Category: Nevin Manimala

Int J Qual Health Care. 2026 Jun 5:mzag081. doi: 10.1093/intqhc/mzag081. Online ahead of print.

ABSTRACT

BACKGROUND: Performance measurement tools, such as quality indicators, shape how services are organized, delivered, and evaluated; they are central to monitoring and improving health system performance. This study examines five years of implementing occupational therapy quality indicators within a large public healthcare organisation and assesses how structured performance measurement can support routine monitoring, accountability, and quality improvement in occupational therapy service delivery.

METHODS: We conducted this retrospective, repeated cross-sectional study within Clalit Health Services, Israel’s largest public healthcare organisation, serving more than 4.9 million members across nine districts. We analysed performance trends (2021 to 2025) for five occupational therapy quality indicators implemented system-wide: children-parental conversations, children-treatment interruption, frail older adults, stroke, and hip fracture. Data were extracted from electronic health records and administrative databases. The analytic sample included all CHS members eligible for at least one occupational therapy quality indicator during the study period. Performance for each occupational therapy quality indicator was calculated as numerator/denominator * 100 national-level longitudinal trends and subgroup associations were analysed.

RESULTS: Four of the five OT-QIs improved significantly over time. from 8.1% to 3.7%, occupational therapy service delivery to frail older adults increased from 51.8% to 77.4%, and occupational therapy after stroke increased from 52.2% to 59.9% (P < 0.001 for all). The hip fracture indicator showed no statistically significant overall change, increasing slightly from 71.3% to 71.8% (P = 0.706), despite fluctuations during the monitoring period. Methodological changes to the denominator definition highlighted the sensitivity of performance metrics to operational definitions. Subgroup analyses further identified socio-demographic and geographic variation in occupational therapy quality indicator performance, particularly by age, socio-economic position, ethnicity, and peripherality, although patterns differed across indicators.

CONCLUSIONS: Implementing occupational therapy quality indicators within a nationwide community rehabilitation system enabled routine longitudinal monitoring of access, timeliness, family engagement, continuity of care, and service consistency. These indicators provided a structured framework for identifying service gaps, improving national-level visibility, and informing organisational decision-making. The findings support the feasibility and value of profession-specific quality indicators as a scalable model for performance monitoring and quality improvement in rehabilitation and allied health services. Future research should link occupational therapy quality indicator performance to patient-level functional, participation, and quality-of-life outcomes and examine geographic and socio-demographic inequities in service delivery.

PMID:42249556 | DOI:10.1093/intqhc/mzag081

Orthop Surg. 2026 Jun 5. doi: 10.1111/os.70356. Online ahead of print.

ABSTRACT

OBJECTIVES: Shaft-anchored prostheses have long been the gold standard in shoulder arthroplasty, but there is a growing trend toward bone-preserving, stemless designs. Despite promising short- and midterm results, long-term data remain limited. This study aims to report the long-term outcomes of a stemless anatomic shoulder prosthesis in patients with primary osteoarthritis and seeks to answer the question of whether it is comparable to other prostheses.

METHODS: This retrospective single-center study included 27 shoulders in 24 patients (mean age 75 ± 8.3 years), who were operated from 2009 to 2011. Outcomes assessed were Constant-Murley score, range of motion, patient satisfaction, revision rate, and radiological findings. Mean follow-up was 142 ± 12.2 months. Twenty-one shoulders underwent total shoulder arthroplasty; six hemiarthroplasty. For the analysis of continuous variables, the Wilcoxon test was used following normality testing. Dichotomous variables were evaluated using the chi² test, with a significance level set at p < 0.05.

RESULTS: The Constant-Murley score improved significantly from 23.1 ± 9.4 (27.5% age-adjusted) preoperatively to 58.8 ± 18.6 (72.3% age-adjusted) postoperatively (p < 0.001). Range of motion increased in flexion (89.5°-137.2°), abduction (70.9°-117.2°), and external rotation (10°-36.8°), all statistically significant. Overall, 85% of patients were (very) satisfied. Four revisions were performed: two with conversion to alternative treatment, two within the same system due to loosening and infection. Ten- and 12-year survival rates were 89% and 85%, respectively. A 30% risk of loosening was observed (per Molé), though no glenoid loosening occurred; humeral loosening was seen in one case.

CONCLUSION: The clinical, functional, and radiological outcomes of the investigated stemless shoulder arthroplasty system remain satisfactory even in long-term follow-up. High patient satisfaction was observed. The data, which are unique in terms of the length of follow-up, are comparable to those of other stemless anatomic shoulder arthroplasty designs.

