Nevin Manimala

J Interprof Care. 2026 Jul 12:1-8. doi: 10.1080/13561820.2026.2698726. Online ahead of print.

ABSTRACT

Interprofessional primary care providers play a central role in delivering palliative care, although it remains challenging to implement. We evaluated a virtual interprofessional education program called CAPACITI, aiming to increase early identification of palliative care needs in the context of interprofessional primary care teams. A three-module two-arm version of CAPACITI was delivered in a randomized controlled trial, with teams assigned to either a self-directed or facilitated learning arm. Participants completed surveys before and after each module, including the Assessment of Interprofessional Team Collaboration Scale-II (AITCS-II). The pre-intervention survey also included the Organizational Readiness to Change Assessment (ORCA) measure. Descriptive statistics, paired t-tests, and generalized linear models were conducted. Of the 566 enrolled, 380 (67.1%) completed Module 1, 274 (48.4%) completed Module 2, 202 (35.7%) completed Module 3, and 192 (33.9%) completed all three modules. AITCS-II scores improved significantly (p < .001) following CAPACTI, with no difference between self-directed and facilitated groups for any module. Participants with lower ORCA scores at baseline experienced greatest improvement in team collaboration. CAPACITI demonstrates promise as an effective and scalable intervention to enhance interprofessional collaboration in palliative primary care. These findings support the integration of virtual team-based training as a strategy to strengthen collaborative care across primary care settings.

PMID:42437374 | DOI:10.1080/13561820.2026.2698726

Environ Sci Technol. 2026 Jul 12. doi: 10.1021/acs.est.6c04963. Online ahead of print.

ABSTRACT

Data-driven modeling in wastewater treatment is increasingly constrained by the reality of small, high-dimensional data, where the abundant monitoring parameters in small-sized data sets obscure fundamental mechanistic understandings. This study proposes a knowledge-driven feature selection framework that integrates mechanistic insights with statistical correlations to identify the most informative predictive features. Using nitrous oxide (N₂O) emission prediction at a full-scale plant as a case study, we compared classic deep-learning feature selection algorithms using attention mechanisms against two new knowledge-based approaches: (i) expert-guided feature selection and (ii) large language model (LLM)-augmented feature selection. Expert-knowledge-guided feature selection substantially enhances predictive accuracy, achieving a mean R² of 0.723 and an MAE of 0.033, compared to R² = 0.712 and MAE = 0.033 for the best-performing attention-based architecture. More importantly, the proposed framework markedly improves model generalizability: under out-of-distribution high-flow conditions where the attention-based model fails to capture N₂O emission patterns, the expert-selected model continues to reproduce the dominant temporal dynamics of N₂O emissions. The LLM-assisted approach also delivers competitive accuracy (mean R² = 0.596, MAE = 0.041) and similarly preserves generalizability under an input distributional shift. By introducing mechanistic understanding into the feature selection process, this framework offers a generalizable pathway for addressing complex wastewater treatment challenges while maintaining a computational efficiency.

PMID:42437349 | DOI:10.1021/acs.est.6c04963

Iran J Allergy Asthma Immunol. 2026 Jun 3;25(4):554-564.

ABSTRACT

To investigate the feasibility and effectiveness of targeted lung recruitment and the titration of optimal positive end-expiratory pressure (PEEP) in neonates under the guidance of lung ultrasound. The atelectasis neonates from June 2022 to June 2024 in the Neonatology Department of People’s Hospital of Pidu were collected and randomly divided into a lung ultrasound scoring (LUS) group and an oxygen (OXY) group, both of which were given mechanical ventilation treatment. The lung recruitment and optimal PEEP were performed by the LUS and OXY methods, respectively. The optimal PEEP and the respiratory and hemodynamic indexes of the two groups were compared before and after lung recruitment and after the optimal PEEP was titrated. After the intervention, the dynamic lung compliance (Cdyn) in the LUS group increased by 38.2% compared with the baseline (from 30.6 ± 4.3 to 42.3 ± 5.1 mL/cmH2O), which was significantly higher than the 21.4% increase in the OXY group (from 29.8 ± 4.1 to 35.6 ± 4.8 mL/cmH2O). The improvement in PaO2/FiO2 in the LUS group was 22.5% higher than in the OXY group. There was no statistically significant difference in the incidence of complications between the two groups. Lung ultrasound can guide neonatal lung recruitment and optimal PEEP titration, improving lung compliance and oxygenation without affecting the safety of treatment.

PMID:42437315

Iran J Allergy Asthma Immunol. 2026 Jun 3;25(4):517-528.

