Category: Nevin Manimala

BMC Health Serv Res. 2025 Feb 18;25(1):274. doi: 10.1186/s12913-025-12426-0.

ABSTRACT

BACKGROUND: Nurses have a crucial role in recognizing potential dangers to patient safety during direct patient care. However, there are occasions when they opt to stay quiet instead of voicing their concerns, ultimately endangering patients. The underlying reasons for this silence pose a significant challenge in the nursing industry. While it’s known that workplace conditions contribute to this silence, the specific ways in which this occurs need to be clarified. This research aimed to investigate the factors that lead nurses to remain silent about patient safety, specifically focusing on environmental influences in Ardabil City.

METHODS: This descriptive and analytical study examined 630 nurses, including head nurses, from five medical training centers in Ardabil, northwest Iran. The primary instruments used in the research included the Employee Silence about Patient Safety Questionnaire, the Practice Environment Scale of the Nursing Work Index (PES-NWI), measures of psychological safety, leader-member exchange (LMX) assessments, and evaluations of professional discrimination. Data analysis was performed using SPSS version 16.0, applying descriptive statistics, t-tests, ANOVA, Pearson’s correlation coefficient, and hierarchical regression analysis.

RESULTS: The average score for employee silence regarding patient safety was 2.62, with a standard deviation of 0.98. Several factors were found to be significant predictors of employees’ silence about patient safety, including nurse participation in hospital affairs (ß = 0.196, p = 0.002), nurse’s role in the quality of care (ß = -0.352, p < 0.001), staff and facility adequacy (ß = 0.156, p = 0.001), communication with the physician (ß = -0.105, p = 0.015), LMX (ß = -0.284, p < 0.001), and job position (ß = -0.093, p = 0.018).

CONCLUSION: This study has identified several critical factors influencing employee silence regarding patient safety, including nurse involvement in hospital decision-making, the quality of care, communication with physicians, and job positions. To address these challenges, healthcare organizations must implement standardized protocols, improved communication channels, regular safety training, and the integration of advanced technologies. Increasing nurse participation in decision-making processes and strengthening communication between nursing staff and physicians can foster a culture of openness that encourages employees to voice their safety concerns. By creating an environment where staff feel supported and empowered to speak up, healthcare facilities can enhance patient safety and improve overall care quality, ultimately leading to a safer working environment for healthcare professionals.

PMID:39966779 | DOI:10.1186/s12913-025-12426-0

BMC Pregnancy Childbirth. 2025 Feb 18;25(1):182. doi: 10.1186/s12884-025-07313-9.

ABSTRACT

BACKGROUND: Despite the known benefits of skin-to-skin contact (SSC), limited data exists on its implementation, especially its influencing factors. The current study was designed to use machine learning (ML) to identify the predictors of SSC.

METHODS: This study implemented predictive SSC approaches based on the data obtained from the “Iranian Maternal and Neonatal Network (IMaN Net)” from January 2020 to January 2022. A predictive model was built using nine statistical learning models (linear regression, logistic regression, decision tree classification, random forest classification, deep learning feedforward, extreme gradient boost model, light gradient boost model, support vector machine, and permutation feature classification with k-nearest neighbors). Demographic, obstetric, and maternal and neonatal clinical factors were considered as potential predicting factors and were extracted from the patient’s medical records. The area under the receiver operating characteristic curve (AUROC), accuracy, precision, recall, and F_1 Score were measured to evaluate the diagnostic performance.

RESULTS: Of 8031 eligible mothers, 3759 (46.8%) experienced SSC. The algorithms created by deep learning (AUROC: 0.81, accuracy: 0.75, precision: 0.67, recall: 0.77, and F_1 Score: 0.73) and linear regression (AUROC: 0.80, accuracy: 0.75, precision: 0.66, recall: 0.75, and F_1 Score: 0.71) had the highest performance in predicting SSC. Doula support, neonatal weight, gestational age, attending childbirth classes, and maternal age were the critical predictors for SSC based on the top two algorithms with superior performance.

CONCLUSIONS: Although this study found that the ML model performed well in predicting SSC, more research is needed to make a better conclusion about its performance.

