Category: Nevin Manimala

Int J Health Plann Manage. 2026 Jul 27. doi: 10.1002/hpm.70120. Online ahead of print.

ABSTRACT

Healthcare providers worldwide face challenges in maintaining a delicate balance between rising demand and limited resources. Decision-makers often struggle with planning and implementing new services, leading to costly consequences and hindering efficiency, patient outcomes, and staff well-being. Current systems lack a comprehensive modelling approach that encompasses all aspects of the hospital and fails to generate crucial outputs. Moreover, these tools often require expert modelers, limiting their usability for end users such as service managers, clinicians, and management. To address this gap, a user-friendly decision support tool (DST) is developed that empowers key decision-makers to assess the impact of interventions across all hospital operations. Our DST utilises a discrete event simulation model, encompassing specialties and interconnections among hospital services. The model incorporates a dataset of 360 input parameters and statistical distributions, providing a holistic understanding of operations. Through scenarios from 2023-2027, our DST generated diverse outputs, including activity levels, bed and clinic requirements, theatre utilization, and financial implications. Notably, implementing a virtual ward reduced patient backlogs and eased strain on resources from 113% to 80%. Our adaptable DST enables informed decision-making, enhancing patient outcomes and optimising resource utilization. This user-friendly tool revitalises hospital operations for improved efficiency and effectiveness.

PMID:42504764 | DOI:10.1002/hpm.70120

Stat Med. 2026 Aug;45(18-19):e70681. doi: 10.1002/sim.70681.

ABSTRACT

Group testing is widely recognized for its ability to reduce time and cost in screening for rare diseases. However, with limited samples, the parameter estimation from group-testing data might be inefficient. In some scenarios, the external summary statistics are available. To make full use of them, we propose a multiple-source knowledge transfer method. The resulting prevalence estimator is consistent and more efficient than the conventional estimator based on the target group-testing data alone. We establish the asymptotic normality of the proposed estimator. In addition, we develop a data-driven screening procedure to identify the transferable sources. We extend this framework to Dorfman’s two-stage group testing design and show that integrating the retesting data yields efficiency gains. The asymptotic normality of the corresponding estimator is also established. Extensive simulations and a real-data application support the theoretical results and demonstrate the favorable finite-sample performance of the proposed method.

PMID:42504761 | DOI:10.1002/sim.70681

Dev Psychopathol. 2026 Jul 27:1-12. doi: 10.1017/S0954579426101771. Online ahead of print.

ABSTRACT

Early (before age 6) potentially traumatic events (PTEs) may interact with hypothalamic-pituitary-adrenal (HPA) axis functioning to shape outcomes involving externalizing problems and anxiety. However, directions of effects remain unclear. This study examined associations between aspects of HPA axis reactivity, anxiety, and externalizing problems over two years by early PTE exposure history, while statistically capturing the co-occurrence of symptom domains. Youth (N = 189; M_age = 10.96 years, SD = 2.51, Range = 8-15; 52.4% female, 47.1% male; 50.3% White, 35.4% Black/African American, 6.4% Other; 7.4% Hispanic/Latine) were included if they had early PTE exposure (n = 107) or had never experienced a PTE (n = 82). HPA axis reactivity to social stress was calculated using area under the curve with respect to ground (AUCg) and increase (AUCi). For youth with early PTE exposure, higher AUCg was concurrently associated with more externalizing symptoms and greater predominance of externalizing over anxiety. Blunted AUCi predicted increasing predominance of externalizing for the early PTE group, but elevated AUCi predicted increases in anxiety for the no PTE group. Findings highlight distinct roles of overall and reactive HPA axis functioning in shaping outcomes following early trauma.

PMID:42504721 | DOI:10.1017/S0954579426101771

Addiction. 2026 Jul 27. doi: 10.1111/add.70554. Online ahead of print.

ABSTRACT

AIMS: To examine the efficacy of a mobile phone-based brief intervention aimed at reducing driving under the influence of cannabis among emerging adult cannabis users in the context of a randomized 3-group randomized clinical trial (RCT).

DESIGN: Phase II, 3-arm RCT conducted from October 2022 to September 2025, with participants randomized to one of three conditions.

