Category: Nevin Manimala

Knee Surg Sports Traumatol Arthrosc. 2025 Sep 30. doi: 10.1002/ksa.70079. Online ahead of print.

ABSTRACT

PURPOSE: The peroneus longus tendon (PLT) has emerged as a promising autograft option for anterior cruciate ligament (ACL) reconstruction, but concerns persist regarding donor-site morbidity and ankle functional outcomes. This systematic review and meta-analysis aimed to evaluate ankle performance following PLT harvest for ACL reconstruction.

METHODS: This systematic review and meta-analysis performed by searching five databases (PubMed, Embase, Web of Science, Scopus, and the Cochrane Library) up to March 2025. Inclusion criteria included: ACL reconstruction using PLT autograft, ≥6-month follow-up, and validated ankle outcomes (American Orthopaedic Foot And Ankle Society [AOFAS]/Foot and Ankle Disability Index [FADI] scores). Pooled effect sizes were calculated using random-effects models using R software (version 4.4.3). Heterogeneity was assessed via I² statistics, and risk of bias was evaluated using JBI checklists.

RESULTS: Twenty articles (1024 patients) were identified, comprising eleven prospective cohort studies and nine randomised clinical trials (RCT), based on title, abstract, and quality assessments. Meta-analysis demonstrated excellent postoperative ankle function, with pooled AOFAS scores of 96.0 (95% confidence interval [CI]: 92.6-99.3) at 6 months, 96.1 (93.9-98.2) at 12 months, and 97.2 (93.9-100.6) at 24 months. FADI scores similarly improved to 97.4 (96.0-98.9) by 6 months and 99.4 (98.7-100.1) at 24 months. Meta-regression revealed no significant association between age and AOFAS outcomes (β = -0.23, p = 0.36). Minor complications (e.g., transient hypaesthesia) occurred in 13%-23% of patients but resolved within months. No studies reported major nerve injuries or ankle instability.

CONCLUSION: Peroneus longus tendon harvest for ACL reconstruction yields minimal donor-site morbidity, with consistently high AOFAS/FADI scores across all age groups. These findings support the safety of PLT autografts, though heterogeneity is evident, and the predominance of male participants and the regional focus of studies, mainly Asian populations, may affect generalisability.

LEVEL OF EVIDENCE: Level II.

PMID:41025611 | DOI:10.1002/ksa.70079

Knee Surg Sports Traumatol Arthrosc. 2025 Sep 30. doi: 10.1002/ksa.70074. Online ahead of print.

ABSTRACT

PURPOSE: The circles measurement is a newly validated in vivo method to evaluate acromioclavicular joint (ACJ) dislocations, but its postoperative and clinical relevance has not been evaluated. We hypothesised that the postoperative circles measurement would capture recurrent vertical as well as horizontal instability and that it would be associated with outcome scores in patients undergoing acute, bidirectional arthroscopically assisted ACJ stabilisation.

METHODS: Male patients (18-55 years) with an acute ACJ dislocation (Rockwood type V) were included retrospectively. Radiographs included a single, bilateral anteroposterior stress view and bilateral Alexander views preoperatively and postoperatively (final follow-up of minimum 2 years). Excluded were patients with previous injuries/minors/polytrauma or insufficient radiographs. The side-to-side difference (SSD) coracoclavicular distance (CCD), the degree of dynamic horizontal translation (DHT) and the SSD circles measurement as well as the ACJ instability (ACJI) and Taft (TF) score, subjective shoulder value (SSV) and Constant score were recorded at the final follow-up (minimum 2 years). The postoperative SSD circles measurement was analysed in relation to these. Statistical analysis comprised correlations and group comparisons.

RESULTS: Fifty-six patients (mean age, 38.9 ± 10.7 years) with a follow-up of 33.0 months (range, 24-55 months) were included. The postoperative SSD circles measurement demonstrated a correlation with recurrent vertical instability (SSD CCD: r = 0.37; p = 0.006), and with recurrent horizontal instability (DHT: r = 0.46; p < 0.001). A higher postoperative SSD circles measurement was associated with lower outcome scores (SSV: r = -0.31; p = 0.021; TF score: r = -0.29; p = 0.031; ACJI score: r = -0.35; p = 0.01). The cut-off values for lower scores (p < 0.05 by stepwise group comparison) were 0 mm for the SSV (p = 0.022); 2.2 mm for the TF score (p = 0.022) and 2.7 mm for the ACJI score (p = 0.024).

CONCLUSIONS: The postoperative circles measurement reflects both recurrent vertical and horizontal instability and correlates with lower outcome scores following arthroscopically assisted ACJ stabilisation, supporting its use as a radiographic adjunct.

