Category: Nevin Manimala

Nurs Crit Care. 2026 Sep;31(5):e70591. doi: 10.1111/nicc.70591.

ABSTRACT

BACKGROUND: Family Presence During Resuscitation (FPDR) is a key component of family-centred care in paediatric settings, supported by international guidelines. However, limited evidence exists regarding how nurses’ perceptions of FPDR relate to self-confidence during paediatric resuscitation.

AIM: This study investigated the relationship between FPDR perceptions and self-confidence levels among paediatric nurses in critical care units.

STUDY DESIGN: A descriptive, cross-sectional study was conducted between April 10 and June 20, 2025, with nurses working in paediatric critical care units of a tertiary city hospital. Data were collected through face-to-face survey administration using a Personal Information Form and the Family Presence Risk-Benefit Scale, and analysed using descriptive statistics, correlation analyses, and multiple linear regression.

RESULTS: A total of 194 eligible nurses were approached, of whom 138 completed the survey, yielding a response rate of 71.1%. The majority of nurses opposed FPDR, citing concerns related to team communication, increased stress, interruption of medical interventions and risk of violence. Mean total self-confidence and risk perception scores were 47.24 ± 18.06 and 32.75 ± 10.37, respectively. Age, professional experience and certificate status did not significantly predict risk perception or self-confidence. Postgraduate education significantly increased risk perception, while working in paediatric haematology units significantly decreased self-confidence levels. A weak but statistically significant positive correlation was found between risk perception and self-confidence (r_s = 0.25, 95% CI [0.09, 0.40], p = 0.013).

CONCLUSION: The findings indicate that paediatric nurses’ perceptions of family presence during resuscitation are influenced more by clinical and organisational context than by individual experience or certification. These results highlight the need for clear institutional policies and structured paediatric-specific training to support the safe implementation of family-centred resuscitation practices.

RELEVANCE TO CLINICAL PRACTICE: The findings may inform the development of context-sensitive institutional policies and structured educational programs to support safer implementation of family-centred resuscitation practices.

PMID:42529835 | DOI:10.1111/nicc.70591

JMIR Form Res. 2026 Jul 29;10:e71746. doi: 10.2196/71746.

ABSTRACT

BACKGROUND: People with dementia and their caregivers experience significant psychological distress, which may increase their vulnerability to trauma across the dementia diagnostic and caregiving trajectory. Specialist dementia helplines offer immediate emotional support, information, and signposting; however, little empirical evidence exists about how call handlers account for potential trauma in their responses.

OBJECTIVE: This study aimed to examine the extent to which call handlers’ responses on the United Kingdom’s only 24-hour dementia helpline reflected trauma-informed (TI) principles of safety, trust, choice, collaboration, and empowerment and to describe caller characteristics and reasons for contact during the COVID-19 pandemic.

METHODS: No participants were actively recruited. Instead, the study analyzed 198 anonymized, routinely collected helpline call logs (out of 200 randomly selected) drawn from 7357 calls received by Alzheimer Scotland’s 24-hour helpline between April 2020 and April 2021. A retrospective deductive framework analysis mapped narrative summaries to 5 TI principles (safety, trustworthiness and transparency, choice, collaboration, and empowerment). Double‑coding and calibration were undertaken in line with established guidance on intercoder reliability for qualitative research. Descriptive statistics summarized caller characteristics and theme frequencies; no inferential testing was conducted due to the exploratory nature of the analysis, sample properties, and the subjective nature of theme ratings.

RESULTS: Most calls were made during daytime hours (159/198, 79.5%) and were made by carers, family members, or friends (n=179, 89.5%). Emotional support was the most frequently recorded reason for contact (91 instances), followed by carer stress (66 instances) and information on caring (51 instances). Across call handlers’ responses, collaboration (126/179, 70.4%) and empowerment (108/179, 60.3%) were the most frequently observed TI principles, followed by safety (105/179, 58.7%), choice (66/179, 37.4%), and trust (56/179, 31.3%). Safety-focused responses were more prevalent in nighttime calls than daytime calls (76.9% vs 56%). Illustrative call log excerpts demonstrated empathetic listening, validation, shared problem-solving, and signposting practices aligned with TI principles.

