Category: Nevin Manimala

CPT Pharmacometrics Syst Pharmacol. 2026 Jun;15(6):e70281. doi: 10.1002/psp4.70281.

ABSTRACT

Clinical trials in asthma and chronic obstructive pulmonary disease often use exacerbation risk as the primary endpoint. However, exacerbations occur with low frequency, leading to long and costly clinical trials. Home-measured spirometry, which is becoming more common, provides an alternative and has previously been used to shorten the necessary trial duration. In this work, we develop a mixed-effects hidden Markov model (MEHMM) for analyzing home-measured peak expiratory flow (PEF), combining an observation model with a latent two-state disease process representing sustained periods of high and low PEF, respectively. An inference framework is implemented to estimate fixed and random effects together with measures of uncertainty. Data from a phase 2b dose-finding study of velsecorat in asthma are used to investigate dose-response relationships, complemented by an extensive simulation study. The results demonstrate reliable estimation of parameters and identify statistically significant treatment effects on multiple model components. These findings support the use of latent disease-state models for extracting meaningful information from home-measured spirometry.

PMID:42249718 | DOI:10.1002/psp4.70281

J Adv Nurs. 2026 Jun 6. doi: 10.1111/jan.70645. Online ahead of print.

ABSTRACT

AIMS: The Parent Support Team (PST) is an intensive early intervention home visiting programme delivered by child and family health nurses to families with infants aged 0-6 months experiencing psychosocial and health vulnerabilities. In contrast, mainstream services provide universal clinic-based care and scheduled developmental checks. This mixed-methods study aimed to: (1) describe demographic and psychosocial characteristics, service activity and well-baby check attendance among PST clients compared with mainstream service clients; (2) evaluate changes in maternal depressive symptoms following PST engagement; and (3) explore client experiences, including perceived outcomes and facilitators and barriers to change.

DESIGN: Convergent parallel mixed-methods study.

METHODS: Retrospective data were extracted from electronic medical records for PST clients (909 mothers; 1038 children) and mainstream service clients (17,707 mothers; 21,764 children) between August 2019 and December 2022. Quantitative analyses described demographics, psychosocial characteristics, service use and maternal depressive symptoms. PST client experience surveys (166 mothers) were analysed using descriptive statistics and thematic analysis.

RESULTS: PST clients demonstrated greater psychosocial complexity and higher maternal depressive symptoms at entry than mainstream clients. PST mothers had more frequent service contacts and maintained stronger engagement with services after discharge. The proportion of mothers with clinically significant depressive symptoms decreased following programme participation. Survey findings indicated improved parenting confidence and practical skills. Positive outcomes were attributed to nurse qualities, opportunities to discuss concerns, a holistic care approach and the service model. Reported barriers included accessibility, scope of education topics and communication challenges.

CONCLUSION: The PST programme effectively engages vulnerable families, supports maternal mental health and promotes sustained connection with child and family health services.

IMPACT: Intensive early intervention home visiting programmes may improve outcomes for families with complex needs and warrant broader implementation.

REPORTING METHOD: SRQR guidelines were followed.

PATIENT OR PUBLIC CONTRIBUTION: None.

PMID:42249697 | DOI:10.1111/jan.70645

Cancer Med. 2026 Jun;15(6):e71998. doi: 10.1002/cam4.71998.

ABSTRACT

BACKGROUND: Early diagnosis of colorectal cancer (CRC) can significantly improve prognosis, but currently there is a lack of simple and effective screening methods in clinical practice.

METHODS: This single-center retrospective study included patients with CRC and benign colorectal polyps (BCP) diagnosed at our hospital between December 2020 and December 2023, as well as healthy controls (HCs). Eligible participants were randomly assigned to a training cohort and an internal validation cohort in a 7:3 ratio. Univariable and multivariable logistic regression analyses were performed in the training cohort to identify independent diagnostic predictors of CRC. A diagnostic nomogram was then constructed based on these predictors and internally validated.

