Nevin Manimala

Int J Gynecol Cancer. 2025 Feb 1:101676. doi: 10.1016/j.ijgc.2025.101676. Online ahead of print.

ABSTRACT

OBJECTIVE: The oncologic safety of less-radical surgery for early-stage cervical cancer is currently being actively investigated. Given the paucity of data, this study assessed the temporal trends and oncologic outcomes associated with modified radical hysterectomy for stage IB1 (≤2 cm) cervical cancer in the United States.

METHODS: This retrospective cohort study used data from the Commission-on-Cancer’s National Commission on Cancer Database. The study population was 2902 patients with clinical stage IB1 (≤2 cm) cervical cancer from 2010 to 2020. Temporal trends based on hysterectomy modality (radical hysterectomy, modified radical hysterectomy, and simple hysterectomy) were assessed using linear segmented regression with log-transformation, and the overall survival was assessed using a multivariable Cox proportional hazard regression model.

RESULTS: There was a statistically significant increase in modified radical hysterectomy from 2013 to 2020 (annual percentage rate increase 4.4, 95% CI 0.7 to 16.0, p=.040) and a decrease in simple hysterectomy from 2012 to 2020 (-2.3, 95% CI -3.7 to -1.3, p<.001). The lymphovascular space invasion rates (26.8%, 26.8%, and 23.1% for the radical, modified radical, and simple hysterectomy groups, respectively, p=.10) and pathological nodal metastasis rates (5.0%, 4.4%, and 4.0%, respectively, p=.54) were similar among the 3 groups. The use of adjuvant radiotherapy was higher in the simple hysterectomy group (13.0%, 13.0%, and 18.2% in the radical, modified radical, and simple hysterectomy groups, respectively, p<.001). The 5-year overall survival rates for radical hysterectomy, modified radical hysterectomy, and simple hysterectomy were 96.6 %, 96.3 %, and 95.8 %, respectively (p=.0.66). In multivariable analysis, modified radical hysterectomy (adjusted HR 1.23, 95% CI 0.73 to 2.06) and simple hysterectomy (adjusted HR 1.02, 95% CI 0.70 to 1.48) were not associated with decreased overall survival compared with radical hysterectomy.

CONCLUSIONS: The results of this cohort study in the United States suggest that modified radical hysterectomy for stage IB1 (≤2 cm) may not be associated with overall survival. This observed survival association warrants further investigation stage IB1 (≤2 cm) cervical cancer that does not meet the low-risk criteria.

PMID:40087120 | DOI:10.1016/j.ijgc.2025.101676

Nurse Educ Pract. 2025 Mar 6:104326. doi: 10.1016/j.nepr.2025.104326. Online ahead of print.

ABSTRACT

AIM/OBJECTIVE: To design and test the usability of case-based HIV microlearning lessons using WhatsApp groups. This paper reports on effectiveness and uptake.

BACKGROUND: South Africa has the largest antiretroviral treatment program globally. National guidelines are regularly updated. Ongoing training of healthcare workers is vital but complicated by infrastructural, financial and human resource shortages. Innovative solutions are needed.

DESIGN: A pragmatic, mixed methods, parallel group, cluster randomised trial.

METHODS: Nurses and community health workers (CHWs) at 50 clinics in the Eastern Cape were invited to participate. Online questionnaires tested knowledge and retention of knowledge; retrospective folder reviews measured changes in patient care. Patient folders were sampled purposively pre-/post-intervention for clinical points learned. Descriptive and inferential analyses were performed.

RESULTS: Uptake and participation were good: 232 (79 %) nurses and 207 (76 %) CHWs participated. 96 % of nurses and 88 % of CHWs read the lessons within two weeks. There was a significant intervention effect on knowledge, based on the online questionnaires: nurses (0.5 units; 95 % CI 0.11-1.0; p = 0.0499) and CHWs (0.7 units; 95 % CI 0.2-1.3; p = 0.004). 1083 patient folders were reviewed to compare changes in patient care between the study arms. Adjusting for pre-care differences between the arms, the intervention increased correct patient care by 21 % ( 95 % CI 10 %-32 %; p < 0.001) in the year after the training.

