Nevin Manimala

Invest Educ Enferm. 2025 Sep;43(3). doi: 10.17533/udea.iee.v43n3e13.

ABSTRACT

OBJECTIVE: To assess the effectiveness of nurse-led or nurse-integrated interventions in improving maternal health outcomes, particularly antenatal care (ANC) attendance, in resource-constrained settings.

METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases including PubMed, Scopus, CINAHL and Web of Science were searched for studies evaluating the impact of nursing interventions on maternal health outcomes. Risk of bias was assessed using the Cochrane RoB 2 tool and Newcastle-Ottawa Scale. A random-effects meta-analysis was performed for studies reporting ANC attendance (4 and more visits). (PROSPERO CRD420251067253).

RESULTS: Of the 1038 records identified, 11 studies met the inclusion criteria, and 3 were eligible for meta-analysis. The pooled Odds Ratio for ANC attendance was 1.48 (95% CI = 1.06-2.08), indicating a statistically significant improvement. For facility use at birth, results also showed positive effects (OR=1.49, 95% CI = 1.21-1.77). Mortality-related outcomes showed a midwife-delivered postpartum hemorrhage bundle reduced a composite outcome including severe hemorrhage and death (RR = 0.40, 95% CI = 0.32-0.50) Narrative synthesis of other outcomes such as skilled birth attendance and maternal mortality also suggested a positive impact of nurse-led interventions.

CONCLUSION: Nurse-led and nurse-integrated maternal health interventions significantly improve ANC utilization in low-resource settings. Policymakers should consider scaling these models as part of broader maternal health strategies.

PMID:41289537 | DOI:10.17533/udea.iee.v43n3e13

Invest Educ Enferm. 2025 Sep;43(3). doi: 10.17533/udea.iee.v43n3e12.

ABSTRACT

OBJECTIVE: To test the effectiveness of nursing intervention to control fluid volume on improving laboratory test results and dialysis adequacy in patients with Excess fluid volume.

METHODS: This is a randomized, double-blind, parallel-group controlled trial involving 34 patients with chronic kidney disease and a nursing diagnosis of Excess Fluid Volume undergoing chronic hemodialysis equally randomized into two groups (control n=17 and intervention n=17). Data were collected on sociodemographic and clinical factors, the presence of Excess Fluid Volume, and water balance. Laboratory parameters, including serum electrolytes, urea, creatinine, and dialysis adequacy markers, were assessed before and after the intervention. The intervention consisted of 13 nursing activities, including educational, follow-up, and reminder components, such as fluid balance monitoring, daily weight control, edema assessment, laboratory follow-up, and health education on diet and self-care. The control group received only the usual care provided at the dialysis clinic.

RESULTS: There were significant improvements in laboratory test results and dialysis adequacy. The statistical difference between the groups was significant in the mean values of calcium (p<0.001), post-hemodialysis urea (p=0.002), and creatinine (p=0.006), demonstrating the direct effect of the intervention. In addition, there were improvements in overall dialysis quality and adequacy measures.

CONCLUSION: The nursing intervention significantly improved laboratory test results and dialysis adequacy in patients with chronic renal failure and Excess Fluid Volume, highlighting its potential for enhancing patient management and nursing care.

PMID:41289536 | DOI:10.17533/udea.iee.v43n3e12

Invest Educ Enferm. 2025 Sep;43(3). doi: 10.17533/udea.iee.v43n3e11.

ABSTRACT

OBJECTIVE: To verify evidence of validity of the instrument “Knowledge, Attitude, and Practice of Nurses in Prenatal Care for Visually Impaired Pregnant Women”.

METHODS: Methodological study to assess content validity with the participation of 22 expert nurses (11 from the area of Sexual and Reproductive Health and 11 from the area of People with Disabilities). The instrument was adapted into a Google Forms questionnaire and assessed Objectivity, Clarity, and Relevance. The data were analyzed using the Content Validity Coefficient and Content Validity Ratio, in addition to calculating Cronbach’s Alpha for internal consistency. Ten generalist nurses from Primary Care participated in the semantic validation, evaluating comprehension, relevance, and possible adjustments to the instrument, with calculation of the Semantic Concordance Index.

RESULTS: The instrument obtained an overall Content Validity Coefficient above 0.90 for objectivity, clarity, and relevance, with internal consistency (Cronbach’s Alpha = 0.89). The experts’ suggestions improved the wording and structure. In semantic validation, the Semantic Concordance Index was 0.97, reinforcing clarity and applicability.

