Category: Nevin Manimala

Vox Sang. 2025 Mar 17. doi: 10.1111/vox.70018. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) provides cardiopulmonary support to over 4000 neonates and children annually worldwide. Although potentially lifesaving, ECMO carries bleeding and thromboembolic risks, often managed with platelet transfusions to maintain specific thresholds. Platelet transfusions themselves carry many risks. This survey aimed to describe stated prophylactic platelet transfusion practices among paediatric veno-arterial (VA)-ECMO providers and identify factors influencing transfusion decisions.

MATERIALS AND METHODS: This is a cross-sectional electronic survey of paediatric ECMO providers from 10 centres evaluating platelet transfusion thresholds based on six patient scenarios (non-bleeding, minimally bleeding and resolved bleeding in neonates and children). Descriptive statistics were used for analysis.

RESULTS: The survey response rate was 56% (114 of 204). Paediatric intensivists comprised 66% of respondents. The median pre-transfusion platelet count varied across VA-ECMO scenarios, with a threshold of 50 × 10⁹/L (interquartile range [IQR] 45-75) for non-bleeding children and 70 × 10⁹/L (IQR 50-85) for non-bleeding neonates. The threshold for minimally bleeding children, minimally bleeding neonates and resolved bleeding in children was 75 × 10⁹/L (IQR 50-100). The threshold for resolved bleeding in neonates was 80 × 10⁹/L (IQR 50-100). There was significant heterogeneity between and within sites (p < 0.001). Uncertainty about the level of evidence was high (59%), with clinical judgement being the most influential factor in transfusion decisions (85%).

CONCLUSION: Prophylactic platelet transfusion practices in paediatric ECMO vary widely, highlighting uncertainty and the need for clinical trials to improve patient outcomes.

PMID:40097240 | DOI:10.1111/vox.70018

BMJ Open Qual. 2025 Mar 17;14(1):e002908. doi: 10.1136/bmjoq-2024-002908.

ABSTRACT

The ongoing drug toxicity crisis is a growing public health challenge in many countries across the world. Despite the WHO’s recommendation of take-home naloxone (THN) kits as a cost-effective harm reduction strategy to prevent drug toxicity deaths, the Addiction Medicine Consult Team (AMCT) at Burnaby Hospital found that only 51% of their eligible patients were receiving a kit before discharge. In response, the AMCT created a quality improvement (QI) team with the aim of increasing their THN kit distribution rate on two hospital wards from 51% to over 80% within 10 months.Change ideas were implemented with the aim of targeting various components of the THN kit distribution process. Changes included adjusting THN kit inventory on wards, hosting education sessions for nurses, creating just-in-time training using nursing station whiteboards, streamlining the documentation process for nurses and standardising the ordering process for providers. The QI team collaborated with hospital interest holders including senior executives, nursing and pharmacy groups to facilitate change ideas. The project culminated with 4 months of sustained THN kit provision above 80%.The QI team is currently in talks with hospital operations to ensure that an effective documentation system will be integrated into the new electronic medical record system when the hospital transitions away from paper charting in 2025.

PMID:40097234 | DOI:10.1136/bmjoq-2024-002908

BMJ Open. 2025 Mar 17;15(3):e087903. doi: 10.1136/bmjopen-2024-087903.

ABSTRACT

OBJECTIVES: Although both infertility and mental illness are serious public health issues, relatively little is known about the mental health of women seeking fertility help in many lower and middle-income countries. This survey analyses the type of psychological burden that affects women who are unable to access in vitro fertilisation treatment (IVF), the risk factors for depression and anxiety among those seeking IVF treatment in Pakistan, and the existing mental health issues in women who seek help for the treatment of infertility to understand the accessibility and availability of specialist services. The aim of the study was to estimate the prevalence of depression among women seeking fertility treatments in three different settings at the same time.

DESIGN: A cross-sectional survey with convenience sampling.

SETTINGS: Different types of settings: private and public hospitals and traditional clinics in the community.

PRIMARY OUTCOME MEASURE: Screening for depression using HADS (Hospital Anxiety and Depression Scale) and psychiatric interviews of those scoring above the cut-off level on HADS with WHO SCAN (Schedules for Clinical Assessment in Neuropsychiatry).