SETTING: Participants were recruited from Western Kentucky University in Bowling Green, KY, and the surrounding community within a 60-mile radius. All interventions were delivered remotely via mobile phone.

PARTICIPANTS: 149 emerging adults who reported driving under the influence of cannabis at least three times in the past 3 months were enrolled in the RCT.

INTERVENTION AND COMPARATOR: Participants in the personalized feedback and motivational interviewing text messaging group (PF + MIT; n = 45) received personalized feedback on substance-impaired driving plus a series of interactive, motivational interviewing-style text messages delivered by a trained graduate student over a single session. Participants in the personalized feedback group (PF; n = 50) received personalized feedback only. The information control group (IC; n = 54) received standard, non-personalized substance use information.

MEASUREMENTS: The primary outcome was the number of times driving under the influence of cannabis in the past 3 months, which was self-reported via mobile web survey during follow-up assessments at 3 and 6 months post-intervention. The secondary outcome was the number of times driving after simultaneous alcohol and cannabis use in the past 3 months.

FINDINGS: Negative binomial mixed models analyses indicated that participants in the PF + MIT group showed statistically significantly greater reductions in driving under the influence of cannabis at 3 months compared with the IC group [incidence rate ratio (IRR) = 0.34, 66% reduction; P < 0.001] and maintained reductions at 6 months (IRR = 0.40, 60% reduction; P < 0.001). Participants in the PF group demonstrated statistically significant reductions in driving under the influence of cannabis at 6 months relative to the IC group (IRR = 0.25, 75% reduction; P < 0.001). No statistically significant differences over time between groups were found for the number of times driving after simultaneous use of alcohol and cannabis.

CONCLUSIONS: A randomized clinical trial found that personalized feedback and motivational interviewing text messaging accelerated reductions in driving under the influence of cannabis at 3-month follow-up compared with controls, and personalized feedback alone showed delayed reductions in driving under the influence of cannabis at 6-month follow-up compared with controls.

PMID:42504715 | DOI:10.1111/add.70554

Acta Oncol. 2026 Jul 27;65:624-631. doi: 10.2340/1651-226X.2026.45981.

ABSTRACT

BACKGROUND AND PURPOSE: To compare follow-up preferences and health-related quality of life between newly operated endometrial cancer patients and those already enrolled in a traditional hospital-based follow-up program, and to explore whether preferences differ depending on follow-up experience. Patient/material and methods: In this prospective cross-sectional study, patients who underwent primary surgery for endometrial cancer in northern Sweden were included. Group 1 consisted of newly operated patients recruited before entering follow-up, and Group 2 included patients already participating in the standard hospital-based follow-up program. Participants completed questionnaires on sociodemographic characteristics, follow-up preferences, and quality of life (EORTC QLQ-C30). Clinical data were obtained from medical records. The primary outcome was follow-up preference; secondary outcomes included quality of life and associations with clinical and demographic variables.

RESULTS: Of the 121 invited patients, 92 (76%) responded, and 90 were included in the analysis (48 in Group 1; 42 in Group 2). The groups were comparable in baseline characteristics. Newly operated patients demonstrated more diverse follow-up preferences, with 51.1% preferring physician-led hospital visits compared to 82.9% in Group 2 (p = 0.035). Global quality of life did not differ significantly (p = 0.165), although Group 1 reported lower functional scores, particularly in role and emotional functioning. Appetite loss was the only symptom that differed significantly between groups.

INTERPRETATION: Newly operated patients are more open to alternative follow-up models despite similar overall quality of life. Integrating patient preferences into follow-up care may enhance personalization and sustainability.

PMID:42504700 | DOI:10.2340/1651-226X.2026.45981

Endokrynol Pol. 2026 Jul 27. doi: 10.5603/ep.112146. Online ahead of print.

ABSTRACT

INTRODUCTION: Among all RET proto-oncogene variants, Y791F has been the most controversial and widely debated with regard to itspathogenicity and clinical significance.

