Category: Nevin Manimala

Physiother Theory Pract. 2025 Feb 28:1-12. doi: 10.1080/09593985.2025.2471409. Online ahead of print.

ABSTRACT

INTRODUCTION: Qualitative research methods in healthcare delve into the nuanced complexities of health professions work, seeking to comprehend the contextual and interpretive dimensions of patient, caregiver, and provider perspectives and experiences. Qualitative research is an essential contribution to evidence-based and evidence-informed practice, and therefore foundational for practice across all health professions.

PURPOSE: This study aimed to examine the breadth and depth of curricular content, delivery models, instructional strategies, and resources related to qualitative research methods in Doctor of Physical Therapy (DPT) programs in the United States.

METHODS: In this cross-sectional design, an online survey was developed, piloted, and emailed to 256 Commission for the Accreditation of Physical Therapy Education accredited DPT programs. Descriptive statistics, independent samples t-tests, one-way ANOVA, and chi-square statistics were completed.

RESULTS: The overall response rate was 31.6%. Respondents reported a mean of 5 instructional hours of qualitative research content, ranging from 0 to 12 hours. Analysis revealed a significant difference in contact hours (p = .026) between faculty reporting no expertise (2.7 hours) and high expertise (7.5 hours). Qualitative research content was primarily located early in the curriculum (76%) and in a stand-alone course (70%), with wide variability in intended learning outcomes, activities, and resources.

CONCLUSION: Given the critical importance that clinicians understand and apply qualitative and quantitative findings as part of evidence informed practice, this study highlights the need for building resources and faculty capacity to integrate qualitative methods of education in DPT curricula. Findings may inform the development of curriculum models, guidelines, and DPT learner competencies.

PMID:40018838 | DOI:10.1080/09593985.2025.2471409

Med Phys. 2025 Feb 28. doi: 10.1002/mp.17718. Online ahead of print.

ABSTRACT

BACKGROUND: Endometrial cancer (EC) is one of the most common gynecological malignancies and the second most common gynecological malignancy cause of death in women. Heterogeneous tissues with different grades of complexity and different diffusion properties characterize the EC. Several diffusion magnetic resonance imaging (DMRI) protocols have been used to perform a non-invasive and global evaluation of EC for diagnostic and prognostic purposes. However, the association of a single value for the diffusion coefficient to an EC tissue could be a severe limit for developing a DMRI virtual histology protocol.

PURPOSE: This study evaluates the potential of diffusion kurtosis imaging (DKI) and tissue multiple diffusion clusterization in detecting the specific features of healthy/cancer tissue that can be useful in EC diagnosis and prognosis.

METHODS: Thirty-eight subjects were analyzed: 18 with a final diagnosis of EC and 20 healthy, asymptomatic, with no history of endometrial pathology and uterine tumor pathology. Diffusion-weighted Spin-Echo Echo-Planar Imaging (DW-EPI) with TR/TE = 2000 ms/77 ms was used at 3T using six different b-values: (500, 800, 1000, 1500, 2000, and 2500)s/mm2 along three gradient directions (x, y, z). The decay of the signal in each voxel was used to obtain clusters of different diffusion compartments reflecting tissue heterogeneity. Moreover, using the Kurtosis representation, the parametric maps of the apparent kurtosis (K) and diffusivity (D) coefficients were obtained. The statistical analysis of the differences in the mean value of the parameters obtained in the selected regions of interest (ROIs) in tumor area (T) peritumor area (PT) and healthy tissue was carried out using a Kruskal-Wallis Test. A p-value < 0.05 indicated a statistically significant difference. To validate DKI and multiple diffusion clusterization in the detection of EC and healthy tissue, DMRI results were compared with EC histology. A ROC curve analysis was performed to evaluate the performance of the clustering feature in differentiating healthy and tumoral tissues.

RESULTS: K discriminates the peritumor area (PT) of the tumor from the healthy tissues (p < 0.05) and the area inside the EC (cancerous tissue, p < 0.05). This result is validated and explained by the diffusion clustering, which shows a great variability in K for pathological compared to healthy subjects. Moreover, the standard deviation of K in the cluster defined by the highest K/D ratio differentiates T and H ROIs.

CONCLUSIONS: K as well as diffusion clusterization are sensitive to the different microstructural organizations in EC and healthy tissue, promoting themself as a potential tool for the diagnosis and prognosis of EC.

PMID:40018821 | DOI:10.1002/mp.17718

Foot Ankle Spec. 2025 Feb 28:19386400251318965. doi: 10.1177/19386400251318965. Online ahead of print.

