27740 research outputs found
Sort by
Institutional Practices Drive Antibiotic Variability in Neonatal Intensive Care Units: Baseline Evidence to Inform National Stewardship Interventions in Oman
No full textBackground: Antibiotic overuse in Neonatal Intensive Care Units (NICUs) is a major contributor to antimicrobial resistance and adverse neonatal outcomes. This study aims to evaluate baseline antibiotic utilization (AU), identify factors influencing variability, and assess the impact of neonatal characteristics and sepsis incidence. Methods: A multicenter retrospective analysis examined AU in seven NICUs from 2019 to 2023, involving 25,532 neonatal admissions during national antibiotic stewardship program implementation. Data encompassed neonatal clinical parameters, sepsis incidence, and AU metrics, including days of therapy (DOT) per 1000 patient-days. Statistical analyses included correlation assessments and multivariate regression to identify determinants of antibiotic use. Results: Overall, 43.8% of neonates received antimicrobials, with individual NICUs ranging from 24% to 73% (p \u3c 0.001). Antimicrobial-exposed neonates had a mean gestational age of 35.1 weeks [SD ± 4.4] and a mean birth weight of 2360 g [SD ± 970]. Antimicrobial-exposed neonates were generally more premature [35.1 (±4.4) weeks vs. 37.5 (±2.5) weeks (p \u3c 0.001)] and had lower mean birth weight [2360 g (±971) vs. 2817 g (±686) (p \u3c 0.001)] compared to those not exposed to antimicrobials. Total antimicrobial days varied markedly (8761 to 37,683 days), with DOT per 1000 patient-days ranging from 322 to 1031. Antimicrobial use for culture-negative sepsis varied widely among centers, from 23% to 73%. Antimicrobial-exposed neonates had higher all-cause mortality compared to those who did not [(7.5% vs. 3.2%), (p \u3c 0.001)]. Multivariate analysis revealed individual NICU practice patterns remained significant predictors after adjusting for neonatal characteristics. Conclusions: Neonatal antimicrobial use varied significantly among NICUs, driven primarily by institutional practices rather than neonatal demographics. These findings provide nationally representative baseline data to inform neonatal antimicrobial stewardship interventions and offer transferable lessons for other countries seeking to optimize antibiotic use in NICUs amid rising global antimicrobial resistance
Continent Ileostomy: Evolution and Indications
No full textRoadmap History Indications Modern Approac
Cervical Laminectomy for Degenerative Cervical Myelopathy: Is There a Role in the Modern Day? A Systematic Review and Meta-Analysis
No full textStudy DesignSystematic Review and Meta-Analysis.ObjectivesTo compare clinical outcomes in degenerative cervical myelopathy (DCM) patients treated with laminectomy alone (LA) vs laminectomy with fusion (LF) and determine post-laminectomy kyphosis incidence.MethodsWe searched PubMed, Scopus, Embase, Web of Science, and MEDLINE from inception-September 2024 for studies comparing LA and LF for DCM. Outcomes assessed included post-laminectomy kyphosis, neurological recovery outcomes, patient-reported outcomes (PROs), and complication rates. Meta-analyses were performed using random-effects models.ResultsTwenty-seven studies including 3286 patients (2272 LA and 1014 LF), met the inclusion criteria. The pooled incidence of post-laminectomy kyphosis in the LA patients was 2.02 events per 100 person-years (95% CI: 1.26-2.78). Post-laminectomy kyphosis declined from 3.67 cases per 100 person-years in pre-2004 studies, to 0.88 cases per 100 person-years in post-2014 studies. No significant differences were observed between LA and LF in neurologic recovery (SMD 0.29, 95% CI 0.02-0.59), pain score improvement (SMD 0.13, 95% CI: -0.38 to 0.64) and complications (OR 0.77, 95 % CI 0.29-2.08), although subgroup analysis demonstrated that the risk of complications in LA may be lower in patients with less than four operative levels.ConclusionsAlthough the annual rate of kyphosis after LA is approximately 2 events per 100 person-years, PROs and complication rates may be similar between LA and LF. These findings should be interpreted with the caveat of considerable heterogeneity between studies and further randomized trials are needed to better delineate the benefits of each approach and to optimize patient selection
What\u27s Next for Public Health and Health Equity? Making Sense of the Political Moment and Advocating for Patients and Communities
No full textOverview Explore changes to vaccine policy, Medicaid, and health equity efforts Connect attacks on health and science to broader threats Discuss strategies for defending and reimagining systems Offer resources and ideas on how to take actio
Using Complexity Science to Improve Patient Outcomes
No full textObjectives Describe the current state of health outcomes Define complexity science Describe healthcare as a complex adaptive system Introduce implementation science Describe the Cynefin framework for decision makin
Pilot Evaluation of the Health Passport (HSE) for People with Intellectual and Developmental Disabilities (PWIDD)
No full textPurpose: People with Intellectual and Developmental Disabilities (PWIDD) have disparities in health outcomes that are in part due to communication barriers. The Health Passport (HSE) application was developed in Ireland to promote participation and inclusion of PWIDD in their own healthcare experience. This evaluation’s aim was to examine the acceptability, usability, and feasibility of the Health Passport (HSE) among three United States (US) stakeholder groups: PWIDD, care partners, and healthcare and community service providers.