PMID:39966775 | DOI:10.1186/s12884-025-07313-9

BMC Oral Health. 2025 Feb 18;25(1):255. doi: 10.1186/s12903-025-05660-9.

ABSTRACT

OBJECTIVE: To evaluate the impact of preoperative oral ibuprofen premedication as a preemptive analgesia protocol on postoperative pain following the insertion of a single miniscrew insert.

METHODS: A randomized, single-blind, placebo-controlled parallel-group trial design was adopted. A total of 68 patients seeking miniscrew insert placement were recruited based on inclusion and exclusion criteria. Patients were randomly assigned in a 1:1 ratio to either the ibuprofen group or the control group, with 34 patients in each group. The ibuprofen group and the control group received 300 mg of ibuprofen sustained-release capsules and a placebo, respectively, 30 min before surgery. Postoperative analgesics were administered as needed. Pain scores at 2, 4, 6, 8, 12, and 24 h postoperatively were recorded using the Numerical Rating Scale (NRS), and the postoperative analgesic consumption was documented.

RESULTS: A total of 68 patients (34 in the control group and 34 in the preemptive analgesia group) completed the trial. No adverse events such as nausea or vomiting occurred in any of the patients. The preemptive analgesia group exhibited significantly lower pain scores at 2, 4, 6, and 8 h postoperatively [2 (0,3), 0 (0,2), 0 (0,0), 0 (0,0.25), respectively] compared to the control group [3 (2,5), 3 (2,4), 2 (0.75,4), 1 (0,3), respectively] (P = 0.0396, P = 0.0067, P = 0.0111, P = 0.0299). The proportions of patients requiring additional analgesics within 2-24 h postoperatively were 17.6% (6/34) in the preemptive analgesia group and 64.7% (22/34) in the control group, with a statistically significant difference between the two groups (P = 0.013).

CONCLUSION: Preemptive analgesia with ibuprofen can effectively reduce postoperative pain following miniscrew insert placement and represents a safe and effective perioperative pain management strategy.

TRIAL REGISTRATION: The UK’s Clinical Study Registry; ISRCTN68332234 (Retrospectively registered); 20/12/2024.

PMID:39966769 | DOI:10.1186/s12903-025-05660-9

BMC Public Health. 2025 Feb 18;25(1):670. doi: 10.1186/s12889-025-21766-9.

ABSTRACT

BACKGROUND: The effect of pre-pregnancy intrauterine device (IUD) use on subsequent preterm birth (PTB) remains unclear. We aim to investigate the association between IUD use before pregnancy and subsequent PTB.

METHODS: A total of 240,437 women who participated in the National Free Preconception Health Examination Project (NFPHEP) in Yunnan from 2013 to 2019 were included in the study. All study participants were classified into three groups according to their use of pre-pregnancy contraceptive methods: non-method users, IUD users, and other method users. We used a multivariable Poisson regression model to investigate the association between the use of an IUD before pregnancy and subsequent PTB. Further models analyzed the multiplicative and additive interactions between pre-pregnancy IUD use and county deprivation.

RESULTS: Of all the participants, 45,374 (18.9%) used IUDs before pregnancy, 39,414 (16.4%) used other contraceptive methods, and 155,649 (64.7%) were non-method users. The overall PTB rate was 5.30% (95% confidence interval [95% CI], 5.20-5.38%), and women in the IUD group had a significantly lower PTB rate (4.86%, 95% CI 4.66-5.06%) than women in the non-method (5.42%, 95% CI 5.31-5.53%) and other method groups (5.33%, 95% CI 5.11-5.56%). IUD use before pregnancy was associated with a reduced risk of subsequent PTB (model 1: adjusted relative risk [aRR] 0.84, 95% CI 0.80 to 0.89; model 2: aRR 0.84, 95% CI 0.79 to 0.90). In counties with a normal level of development, IUD users had a 30% lower risk of subsequent PTB than non-users (aRR 0.70, 95% CI 0.63 to 0.78). Compared with non-IUD users (incuding non-method and other method users) from the least developed counties, those from counties with a normal level of socioeconomic development had the lowest risk of subsequent PTB (aRR 0.71, 0.62 to 0.82). The additive interaction between pre-pregnancy IUD use and low level of county development was statistically significant (relative excess risk due to interaction [RERI] -0.27, -0.41 to -0.14).