LEVEL OF EVIDENCE: Level IV, retrospective case series.

PMID:41025591 | DOI:10.1002/ksa.70074

J Clin Nurs. 2025 Sep 30. doi: 10.1111/jocn.70124. Online ahead of print.

ABSTRACT

AIM: To analyse current Glasgow Coma Scale practice among emergency nurses in China and identify factors influencing assessment quality.

DESIGN: A quantitative, multicenter cross-sectional design.

METHODS: A convenience sample of 1740 emergency nurses from secondary and tertiary hospitals across 21 provinces completed a validated structured questionnaire between March and April 2025. Participants had at least 6 months of emergency nursing experience. Data analysis included descriptive statistics, chi-square tests, and multiple logistic regression to examine factors influencing correct Glasgow Coma Scale application.

RESULTS: Participants had a mean age of 29.8 years (SD = 6.2). Only 52.5% of nurses demonstrated correct Glasgow Coma Scale application despite 97.0% having theoretical knowledge of scoring criteria. While 56.8% had received Glasgow Coma Scale training, significant standardisation deficiencies emerged. Notably, 41.8% of departments lacked operational guidelines, and 53.7% of nurses experienced scoring disagreements with colleagues. Clinical utilisation varied substantially by patient population: traumatic brain injury (97.8%), neurological diseases (96.9%), and systemic critical illness (85.8%). Multivariate analysis identified six significant factors influencing correct application: standardised training (OR = 2.252, 95% CI: 1.789-2.825), manageable workload ≤ 4 patients/shift (OR = 1.652, 95% CI: 1.327-2.057), departmental guidelines (OR = 1.523, 95% CI: 1.233-1.881), extensive work experience ≥ 9 years (OR = 1.534, 95% CI: 1.182-1.992), while multidisciplinary collaboration issues (OR = 0.559, 95% CI: 0.439-0.712) and special patient experience (OR = 0.520, 95% CI: 0.406-0.666) were associated with reduced accuracy.

CONCLUSION: Substantial standardisation challenges exist in Glasgow Coma Scale practice among Chinese emergency nurses, characterised by significant gaps between theoretical knowledge and clinical application. Major barriers include insufficient standardised guidelines, inconsistent training approaches, and inadequate interdisciplinary collaboration.

IMPACT: Healthcare administrators should develop national standardised guidelines, implement simulation-based training programs, optimise emergency workflows, and integrate alternative assessment tools to enhance consciousness assessment accuracy and improve patient safety.

REPORTING METHOD: STROBE statement adherence.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:41025569 | DOI:10.1111/jocn.70124

J Transcult Nurs. 2025 Sep 30:10436596251372840. doi: 10.1177/10436596251372840. Online ahead of print.

ABSTRACT

INTRODUCTION: Nursing education plays a key role in addressing xenophobia. The aim of this study was to examine the effect of forum theater on nursing students’ attitudes toward immigrants.

METHOD: The study was a quasi-experimental research conducted with undergraduate nursing students. Forum theater was used as an educational technique in the study. The sample of the study consisted of n = 24 nursing students. Personal information form and Health Workers’ Attitudes Toward Immigrants Scale were used as data-collection tools. Wilcoxon Signed Ranks Test was used for statistical analysis.

RESULTS: The findings of the study show that the forum theater practice significantly changed nursing students’ attitudes toward racism and discrimination. As a result of the study, nursing students’ positive attitudes increased and negative attitudes decreased (p < .05).

DISCUSSION: Forum theater may be an effective educational tool for nursing students to decrease negative attitudes and increase positive attitudes toward racism and discrimination.

PMID:41025285 | DOI:10.1177/10436596251372840

Ann Geriatr Med Res. 2025 Sep;29(3):393-402. doi: 10.4235/agmr.25.0080. Epub 2025 Aug 13.

ABSTRACT

BACKGROUND: As the global population ages, including Thailand, health-promoting behaviors (HPBs) have emerged as critical challenges affecting the well-being of community-dwelling older adults. This situation calls for a deeper understanding of the modifiable protective factors involved. The current study aimed to examine the associations between frailty, depression, social support, health literacy (HL), and HPBs among community-dwelling older adults in Thailand.

METHODS: A cross-sectional study with a convenience sample of 250 older adults was employed. We collected using validated questionnaires-including Tilburg Frailty Indicator, Thai Geriatric Depression Scale, Social Support Scale, Health Literacy Scale, and Health Promoting Behaviors Scale. We analyzed using descriptive statistics and stepwise multiple linear regression.