CONCLUSIONS: In this exploratory retrospective evaluation, responses from a national dementia helpline commonly reflected TI principles, despite call handlers receiving primarily awareness-level TI content within their wider role preparation. Findings should be interpreted as descriptive and hypothesis-generating because they are based on call log summaries rather than recorded interactions and were obtained within the unique context of the COVID-19 pandemic. The results suggest that TI principles may be feasible and relevant in dementia helpline services and highlight the potential value of more structured approaches to TI workforce development. Future prospective research incorporating richer data sources such as recorded calls and call-reported outcomes is warranted to support service development and evaluation.

PMID:42529812 | DOI:10.2196/71746

Malays J Med Sci. 2025 Dec;32(6):131-142. doi: 10.21315/mjms-05-2025-349. Epub 2025 Dec 31.

ABSTRACT

BACKGROUND: Posterior inferior cerebellar artery (PICA) aneurysm is rare. Endovascular treatment does not provide a decompressive effect, and the complex morphological features of PICA aneurysm make treatment approaches challenging. The objective of this study was to formulate a decision-making guide for PICA aneurysm according to location, based on an illustrative case and a review of the literature.

METHODS: From January 2022 until April 2023, a total of 157 aneurysm cases were treated using surgical and endovascular intervention. Fourteen patients were confirmed to have PICA aneurysm based on cerebral DSA/CTA. Demographic data, clinical characteristics, radiological findings, treatment plans, and outcomes were analysed. Outcomes were assessed using the modified Rankin Scale (mRS), with scores of zero to three considered good. Statistical analyses included Fisher’s exact test, Chi-square test, and McNemar test, where appropriate.

RESULTS: Of the total aneurysm cases, 8.9% were ruptured PICA aneurysms. Seven cases were located at the proximal PICA (P1 = 4 cases, P2 = 3), two cases at the mid PICA (P3), and five cases at the distal PICA (P4, P5). Out of 14 PICA aneurysms cases, nine were saccular, four were fusiform, and one was a dissecting aneurysm. Three patients underwent endovascular intervention (two saccular and one dissecting), while 11 underwent surgery (1 PICA-PICA in situ bypass with vertebral artery ligation, and 10 craniotomies with aneurysm clipping, with or without aneurysm reconstruction). Seven of 14 patients initially presented with good mRS scores, and at discharge, 10 patients had good scores. At discharge, two of three patients who had endovascular intervention had good mRS scores, and eight of 11 patients who went for surgery achieved good outcomes. Comparative analyses revealed no statistically significant associations between intervention type, aneurysm complexity, or location and outcome (P > 0.05). The McNemar test showed no significant difference between pre- and postoperative mRS scores (P = 0.25). However, a clinical trend toward improvement was observed, with the proportion of patients achieving good functional outcomes increasing from 50% before surgery to 71.4% at discharge.

CONCLUSION: Favourable outcomes could be achieved when PICA aneurysm is treated with appropriate surgical strategies by experienced surgeons. Neurovascular surgeon must acquire knowledge of different surgical approaches and the technical skills required to perform these procedures.

PMID:42529789 | PMC:PMC13419060 | DOI:10.21315/mjms-05-2025-349

Cureus. 2026 Jun 29;18(6):e111728. doi: 10.7759/cureus.111728. eCollection 2026 Jun.

ABSTRACT

Metabolic dysfunction-associated steatotic liver disease (MASLD) and its inflammatory form, metabolic dysfunction-associated steatohepatitis (MASH), are strongly linked to obesity, insulin resistance, type 2 diabetes, and progressive liver fibrosis. Dual and triple glucagon-like peptide-1 (GLP-1)-based polyagonists may provide complementary hepatic and metabolic benefits, but their overall efficacy and safety have not been fully established. This systematic review and meta-analysis evaluated randomized controlled trials comparing dual or triple GLP-1-based polyagonists with placebo in adults with MASLD or MASH. PubMed, the Cochrane Central Register of Controlled Trials, ScienceDirect, and Google Scholar were searched from inception through May 19, 2026. Dichotomous outcomes were pooled as risk ratios (RRs), and continuous outcomes were analyzed as mean differences (MDs), using random-effects models. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Six randomized controlled trials involving 961 participants were included. The included GLP-1-based polyagonists-tirzepatide, survodutide, pemvidutide, retatrutide, and cotadutide-significantly increased MASH resolution or histological improvement without worsening of fibrosis (RR 3.32, 95% CI 2.28-4.84; I² = 20%) and fibrosis improvement without worsening of MASH (RR 1.49, 95% CI 1.15-1.94; I² = 0%). Treatment also produced a greater relative reduction in liver fat content (MD -44.60 percentage points, 95% CI -51.17 to -38.04; I² = 0%) and increased the likelihood of achieving at least a 30% relative reduction in liver fat by magnetic resonance imaging-proton density fat fraction (RR 4.71, 95% CI 3.04-7.30; I² = 22%). Body weight was significantly reduced, although heterogeneity was considerable (MD -9.14 percentage points, 95% CI -17.38 to -0.91; I² = 98%). Nausea, diarrhea, and vomiting were more frequent with polyagonists, but no statistically significant differences were observed in serious adverse events or adverse events leading to treatment discontinuation. In conclusion, dual and triple GLP-1-based polyagonists improve histological and imaging-based hepatic outcomes in MASLD and MASH and may simultaneously address underlying metabolic dysfunction. However, gastrointestinal intolerance, pharmacological heterogeneity, the small number of trials, and limited follow-up warrant cautious interpretation. Larger phase 3 trials are needed to clarify drug-specific efficacy, long-term safety, and effects on liver-related and cardiovascular outcomes.

