Palliative care consultation (PCC) in acute decompensated heart failure (ADHF) may enhance care quality and align treatment with patient goals. However, national trends and predictors of PCC in ADHF remain poorly defined. We used the National Inpatient Sample (2018–2020) to identify hospitalizations for adults (≥18 years) with a primary diagnosis of ADHF using ICD-10-CM codes. PCC was defined by ICD-10-CM code Z51.5. Multivariable survey-weighted logistic regression identified predictors of PCC use, adjusting for demographics, socioeconomic status, comorbidities, and hospital factors. Among 3,655,265 hospitalizations, older age was associated with higher odds of PCC (aOR 1.05 per year; 95 % CI, 1.05–1.05). Compared to White individuals, odds of PCC were lower for Asian or Pacific Islander (aOR 0.74), Black (aOR 0.83), and Hispanic individuals (aOR 0.76). Medicare patients had lower odds than those with Medicaid (aOR 0.72). The highest income quartile was associated with greater PCC use (aOR 1.18). PCC was less common in the Northeast (aOR 0.88), South (aOR 0.93), and West (aOR 0.91) compared to the Midwest. Urban teaching hospitals had higher PCC rates than rural hospitals (aOR 1.48). Patients with greater comorbidity and higher mortality risk were more likely to receive PCC. PCC use in ADHF is influenced by demographic, socioeconomic, clinical, and institutional factors. Racial, regional, and hospital-level disparities suggest a need for interventions to promote equitable access to palliative care for patients with ADHF.

Background: Sepsis and acute renal failure (ARF) are major contributors to mortality in critically ill patients in the United States. Despite advancements in critical care, trends in mortality associated with these conditions among adults aged ≥55 years have not been well studied. Methods: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database was utilized to retrospectively analyze national mortality trends related to sepsis and ARF in the United States from 1999 to 2020, stratified by sex, race/ethnicity, age groups, U.S. Census region, and state. Results: The overall AAMR exponentially increased from 9.4 in 1999 to 18.5 in 2009 (APC: 7.73; 95% CI: 6.11 to 10.30) and it gradually increased to 22.6 in 2020 (APC: −0.14; 95% CI: −1.58 to 0.99, P -value = 0.819), with an average annual percentage (AAPC) of 3.53 (95% CI: 3.02 to 4.11, P -value = < 0.000001). Men had consistently higher AAMRs than women from 1999 (AAMR men: 12.4 vs. women: 7.5) to 2020 (AAMR men: 27.9 vs. women: 18.5), the AAPC for men is 3.22 (95% CI: 2.58 to 4.00) and for women is 3.96 (95% CI: 3.56 to 4.42). When stratified by race, the highest overall AAMR was observed in Black Americans (25.4%) and the lowest in Asians (13.4%). Overall, AAMR was highest for the South (19.5) and lowest for the Northeast (14). Conclusions: Following a period of dynamic fluctuations, sepsis and ARF-related mortality in U.S. adults have increased over the last 20 years. Focused interventions in prevention and treatment are crucial to mitigate the escalating impact of sepsis and ARF-related mortality.

Background: Alzheimer's disease (AD) is a progressive neurodegenerative disorder and the leading cause of dementia globally, with no definitive disease-modifying treatment currently available. Recent therapeutic advances targeting amyloid-beta, tau protein, neuroinflammation, and metabolic pathways reflect a shift in treatment paradigms. However, the comparative efficacy, safety, and translational potential of these emerging strategies remain insufficiently synthesized. Objective: This systematic review aimed to evaluate the latest therapeutic interventions for AD by analyzing randomized clinical trials and pilot studies assessing pharmacologic and non-pharmacologic treatments, with a focus on cognitive outcomes, biomarker changes, and treatment safety. Methods: A systematic review was conducted following PRISMA 2020 guidelines. Databases searched included PubMed, Scopus, Web of Science, and the Cochrane Library, covering publications from December 2018 to August 2023. Studies were included if they were randomized clinical trials involving AD patients aged ≥18 years. Data on interventions, outcomes, and risk of bias were extracted and synthesized narratively. The final sample comprised 21 eligible trials. Ethical compliance with the Declaration of Helsinki was ensured by all primary studies. Statistical outcomes and clinical effects were reported descriptively. Results: Trials included a total of over 7,000 participants. Lecanemab, Donanemab, BI 425809, and masitinib demonstrated statistically significant improvements in cognitive measures (e.g., ADCOMS, ADAS-Cog) and biomarker modulation (e.g., amyloid PET, tau levels). Intranasal insulin and metabolic activators showed functional gains. Safety profiles were generally favorable, though some studies had limited generalizability due to sample size and trial duration. Conclusion: Multiple emerging interventions show promise in modifying the trajectory of Alzheimer’s disease, supporting a move toward personalized and mechanism-based treatment approaches. These findings offer valuable clinical insights and highlight the need for integrated, large-scale trials to translate these advances into real-world patient care.