CONCLUSION: The instrument showed evidence of content validity, being objective, clear, and relevant for assessing the Knowledge, Attitude, and Practice of nurses in the prenatal care of pregnant women with visual impairment.

PMID:41289535 | DOI:10.17533/udea.iee.v43n3e11

J Orthop Sports Phys Ther. 2025 Dec;55(12):1-9. doi: 10.2519/jospt.2025.13558.

ABSTRACT

OBJECTIVES: To (a) estimate the association between socioeconomic position (SEP) and the use and frequency of physical therapy visits in the year preceding hip arthroscopic surgery for femoroacetabular impingement (FAI) syndrome in Denmark and (b) compare these associations before and after 2019, following international recommendations. STUDY DESIGN: Retrospective cohort study. METHODS: A cohort of 5739 patients with FAI syndrome and hip arthroscopy (2012-2024) was identified from the Danish Hip Arthroscopy Registry. Physical therapy use (yes/no) and visit frequency in the year preceding surgery were identified from national registries. SEP was categorized as low, medium, or high based on a composite score of educational attainment, income, and labor market affiliation. Binomial and negative binomial regressions were used to estimate relative risk ratios (RRs) and incidence rate ratios (IRRs). RESULTS: Overall, 35.1% of patients used physical therapy before hip arthroscopy, with lower use among those in the low-SEP group (29.3%) compared to the high-SEP group (36.0%) (directed acyclic graph [DAG]-adjusted RR = 0.83 [95% CI: 0.70, 0.98]) and no significant difference in visit frequency (DAG-adjusted IRR = 0.79 [95% CI: 0.59, 1.07]). Use declined from 38.9% before 2019 to 30.1% after (DAG-adjusted RR = 0.77 [95% CI: 0.72, 0.83]), with visits decreasing from 3.95 to 2.59 (DAG-adjusted IRR = 0.64 [95% CI: 0.56, 0.74]). CONCLUSION: One third of patients used physical therapy in the year before hip arthroscopy in Denmark, with one fifth having 6 or more visits. Patients in the lowest SEP group were less likely to use physical therapy, while differences in visit frequency were not statistically significant. Use of physical therapy declined from 39% before 2019 to 30% after. J Orthop Sports Phys Ther 2025;55(12):1-9. Epub 30 October 2025. doi:10.2519/jospt.2025.13558.

PMID:41288047 | DOI:10.2519/jospt.2025.13558

J Genet Couns. 2025 Dec;34(6):e70129. doi: 10.1002/jgc4.70129.

ABSTRACT

Current reproductive guidelines call for offering expanded carrier screening (ECS) for genetic conditions. Currently available panels can include screening for carrier status of tens to hundreds of autosomal recessive and/or X-linked conditions. Clinical utility is based on alterations to reproductive decision-making, but study cohorts supporting the utility of ECS largely consist of individuals of European ancestry who are highly educated, of high income, and who often receive preconception counseling. There is a lack of research on the views of patients from diverse backgrounds. Therefore, we aimed to assess and compare perceptions of the utility of ECS and targeted carrier screening (TCS) in an ethnically, economically, and educationally diverse population. We administered a survey to obstetrics and gynecology patients in Houston, Texas in the fall of 2022. Questions regarding genetic testing, reproductive management, and demographics were asked. Of the respondents who wanted children in the future, expressed interest in knowing reproductive genetic risks, and would consider using this information to change reproductive plans (114/186, 61%), 100 indicated their test preference, with 70 (70%) preferring ECS and 30 (30%) preferring TCS. There was no statistical difference in test preference by race and ethnicity, education, income, or insurance. Eighty-one of the 114 participants provided feedback on the utility of CS, and 74/81 (91%) of them found it useful. Only 30/81 (37%) of them, however, stated that they would change their reproductive plans if identified as at-risk. Participants were more likely to change their reproductive plans if they were not pregnant (OR = 3.63; 95 CI = 1.26-10.47), had not had prior genetic testing (OR = 3.03; 95 CI = 1.02-8.95), or had higher income (OR = 1.25; 95 CI = 1.00-1.55). This heterogeneous cohort expands upon data from previous homogeneous cohorts assessing CS utility. While attitudes toward CS were favorable, its perceived utility was lower. Information on reproductive management options should be provided to patients in the preconception period, and access to reproductive services must be improved for those with lower incomes. Further insight on the perspectives of diverse populations is imperative to defining the utility of carrier screening most accurately and equitably.