RESULTS: This study involved a total of 250 community-dwelling older adults, with a mean age of 70.41 years. The participants had a mean frailty score of 6.78±1.95, indicating that most were classified as frail (score ≥5) based on the Tilburg Frailty Indicator. They also reported no significant depressive symptoms (3.80±2.62), moderate levels of social support (36.70±4.20), poor health literacy (33.15±2.71), and moderate health-promoting behaviors (101.19±7.67). Health literacy, social support, frailty, depression, and comorbidity conditions were significant predictors of health-promoting behaviors, collectively explaining 80.5% of the variance.

CONCLUSION: These findings emphasize that improved HL, greater social support, reduced frailty, and lower depression scores were associated with healthier behaviors in older adults. Multidisciplinary healthcare teams should consider these factors when designing their intervention strategies to gain a more comprehensive understanding and improve health outcomes.

PMID:41025274 | DOI:10.4235/agmr.25.0080

Ann Geriatr Med Res. 2025 Sep;29(3):384-392. doi: 10.4235/agmr.25.0047. Epub 2025 Jun 16.

ABSTRACT

BACKGROUND: To examine the association between participation frequency in the long-term care prevention program and frailty and locomotive syndrome (LS), stratified by sex.

METHODS: A total of 486 older adults residing in City A, Tochigi Prefecture, were included in this study. The participants were categorized into three groups based on the frequency of participation in the long-term care prevention program: low participation, medium participation, and high participation groups. Frailty was assessed using the Questionnaire for Medical Checkup of Old-Old (QMCOO), and LS was assessed using the 5-question Geriatric Locomotive Function Scale (GLFS-5). Frailty and LS were compared separately for men and women in three groups. Additionally, a binomial logistic regression analysis was conducted to examine the association between non-frailty and participation frequency in men.

RESULTS: A total of 141 participants (29.0%) were classified as having frailty, and 160 (32.9%) met the criteria for LS. Intergroup comparisons showed significant differences in frailty prevalence, QMCOO Q1, and Q5, and LS total GLFS-5 score and GLFS-5 Q3, Q4, and Q5 in men. In contrast, intergroup item comparisons showed no significant differences in women. High participation was associated with non-frailty in men across all models in the binomial logistic regression analysis.

CONCLUSIONS: For men, a higher frequency of participation in the long-term care prevention program was suggested to be associated not only with frailty but also with components of LS. These findings highlight the importance of promoting social participation among men, maintaining social participation among women, and adopting sex-specific approaches within community settings.

PMID:41025273 | DOI:10.4235/agmr.25.0047

Nord J Psychiatry. 2025 Sep 30:1-9. doi: 10.1080/08039488.2025.2565825. Online ahead of print.

ABSTRACT

BACKGROUND: The identification of patients in forensic psychiatric care within national health registries has historically posed significant challenges, limiting research to small-scale studies and restricting its scope. This study aims to evaluate the utility of the Danish National Patient Register (DNPR) for research purposes by assessing the criterion concurrent validity of administrative trajectory markers for identifying incident patients receiving forensic psychiatric care.

METHODS: We employed a population-wide design, analyzing data from the entire Danish population aged 15 years and older (almost 5 million individuals). Incident forensic psychiatric patients between January and December, 2022, were identified through a trajectory start marker in the DNPR. Validity was assessed by comparing these cases to confirmed cases from the Central Criminal Register (CCR). Test statistics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value, were calculated.

RESULTS: A total of 323 forensic psychiatric patients were identified in the DNPR, of whom 289 (89.5%) were confirmed as incident cases in the CCR. The sensitivity of any trajectory start marker was .755 (.708-.797), and the PPV was .895 (.856, .926). PPV varied across the five Danish regions and between individual trajectory markers, with the highest PPV (.950) observed among patients sentenced to outpatient psychiatric treatment with the option of hospitalization.

CONCLUSIONS: The findings suggest that trajectory markers are a promising approach for reliably identifying incident forensic psychiatric cases within Danish national health registers. Further studies are needed to confirm their validity across different contexts, informing clinical practice and policy decisions in forensic psychiatry.

PMID:41025265 | DOI:10.1080/08039488.2025.2565825

Med J Aust. 2025 Sep 30. doi: 10.5694/mja2.70053. Online ahead of print.

ABSTRACT

OBJECTIVES: To quantify the cost of hospital separations attributable to environmental risk factors in the Northern Territory, including for Indigenous and remote subgroups.

STUDY DESIGN: A retrospective cross-sectional secondary data analysis of hospital separations data. Data collection, analysis and presentation were guided by our Indigenous Steering Committee.

SETTING AND PARTICIPANTS: All episodes of care from 1 July 2021 to 30 June 2022 with an inpatient separation (discharge, transfer, death) from NT public hospitals were included. Non-inpatient episodes of care (outpatient, emergency department and primary care presentations) were excluded.