ABSTRACT

Postoperative infections (POIs) significantly contribute to morbidity and mortality following partial hepatectomy for hepatocellular carcinoma (HCC). While the Systemic Immune-Inflammation Index (SII) and Prognostic Nutritional Index (PNI) are recognized biomarkers for immune-inflammatory and nutritional status, their combined predictive value for POIs in liver surgery requires further investigation. This study evaluates SII and PNI as preoperative predictors for infections in this patient population. A retrospective observational study was conducted on 300 patients undergoing partial hepatectomy between 2022 and 2024. Preoperative laboratory data were used to calculate SII and PNI, with POIs identified within 30 days based on CDC guidelines. Statistical analyses, including multivariate logistic regression, were performed to compare infected and non-infected cohorts and identify independent predictors of infection. Of the 300 patients, 96 (32%) developed POIs. The infected group exhibited significantly higher SII (1142 ± 618 vs 792 ± 450) and lower PNI (40.1 ± 5.8 vs 46.4 ± 5.9) than the non-infected group. Multivariate analysis confirmed high SII (OR 2.85) and low PNI (OR 3.26; 95% CI, 2.01-5.12) as independent predictors. Furthermore, infections were associated with prolonged hospitalization, increased ICU admissions, and higher 30-day mortality. Preoperative SII and PNI are effective, independent predictors of POIs in patients undergoing hepatectomy for liver cancer. Integrating these biomarkers into routine evaluation enhances risk stratification and guides perioperative optimization. Early identification through these indices allows for targeted interventions, such as nursing-led nutritional support and intensified surveillance, to reduce complications and improve surgical outcomes.

PMID:42437312

Malays Fam Physician. 2026 Jun 4;21:32. doi: 10.51866/oa.1006. eCollection 2026.

ABSTRACT

INTRODUCTION: Menopause is a substantial life transition for women, signifying the end of reproductive capability, with implications for symptoms, long-term health and well-being. Women’s experiences during menopause can differ widely, affecting their attitudes towards this transition. This study aimed to investigate knowledge and attitudes towards menopause among midlife women in Malaysia.

METHODS: A community-based cross-sectional online survey using non-probability sampling was conducted among Malaysian women aged 40-60 years residing in an urban setting. A validated online questionnaire was used to assess the study parameters. Knowledge and attitudes were quantified, and associations with sociodemographic factors were examined using the Kruskal-Wallis test. Descriptive statistics and Spearman’s correlation analysis were performed using the IBM Statistical Package for the Social Sciences Statistics version 26.0.

RESULTS: Of the 300 respondents, the majority were Malay (94.7%), married (85.3%) and aged 55-60 years (27.3%). Over half (52.0%; mean score=12.98±6.77 [22 max score]) demonstrated poor knowledge, while 45.3% held negative attitudes towards menopause. The average attitude score was 33.48±6.58 [56 max score], indicating a generally negative orientation towards menopause. A weak but significant positive correlation was observed between knowledge and attitudes (r=0.249, P<0.01).

CONCLUSION: Targeted educational initiatives may be beneficial in enhancing menopause-related knowledge and fostering more positive attitudes among midlife Malaysian women. Future research should rigorously assess changes in knowledge, attitudes and related clinical behaviours after such interventions to inform policy and practice.

PMID:42437304 | PMC:PMC13355863 | DOI:10.51866/oa.1006

Malays Fam Physician. 2026 Jun 26;21:33. doi: 10.51866/oa.1109. eCollection 2026.

ABSTRACT

INTRODUCTION: Sarcopaenia is underdiagnosed in primary care due to limitations in available tools. The SARC-F questionnaire is a recommended screening tool, but its diagnostic accuracy among Malaysian community-dwelling older adults is not well established. This study aimed to determine the diagnostic accuracy of the SARC-F score against hand grip strength (HGS) for identifying possible sarcopaenia among community-dwelling older adults.

METHODS: A cross-sectional study was conducted from January to November 2024 across 11 public health clinics. Community-dwelling older adults aged ≥60 years were recruited. Sarcopaenia risk was assessed using the SARC-F questionnaire, with scores of ≥4 indicating a high risk. HGS was measured using a Jamar dynamometer, with possible sarcopaenia defined according to the Asian Working Group for Sarcopenia 2019 criteria (<28 kg for men, <18 kg for women). Statistical analysis included the Mann-Whitney U test to compare mean rank distributions of HGS between SARC-F risk groups and Cohen’s kappa to assess the agreement between the SARC-F score- and HGS-based classifications. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminatory performance of the SARC-F score in identifying possible sarcopaenia, using HGS as the reference standard.

RESULTS: Among 578 participants, the median HGS was significantly lower in the high-risk SARC-F group for both men (19.0 kg vs 28.0 kg, P<0.001) and women (14.0 kg vs 18.0 kg, P<0.001). The agreement between the SARC-F score- and HGS-based classifications was poor to fair (kappa=0.219). The SARC-F score demonstrated low sensitivity (34.7%) but high specificity (87.5%); it showed poor discriminative ability in detecting possible sarcopaenia (area under the ROC curve=0.67; 95% confidence interval=0.622-0.710; P<0.001). The positive predictive value was 74.6%; negative predictive value, 55.9%; and overall accuracy, 60.4%.

