Category: Nevin Manimala

Shock. 2025 Sep 23. doi: 10.1097/SHK.0000000000002710. Online ahead of print.

ABSTRACT

BACKGROUND: Although Sepsis-3.0 defines septic shock as hypotension with serum lactate levels >2.0 mmol/L, this criterion may miss low-lactate shock: a clinically significant phenotype characterized by hypotension but without elevated lactate levels. The epidemiological characteristics and prognostic significance of low-lactate shock remain unclear, highlighting a critical gap in current shock management models.

METHODS: We conducted a retrospective cohort study of 3,134 patients with shock admitted to a tertiary care medical institution from January 2015 to March 2022. We used propensity score matching (1:2 ratio) to control for confounding factors, aiming to determine the prevalence of low-lactate shock (lactate ≤ 2.0 mmol/L), identify risk factors through multivariable logistic regression, and validate the predictive model (NRS-APACHE II-TG-TBIL) using ROC analysis.

RESULTS: The 28-day mortality rate was slightly lower in the low-lactate shock group compared to the high-lactate group (25.4% [94/369] vs. 35.8% [990/2,765], respectively). The age, nutritional risk screening (NRS-2002) score, and venous thromboembolism (VTE) risk score were significantly lower in the low-lactate shock group than in the high-lactate shock group (P < 0.05). No statistically significant differences were observed in gender distribution (P = 0.092). Multivariable analysis identified four independent predictors of low-lactate shock: NRS-2002 (OR=0.570, P<0.001), APACHE II (OR=0.869, P<0.001), TG (OR=0.772, P=0.035), and TBIL (OR=0.993, P=0.002). The composite NRS-APACHE II-TG-TBIL model showed excellent discrimination (AUC=0.800, P<0.001) with balanced sensitivity (72.6%) and specificity (73.5%).

CONCLUSIONS: Low-lactate shock carries substantial mortality risk (25.4%). The validated NRS-APACHE II-TG-TBIL model (AUC=0.800) provides an effective tool for early detection, addressing critical diagnostic gaps in shock management.

PMID:40986916 | DOI:10.1097/SHK.0000000000002710

Pain Physician. 2025 Sep;28(5):E555-E566.

ABSTRACT

BACKGROUND: The sacroiliac joint (SIJ) is a frequently overlooked source of lower back pain (LBP), contributing to 15-30% of cases. Nonoperative treatments such as NSAIDs, physical therapy, and SIJ injections have limited effectiveness on LBP. When conservative measures fail, SIJ fusion is recommended, with minimally invasive techniques showing better outcomes than traditional open surgery. However, there is no clear agreement on the optimal approach for SIJ fusion.

OBJECTIVES: This study aims to evaluate the outcomes of minimally invasive SIJ fusion performed by a single surgeon, comparing the lateral and posterior approaches to another in terms of pain relief, functional improvement, and procedure durability.

STUDY DESIGN: A retrospective comparative study.

SETTING: A single pain management center at the Interventional Pain Institute, where patients underwent SIJ fusion between April 2020 and May 2024.

METHODS: A total of 115 patients who underwent minimally invasive SIJ fusion and met the inclusion criteria were included in the study. Patients were assessed before and after the procedure for pain using the Visual Analog Scale (VAS), functional outcomes using the Oswestry Disability Index (ODI), opioid consumption, sleep quality, and procedure durability. Statistical comparisons between the lateral and posterior approaches were performed using the chi-square (c²), Fisher’s exact test, and t-test as appropriate, while durability was analyzed with the Kaplan-Meier curve and log-rank test.

RESULTS: The average follow-up duration was 11.3 ± 5.8 months. Lateral SIJ fusion demonstrated longer procedural durability compared to the posterior approach, with greater improvements in VAS pain scores (66.3% vs. 53.8%, P = 0.017), ODI functional outcomes (45.0% vs. 30.7%, P = 0.002), higher rates of sleep improvement (83.9% vs. 61.0%, P = 0.006), and lower recurrence rates (12.5% vs. 28.8%, P = 0.031). At the last follow-up, most patients (79.1%) maintained their improvements.

