Nevin Manimala

BMC Palliat Care. 2024 Dec 21;23(1):297. doi: 10.1186/s12904-024-01629-7.

ABSTRACT

BACKGROUND: Global demand for care during the last year of life (end-of-life) is rising and with shortfalls in community healthcare services, paramedics are increasingly called on to deliver this. Despite this growing demand on the paramedic workforce, little large-scale or detailed empirical research has evaluated current practice and paramedic experiences of attending this patient group. Therefore, as part of a wider study evaluating paramedic delivery of end-of-life care, a large-scale survey in England describing paramedics’ current practice and experiences providing end-of-life care was undertaken.

METHODS: A cross-sectional online survey design. Quantitative data were analysed using descriptive statistics and qualitative free text responses using Framework Analysis. The survey link was distributed to registered paramedics employed by all 11 NHS Trusts employing paramedics in England, United Kingdom.

RESULTS: Nine hundred and twenty responses were received. They reported shortfalls in availability of healthcare professionals for advice and/or referral. Respondents often, always or sometimes: lacked patient medical history (91%, 839), access to existing advance care planning documentation (98%, 900) and specific medicines needed (80%, 737); encountered conflicting views (89%, 819); and reported lack of pre-registration training (81%, 743) or continuing professional development (77%, 708) influenced their ability to meet patient needs.

CONCLUSIONS: This first national survey of paramedic practice and experiences in delivering end-of-life care provides new evidence and insight into the challenges faced by paramedics and the potential impact of these challenges on their perceived levels of competence and confidence. Respondents reported multiple challenges, which potentially impact their ability to provide good quality end-of-life care and increase the risk of hospital conveyance. Paramedic practice at end-of-life must be supported via improved access to: patient records; anticipatory medicines and authority to administer; 24/7 palliative care advice (for shared decision-making); and paramedic specific palliative and end-of-life care training and education (including via integrative ways of working between palliative care and ambulance services). Action is required to integrate paramedicine within the wider healthcare professional team, with robust education and training to support care delivery.

PMID:39709434 | DOI:10.1186/s12904-024-01629-7

BMC Nurs. 2024 Dec 21;23(1):944. doi: 10.1186/s12912-024-02634-0.

ABSTRACT

AIM: This study aimed to translate and evaluate the psychometric properties of the Persian version of the Innovative Behavior Inventory-20 (IBI-20) among clinical nurses in northwest Iran.

METHODS: A descriptive survey with psychometric analysis was conducted involving 321 nurses from Ardabil medical training centers. The study employed a stratified proportional sampling method. Data were collected using standard questionnaires, including a demographic profile form and the innovative behavior questionnaire. Descriptive statistics, such as mean, standard deviation, frequency, and percentage, were calculated using IBM SPSS Statistics for Windows, version 26.0. Reliability was assessed through Cronbach’s alpha, McDonald’s omega, and Coefficient H. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) was performed using IBM SPSS version 26.0 and AMOS version 24.0, with a significance level set at p < 0.05.

RESULTS: The findings indicate that the IBI-20 possesses good face validity, content validity, construct validity, convergent and discriminant validity, and reliability. CFA confirmed the accuracy of the tool’s six-factor structure, with all factors exhibiting factor loadings greater than 0.3. Internal consistency was excellent, as demonstrated by a high Cronbach’s alpha, McDonald’s omega, and Coefficient H. The test-retest reliability of the IBI was also robust, with an intraclass correlation coefficient (ICC) of 0.942.

CONCLUSION: Our study validated the Persian version of the Innovative Behavior Inventory-20 (IBI-20) for assessing innovative behaviors among Iranian nurses. The IBI-20 is a vital tool for addressing healthcare challenges. The validation process, including face validity, content validity, and confirmatory factor analysis, demonstrated excellent validity, establishing it as a reliable instrument for evaluating innovative behaviors among nurses. These findings significantly impact nursing practice and research, ultimately enhancing patient outcomes.

PMID:39709430 | DOI:10.1186/s12912-024-02634-0

J Hematol Oncol. 2024 Dec 21;17(1):129. doi: 10.1186/s13045-024-01653-3.

NO ABSTRACT

PMID:39709429 | DOI:10.1186/s13045-024-01653-3

World J Surg Oncol. 2024 Dec 21;22(1):347. doi: 10.1186/s12957-024-03618-9.

