Category: Nevin Manimala

Inquiry. 2025 Jan-Dec;62:469580251356131. doi: 10.1177/00469580251356131. Epub 2025 Jul 19.

ABSTRACT

Few studies assessing stress symptoms are specific to medical education, and even fewer are designed to determine which stressors affect medical students. It was aimed to adapt the Medical Student Stress Factor Scale (MSSF) into Turkish and to provide a valid and reliable tool to determine stress caused by medical education in medical students. Between January and May 2024, 632 medical students participated. The Depression Anxiety Stress Scale-21 (DASS-21), the MSSF, and a sociodemographic data form were used. The MSSF is a 7-point Likert-type scale with 28 items. Although individual item scores range from 1 to 7, the total and subscale scores are calculated by averaging item scores, resulting in an overall score range from 1 to 7. Test-retest, Cronbach α, Davis technique, exploratory and confirmatory factor analyses (EFA and CFA), Pearson correlation, and descriptive analyses were used. The scale’s Cronbach’s alpha was .937, and the Kaiser-Meyer-Olkin (KMO) coefficient was .935. The sphericity results of the Bartlett test were x^² = 9302.227, P < .001. In the CFA analysis, GFI = 0.814, CFI = 0.840, x^²/df = 3.108, and RMSEA = 0.081 were determined. The MSSF total and subscale scores were positively correlated with all DASS-21 subscales (P < .001), supporting the construct validity of the Turkish version of the scale. It was found that the validity and reliability analyses of the Turkish version of the MSSF were satisfactorily met.

PMID:40682447 | DOI:10.1177/00469580251356131

J Clin Endocrinol Metab. 2025 Jul 19:dgaf417. doi: 10.1210/clinem/dgaf417. Online ahead of print.

ABSTRACT

BACKGROUND: Total thyroidectomy requires lifelong levothyroxine (LT4) therapy. Achieving optimal thyroid hormone replacement at the first post-operative follow-up might be harder than it could be expected. Despite various LT4 dose choosing strategies were tested, there is no consensus on the most effective approach to achieve early euthyroidism.

MATERIALS AND METHODS: We performed a systematic review and meta-analysis, including studies published between 2000 and 2024 that reported the proportion of patients achieving euthyroidism at first follow-up after total thyroidectomy. Data from 11 studies comprising 2577 patients were analyzed. LT4 dosing strategies included fixed-dose, weight-based (dose/kg), and individualized algorithm-based methods. Meta-regression and subgroup analyses were used to explore sources of heterogeneity.

RESULTS: The pooled euthyroidism rate at first follow-up was 33.9%, with high heterogeneity across studies (I² = 82.68%). No dosing strategy consistently outperformed others: dose/kg methods achieved 29% euthyroidism, while fixed or algorithm-based approaches achieved 40%, though without statistical significance. Meta-regression analysis did not identify any statistically significant predictor. No significant differences emerged between patients treated for benign or malignant thyroid diseases or between retrospective and prospective study designs.

CONCLUSIONS: Only about one-third of patients achieve euthyroidism at first follow-up after thyroidectomy, regardless of LT4 dosing strategy. The current guidelines recommendation of applying a pro/kg dose may not be adequate, and even personalized algorithms yield inconsistent results. Future prospective studies are needed to refine individualized dosing protocols and identify additional factors influencing LT4 requirements.

PMID:40682434 | DOI:10.1210/clinem/dgaf417

J Geriatr Psychiatry Neurol. 2025 Jul 19:8919887251362470. doi: 10.1177/08919887251362470. Online ahead of print.

ABSTRACT

ObjectiveAnosognosia for memory deficits is frequently observed in patients with Alzheimer’s disease (AD). Despite its relevance, this phenomenon is understudied in individuals with Mild Cognitive Impairment (MCI). People with MCI often struggle to update self-referential beliefs about memory functioning. Nonetheless, findings on error monitoring capacity are mixed and methodologically weak, especially in visuospatial tasks. Here, we investigated online metamemory appraisal for verbal and visuospatial material in patients with MCI due to AD. The potential diagnostic utility of metamemory accuracy was evaluated.MethodsSixteen patients with MCI and 19 healthy controls completed metamemory tasks involving predictions on list and position memory performance. Metamemory accuracy was quantified using the Objective Judgment Discrepancy (OJD) index, the percentage difference between predicted and actual performance. Linear mixed-effects models were used to analyze main effects and interactions.ResultsCompared to controls, patients overestimated their memory performance (P < 0.001, d = 0.51), with greater overestimation in the visuospatial task (P < 0.001, d = 0.57). After adjusting for cognitive functioning, only overestimation in visuospatial memory persisted. Visuospatial OJD correlated significantly with executive and visuospatial abilities (all rho ≥ -0.50, P < 0.05). Clinimetric analyses highlighted visuospatial OJD as a promising marker for diagnostic use (AUC = 0.814, P < 0.001, sensitivity = 0.67, specificity = 0.95).ConclusionOverestimation in verbal memory reflects a statistical artifact consistent with the Dunning-Kruger effect. A selective metacognitive deficit was found in visuospatial memory. Our results support the view of AD as a visuospatial-driven disease and underscore the diagnostic potential of visuospatial metamemory assessments.

