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Socio-Clinical Correlations With Threat Perception and Self-Efficacy in People With Type 2 Diabetes.
No full text[No abstract available
Pediatric nurse perspectives on patient- and family-centered rounds: A qualitative study.
No full textBACKGROUND: Patient- and family-centered rounding (PFCR) models are used widely in pediatric hospitals and have been associated with better communication and fewer errors. Although model fidelity and sustainability are well-documented challenges reported by physicians and families, nurse perspectives are less known.
OBJECTIVE: Our objective was to identify benefits for nurses and describe barriers and facilitators to nurse involvement in a PFCR model.
METHODS: We used a qualitative descriptive approach to conduct and analyze focus group data. Focus group participants were nurses from sites participating in the Patient- and Family-centered (PFC) I-PASS Safer Communication on Rounds Every Time (SCORE) study, a hybrid effectiveness implementation study of a PFCR model at 21 US pediatric hospitals.
RESULTS: Twenty-nine nurses from 14 study sites participated in four focus groups. We identified multiple benefits, barriers, and facilitators of nurse participation in PFC I-PASS rounds. Benefits included better communication, time savings and efficiency, conveying that nursing is a contributing part of the team. Barriers included competing demands of nurses\u27 workload, lack of fidelity during rounds, and uncertainty about whether nurses are welcome by other care team members. Facilitators key to supporting nurse participation and engagement in rounds included clear nursing role in rounds, predictable rounding schedule and format, attending physicians fostering a welcoming environment, and strategies for when a nurse is not available.
CONCLUSIONS: Nurses report many benefits of PFC I-PASS rounds. Increasing and sustaining nurse participation in PFC I-PASS requires specific, nurse-informed implementation strategies targeting both structural and interprofessional aspects of rounds
TCT-1120 Percutaneous MitraClip Versus Surgical Mitral Valve Repair or Replacement for Severe Functional Mitral Regurgitation: A Comparative Analysis of Long-Term Clinical Outcomes
No full textBackground: Functional mitral regurgitation (FMR) results from left ventricular dilation or dysfunction, rather than primary mitral valve pathology. Surgical mitral valve repair or replacement (sMVR) has been the traditional treatment for severe FMR, particularly in patients undergoing concomitant cardiac surgery. However, many patients with FMR are poor surgical candidates due to advanced age or comorbidities. MitraClip, a transcatheter edge-to-edge repair (TEER) device, has emerged as a less invasive alternative. This study compares long-term outcomes of MitraClip versus sMVR in patients with isolated severe FMR. Methods: A multicenter retrospective cohort study was conducted, analyzing data from 1,368 patients with isolated severe FMR (n=678 MitraClip, n=690 sMVR). Patients were propensity score matched for age, left ventricular ejection fraction (LVEF), NYHA class, and comorbidity index. The primary endpoints were all-cause mortality and heart failure (HF) rehospitalization at 3 years. Secondary outcomes included NYHA class improvement, procedural complications, and residual MR ≥ moderate. Kaplan-Meier survival analysis and Cox proportional hazard models were used. P-values \u3c 0.05 were considered significant. Results: At 3-year follow-up, all-cause mortality was significantly lower in the MitraClip group compared to the surgical group (25.5% vs. 32.7%, p=0.01). Heart failure rehospitalization occurred less frequently in MitraClip patients (28.4% vs. 36.9%, p=0.007). MitraClip patients also experienced greater functional improvement, with more achieving NYHA class I/II (58.7% vs. 49.1%, p=0.02). However, residual MR ≥ moderate was more common in the MitraClip group (22.5% vs. 8.1%, p\u3c 0.001). Procedural complications, including stroke, bleeding, and arrhythmia, were significantly higher in the surgical group. Conclusion: For patients with severe functional MR, especially those at elevated surgical risk, percutaneous MitraClip therapy provides a favorable balance of safety and clinical benefit, with lower mortality and hospitalization rates over 3 years. Surgical MVR remains appropriate for select lower-risk patients requiring more complete valve correction. Categories: STRUCTURAL: Valvular Disease and Intervention: Mitra
Community Health Worker and Mobile Health Interventions for Quality of Life Among Young Adults With Sickle Cell Disease: A Randomized Clinical Trial.