CONCLUSION: Pre-pregnancy IUD use is associated with a reduced risk of subsequent PTB. Pre-pregnancy IUD users in counties with a normal level of development were associated with a lower risk of subsequent PTB than their counterparts in the least developed countries.

PMID:39966761 | DOI:10.1186/s12889-025-21766-9

Clin Nutr. 2025 Feb 3;46:191-203. doi: 10.1016/j.clnu.2025.01.034. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence linking circulating fatty acids (FAs) to mortality from age-related chronic diseases was limited and inconsistent. We aimed to investigate the associations of plasma FAs with total, cardiovascular disease (CVD), and cancer mortality and explore the potential mechanism.

METHODS: 117,871 individuals were prospectively followed in the UK Biobank. Circulating FAs were measured by a high-throughput NMR-based metabolic platform. Causes and dates of death were collected from death certificates according to the code of International Statistical Classification of Diseases (ICD-10).

RESULTS: Over a median follow-up of 11.9 years, 7805 (6.6 %) deaths occurred. Plasma saturated FAs (SFAs) were positively associated with total mortality risk while plasma polyunsaturated FAs (PUFAs) exhibited an inverse association. For cause-specific mortality, circulating PUFAs, linoleic acid (LA), and n-3 PUFAs were associated with 34 %, 30 %, and 37 % lower risk of CVD mortality, respectively. Moreover, plasma n-3 PUFAs were related to a 24 % lower risk of cancer mortality. However, circulating non-LA n-6 PUFAs were associated with 11 % and 22 % higher risk of total and cancer mortality, respectively. Serum levels of C-reactive protein (CRP) and apolipoprotein A (ApoA) had significant mediation effects on these associations. Additionally, the inverse association of plasma n-6 PUFAs with total mortality only existed among carriers of the GG genotype at rs16966952 and the inverse association of plasma PUFAs with CVD mortality was only observed among TT genotype carriers at rs174547.

CONCLUSIONS: Circulating PUFAs, particularly n-3 PUFAs and LA, were inversely related to premature death from chronic diseases and longevity. Inflammatory and lipid metabolism partially explained these associations. Genetic interactions with rs16966952 and rs174547 further modified these associations.

PMID:39965263 | DOI:10.1016/j.clnu.2025.01.034

Aging Dis. 2025 Feb 11. doi: 10.14336/AD.2024.1166. Online ahead of print.

ABSTRACT

The association between socioeconomic position (SEP) and non-communicable diseases (NCDs) is well established, but its role in driving multimorbidity remains unclear. Multimorbidity, defined as the co-occurrence of more than one chronic condition, is linked to higher mortality and reduced quality of life. This study investigates the association between SEP and multimorbidity using data from the European Prospective Investigation into Cancer and Nutrition (EPIC). Incident cases of cancer, type 2 diabetes (T2D), and cardiovascular diseases (CVDs) were analysed alongside lifestyle factors such as smoking status, alcohol intake, body mass index (BMI), physical activity and diet. Multimorbidity was defined as the presence of at least two of the studied NCDs. SEP was assessed using the Relative Index of Inequality (RII) and categorized into high, medium, and low SEP. The cohort included 277 302 participants (60.7% women) from seven countries, enrolled between 1992-2000 and followed until the first diagnosis, end of follow-up (31/12/2007), or death. For transitions to multimorbidity, follow-up extended from the first diagnosis to the second diagnosis, end of follow-up, or death. Multistate models were used to examine the nine possible transitions to first diagnoses and multimorbidity combinations. Lifestyle factors were risk factors for all the transitions, except alcohol intake. In the main model, not stratified by sex, low SEP was associated with higher risks of progressing from cancer to CVD (Hazard Ratio (HR): 1.23, CI: 1.02-1.50), CVD to T2D (HR: 1.35, CI: 1.07-1.71), and cancer to T2D (HR: 1.37, CI: 1.10-1.69). These findings highlight the persistent influence of social inequalities on the risk of multimorbidity, even in individuals with an existing chronic condition.