MATERIAL AND METHODS: Medical records of 104 RET Y791F variant carriers were retrospectively analyzed. The population comprised 30 probands with medullary thyroid carcinoma (MTC), 6 probands with pheochromocytoma, 63 family members, and 5 patients in whomthe RET Y791F variant was found during genetic screening. The characteristics of the 30 RET Y791F carriers with MTC were comparedwith those of the control group of 208 patients with sporadic MTC.

RESULTS: The median age at surgery in the 30 probands with MTC was 58 years (range: 20-79), and in the control group with sporadic MTC it was 55 years (range: 21-80), with no statistically significant difference (p = 0.16). Multifocal MTC was observed in 8 of 30 operatedprobands (26%) and in 29 of 208 patients (13.9%) with sporadic disease (p = 0.07). Prophylactic surgery was performed in 21 familymembers. No MTC was identified in the postoperative material. Among patients under surveillance, none of the RET Y791F carriersshowed any abnormalities on thyroid ultrasound or any increase in calcitonin concentration. None of the followed-up patients (except 6after adrenalectomy) was diagnosed with pheochromocytoma. None of the 104 RET Y791F carriers had hypercalcemia.

CONCLUSIONS: Based on our results, individuals with the RET Y791F variant do not require enhanced clinical surveillance or prophylactic intervention and should be managed according to general population guidelines, unless additional clinical indications arise.

PMID:42504689 | DOI:10.5603/ep.112146

Turk J Gastroenterol. 2026 Jul 21. doi: 10.5152/tjg.2026.26198. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: miR-143-5p functions as a tumor-suppressive microRNA across various cancer types. The current study investigated the expression, prognostic value, and role of miR-143-5p in colorectal cancer (CRC).

MATERIALS AND METHODS: The expression of miR-143-5p was measured by quantitative reverse transcription polymerase chain reaction. Associations between miR-143-5p expression and clinicopathological characteristics of patients with CRC were statistically analyzed. A series of in vitro cell-based assays were performed to investigate the underlying regulatory mechanisms.

RESULTS: miR-143-5p was downregulated in CRC and may serve as a promising independent prognostic biomarker. Reduced miR- 143-5p expression was associated with adverse clinicopathological characteristics and decreased 5-year overall survival. MYCBP was identified as a direct target of miR-143-5p. Overexpression of miR-143-5p suppressed the malignant behaviors of CRC cells, which were partially restored by enforced MYCBP expression.

CONCLUSION: miR-143-5p is downregulated in CRC and may function as a potential independent prognostic biomarker. Moreover, miR- 143-5p may play a tumor-suppressive role in CRC by specifically targeting MYCBP.

PMID:42504669 | DOI:10.5152/tjg.2026.26198

J Neurogastroenterol Motil. 2026 Jul 30;32(3):396-404. doi: 10.5056/jnm25126.

ABSTRACT

BACKGROUND/AIMS: : The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet is a well-researched treatment for diarrhea-predominant irritable bowel syndrome (IBS-D), but its value for constipation-predominant IBS (IBS-C) is uncertain. Clinicians may hesitate to recommend it for IBS-C, fearing it could worsen constipation or offer little relief. This study aims to assess the diet’s effectiveness across all IBS subtypes, specifically investigating its impact on stool patterns in IBS-C and the correlation with symptom relief.

METHODS: : This prospective service evaluation involved 294 IBS patients (84% female, mean age 44.6) attending dietitian-led group sessions on FODMAP restriction (baseline) and reintroduction (follow-up). The primary outcome was “satisfactory relief of gut symptoms” via the global symptom question; secondary outcomes included changes in stool consistency, IBS subtype, and gastrointestinal symptoms.

RESULTS: : At baseline, 23.8% (70/294) had IBS-C and 35.7% IBS-D (105/294). All subtypes except IBS-M showed significant symptom relief at follow-up (P < 0.001), with no statistically significant difference between IBS-C (50.7%, 35/69) and IBS-D (44.8%, 47/105) (P = 0.158). After FODMAP restriction, 50.7% (35/69) IBS-C remained IBS-C, while 44.9% (31/69) shifted to unclassified IBS (IBS-U). Those who shifted (IBS-C to IBS-U) reported greater relief (74.2%, 23/31 vs 45.7% 16/35, P = 0.019) and reduced pain (P = 0.006), unlike those who remained IBS-C (P = 0.180).