LIMITATIONS: This study is limited by its retrospective design, its single-center setting, and the lack of randomization between the lateral and posterior approaches.

CONCLUSION: Both the lateral and posterior approaches to minimally invasive SIJ fusion were beneficial. However, the lateral approach used in our study demonstrated superior outcomes in the areas of pain relief, functional improvement, and procedure durability. Further multicenter prospective studies with larger patient populations are recommended to confirm these findings.

PMID:40986910

West Afr J Med. 2025 Apr 30;42(4):303-310.

ABSTRACT

BACKGROUND: Multiple injured patients are patients who sustained injury to more than one system in the body, while a polytraumatized patient is the one who sustained injury to two or more regions of a system in the body. Better patient outcomes and effective management depend on an understanding of the patterns and characteristics of limb injuries in the multiply injured individuals. This is especially important in places with little resources, like Southwestern Nigeria, where trauma is common and it’s important to make the best use of the few available medical resources. Therefore, the aim of this research is to determine the common aetiology that led to various limb injuries in the multiple injured patients at UNIOSUN Teaching Hospital, Osogbo, Osun state.

METHODOLOGY: A prospective observational design was employed, involving multiple injured patients admitted to UNIOSUN Teaching Hospital from May 1st, 2022 to April 30th, 2024. Data collection includes demographic information, aetiology of the injury and type of injury sustained. SPSS Version 20 was employed to determine the frequency and distribution of data. Descriptive analysis revealed demographic characteristics, patterns of limb injury, highlighting the common causes, prevalence of different types of limb injuries, distribution of affected limbs and sides in the multiply injured patients.

RESULT: The study found a higher representation of males in road traffic accidents, with a diverse age group. Most participants were passengers or pedestrians, with 71.4% of injuries being closed. Most participants did not use seat belts and were not seated.

CONCLUSION: This study demonstrated that limb injuries from road traffic accidents predominantly affected young adult males, with motorcycle crashes being the leading cause. Fractures, especially of the lower limbs, were the most common injury types, and surgical intervention was frequently required. These findings show the significant burden of limb trauma managed at UNIOSUN Teaching Hospital and emphasize the demographic and clinical patterns associated with such injuries.

PMID:40986889

Health Informatics J. 2025 Jul-Sep;31(3):14604582251381145. doi: 10.1177/14604582251381145. Epub 2025 Sep 23.

ABSTRACT

Background: Nurses’ clinical decision-making skills are vital for ensuring safe care and achieving optimal patient outcomes. Similarly, evidence-based practice improves quality of care and standardizes nursing services. Research is needed to examine factors affecting these skills. Objective: This study examined the relationship between informatics competency, attitudes toward evidence-based practice, and clinical decision-making skills among nurses. Method: This descriptive correlational study was conducted in 2024 with 300 nurses from hospitals affiliated with Birjand University of Medical Sciences, Birjand, Iran. Data were collected using questionnaires on demographic information, informatics competency, attitudes toward evidence-based practice, and clinical decision-making skills. Data were analyzed using SPSS-25 software at a significance level of p < 0.05. Results: A significant positive correlation was found between informatics competency (and its components), clinical decision-making skills, and evidence-based practice in the studied nurses. Informatics competency predicted about 26% of the variance in clinical decision-making skills and 20% of the variance in attitudes toward evidence-based practice. Conclusion: Nurse managers should implement targeted interventions to enhance informatics competency and improve attitudes toward evidence-based practice and decision-making skills.

PMID:40986884 | DOI:10.1177/14604582251381145

Orthop Nurs. 2025 Sep-Oct 01;44(5):286-295. doi: 10.1097/NOR.0000000000001151. Epub 2025 Sep 23.