CONCLUSIONS: WhatsApp-based microlearning improves knowledge and patient care. This, with the companion paper’s data showing that it is well received and accepted, makes it a valuable option for simple, accessible, scalable continuing medical education for HCWs.

PMID:40087110 | DOI:10.1016/j.nepr.2025.104326

J Hand Ther. 2025 Mar 13:S0894-1130(25)00008-0. doi: 10.1016/j.jht.2025.01.007. Online ahead of print.

ABSTRACT

BACKGROUND: Musculoskeletal problems, or aromatase inhibitor-associated musculoskeletal syndrome, in the hands and wrists is a known side effect of aromatase inhibitor medication, often prescribed for 5years or more for breast cancer survivors. No studies were found on the effectiveness of hand therapy for breast cancer survivors experiencing aromatase inhibitor-associated musculoskeletal syndrome in the hands and wrists.

PURPOSE: The primary objective of this study is to determine the effectiveness of hand therapy on reducing hand and wrist pain, improving grip strength, improving upper extremity function, and improving health related quality of life in breast cancer survivors diagnosed with aromatase inhibitor-associated musculoskeletal syndrome in the hands and wrists.

STUDY DESIGN: Longitudinal case series.

METHODS: A pre-post design was used to compare the results of standardized testing from initial evaluation to discharge. Participants were evaluated using standard hand therapy methods. Outcome measurements studied were pain levels, grip strength, upper extremity function, and breast cancer health related quality of life, measured with a patient-reported outcome measure specific to this population. A multimodal client centered treatment plan was utilized with each participant. Frequency and duration of the treatment was determined through collaboration with the participant.

RESULTS: Thirty-two participants enrolled and 29 completed the study. Comparison of pre and post data for all four outcome measures revealed statistically significant improvements (p<0.05). Cohen’s d analysis demonstrated large effect for pain, moderate effects for upper extremity function and health related quality of life, and low effect for grip strength. Trigger finger was noted to be present in 62.1% of participants.

CONCLUSIONS: This study demonstrates that hand therapy resulted in statistically and clinically significant improvement in pain, grip strength, upper extremity function, and health related quality of life. The results support the effectiveness of hand therapy for breast cancer survivors experiencing aromatase inhibitor-associated musculoskeletal syndrome in the hands and wrists.

PMID:40087098 | DOI:10.1016/j.jht.2025.01.007

J Pediatr Urol. 2025 Mar 6:S1477-5131(25)00132-9. doi: 10.1016/j.jpurol.2025.02.041. Online ahead of print.

ABSTRACT

INTRODUCTION: Among techniques for short spermatic vessels in nonpalpable undescended testis (UDT), the Fowler-Stephens (F-S) procedure is the most favored. However, traction methods have regained popularity with gradual testicular tension for elongation to avoid ligating the spermatic vessels.

OBJECTIVE: To compare two techniques for low intra-abdominal UDT with a short spermatic cord: staged laparoscopic F-S and a modified staged open traction technique, and to determine if long-practicing surgeons should change their preferred method.

STUDY DESIGN: Seventy boys under six with nonpalpable low intra-abdominal UDT and short cords underwent either staged laparoscopic F-S or staged open traction orchiopexy. Based on surgical exploration and the surgeons’ opinions, the included patients had vessels too short for one-stage orchiopexy. Two expert pediatric surgeons performed the surgeries, each using their preferred technique. Surgeon 1 used staged open traction, anchoring the testis to the pubic tubercle with low tension, followed by canal mobilization and fixation in the scrotum, while Surgeon 2 performed staged laparoscopic F-S. Post-operative ultrasonography at six months assessed success based on the absence of testicular atrophy and correct testis location.