Background: Major depressive disorder (MDD) is a leading global cause of disability, with a substantial proportion of patients failing to respond to pharmacotherapy or psychotherapy. Theta burst stimulation (TBS), a newer form of transcranial magnetic stimulation (TMS), offers the advantage of shorter treatment duration, but its comparative efficacy against conventional TMS and sham remains uncertain. Despite growing clinical interest, prior reviews have lacked sufficient data to establish TBS as a frontline neuromodulatory option. Objective: This study aimed to conduct an updated systematic review and meta-analysis evaluating the efficacy and safety of TBS compared to both sham stimulation and conventional TMS in adults with MDD, focusing on categorical response, percent symptom reduction, remission, and adverse events. Methods: This systematic review and meta-analysis included randomized controlled trials (RCTs) comparing TBS with sham or standard TMS in adult patients diagnosed with MDD. A comprehensive search of PubMed, CENTRAL, and EBSCO/CINAHL was performed through March 28, 2025. Primary outcome was defined as ≥50% reduction in Hamilton Rating Scale for Depression (HRSD) scores. Secondary outcomes included percent change in HRSD, remission (HRSD <11), Beck Depression Inventory (BDI) scores, and adverse events. Data were pooled using a random-effects model in Review Manager (RevMan) 5.4, with quality assessed via the Cochrane Risk of Bias tool and GRADE. Ethical approval was not applicable due to the nature of secondary data synthesis The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD420251008712. Results: Fourteen RCTs met inclusion criteria. TBS showed significantly higher response rates than sham (RR = 2.40, 95% CI: 1.27–4.55, p = 0.007) and was comparable to standard TMS (RR = 1.02, p = 0.80). Percent change in HRSD and MADRS outcomes favored TBS, while adverse event rates did not differ significantly between groups. Conclusion: TBS is a clinically effective and time-efficient intervention for MDD, offering comparable or superior outcomes to conventional TMS and significantly outperforming sham. Its favorable tolerability and shorter session duration support broader clinical application and integration into psychiatric care settings.

Background: Amiodarone and lidocaine are antiarrhythmic agents recommended for advanced cardiac life support in shockable ventricular arrhythmias during cardiac arrest, yet their comparative effectiveness in in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) remains uncertain. Methods: From 930 records identified in PubMed, ScienceDirect, Embase, and Cochrane Library, 14 studies were included. Outcomes were analyzed using random-effects meta-analysis in R with IHCA and OHCA subgroup analyses. Bayesian meta-analysis using the bayesmeta package assessed result credibility. Results: Amiodarone did not improve return of spontaneous circulation (R0SC) compared with lidocaine (Risk ratio (RR) 0.96, p = 0.40). In IHCA, amiodarone was associated with lower survival to hospital discharge (RR 0.88, p < 0.0001), lower 24 h survival (RR 0.93, p < 0.0001), worse neurological recovery (RR 0.83, p < 0.0001), and longer arrest duration (Mean difference (MD) 7.46 min, p = 0.002). Termination of shockable rhythms favored lidocaine only after sensitivity analysis (RR 0.51, p = 0.02). In OHCA, amiodarone did not improve survival to discharge (RR 0.93, p = 0.44), while return of spontaneous circulation favored lidocaine after sensitivity analysis (RR 0.88, p = 0.002). No consistent benefit was observed across outcomes. Bayesian analysis showed overlapping credible intervals and low probabilities of benefit, indicating no clear superiority. Conclusions: No survival difference was observed between amiodarone and lidocaine arrest. Although lidocaine showed more favorable in-hospital outcomes, long-term survival was similar, suggesting agents may be selected based on availability and practice.