PMID:41288026 | DOI:10.1002/jgc4.70129

Int J Surg. 2025 Nov 24. doi: 10.1097/JS9.0000000000003920. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior cruciate ligament (ACL) tears are common injuries, that often lead to long-term knee instability and complications. Anterior cruciate ligament reconstruction can be performed using either single-bundle (SB) or double-bundle (DB) techniques. This study aimed to systematically compare clinical, functional, and complication outcomes between the two techniques through an umbrella review and meta-meta-analysis.

MATERIALS AND METHODS: Our study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included meta-analyses published in PubMed, Embase, Cochrane, and Web of Science up to January 2025. Data on knee stability, functional scores, complications (graft failure, osteoarthritis incidence, knee extension/flexion deficits), and clinical outcomes were extracted, and quality was assessed using the A Measurement Tool to Assess Systematic Reviews 2 and Grading of Recommendations Assessment, Development, and Evaluation systems. Continuous outcomes were synthesized using the Mean Difference (MD) and Standardized Mean Difference (SMD).

RESULTS: A total of 22 meta-analyses were analyzed. The results of our meta-meta-analysis showed no statistically significant differences in objective knee joint stability between DB and SB reconstruction on the pivot shift test, KT 1000/2000 arthrometer, and Lachman test. Clinical outcomes favored the DB technique, which showed statistically superior Lysholm scores (MD = 0.82, P = 0.02) and better subjective IKDC scores (MD = 1.42, P = 0.007); however, these differences did not reach the minimum clinically important difference. There were also no significant differences in complication rates, including graft failure, incidence of osteoarthritis, and knee extension/flexion deficits.

CONCLUSION: This meta-meta-analysis indicates no definitive superiority for either DB or SB anterior cruciate ligament reconstruction. We found no significant differences in knee joint stability or complication rates. While minor statistical differences in clinical outcomes were observed-favoring DB for both Lysholm and subjective IKDC scores-these were not clinically meaningful.

PMID:41287961 | DOI:10.1097/JS9.0000000000003920

Int Endod J. 2025 Nov 25. doi: 10.1111/iej.70072. Online ahead of print.

ABSTRACT

BACKGROUND: There is a strong association between root canal curvatures and iatrogenic complications during root canal treatment.

INTRODUCTION: This study compared the curvature of mesiobuccal (MB) and mesiolingual (ML) canals in mandibular first molars between sagittal and coronal planes using cone-beam computed tomography.

METHODS: Two hundred mesial roots (400) canals from a Brazilian subpopulation were analysed. Curvature angles were measured in sagittal and coronal planes using Schneider’s and Weine’s methods, while curvature radii were calculated geometrically. The prevalence of S-shaped canals was also recorded. Curvature severity was classified according to the American Association of Endodontists Case Difficulty Assessment form, EndoApp, and modified versions incorporating curvature and radius. The influence of the angle measurement method and radius on case complexity was evaluated. Statistical analyses were performed using t-tests and chi-squared tests, with significance set at p ≤ 0.05.

RESULTS: Sagittal planes showed significantly greater angles and smaller radii than coronal planes. Weine’s method yielded consistently higher angles and smaller radii than Schneider’s. Severe single curvatures (≥ 30°) were more frequent in sagittal planes, whereas S-shaped canals were more prevalent in coronal planes. MB was more often classified as higher difficulty than ML canals. Incorporating radius into the classification systems generally shifted cases towards greater severity.

CONCLUSIONS: Sagittal planes revealed more severe single curvatures, whereas coronal planes showed a higher prevalence of S-shaped canals. Weine’s method resulted in greater curvature severity than Schneider’s. Inclusion of radius increased case severity grading. These findings highlight the importance of considering both measurement method and projection plane in endodontic treatment planning and research.

PMID:41287941 | DOI:10.1111/iej.70072

Cardiol J. 2025 Nov 25. doi: 10.5603/cj.99990. Online ahead of print.

ABSTRACT

BACKGROUND: The global mortality rates due to cardiovascular diseases (CVD) are still alarmingly high, highlighting the need for accurate assessment of the risk of severe cardiovascular (CV) events. To address this, the Pol-SCORE and SCORE2 scales have been developed.

METHODS: We conducted an observational and retrospective analysis of 450 patients with LDL ≥ 100 mg/dL admitted to the Clinical Hospital of the Medical University of Warsaw between 2019 and 2020. The objective of our study was to assess the treatment in patients with high levels of LDL cholesterol, without pre-existing CVD, by estimating their CV risk using the Pol-SCORE and SCORE2 scales.