RESULTS: The study sample consisted of 485 participants. The complete demographic data were available for 477 women. The HADS questionnaire was completed by 466 women, of whom 162 also completed the SCAN interview. Ages ranged from 15 to 60 years, with a mean age of 28.5 years, and 100% were married. According to HADS, 69% of cases of depression and anxiety were diagnosed, whereas 50% of those who were interviewed with SCAN had a diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), varying across settings (63% in government hospital, 42% traditional setting and 36% private hospital, respectively). There was a twofold risk of depression among the participants attending government hospitals (OR=2.4, CI=1.2, 4.7, p=0.03) as compared with women attending traditional clinics, and there was a slightly lower risk among the participants of private hospitals (OR=0.9, CI=0.4, 2.3, p=0.03) than other groups. The main risk factors found were having a traditional previous contact for treatment and attempting time (years). The HADS showed efficient performance with 97% sensitivity and 49% specificity with cut-off score 12. The main risk factors for depression were identified in those who had sought any previous treatment, having very low income and increased time spent attempting, with a clear difference in the risk of depression between those being treated at government hospitals and those following other treatment pathways.

CONCLUSION: In this study of women seeking infertility treatment in Pakistan, there was variation in the proportion meeting diagnostic criteria in different settings (as measured by HADS and WHO SCAN). This variation is likely to be due to the markedly different communities accessing the particular setting as well as the quality of treatment or help provided. It was clear overall that repeated attempts to seek help and length of trying are associated with higher prevalence of depression in this population. It is essential to provide appropriate and affordable fertility treatment in all government hospitals to ameliorate the effects of prolonged treatments and time spent struggling to reach places offering medical fertility care, and to introduce the concept of mental healthcare at fertility clinics within these government hospitals. The high risk of depression among the lower income group shows that providing access to specialist care and assisted reproduction to poor patients is urgently needed.

PMID:40097232 | DOI:10.1136/bmjopen-2024-087903

BMJ Open. 2025 Mar 17;15(3):e082327. doi: 10.1136/bmjopen-2023-082327.

ABSTRACT

OBJECTIVES: This study was conducted to determine the predictors of sexual dysfunction and quality of life (QOL) in patients with type 2 diabetes (T2D). Sexual dysfunction is a long-term consequence of diabetes that is widely ignored in personal management, even though it can have an adverse effect on QOL.

DESIGN: This research was designed as a cross-sectional study.

SETTING: 12 diabetes centres and clinics in Shiraz, south of Iran.

PARTICIPANTS: 390 male patients with T2D mellitus participated in this project. The inclusion criteria were being 30-65 years, having a history of diabetes of at least 1 year, having fasting blood sugar and glycosylated haemoglobin tests and being willing to participate in the study. Patients with medication treatment for mental disorders, a history of heart disease and renal failure were excluded.

PRIMARY OUTCOME MEASURES: QOL and erectile dysfunction (ED). The questionnaires were the Audit of Diabetes-Dependent QOL (ADDQOL) and the International Index of Erectile Function (IIEF-15). Data were reported using descriptive and analytical statistics methods.

RESULT: The participants’ mean age was 48.35±9.27 years. The average weighted impact (AWI) score of ADDQOL for the participants was -3.01, indicating the negative influence of diabetes on their QOL. The mean value of the total score of sexual dysfunction was 42.79±22.75, and the rates of mild, mild to moderate, moderate and severe ED were 19%, 17.7%, 17.2% and 24.6%, respectively. Sexual dysfunction was significantly related to age (OR=1.06; 95% CI: 1.02 to 1.09), diabetes duration (OR=1.04, 95% CI: 1.01 to 1.07), HbA1c (OR=1.45, 95% CI: 1.07 to 1.95), BMI (OR=1.10, 95% CI: 1.03 to 1.16), marital status (married: OR=2.30, 95% CI: 1.40 to 3.77), without diabetes complication (OR=0.17, 95% CI: 0.08 to 0.31) and insulin therapy (OR=2.86, 95% CI: 1.67 to 4.92). ADDQOL was significantly related to age (OR=1.049), HbA1c (OR=2.192), marital status (married: OR=2.089), educational level (high school certificate: OR=0.337, university degree: OR=0.295), diabetes complication (no complication: OR=0.372) and insulin therapy (OR=3.82). AWI was correlated with the total score of IIEF-15 (r=0.78, p value <0.001).