PMID:39965252 | DOI:10.14336/AD.2024.1166

Otol Neurotol. 2025 Jan 22. doi: 10.1097/MAO.0000000000004415. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify the incidence of positive autoimmune laboratory markers in idiopathic sudden sensorineural hearing loss (iSSNHL) and its impact on hearing prognosis.

STUDY DESIGN: Retrospective cohort database study.

SETTING: A collaborative national database (TriNetX) sourced from 79 large healthcare organizations in the United States.

PATIENTS: Adults (≥18 years old) diagnosed with iSSNHL (ICD-10 H91.2) treated with systemic steroids.

INTERVENTIONS: Autoimmune laboratory markers and salvage intratympanic (IT) steroids for SSNHL (CPT 69801).

MAIN OUTCOME MEASURES: 1) Positivity of autoimmune laboratory markers-rheumatoid factor (RF), ANCA, DNA double strand antibody (Ab), Sjogren syndrome A and B Abs, SCL-70 Ab, cardiolipin IgG Ab, Jo-1 Ab, ANA, mitochondria Ab. 2) Percent of patients that underwent salvage IT steroids, cochlear implantation, or hearing aid evaluation-all utilized as a proxy for hearing outcomes.

RESULTS: Subjects with iSSNHL who had autoimmune testing (n = 17,413) were marginally more likely to be positive for at least one autoimmune laboratory marker compared to subjects without iSSNHL (n = 17,413; 23.0% vs. 21.4%, p = 0.0006). Statistical significance was lost after removing nonspecific autoimmune markers, however. Of those with iSSNHL who received systemic steroid treatment, subjects with positive autoimmune markers (n = 5,153) versus negative autoimmune markers (n = 5,153) underwent similar rates of salvage IT steroids (7.1% vs. 7.8%, p = 0.154), hearing aid evaluation (2.76% vs 2.47%, p = 0.354), and cochlear implantation (1.65% vs. 1.69%, p = 0.878).

CONCLUSIONS: Patients with iSSNHL have a marginally higher incidence of nonspecific positive autoimmune laboratory markers compared to those without iSSNHL; however, the presence of these markers does not predict treatment response or prognosis. Specifically, autoimmune markers did not predict the need for salvage IT steroids, nor CI and hearing aid use in iSSNHL. Autoimmune laboratory testing may be useful in iSSNHL patients with additional symptoms suspicious for an autoimmune disorder; however, a generalized screening is not recommended as it is unlikely to alter management or prognosis.

PMID:39965237 | DOI:10.1097/MAO.0000000000004415

Otol Neurotol. 2025 Feb 4. doi: 10.1097/MAO.0000000000004410. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the quality of information provided by artificial intelligence platforms ChatGPT-4 and Claude 2 surrounding the management of vestibular schwannomas.

STUDY DESIGN: Cross-sectional.

SETTING: Skull base surgeons were involved from different centers and countries.

INTERVENTION: Thirty-six questions regarding vestibular schwannoma management were tested. Artificial intelligence responses were subsequently evaluated by 19 lateral skull base surgeons using the Quality Assessment of Medical Artificial Intelligence (QAMAI) questionnaire, assessing “Accuracy,” “Clarity,” “Relevance,” “Completeness,” “Sources,” and “Usefulness.”

MAIN OUTCOME MEASURE: The scores of the answers from both chatbots were collected and analyzed using the Student t test. Analysis of responses grouped by stakeholders was performed with McNemar test. Stuart-Maxwell test was used to compare reading level among chatbots. Intraclass correlation coefficient was calculated.

RESULTS: ChatGPT-4 demonstrated significantly improved quality over Claude 2 in 14 of 36 (38.9%) questions, whereas higher-quality scores for Claude 2 were only observed in 2 (5.6%) answers. Chatbots exhibited variation across the dimensions of “Accuracy,” “Clarity,” “Completeness,” “Relevance,” and “Usefulness,” with ChatGPT-4 demonstrating a statistically significant superior performance. However, no statistically significant difference was found in the assessment of “Sources.” Additionally, ChatGPT-4 provided information at a significant lower reading grade level.

