Ai-enhanced clinical decision support reduces medication errors and adverse drug events in a multicenter teaching hospital network: A prospective randomized controlled trial.

Suboptimal weight loss affects 20%-35% of patients after metabolic bariatric surgery (MBS). Randomised evidence on glucagon-like peptide-1 receptor agonist (GLP-1 RA) pharmacotherapy in this population is limited to small, single-center Western trials. No data exist from Chinese populations. To emulate a target trial comparing GLP-1 RA initiation with standard care among suboptimal responders to MBS in a Chinese multicenter cohort. Target trial emulation using electronic health record (EHR) data from two Tertiary A teaching hospitals in China (March 2019 to June 2024). Eligible adults aged 18-65 years had undergone sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB), were 12-36 months post-surgery with body mass index (BMI) ≥ 28 kg/m2 and suboptimal weight loss. The clone-censor-weight approach handled the 30-day grace period. 1:5 propensity score matching yielded 624 patients (104 GLP-1 RA, 520 standard care). Strategy A: GLP-1 RA initiated within 30 days. Strategy B: standard post-MBS care without GLP-1 RA. Percentage of total body weight loss (%TBWL) at 12 months. Mean age was 36.4 years; 66% were female; mean BMI was 33.7 kg/m2. At 12 months, mean %TBWL was 7.5% in the GLP-1 RA group versus 1.2% in the standard care group (difference, 6.28 percentage points; 95% CI, 5.50 to 7.07; p < 0.001). The ≥ 5% TBWL responder rate was 75% versus 7%. The per-protocol effect was 6.44 percentage points (95% CI, 5.65 to 7.23). Results were consistent across surgery types, BMI thresholds, diabetes status, and all sensitivity analyses. In this target trial emulation, GLP-1 RA initiation was associated with clinically meaningful weight loss among Chinese suboptimal responders to MBS. These findings extend Western randomised trial evidence to a Chinese multicenter real-world setting and support the integration of GLP-1 RA pharmacotherapy into post-bariatric care pathways in China.

Exploring the impact of intermittent fasting plus time-restricted eating versus calorie restriction on eating behavior, mood, sleep, quality of life in adults with obesity.

To evaluate the efficacy and safety of automated insulin delivery (AID) systems in very young children with type 1 diabetes (T1D). PubMed, Embase, Scopus, and Web of Science were searched until 10 October 2025. Inclusion criteria were randomized controlled trials (RCTs); T1D populations under 7 years old; comparing AID systems with standard care (SC). Primary efficacy endpoint was the percentage of time-in-range of 70-180 mg/dL (TIR) derived from continuous glucose monitoring (CGM), secondary outcomes included glycated haemoglobin (HbA1c), other CGM metrics, and insulin dose. Safety endpoints included severe hypoglycaemia (SH) and diabetic ketoacidosis (DKA). Four RCTs involving 292 participants were included. The mean age was 4.70 years, with a mean T1D duration of 1.96 years. The study duration ranged from 8 to 16 weeks. Compared with SC, AID significantly improved TIR by mean difference (MD) +9.29% (95% confidence interval [CI]: 7.27-11.30, I2 = 70%, p < 0.001) accompanied by a favourable effect on HbA1c by MD -4 mmol/mol (-0.39%) (95% CI [-6 to -2] (-0.57 to -0.21), I2 = 82%, p < 0.001). A favourable decrease in time-above-range (TAR, >180 mg/dL; >250 mg/dL) and mean blood glucose were also observed in AID over SC (all p < 0.05). No significant differences were observed between AID and SC groups in time in hypoglycaemia, insulin dose, and risk of SH and DKA (all p > 0.05). AID systems may outperform SC in improving short-term glycaemic control (TIR, HbA1c, TAR) in very young children with T1D, without increasing time in hypoglycaemia, insulin dose, or risk of SH and DKA. These preliminary findings support the clinical potential of AID systems and highlight the need for longer term studies.

Cost-Effectiveness of Pembrolizumab as First-Line Therapy for Advanced Colorectal Cancer With High Microsatellite Instability or Mismatched Repair Deficiency in Japan.