ABSTRACT

BACKGROUND: Syndesmotic ankle fractures occur when damage to the syndesmosis complex is combined with a malleolar fracture. This can result in severe pain, weakness, and instability. Surgical interventions include syndesmotic screw fixation (SS), suture button fixation (SB), and tibiotalocalcaneal nail (TTC). This meta-analysis aims to compare the outcomes of these treatment methods for syndesmotic ankle fractures.

METHODS: A literature search was conducted on PubMed and Embase for comparison studies that included at least 2 surgical interventions and at least one of the relevant functional outcomes and/or complication metrics until June 2024. The Olerud-Molander Ankle Score (OMAS) was used to compare functional outcomes, and it is a self-reported outcome measure that evaluates the symptoms and function of those with ankle fractures, while infections and reoperations were reported to compare complication outcomes. Statistical analyses were performed using Review Manager 5.4. A P-value ≤ .05 was considered statistically significant. The risk of bias was assessed with Review Manager 5.4. and the Newcastle-Ottawa scale.

RESULTS: A total of 18 studies with a total of 1,040 patients were ultimately included in this study. The SS had a significantly higher OMAS 2-year follow-up compared to TTC. The TTC had a significantly lower infection rate compared to SS. The SB had a significantly higher OMAS at both 1-year and 2-year follow-ups than SS. The SB had a significantly lower reoperation rate compared to SS. The SB had a significantly higher OMAS at both 1-year and 2-year follow-ups than TTC. The SB had a significantly lower infection rate compared to TTC.

CONCLUSION: The SB emerges as the preferred treatment method for syndesmotic ankle fractures, while TTC stands as a viable alternative. The SB is recommended as the primary surgical intervention for patients with syndesmotic ankle fractures due to its superior clinical benefits when compared to TTC and SS.

LEVELS OF EVIDENCE: 3.

PMID:40018814 | DOI:10.1177/19386400251318965

Cancer Med. 2025 Mar;14(5):e70722. doi: 10.1002/cam4.70722.

ABSTRACT

BACKGROUND/PURPOSE OF THE STUDY: The treatment landscape for very early to intermediate stage hepatocellular carcinoma (HCC) is rapidly evolving, with new data and treatments emerging in recent years. There is a lack of data on current patterns of management for very early to intermediate stage HCC in Australian clinical practice and the role of newly emerging treatment options.

METHODS: Multidisciplinary specialists involved in HCC management (N = 86) participated in one of six state-based meetings across Australia. Specialists were surveyed on their preferred management approaches at key clinical decision points for four patient case studies ranging from very early to intermediate stage HCC.

RESULTS: Preferred management strategies for each of the patient case studies were largely consistent with current Australian HCC recommendations in relation to surveillance, diagnosis, and treatment of HCC although the preferred initial treatment selection varied considerably within and between hepatologists and other craft groups. There was, however, growing interest in emerging treatments, including stereotactic ablative body radiotherapy (SABR) for early stage HCC and systemic treatments used as adjuvant therapy or in combination with locoregional therapy in early and intermediate-stage HCC. However, many participants required more data on these treatment modalities before incorporating them into routine clinical practice.

CONCLUSION: The heterogeneity of (very) early to intermediate-stage HCC patients and the increasing number of available treatment options means clinical decision-making, including treatment selection, is becoming more complex and diverse. More data are required to define the role of SABR and systemic therapies in very early to intermediate stage HCC before being adopted as standard of care in Australia.

PMID:40018806 | DOI:10.1002/cam4.70722

Cancer Med. 2025 Mar;14(5):e70660. doi: 10.1002/cam4.70660.

ABSTRACT

BACKGROUND: The cancer journey from diagnosis through survivorship is complex and involves care from many healthcare providers across a variety of settings. Navigating the transitions between care providers and settings can be improved through interventions. The objective of this study was to map and characterize evidence on interventions to improve transitions in care among patients with cancer.

METHOD: Six databases were searched to identify relevant studies that described or evaluated interventions to support transitions in care for patients with cancer. Data on the interventions, the type of transition in care, type of cancer, and outcomes (including measure of effectiveness) were abstracted. Data were synthesized and analyzed using descriptive statistics.

RESULT: Of the 38,876 data sources identified, 150 were included. Most included studies were from the United States and were observational studies exploring interventions to facilitate the transition from treatment to survivorship (followed by interventions for the transition from hospital to home) among patients with breast cancer (followed by gastrointestinal cancers, lung cancers, and hematologic cancers). Interventions that were found to be effective were most commonly those that facilitated the transition from diagnosis to treatment and for the transition from hospital to home.

