Nevin Manimala

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

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