PMID:40682426 | DOI:10.1177/08919887251362470

Laryngoscope. 2025 Jul 19. doi: 10.1002/lary.32426. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the role of fine needle aspiration thyroglobulin (FNA-TG) and fine needle aspiration cytokeratin 19 fragment antigen 21-1 (FNA-CYFRA 21-1) in the diagnosis of cervical lymph node metastasis of differentiated thyroid carcinoma (DTC), then analyze whether different neck lymph node compartmentalization affected the cut-off values of FNA-TG and FNA-CYFRA 21-1.

METHODS: One hundred and sixteen lymph nodes with suspicious ultrasound signs between September 2023 and September 2024 were analyzed, and the lymph nodes were classified into central lymph nodes and lateral neck nodes, and all lymph nodes underwent fine needle aspiration cytology (FNAC), FNA-TG, and FNA-CYFRA 21-1 preoperatively. Differences in the levels of FNA-TG and FNA-CYFRA 21-1 in the lateral neck nodes and central lymph nodes were analyzed, and the optimal cut-off values of the two were calculated to further analyze the value of FNAC, FNA-TG, and FNA-CYFRA 21-1 for diagnosis alone and in combination.

RESULTS: In the non-metastatic lymph node group, the difference in FNA-TG levels between the lateral neck zone and the central zone was statistically significant. The levels of FNA-CYFRA 21-1 were not affected by the zoning of the cervical lymph nodes. In the lateral neck region, the area under the diagnostic curve was highest for the combination of the three.

CONCLUSIONS: FNA-CYFRA 21-1 is valuable in DTC cervical lymph node metastasis and can assist in the diagnosis of FNAC and FNA-TG, especially in suspected centralized lymph nodes that are not diagnosed preoperatively.

PMID:40682374 | DOI:10.1002/lary.32426

Expert Rev Gastroenterol Hepatol. 2025 Jul 19. doi: 10.1080/17474124.2025.2537187. Online ahead of print.

ABSTRACT

BACKGROUND: Gender disparity has been documented in celiac disease (CD) with a female (F)-to-male (M) ratio of 2-2.5:1. Studies examining gender differences have yielded conflicting results.

AIMS: To investigate gender differences in clinical presentation at diagnosis, adherence to gluten-free diet (GFD), modification of clinical symptoms with the GFD in adult CD patients.

METHODS: Single-center retrospective study, including all consecutive CD patients referred to our Center between September 2022-July 2024.

RESULTS: 191 patients, 141 F/50 M, mean age at diagnosis of 35.4/37.4 years were included. In 59% F/54% M the diagnosis was prompted by gastrointestinal symptoms. At the diagnosis 13 F (9.1%), 11 M (22%) were asymptomatic. Extra-intestinal manifestations were reported by 34 women (23.9%), 6 men (12%). A low/absent adherence to GFD was reported by 17 women (12%), 9 men (18%). Statistically significant differences were found regarding the prevalence of bone mineral density alterations ( > in M, p-value = 0.017) and the degree of duodenal damage at the diagnosis ( > in F, p-value = 0.021).

CONCLUSIONS: Only slight discrepancies in the clinical presentation at CD diagnosis between the two genders were identified, which are mostly resolved with the GFD. No significant difference with regard to dietary adherence between F/M was found.

PMID:40682368 | DOI:10.1080/17474124.2025.2537187

Womens Health (Lond). 2025 Jan-Dec;21:17455057251347717. doi: 10.1177/17455057251347717. Epub 2025 Jul 19.

ABSTRACT

BACKGROUND: An alarming observation from high-volume obstetric facilities in Nepal indicating a decreased institutional delivery rate and increased institutional neonatal mortality rate after the initial nationwide lockdown signaled the adverse population-level impact of the pandemic on the national trajectory of neonatal survival.

OBJECTIVES: We aimed to estimate the impact of change in institutional delivery coverage on cause-specific neonatal mortality during the coronavirus disease 2019 pandemic in Nepal.

DESIGN: Modeling-based study.