CONCLUSIONS: : IBS-C and IBS-D showed similar symptom relief after FODMAP restriction. Notably, 44.9% of IBS-C patients shifted to normal stool consistency (IBS-U), with greater symptom relief and reduced pain. FODMAP restriction does not necessarily exacerbate constipation in IBS-C and remains a viable treatment option in real world clinical practice.

PMID:42504656 | DOI:10.5056/jnm25126

Cancer Med. 2026 Aug;15(8):e72085. doi: 10.1002/cam4.72085.

ABSTRACT

Ibrutinib has demonstrated inhibition of ErbB/HER tyrosine kinases in preclinical models. This Phase I/II study investigated the safety, efficacy, and immunomodulatory effects of ibrutinib in combination with trastuzumab in patients with HER2-positive metastatic breast cancer (MBC) whose disease had progressed on ado-trastuzumab emtansine therapy. In Phase I, cohorts of three patients received ibrutinib 560 mg or 420 mg by mouth once daily combined with standard dosing of trastuzumab. Phase II enrolled additional patients to assess the primary endpoint of clinical benefit rate (CBR) at 420 mg ibrutinib plus trastuzumab. Flow cytometry and NanoString analyses were performed on peripheral blood mononuclear cells. Overall, 26 patients were enrolled. Patients received a median of three prior regimens containing a HER2-targeted therapy in any setting. The most common treatment-related adverse events were bruising, rash, fatigue, and thrombocytopenia. Four patients (15%) experienced cardiac adverse events, including decreased left ventricular ejection fraction in two patients. The CBR of ibrutinib plus trastuzumab was 19.2% (95% confidence interval: 6.6-39.4). Flow cytometry of T- and natural killer (NK)-cell and myeloid-cell panels showed that treatment statistically significantly decreased T helper 17 (T_H17) and myeloid-derived suppressor cells (MDSC) with no decrease in T helper 2 (T_H2) cells. Ibrutinib plus trastuzumab was well-tolerated but had limited anti-tumor activity in patients with heavily pretreated, HER2-positive MBC (NCT03379428). Trial Registration: Clinicaltrials.gov, NCT03379428.

PMID:42504645 | DOI:10.1002/cam4.72085

AIDS. 2026 Jul 24. doi: 10.1097/QAD.0000000000004584. Online ahead of print.

ABSTRACT

OBJECTIVES: To gain insight into HIV prevention pathways of individuals following pre-exposure prophylaxis (PrEP) care disengagement at the Center of Sexual Health in Amsterdam (CSHA), the Netherlands, to improve prevention services.

DESIGN: Cross-sectional study.

METHODS: CSHA clients disengaged from PrEP care were asked to complete an online survey (January-April 2025). The survey included open-ended, closed-ended, and multiple-choice questions on PrEP care discontinuation reasons at CSHA, continuing PrEP care elsewhere and sexual behavior. This was complemented by routine CSHA data. Data was analyzed using descriptive statistics, thematic analysis, and multivariable Bayesian logistic regression to identify determinants of non-PrEP-use elsewhere.

RESULTS: Of the 734 people who disengaged from PrEP care, 273 (37.2%) responded to the questionnaire. Changes in sexual behavior to reduce the chance of HIV acquisition was the main reason for discontinuation (n = 117, 62.6% of those with available data). Among respondents who confirmed their PrEP discontinuation at CSHA and were not living with HIV (n = 247), 82 (33.2%) could still benefit from PrEP. Of those, 56 (68.3%) continued PrEP use elsewhere, leaving a PrEP need of 31.7% (n = 26); 11 (13.4%) did not use any HIV prevention strategy. People who were lost-to-follow-up (i.e., stopping without notification) and ≤35 years old had higher odds of non-PrEP-use elsewhere.

CONCLUSIONS: Most PrEP discontinuations reflected periods without an indication for PrEP. Nevertheless, a substantial proportion of individuals who could benefit from PrEP reported not using HIV prevention after disengagement from PrEP care at CSHA. Our results highlight a need to support these individuals for re-engagement in care to reduce chance of acquiring HIV.

PMID:42504601 | DOI:10.1097/QAD.0000000000004584