PMID:42529769 | PMC:PMC13418920 | DOI:10.7759/cureus.111728

EJHaem. 2026 Jul 29;7(4):e70366. doi: 10.1002/jha2.70366. eCollection 2026 Aug.

ABSTRACT

Objectives: To study the predictive and prognostic values of serum erythropoietin levels (sEPO) measured at diagnosis in lower-risk myelodysplastic syndromes. Methods: We analyzed clinical associations and prognosis with sEPO in 672/1610 patients with at least one year of follow-up data in the prospective EUMDS study. Results: sEPO levels increase with WHO subtypes associated with erythroid hypoplasia and poorer risk IPSS-R scores. sEPO is an independent predictor of transfusion free survival and levels < 200 IU/L predict response to ESA. sEPO is not an independent predictor of overall survival. Conclusions: sEPO predicts transfusion free survival and response to ESA. Trial Registration: The EUMDS Registry (ClinicalTrials.gov: Identifier NCT00600860).

PMID:42529759 | PMC:PMC13418852 | DOI:10.1002/jha2.70366

Int J Nurs Stud Adv. 2026 Jul 12;11:100628. doi: 10.1016/j.ijnsa.2026.100628. eCollection 2026 Dec.

ABSTRACT

BACKGROUND: Gerontogeriatric competencies are considered essential for preparing nurses to meet the complex care needs of ageing populations. However, the intention to work with older adults remains comparatively low among nursing professionals, particularly among newly graduated registered nurses (NGRNs).

OBJECTIVE: This study explored the structural relationships between nursing education, gerontogeriatric competencies, ageism, and the intention to work with older adults.

DESIGN: A nationwide cross-sectional study was conducted.

SETTINGS AND PARTICIPANTS: This nationwide cross-sectional study was conducted in Portugal and included NGRNs who had completed their undergraduate nursing degree in the 2021-2022 academic year. The final sample comprised 242 NGRNs from public and private nursing education institutions.

METHODS: An exploratory structural equation modelling approach was used to examine potential relationships among five latent constructs: Nursing Education (NEDU), Gerontogeriatric Competencies (GGC), Hostile Ageism (AAS_HA), Benevolent Ageism (AAS_BA), and Intention to Work with Older Adults (INT_OA). Model estimation followed an iterative refinement process.

RESULTS: Model estimation encountered convergence difficulties, and the full structural framework could not be fully identified. Consequently, global model fit indices could not be obtained, and the results should be interpreted as exploratory structural associations. Among the estimated paths, a statistically significant association was identified between nursing education and gerontogeriatric competencies (b = 0.437, 95% CI [0.31, 0.57], p < 0.0001), while no statistically significant structural associations were observed between competencies or ageism to the intention to work with older adults.

CONCLUSIONS: Nursing education was positively associated with perceived gerontogeriatric competence; however, the intention to work with older adults appears to be shaped by more complex and potentially contextual factors. These findings highlight the need for theoretical refinement and further research using alternative modelling strategies and larger samples.

PMID:42529745 | PMC:PMC13418224 | DOI:10.1016/j.ijnsa.2026.100628

Clin Cosmet Investig Dermatol. 2026 Jul 25;19:617844. doi: 10.2147/CCID.S617844. eCollection 2026.

ABSTRACT

BACKGROUND: Microwave therapy has emerged as a minimally invasive treatment option, but long-term real-world data, particularly from Southeast Asian populations, remain limited.