METHODS: We used the open-access Lives Saved Tool, based on a linear deterministic mathematical model validated for estimating cause-specific neonatal mortality in low- and middle-income countries, to estimate the number of additional neonatal lives saved and neonatal mortality rates. Using coverage change in institutional delivery rates as a proxy for interventions during childbirth, we compared the estimates using ‘reported’ coverage change during the pandemic with the ‘targets’ per Nepal Every Newborn Action Plan.

RESULTS: The projected number of additional neonatal lives saved when the pandemic hit the hardest (Nepalese fiscal year 2020-2021) when national annual institutional delivery rate reportedly decreased was lower (104; 95% confidence interval: 69-148) compared to the target scenario (222; 95% confidence interval: 152-313). However, in the next year 2021-2022 when the institutional delivery rate increased, the number was higher (926; 95% confidence interval: 643-1295) compared to target scenario (329; 95% confidence interval: 226-466). The trajectory of the projected neonatal mortality rate per 1000 live births reversed (increased to 20.18) in 2020-2021 compared to 20.11 in 2019-2020 and then tracked down to 18.75 in 2021-2022. Most newborn lives would be saved from asphyxia, sepsis, and prematurity-related complications. Neonatal resuscitation, thermal protection, and cord care are the top three lifesaving interventions during childbirth.

CONCLUSION: Neonatal survival in Nepal was adversely impacted during the peak of the coronavirus disease 2019 pandemic, with a favorable bounce back next year, based on the Lives Saved Tool projection per change in institutional delivery coverage.

PMID:40682341 | DOI:10.1177/17455057251347717

Cancer Med. 2025 Jul;14(14):e71072. doi: 10.1002/cam4.71072.

ABSTRACT

BACKGROUND: CAR-T therapy is approved for the treatment of relapsed refractory multiple myeloma (MM) and is being studied for newly diagnosed MM (NDMM). The use of novel therapies in early-line MM raises questions on the acceptability of upfront risks in exchange for extended relapse-free periods without the treatment burden and limitations on daily activities associated with maintenance therapy.

METHODS: A discrete-choice experiment was designed to elicit adults’ preferences for hypothetical NDMM treatments. Benefits included time to relapse and reduction of treatment impact on daily activities. Severe adverse events were included to better understand patient preferences for rare but significant events.

RESULTS: On average, extending the time to relapse from 3 years (with moderate limitations on daily activities) to 5 years (without limitations) was three times more important than avoiding a 20% risk of hospitalization due to severe ICANS/CRS. Analysis revealed three latent preference classes: a benefit-risk trading class (65%), a class (28%) unwilling to accept increases in short-term treatment-related mortality, and a class (7%) that provided statistically uninformative data. For the trading class, for two additional relapse-free years with minor limitations, all else equal, patients would accept up to a 30% risk of severe ICANS/CRS-related hospitalization along with 0% risk of treatment-related mortality. Alternatively, they would accept up to an 8% risk of treatment-related mortality with a 0% risk of severe ICANS/CRS-related hospitalization, or various combinations of lower AE risks.

CONCLUSION: These results reveal preference heterogeneity among MM patients and the importance of effective communication about the benefits and risks of novel therapies.

PMID:40682335 | DOI:10.1002/cam4.71072

J Adv Nurs. 2025 Jul 19. doi: 10.1111/jan.70098. Online ahead of print.

ABSTRACT

AIM: To better understand what enables evidence-based practice, this study investigated contextual factors influencing evidence-based practice in general, and in relation to the implementation of bladder-monitoring guidelines in orthopaedic care.

DESIGN: Convergent parallel mixed method.

METHODS: This study was part of a hybrid research project across 17 Swedish orthopaedic sites. The data collection (2021-2023) included interviews with orthopaedic staff and patients post-hip surgery, patient survey free-text responses, and a staff survey on organisational context. Data were analysed with deductive content analysis and descriptive statistics, later integrated using a mixed methods approach.

RESULTS: Evidence-based practice was supported by context factors such as staff collaboration and multiprofessional engagement. Staff addressed patient safety and equality by using evidence-based guidelines, but rarely involved the patients. Orthopaedic fast-track procedures positioned patients as passive recipients, while staff voiced a call for a more person-centred context. Positive attitudes, leadership engagement, use of champions, and adequate staffing enabled evidence-based practice, though a shortage in evaluation and high staff turnover hindered its implementation.

CONCLUSION: Orthopaedic context is characterised by several enabling organisational context factors for evidence-based practice, although patients lacking recognition of their needs and queries justify greater focus on person-centredness and mutual information exchange. Audit and feedback are crucial for improvements, but were lacking in the orthopaedic care context.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Assessments of efforts made to implement evidence-based practice and its outcomes should incorporate nursing care. Slimmed care processes require attention to ensure patient participation.

