No embarg
Best practices for public dissemination and language on suicide research
Get PDFMany of us are aware of the media guidelines for responsible media reporting around suicide (e.g., from Reporting on Suicide, the World Health Organization, and Samaritans). Irresponsible communication around suicide in the media has been shown to increase risk and can even contribute to higher suicide rates (Niederkrotenthaler et al., 2012; 2020). As researchers, we have a part to play in responsible reporting and sharing of suicide research findings with the public.
As you start to share your research as part of CAPES or in other suicide research, please keep these guidelines in mind
Critical review of partial volume correction methods in PET and SPECT imaging: benefits, pitfalls, challenges, and future outlook
Get PDFPurpose: Partial volume effects (PVE) remain a major challenge in quantitative single-photon emission computed tomography (SPECT) and positron emission tomography (PET) imaging, often compromising both accuracy and reproducibility. While numerous Partial Volume Correction (PVC) methods have been proposed, their clinical translation is still limited. This review provides a clinically oriented evaluation of PVC methods with a particular focus on state-of-the-art applications in neurology, cardiovascular imaging, oncology, and radiopharmaceutical therapy dosimetry, highlighting where these techniques offer the greatest added value. In addition, we outline which PVC techniques have the potential to be used in clinical practice and which remain primarily suited for research purposes, along with their suitability in each of the above-mentioned clinical domains. Finally, this review addresses the central question of whether PVC is essential in clinical practice or whether its impact is context dependent.
Methods: This review categorizes PVC approaches into three partially overlapping classes: reconstruction-based, post-reconstruction-based, and AI-driven or hybrid methods. Each class is further divided into anatomical and non-anatomical subcategories. We systematically compare their clinical applicability across key dimensions: quantitative accuracy, lesion detectability, robustness to noise and artifacts, anatomical dependence, generalizability across scanners and tracers, and clinical readiness.
Results: PVC techniques often improve quantitative accuracy in small structures and in regions affected by spill-over from adjacent high-uptake tissues. However, these benefits can come at the cost of increased noise or edge artifacts, which may limit their robustness for routine clinical use. Post-reconstruction methods are sensitive to segmentation errors, while AI-driven models, despite their promise, require further validation using clinical benchmarks, comparison to ground truth, and testing on diverse datasets. Issues, such as generalizability and interpretability remain significant barriers.
Conclusion: This review emphasizes the importance of application-tailored PVC protocols for reliable quantitative imaging in neurology, cardiology, oncology, and radiopharmaceutical therapy dosimetry. Not all PVC methods are beneficial; some may even impair interpretation in certain contexts. We provide a practical overview of which PVC approaches are most beneficial for each clinical scenario, aiming to guide both researchers and clinicians in selecting appropriate techniques for future studies and routine practice, and also outline key areas requiring further development for broader integration into research and clinical workflows.No embarg
Do iterative implant innovations translate to better outcomes? A comparison of three implant designs after uncemented total knee arthroplasty
No full textBACKGROUND: Despite advancements in total knee arthroplasty (TKA) implant design, 20 % of patients remain dissatisfied. Implants have been developed to improve biomechanics and patient-reported outcomes, yet evidence suggests comparable long-term results between modern anatomic and traditional implants. This study evaluated whether newer implant designs provide meaningful and measurable clinical value.
METHODS: Retrospective chart review for primary TKA patients at a single institution (01/2016 - 05/2023). Patients were stratified based on uncemented implant design. Exclusion criteria: missing data, incomplete Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS) questionnaires, or follow-up under 12 months. Preoperative and 12-month postoperative KOOS scores for activities of daily living (ADL), PAIN, and quality of life (QoL), as well as Mental (MCS) and Physical Component Scores (PCS), were analyzed. The Kruskal-Wallis test was used for continuous variables, and -square/Fisher's exact tests for categorical data (P < 0.05).
RESULTS: Baseline characteristics and preoperative outcome scores were comparable across groups. ADL, PAIN, QoL, and KOOS (P = 0.883) scores were comparable between groups at 12 months. MCS score change from baseline to 12 months was significantly different (P = 0.02), though its clinical relevance remains uncertain.
CONCLUSION: Design modifications from the multi-radius trochlear groove for altered femoral geometry and 3D-printed porous surface for uncemented fixation were introduced to improve patellofemoral mechanics and implant integration, there was no significant translation to improved patient-reported outcomes in this study. These findings suggest that patient and procedure-specific factors may be influential in determining TKA outcomes more than implant design alone.No embarg
Defining terminology and outcome measures for evaluating overdose response technology: An international Delphi study
Get PDFIntroduction: Various novel harm reduction services leverage technology to reduce the rising number of drug poisoning deaths, particularly among those who use drugs alone. There is significant variability in terminology and outcome measures in reporting these interventions, complicating efforts to build a comprehensive knowledge base. Thus, we conducted a Delphi study to establish consensus and heterogeneity in these metrics.