CONCLUSION: To improve the QOL of diabetic patients, it is suggested that all the predictors of sexual dysfunction, such as glycaemic control, obesity, diabetes complications and duration, should be considered in diabetic management guidelines.

PMID:40097231 | DOI:10.1136/bmjopen-2023-082327

Zhongguo Zhen Jiu. 2025 Mar 12;45(3):379-384. doi: 10.13703/j.0255-2930.20240110-0002. Epub 2024 Nov 26.

ABSTRACT

This article analyzes the current status of the researches on acupuncture-moxibustion for idiopathic facial palsy (Bell’s palsy). Acupuncture-moxibustion is widely applied in treatment of Bell’s palsy and the relevant researches are enriched. But the hierarchical discussion on the effectiveness is reported inadequately. Consequently, the necessity and advantages of acupuncture-moxibustion are hardly prominent. Besides, the safety of acupuncture-moxibustion in treatment is not fully explored. The common shortcomings are presented in professional study and statistical designs, and the quality of the evidences is not high. The recommendation strength of acupuncture-moxibustion is weak in international guidelines. The crucial questions are not deeply discussed, and there are lack of the recognized optimal protocol in clinical practical guidelines. It is suggested that the researches should improve the evaluation of the disease itself that may affect the prognosis of Bell’s palsy, such as location, conditions and duration of illness, basic diseases and syndrome/pattern differentiation. The effect of acupuncture-moxibustion should be verified hierarchically, the questions on safety should be emphasized, the quality of study should be improved, the staging of treatment should be specified and the effect of acupuncture-moxibustion should be evaluated in multi-dimensions, and the elements of acupuncture-moxibustion should be optimized systematically in the aspects of timing, acupoint selection, needle devices, manipulation, intervention measures and regimen composition. So as to promote the research of acupuncture-moxibustion for Bell’s palsy to a new process.

PMID:40097224 | DOI:10.13703/j.0255-2930.20240110-0002

Zhongguo Zhen Jiu. 2025 Mar 12;45(3):300-311. doi: 10.13703/j.0255-2930.20240813-k0005. Epub 2024 Dec 18.

ABSTRACT

OBJECTIVE: To observe the effects of thumbtack-needle embedding therapy of auricular acupuncture on gastrointestinal function and intestinal microflora in the patients with gastric cancer after operation, and to explore its mechanism.

METHODS: A total of 80 patients with gastric cancer after radical operation were randomly divided into an observation group (40 cases, 3 cases discontinued) and a control group (40 cases, 3 cases discontinued). The patients of both groups received the perioperative care for accelerating recovery. Additionally, in the observation group, the thumbtack-needle embedding therapy of auricular acupuncture was delivered at the auricular points of unilateral side, including Wei (CO₄), Pi (CO₁₃), Dachang (CO₇), Xiaochang (CO₆), Yuanzhong (AT_2,3,4i), Erzhong (HX₁), Sanjiao (CO₁₇) and Jiaowozhong (TF₃), and the needles were embedded and retained for 72 h. The postoperative recovery time of gastrointestinal function (the postoperative bowel sound recovery time, the first exhaust time, the first defecation time), the postoperative hospital stay and pain visual analogue scale (VAS) score were observed in the two groups. Before operation and on day 5 after operation, the serum gastrin level was detected in the two groups. The third-generation 16S rRNA sequencing technology was used to detect the composition and relative abundance of intestinal flora in the two groups before and after operation.

RESULTS: Compared with the control group, the postoperative bowel sound recovery time, the first exhaust time and the first defecation time were shortened in the observation group (P<0.05). In the observation group, the VAS scores at 24 h, 48 h, and 72 h after surgery were lower than those of the control group, respectively (P<0.05). There was no significant differences in postoperative hospital stay and serum gastrin level between the two groups (P>0.05). The alpha diversity analysis showed that the differences in Shannon index, Simpson index, Pielou_J index and Pd_fath index were not significant statistically after intervention between the two groups (P>0.05). After intervention, the community structure of the fecal sample was similar at each taxonomic level between the two groups, and although the proportion between species was various, the difference was not significant (P>0.05). After intervention, there were 55 species with the differences between the two groups, 17 species of them presented significant difference in relative abundance in the observation group and 38 species in the control group. Regarding the level of genus, the levels of Klebsiell and Enterobacter increased (P<0.05) and the level of Streptococcus decreased (P<0.05) in the observation group. The main microbial groups that played an important role were Coprobacillaceae, Sutterellaceae and Yersiniaceae in the observation group. KEGG function prediction indicated that the function of intestinal microflora was mainly associated with the cofactor and vitamin metabolism, carbohydrate metabolism, and amino acid metabolism.