No full textIMPORTANCE: Young adults with sickle cell disease (SCD) experience challenges transitioning from pediatric to adult care, leading to increased morbidity and mortality.
OBJECTIVE: To evaluate the effectiveness of community health worker (CHW) support or a mobile health application (mHealth) compared with enhanced usual care (EUC) in improving health-related quality of life (HRQOL) for young adults with SCD transitioning to adult care.
DESIGN, SETTING, AND PARTICIPANTS: The Community Health Workers and Mobile Health for Emerging Adults Transitioning Sickle Cell Disease Care study was an observer-blinded, multicenter, randomized clinical trial performed at 5 US children\u27s hospitals with a recruitment period from January 15, 2019, to December 31, 2022, and data analysis performed from September 30, 2024, to June 30, 2025. Participants were 17 years or older with SCD.
INTERVENTIONS: Participants were randomized 1:1:1 to 6 months of EUC, CHW plus EUC, or mHealth plus EUC. Both interventions included goal setting, self-management, skill development, symptom tracking, and transition support. The CHW plus EUC intervention provided weekly synchronous support primarily via phone calls, while mHealth plus EUC offered virtual peer support via interaction with discussion boards. The EUC group received standard care consisting of a transition checklist for consistency across sites.
MAIN OUTCOMES AND MEASURES: The main outcome was HRQOL, assessed using the Pediatric Quality of Life Inventory (PedsQL) for SCD module. Clinically meaningful improvement was prespecified as a 10-point change. Secondary outcomes included SCD knowledge, transition readiness, and social support. All outcomes were collected at baseline and follow-ups at 6, 12, and 18 months.
RESULTS: Of the 700 eligible patients across the 5 sites, 405 were enrolled, and 375 participants with SCD were randomized, 191 (51.5%) of whom were women. The mean (SD) age was 18.9 (1.9) years; the median age was 18.0 (IQR, 17-20) years. Baseline demographic data, clinical characteristics, and markers of disease severity were comparable across the study groups. At 6 months, the CHW plus EUC group showed modest improvements in HRQOL compared with the EUC group at 2.67 (95% CI, 0.25-5.09) at 6 months; there was no change for the mHealth plus EUC group at 0.73 (95% CI, -1.48 to 2.93) at 6 months; and the EUC group had a decline of 2.58 (95% CI, -4.67 to -0.49). CHW support demonstrated the greatest improvement in PedsQL scores compared with EUC at 6 (5.25 [95% CI, 2.05-8.45] points), 12 (5.56 [95% CI, 1.52-9.61] points), and 18 (6.14 [95% CI, 1.75-10.54] points) months. The mHealth plus EUC intervention demonstrated improvement in PedsQL scores at 6 months only (3.31 [95% CI, 0.27-6.35] points). Throughout the study, the HRQOL for the EUC group declined. No significant differences were found in secondary outcomes.