ABSTRACT

This study was conducted to determine the relationship between older patients’ readiness for discharge after total arthroplasty and fear of falling, kinesiophobia, and other variables. This correlational and cross-sectional study was conducted with 250 older people who had undergone total knee and hip arthroplasty. Data were collected using a Patient Descriptive and Clinical Information Form, the Fear of Falling Scale, the Visual Analog Scale, the Tampa Kinesiophobia Scale, and the Readiness for Hospital Discharge Scale-Short Form. The mean Readiness for Hospital Discharge Scale (RHDS) score was 4.70 ± 1.23, and 84.4% of the participants were found to be not ready for discharge. This is low in comparison to the findings from other studies. The model created for readiness for discharge explained 30% of the total variance (p < .005). The independent variables included in the model, namely fear of falling, pain, age, and number of mobilizations, were determined to be statistically significant predictors of readiness for discharge. It is necessary to support mobilization and manage the fear of falling and pain to increase older patients’ readiness for discharge following surgery.

PMID:40986878 | DOI:10.1097/NOR.0000000000001151

Orthop Nurs. 2025 Sep-Oct 01;44(5):278-285. doi: 10.1097/NOR.0000000000001150. Epub 2025 Sep 23.

ABSTRACT

The article aims to examine the effect of a pre-operative high-carbohydrate drink (HCD) on unilateral, primary total hip arthroplasty and total knee arthroplasty patients by measuring post-operative antiemetic medication use and length of stay in the post-anesthesia care unit (PACU). The study used a quasi-experimental cohort design using a historical control group. We compared the intervention group who consumed the pre-operative HCD, to a historical control group, 1 year prior, who did not. The intervention group had more females (62%), was more likely to have spinal anesthesia, and was less likely to receive preoperative antiemetic medications (odds ratio (OR) = 0.41; confidence interval (95% CI): 0.21, 0.79) and postoperative antiemetics (OR = 0.48; 95% CI: 0.29, 0.81). The intervention group’s PACU stay was 10.1 min shorter (p < .0001) than the control group. Patients who consumed HCDs exhibited decreased PACU stay and decreased antiemetic medication use. These findings were used to change institutional preoperative policies for orthopedic patients to enhance outcomes.

PMID:40986877 | DOI:10.1097/NOR.0000000000001150

West Afr J Med. 2025 Apr 30;42(4):298-302.

ABSTRACT

BACKGROUND: Monitoring kidney function during pregnancy is vital, especially in women with hypertensive disorders like preeclampsia. Serum creatinine, although widely used, is limited in sensitivity due to physiological changes in pregnancy. Cystatin C, a novel biomarker, has emerged as a potentially superior and early indicator of glomerular filtration rate (GFR). The aim of this study was to evaluate the diagnostic performance of cystatin C compared to creatinine in pregnant women.

METHODS: A cross-sectional comparative study was conducted among 180 pregnant women at a tertiary centre in Nigeria. Participants included 90 women with preeclampsia and 90 normotensive controls. The respondents were interviewed using a pre-tested, interviewer -administered, semi-structured questionnaire. Serum creatinine and cystatin C levels were measured, and estimated GFR was calculated using the CKD-EPI equation. Group comparisons and correlation analyses were performed.

RESULTS: Mean serum cystatin C levels were significantly higher in preeclamptic women (1.09 ± 0.62 mg/L) compared to controls (0.80 ± 0.22 mg/L, p < 0.001). Although mean serum creatinine levels were slightly higher in the preeclamptic group (89.4 ± 52.5 µmol/L) than in the control group (86.9 ± 47.5 µmol/L), the difference was not statistically significant (p = 0.168). Cystatin C demonstrated a stronger inverse correlation with eGFR (r = -0.68) than creatinine (r = -0.49). Kidney dysfunction (eGFR < 60 mL/min) was detected in 11.1% of preeclamptic women using cystatin C-based threshold and absent in normotensive controls (p < 0.001).

CONCLUSION: Cystatin C outperforms serum creatinine in detecting early kidney dysfunction in pregnancy and may be a more reliable tool for antenatal screening, especially in high-risk populations. Its adoption could improve early diagnosis and clinical outcomes in resource-limited settings.

PMID:40986868

JMIR Res Protoc. 2025 Sep 23;14:e74408. doi: 10.2196/74408.