PMID:42249544 | DOI:10.1111/os.70356

Crit Care Explor. 2026 Jun 8;8(6):e1420. doi: 10.1097/CCE.0000000000001420. eCollection 2026 Jun 1.

ABSTRACT

IMPORTANCE: Evidence for prone positioning in post-cardiac surgery acute respiratory distress syndrome (ARDS), especially after acute type A aortic dissection (ATAAD) repair, is extremely limited. Clinicians remain uncertain about its safety, feasibility, and the optimal timing of initiation in this hemodynamically vulnerable population.

OBJECTIVES: To evaluate the effectiveness and safety of prone positioning for moderate-to-severe ARDS (MS-ARDS) after ATAAD repair, and to determine whether early initiation (≤ 48 hr) provides additional clinical benefit.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective, single-center cohort study conducted in a tertiary cardiovascular center. Seventy-eight adults with MS-ARDS after ATAAD surgery were included: 58 received prone positioning and 20 remained supine.

MAIN OUTCOMES AND MEASURES: Primary outcomes were duration of mechanical ventilation (MV) and postoperative ICU length of stay (LOS). Secondary outcomes included hospital LOS, hospitalization cost, and 28- and 90-day mortality. Adverse events were systematically captured using prespecified hemodynamic and respiratory categories.

RESULTS: Preoperative and perioperative characteristics were comparable between groups. In the prone cohort, the Pao2/Fio2 improved from 92.67 ± 21.04 to 152.45 ± 64.28 mm Hg at 4 hours (p < 0.001), demonstrating rapid oxygenation gain. Patients were further stratified by timing of intervention: early prone positioning (EPP: ≤ 48 hr from ARDS onset) and delayed prone positioning (DPP). EPP was associated with a significantly shorter duration of MV 5.03 ± 1.87 days compared with DPP 8.32 ± 4.73 days and the supine group 7.51 ± 4.08 days (p = 0.002). No increase in adverse events was observed, and no episodes of malignant arrhythmia or cardiac arrest occurred.

CONCLUSIONS AND RELEVANCE: Prone positioning for MS-ARDS after ATAAD repair was feasible, safe, and rapidly improved oxygenation. Initiation within 48 hours was associated with a clinically meaningful reduction in ventilation duration. These findings support early, protocolized prone positioning in selected postoperative ATAAD patients and justify further evaluation in prospective trials.

PMID:42249540 | DOI:10.1097/CCE.0000000000001420

BMC Psychol. 2026 Jun 5. doi: 10.1186/s40359-026-04936-1. Online ahead of print.

ABSTRACT

BACKGROUND: Existing literature indicates that bullying victimization elevates the risk of depression among adolescents; however, longitudinal evidence on the associations between specific types of victimization (physical, verbal, relational, and cyberbullying) and depression remains limited, particularly with regard to gender differences. This study examined the predictive effects of these four forms of victimization on depression at a six-month follow-up and further explored the moderating role of gender.

METHODS: We collected two-wave longitudinal data from 457 Grade 10 students (230 boys, 227 girls; Mage = 15.93, SD = 1.94) at a high school in Gansu Province, China, in June 2024 (T1) and December 2024 (T2). Participants completed a series of self-report questionnaires, including measures of demographic characteristics, the Revised Bullying Victimization Questionnaire (BVQ-R), and the depression subscale of the Depression Anxiety Stress Scales (DASS-21). Hierarchical multiple regression analyses were conducted to examine both main and interaction effects, and simple slope analyses were performed to probe significant interactions.

RESULTS: After adjusting for demographic covariates, all four forms of T1 bullying victimization significantly predicted higher levels of depressive symptoms at T2 in the main-effects models. In the interaction models, none of the victimization × gender interaction terms reached statistical significance.

CONCLUSION: These findings suggest that multiple forms of bullying victimization are prospectively associated with subsequent depressive symptoms and that these associations do not appear to vary by gender in this sample.

PMID:42249517 | DOI:10.1186/s40359-026-04936-1

BMC Pharmacol Toxicol. 2026 Jun 5. doi: 10.1186/s40360-026-01158-4. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer remains one of the leading causes of cancer-related mortality among women worldwide. Although methyltestosterone (MT) has demonstrated therapeutic potential in hormone-responsive breast cancer, its clinical application may be limited by poor aqueous solubility and non-specific distribution. Albumin-based nanocarriers may enhance drug stability and intracellular availability. This study aimed to develop genipin-crosslinked human serum albumin (HSA) nanoparticles loaded with MT and to evaluate their physicochemical properties, release behavior, and in-vitro pharmacological and cytotoxic effects in MCF-7 breast cancer cells.