PURPOSE: To evaluate the effectiveness of microwave therapy and its impact on quality of life (QoL) in patients with axillary hyperhidrosis and bromhidrosis.

PATIENTS AND METHODS: A longitudinal ambispective case series study was conducted on 52 adult patients with axillary hyperhidrosis and bromhidrosis treated with microwave therapy. Treatment efficacy and QoL improvement were assessed at 1 week and at 3, 6, 9, and 12 months post-intervention using the Minor test, Hyperhidrosis Disease Severity Scale (HDSS), Visual Analog Scale (VAS), and Dermatology Life Quality Index (DLQI). Repeated measures were analyzed using mixed-effects models.

RESULTS: At 1 week, the mean area of discoloration decreased markedly from 49.1 cm² to 0.3 cm² in the left axilla, with similar improvement observed in the right axilla. At 12 months, compared with baseline, the model-predicted probability of HDSS grade 4 decreased from 68.2% to 5.7%, while the mean odor score and DLQI score decreased from 6.8 to 3.0 and from 19.5 to 6.5, respectively. Overall satisfaction at 12 months was 66.6%. Statistically significant improvements were observed across the majority of efficacy outcomes (p < 0.05). The most common adverse events were pain and swelling, which were mild and self-limiting, with no serious complications reported.

CONCLUSION: Microwave therapy demonstrated a favorable safety profile and sustained clinical benefits in patients with axillary hyperhidrosis and bromhidrosis over 12 months of follow-up. Although patient satisfaction declined modestly at 12 months, overall treatment outcomes remained favorable.

PMID:42529744 | PMC:PMC13418893 | DOI:10.2147/CCID.S617844

Can J Stat. 2020 Jun;48(2):204-221. doi: 10.1002/cjs.11527. Epub 2019 Dec 11.

ABSTRACT

With a growing interest in using non-representative samples to train prediction models for numerous outcomes it is necessary to account for the sampling design that gives rise to the data in order to assess the generalized predictive utility of a proposed prediction rule. After learning a prediction rule based on a non-uniform sample, it is of interest to estimate the rule’s error rate when applied to unobserved members of the population. Efron (1986) proposed a general class of covariance penalty inflated prediction error estimators that assume the available training data are representative of the target population for which the prediction rule is to be applied. We extend Efron’s estimator to the complex sample context by incorporating Horvitz-Thompson sampling weights and show that it is consistent for the true generalization error rate when applied to the underlying superpopulation. The resulting Horvitz-Thompson-Efron estimator is equivalent to dAIC, a recent extension of Akaike’s information criteria to survey sampling data, but is more widely applicable. The proposed methodology is assessed with simulations and is applied to models predicting renal function obtained from the large-scale National Health and Nutrition Examination Study survey.

PMID:42529736 | PMC:PMC13417605 | DOI:10.1002/cjs.11527

Gastroenterol Hepatol Bed Bench. 2026;19(1):e5. doi: 10.22037/ghfbb.v19i01.3189. Epub 2026 Mar 2.

ABSTRACT

AIM: This study evaluated the prognostic value of Strasberg classification on 30-day bile duct patency and explored relevant clinical and procedural factors.

BACKGROUND: Bile duct injury (BDI) is a serious complication of cholecystectomy that may influence early outcomes after endoscopic retrograde cholangiopancreatography (ERCP).

METHODS: We retrospectively reviewed 33 patients with BDI treated with ERCP at Dr. Moewardi Hospital from January 2023 to May 2025. Data included demographics, laboratory results, cholecystectomy type, timing of diagnosis and repair, and injury severity (minor: A-C; major: D-E). The primary outcome was bile duct patency at 30 days, assessed by imaging and clinical indicators. Statistical analyses included chi-square, Fisher’s exact, Kaplan-Meier survival, and ROC curves.

RESULTS: Patients had a mean age of 45.9 years; 54.5% were female, and 54.5% had laparoscopic cholecystectomy. Minor and major injuries were observed in 51.5% and 48.5%, respectively. 63.6% achieved bile duct patency by day 30. No significant associations were found between demographic, laboratory, procedural variables, and either injury severity or outcomes (all p>0.05). Kaplan-Meier analysis revealed significantly longer patency in minor injuries compared to major injuries (mean 25.88 vs. 20.88 days, p=0.030).