ABSTRACT

BACKGROUND: Psychotic disorders such as schizophrenia present a significant challenge to health care systems due to their high disability rates and treatment costs. With discontinuation rates for antipsychotics reaching over 40% in the first year and 80% after 3 years, it is crucial to tailor antipsychotic selection and dosing early in treatment. Personalized precision psychiatry, underpinned by pharmacogenetics, holds considerable potential in individualizing antipsychotic treatment for patients with first-episode psychosis. An internationally pioneering method called 5-step precision medicine (5SPM) focuses on the application of pharmacogenetics to clinical practice. The recently launched Prevention and Early Intervention in Mental Health (PRINT) program in Salamanca, Spain, integrates this method to enhance early intervention for adolescents and young people with first-episode psychosis.

OBJECTIVE: The Clinical Utility of Early Intervention Including the 5SPM Method in First-Episode Psychosis (CLUMP) project aims to explore whether an early intervention model of personalized precision psychiatry including pharmacogenetics improves adherence to antipsychotic medicines and, therefore, clinical and functional outcomes in young people experiencing the first episode of a psychotic illness.

METHODS: To achieve our objectives, we shall compare adherence to the first prescribed antipsychotic medication and clinical and functional outcomes between patients with first-episode psychosis. We shall compare 2 cohorts: cohort 1 will receive the recently introduced PRINT program including the 5SPM method, and cohort 2 will have received standard care provided by mental health services before the PRINT program implementation. The primary outcome to measure treatment adherence will be all-cause discontinuation proportions during the 1-year follow-up. Secondary outcome measures will include pragmatic efficacy, tolerability, and functional outcome measures. For additional comparative purposes, we shall analyze the environmental, clinical, and pharmacogenetic information of patients with psychotic disorders of more than 5 years of evolution and with other mental disorders whose data are currently stored and have been ethically approved for research use. A total of 300 patients will be included in the study. Analyses will include descriptive statistics, comparison tests, Kaplan-Meier survival curves, multivariate log rank tests, qualitative analysis, and cost-benefit evaluation.

RESULTS: Ethics approval was obtained in June 2023. Recruitment for the CLUMP project began in January 2025, and enrollment for cohort 1 will continue until May 2026. All data collection is expected to be completed by June 2027. Data analyses are estimated to take approximately 6 months. The project is scheduled to conclude in December 2027.

CONCLUSIONS: The CLUMP project is set to provide the first clear blueprint for implementing and evaluating the impact of personalized precision psychiatry based on pharmacogenetics in the context of early intervention programs for the benefit of young people experiencing the first episode of a severe mental illness such as schizophrenia.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/74408.

PMID:40986864 | DOI:10.2196/74408

JMIR Cancer. 2025 Sep 23;11:e71102. doi: 10.2196/71102.

ABSTRACT

BACKGROUND: Complementary therapies are being increasingly used by cancer survivors. As a channel for customers to share their feelings, outcomes, and perceived knowledge about the products purchased from e-commerce platforms, Amazon consumer reviews are a valuable real-world data source for understanding cancer survivorship care needs.

OBJECTIVE: In this study, we aimed to highlight the potential of using Amazon consumer reviews as a novel source for identifying cancer survivorship care needs, particularly related to symptom self-management. Specifically, we present a publicly available, manually annotated corpus derived from Amazon reviews of health-related products and develop baseline natural language processing models using deep learning and large language model (LLM) to demonstrate the usability of this dataset.

METHODS: We preprocessed the Amazon review dataset to identify sentences with cancer mentions through a rule-based method and conducted content analysis including text feature analysis, sentiment analysis, topic modeling, cancer type, and symptom association analysis. We then designed an annotation guideline, targeting survivorship-relevant constructs. A total of 159 reviews were annotated, and baseline models were developed based on deep learning and large language model (LLM) for named entity recognition and text classification tasks.