RESULTS: Of the 70 boys, 36 (51.4 %) underwent staged open traction, and 34 (48.6 %) underwent staged laparoscopic F-S. The median age was 1.7 years. No intra- or post-operative complications occurred, and all testes were correctly placed in the scrotum. Testicular atrophy occurred in 6 patients (8.6 %): 2 (5.6 %) in the traction group and 4 (11.8 %) in the F-S group (p-value: 0.422). Atrophy was more common in bilateral cases, but all instances were unilateral (p-value: 0.022).

DISCUSSION: Both techniques had comparable results with no post-operative complications, and all testes were correctly positioned in the scrotum during follow-up. Although 5.6 % of patients in the traction group and 11.8 % in the F-S group experienced testicular atrophy, the difference was not statistically significant. Surgeon 1 performed all open traction surgeries, and Surgeon 2 performed all F-S operations due to their preferences and over 10 years of experience. Acceptable and comparable outcomes in both techniques show that both are safe when performed by an expert surgeon. We suggest that surgeons continue using their preferred technique if they are experts in it for the treatment of UDT. Although we assume our modified open traction method has an acceptable learning curve for less experienced surgeons, this needs further study.

CONCLUSIONS: Both staged traction and F-S techniques, performed by expert surgeons, yielded comparable outcomes, supporting the continued use of preferred methods.

PMID:40087088 | DOI:10.1016/j.jpurol.2025.02.041

J Craniomaxillofac Surg. 2025 Mar 13:S1010-5182(25)00048-4. doi: 10.1016/j.jcms.2025.02.003. Online ahead of print.

ABSTRACT

A modified thoracodorsal artery lateral branch (TDAL) chimeric flap was developed using dual-energy computed tomography (CT) angiography data of perforators to explore the anatomical characteristics and postoperative outcomes of TDAL flaps in complex maxillofacial defect repair. TDAL flaps were harvested from patients with locally advanced oral cancer. Preoperative perforator detection was performed with dual-energy CT angiography. Anatomical data were collected, and patients’ perioperative recovery details and complications were recorded. Upper extremity function and quality of life (QoL) data were compared to control data from a paired anterolateral thigh (ALT) flap group. Seventy-six patients survived without major complications. The length of the vascular pedicle was 8.97 ± 1.34 cm, and the diameter of the supplying artery was 1.60 ± 0.48 mm. In the first 3 months postoperatively, the TDAL group showed improved QoL. However, upper extremity function and QoL did not differ significantly between the TDAL and ALT groups at 6, 9, and 12 months postoperatively. A two-dimensional map of the perforation distribution was drawn based on the statistical distribution of perforations. TDAL can be designed as a long spindle-shaped or multi-leaf chimeric flap based on the perforator distribution map. This flap can be used as an alternative to repair large oral and maxillofacial defects.

PMID:40087081 | DOI:10.1016/j.jcms.2025.02.003

Transplant Proc. 2025 Mar 13:S0041-1345(25)00126-5. doi: 10.1016/j.transproceed.2025.02.024. Online ahead of print.

ABSTRACT

INTRODUCTION: Hypotension is a frequent complication of patients who are on chronic maintenance hemodialysis. Midodrine is an alpha-1 adrenergic agonist used to treat patients on hemodialysis who have chronic hypotensiom. The aim of our study was to evaluate if patients who required midodrine for hypotension had inferior outcomes compared to those who did not require midodrine.

METHODS: All kidney transplants performed at The Ohio State University Wexner Medical Center between January 2015 and January 2021 were analyzed. Patients that had a dual solid organ transplant that included a kidney transplant were excluded from our study. Patients were divided into two groups based on midodrine use. The main outcomes of interest were graft and patient survival at 1-year.

