Category: Nevin Manimala

BMC Psychol. 2026 Jun 5. doi: 10.1186/s40359-026-04405-9. Online ahead of print.

ABSTRACT

BACKGROUND: Anxiety reduction is an objective that should be part of each patient’s care plan. The aim of this study was to develop, implement, and evaluate an anxiety management program for women under gynecological surgery with spinal anesthesia based on the participatory action research using PARIHS framework.

METHODS: This participatory action research was conducted from 2020 to 2023 in a referral gynecological surgery center in northeastern Iran and followed four phases: (1) problem identification using interviews, observations, literature review, and Numeric Visual Analog Anxiety Scale (NVASA); (2) planning through 16 expert panel and stakeholder sessions to design feasible evidence-based actions; (3) action, implemented in three cycles targeting healthcare providers, the environment, and patients; and (4) evaluation, was conducted by using NVASA measurements across cycles and assessments of communication skills and stress among healthcare providers. Data were analyzed using conventional content analysis for qualitative findings and paired statistical tests for quantitative outcomes.

RESULTS: Data analysis from interviews and observations in the first phase of the research process, led to the emergence of 20 subcategories and 6 main categories. A comprehensive literature review further delineated three intervention categories: healthcare provider, patient, and environmental interventions, along with 13 subcategories. In the main evaluation of the effectiveness of the cycles of action phase, mean anxiety score of patients before the interventions were 6.1 ± 1.9, and after the interventions of the health care providers, environment, and patient was 4.66 ± 2.17, 2.86 ± 1.79, and 2.64 ± 1.2, respectively, which had a statistically significant difference (p < 0.001).

CONCLUSIONS: Anxiety management program based on action research steps has reduced anxiety in patients of study, the application of the anxiety management program with the participation of patients and healthcare providers in the context with a combination of extracted evidence led to the change in the attitude of the stakeholders.

PMID:42249493 | DOI:10.1186/s40359-026-04405-9

BMC Health Serv Res. 2026 Jun 5. doi: 10.1186/s12913-026-14843-1. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence based medicine is a critical cornerstone in contemporary medicine, yet uptake and adoption of evidence remain suboptimal. This is prominent in many fields of healthcare, including musculoskeletal health and surgery. Understanding the drivers of this translational lag is critical to ensure high-quality care and improved patient outcomes.

METHODS: A survey questionnaire, informed by the Theoretical Domains Framework was distributed to musculoskeletal clinicians and healthcare professionals, including surgeons, physiotherapists and nurses, around Australia. We assessed the barriers and enablers to translating evidence into practice, preferred sources of evidence for clinical decision-making, and the main drivers of change and improving implementation. Quantitative data were analysed using descriptive statistics and qualitative data were assessed using inductive thematic analysis.

RESULTS: 771 clinicians were invited to participate, of whom 82 completed the survey. Participants were from Australia and covered a range of disciplines, including surgeons, nurses and physiotherapists. In general, participants were supportive of evidence-based medicine and more than 90% agreed that engagement with literature was essential for determining the best treatment options. All respondents also considered delivery of evidence-based care to be a professional responsibility. Nonetheless, multiple barriers to translating evidence into practice were identified: poor support from leadership and professional culture (n=33, >40%), policy reform (n=18, >20%), improving access to research and the prioritisation of clinically relevant and practical evidence (n=25, >30%).

CONCLUSION: This survey study highlights the barriers surrounding the translation of research evidence into musculoskeletal care. Improving implementation will require multifaceted strategies including building stronger clinical and executive leadership, fostering supportive professional cultures and updating policy frameworks. Future research should evaluate these approaches to determine the most effective method for embedding evidence-based medicine into routine musculoskeletal care.

PMID:42249490 | DOI:10.1186/s12913-026-14843-1

J Cardiothorac Surg. 2026 Jun 5. doi: 10.1186/s13019-026-04288-2. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to investigate the temporal biological distribution characteristics of acute aortic dissection (AAD) onset in East China, analyze differences in onset patterns between patients with different types (Stanford Type A and Type B) and genders, and provide regional epidemiological evidence to inform our understanding of the temporal distribution of AAD in East China.