RESULTS: Six hundred forty seven CRC, 365 BCP, and 400 HC were ultimately included in the study. Univariate and multivariate analysis showed that sex, HB, CEA, CA19-9, CONUT score, and HALP score were independent diagnostic predictors associated with CRC. The internal validation results indicated that the predictive ability of the nomogram (AUC_nomogram = 0.896) is significantly stronger than that of each individual indicator (AUC_HB = 0.78, AUC_CEA = 0.73, AUC_CA19-9 = 0.72, AUC_CONUT = 0.64, AUC_HALP = 0.72) (p < 0.05). The calibration curves confirmed the high consistency between the predicted probability and observed probability of the nomogram, and the decision curve analysis demonstrated its good clinical utility.

CONCLUSION: This study integrated multiple independent diagnostic predictors of CRC and developed an internally validated diagnostic nomogram with good discrimination and calibration in this single-center retrospective cohort.

PMID:42249647 | DOI:10.1002/cam4.71998

Urol J. 2026 May 29;23(1):35-36. doi: 10.22037/uj.v22i.8797.

ABSTRACT

We conducted a retrospective cross-sectional analysis of 288 complaints filed against urologists between 2017 and 2023 at the Forensic Medicine Organization in Shemiranat, Tehran. The number of complaints increased steadily, peaking in 2023 (n = 66) and reaching a nadir in 2020 (n = 13), likely reflecting the impact of the COVID-19 pandemic. Most complainants were male (89.6%), and patients aged >60 years comprised the largest group (31.3%). Complaints were overwhelmingly directed at specialist urologists (97.6%), with subspecialists accounting for only 2.4%. Cases more frequently originated from public hospitals (66.3%) than from private institutions (33.7%).

PMID:42249634 | DOI:10.22037/uj.v22i.8797

Oral Dis. 2026 Jun 5. doi: 10.1111/odi.70380. Online ahead of print.

ABSTRACT

BACKGROUND: This research was designed to establish an innovative diagnostic strategy employing whole-slide imaging (WSI) technology to address the diagnostic difficulties arising from the intricate histological architecture and morphological diversity observed in oral squamous cell carcinoma (OSCC).

METHODS: We proposed a cutting-edge multi-task learning architecture (MILGDF) that combines local-global attention mechanisms with dynamic weighted fusion. This model utilizes instance-level category-specific attention to enhance feature extraction efficacy while overcoming the limitations inherent in traditional bag-level attention methods. An adaptive weighting system was incorporated to dynamically adjust the contribution of local and global features, ensuring optimal performance in diverse prediction tasks.

RESULTS: Rigorous validation on the HIDOC and TCGA-OSCC datasets revealed the exceptional predictive performance of our model. The MILGDF framework attained an AUC of 0.952 (accuracy: 0.909) on HIDOC and 0.745 (accuracy: 0.725) on TCGA-OSCC, demonstrating statistically significant superiority over existing comparative models in both staging classification and diagnostic prediction.

CONCLUSIONS: The MILGDF model is capable of effectively utilizing information from wide-field images (WSI) for the accurate diagnosis and staging of oral squamous cell carcinoma (OSCC); its performance surpasses that of existing methods, demonstrating significant potential for clinical application.

PMID:42249621 | DOI:10.1111/odi.70380

Womens Health (Lond). 2026 Jan-Dec;22:17455057261456875. doi: 10.1177/17455057261456875. Epub 2026 Jun 5.

ABSTRACT

BackgroundPrenatal stress is linked to adverse perinatal outcomes. Indigenous women in Canada face high risks for adverse maternal and perinatal health.ObjectivesThis project aimed to understand levels and sources of stress experienced by Indigenous women during pregnancy and utilization of and experiences with available support.DesignThe project employed a mixed-methods cross-sectional design.MethodsThe project was conducted in three communities in Northwest Territories, Canada with varying road and healthcare accessibility. Indigenous women who were pregnant or had given birth within three years were invited to participate in a semi-structured interviewer-administered questionnaire, which included open and close-ended questions on pregnancy history, stress levels, healthcare access, available support, and experiences during and after giving birth. Descriptive statistics, regression modelling, and deductive thematic analysis were used.ResultsOf 156 participants between the ages of 17 and 47 years (mean age: 29.7 years; SD=6.0), 93.0% had given birth in the past three years, 18.0% were pregnant, and 85.3% were multiparous. Most participants reported pregnancy as somewhat stressful (49.7%) or very stressful (27.5%). Multiparity was associated with greater odds of reporting stressful pregnancy compared to first-time pregnancies (OR = 3.31, 95% CI: 1.22-8.97, p = 0.0186). Qualitative themes included reaction to pregnancy, stress during pregnancy, community support, and professional support. Factors contributing to prenatal stress included personal responsibilities, financial insecurity, housing concerns, and family issues. Support varied, with some feeling inadequately supported.ConclusionWhile various social supports exist, some participants reported inadequate support. The findings suggest the urgent need to expand community support programs in remote areas, both in numbers and access, is crucial for addressing maternal health concerns. Including kin and community supports and supporting community-driven initiatives would be effective strategies and require future exploration as to the impacts on addressing prenatal stress in Indigenous women in remote communities.