RESULTS: A total of 1538 kidneys were transplanted during the study period. A total of 1070 were recipients of deceased donor kidney transplants, 468 were recipients of living donor kidney transplants. In the deceased donor group the estimated glomerular filtration rate was higher in the non-midodrine patients compared to the midodrine group and this difference was statistically significant. Graft survival at 1 year was higher in the non-midodrine group (96% vs 79% P, .0001 OR 6.6). Patient survival at 1-year was also higher in the non-midodrine group (97% vs 86%, P = .0002, OR 6.3). Time to graft failure and patient death was faster in the midodrine group (P < .0001 for both).

CONCLUSION: The need for Midodrine to maintain blood pressure before kidney transplantation can serve as a marker for inferior graft and patient outcomes at 1-year. Additional studies with more data are needed to further support this theory and adjust for confounding effects.

PMID:40087051 | DOI:10.1016/j.transproceed.2025.02.024

J Evid Based Dent Pract. 2025 Mar;25(1S):102057. doi: 10.1016/j.jebdp.2024.102057. Epub 2024 Nov 26.

ABSTRACT

OBJECTIVE: Dental patient-reported outcomes (dPROs) are critical indicators of shared decision-making in oral healthcare. This study aimed to assess the frequency of use of dPROs and dPRO-related factors being used as predictors or predicted outcomes in clinical prediction models (CPMs) in oral health, and to identify variables associated with the use of dPROs and/or dPRO-related factors in CPMs.

METHODS: A PubMed search was conducted on 17th May, 2024, to identify eligible studies. The studies which aimed to develop CPMs in oral health using traditional statistical techniques (e.g. logistic or Cox regression) and were published from 2018 onwards were included. The dPROs and dPRO-related factors used as potential predictors, final predictors, and predicted outcomes in the CPMs were extracted and summarized. Logistic regression analyses were performed to assess the associations between various variables and the use of dPROs and dPRO-related factors.

RESULTS: A total of 144 studies were included, of which 88.2% were retrospective studies and 73.6% were on oral oncology. dPROs and/or dPRO-related factors were used as potential predictors, final predictors, and predicted outcomes in 28 (19.4%), 21 (14.6%), and 7 (4.9%) studies, respectively. The most frequently used dPRO as both potential and final predictors was self-reported orofacial pain, while the most frequently used dPRO-related factor was self-reported toothbrushing. The most frequently used dPRO as a predicted outcome was self-reported xerostomia, while no studies used dPRO-related factors as outcomes. The study topic was statistically significantly associated with the use of dPROs and/or dPRO-related factors (Odds Ratio [OR]: 9.98; 95% confidence interval [CI]: 3.36 29.67; P < .01).

CONCLUSIONS: dPROs and dPRO-related factors were infrequently used as predictors or predicted outcomes in prediction modeling studies in oral health. Studies in dental fields other than oral oncology, such as cariology and periodontology, were more likely to use dPROs and/or dPRO-related factors compared to those in oral oncology.

PMID:40087020 | DOI:10.1016/j.jebdp.2024.102057

Soc Sci Res. 2025 Mar;127:103137. doi: 10.1016/j.ssresearch.2024.103137. Epub 2024 Dec 27.

ABSTRACT

This study brings together scholarship on racial socialization and racialized organizations to explore how parental racial socialization operates in schools. Using student-level data from the Maryland Adolescent Development In Context Study and school-level data from the National Center for Education Statistics and the Civil Rights Data Collection, I investigate the extent to which engagement in parental racial socialization affects the academic outcomes and educational experiences of Black and White high school students. I find parental racial socialization has positive impacts on students’ GPAs for Black students and on students’ probability of liking school for both Black and White students. Additionally, I evaluate students’ perceptions of school organizational practices as racialized and find negative impacts on academic outcomes and educational experiences for all students. Finally, I find a significant interaction between parental racial socialization and perceived racialized organizational practices of schools, highlighting the moderating impact of parental racial socialization on Black students’ GPAs. Overall, findings suggest that academic outcomes and educational experiences are both a function of parental racial socialization and the perceived racialized organizational practices of schools. Moreover, within schools as racialized organizations, the variation in findings suggest parental racial socialization serves as an academic tool for Black students and a social tool for White students.