METHOD: Clinical data were retrospectively collected from 1,038 patients with confirmed AAD diagnosed between January 2009 and September 2025. SPSS 27.0 software was employed to analyze temporal distribution patterns of onset, including seasonal, monthly, weekly, and daily rhythmic characteristics, whilst investigating the influence of gender and disease subtype on temporal biological features.

RESULT: A total of 1,038 patients with AAD were included, comprising 571 cases (55.0%) of Stanford Type A AAD and 467 cases (45.0%) of Stanford Type B AAD; 767 were male (73.9%), with a mean age of 55.7 ± 13.5 years. Circadian patterns showed that 17:00-20:00 was the peak period for onset (21.4%), whilst 01:00-04:00 was the trough (12.5%); females exhibited more pronounced fluctuations across certain time scales. Regarding weekly distribution, Stanford Type B cases had the lowest proportion on Saturdays (11.8%); the weekly distribution of female patients showed a certain degree of variation. At the monthly and seasonal levels, cases were concentrated in January, February, March, November and December; the incidence was highest in winter (32.6%), followed by autumn (25.4%), spring (24.6%) and summer (17.4%). Seasonal differences were statistically significant (P < 0.0001), and the seasonal fluctuations in Stanford Type A AAD were greater than those in Stanford Type B AAD. Furthermore, significant differences were observed between patients of different subtypes in terms of gender distribution, history of smoking and alcohol consumption, and the prevalence of comorbidities (P < 0.05).

CONCLUSION: The incidence of AAD in East China exhibits distinct circadian patterns, with potential variations across different subtypes and gender groups at certain temporal scales. These findings provide an epidemiological basis for understanding the temporal distribution of AAD incidence in East China and for the preparation of clinical resources.

PMID:42249482 | DOI:10.1186/s13019-026-04288-2

J Cardiothorac Surg. 2026 Jun 5. doi: 10.1186/s13019-026-04397-y. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to investigate the impacts of various body mass index (BMI) classifications on perioperative parameters and short-term outcomes in patients undergoing Da Vinci robot-assisted atrial septal defect (ASD) repair providing evidence for personalized perioperative management.

METHODS: A retrospective analysis was conducted on 100 patients who underwent Da Vinci robot-assisted ASD repair at Qingdao University Affiliated Hospital between November 2014 and December 2025. Based on the Chinese adult BMI classification criteria, the patients were categorized into four groups: underweight group (BMI < 18.5 kg/m², n = 9), normal weight group (18.5 ≤ BMI < 24.9 kg/m², n = 52), overweight group (25.0 ≤ BMI < 29.9 kg/m², n = 26), and obese group (BMI ≥ 30.0 kg/m², n = 13). This study compared baseline characteristics, intraoperative indicators, postoperative recovery, and short-term prognosis across these groups. Furthermore, multivariate logistic regression analyzed the independent associations of BMI classification and age with postoperative surgical site infection and hospital readmission.

RESULTS: No significant differences were observed among the four groups concerning baseline echocardiographic parameters, key intraoperative metrics (e.g., operation duration, cardiopulmonary bypass time), or most postoperative recovery measures (e.g., mechanical ventilation duration, length of intensive care unit stay), with all P > 0.05. No sternotomy conversion or early mortality occurred. Univariate analysis showed the obese group had significantly higher rates of surgical site infection (15.4%) and readmission (23.1%) (all P < 0.05), but multivariate regression did not identify BMI classification or age as independent predictors (all P > 0.05).

CONCLUSION: Da Vinci robot-assisted ASD repair is safe and effective across different BMI levels, with its minimally invasive nature appearing to mitigate weight-related surgical challenges within this cohort. Although obese patients face higher risks of postoperative infection and readmission, BMI was not found to be an independent influencing factor in this exploratory analysis; however, small subgroup sizes and sparse data limit the statistical reliability of this finding. Individualized enhanced perioperative management for obese populations is recommended, and weight status should not be a contraindication for this procedure.

PMID:42249473 | DOI:10.1186/s13019-026-04397-y

J Cardiothorac Surg. 2026 Jun 5. doi: 10.1186/s13019-026-04345-w. Online ahead of print.