ABSTRACT

BACKGROUND: Postmastectomy radiation therapy (PMRT) can influence the outcome of implant-based breast reconstruction (IBBR). This study aims to investigate the complications and patient-reported outcomes (PROs) following PMRT between direct-to-implant (DTI) and tissue expander-to-implant (TEI) reconstruction.

METHODS: The retrospective study included breast cancer patients undergoing IBBR and PMRT. Patients were divided into a permanent implant group (PI-PMRT) and a tissue expander group (TE-PMRT). Complications, reconstruction failure, and reoperation were compared between the two groups. PROs were assessed using the BREAST-Q scale.

RESULTS: A total of 203 patients were included: 99 in the PI-PMRT group and 104 in the TE-PMRT group. The incidence of severe capsular contracture was significantly higher in the PI-PMRT group compared to the TE-PMRT group (37.4% vs. 24.0%, p = 0.039). The PI-PMRT group had a significantly lower rate of reconstruction failure (9.1% vs. 19.2%, p = 0.039) and reoperation (13.1% vs. 24.0%, p = 0.046). Multivariate analysis revealed that the absence of mesh (OR = 2.177, p = 0.040) and DTI reconstruction (OR = 1.922, p = 0.046) were independent predictors of severe capsular contracture; the absence of mesh (OR = 4.699, p = 0.015) and TEI reconstruction (OR = 2.429, p = 0.043) were independent predictors of reconstruction failure. BREAST-Q scores indicated greater breast satisfaction in the PI-PMRT group (p = 0.031).

CONCLUSIONS: Although DTI reconstruction resulted in a higher risk of severe capsular contracture, the higher risk of reconstruction failure and reoperation in patients undergoing TEI reconstruction was even more concerning. Furthermore, patients were more likely to report greater breast satisfaction with DTI reconstruction. Therefore, DTI reconstruction may be a more appropriate option for patients anticipating PMRT.

PMID:39709427 | DOI:10.1186/s12957-024-03618-9

Respir Res. 2024 Dec 21;25(1):438. doi: 10.1186/s12931-024-03056-x.

ABSTRACT

To optimize patient outcomes, healthcare decisions should be based on the most up-to-date high-quality evidence. Randomized controlled trials (RCTs) are vital for demonstrating the efficacy of interventions; however, information on how an intervention compares to already available treatments and/or fits into treatment algorithms is sometimes limited. Although different therapeutic classes are available for the treatment of chronic obstructive pulmonary disease (COPD), assessing the relative efficacy of these treatments is challenging. Synthesizing evidence from multiple RCTs via meta-analysis can help provide a comprehensive assessment of all available evidence and a “global summary” of findings. Pairwise meta-analysis is a well-established method that can be used if two treatments have previously been examined in head-to-head clinical trials. However, for some comparisons, no head-to-head studies are available, for example the efficacy of single-inhaler triple therapies for the treatment of COPD. In such cases, network meta-analysis (NMA) can be used, to indirectly compare treatments by assessing their effects relative to a common comparator using data from multiple studies. However, incorrect choice or application of methods can hinder interpretation of findings or lead to invalid summary estimates. As such, the use of the GRADE reporting framework is an essential step to assess the certainty of the evidence. With an increasing reliance on NMAs to inform clinical decisions, it is now particularly important that healthcare professionals understand the appropriate usage of different methods of NMA and critically appraise published evidence when informing their clinical decisions. This review provides an overview of NMA as a method for evidence synthesis within the field of COPD pharmacotherapy. We discuss key considerations when conducting an NMA and interpreting NMA outputs, and provide guidance on the most appropriate methodology for the data available and potential implications of the incorrect application of methods. We conclude with a simple illustrative example of NMA methodologies using simulated data, demonstrating that when applied correctly, the outcome of the analysis should be similar regardless of the methodology chosen.

PMID:39709425 | DOI:10.1186/s12931-024-03056-x

BMC Womens Health. 2024 Dec 21;24(1):656. doi: 10.1186/s12905-024-03481-6.

ABSTRACT

BACKGROUND: Hysteroscopy is considered the standard for evaluating the uterine cavity. Limited data exists regarding hysteroscopy in Ethiopia. Therefore, the objective of the study was to describe the diagnostic and operative hysteroscopic procedures at St. Paul’s Hospital.