CONCLUSION: While a high SARC-F score is significantly associated with low HGS, the low sensitivity of the SARC-F score limits its use as a standalone screening tool in primary care. A two-step approach, using the SARC-F questionnaire followed by objective HGS measurement, may enhance early detection efforts in primary care.

PMID:42437303 | PMC:PMC13355861 | DOI:10.51866/oa.1109

Malays Fam Physician. 2026 Jun 7;21:26. doi: 10.51866/rv.1027. eCollection 2026.

ABSTRACT

INTRODUCTION: Ischaemic heart disease (IHD) remains a major cause of mortality among individuals with type 2 diabetes mellitus (T2DM) in Malaysia. Conventional cardiovascular risk models, such as the Framingham risk score, often show limited calibration in Asian populations. Artificial intelligence (Al)-calibrated models have emerged as potential alternatives, yet their generalisability and clinical utility across different populations remain uncertain. This narrative review aimed to summarise existing prognostic models for IHD in patients with T2DM and identify methodological gaps relevant to the development of a locally calibrated model.

METHODS: This narrative review employed a structured search strategy guided by PRISMA principles but was not conducted as a full systematic review. We synthesised evidence from epidemiological and prognostic research. Studies comparing conventional statistical approaches (e.g. logistic regression and Cox models) with AI-calibrated models such as extreme gradient boosting, random forest and support vector machines were reviewed.

RESULTS: Eleven studies met the inclusion criteria; four used conventional statistical methods, and seven applied AI or machine learning algorithms. The reported discrimination (area under the curve=0.66-0.94) varied widely. Conventional models commonly lacked external validation and demonstrated restricted applicability beyond their original cohorts. AI-calibrated models showed promising discrimination in some datasets but similarly experienced limited validation and lacked benchmarking against traditional statistical methods. Across the studies, limited calibration and validation reduced generalisability to heterogeneous Malaysian populations.

CONCLUSION: Developing a locally AI-calibrated i-IHD score could enable early risk identification, guide targeted interventions and support national health initiatives, including the Health White Paper 2023 and 13th Malaysia Plan.

PMID:42437302 | PMC:PMC13355864 | DOI:10.51866/rv.1027

SAGE Open Nurs. 2026 Jul 10;12:23779608261468455. doi: 10.1177/23779608261468455. eCollection 2026 Jan-Dec.

ABSTRACT

BACKGROUND: Digital health technologies are increasingly embedded in Neonatal Intensive Care Units (NICUs), yet the role of nurse-led governance in shaping safe, sustainable implementation for high-risk neonates remains underexplored. This review synthesized evidence on nursing leadership and digital health integration in NICUs.

METHODS: Following PRISMA 2020, six databases were searched (January 2013-January 2025), supplemented by grey literature, reference-list screening, and forward citation tracking. The protocol was prospectively registered with PROSPERO. Eligible empirical studies (n = 18) addressed formal nurse-led governance, operational governance enactment by nurses, or leadership-relevant determinants. Risk of bias was appraised with design-specific tools (Cochrane RoB 2, ROBINS-I, JBI, MMAT); synthesis combined structured narrative and reflexive thematic analysis.

RESULTS: Findings are presented as associations, not causal effects. Favorable signals included a 60% reduction in high-stage device-related pressure injuries in one quality-improvement initiative; 30-day readmission rates of 13.8% among enrolled versus 30.9% among non-enrolled caregivers in a nurse-led post-discharge telehealth intervention; and an approximately 12-day shorter length of stay favoring the intervention in one randomized trial of nurse-led developmental care. Using conservative, author-reported coding, organizational/leadership support (17/18; 94%) and structured training (8/18; 44%) were most frequently documented; funding/IT (22%) and clinical champions (17%) less so. Nurse-led governance could not be statistically separated from co-occurring implementation activities.

CONCLUSION: Across a predominantly observational, low-to-moderate-certainty evidence base, nurse-led governance was consistently associated with stronger implementation processes and selected family- and clinical-level signals when embedded in coordinated training, workflow redesign, and audit-and-feedback. Findings are hypothesis-generating. Comparative-effectiveness and economic evaluations decomposing leadership from co-occurring implementation components are needed.

PMID:42437296 | PMC:PMC13354904 | DOI:10.1177/23779608261468455

Cureus. 2026 Jun 11;18(6):e110670. doi: 10.7759/cureus.110670. eCollection 2026 Jun.