ABSTRACT

BACKGROUND: Allogeneic blood is a limited and globally scarce resource. Protocols based on the Patient Blood Management (PBM) program, incorporating therapeutic alternatives to reduce the use of red blood cells (RBCs), fresh frozen plasma (FFP), and platelet concentrates (PCs), have become urgently needed. The aims of this study were: as a primary objective, to evaluate whether the implementation of a Patient Blood Management (PBM) protocol reduces allogeneic transfusion in patients undergoing coronary artery bypass grafting (CABG); and as a secondary objective, to assess the impact of transfusion on clinical outcomes and mortality following CABG surgery.

METHODS: The study analyzed patients ≥ 18 years undergoing isolated and elective on-pump coronary artery bypass grafting (CABG), including both arterial and venous grafts. Data were retrospectively collected for two distinct periods, forming two groups: Pre-PBM (2010) and Post-PBM (2012), based on the implementation of a multidisciplinary PBM protocol aimed at optimizing erythropoiesis, hemostasis, and physiological tolerance to anemia. Statistical analyses included between-group comparisons, correlation analyses, and multiple regression to identify independent predictors of increased mortality. Statistical significance was defined as a p-value < 0.05.

RESULTS: A total of 3,564 patients undergoing CABG were stratified into the Pre-PBM (n = 2,150) and Post-PBM (n = 1,414) groups. Implementation of a PBM protocol was associated with a significantly reduced allogeneic transfusions-RBC (62.7% to 48.4%), FFP (13.1% to 6.7%), and PC (5.4% to 3.0%) (p < 0.001). Mortality decreased from 4.5% to 3.1% (p = 0.042), with lower deep sternal wound infection rates (p < 0.001). Transfusion was an independent risk factor for increased mortality, with RBC (OR 3.63, 95% CI 2.20-5.99, p < 0.001), FFP (OR 5.69, 95% CI 3.91-8.27, p < 0.001), and PC (OR 6.45, 95% CI 4.07-10.24, p < 0.001) therapy demonstrating a dose-dependent association. Even in low-risk patients (EuroSCORE ≤ 2), allogeneic transfusion was associated with a significantly higher mortality (p < 0.001).

CONCLUSIONS: Implementing a PBM protocol was associated with significant reductions in blood transfusions, infection rates, and mortality following CABG. Allogeneic transfusion was a strong predictor of adverse outcomes, including higher mortality, supporting the routine use of PBM strategies in CABG.

PMID:42249468 | DOI:10.1186/s13019-026-04345-w

Trials. 2026 Jun 5. doi: 10.1186/s13063-026-09828-8. Online ahead of print.

ABSTRACT

BACKGROUND: Prior distributions must be specified for the parameters of interest in a Bayesian clinical trial. When existing evidence on the effects of the trial interventions is limited or inconclusive, prior distributions can be constructed with expert elicitation. However, conventional elicitation requires face-to-face interactions and intensive pre-elicitation training, which can be infeasible and costly. Our remote elicitation was based on an established expert elicitation methodology, and we incorporated bivariate prior distributions to introduce dependencies between the elicited probabilities. We aimed to elicit a prior distribution for the Croup Dosing Trial, which assesses the efficacy of two separate doses of dexamethasone on the number of return visits to the emergency department within 7 days in children with croup. This trial evaluates the non-inferiority of 0.15 mg/kg of dexamethasone, compared to the standard dose of 0.60 mg/kg to treat croup.

METHODS: We conducted three remote workshops to elicit expert beliefs on the efficacy of the two doses of dexamethasone. Each workshop consisted of two survey rounds, separated by a group discussion. Prior to the workshop, experts reviewed the same current literature that was provided on the effects of the two doses of dexamethasone. Beliefs were aggregated using expert-specific bivariate distributions with latent effects. The aggregated distribution, along with the surveyed non-inferiority margin, determined the sample size for the Bayesian non-inferiority trial design.

RESULTS: Twelve emergency medicine physicians participated in our remote elicitation exercise. The elicitation generated a prior distribution centered at 6% for the 0.60 mg/kg dose and 8% for the 0.15 mg/kg dose. The aggregated prior distribution produced a sample size of 1850, based on a non-inferiority margin of 4%.

