Category: Nevin Manimala

Hematol Transfus Cell Ther. 2026 Jul 28;48(4):106490. doi: 10.1016/j.htct.2026.106490. Online ahead of print.

ABSTRACT

BACKGROUND: Hematopoietic stem cell transplantation is the sole therapeutic approach that can provide a complete cure for thalassemia. However, this procedure is associated with complications that may have life-threatening consequences. To date, long-term survival outcomes after transplantation in thalassemia have not been systematically synthesized. This study aims to specifically evaluate long-term overall survival in patients with thalassemia undergoing hematopoietic stem cell transplantation.

METHODS: A comprehensive search was conducted across multiple databases, including PubMed, CENTRAL, Europe PMC (incorporating medRxiv and bioRxiv), EBSCOHost (Medline), and ProQuest. The search spanned from the inception of each database through July 10, 2024, using a combination of predefined keywords: ‘Hematopoietic Stem Cell Transplantation’, ‘Thalassemia’, ‘Survival Rates’, and synonyms. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Heterogeneity was evaluated via I² statistics, while pooled effect estimates were calculated using the DerSimonian-Laird inverse-variance random-effects model. Statistical significance was defined as p < 0.05. Additionally, a leave-one-out sensitivity analysis was performed to ensure the robustness of the findings.

RESULTS: Out of an initial 690 records identified, four articles involving a total of 616 transplanted thalassemia patients were included in this study. The survival rates were 86.8% (95% CI: 80.1%- 92.3%) in 15 years, 89.2% (95% CI: 82.2%-96.2%) in 20 years, 82.6% (95% CI: 79.9%-85.3%) in 30 years, and 81.4% (95% CI: 74.5%-88.9%) in 39 years. The pooled survival rate was 85% (95% CI: 81%-89%; I² = 40%). The pooled survival rate showed no significant differences in leave-one-out sensitivity analysis.

CONCLUSION: The present meta-analysis shows relatively high long-term overall survival rates in patients with thalassemia after hematopoietic stem cell transplantation. Nonetheless, the relatively small patient population, heterogeneity in anti-thymocyte globulin implementation, and potential confounding risks intrinsic to the study necessitate cautious interpretation of the findings.

PMID:42520329 | DOI:10.1016/j.htct.2026.106490

Int J Pharm Pract. 2026 Jul 28:riag100. doi: 10.1093/ijpp/riag100. Online ahead of print.

ABSTRACT

OBJECTIVES: This study describes an elective pharmacy entrepreneurship course and reports on students’ satisfaction, knowledge, and perceptions of the course’s effectiveness.

METHODS: An observational, cross-sectional study design was used to analyze retrospective data on direct and indirect assessments from first- and second-year professional pharmacy students who completed the course between 2017-2018 and 2024-2025. Students completed end-of-course surveys assessing their satisfaction with course structure, instructional methods, and perceived attainment of the course’s learning objectives, using Likert-scale responses. Direct assessment data were obtained by mapping examination items and graded assignments to course learning objectives. Qualitative data were collected and analyzed from the students’ survey comments. Descriptive statistics were used for data analysis.

KEY FINDINGS: The course used a project-based learning approach, including a semester-long entrepreneurial project and an individual case analysis. Overall, 362 students (62% of 8 class years) completed the course across 12 sessions. Survey results showed high student satisfaction, with 89%-98% of respondents agreeing or strongly agreeing in various areas. Direct assessment confirmed significant achievement of learning objectives, with normalized mean scores from 4.44 to 4.53 (out of 5) and 88%-100% of students earning at least 80% of the points. Indirect assessment results were similar, with 76%-84% of students expressing satisfaction with the course’s coverage of its learning objectives. Students praised the course’s relevance, value, and instruction, but found the workload and projects excessive.

CONCLUSIONS: A project-based elective course in pharmacy entrepreneurship effectively supports student learning and satisfaction, highlighting the value of incorporating entrepreneurship education into the pharmacy curriculum.

PMID:42520325 | DOI:10.1093/ijpp/riag100

Radiat Prot Dosimetry. 2026 Jul 28:ncag085. doi: 10.1093/rpd/ncag085. Online ahead of print.