BackgroundLecanemab is the first approved disease-modified therapy in Japan for patients with mild cognitive impairment (MCI) due to Alzheimer's disease (AD) or mild AD dementia (AD-D).ObjectiveThis study aims to evaluate the social value of lecanemab in Japan.MethodsThe social value was evaluated using a cost-effectiveness model. The intervention was lecanemab added to the standard of care (SOC), and the comparator was SOC alone. The effect of lecanemab was determined based on the phase III trial and subsequent long-term follow-up observation studies. Health outcomes were quantified in life years and quality-adjusted life years (QALYs). Both patient and caregiver utilities were considered by summing the absolute values of utility for both the caregiver and patient. The base-case analysis was conducted from the public healthcare and long-term care payer's perspectives.ResultsLecanemab extended the time spent in early AD, thereby maintaining quality of life (QOL), reducing caregiver burden, and medical and long-term care resource usage. The incremental QALYs were 1.31 QALYs for MCI due to AD and 0.85 QALYs for mild AD-D, and the incremental cost-effectiveness ratios (ICERs) were JPY 8.5 million /QALY and JPY 7.9 million /QALY ($1 = JPY 150), respectively.ConclusionsThe value-based price or the ICER of lecanemab varied greatly depending on the perspectives and the methods of reflecting caregiver QOL. In AD, where the progression of the illness spans a long period and had a significant impact on families and society, narrowly defined value assessments were not sufficient, indicating the need to consider broader social value.

Early, controlled weight-bearing using an antigravity treadmill may improve outcomes following definitive fixation of lower extremity periarticular fractures. We hypothesized that patients randomized to 10 weeks of antigravity treadmill therapy would report better 6-month joint-specific patient-reported function compared with standard of care. This prospective, multicenter, randomized trial included patients 18 to 55 years of age with fractures of the knee and distal tibia randomly assigned to either 10 weeks of antigravity treadmill therapy (intervention) or standard of care (control). The primary outcome was 6-month patient-reported function (Knee injury Osteoarthritis Outcome Score) for patients with knee fractures and Ankle Osteoarthritis Scale for patients with distal tibia fractures. Secondary outcomes included 6-month Patient-Reported Outcomes Measurement Information Systems Physical Function scores, 12-month fracture healing and complications, and 6-week, 3- and 6-month satisfaction with therapy. Of 80 randomized patients, 78 were included in the final analysis (intervention n = 38; control n = 40). Their mean age was 37 years; 55 (71%) had knee fracture and 23 (29%) had distal tibia fracture. The average Knee injury Osteoarthritis Outcome Score were 54 and 61 in the intervention and control groups, respectively (adjusted difference: -6.1; 95% confidence interval, -18.4, 6.2; P = 0.32). The average Ankle Osteoarthritis Scale scores were 28 and 50 for the intervention and control groups, respectively (adjusted difference: -19.5; 95% confidence interval, -39.3, 0.30; P = 0.05). No difference was found between treatment groups in Patient-Reported Outcomes Measurement Information Systems Physical Function, fracture healing, or complications. Patients in the intervention group reported higher satisfaction with their therapy at 6 weeks (9.5 vs. 8.5; P = 0.01) and 3 months (9.5 vs. 8.6; P = 0.04). This study suggests that antigravity treadmill therapy may be beneficial for patients with distal tibia fractures. Moreover, the study demonstrates that a 10-week antigravity treadmill therapy program is safe and feasible with high patient satisfaction, providing foundation for future effectiveness trials for patients with periarticular injuries.

Recovery centered perinatal care: A retrospective cohort study evaluating a scalable prenatal care model to improve outcomes for birthing people with opioid use disorder and their newborns.

Changes of gut microbiota, hormone and glycolipid metabolism by dietary fiber (oat bran) supplementation in patients with laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass: A randomized controlled study.

Acute chest syndrome (ACS) is a severe complication of sickle cell disease (SCD) associated with significant morbidity and mortality, necessitating optimized prevention and management strategies for improved patient outcomes. This review does not evaluate red blood cell exchange, as no randomized controlled trials meeting our inclusion criteria reported outcomes for this intervention. A thorough literature review identified interventions for ACS in SCD patients. Seventeen randomized controlled trials (RCTs) underwent assessment using the Cochrane Risk of Bias 2 tool, and a frequentist network meta-analysis was conducted to compare interventions. The use of hydroxyurea and simple transfusion was associated with a lower proportion of patients who developed ACS during the study period compared with standard care (RR: 0.42, 95% CI [0.20-0.86]; RR: 0.31, 95% CI [0.12-0.75], respectively). Intravenous dexamethasone was associated with a lower risk of persistent fever, reduced need for blood transfusion, and shorter durations of both opioid and oxygen therapy, as well as a shorter in-hospital stay (p < 0.01 for all comparisons). When compared with standard care, hydroxyurea was associated with reduced requirement for blood transfusion (RR: 0.17, 95% CI [0.04, 0.73]), with a similar association observed for intravenous dexamethasone (RR: 0.19, 95% CI [0.05, 0.77]). No significant associations were identified between any treatment and rates of hospitalization or readmission. This study offers insights into ACS treatment efficacy and safety in SCD patients. Hydroxyurea and transfusion strategies demonstrated the strongest evidence for reducing acute chest syndrome risk. Corticosteroids were associated with improved inpatient outcomes in predominantly pediatric populations, but concerns regarding potential rebound pain and rehospitalization warrant cautious interpretation. Larger trials are required before routine steroid use can be broadly recommended.