METHODOLOGY: A three-year retrospective descriptive study examined patients who underwent diagnostic and therapeutic hysteroscopy at the Center for Fertility and Reproductive Medicine, St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia, from June 2018 to June 2021. Descriptive statistics were employed to summarize the findings observed during the hysteroscopy procedures.

RESULT: A total of 328 patient records underwent review and analysis in the study. The mean participant age was 31.9 years (31.9 ± 5.1 years), with about 81.4% being nulliparous. Primary infertility (48.5%) was the leading indication for hysteroscopic evaluation, followed by secondary amenorrhea (18%), secondary infertility (17.4%), and abnormal uterine bleeding (8.8%). Concerning hysteroscopic procedures, 6.1% of participants exhibited no uterine cavity abnormalities. Primary hysteroscopy findings comprised intracavitary adhesions (48.2%), endometrial polyps (18%), and submucosal myomas (9%). Adhesiolysis stood out as the foremost surgical procedure, conducted in 48.2% of patients, followed by polypectomy in 20.7%, and fibroid removal in 9%. The complication rate was 2.4%, exclusively during operative hysteroscopy, with uterine perforation observed in six patients.

CONCLUSION: Our hysteroscopic evaluation was predominantly requested for primary infertility cases, with secondary amenorrhea, secondary infertility, and abnormal uterine bleeding also being commonly encountered indications. Adhesiolysis was the leading intervention during hysteroscopy, while uterine perforation was the main complication. The hysteroscopy procedures exhibited a strong safety profile, with few complications noted. Future studies should address factors affecting outcomes in diagnostic and operative hysteroscopy, and common factors linked to intrauterine adhesions.

PMID:39709420 | DOI:10.1186/s12905-024-03481-6

BMC Womens Health. 2024 Dec 21;24(1):652. doi: 10.1186/s12905-024-03488-z.

ABSTRACT

BACKGROUND: Primary ovarian insufficiency (POI) is a critical cause of infertility and is increasingly recognized as a complex metabolic disorder. Dietary factors may influence the risk of POI, but causal relationships remain unclear.

METHODS: We conducted an MR study using genetic instrumental variables for 83 dietary preferences from the UK Biobank, with the Inverse Variance Weighted method as the primary analysis.

RESULTS: Consumption of butter and full-fat dairy products was strongly associated with an increased risk of primary ovarian insufficiency (POI). Women who consumed butter had nearly ten times the risk of developing POI (OR = 9.54, p = 0.048), while full-cream milk was associated with an even greater risk (OR = 29.22, p = 0.018). Interestingly, semi-skimmed milk, despite its lower fat content, also showed a significant positive association with POI (OR > 100, p = 0.008). In contrast, dietary patterns including oily fish and pork were protective against POI. Oily fish, rich in omega-3 fatty acids, was linked to a 82% reduced risk of POI (OR = 0.18, p = 0.008), and pork consumption also showed a protective effect (OR = 0.13, p = 0.041). Additionally, women who did not consume eggs had a significantly lower risk of POI (OR < 0.001, p = 0.044).

CONCLUSION: This study demonstrates that high-fat dairy products may increase the risk of POI, while oily fish and pork consumption could offer protective effects. These findings providing a foundation for future clinical and public health strategies targeting reproductive health.

PMID:39709418 | DOI:10.1186/s12905-024-03488-z

BMC Womens Health. 2024 Dec 21;24(1):658. doi: 10.1186/s12905-024-03490-5.

ABSTRACT

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Body image distress (BID) refers to psychological distress caused by deviations in the individual’s self-aesthetic ability. The objectives of this study are to investigate the prevalence of psychological distress; and to assess the role of anxiety in the relationship between body image distress and quality of life (QoL) among women with polycystic ovary syndrome using a path analysis approach.

METHOD: A multi-center cross-sectional study design was conducted among 294 women with PCOS in 29 provinces in mainland China from July 2021 to December 2021, and the data were analyzed using path analysis. The Multidimensional Body-Self Relations Questionnaire-Appearance Scales, Modified Polycystic Ovary Syndrome Questionnaire, and Hospital Anxiety and Depression Scale were administered to women who gave informed consent to participate.