RESULT: We enrolled a total of 150 patients in the study: 86 women (57.3%) and 64 men (42.7%), with an average age of 55.1 years. The high-risk category in the SCORE2 scale included patients with low, moderate, high, and very high risk estimated in the Pol-SCORE scale. It was statistically significant (p < 0.0001) in the distribution of risk assessment results between groups of CV risk.

CONCLUSIONS: According to research, the Pol-SCORE scale has been found to potentially underestimate the likelihood of CV events occurring when compared to the SCORE2 scale, which has a more cautious and restrictive approach. Patients with high and very high risk of fatal and non-fatal CVD are not receiving appropriate treatment. To identify and implement proper recommendations and treatments for patients with elevated risk, the SCORE2 scale should be utilized to estimate CV risk events.

PMID:41287937 | DOI:10.5603/cj.99990

Dis Model Mech. 2025 Nov 25:dmm.052460. doi: 10.1242/dmm.052460. Online ahead of print.

ABSTRACT

Collagen VI Related Dystrophies (COL6-RD) are congenital muscle diseases, typically inherited as an autosomal dominant trait. A frequent type of mutation involves glycine substitutions in the triple helical domain of collagen VI alpha chains, exerting a dominant-negative effect on the unaltered protein. Despite this, no prior animal model captured this mutation type. Using CRISPR/Cas9, we generated transgenic mice with the equivalent of the human COL6A1 c.877 G>A; p. Gly293Arg mutation. We characterized their skeletal muscle phenotype over time, utilizing computer-aided tools applied to standardized parameters of muscle pathology and function. Knock-in mice exhibited early-onset reduced muscle weight, myopathic histology, increased fibrosis, reduced collagen VI expression, muscle weakness, and impaired respiratory function. These features provide adequate outcome measures to assess therapeutic interventions. The different automated image analysis methods deployed here analyze thousands of features simultaneously, enhancing accuracy in describing muscle disease models. Overall, the Col6a1 Ki Gly292Arg mouse model offers a robust platform to deepen our understanding of COL6-RD and advance its therapeutic landscape.

PMID:41287928 | DOI:10.1242/dmm.052460

J Esthet Restor Dent. 2025 Nov 25. doi: 10.1111/jerd.70064. Online ahead of print.

ABSTRACT

OBJECTIVE: Multimodal large language models (LLMs) have the potential to transform dental learning and decision-making by addressing multimodal dental inquiries that integrate text, images, and analytical data. The purpose of this study was to evaluate the performance of various multimodal LLMs in responding to multimodal dental queries and to identify factors influencing their performance.

MATERIALS AND METHODS: Four multimodal LLMs (ChatGPT-4V, Claude 3 Sonnet, Microsoft 365 Copilot 2024, and Google Gemini 1.5 Pro) were evaluated based on their correct answers and passing margin for the Integrated National Board Dental Examination (INBDE) and the Advanced Dental Admission Test (ADAT). Descriptive statistics, χ² tests, Cohen’s κ, Kruskal-Wallis tests, and Mann-Whitney U tests were used to analyze the performance across different question types, independent inputs, and picture types (α = 0.05).

RESULTS: Claude 3 Sonnet outperformed the other models in both INBDE and ADAT exams, achieving the highest accuracy, followed by ChatGPT-4V, Microsoft 365 Copilot 2024, and Google Gemini 1.5 Pro. χ² tests revealed significant differences between chatbots in the ADAT exam, but not in the INBDE. Cohen’s κ showed weak to moderate model agreement for INBDE and stronger agreement for ADAT, with the highest agreement between Claude 3 Sonnet and ChatGPT-4V (κ = 0.757) and the lowest between Google Gemini 1.5 Pro and Microsoft 365 Copilot 2024 (κ = 0.059). Model performance was influenced by question type (theoretical and clinical), with common errors including misinterpreting clinical scenarios, visual data difficulties, and dental terminology ambiguities.

CONCLUSION: Multimodal LLMs show potential in answering multimodal dental inquiries, though performance varies across models, with challenges in interpreting clinical scenarios, visual data, and terminology ambiguity.

CLINICAL SIGNIFICANCE: Large language models canbe applied not only to memorization-type but also interpretation andproblem-solving cognitive questions in dentistry. Tomaximize the utility of these artificial intelligence models, users need bothan understanding of their differences and the ability to manage complexclinical data.

PMID:41287924 | DOI:10.1111/jerd.70064