Enhanced recovery protocols for pediatric colorectal surgery demonstrate cost-effectiveness: An economic analysis to support programmatic development.

To undertake a systematic review evaluating the clinical and cost-effectiveness of technology-enhanced positive end-expiratory pressure (PEEP) optimization strategies in adults and children receiving invasive mechanical ventilation on an ICU. We searched key electronic databases (including MEDLINE and Embase) from inception to July 2024. We included randomized studies examining clinical or cost-effectiveness of technology-enhanced PEEP optimization strategies compared with standard care or an alternative PEEP optimization strategy in adults and children. The primary outcome was duration of mechanical ventilation and secondary outcomes were clinical effectiveness (e.g., mortality) and efficacy (e.g., PEEP). Two reviewers independently assessed eligibility, extracted data, assessed risk of bias (Revised Cochrane tool) and performed Grading of Recommendations Assessment, Development and Evaluation evidence certainty assessments. Our database and trial register search retrieved 8845 results, of which 34 studies (2951 patients) were included. Eight studies were at low risk of bias. Across studies, 7 technologies were evaluated, most commonly esophageal balloon measurement of transpulmonary pressure (10 studies), electrical impedance tomography (7 studies), pressure-volume curve analysis (6 studies), and fully automated closed-loop ventilation (5 studies). Meta-analysis used random-effects models. Duration of mechanical ventilation was reported in only three studies (172 patients, two technologies) and there was no effect compared with standard care (mean difference -0.06 d; 95% CI, -0.20 to 0.09; very low-certainty evidence).For 28-day mortality (10 studies; 1,719 patients; six technologies), technology-enhanced PEEP optimization reduced 28-day mortality (risk ratio 0.69; 95% CI, 0.52-0.93; very low-certainty evidence). No significant differences were found for other clinical-effectiveness outcomes. We identified no evidence in children or on cost-effectiveness. Technology-enhanced PEEP optimization strategies did not reduce duration of mechanical ventilation, but these technologies may reduce mortality. Evidence certainty was low or very low, highlighting the urgent need for adequately powered randomized trials. PROSPERO (CRD42024555390).

Comparative efficacy of tarlatamab and second-line therapies in extensive-stage small cell lung cancer: A network meta-analysis.

The term standard of care is a legal concept in health care representing the duty a practitioner owes to each patient, and this duty is the same for telehealth encounters, whether video based or audio only, as it is for in-person encounters. This article presents an anonymized case analysis of a fatal peritonsillar abscess misdiagnosed during an audio-only telehealth encounter, highlighting the telehealth regulatory variations across states and emphasizing professional liability considerations for nurse practitioners (NPs) delivering remote care. Through the PEP and AUDIO telehealth frameworks, NPs can implement the telehealth modality that is most clinically appropriate and best safeguards diagnostic accuracy and patient safety for each patient encounter. Understanding evolving regulatory landscapes and maintaining proper documentation allow NPs to leverage telehealth advantages while fulfilling their professional duty and preventing potentially fatal diagnostic and management errors.

For patients with early-stage low-risk uterine cervical cancer ≤2cm, simple hysterectomy is recommended, and this can now be considered the new standard of care.1 However, for patients with cervical cancer >2cm with "non-SHAPE" criteria, radical hysterectomy is still recommended as the standard primary treatment.2. Nerve-sparing radical hysterectomy requires deep knowledge of pelvic neurovascular anatomy. Lack of proper anatomical knowledge and adequate surgical skills are associated with not only the risk of hypogastric nerve injury but also unnecessary bleeding during surgery, which may lead to unintentionally less radical surgery. We performed nerve-sparing radical hysterectomy (Querleu-Morrow classification: type C13) using the following eight steps (Video). In Japan, total laparoscopic radical hysterectomy is performed under the public health insurance system. Step 1: Development of the lateral pararectal space and the paravesical space. Step 2: Isolation of the ureter and separation of the hypogastric nerve. Step 3: Development of the rectovaginal space. Step 4: Dissection of the anterior leaf of the vesicouterine ligament. Step 5: Development of the paravaginal space and dissection of the posterior leaf of the vesicouterine ligament Fig. 1). Step 6: Separation of the cut end of the deep uterine vein from the pelvic splanchnic nerve (Fig. 2). Step 7: Transection of the uterine branch from the inferior hypogastric plexus and ligation of the paracolpium. Step 8: Vaginal cuff creation and transection of the vaginal wall. Surgeons should recognize the importance of developing a retroperitoneal avascular space based on precise anatomical landmarks, and each surgical step must be reproducible. Fig. 1 Anatomical relationships between the posterior leaf of the vesicouterine ligament and the paravaginal space (Left side). (A) and (B) The surgical forceps can easily penetrate the paravesical space. This space is known as the "paravaginal space." (C) After development of the paravaginal space, the posterior leaf of the vesicouterine ligament can be dissected. Fig. 2 Anatomical relationships between deep uterine vein, hypogastric nerve and bladder branch (right side). (A) The bladder branch from the inferior hypogastric plexus can be identified when the cut end of the deep uterine vein is cranially retracted. (B) Dot line: dissection line.