Methods: A sequential exploratory mixed-methods approach was used in this evaluation. In Phase 1, semi-structured qualitative interviews examined usability, acceptability, and feasibility of the Health Passport (HSE) and explored stakeholder suggestions for adaptations and improvements for use in US-based healthcare and community service encounters. In Phase 2, a nationwide stakeholder group survey assessed the Phase 1 suggestions and evaluated the outcomes of interest using three validated measures: Acceptability of Intervention Measure (AIM), Systems Usability Scale (SUS), and Feasibility of Intervention Measure (FIM).
Results: In Phase 1, stakeholder interviews (n=18) found the Health Passport (HSE) to be widely acceptable, usable, and feasible and a detailed list of suggestions was compiled to improve the app. Phase 2 stakeholder (n=39) survey results were consistent with Phase 1 results.
Conclusions: This evaluation provided researchers with clear recommendations to adapt the Health Passport (HSE) for use in US-based encounters and provided insight into methodology for a pilot intervention trial. Small sample sizes limited the generalizability of this evaluation. Further research efforts would assess a larger, more diverse group of stakeholders
Elevated tRNA Halves in Olfactory Epithelial Cells of Patients With Schizophrenia
No full textSchizophrenia patients\u27 olfactory epithelial cells contain abundant immune-activating tRNA fragments, linking small RNA biology to inflammation and suggesting avenues for diagnostics
Gene Regulatory Programs of NK Cells Show That NCAM1 (CD56) and KIRs Are Controlled by Genetically Polymorphic Distal Regulatory Elements
No full textOwing to their immunoprotective properties, natural killer (NK) cells are critical for the innate immune response to pathogens, as well as a new wave of cancer immunotherapy that harnesses natural cytotoxicity. We sought to study the genetic and epigenetic drivers behind human-specific NK cell receptors, so that we can better understand the underlying cellular function. Here, we present a transcriptomic, proteomic (CITE-seq), and chromatin (single nuclei ATAC-seq) profiling of human peripheral NK cell subsets, which was then compared with genomic databases. Through integrative multi-omics, we demonstrate that CD56bright versus CD56dim NK cell subsets have differential distal regulatory element (DRE) landscapes, with fewer accessible DREs in the CD56dim NK cells. We combine our epigenetic data, deposited Hi-C, and human genetic data to show mechanisms governing the NCAM1 (encoding CD56) and the killer cell immunoglobulin-like receptors (KIRs) loci. We identify an NCAM1 DRE that binds STAT3 in most NK cells, while identifying a genetic cohort that has motifs for binding repressive BLIMP1 at the DRE and resulting in less CD56 expression. Together, our findings reveal novel epigenetic and transcriptomic systems for the regulation of NK cell receptors driving NK cell cytotoxicity and diversity. © 2026 The Author(s). European Journal of Immunology published by Wiley-VCH GmbH
Prognostic Value of Baseline QFR in Single-Vessel Intermediate Coronary Stenosis
No full textBACKGROUND AND OBJECTIVES: The prognostic value of baseline Quantitative Flow Ratio (QFR) in real-world patients remains unclear. This study aimed to evaluate the prognostic value of baseline QFR and its three-tier model-low, grey-zone, and high QFR-in patients with single-vessel intermediate stenosis.
METHODS: This retrospective study included 478 patients with QFR between 0.70 and 0.90 who underwent coronary angiography between May and June 2023. Patients were stratified into Low (0.70-0.74), Grey-Zone (0.75-0.85), and High (0.86-0.90) QFR groups. The primary endpoint was major adverse cardiac events (MACE); the key secondary endpoint was target vessel failure (TVF). Kaplan-Meier and Cox proportional hazards models were used to evaluate outcomes.
RESULTS: During the 18-month follow-up period, MACE incidence was 13.5%, 6.6%, and 3.4% in Low, Grey-Zone, and High QFR groups, respectively (P = 0.008), mainly driven by MI (3.2% vs. 1.4% vs. 0.0%, P = 0.029) and ischemia-driven revascularization (11.5% vs. 6.1% vs. 2.3%, P = 0.004), including ID-TVR (6.7% vs. 3.3% vs. 1.1%, P = 0.027). Each 0.01 increase in QFR was associated with a 7.23% lower risk of MACE (P = 0.012) and a 10.04% lower risk of ID-TVR (P = 0.011). Multivariate analysis confirmed QFR group as an independent predictor, with a per-category decrease from High to Low QFR associated with an 86% higher risk of MACE (adjusted HR = 1.858, 95% CI 1.038-3.326, P = 0.037) and a 2.33-fold higher risk of ID-TVR (adjusted HR = 2.333, 95% CI 1.004-5.510, P = 0.049).
CONCLUSIONS: Baseline QFR and its three-tier stratification across the grey-zone and adjacent ranges show a continuous association with adverse events in single-vessel intermediate coronary stenosis, supporting its role in functional evaluation, risk stratification, and prognostic prediction