PMID:42249615 | DOI:10.1177/17455057261456875

Clin Oral Implants Res. 2026 Jun 5. doi: 10.1111/clr.70140. Online ahead of print.

ABSTRACT

INTRODUCTION: Accurate implant placement with Computer-Assisted Implant Surgery (CAIS) is critical to ensure long-term success. Dynamic-CAIS systems enhance surgical precision through real-time feedback, though comparative data on their accuracy and efficiency remain limited. This study evaluated how different registration methods in d-CAIS systems influence implant placement accuracy and procedural time.

MATERIALS AND METHODS: In this laboratory study, three registration methods were assessed: ND group, XC group, and XM group. Five experienced operators placed 25 implants per group (75 total) in partially edentulous maxillary models. Postoperative CBCT scans were used to measure deviations at the implant entry point, apex, vertical depth, and angle. One-way ANOVA and Tukey’s HSD test were used for statistical analysis.

RESULTS: Mean 3D deviations at the implant entry point were 1.06 mm (ND), 0.71 mm (XC), and 0.90 mm (XM); at the apex 1.23 mm, 0.83 mm, and 1.07 mm, respectively. Vertical depth deviations at the apex were similar across groups: 0.61 mm (ND), 0.59 mm (XC), and 0.64 mm (XM). Angular deviation was highest in the ND group (2.96°) compared to XC (1.17°) and XM (1.02°), with a significant difference between ND and XM (p = 0.028). The average procedural time was shortest in the XM group (7.20 ± 2.48 min), though differences were not statistically significant.

CONCLUSIONS: Although registration methods minimally affect overall accuracy, system-specific factors may influence angular deviation. Future studies should prioritize clinical trials with larger sample sizes and explore the influence of operator experience and learning curves.

PMID:42249609 | DOI:10.1111/clr.70140

Int Wound J. 2026 Jun;23(6):e70969. doi: 10.1111/iwj.70969.

ABSTRACT

Diabetic foot ulceration (DFU) contributes significantly to diabetes-related morbidity and amputation. In Barbados, where amputation rates are among the highest globally, the influence of socioeconomic factors on ulceration outcomes remains underexplored. Educational attainment, a social determinant of health, may influence health behaviours, engagement with healthcare services, and ultimately clinical outcomes. This study examines whether educational attainment is associated with diabetic foot ulcer severity, as measured by the SINBAD scoring system, and six-week healing outcomes among inpatients with DFU. A prospective observational study was conducted over 6 months at Barbados’ sole public hospital. A total of 176 participants admitted with a diagnosis of DFU were recruited. Baseline demographics, comorbidities, and ulcer characteristics were collected, and SINBAD scores were determined. Random forest modelling was employed to evaluate predictors of complete healing at 6 weeks and to assess ulcer severity stratified by educational attainment. Of the cohort, 17.5% reported primary education as their highest attainment level, compared with 2.9% of the general adult population. The mean SINBAD score was 2.45 among those with primary education and 2.51 among those with secondary education (p > 0.05). No statistically significant association was found between educational attainment and healing outcomes at 6 weeks. Educational attainment in this inpatient DFU cohort was lower than that of the general Barbadian population; however, it was not significantly associated with ulcer severity or six-week healing outcomes. In a universal healthcare setting, equitable access to care may attenuate the effect of educational attainment on clinical outcomes. These null findings highlight the need for future adequately powered studies incorporating health literacy assessment and key clinical confounders. Nonetheless, the observed disparity in educational attainment among DFU inpatients suggests that foot health education initiatives should be designed to be accessible to individuals across all educational levels.