CONCLUSIONS: We elicited a prior distribution that incorporated past evidence and expert opinion. The elicited prior is consistent with previous literature on the efficacy of the dexamethasone doses in treating croup. Our approach demonstrates the feasibility of remotely eliciting bivariate distributions to design clinical trials.

TRIAL REGISTRATION: NCT06272383 (Registered May 8, 2024).

PMID:42249465 | DOI:10.1186/s13063-026-09828-8

BMC Psychol. 2026 Jun 5. doi: 10.1186/s40359-026-04843-5. Online ahead of print.

ABSTRACT

PURPOSE: Emotional contagion, which is known as individuals unknowingly experiencing similar emotions, may cause fear of contagion and transmission in the presence of communicable diseases. This study aimed to evaluate the effect of emotional contagion on the fear of contracting or transmitting communicable diseases.

METHOD: This study employed a mixed-methods approach, conducted in December 2022. The quantitative dimension of the study was completed with 509 students, and the qualitative dimension with 49 university students. Data were collected with emotional contagion and fear of contagion/transmission scales. Pearson Correlation and linear regression were used to analyze quantitative data. Qualitative data were analyzed using descriptive analysis.

RESULTS: The mean score of the emotional contagion scale was 2.96 ± 0.49, and the mean score of the fear of contagion/transmission scale was 89.65 ± 16.58. A weak positive correlation was found between emotional contagion and fear of contamination. It was found that emotional contagion predicts fear of infection/transmission at a statistically significant level, though with a low effect size (r = 0.29). A total of 16 main themes were reached in the qualitative dimension of the study. The themes were as follows: fear, a compulsory process, taking precautions, danger to society, not finding it scary, disruption in social life, importance of hygiene, maintaining social distance, use of masks, strengthening immunity, negative psychological impact, negative social impact, negative physical impact, turning to positive thoughts, uneasiness, fear of the future and a normal process.

CONCLUSION: This study highlights the significance of emotional contagion in shaping the fear of contracting communicable diseases.

PMID:42249459 | DOI:10.1186/s40359-026-04843-5

BMC Pharmacol Toxicol. 2026 Jun 5. doi: 10.1186/s40360-026-01159-3. Online ahead of print.

ABSTRACT

BACKGROUND: Individual variability of therapeutic response and adverse effects of diazepam is frequently observed in pediatric cohorts. It might be related to the genetic polymorphisms in cytochrome P450 2C19 (CYP2C19), a principal enzyme mediating diazepam metabolism.

OBJECTIVES: To investigate the association between CYP2C19*2 (c.681G > A), CYP2C19*3 (c.636G > A), and CYP2C19*17 (-806 C > T) polymorphisms and clinical outcomes-specifically treatment efficacy and respiratory adverse effects-following intravenous diazepam administration in children with seizures.

METHODS: This prospective, single-center cohort study enrolled 100 pediatric patients (0-18 years) treated with IV diazepam for febrile/afebrile seizures. Genetic analysis was performed using next-generation sequencing. Clinical endpoints included seizure control following one or two diazepam doses and the incidence of respiratory complications. Statistical analyses assessed associations between CYP2C19 genotypes and seizure control outcomes.

RESULTS: The median age was 4.5 years (IQR: 2.4-8.5); 61% were male. Overall, seizure cessation was achieved in 76% with the first dose of IV diazepam and in 79% cumulatively. Respiratory side effects were observed in 15% of patients, with 9% requiring positive pressure ventilation. The CYP2C19*2 and CYP2C19*17 alleles were identified in 19% and 49% of participants, respectively. However, the CYP2C19*3 variant was absent. Notably, the presence of the CYP2C19*17 CT/TT genotype-particularly in combination with the CYP2C19*2 GG genotype-was significantly associated with both diazepam treatment failure (p = 0.038) and increased risk of respiratory adverse effects (p = 0.005).

CONCLUSION: This study is the first to delineate the clinical relevance of CYP2C19 polymorphisms in a Turkish pediatric population treated with diazepam. The findings underscore the potential utility of pharmacogenetic profiling to predict therapeutic response and enhance the safety of benzodiazepine use in pediatric seizure management.