CONCLUSION: The thumbtack-needle embedding therapy of auricular acupuncture improves the postoperative gastrointestinal function of the patients with gastric cancer probably through regulating the structure and relative abundance of intestinal microflora and affecting the energy metabolism.

PMID:40097211 | DOI:10.13703/j.0255-2930.20240813-k0005

BMJ Open Respir Res. 2025 Mar 17;12(1):e002808. doi: 10.1136/bmjresp-2024-002808.

ABSTRACT

BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) outcomes vary by sex. We investigated whether males and females with asthma or COPD are managed differently in-hospital when admitted for an exacerbation.

METHODS: Data from the National Asthma and COPD Audit Programme were used to determine three cohorts of people hospitalised for an exacerbation: (1) adults with asthma, (2) children and young people (CYP) with asthma, and (3) adults with COPD. Outcomes included the following in-hospital interventional measures: spirometry recording, respiratory specialist review, respiratory medication administration and discharge bundle recording. Linked hospital data were used to determine 30-day and 90-day readmissions and Office for National Statistics data for 90-day mortality. Random effects logistic regression was used to investigate the association between sex and in-hospital outcomes, readmission and mortality.

RESULTS: 16 370 adults with asthma, 7156 CYP with asthma and 28 354 adults with COPD were included. Female adults with asthma had higher odds of being seen by a respiratory specialist (_aOR 0.1.13, 1.02-1.26) and higher odds of readmission within 30 and 90 days (_aOR 1.22, 1.10-1.37, _aOR 1.34, 1.23-1.46) compared with males. Female adults with COPD had higher odds of being seen by a respiratory specialist, (_aOR 1.10,1.02-1.19), being administered non-invasive ventilation (_aOR 1.18, 1.09-1.29), and receiving a discharge bundle (_aOR 1.07, 1.00-1.14), and lower odds of readmission within 90 days (_aOR 0.95, 0.90-1.01), or mortality within 90 days (_aOR 0.88, 0.81-0.96). Lastly, female CYP had higher odds of steroids administered within 1 hour (_aOR 1.13, 1.00-1.28) and higher 30-day and 90-day readmission compared with males (_aOR 1.21, 1.00-1.44 and 1.17, 1.03-1.34).

INTERPRETATION: Sex differences in in-hospital care exist in adults COPD, which may impact readmissions and mortality; however, little to no sex differences in in-hospital care were seen in people with asthma yet females were more likely to be readmitted to hospital.

PMID:40097201 | DOI:10.1136/bmjresp-2024-002808

BMJ Ment Health. 2025 Mar 17;28(1):e301317. doi: 10.1136/bmjment-2024-301317.

ABSTRACT

QUESTION: The Green Brain Capital Model emphasises the bidirectional relationship between brain health and the environment, making it an environmentally focused type of brain capital. This work represents the initial stage of conceptualising the Green Brain Capital Model, which is essential to avoid ambiguity and misinterpretation while developing a quantitative model. Ecological intelligence (EI) is identified as a key component of the model in the literature. Therefore, the objective of this review was to systematically review the literature to define EI, its features and quantitative assessment tools, to develop comprehensive metrics for Green Brain Capital.

STUDY SELECTION AND ANALYSIS: We conducted a search in Scopus, ScienceDirect and Scopus secondary literature and identified 11 articles that provide definitions of EI and quantitative tools to assess it.

FINDINGS: The study revealed that EI is a multifaceted concept with cognitive, affective and behavioural domains. Seven quantitative tools for measuring EI were identified, with the Ecological Intelligence Measurement Tool by Okur-Berberoglu and the Ecological Intelligence Scale by Akkuzu, demonstrating strong theoretical grounding, reliability and validity. Additionally, our review included searching open-access databases provided by reputable organisations, but no indicators for the assessment of EI were found in these databases.