CONCLUSION: This comprehensive synthesis is an important resource for those trying to improve transitions in care for patients living with and beyond cancer. Despite the large body of evidence identified, gaps remain; there is a paucity of studies exploring transitions in care during cancer treatment and among some cancers (e.g., brain tumors, head and neck, pancreatic).

PMID:40018786 | DOI:10.1002/cam4.70660

Clin Exp Rheumatol. 2025 Feb;43(2):290-299. doi: 10.55563/clinexprheumatol/kcdmct. Epub 2025 Feb 26.

ABSTRACT

OBJECTIVES: To evaluate causes of death in the single-centre Polish cohort of patients with idiopathic inflammatory myopathies (IIM) and to identify risk factors associated with fatal outcomes.

METHODS: Electronic medical database was retrospectively analysed, data on the clinical symptoms, serological profiles, administered treatment and outcomes in IIM patients were collected. Two subgroups were distinguished – the deceased and the survived group. Statistical analysis was performed to identify differences between the subgroups and risk factors contributing to fatal outcomes.

RESULTS: 79 patients with IIM were identified, most frequently with antisynthetase syndrome, dermatomyositis and polymyositis. Among them 9 patients (11.39%) deceased. The mean age at the time of diagnosis was 57.10 ± 14,59years old. Median diagnostic delay reached 5 months. The majority of the deaths (77.78%) occurred within the first 18 months after IIM diagnosis. As compared to the survivors, patients with fatal outcomes were more frequently affected by cardiac involvement (p=0.026), suffered from concomitant autoimmune disorders (p=0.028) were treated with mycophenolate mofetil (p=0.005) and cyclophosphamide (p=0.006). 89.89% of all deaths in our cohort were caused by various infections, predominantly of the respiratory tract. Although 10.13% of the patients had a history of malignancy, none of the deaths was caused by malignancy.

CONCLUSIONS: Patients with IIM associated with cardiac involvement and concomitant autoimmune diseases may be at higher risk of fatal outcomes. Infections were the predominant cause of death in our cohort of patients. The majority of fatal outcomes occurred at the relatively early stage of the disease.

PMID:40018745 | DOI:10.55563/clinexprheumatol/kcdmct

J Indian Soc Periodontol. 2024 Jul-Aug;28(4):449-455. doi: 10.4103/jisp.jisp_275_23. Epub 2025 Jan 6.

ABSTRACT

BACKGROUND: Mandibular canal visibility (MCV) is important to determine the relative position of the mandibular canal (MC) before any invasive surgery. It depends on the cortication ratio (CR) of the canal’s superior border. This study aimed to evaluate the MCV and CR in patients with mandibular cortical index 1 (MCI1).

MATERIALS AND METHODS: In this retrospective study, 132 mandibular cone-beam computed tomography images of patients with MCI1 were evaluated. 6-point rating MCV score and CR were determined for cross-sections of the MC in the following areas: incisive canal (INC), mental foramen and canal (MF), first premolar to the third molar (1PM, 2PM, 1M, 2M, and 3M), and the corresponding edentulous areas (E1PM-E3M). 1PM was overlapped with MF in most cases. An MCV score1 (excellent visibility) and 2PM area were considered reference levels.

RESULTS: Sex and age did not significantly affect the MCV score or CR (P > 0.05). 98.6% of the INC and 92.31%-100% of the MC were visible. The mean ± SD of the CR in the INC and MC was 0.86 (0.23) and 0.77 (0.29), respectively. The estimated difference in the mean CR was statistically significant only between the INC area and dentulous areas (P < 0.001).

CONCLUSION: Despite the higher presence probability of score 2 in the 1M relative to 2PM, there was no significant decrease in the visible cases and CR of this area. Invisible cases were significantly lower in the INC, MF, and 3M areas.

PMID:40018724 | PMC:PMC11864344 | DOI:10.4103/jisp.jisp_275_23

J Indian Soc Periodontol. 2024 Jul-Aug;28(4):431-435. doi: 10.4103/jisp.jisp_6_24. Epub 2025 Jan 6.

ABSTRACT

BACKGROUND AND OBJECTIVES: Various guided tissue regenerative procedures have been used in treatment of furcation defects. A combination of various graft materials and barrier membranes have been used over a period of time. The present study was designed to test whether autologous platelet-rich fibrin (PRF) can be effectively used as a barrier membrane along with porous hydroxyapatite (HA) bone graft in the treatment of Grade II furcation defects.