ABSTRACT

Long-term standardized personal dose monitoring is essential for occupational radiation protection and health risk assessment of radiation workers. This study aimed to analyse the distribution characteristics, major causes, and actual exposure risks of abnormal individual dose monitoring results among radiation workers in Beijing from 2021 to 2025. A 5-year large-sample analysis of abnormal individual dose data among local radiation workers was performed to systematically explore the key problems in daily dose monitoring management. A total of 286 339 person-times of occupational external exposure monitoring (Hp(10)) were included, and 313 records exceeding the quarterly investigation level of 1.25 mSv were selected for retrospective investigation and statistical analysis. The overall 5-year abnormal rate was 0.11%, with no significant annual variation. Most abnormal cases were concentrated in medical institutions, especially in diagnostic radiology and interventional radiology. Non-standard behaviours such as improper placement and irregular wearing of dosemeters were the main causes of false abnormal doses, accounting for the majority of over-threshold records. Only 46 cases were confirmed as actual occupational exposure, and all quarterly doses were below 3 mSv. Interventional radiology personnel had a significantly higher actual exposure fraction than other radiation worker groups, with both the highest proportion of exposed individuals and the largest collective occupational exposure dose. The overall occupational exposure level of radiation workers in Beijing remained under effective control during the study period. In conclusion, inappropriate dosemeter management is the primary factor leading to abnormal monitoring data. Targeted radiation protection training and standardized dose supervision should be strengthened for high-risk groups, especially interventional radiology workers, to improve the authenticity and effectiveness of occupational dose monitoring and optimize regional radiation protection management.

PMID:42520320 | DOI:10.1093/rpd/ncag085

Mil Med. 2026 Jul 28:usag348. doi: 10.1093/milmed/usag348. Online ahead of print.

ABSTRACT

INTRODUCTION: Upper extremity injuries, particularly those involving the hand, are a significant source of morbidity and reduced operational readiness within military populations. Hand and finger trauma are among the most common musculoskeletal injuries encountered across deployed and non-deployed military settings, frequently affecting the ability to perform mission-essential tasks. In austere and resource-constrained environments, early stabilization strategies must balance protection of injured structures with preservation of function and operational capability. Current military trauma systems emphasize prolonged management in environments where evacuation may be delayed, increasing the importance of rapid, reproducible interventions that support continued function. Traditional immobilization techniques such as plaster splinting are time-intensive, operator-dependent, and often restrict functional hand use. This pilot study evaluates a rapid, motion-permissive hand stabilization system (GRASP Hand) designed to achieve intrinsic-plus positioning while allowing controlled motion, with potential application across Tactical Combat Casualty Care (TCCC) and Prolonged Casualty Care (PCC) settings.

MATERIALS AND METHODS: A pilot feasibility study was conducted in a controlled outpatient setting following institutional review board approval. Eight surgeons with varying levels of experience applied both the GRASP Hand and a traditional plaster splint to a single healthy subject in randomized sequence. The primary outcome was application time. Secondary outcomes included index finger metacarpophalangeal joint (MPJ) flexion angle immediately after application and again at 10 minutes. During the observation period, the subject performed light functional tasks to approximate low-demand activity. Paired t-tests were used for statistical comparison.

RESULTS: The GRASP Hand demonstrated significantly reduced application time compared to plaster splinting (23.5 ± 5.1 seconds vs. 359 ± 81.4 seconds, P < .001). Both methods achieved intrinsic-plus positioning; however, the GRASP Hand produced more consistent initial MPJ flexion (73.9° ± 3.8° vs. 64.4° ± 11.4°) with reduced inter-user variability. Maintenance of positioning over 10 minutes was comparable between groups (angle change: 4.3° ± 1.4° vs. 3.9° ± 5.0°, P = .863). No complications or device failures were observed.