PMID:42249595 | DOI:10.1111/iwj.70969

J Hand Surg Eur Vol. 2026 Jun 5:17531934261457024. doi: 10.1177/17531934261457024. Online ahead of print.

ABSTRACT

INTRODUCTION: Thumb metacarpophalangeal arthrodesis may be done by a variety of techniques. This study examines range of motion, complications and patient-reported outcomes after arthrodesis using different fixations.

METHODS: Patients treated at a single institution from 2013 to 2025 were retrospectively identified. The fixation techniques were categorized as plate, screw, Kirschner wires with tension band or Kirschner wires alone. Indications included degenerative osteoarthritis and post-traumatic instability; patients with inflammatory arthritis were excluded. Outcomes included range of motion, visual analogue scale pain scores, Patient-Reported Outcome Measurement Information System scores and complications. A secondary cohort treated by arthrodesis alone excluded patients with concurrent procedures.

RESULTS: A total of 106 patients were included (49 plate, 21 screw, 24 Kirschner wire with tension band and 12 Kirschner wire only). Range of motion, postoperative Patient-Reported Outcome Measurement Information System scores and pain scores were statistically similar for all fixation techniques. Complication rates were similar for all techniques except for removal of fixation, which was most frequent in patients treated by Kirschner wire and tension band (27%). This was also found in the pure arthrodesis cohort. Nonunion rates were low and did not differ by fixation technique.

CONCLUSION: Thumb metacarpophalangeal arthrodesis has similar functional and patient-reported outcomes in different fixation techniques. However, Kirschner wire fixation with tension bands is associated with a higher instance of fixation removal.

LEVEL OF EVIDENCE: III.

PMID:42249580 | DOI:10.1177/17531934261457024

Med Decis Making. 2026 Jun 5:272989X261450971. doi: 10.1177/0272989X261450971. Online ahead of print.

ABSTRACT

ObjectiveTo evaluate the clinical and cost-effectiveness of SHARE TO CARE (S2C), a complex intervention for hospital-wide, systematic implementation of shared decision making.MethodsWe analyzed clinical effectiveness, health care resource utilization, and implementation costs of S2C from the statutory health insurance perspective using a quasi-experimental difference-in-differences approach with evidence from the Department of Neurology. Clinical outcomes included inpatient hospital admissions, emergency department admissions, and rates of standard and advanced imaging procedures. Implementation costs comprised those related to the conception, development, process integration, ongoing support, and auditing of S2C. Health care utilization data covered inpatient and outpatient care, pharmaceuticals, therapeutic services, assistive devices, and nursing care. We conducted sensitivity analyses to account for uncertainties.FindingsS2C was associated with a reduction in inpatient hospital admissions, emergency department admissions, and imaging rates in the intervention group. The cost analyses aligned with these findings, showing reduced total costs and health care resource utilization in the intervention group. Although none of the estimates reached the predefined thresholds for statistical significance, the primary analysis yielded weak evidence (P < 0.1) of a reduction in emergency department admissions in the intervention group. Overall, savings outweighed the costs of implementing S2C, suggesting cost-effectiveness.ConclusionsS2C has the potential to reduce emergency department admissions and overall health care costs from the statutory health insurance perspective. Further research should investigate generalizability, the timing of the treatment effect, and potential biases introduced by the COVID-19 pandemic. The demonstrated effects of shared decision making (SDM) have encouraged statutory health insurances in Germany to offer additional reimbursement for clinics certified under the S2C program. The S2C model illustrates how payers and providers can collaborate to facilitate the nationwide implementation of SDM.HighlightsThe implementation of SHARE TO CARE (S2C) was associated with a statistically nonsignificant reduction in emergency department admissions after 1 y from the statutory health insurance perspective, based on data from the Department of Neurology.The cost savings from reduced health care utilization outweighed the implementation costs, and despite not reaching statistical significance, the results support the potential cost-effectiveness of S2C.S2C has the potential for nationwide implementation as a systematic form of shared decision making.Future research should investigate the generalizability of the results to other health care settings.

PMID:42249569 | DOI:10.1177/0272989X261450971