PMID:42249455 | DOI:10.1186/s40360-026-01159-3

Arthritis Res Ther. 2026 Jun 6. doi: 10.1186/s13075-026-03834-6. Online ahead of print.

ABSTRACT

OBJECTIVES: To propose and evaluate a CDASI-informed, medical-record-based site-by-lesion cutaneous phenotyping framework for anti-MDA5-positive dermatomyositis, using established systemic and immunological markers as reference anchors to examine whether this framework provides additional phenotypic resolution beyond conventional binary skin assessment.

METHODS: This single-centre retrospective cross-sectional study enrolled 339 anti-MDA5-positive DM patients. Cutaneous involvement was coded as binary ulceration, itch, and scale features across seven prespecified anatomical regions. The framework was CDASI-informed but did not use formal CDASI activity or damage scores. FLATCAN components, PAH, IgG, and IgM were used as systemic and immunological reference markers. Analyses included FDR-corrected univariate screening, hypothesis-driven multivariable association models, restricted cubic spline analysis, exploratory internal model-performance summaries, cross-correlation SVD (CC-SVD), and exploratory clustering.

RESULTS: The framework revealed complementary skin-systemic association patterns. First, the spatial extent of ulceration refined a conventional binary ulcer signal: any cutaneous ulceration was associated with CD8 + T-cell depletion (OR = 3.35, P < 0.001; FDR q = 0.026), and ulcer site count remained independently associated with CD8 + depletion (OR = 1.43 per site, P = 0.008). Second, anatomical location contributed distinct information: facial ulceration was associated with PAH (OR = 2.28, P = 0.003) more strongly than overall ulcer site count. Third, lesion-feature type separated different immunological patterns, with ulceration preferentially associated with CD8+/IgG-related signals and itch with IgM-related signals. CC-SVD organised these observations into exploratory dimensions, including a bootstrap-stable facial involvement-PAH/infection dimension and a statistically less stable acral ulcer-CD8+/IgG dimension.

CONCLUSION: Site-by-lesion cutaneous phenotyping may provide a useful framework for studying phenotypic heterogeneity in anti-MDA5-positive dermatomyositis. The observed associations are exploratory and require prospective validation using standardised skin assessment and clinical outcome follow-up.

PMID:42249434 | DOI:10.1186/s13075-026-03834-6

BMC Oral Health. 2026 Jun 5. doi: 10.1186/s12903-026-08783-9. Online ahead of print.

ABSTRACT

BACKGROUND: Despite National Oral Health Programme launched in India significant knowledge-practice gaps persist in rural populations. This study evaluates oral health literacy, behavioural determinants, and clinical outcomes among rural Odisha residents using contemporary health behaviour frameworks. However, evidence on behavioural pathways and public dental service utilisation under NOHP in rural populations remains limited.

METHODS: A community based cross-sectional study was conducted among 417 adults (≥ 18 years) through two-stage stratified random sampling in Satyabadi Block, Puri District (May-September 2024). Data was collected using a validated 20-item questionnaire assessing knowledge, attitudes and practices (KAP) regarding National Oral Health Programme (NOHP) and WHO 2013 for oral health examination. Statistical analyses included descriptive statistics, regression models, and structural equation modelling (SEM) to examine complex pathways linking knowledge, attitudes, practices, and clinical outcomes.

RESULTS: Oral health program knowledge was low (6.7%), while attitudes were favourable (75.5-84.7%). Despite this, service utilisation remained minimal (2.4%). Mean DMFT was 3.69 ± 1.80. SEM showed significant pathways from knowledge to practice (β = 0.458, p < 0.001), explaining 34.2% of variance in behaviour. A substantial knowledge-practice gap (95.2%) was observed.

CONCLUSIONS: This study reveals a critical “know-do” gap where favourable attitudes fail to translate into preventive behaviours or service utilization. Structural barriers like geographic isolation, financial constraints, poor infrastructure may play a dominant role in individual-level factors. Multi-level interventions addressing systemic barriers, community health worker training, mobile dental units and behaviour change communication are imperative for NOHP effectiveness. Findings suggest that utilisation is likely influenced by structural barriers such as accessibility and service availability.

PMID:42249431 | DOI:10.1186/s12903-026-08783-9