ABSTRACT

Background Hamstring tendon (HT) autografts are commonly used in anterior cruciate ligament reconstruction (ACLR), although graft dimensions may vary among patients. Smaller graft diameters have been associated with higher graft failure rates, emphasizing the clinical importance of understanding factors related to the graft size. Consequently, preoperative anthropometric measurements have been investigated for their association with hamstring graft dimensions. However, findings from previous studies remain inconsistent across different populations, and data from Southeast Asian populations are still limited. Therefore, this study aimed to examine the relationship between preoperative anthropometric parameters and intraoperative hamstring graft dimensions, including diameter and length, in single-bundle ACLR patients using a five-strand hamstring autograft. Methods We retrospectively analyzed 91 patients who underwent primary single-bundle ACLR from 2018 to 2023 at a single institution. Preoperative data, including age, gender, height, weight, body mass index (BMI), and thigh circumference, were collected. Intraoperative graft diameter and length were obtained from the operative records. Pearson correlation and simple linear regression analyses were used to evaluate associations between anthropometric parameters and graft diameter. A p-value < 0.05 was considered statistically significant. Results Graft diameter showed a positive correlation with weight (r = 0.22, p = 0.040) and height (r = 0.51, p < 0.001), while graft length was positively correlated with height (r = 0.31, p = 0.003). Regression analysis confirmed a significant association between height and graft diameter (F (1, 89) = 30.649, p < 0.001), with height showing moderate explanatory power (R² = 0.256) and the strongest predictive relationship. In contrast, weight showed a statistically significant but weak association with graft diameter, explaining only a minimal proportion of variance (R² = 0.046). Conclusion Patient height showed a significant yet modest association with five-strand hamstring autograft diameter. These findings may provide supportive reference data for preoperative assessment in similar populations. Further studies are required to refine and validate predictive models for graft size estimation.

PMID:42437261 | PMC:PMC13355849 | DOI:10.7759/cureus.110670

Cureus. 2026 Jun 11;18(6):e110672. doi: 10.7759/cureus.110672. eCollection 2026 Jun.

ABSTRACT

Introduction Acne scarring represents a permanent structural sequela of acne vulgaris and is predominantly characterized by atrophic morphological patterns. Beyond cosmetic disfigurement, facial acne scars may contribute to significant psychosocial distress, including body image disturbance and quality-of-life impairment. Limited data are available correlating scar morphology with body image concerns and scar-specific quality-of-life impairment in the Indian population. Objectives The objectives of this study are to examine the morphological profile of facial acne scars, evaluate the body image concerns and quality of life among patients with acne scars, and determine the correlation of facial acne scarring with body image concerns and quality-of-life impairment. Materials and methods This cross-sectional observational study was conducted in the Department of Dermatology, Venereology and Leprosy, Adichunchanagiri Hospital and Research Centre, Karnataka, over a period of 18 months. It included 150 patients of either gender, aged 18-40 years, with facial acne scars. Morphological assessment was performed under standardized illumination. Scar severity was graded using the Goodman and Baron qualitative grading system and the Self-assessment of Clinical Acne-Related Scars (SCARS) questionnaire. The Body Image Concern Inventory (BICI) and Facial Acne Scar Quality of Life (FASQoL) questionnaires were used for fulfilling the respective objective. Statistical analysis was performed using Epi Info software. Correlations were assessed using Spearman’s rank correlation coefficient. A p-value of < 0.05 was considered statistically significant. Results The majority of participants (63.3%; n=95) were aged 21-25 years, and 69.3% (n=104) were female. Icepick scars were the most common morphological type at 78.7% (n=118), followed by boxcar scars at 61.3% (n=92). Clinician-based grading revealed that 72.6% (n=109) of participants had moderate to severe acne scarring. Based on a SCARS assessment, 36.0% (n=54) had mild, 30.0% (n=45) had moderate, and 15.3% (n=23) had severe/very severe scarring. Mean BICI scores increased significantly across SCARS severity categories (p<0.001). The mean FASQoL score was 6.79 ± 7.11, with higher scores observed in severe scarring (p<0.001). Moderate positive correlations were observed between SCARS and BICI (rₛ=0.419, p<0.001), SCARS and FASQoL (rₛ=0.500, p<0.001), Goodman-Baron grade and FASQoL (rₛ=0.448, p<0.001), and Goodman-Baron grade and BICI (rₛ=0.367, p<0.001). Conclusion Body image concern is evident across domains of dissatisfaction with appearance, preoccupation with perceived flaws, and mirror-checking behaviors. Scar-specific quality-of-life impairment manifests as emotional distress, social self-consciousness, and reduced interpersonal confidence. Patient-perceived severity demonstrates a particularly strong relationship with psychosocial burden, underscoring the importance of integrating clinician-based grading with validated patient-reported outcome measures for comprehensive assessment and patient-centered management.

PMID:42437257 | PMC:PMC13355855 | DOI:10.7759/cureus.110672