CONCLUSIONS: A motion-permissive hand stabilization system enabled rapid, reproducible achievement of intrinsic-plus positioning while maintaining short-term positional stability comparable to plaster splinting. These findings support the feasibility of rapid functional hand stabilization in operational environments where evacuation delays, limited resources, and preservation of functional capability are critical considerations. Emerging evidence supporting controlled motion and functional hand-based stabilization suggests that early protected mobilization may reduce stiffness and improve functional recovery while maintaining fracture alignment in appropriately selected injuries. This approach may represent a complementary strategy within the military trauma care continuum for select hand injuries not requiring rigid immobilization.

CLINICAL TRIAL REGISTRATION: Identifier: NCT06592040.

PMID:42520311 | DOI:10.1093/milmed/usag348

Animal Model Exp Med. 2026 Jul 28. doi: 10.1002/ame2.70268. Online ahead of print.

ABSTRACT

BACKGROUND: Metabolic and behavioral traits in mice exhibit substantial variability across strains, ages, and disease states, which can confound preclinical study outcomes. However, systematic characterization of these parameters (e.g., energy metabolism, activity, and feeding behavior) across diverse experimental conditions remains limited.

METHODS: Core metabolic and behavioral parameters were assessed via metabolic cages in five 8-week-old mouse strains (ICR, C57BL/6J, BALB/c, BALB/c-nude, NOD-SCID), six C57BL/6J age groups (3 weeks to 18 months), and four mouse disease models (LPS-induced pneumonia, chronic kidney disease, acute myocardial infarction, and type 1 diabetes). Data were stratified by light/dark cycles and statistically compared.

RESULTS: Herein, metabolic and behavioral phenotypes of mice were systematically characterized across different strains, ages, and four disease models (three organ-specific, one systemic). Distinct strain- and age-related differences in basal metabolism, activity, and energy expenditure were observed. Specifically, ICR mice displayed higher basal aerobic metabolism, whereas C57BL/6J mice exhibited greater locomotor activity; metabolism and energy balance also underwent marked shifts during development, pregnancy, and aging. Furthermore, all disease models presented unique metabolic rearrangements: LPS-induced acute pneumonia reduced aerobic metabolism and locomotor activity; CKD caused hypometabolism, polydipsia, and a substrate shift to carbohydrate oxidation; AMI increased respiratory exchange ratio (RER) and water intake; and T1DM induced polyphagia and polydipsia, with normal metabolism but impaired energy utilization.

CONCLUSIONS: Mouse metabolic and behavioral phenotypes are highly dependent on strain, age, and disease state. These findings highlight the need to standardize experimental conditions (e.g., age, strain, disease state) and account for baseline variability when designing preclinical studies.

PMID:42520300 | DOI:10.1002/ame2.70268

Adv Neonatal Care. 2026 Jul 28. doi: 10.1097/ANC.0000000000001415. Online ahead of print.

ABSTRACT

BACKGROUND: Maternal voice exposure provides significant neurodevelopmental benefits for preterm infants, yet its integration into routine clinical care remains inconsistent. Understanding the “knowledge-to-action” gap is critical for establishing effective developmental care practices in the neonatal intensive care unit (NICU).

PURPOSE: To determine the knowledge levels of NICU nurses regarding maternal voice exposure, evaluate their clinical practices, and identify perceived systemic barriers to implementation.

METHODS: A descriptive, cross-sectional design was used. Data were collected from 166 NICU nurses across Türkiye using a structured knowledge questionnaire (content validity index = 0.99) and a clinical practice assessment tool. Statistical analyses included descriptive statistics and group comparisons (t-tests and analysis of variance).

RESULTS: The mean knowledge score was high (82.70 ± 9.29). Despite this, 75.9% of nurses did not implement maternal voice exposure in their units. A significant majority (94.0%) reported a total absence of written protocols. Key barriers identified were lack of guidelines, time constraints, and equipment shortages. Knowledge scores positively correlated with age and professional experience (P < .05).

IMPLICATIONS FOR PRACTICE AND RESEARCH: Although NICU nurses possess high theoretical knowledge, a profound “knowledge-to-action” gap exists. The primary systemic barrier is the lack of standardized, evidence-based written protocols. Neonatal intensive care unit leadership should prioritize developing clinical guidelines and nursing education programs that address perceived barriers, such as infection control and equipment use, to transition theoretical knowledge into routine bedside practice.