CONCLUSIONS AND RELEVANCE: Although neither intervention met the prespecified 10-point threshold for a large clinical effect, the CHW intervention produced a significant and durable improvement in HRQOL that halted the decline observed in EUC. This sustained effect during the 18 months of follow-up suggests that CHW support provides a clinically relevant benefit for young adults with SCD during their transition to adult care. Integrating such programs into routine care could improve outcomes for this vulnerable population.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03648710
1.2 Legal, Ethical, and Multidisciplinary Approaches to Reproductive Health in Adolescents with Intellectual Developmental Disorder and ASD
No full textObjectives: Adolescents with intellectual and developmental disabilities (IDDs) and ASD face complex legal, ethical, spiritual, and clinical challenges in reproductive decision-making. This study aims to: 1) examine ethical dilemmas around informed consent, autonomy, and spiritual care in clinical settings; 2) compare legal and guardianship frameworks across countries in relation to autonomy and dignity; and 3) assess the role of multidisciplinary collaboration—including spiritual care—in supporting person-centered reproductive healthcare. Methods: A comparative policy analysis of legal frameworks in South Asia and high-income countries (HICs) was conducted to evaluate their impact on healthcare access for adolescents with IDDs/ASD. Case studies illustrate the ethical and spiritual tensions in consent processes and reproductive decision-making. Additionally, literature from occupational therapy, psychiatry, and disability studies was reviewed to identify evidence-based models integrating medical, psychological, social, educational, and spiritual domains. Results: Legal approaches vary significantly: some jurisdictions emphasize autonomy and supported decision-making, while others rely on protective guardianship. Ethical tensions arise in assessing capacity while honoring familial, cultural, and spiritual values. In many low- and middle-income countries (LMICs), parental attitudes shaped by spiritual or religious beliefs influence perceptions of sexuality, often restricting open discussion or consent. HICs that embed spiritual care (eg, chaplaincy, ethics consults) within interdisciplinary teams offer more inclusive, trust-building environments. Holistic models improve care by addressing identity, emotional resilience, and meaning-making—core concerns for adolescents with IDDs/ASD. Conclusions: Reproductive healthcare for adolescents with IDDs and ASD must integrate legal protections, ethical clarity, and spiritual responsiveness. Including spiritual perspectives in care planning enhances dignity, cultural congruence, and resilience, affirming adolescents as whole persons in their reproductive lives. AC, ID, AS
Thromboembolism In Patients With Atrial Fibrillation Due To Hyperthyroidism-a Systematic Review And Meta-analysis
No full textBackground: Hyperthyroidism (HTH) is a reversible etiology of atrial fibrillation (AFib). There is no definite evidence whether the risk of thromboembolism (TE) in AFib due to HTH is higher or lower compared to AFib without HTH. Objective: To assess the clinical outcomes and risk of TE in patients with AFib due to HTH. Methods: A systematic literature search of PUBMED, Scopus and Embase on articles reporting AFib due to HTH yielded 4938 results. 294 studies fulfilled inclusion criteria, of which 274 were included in individual patient data analysis and 20 in meta-analysis. Meta-analysis assessed the proportion of patients developing TE in patients with AFib due to HTH. The protocol was registered on PROSPERO (CRD42022352406). Results: Individual patient data analysis (274 articles) Data was available for 418 patients. The mean age was 54.8±14.8 years. The majority were females (58.1%). 58.4% had newly diagnosed HTH at the time of presentation. Graves\u27 disease was the most common etiology of HTH (55.7%). 22% of patients had thyroid storm. ICU admission rate was 21.3%. 15.6% had concomitant high-output cardiac failure. The mean CHA2DS2-VASc score was 1.3±1.2. 30.4% of patients were discharged on anticoagulation (80.5% on warfarin and 19.5% on direct oral anticoagulants). TE events were reported in 19.4% of patients. Patients with TE events were older (57±14 vs 52.3±14.7 years; p \u3c 0.001), predominantly females (34.4% vs. 18.8%; p = 0.008) and had a higher CHA2DS2-VASc score (1.6±0.2 vs. 1.2±0.1; p = 0.03) compared to those who did not have TE. There were no differences in number of comorbidities, type of thyroid disease, thyroid antibody status, and TSH level between the two groups. A statistically significant correlation was found between CHA2DS2-VASc score and TE events on spearman correlation analysis (p = 0.02). No correlation was found between free T4 levels at presentation and TE events development at the follow-up (p = 0.33). Meta-analysis (20 studies) A total of 20 observational cohort studies encompassing 30,729 patients with AFib due to HTH were included in the proportional meta-analysis. The pooled prevalence of thromboembolic events in this population was 11.64% (95% CI: 7.88% - 15.96%). However, substantial heterogeneity was observed among the included studies (I2 = 89.3%, τ2 = 0.0151, p \u3c 0.0001), suggesting considerable variability in event rates across studies. Conclusion: Patients with AFib due to HTH with advanced age are at higher risk of developing TE events. CHA2DS2-VASc score can be used for risk stratification in these patients and as it correlates with the risk of TE in these patients. The pooled prevalence of TE events is 11.64%. However, there is significant heterogeneity in the literature, highlighting the possibility of publication bias that may have overstated event risks. A formal trial or registry would better answer the question of incidence of TE in HTH
Rheumatic Diseases in Pregnancy: Emerging Pharmacologic Management and Safety
No full textRheumatic diseases distinctly affect women of childbearing age, creating complex challenges in balancing maternal disease control with fetal safety during pregnancy and lactation. This review summarizes the pathophysiology and management of common rheumatic diseases, with a focus on the safety and efficacy of conventional and biologic disease-modifying antirheumatic drugs (DMARDs). Particular emphasis is placed on pregnancy-compatible therapies, contraindicated agents, and emerging evidence supporting the use of select biologics such as tumor necrosis factor inhibitors (TNKs). Current guidelines and primary literature have been reviewed to show the importance of preconception counseling and individualized treatment plans to optimize maternal and fetal outcomes
In adults living near highways, 30 d of home HEPA vs. sham filtration did not differ for BP.
