Functional independence trajectories over 5 years in older veterans with traumatic brain injury: A model systems study.

Background: Research on older adults who sustain a traumatic brain injury (TBI) has predominantly been on civilian, nonveteran populations. Military populations experience higher rates of TBI and often experience the additive effects of TBI and other comorbid disorders, including posttraumatic stress disorder and/or substance use that may increase disability over time.

Objective: To investigate predictors of functional independence trajectories over the 5 years after TBI in veterans 55 years or older at injury.

A health-equity framework for tailoring digital non-pharmacological interventions in aging.

If designed with health equity in mind, digital non-pharmacological interventions (NPIs) represent a cost-effective, scalable means of reducing health disparities associated with age-related mental health disorders in older adults in the USA. However, disparities in technological access, literacy and effectiveness can limit the impact of these interventions in older adults from disadvantaged groups. We present a health-equity-promoting framework for the development of digital NPIs for age-related mental health disorders and provide an example from the literature that highlights how interventions can be targeted at specific groups to increase technological access, literacy and effectiveness to ensure that these interventions can meet their potential of reducing health disparities.

Nutritional Status Modifies the Association Between Hemoglobin Level and Mortality in Older Patients Undergoing Hemodialysis: A Nationwide Dialysis Registry in Japan.

Objective: Anemia is a common complication associated with adverse outcomes in older patients undergoing hemodialysis (HD). They also tend to experience malnutrition, which can affect the course of anemia. We hypothesized that the optimal hemoglobin (Hb) level varies depending on nutritional status in older patients undergoing HD and aimed to investigate the association between Hb levels and mortality according to nutritional status.

Contextual Factors that Influence Antibiotic Prescribing: A Discrete Choice Experiment of GP Registrars.

Introduction: Antimicrobial resistance is a global emergency related to overprescribing of antibiotics. Few studies have explored how prescribing behaviours may change as the consequence of changing resistance. Understanding how contextual factors influence antibiotic prescribing will facilitate improved communication strategies to promote appropriate antibiotic prescribing.

Melatonin: A Review of the Evidence for Use in Hospital Settings.

New onset insomnia is often experienced by patients during hospitalization due to environmental disruptions, pain and increased patient care activities. Patient distress arising from poor sleep quality and quantity often results in the prescribing of hypnotics. Melatonin use in hospital settings is common and is increasingly used for off label indications including primary insomnia in those aged < 55 years, prevention of delirium and to facilitate benzodiazepine discontinuation.

Renal anemia and hyporesponsiveness to ESA for preservation of residual kidney function in patients undergoing peritoneal dialysis.

Preservation of residual kidney function (RKF) is important in patients undergoing peritoneal dialysis (PD). We aimed to examine the association between anemia management and residual urine output using data from a nationwide survey of dialysis patients. After excluding patients with anuria at baseline from the Total cohort of 2,712, 659 of 1,640 patients developed anuria during a median follow-up of 2.

Clinical entity augmented retrieval for clinical information extraction.

Large language models (LLMs) with retrieval-augmented generation (RAG) have improved information extraction over previous methods, yet their reliance on embeddings often leads to inefficient retrieval. We introduce CLinical Entity Augmented Retrieval (CLEAR), a RAG pipeline that retrieves information using entities. We compared CLEAR to embedding RAG and full-note approaches for extracting 18 variables using six LLMs across 20,000 clinical notes.

Population attributable fractions for modifiable risk factors of neonatal, infant, and under-five mortality in 48 low- and middle-income countries.

Background: Identifying the modifiable risk factors for childhood mortality using population-attributable fractions (PAFs) estimates can inform public health planning and resource allocation in low- and middle-income countries (LMICs). We estimated PAFs for key population-level modifiable risk factors of neonatal, infant, and under-five mortality in LMICs.

Methods: We used the most recent Demographic and Health Survey data sets (2010-22) from 48 LMICs, encompassing 35 sub-Saharan African countries and 13 countries from South and Southeast Asia (n = 506 989).

Comprehensive care processes for substance use disorders in adult mental health services: A systematic review.

Background And Objectives: Assessment and care of substance use disorder within mental health services are essential due to the high prevalence and harms associated with comorbidity. Substance use disorder assessment and care are routinely recommended in clinical guidelines; however, processes are not agreed. This systematic review of routine clinical practice in relation to substance use disorders in adult mental health service aims to identify routine assessment and diagnosis processes, the proportion of patients and service episodes in which they occur and their outputs.

Longitudinal Twin Growth Discordance Patterns and Adverse Perinatal Outcomes.

Objective: The objective of this study was to conduct a longitudinal assessment of inter-twin growth and Doppler discordance, to identify possible distinct patterns, and to investigate the predictive value of longitudinal discordance patterns for adverse perinatal outcomes in twin pregnancies.

Methods: This retrospective cohort study included twin pregnancies followed and delivered at a tertiary University Hospital in London (UK), between 2010 and 2023. We included pregnancies with at least three ultrasound assessments after 18 weeks and delivery after 34 weeks' gestation.

Differences in Phenotypes, Treatments, and Outcomes of ANCA-associated Vasculitis across Europe, Japan, and the United States in 2020.