Methods: Panellists from three stakeholder groups (people who use drugs, virtual harm reduction service operators and academics) participated in a multi-round Delphi study. The first round included open-ended questions to propose items in three categories: terminology, demographic information and outcomes. Subsequent rounds included options from a previously conducted scoping review for consideration. Likert ratings were used to achieve consensus, with a 70% threshold. Final rounds involved ranking terminology that reached a consensus.
Results: Of 23 initial participants, 14 completed the fourth survey round. "Overdose response technology" was identified as the most appropriate term for these harm reduction technologies. This definition includes drug contamination alerts, overdose response hotlines and applications, wearable overdose detection technology and overdose detection tools. Fourteen demographic outcomes reached a consensus for data collection, including name or handle, neighbourhood, age, gender, past overdose experience, substance used, amount and route of use. Six service use outcomes were recommended: response type, service outcomes, morbidity and mortality, overdose events, responder arrival time and post-rescue care.
Discussion and conclusions: The study results are recommended to standardise terminology and guide future research and knowledge dissemination in the field, ensuring clear communication with a shared language.No embarg
A single cell atlas of the mouse seminal vesicle
No full textDuring mammalian reproduction, sperm are delivered to the female reproductive tract bathed in a complex medium known as seminal fluid, which plays key roles in signaling to the female reproductive tract and in nourishing sperm for their onwards journey. Along with minor contributions from the prostate and the epididymis, the majority of seminal fluid is produced by a somewhat understudied organ known as the seminal vesicle. Here, we report the first single-cell RNA-seq atlas of the mouse seminal vesicle, generated using tissues obtained from 23 mice of varying ages, exposed to a range of dietary challenges. We define the transcriptome of the secretory cells in this tissue, identifying a relatively homogeneous population of the epithelial cells which are responsible for producing the majority of seminal fluid. We also define the immune cell populations - including large populations of macrophages, dendritic cells, T cells, and NKT cells - which have the potential to play roles in producing the various immune mediators present in seminal plasma. Together, our data provide a resource for understanding the composition of an understudied reproductive tissue, with potential implications for paternal control of offspring development and metabolism.No embarg
Letter of Concern from the Association of Academic Chairs of Emergency Medicine Regarding ACGME Proposed Changes
Get PDFThis letter, signed by over 50 academic chairs of emergency medicine, urges the ACGME to reconsider a proposed mandate requiring all emergency medicine residency programs to adopt a four-year training model. The authors argue that current three-year programs are supported by data demonstrating equivalent educational and clinical outcomes compared to four-year formats. They criticize the flawed survey methodology underpinning the proposal, note the loss of milestone-based training flexibility, and highlight the lack of added scholarly or clinical value in the fourth year. The letter also outlines negative consequences for fellowship participation, workforce development, trainee debt, and diversity. The signatories advocate for maintaining the current flexible training model to preserve excellence, equity, and innovation in emergency medicine education.No embarg
Evaluation of protocol fidelity for prehospital antibiotic administration
No full textBackground: Sepsis is a common, critical, time-sensitive medical emergency, with mortality rates of up to 56%. Early antibiotic administration is a cornerstone of sepsis management, yet prehospital antibiotic administration remains uncommon in the United States.
Methods: This prospective observational study evaluated the implementation of a prehospital sepsis protocol in an urban EMS system. Patients were eligible for prehospital antibiotic administration if they were ≥18 years old, hypotensive (SBP 100.4°F). Paramedics drew blood cultures and administered piperacillin/tazobactam or ceftriaxone. A report was generated to prospectively identify patients eligible for the study by hemodynamic data and/or if they were administered prehospital antibiotics. Demographic, operational, and clinical data were abstracted from patient care records and electronic health records. Outcomes were reported descriptively.
Results: A sample of 147 patients was included for encounters from December 1, 2019, to December 1, 2024 (mean age 72.8 years, 31.3% female). Antibiotics were administered to 132 patients (89.8%). Of encounters with antibiotic administrations, 127/132 (96.2%) complied with the clinical protocol, and five (3.8%) were protocol violations. Additionally, six patients (4.1%) were inappropriately not administered antibiotics, and nine patients (6.1%) had contraindications to the protocol, so antibiotics were withheld. Of 356 blood culture bottles that underwent laboratory analysis, nine (2.5%) were contaminated. The mean (±SD) time from patient contact to antibiotics was 32.7 (±8.2) min.
Conclusions: Prehospital clinicians can reliably and safely administer antibiotics for sepsis with hypotension and severe sepsis, observing high protocol adherence and low contamination rates while expediting time from recognition of sepsis to first antibiotics. These findings support the integration of prehospital antibiotics into broader sepsis care pathways. Expanding such protocols could improve compliance with sepsis care quality measures and enhance patient outcomes, particularly in resource-constrained environments.No embarg