CONCLUSIONS: All the available tools were designed to assess EI at the individual level and for research purposes within certain cultural contexts. There is a lack of global indicators reflecting countries’ EI development status and global positioning. Establishing country-level indicators across EI domains is essential for policymaking and public awareness.

PMID:40097196 | DOI:10.1136/bmjment-2024-301317

Am J Perinatol. 2025 Mar 17. doi: 10.1055/a-2559-7261. Online ahead of print.

ABSTRACT

This study examined associations between prenatal care utilization and adverse obstetric outcomes including severe maternal morbidity (SMM), preterm birth, and stillbirth in a large, commercially insured U.S. patient population. This is a retrospective cohort study using an insurance claims database evaluating associations between prenatal care utilization and obstetric outcomes over four years (2017 – 2020). Prenatal care utilization was characterized based on the Adequacy of Prenatal Care Utilization (APNCU) index. The primary outcome was SMM (as per Centers for Disease Control). Secondary outcomes included preterm birth < 37 weeks and stillbirth. Associations between exposure and outcome were investigated using logistic regression models in designated “low” and “medium” maternal risk groups, defined based on obstetric co-morbidity index (OB-CMI) scores modeled at the time of the first trimester and at delivery. 297,453 patients were included: 78,100 in the sub-group who remained low-risk throughout pregnancy and 49,920 in the sub-group who remained medium-risk. The largest number of patients overall (29.9%) received “adequate plus” care, as defined by the APNCU index, while a plurality of low- and medium-risk patients received “intermediate” care (35.6% and 29.9%, respectively). 1.77% of patients experienced SMM, 8.63% delivered preterm, and 0.88% had stillbirth. Adjusted analysis comparing volume of prenatal care with these outcomes demonstrated no statistically significant associations, with the exception of preterm birth, which was positively associated with “adequate” and “adequate plus” care in low- and medium-risk patients. “Inadequate care” was not associated with any of the studied outcomes. Overall volume of prenatal care was not associated with a reduction in adverse obstetric outcomes. Clinical quality improvement and health policy efforts to improve prenatal care delivery models may need to bypass adherence to established guidelines in terms of gross visit number as a key metric and instead work to revise practices based on more meaningful clinical outcomes.

PMID:40097170 | DOI:10.1055/a-2559-7261

Br J Sports Med. 2025 Mar 17:bjsports-2024-108808. doi: 10.1136/bjsports-2024-108808. Online ahead of print.

ABSTRACT

OBJECTIVE: To prospectively examine the prevalence of diagnosed eating disorders (ED-diagnosis), ED-symptoms and factors predicting ED-symptoms in three male and female high school student groups: elite athletes, trained athletes and a non-athlete reference group at baseline (T1) and 1-year follow-up (T2).

METHODS: A survey was administered at baseline (T1) (n=1186) and 1-year follow-up (T2) (n=1144) (step-one). Participants classified with ED-symptoms by the Eating Disorder Examination Questionnaire (EDEQ 6.0) at T2 were invited to a diagnostic interview (step-two).

RESULTS: Prevalence of ED-diagnosis for males and females were 6.9% and 9.3% in elite athletes, 5.9% and 11.2% in trained athletes and 3.0% and 11.9% in references, respectively. No group differences were statistically significant. Male references had more ED-symptoms compared with elite and trained male athletes (EDEQ-global score 0.81 vs <0.55), while elite female athletes had fewer ED-symptoms compared with trained female athletes and female references (EDEQ-global score 1.14 vs >1.59). Trained female athletes increased ED-symptoms over time, whereas elite female athletes consistently had fewer ED-symptoms in comparison. High ED-symptom presentation was predicted by high body mass index and more psychological distress in males, whereas for females, ED-symptoms were predicted by lower resilience, more psychological distress and being a non-athlete reference.

CONCLUSION: No statistically significant group differences in the prevalence of ED-diagnosis were observed between elite athletes, trained athletes and a non-athlete reference group. Female elite athletes had fewer ED-symptoms compared with other female groups, and male references had more ED-symptoms compared with male athlete groups. Preventive measures that address psychological resilience and distress should be considered.

TRIAL REGISTRATION NUMBER: NCT04003675.

PMID:40097165 | DOI:10.1136/bjsports-2024-108808