CONCLUSIONS: Artificial intelligence platforms failed to consistently provide accurate information surrounding the management of vestibular schwannoma, although ChatGPT-4 achieved significantly higher scores in most analyzed parameters. These findings demonstrate the potential for significant misinformation for patients seeking information through these platforms.

PMID:39965220 | DOI:10.1097/MAO.0000000000004410

Rev Neurosci. 2025 Feb 20. doi: 10.1515/revneuro-2024-0149. Online ahead of print.

ABSTRACT

This review explores the correlation of non-alcoholic fatty liver disease (NAFLD) with cognitive function and brain changes. A comprehensive search of relevant studies in the PubMed database up to June 2024 was conducted, including various study designs such as cross-sectional, longitudinal, case-control, and cohort studies. Data were extracted from 24 studies, focusing on study design, sample size, NAFLD diagnosis, control of confounders, key findings, and limitations. Neuropsychological tests utilized within each study were grouped into relevant cognitive domains. Statistical analyses and comparisons were also performed on the observed changes in brain parameters across the studies. The meta-analysis on the domain of general cognition was conducted. Results indicated that NAFLD was significantly associated with general cognition, executive function, attention, and memory. NAFLD impacts the total brain volume, the volumes of specific brain regions and certain high-intensity brain regions, the cerebral blood flow and perfusion, the integrity of nerve fiber bundles, and the brain abnormalities or lesions such as cerebral hemorrhage, cerebral microbleeds, and white matter lesions. NAFLD also affects the thickness and surface area of certain cortical regions and the resting-state brain function MRI indicators in specific brain areas. Despite these findings, the included studies varied in design, population characteristics, and outcome measures, which introduced heterogeneity that might influence the generalizability of the results. Overall, NAFLD is associated with a decline in cognitive function and alterations in certain brain parameters. Furthermore, NAFLD may exert its influence on cognition by impacting brain structure.

PMID:39965194 | DOI:10.1515/revneuro-2024-0149

JMIR Form Res. 2025 Feb 18;9:e57826. doi: 10.2196/57826.

ABSTRACT

BACKGROUND: Spinal pain, one of the most common musculoskeletal disorders (MSDs), significantly impacts the quality of life due to chronic pain and disability. Physical activity has shown promise in managing spinal pain, although optimizing adherence to exercise remains a challenge. The digital development of artificial intelligence (AI)-driven applications offers a possibility for guiding and supporting patients with MSDs in their daily lives.

OBJECTIVE: The trial aimed to investigate the effect of an 8-week AI-composed exercise program on pain intensity and well-being in patients with spinal pain. It also examined the relationship between exercise frequency, pain intensity, and well-being. In addition, app usage frequency was examined as a proxy for app engagement.

METHODS: Data from users who met the inclusion criteria were collected retrospectively from the medicalmotion app between January 1, 2020, and June 30, 2023. The intervention involved the use of the medicalmotion app, which provides 3-5 personalized exercises for each session based on individual user data. The primary outcomes assessed pain intensity and well-being using the numeric rating scale (NRS) and the Likert scale. Data were collected at baseline (t0), 4 weeks (t1), and 8 weeks (t2). The correlation between exercise frequency, pain intensity, and well-being was analyzed as a secondary outcome. In addition, average session length and frequency were measured to determine app engagement. Statistical analysis included ANOVA and Spearman correlation analysis.

RESULTS: The study included 379 participants with a mean age of 50.96 (SD 12.22) years. At t2, there was a significant reduction of 1.78 points on the NRS (P<.001). The score on the Likert scale for well-being improved by 3.11 points after 8 weeks. Pain intensity showed a negative correlation with the number of daily exercises performed at t1 and t2. Well-being had a small negative correlation with the average number of exercises performed per day. The average number of exercises performed per day was 3.58. The average session length was approximately 10 minutes, and the average interaction with the app was 49.2% (n=27.6 days) of the 56 available days.

CONCLUSIONS: Overall, the study demonstrates that an app-based intervention program can substantially reduce pain intensity and increase well-being in patients with spinal pain. This retrospective study showed that an app that digitizes multidisciplinary rehabilitation for the self-management of spinal pain significantly reduced user-reported pain intensity in a preselected population of app users.

PMID:39965189 | DOI:10.2196/57826