No full textGIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text] Public Health: [Formula: see text]
TCT-1231 Comparison of Micropuncture Versus Ultrasound-Guided Arterial Access Techniques: A Systematic Review of Patient Outcomes and Procedural Safety
No full textBackground: Arterial access is foundational to many endovascular procedures. Micropuncture and ultrasound-guided techniques are increasingly used to minimize complications. This study compares these two methods in terms of access success, procedural complications, and clinical outcomes. Methods: A systematic review and pooled analysis was conducted on studies comparing micropuncture and ultrasound-guided arterial access in femoral and radial procedures. Key endpoints included access success rate, access time, hematoma formation, pseudoaneurysm, and need for surgical repair. Results: Seven studies with 2,840 patients (micropuncture: n=1,420; ultrasound-guided: n=1,420) were included. Ultrasound guidance showed superior first-pass success (93.8% vs. 87.1%, p\u3c 0.001) and reduced access site complications, especially hematomas (1.8% vs. 4.7%, p=0.02). Micropuncture offered shorter mean access time in radial access procedures. Pseudoaneurysm formation was significantly lower with ultrasound guidance (0.2% vs. 1.1%, p=0.01). Conclusion: Ultrasound-guided arterial access demonstrates a superior safety profile and higher success rate compared to micropuncture techniques, especially for femoral access. Micropuncture remains valuable for radial access and high-risk patients due to smaller initial puncture size. Categories: CORONARY: Vascular Access: Coronar
In-Hospital Outcomes of Neonates with Hypoxic-Ischemic Encephalopathy Receiving Sedation-Analgesia during Therapeutic Hypothermia.
No full textOBJECTIVE: This study aimed to compare magnetic resonance imaging (MRI) severity scores and in-hospital outcomes among neonates with perinatal hypoxic-ischemic encephalopathy (HIE) with and without exposure to sedation-analgesia (SA) during therapeutic hypothermia (TH).
STUDY DESIGN: A single-center, retrospective cohort study of neonates with perinatal HIE undergoing TH between January 2010 and December 2020. Demographics, clinical characteristics, MRI scores, and in-hospital outcomes were compared between patients without SA exposure and those with SA use.
RESULTS: Of the 131 neonates, 55 (42%) did not have SA exposure, and 76 (58%) had SA during TH. Groups were similar in birth weight, gestational age, and severity of HIE. A higher proportion of neonates in the SA group received inhaled nitric oxide (iNO, 39.4% vs. 2%,
CONCLUSION: SA during TH for perinatal HIE did not alter early MRI severity scores. A lower survival to discharge in the SA group may be related to illness severity rather than SA use alone.
KEY POINTS: · Conflicting studies exist regarding the efficacy of SA use during TH.. · SA use during TH did not alter in-hospital MRI severity scores.. · SA use was associated with a lower survival to discharge, correlated to the severity of illness rather than SA use alone.