IMPACT: The orthopaedic care context is enabling for evidence-based practice, although staff are challenged by fast-track procedures with extensive information exchange and insufficient person-centredness.

REPORTING METHOD: The Mixed Methods Reporting in Rehabilitation & Health Sciences checklist.

PATIENT OR PUBLIC INVOLVEMENT: No patient or public contribution.

TRIAL REGISTRATION: Identifier: NCT04700969.

PMID:40682329 | DOI:10.1111/jan.70098

Nutr Clin Pract. 2025 Jul 19. doi: 10.1002/ncp.11352. Online ahead of print.

ABSTRACT

BACKGROUND: Hospital nutrition services rarely offer Indigenous-specific menu options, an essential element of delivering “Indigenous cultural safety” in nutrition care to Indigenous patients.

METHODS: Indigenous participants (n = 370) completed a semistructured Indigenous Food Ways survey (paper-based and online) from 2021 to 2022 as part of continuous healthcare quality improvement. Descriptive statistics summarized cultural/traditional foods respondents wanted to see or did not want to see as options on hospital menus.

RESULTS: A majority of respondents (83%) agreed that a menu option for cultural/traditional foods was important, with 716 unique items reported. Seafood and meat/alternatives were common cultural/traditional items for menu options, specifically salmon (22%), traditional meat (14%), moose (12%), and venison (12%). Grain items reported were mostly Bannock (22%). Nearly 20% of the sample listed traditional foods, medicine, or tea as options for hospital menus. Respondents identified 254 items they did not want to see on hospital menus, which were commonly energy-dense/processed foods (16%) or poorly prepared/flavored items (13%), as well as peas and carrots (7%). Notably, some foods (eg, Bannock, salmon, fish eggs) were listed among both desired and not desired menu options.

CONCLUSION: Results showed that offering cultural or traditional foods on hospital menus is considered important by Indigenous people, and that a wide range of foods would be desired. Specific cultural foods to include on menus were salmon, traditional meats, or traditional teas. Foods not to include were also identified. Improving future nutrition care and services will require menu modifications to provide culturally safe options for Indigenous patients.

PMID:40682323 | DOI:10.1002/ncp.11352

J Interpers Violence. 2025 Jul 18:8862605251350127. doi: 10.1177/08862605251350127. Online ahead of print.

ABSTRACT

To align with emerging policies for adolescents, feasible, accurate, and equitable trauma-focused assessment protocols need to be developed. To date, most research on this topic has focused on whether traditional adverse childhood experiences (i.e., maltreatment, impaired caregiving) can adequately index mental health risk. Yet, there are noted clinical and statistical drawbacks to this approach. Instead, examining threat and reward biases, two subtypes of cognitive biases stemming from interpersonal trauma exposure, may provide a reasonable alternative to adversity screening. Thus, the aim of this study was to examine the accuracy and fairness of self-reported, trauma-informed cognitive vulnerabilities for classifying concurrent and prospective adolescent mental health risk relative to more commonly assessed childhood adversities. In a diverse adolescent sample (N = 584; M_Age = 14.43; 48.9% female; 35% African American; 38.5% White; 40% Hispanic) youth completed measures for adversity exposure (family, dating, and community violence), threat biases (posttraumatic cognitions, hostility), and reward biases (anticipatory, consummatory) during an initial assessment, as well as symptoms of posttraumatic stress (PTS), depression, and violent behavior at baseline and 1 year later. Indices of statistical discrimination, calibration, and statistical fairness were examined using an evidence-based medicine analytic approach, which was subsequently compared to a machine learning approach. Overall, posttraumatic cognitions emerged as an accurate and statistically fair predictor of prospective PTS (area under the curve [AUC]_{95% CI} = [0.63, 0.78]; diagnostic likelihood ratio [DLR]_{95% CI} = [1.32, 3.52]), and to a lesser extent depression (AUC_{95% CI} = [0.56, 0.70]; DLR_{95% CI} = [1.25, 2.98]), and both models were well calibrated (i.e., p-value >05 for Spiegelhalter’s Z test). Meanwhile, community violence (CV) exposure best classified the risk for prospective violent behavior (AUC_{95% CI} = [0.62, 0.73]; DLR_{95% CI} = [2.68, 5.49]), especially in males, and was well calibrated. The machine learning algorithms added limited incremental validity to our predictions. Our study suggests that focusing on posttraumatic cognitions and less invasive adversity items (i.e., CV exposure) may lead to trauma screening and assessment protocols that are accurate, equitable, and feasible to implement within applied settings serving diverse youth.

PMID:40682318 | DOI:10.1177/08862605251350127