RESULT: The results of path analysis are indicated that anxiety significantly mediated BID and QoL in women with PCOS (p < 0.05) and the structural equation model analysis further confirmed the statistical significance of this mediating effect. The fit indices CFI = 1.00, TLI = 1.00, and RMSEA = 0.00, indicating that the model represents the data well. A good fit of the proposed model to the observed data was obtained, which revealed that BID not only directly influenced QoL, but also had a significant indirect effect on QoL via anxiety.

CONCLUSION: Psychological counseling clinics is as well needed to provide patients with individualized psychological counseling and avoid mental health problems caused by body image troubles. Anxiety mediated the relationship between BID and QoL, adding to the paucity of research for women with polycystic ovary syndrome.

PMID:39709416 | DOI:10.1186/s12905-024-03490-5

Ann Med. 2025 Dec;57(1):2445192. doi: 10.1080/07853890.2024.2445192. Epub 2024 Dec 21.

ABSTRACT

OBJECTIVE: Advancing the understanding of the pathophysiology of eosinophilic oesophagitis (EoE) and other eosinophilic gastrointestinal diseases (EGIDs) has spurred research into targeted biological therapies, while the conclusive therapeutic efficacy of biologics remains uncertain. In this review, we conducted a meta-analysis of all RCTS of biologics in the treatment of EoE to evaluate their efficacy and safety and discussed their treatment of non-EoE EGIDs.

METHODS: We searched the PubMed, EMBASE, Cochrane Library, and Web of Science databases. Double-blind randomized controlled trials comparing biologics with placebo in patients with EoE and non-EoE EGIDs were collected and further screened for inclusion and exclusion. The caliber of the included literature was evaluated using the Cochrane risk assessment tool findings. Data extraction and meta-analysis were conducted using RevMan 5.4 and Stata 17.0. Clinical response and histological remission were the major endpoints.

RESULTS: Our search retrieved 3,237 articles. There were seven trials in total, comprising 792 people with EoE. Key outcomes of this meta-analysis include the following: Anti-IL-5 biologics exhibited statistically significant benefits in histological remission (RR 2.03 [CI 1.45-2.85]; p < 0.0001) compared to the placebo, but there was no significant difference in symptom relief (RR 1.06 [CI 0.88 to 1.28]; p = 0.53); anti-IL-4/13 biologics had significant effects on histologic improvement (RR 10.48 [CI 5.54-19.82]; p < 0.00001) and symptom related score reduction (RR 1.44 [CI 1.08-1.93]; p = 0.01), with a better outcome for endoscopic remission than with placebo (SMD-1.06 [CI-1.26-0.86], p < 0.00001); no statistically significant differences in adverse effects were observed between the intervention and control groups.

CONCLUSIONS: Our findings suggest that the biologics currently being investigated are considered safe and effective treatments for EoE, while their efficiency varies. However, the discussion of biologics in non-pharyngitis EGID is hampered by a lack of research, necessitating more research in high-quality trials.

PMID:39707826 | DOI:10.1080/07853890.2024.2445192

Stress Health. 2025 Feb;41(1):e3507. doi: 10.1002/smi.3507.

ABSTRACT

Increasing mental health problems among university students highlight the need for scalable, effective solutions. We have developed a transdiagnostic mobile intervention called ROOM, promoting adaptive emotion regulation (ER) skills among university students. Understanding how the intervention works and optimising content and delivery is essential for creating an effective and adaptive system. Therefore, this study aimed to optimise ROOM through a sequential explanatory mixed-methods design, combining a Micro-Randomized Trial (MRT), evaluating within-person effects using repeated randomisation, with user experience interviews. 161 university students (82% females) participated in a 3-week MRT to assess the intervention proximal outcomes, that is, participants’ positive and negative emotional states after completing intervention exercises. Additionally, we evaluated impact on distal outcomes (i.e., distress symptoms and ER skills), and user experience by combining objective (e.g., exercise completion rates) and subjective (e.g., exercise likability and helpfulness ratings) engagement patterns with insights from the semi-structured interviews (n = 18). Upon receiving the intervention, positive emotional states increased and negative ones decreased. The effect on positive emotional states gradually decreased over time while the effect on negative emotional states remained stable throughout the 3-week intervention period. Distress symptoms and ER skills either remained stable or improved over the 3 weeks, which indicated the intervention’s safety. Overall, engagement patterns and interview data show that the intervention was well received, students enjoyed this study design and found context-sensitive content recommendations highly relevant.

PMID:39707816 | DOI:10.1002/smi.3507