METHODS: MT-loaded HSA nanoparticles were prepared using the desolvation method followed by genipin crosslinking. Particle size, polydispersity index (PDI), and zeta potential were determined by dynamic light scattering (DLS), while morphology and crystallinity were evaluated using SEM and XRD analysis. Drug loading (DL) and encapsulation efficiency (EE) were quantified spectrophotometrically. In-vitro release was assessed under different pH conditions (5.5, 6.8, and 7.4). Cytotoxicity and pharmacological activity were evaluated in MCF-7 cells using MTT, LDH, and TUNEL assays. Statistical analysis was performed using one-way ANOVA (p < 0.05).

RESULTS: The formulated MT-HSA nanoparticles exhibited a mean diameter of 83 nm (PDI 0.25) and a zeta potential of – 16.3 mV, indicating uniform nanoscale distribution and moderate colloidal stability. Encapsulation efficiency and drug loading were 77% and 11%, respectively. Sustained and pH-dependent drug release was observed over 100 h, with higher release under acidic conditions (83% at pH 5.5). MT-HSA nanoparticles significantly reduced MCF-7 cell viability compared with free MT (p < 0.05), accompanied by increased LDH release and higher apoptotic index in TUNEL assays. Unloaded HSA nanoparticles showed negligible cytotoxicity. The formulation remained physically stable for two months at 4 °C.

CONCLUSIONS: Genipin-crosslinked MT-HSA nanoparticles demonstrated improved in-vitro pharmacological efficacy, enhanced cytotoxic and pro-apoptotic activity compared with free methyltestosterone, and favorable carrier biocompatibility. These findings support albumin-based nanoencapsulation as a promising strategy for optimizing steroid-based therapy in hormone-responsive breast cancer, although further in-vivo studies are required to confirm translational potential.

PMID:42249506 | DOI:10.1186/s40360-026-01158-4

BMC Nutr. 2026 Jun 5. doi: 10.1186/s40795-026-01360-x. Online ahead of print.

ABSTRACT

BACKGROUND: This study evaluated the effectiveness of a brief, Theory of Planned Behavior-based educational program on weight management and related health outcomes among university employees.

METHODS: In this quasi-experimental study conducted at two major universities in Erbil, Iraq, 200 employees with a body mass index (BMI) ≥ 25 kg/m² self-selected into an intervention (n = 100) or control (n = 100) group. The intervention consisted of five individual 35-40-minute sessions delivered over 12 weeks and covered obesity awareness, culturally adapted nutrition education, physical activity, and behavior-change strategies. The control group received only standard written materials. Primary outcomes were changes in body weight, BMI, and waist circumference. Secondary outcomes included lipid profile, fasting glucose, quality of life (Impact of Weight on Quality of Life-Lite [IWQOL-Lite]), dietary quality, and physical activity. All assessments were performed at baseline and 12 weeks.

RESULTS: The intervention was associated with a mean weight loss of 7.46 kg (95% CI 6.44-8.48) compared with a gain of 0.58 kg in the control group (adjusted difference – 8.04 kg; p < 0.001; Cohen’s d = 2.40). 79% of intervention participants lost ≥ 5% of their initial body weight (versus 0% in controls), and 41% lost ≥ 10%. Significant improvements were also observed in BMI, waist circumference, lipid profile, quality of life, and dietary quality (all p < 0.001; d > 1.8). Mediation analysis indicated that improvement in dietary quality accounted for 82% of the observed association between group assignment and change in BMI.

CONCLUSIONS: A brief, low-cost, culturally adapted educational intervention delivered in the workplace was associated with exceptionally large weight loss, cardiometabolic benefits, and psychosocial gains, with perfect retention. These findings suggest that this model may offer a promising approach for obesity management in Middle Eastern settings. However, confirmation in randomized controlled trials with longer follow-up is required before firm conclusions regarding scalability and effectiveness can be drawn.

CLINICAL TRIAL REGISTRATION: The study was not prospectively registered in a clinical trial registry because it employed a quasi-experimental design with participant self-selection rather than random allocation. However, the full study protocol including all primary and secondary outcomes, eligibility criteria, intervention details, and the statistical analysis plan was finalized, approved by the Hawler Medical University Ethics Committee (reference HMU-REC-2024-18, 15 September 2024), and locked prior to the start of participant recruitment and data collection. No outcomes were added, removed, or modified after data inspection, and no post-hoc analyses were conducted beyond those pre-specified in the protocol. The manuscript adheres fully to the TREND reporting standards for non-randomized evaluations.

PMID:42249502 | DOI:10.1186/s40795-026-01360-x

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