MAJOR OUTCOME MEASURES: Individual hospital separations were classified as environmentally attributable if the International statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM) code for their primary diagnosis matched an included disease. Included diseases were based on environmental attributable fractions previously generated for the Kimberley region, contextualised to the NT. Costs were assigned to individual hospital separations based on activity-based funding allocations.

RESULTS: Environmental risk factors contributed more than $72 million to inpatient hospital costs in the NT over 1 year. Environmental risks disproportionately affected children aged 0-4 years ($10.9 million), Indigenous people ($47.2 million) and those in remote areas ($41.7 million). Skin disease made up the largest contribution by a single disease ($26.4 million). The two largest categories of environmental risk were “water quality, sanitation and hygiene” and “home condition”, together contributing $37.3 million in costs.

CONCLUSIONS: Quantifying the economic impact of preventable environmental risk in the NT bolsters the argument for strengthening environmental health initiatives. Health disparities between groups reflect the interconnectedness of environmental, social and cultural determinants of health. Targeted interventions to reduce inequities in housing, sanitation and water quality are needed. Delivering on existing environmental health commitments through meaningful partnerships and coordinated action across sectors such as housing and education is essential, particularly within the Northern Territory Implementation Plan on Closing the Gap.

PMID:41025242 | DOI:10.5694/mja2.70053

Stroke. 2025 Sep 30. doi: 10.1161/STROKEAHA.125.052545. Online ahead of print.

ABSTRACT

BACKGROUND: The take charge intervention-a conversation-based, community intervention to improve motivation, improved independence, and physical health 12 months after stroke in 2 randomized controlled trials with 572 participants. This article reports long-term outcomes for the 400 participants in the TaCAS study (Taking Charge After Stroke).

METHODS: Follow-up study of a New Zealand multicenter, randomized, controlled, parallel-group trial. Outcomes were collected by postal questionnaire or telephone call. The TaCAS study recruited 400 participants discharged after stroke, randomized within 16 weeks to one of 3 groups: 1 session of the take charge intervention, 2 sessions 6 weeks apart, or no sessions (control). This study is of participants still alive and willing to answer a questionnaire 5 to 6 years after their index stroke, undertaken in 2022. The primary outcome was the Physical Component Summary of the Short Form 36, comparing the take charge intervention and control. Secondary outcomes were: Frenchay Activities Index; modified Rankin Scale (mRS); survival; and stroke recurrence. These outcomes were compared with those 12 months after stroke. Analysis was by ANOVA or logistic regression.

RESULTS: Mortality data were available for all 400 participants, and functional data for 204/297 (69%) of survivors. The mean difference (95% CI) in Physical Component Summary between take charge and control groups was 2.8 (-0.8 to 6.5) units, P=0.12, and for independence (modified Rankin Scale score, 0-2) the odds ratio (95% CI) was 0.56 (0.28-1.16), P=0.11, both favoring take charge with similar point estimates to those after 12 months. Differences between take charge and control participants for Frenchay Activities Index scores, survival, and stroke recurrence were small and nonsignificant.

CONCLUSIONS: The clinically significant improvements in physical health and independence for take charge participants, observed at 12 months, were sustained 5 to 6 years after stroke, but no longer statistically significant.

REGISTRATION: URL: https://anzctr.org.au; Unique identifier: ACTRN12622000311752.

PMID:41025238 | DOI:10.1161/STROKEAHA.125.052545

Disaster Med Public Health Prep. 2025 Sep 30;19:e285. doi: 10.1017/dmp.2025.10213.

ABSTRACT

OBJECTIVE: Exertional heat stroke (EHS) occurs when core body temperature exceeds 40°C (104°F) with central nervous system dysfunction and has been identified as a leading cause of morbidity and mortality among endurance athletes. With rapid identification and treatment, survival approaches 100%. This study describes the clinical presentation and course of seven patients transported by emergency medical services from a half marathon with EHS.

METHODS: The 2022 Cambridge Half Marathon occurred during unusually warm weather, with a did not finish rate of 2%. Retrospective review was performed of seven patients transported during the race to an urban, level I trauma center with EHS.

RESULTS: Seven patients transported to the study site were included for analysis. All patients treated with cold water immersion at scene were discharged from the emergency department. Three patients without treatment on scene required admission to the intensive care unit. Descriptions of all patients are provided.

CONCLUSIONS: Lessons learned from this event include the importance of rapid cooling, the role of event-day communications, the varied impacts on emergency department operations, and the increasing need to anticipate such events outside of traditional warm weather seasons.

PMID:41025212 | DOI:10.1017/dmp.2025.10213