Objectives: To clarify the differences in clinical phenotypes, therapeutic patterns, and outcomes of patients with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) across geographic regions using a multinational cohort.

Methods: Data were collected from patients with newly diagnosed or relapsing GPA or MPA in Europe, Japan, and the United States (US) from January to July 2020. The composite outcome of kidney failure and/or death within 52 weeks after treatment was evaluated, and the hazard ratios across the regions were estimated using the Cox proportional hazard model.

Podiatric Clinical Triage in a Foot and Ankle Orthopaedic Clinic: A Randomised Trial.

Rationale: Hospitals are increasingly utilising allied-health professionals to provide clinical triage to patients. While these positions are routinely implemented, and several observational studies have reported positive outcomes, the effectiveness of this intervention has been rarely tested in a clinical trial.

Aims And Objectives: The objectives of this study were to (i) evaluate a podiatry-led orthopaedic triage service using patient-reported outcome measures (PROMs), and (ii) determine if it is cost-effective in terms of incremental cost/quality-adjusted life years (QALYs).

Toward expert-level medical question answering with large language models.

Large language models (LLMs) have shown promise in medical question answering, with Med-PaLM being the first to exceed a 'passing' score in United States Medical Licensing Examination style questions. However, challenges remain in long-form medical question answering and handling real-world workflows. Here, we present Med-PaLM 2, which bridges these gaps with a combination of base LLM improvements, medical domain fine-tuning and new strategies for improving reasoning and grounding through ensemble refinement and chain of retrieval.

Neuromodulation Strategies in Lennox-Gastaut Syndrome: Practical Clinical Guidance from the Pediatric Epilepsy Research Consortium.

Lennox-Gastaut syndrome (LGS) is a severe developmental and epileptic encephalopathy characterized by multiple drug-resistant seizure types, cognitive impairment, and distinctive electroencephalographic patterns. Neuromodulation techniques, including vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS), have emerged as important treatment options for patients with LGS who do not respond adequately to antiseizure medications. This review, developed with input from the Pediatric Epilepsy Research Consortium (PERC) LGS Special Interest Group, provides practical guidance for clinicians on the use of these neuromodulation approaches in patients with LGS.

Interstep Variations of Stairways and Associations of High-Contrast Striping and Fall-Related Events: Observational Study.

Background: Interstep variations in step riser height and tread depth within a stairway could negatively impact safe stair negotiation by decreasing step riser height predictability and, consequently, increasing stair users' fall risk. Unfortunately, interstep variations in riser height and depth are common, particularly in older stairways, but its impact may be lessened by highlighting steps' edges using a high-contrast stripe on the top front edge of each step.

Objective: This study aimed to determine (1) if fall-related events are associated with greater interstep riser height and depth variations and (2) if such fall-related events are reduced in the presence of contrast-enhanced step edges compared with a control stairway.

Patient-centred care and quality of life and hope among Japanese patients receiving home medical care: a multicentre, cross-sectional study.

Objectives: Patient-reported outcomes reflecting quality of life (QOL) and hope are essential targets for in-home medical care. This study examined the association between the quality of patient-centred care and both QOL and hope.

Design: Multicentre, cross-sectional study.

Reducing Sedation for Pediatric Thoracic CT Imaging Using Volumetric Target-mode EKG Gating.

Introduction: Many children require sedation for imaging. We aimed to reduce sedation for thoracic (chest and cardiac) computed tomography (CT) scans in children 0-4 years old from 65% to 20% by December 2018 and to sustain.

Methods: We counted baseline, intervention, and a follow-up period thoracic CT scans performed with sedation in children 0-4 years old.

StUdy of Gestational diabetes And Risk using Electronic Data (SUGARED): a population-based cohort study-study protocol.

Introduction: The incidence of gestational diabetes mellitus (GDM) in Australia has tripled in the last 20 years. Consequently, over 40 000 pregnancies are now diagnosed as 'higher risk' each year. This has increased antenatal surveillance and obstetric intervention, often in the form of delivery earlier than 39 weeks gestation.

Validity and reliability of the Japanese version of the ACE tool for assessing evidence-based medicine competencies in medical practitioners and students: An evaluation in an online setting.

Introduction Evidence-based medicine (EBM) competency is crucial for healthcare professionals; however, validated tools to assess EBM skills in Japanese are scarce. This study aimed to develop and validate a Japanese version of the Assessing Competency in EBM (ACE) tool. Methods We translated the ACE tool into Japanese, following international standards, and distributed it online to 99 healthcare professionals and students.

Glucocorticoid tapering pace in microscopic polyangiitis and granulomatosis with polyangiitis in Japanese real-world practice: A propensity score-matched retrospective cohort study from the J-CANVAS registry.

Objective: To assess the prevalence and outcomes among regimens of glucocorticoid tapering for microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) in real-world practice.

Methods: We retrospectively examined the Japan Collaborative Registry of ANCA-associated Vasculitis (J-CANVAS) registry, and evaluated the prevalence of glucocorticoid tapering regimens in the PEXIVAS trial. In patients with newly diagnosed MPA and GPA, we compared outcomes among standard and reduced pace regimens.