PMID:40087003 | DOI:10.1016/j.ssresearch.2024.103137

Food Microbiol. 2025 Aug;129:104756. doi: 10.1016/j.fm.2025.104756. Epub 2025 Feb 20.

ABSTRACT

Novel ultraviolet light emitting diodes (UV-C LED at 279 nm) are being investigated for broad-spectrum antimicrobial activity in addition to traditional mercury-lamp 254 nm UV-C systems. The goals of this study were to determine the doses required for hepatitis A virus (a resilient foodborne virus) inactivation in phosphate buffered saline (PBS, pH = 7.2), apple juice (AJ, pH = 4), and coconut water (CW, pH = 5), when treated with traditional 254 nm UV-C compared to 279 nm UV-C LED. For each tested liquid, 500 μL of HAV (∼5 log PFU/mL) was mixed with 4.5 mL liquid within glass beakers and treated for 0-15 min with 254 nm UV-C (maximum dose of 33.89 mJ/cm²) or for 0-10 min with 279 nm UV-C LED (maximum dose of 7.03 mJ/cm²) with continuous stirring. Mixed model analysis of variance (SAS v 9.4) was used to statistically analyze the recovered viral counts of three replicates. HAV in PBS and CW showed significantly lower D₁₀-values (dose required for a 1-log PFU inactivation) of 4.37 ± 0.61 and 5.59 ± 1.16 mJ/cm² with 279 nm UV-C LED than 15.27 ± 2.01 and 10.46 ± 0.53 mJ/cm² with 254 nm UV-C, respectively (p ≤ 0.05). However, D₁₀-values for HAV in AJ of 4.02 ± 0.27 mJ/cm² by 279 nm UV-C LED and 3.31 ± 0.61 mJ/cm² by 254 nm UV-C were obtained. HAV showed the highest sensitivity to 254 nm UV-C treatments in AJ followed by CW and PBS. Overall, 279 nm UV-C LED systems show potential for HAV inactivation in the tested fluids without visual changes at the target doses, which warrants further investigation for scale-up operations.

PMID:40086994 | DOI:10.1016/j.fm.2025.104756

Appl Nurs Res. 2025 Apr;82:151928. doi: 10.1016/j.apnr.2025.151928. Epub 2025 Feb 27.

ABSTRACT

AIM: To evaluate and compare pre- and post-STB training outcomes of bleeding control knowledge, willingness to act and confidence in doing so.

BACKGROUND: Stop the Bleed® (STB) training improves trainees’ willingness to intervene in pre-hospital bleeding emergencies and confidence in doing so, but few studies report associated knowledge-based outcomes.

METHODS: A cross-sectional, observational study was performed using a pre-/post-test approach. Lay community members aged ≥18 who read and spoke English were included. On enrollment, participants completed the Stop the Bleed Training Survey (STB-TS) (five self-assessment and three knowledge-based items), and provided demographics and work history data; the STB-TS was completed again immediately after training. Descriptive statistics were used to characterize the sample. Paired t-tests were used to compare STB-TS self-assessment items. McNemar’s Test was used to compare proportions of correct answers to STB-TS knowledge-based items.

RESULTS: Trainees (N = 31) had a mean age of 33 ± 16 years, identified as mostly female (58.1 %) and people of color (54.8 %), and reported little experience with bleeding control emergencies. Total STB-TS scores increased from 14.4 ± 6.7 to 17.0 ± 10.8 (p = .26), indicating greater knowledge, confidence, and willingness to act. Correct response rates increased significantly from pre- to post-training (27.6 % vs 69.2 %, p = .003) on only one of the knowledge-based items: proper tourniquet application.

DISCUSSION: Findings suggest a disconnect among trainees’ willingness to act and confidence in doing so compared to their knowledge of bleeding control intervention. Incorporating use of high-fidelity simulation and standardized evaluation instruments may enhance content and skill mastery.

PMID:40086947 | DOI:10.1016/j.apnr.2025.151928