CONCLUSION: This study highlights Strasberg classification as an independent predictor of early bile duct patency after ERCP. Other common clinical factors did not significantly influence outcomes. These findings underscore the importance of Strasberg classification not only for injury assessment but also for guiding early postoperative management and monitoring. Larger prospective studies are needed to confirm these results and to optimize prognostic tools for BDI care.

PMID:42529730 | PMC:PMC13418495 | DOI:10.22037/ghfbb.v19i01.3189

World J Radiol. 2026 Jul 28;18(7):123894. doi: 10.4329/wjr.123894.

ABSTRACT

BACKGROUND: Chronic cardiopulmonary diseases, including chronic obstructive pulmonary disease, interstitial lung disease, and coronary artery disease, represent a major global health burden. Low-dose computed tomography (LDCT) combined with artificial intelligence (AI) quantitative imaging enables the identification of cardiopulmonary imaging abnormalities in asymptomatic individuals.

AIM: To evaluate early risk factors for cardiopulmonary imaging abnormalities in asymptomatic middle-aged and elderly population using single-inspiratory phase LDCT combined with AI-based whole-lung quantitative analysis.

METHODS: A retrospective collection was conducted on 1035 asymptomatic individuals aged ≥ 40 years who underwent routine single-inspiratory-phase LDCT screening at Zhuzhou 331 Hospital in 2025. An AI platform was utilized to automatically extract airway wall area percentage, low-attenuation area percentage, interstitial lung abnormality, and coronary artery calcification score. Based on risk stratification criteria, the population was divided into a high-risk group (n = 689) and a low-risk group (n = 346) and randomly stratified into a training set (n = 724) and a validation set (n = 311) at a 7:3 ratio. Independent sample t-test or χ ² test was applied to analyze between-group differences. Binary logistic regression was used to screen independently associated factors, and a multivariate logistic regression model was constructed after excluding collinear variables using variance inflation factor (VIF < 5), followed by the establishment of a nomogram prediction model. The receiver operating characteristic curve and DeLong test were employed to evaluate model discrimination. The Hosmer-Lemeshow test and calibration curves were used to assess goodness of fit. Decision curve analysis (DCA) was applied to evaluate clinical net benefit, and internal validation was performed using the bootstrap method (1000 resamplings).

RESULTS: Univariate analysis showed that smoking history, abnormal metabolic status, body mass index (BMI), age, and gender were significantly associated with cardiopulmonary imaging-defined high-risk status (P < 0.05), while work style showed a marginal association in univariate analysis (P = 0.043) but did not retain statistical significance in the multivariate model (P = 0.851). After VIF collinearity screening (all VIF < 5) and multivariate logistic regression analysis with forced entry of six candidate variables, smoking history [odds ratio (OR) = 1.968 per level, 95% confidence interval (CI): 1.665-2.325, P < 0.001], abnormal metabolic status (OR = 3.266, 95%CI: 2.259-4.723, P < 0.001), BMI (OR = 1.150 per unit, 95%CI: 1.079-1.226, P < 0.001), and age (OR = 1.028 per year, 95%CI: 1.005-1.052, P = 0.018) were identified as independently associated factors for cardiopulmonary imaging-defined high-risk status, while male gender demonstrated an (inverse) association (OR = 0.427, 95%CI: 0.276-0.660, P < 0.001) after adjustment for smoking and other covariates. The nomogram-based risk stratification model integrating the above five independently associated factors achieved an area under the curve (AUC) of 0.833 (95%CI: 0.787-0.879) in the validation set, significantly outperforming the baseline model containing only age and gender (AUC = 0.647, 95%CI: 0.582-0.712; DeLong test: Delta AUC = 0.186, z = 5.256, P < 0.001). The Hosmer-Lemeshow goodness-of-fit test confirmed satisfactory calibration (training set: χ ² = 10.40, P = 0.238; validation set: χ ² = 6.50, P = 0.591). Calibration curves and DCA demonstrated good agreement and positive clinical net benefit. Bootstrap internal validation (1000 resamples) confirmed model robustness (mean AUC = 0.792, 95%CI: 0.760-0.824).

CONCLUSION: The LDCT-based nomogram model combined with AI quantitative imaging analysis may assist in identifying individuals with cardiopulmonary imaging abnormalities in asymptomatic screening populations, potentially guiding further diagnostic evaluation. Prospective studies are warranted to establish its role in improving clinical outcomes.

PMID:42529724 | PMC:PMC13419150 | DOI:10.4329/wjr.123894