PMID:42520284 | DOI:10.1097/ANC.0000000000001415

Health Informatics J. 2026 Jul-Sep;32(3):14604582261470637. doi: 10.1177/14604582261470637. Epub 2026 Jul 28.

ABSTRACT

ObjectiveThis study evaluates the performance of large language models (LLMs)-ChatGPT-4.0, Gemini 2.0 Pro, o3-mini, Doctor GPT and DeepSeek-V3-in a national orthopaedic proficiency examination and explores their implications for health informatics and medical education. The responses of these models were analysed to assess accuracy rates and differences between models.MethodA total of 100 multiple-choice questions from the 2024 TOTEK examination were administered to each AI model under identical conditions. Correct and incorrect responses were recorded, and differences in performance were evaluated using chi-square testing and frequency analysis. Question categories were also compared to identify domain-specific variations.Resultso3-mini achieved the highest accuracy rate (79%), while Gemini 2.0 showed the lowest (68%); all models exceeded the 60% pass threshold. A statistically significant difference between models was identified in the Surgical Procedures category, in which Gemini 2.0 answered fewer questions correctly (23/36) than the other models (30-32/36) (χ² = 9.87, df = 4, p = 0.043). No significant differences were observed in the remaining categories (all p > 0.05), and the overall difference in accuracy between models did not reach statistical significance (χ² = 4.01, df = 4, p = 0.405). Clinical decision-making and visual content-based questions were the most challenging for all models.ConclusionAI models demonstrate generally high accuracy in medical examinations; however, they struggle with interpreting clinical context, recognising atypical medical scenarios and answering questions involving visual content.

PMID:42520276 | DOI:10.1177/14604582261470637

JMIR Mhealth Uhealth. 2026 Jul 28;14:e74121. doi: 10.2196/74121.

ABSTRACT

BACKGROUND: Heart failure (HF) is a major health care challenge in the United States, with approximately 900,000 older adults hospitalized annually. Gaps in self-management, including unrecognized worsening symptoms and failure to adhere to dietary sodium restriction, can reduce quality of life and precipitate hospital admissions. Existing mobile health approaches to HF self-management have produced mixed results, highlighting the need for innovative strategies to improve postdischarge outcomes in at-risk patients.

OBJECTIVE: The ManageHF trial aimed to evaluate the effectiveness of 2 just-in-time adaptive interventions delivered via a mobile app to enhance HF self-management. The interventions focused on symptom recognition and lower dietary sodium restriction, with the goal of reducing readmissions and improving health-related quality of life (HRQOL) over a 12-week period.

METHODS: The trial was a 2×2 factorial, double-blind, randomized controlled study conducted across several US institutions. Participants recently hospitalized for acute HF were randomized into 4 groups: both interventions, either intervention alone, or an active control. The primary outcome was a composite measure assessing time to all-cause death, time to first HF readmission, and HRQOL changes, using the Minnesota Living with HF Questionnaire.

RESULTS: Recruitment was hindered by the COVID-19 pandemic, leading to the early discontinuation of the trial. Of the 62 participants enrolled, 43 completed the study. Participants were diverse, with a mean age of 55 (SD 14.4) years, 32% (20/62) were female, and 55% (34/62) identified as Black or African American. Most had HF with reduced ejection fraction. However, due to the early termination and small sample size, the ability to detect statistically significant differences was limited.

CONCLUSIONS: The ManageHF trial highlighted the potential of mobile health technology to support HF management, particularly in enhancing HRQOL. Future studies using more effective recruitment and retention strategies are crucial for establishing the efficacy of these interventions with greater certainty.

PMID:42520258 | DOI:10.2196/74121

Global Spine J. 2026 Jul 28:21925682261474153. doi: 10.1177/21925682261474153. Online ahead of print.