MATERIALS AND METHODS: The present study was a split-mouth design, in which a total of thirty patients with bilateral grade II furcation defects in the mandibular molars were selected. On the control side, the furcation defect was treated using only HA bone graft and in the test side, the furcation defect was treated using a combination of HA bone graft and PRF as barrier membrane. The clinical and radiological parameters were recorded presurgically, postsurgical at 3 and 6 months, respectively, and the results were statistically analyzed and compared.

RESULTS: The furcation defects treated in the test side showed better healing and bone fill when compared to control side. The clinical parameters of the test and control sides when compared were found to be statistically significant.

CONCLUSION: PRF can be effectively used as barrier membrane along with a graft material thus enhancing the regenerative potential of the graft material while regenerating the lost periodontal tissue in Grade II furcation defects.

PMID:40018720 | PMC:PMC11864329 | DOI:10.4103/jisp.jisp_6_24

J Indian Soc Periodontol. 2024 Jul-Aug;28(4):461-467. doi: 10.4103/jisp.jisp_399_23. Epub 2025 Jan 6.

ABSTRACT

BACKGROUND: Good oral hygiene is a critical component of overall oral health. Various methods have developed over time to assess oral hygiene status. In 1960, Greene and Vermillion introduced the Oral Hygiene Index (OHI), which assessed debris and calculus on 12 tooth surfaces. In 1964, they proposed a Simplified Oral Hygiene Index (OHI-S), which evaluated only 6 surfaces of six index teeth. The authors recommended the OHI-S due to its faster clinical assessments but concluded that it was less sensitive than the OHI despite both indices being sufficiently sensitive. In 1987, Garg S introduced the Modified Oral Hygiene Index (OHI-M), which provides a more comprehensive evaluation by assessing debris and calculus on the facial (buccal/labial), oral (palatal/lingual), and specifically occlusal surfaces of each fully erupted permanent tooth. The OHI-M is a reliable and sensitive method for accurately evaluating oral hygiene status.

AIM: This study aims to comparatively evaluate oral hygiene status using OHI, OHI-S, and OHI-M and revalidate the OHI-M.

MATERIALS AND METHODS: 221 patients (119 males and 102 females) were randomly selected through simple random sampling. A single investigator performed the scoring. The sample size was determined based on a 95% confidence level. The collected data were analyzed using IBM SPSS Statistics, and Pearson’s correlation test was employed to assess the correlations.

RESULTS: The mean and standard deviation of the OHI-M were found to be the lowest (2.55 ± 0.82) compared to the OHI (7.13 ± 1.79) and OHI-S (3.23 ± 0.99). It indicates that the variation in OHI-M values is smaller than that in OHI and OHI-S. Positive correlations were observed among the three indices, with a statistically significant result (P < 0.001).

CONCLUSION: The OHI-M is found to be the most sensitive scoring method for evaluating oral hygiene status compared to the OHI and OHI-S. These results further confirm the validity of OHI-M.

PMID:40018718 | PMC:PMC11864336 | DOI:10.4103/jisp.jisp_399_23

J Indian Soc Periodontol. 2024 Jul-Aug;28(4):436-442. doi: 10.4103/jisp.jisp_112_23. Epub 2025 Jan 6.

ABSTRACT

BACKGROUND: Partial extraction technique is a method of immediate implant placement, wherein the segment of root is retained in the socket to establish a continuous blood supply and prevent resorption of buccal bundle bone. This study was designed to compare and evaluate implant stability and esthetics by partial extraction therapy (PET) and immediate implant placement in the maxillary anterior region.

MATERIALS AND METHODS: A total of 10 sites were included in the study and divided into two groups; the test group (PET) and the control group (immediate implant). The primary parameters assessed were implant stability, evaluated immediately, 3^rd month and at 6^th month; pink esthetic (PE) score, evaluated immediately, 3^rd month and at 6^th month; and cone-beam computed tomography for evaluating ridge width postoperatively and at the end of 6 months. The secondary parameters such as the Visual Analog Scale were assessed at the end of 24 h of surgical procedure; the sulcular bleeding index was evaluated at the 3^rd month and 6^th month; peri-implant probing depth was evaluated at the end of the 3^rd month and 6^th month.

RESULTS: At the end of the 6^th month, the test group (PET) showed improvement in implant stability, PEs, and ridge width than the control group (immediate implant placement). However, the difference was not statistically significant.

CONCLUSION: Implant placement by PET, serves as a dependable technique for preserving and maintaining alveolar bone and PEs as the retained root fragment within the socket prevents buccal bundle bone from resorption.

PMID:40018712 | PMC:PMC11864327 | DOI:10.4103/jisp.jisp_112_23