RESULTS: A total of 4703 sentences containing positive cancer mentions were identified, drawn from 3349 reviews associated with 2589 distinct products. The identified topics through topic modeling revealed meaningful insights into cancer symptom management and survivorship experiences. Examples included discussions of green tea use during chemotherapy, cancer prevention strategies, and product recommendations for breast cancer. Top 15 symptoms in reviews were also identified, with pain being the most frequent symptom, followed by inflammation, fatigue, etc. The annotation labels were designed to capture cancer types, indicated symptoms, and symptom management outcomes. The resulting annotation corpus contains 2067 labels from 159 Amazon reviews. It is publicly accessible, together with the annotation guideline through the Open Health Natural Language Processing (OHNLP) GitHub. Our baseline model, Bert-base-cased, achieved the highest weighted average F1-score, that is, 66.92%, for named entity recognition, and LLM gpt4-1106-preview-chat achieved the highest F1-score for text classification tasks, that is, 66.67% for “Harmful outcome,” 88.46% for “Favorable outcome” and 73.33% for “Ambiguous outcome.”

CONCLUSIONS: Our results demonstrate the potential of Amazon consumer reviews as a novel data source for identifying persistent symptoms, concerns, and self-management strategies among cancer survivors. This corpus, along with the baseline natural language processing models developed for named entity recognition and text classification, lays the groundwork for future methodological advancements in cancer survivorship research. Importantly, insights from this study could be evaluated against established clinical guidelines for symptom management in cancer survivorship care. By revealing the feasibility of using consumer-generated data for mining survivorship-related experiences, this study offers a promising foundation for future research and argumentation analysis aimed at improving long-term outcomes and support for cancer survivors.

PMID:40986859 | DOI:10.2196/71102

JMIR Form Res. 2025 Sep 23;9:e69394. doi: 10.2196/69394.

ABSTRACT

BACKGROUND: In the United Kingdom, access to and the quality of palliative and end-of-life care (PEOLC) vary widely. In the final months of life, many patients face avoidable accident and emergency (A&E) visits and hospital admissions, driven by gaps in out-of-hours support and poorly coordinated care. This not only increases stress for patients and carers but also places avoidable strain and cost on the National Health Service (NHS). There is an urgent need for more compassionate, person-centered models that support people to remain at home, improve their quality of life (QoL), and reduce unnecessary use of acute services.

OBJECTIVE: This study aimed to explore the usability, user experiences, and impact of the digital dyadic remote monitoring Care and Support System for Patients and Carers (CARE-PAC) for patients in the last year of life, their informal carers, and health professionals involved in their care.

METHODS: Patients and informal carers were recruited to use CARE-PAC for up to 12 weeks. A mixed methods approach was used. Quantitative methods included the use of validated QoL scales and the System Usability Scale (SUS). Paired QoL and usability data were analyzed using the Wilcoxon (Pratt) signed-rank test, while unpaired usability data were analyzed using the Wilcoxon rank-sum test. Qualitative methods involved short catch-up calls, in-depth interviews, and focus groups conducted using topic guides informed by the domains of the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. Data were analyzed thematically.

RESULTS: CARE-PAC was implemented across 5 UK clinical sites with 26 participants (13 patient-carer dyads). No significant changes were observed in patients’ total QoL scores; however, significant improvements were seen in the “overall QoL” and “social” domains, alongside a significant decline in the “physical” domain. Carers showed no significant changes across total or domain-specific QoL scores. Usability was rated highly by patients (mean 87.9, SD 12.4) and carers (mean 94.7, SD 3.8), indicating an excellent user experience. Health care professionals (HCPs) reported lower usability scores (mean 63.6, SD 15.6), falling below average but above the threshold for poor usability. Thematic analysis of qualitative data gathered via catch-up calls (all patient-carer dyads), in-depth interviews (2 patients-2 carers), and 4 focus groups/1 interview (12 HCPs) identified 4 key themes: impact on care experiences, reflections and satisfaction, implementation challenges, and future directions.

CONCLUSIONS: CARE-PAC is a usable, feasible, and acceptable remote monitoring and support system for patients in the last year of life, their carers, and HCPs. It enables real-time identification of needs and has shown positive impacts on the QoL of both patients and carers. These findings support the need for further research to evaluate its effectiveness at scale and explore pathways for wider implementation in PEOLC.

PMID:40986856 | DOI:10.2196/69394