ABSTRACT

Study DesignRetrospective Study.ObjectivesTo compare long-term adjacent-segment kinematic changes and radiographic adjacent segment degeneration (rASD) after two-level cervical hybrid surgery using Bryan or Mobi-C prostheses.MethodsWe retrospectively reviewed 78 patients who underwent contiguous two-level anterior cervical hybrid surgery between 2010 and 2018, including 38 treated with Bryan and 40 with Mobi-C prostheses. All patients had more than 7 years of follow-up. Flexion-extension center of rotation (FE-COR) trajectories at the superior adjacent segment were measured on dynamic radiographs. Long-term rASD was evaluated using the Walraevens score.ResultsClinical outcomes improved significantly in both groups (P < 0.001), with no significant between-group differences. Segmental range of motion remained stable and comparable between groups (P > 0.05). However, FE-COR trajectories differed. At 1 year, the Mobi-C group showed anterior-inferior FE-COR displacement, with FE-COR_Y decreasing to 44.92% ± 12.55%, whereas the Bryan group maintained a relatively stable FE-COR_Y of 59.01% ± 10.66% (P < 0.001). At final follow-up, rASD occurred in 12.5% of Mobi-C patients and 23.7% of Bryan patients, although this difference was not statistically significant (P = 0.198).ConclusionConventional ROM measurements alone cannot fully capture segmental biomechanics. Early anterior-inferior FE-COR displacement in the Mobi-C group was observed and was associated with a numerically lower, but statistically non-significant, rASD rate. These findings suggest that FE-COR may be a sensitive radiographic parameter for describing postoperative micro-kinematic patterns, but its causal relationship with long-term adjacent segment degeneration requires further biomechanical and MRI-based validation.

PMID:42520254 | DOI:10.1177/21925682261474153

J Med Internet Res. 2026 Jul 28;28:e90458. doi: 10.2196/90458.

ABSTRACT

BACKGROUND: Multimorbidity involves heterogeneous disease combinations, treatment burden, competing priorities, and complex care pathways. Digital health interventions (DHIs) may support monitoring, self-management, and care coordination, but their effects on health-related outcomes remain uncertain.

OBJECTIVE: This systematic review and meta-analysis evaluated the effectiveness of DHIs on physiological, psychological, and functional outcomes in adults with multimorbidity, summarized implementation outcomes, and explored intervention-multimorbidity matching patterns.

METHODS: PubMed, Web of Science Core Collection, Embase, Cochrane Library, CINAHL with Full Text, Scopus, gray literature sources, trial registries, reference lists, and forward citations were searched through April 7, 2026. English-language randomized or cluster-randomized trials enrolled adults with 2 or more chronic conditions and compared a DHI with a comparator lacking the same digital component. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Random-effects meta-analyses used restricted maximum likelihood estimation, Hartung-Knapp adjustment, and Nagashima-Noma-Furukawa prediction intervals. Certainty of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.

RESULTS: In total, 36 reports (37 trials) were included. A total of 7 were rated as high risk of bias and 29 as having some concerns; none was rated as low risk overall. No statistically significant pooled effects were observed for glycated hemoglobin, blood pressure, mortality, hospitalization, or readmission, depression response, health-related quality of life, or pain-related functional impact or disability. For glycated hemoglobin, 6 studies (3992 participants) yielded a mean difference of -0.12 percentage points (95% CI -0.36 to 0.11; 95% prediction interval -0.70 to 0.43). For systolic blood pressure, 6 studies including 5596 participants yielded a mean difference of -3.40 mm Hg (95% CI -8.94 to 2.14; 95% prediction interval -19.15 to 13.03). Depression severity was the only outcome whose pooled 95% CI favored the intervention (8 studies; 1861 participants; standardized mean difference -0.49, 95% CI -0.82 to -0.16), but its prediction interval spanned benefit to harm (-1.53 to 0.51). Certainty was low or very low for all 7 GRADE-assessed outcomes. Implementation findings suggested feasibility, especially with monitoring, coaching, or clinician contact, but reporting was heterogeneous.

CONCLUSIONS: Current evidence does not support consistent, transferable benefits of DHIs across most outcomes in adults with multimorbidity. Their real-world value may depend less on technology type than on alignment among intervention mechanisms, patient complexity, outcomes, and delivery context. Future DHIs should be adaptive, burden-sensitive, and workflow-integrated, linking digital data to patient priorities, clinician responses, and care coordination.

PMID:42520248 | DOI:10.2196/90458