Efficacy and safety of enpatoran, a Toll-like receptor 7/8 inhibitor, in patients with skin manifestations of cutaneous lupus erythematosus or systemic lupus erythematosus: findings from Cohort A of a multicentre, international, double-blind, placebo-controlled, dose-finding phase 2 trial.

Biopsy with same-session MRI-guided laser interstitial thermal therapy versus biopsy alone in patients with primary unresectable glioblastoma: a multicentre randomised controlled trial.

Point-of-care (POC) electroencephalography (EEG) enabled with artificial intelligence (AI) algorithms hold the potential to address gaps in EEG access and interpretation. We assessed the clinical association of the patterns recognized by one of such systems. Secondary cohort analysis of the retrospective multicenter Seizure Assessment and Forecasting with Efficient Rapid-EEG (SAFER-EEG) study. EEG and clinical data were gathered from three academic centers with access to POC EEG (Ceribell, Sunnyvale, CA) as part of their standard of care. We used a bedside seizure burden (SzB) monitor ("bedside" algorithm) and a more sensitive online algorithm ("portal" algorithm) to determine SzB. The modified Rankin Scale (mRS) score at discharge was selected as the outcome. Four hundred enrolled adult patients, 359 with complete outcome and clinical data. Time in seizure and peak SzB assessed by AI. Per the bedside algorithm, 39.8% of patients had peak 5-minute SzB greater than 0%. With every additional hour of seizure detected by the bedside algorithm, patients were more likely to have unfavorable outcome (mRS > 3) at discharge (adjusted odds ratio [aOR], 1.98; 95% CI, 1.11-4.29). Compared with 5-minute SzB = 0%, prolonged activity per the bedside algorithm (peak 5-min SzB ≥ 90%) was associated with a 3.4-fold increase in aOR of poor outcome. Every 30 seconds of activity in the maximum hourly SzB of the bedside algorithm was associated with increased odds of unfavorable outcome (aOR, 1.02; 95% CI, 1.00-1.03). Combining outputs from the algorithms increased the strength of associations with outcome, particularly in patients with peak 5-minute SzB greater than or equal to 90% (aOR, 4.4; 95% CI, 1.66-12.69). AI-estimated SzB is associated with functional outcomes at discharge in a dose-response fashion, even after controlling for clinical cofounds. This provides initial evidence of the clinical utility of AI algorithms for detecting clinically important EEG patterns.

Coexisting type2 inflammatory diseases such as allergic rhinitis (AR), atopic dermatitis (AD), chronic rhinosinusitis (CRS) and/or nasal polyposis (NP), eosinophilic esophagitis (EoE), and urticaria are common in asthma. RAPID (NCT04287621), a global prospective registry, aimed to characterize patients with asthma initiating dupilumab in a real-world clinical setting. This analysis investigated the prevalence of coexisting type2 inflammatory diseases in these patients. Patients aged ≥ 12years initiating dupilumab for asthma (primary indication) according to country-specific prescribing information were enrolled in RAPID. Patients had regular assessments at 1month and thereafter every 3months for up to 3years, per standard of care across study sites. At the time of analysis, 205 patients were enrolled. Mean age of patients (stratified by type2 coexisting disease) ranged from 42.3 to 57.3years and mean body mass index from 29.9 to 31.8kg/m2. Most patients were female (67.3% to 77.4%), and mean time since asthma diagnosis was 17.3 to 24.0years, with mean duration of coexisting diseases ranging from 9.8 to 17.0years. A total of 189 (92%) patients had ≥ 1 ongoing type2 coexisting disease (AR, 80%; CRS and/or NP, 45% [CRS with NP, 47%; CRS without NP, 41%; NP, 12%]; AD, 27%; urticaria, 15%; and EoE, 3%). This analysis from the RAPID registry shows that type2 coexisting diseases are highly prevalent in patients with asthma initiating dupilumab in a clinical practice setting and highlights the importance of properly assessing patients to improve patient care. ClinicalTrials.gov: NCT04287621.

Economic Evaluation and Budget Impact Analysis of Secukinumab as a Second-Line Treatment Among Patients With Psoriatic Arthritis Who Were Tumor Necrosis Factor Inadequate Responders in Thailand.