Nevin Manimala

J Clin Ultrasound. 2025 Sep 4. doi: 10.1002/jcu.70061. Online ahead of print.

ABSTRACT

OBJECTIVE: A predictive model of cervical lymph node metastasis and metastasis volume was constructed based on a machine learning algorithm and ultrasound characteristics before surgery.

METHODS: A retrospective analysis was conducted on 573 cases of PTC patients who underwent surgery in our institution, from 2017 to 2022. Patient demographic and clinical characteristics were systematically collected. Feature selection was performed using univariate analysis, Logistic regression (LR) analysis. Statistically significant variables were identified using a threshold of p < 0.05. Predictive models for cervical lymph node metastasis and metastatic volume in papillary thyroid carcinoma were constructed using advanced machine learning algorithms: K-Nearest Neighbors (KNN), Gradient Boosting Machine (XGBoost), and Support Vector Machine (SVM). Model performance was rigorously assessed using validation cohort data, evaluating area under the Receiver Operating Characteristic (ROC) curve, sensitivity, specificity, and accuracy.

RESULTS: In this retrospective study of 573 patients (320 had lymph node metastasis, 127 had small volume lymph node metastasis, and 193 had medium-volume lymph node metastasis). In the model predicting the neck lymph node metastasis, the Gradient Boosting method exhibited the best performance, with an area under the ROC curve of 0.784, sensitivity of 76.2%, specificity of 70.6%, and accuracy of 73.8%. In the model predicting the metastatic volume in neck lymph nodes for PTC, the Gradient Boosting method also demonstrated the best performance, with an area under the ROC curve of 0.779, sensitivity of 71.7%, specificity of 75.9%, and accuracy of 74.4%.

CONCLUSION: Machine learning-based predictive models integrating preoperative ultrasound features demonstrate robust performance in stratifying neck lymph node metastasis risk for PTC patients. These models optimize surgical planning by guiding lymph node dissection extent and individualizing treatment strategies, potentially reducing unnecessary extensive surgeries. The integration of advanced computational techniques with clinical imaging provides a data-driven paradigm for preoperative risk assessment in thyroid oncology.

PMID:40905206 | DOI:10.1002/jcu.70061

Ned Tijdschr Geneeskd. 2025 Aug 21;169:D8612.

ABSTRACT

OBJECTIVE: Gain insight into usage, environmental impact and user experience of different absorbent mats.

DESIGN: Prospective implementation study and life cycle assessments (LCAs).

METHOD: Conducted at the LUMC and UMCG, insight into usage of disposable cellulose pads was obtained through focus groups, interviews and surveys. LCAs analysed the environmental impact of disposable and reusable mats. User experience was evaluated through surveys for patients and healthcare professionals. Finally, functionality and usage trends were evaluated.

RESULTS: Findings reveal that disposable pads are often used for incorrect indications due to convenience and ineffective safety behaviour. The reusable mat has a lower environmental impact than the disposable pad. After implementing the reusable mat, a reduction in usage numbers is acquired and usage is perceived positively.

CONCLUSION: The environmental impact of absorbent mats in healthcare can be reduced by using them more efficiently and replacing them with reusable mats while maintaining a positive user experience.

PMID:40905204

Trop Med Int Health. 2025 Sep 4. doi: 10.1111/tmi.70024. Online ahead of print.

ABSTRACT

BACKGROUND: Ensuring a continuum of care in accessing antenatal to postnatal healthcare services is crucial for improving maternal and child health outcomes. This study aims to explore trends in the continuum of care over the years, both nationally and across regions; to provide district-level estimates; and to examine socio-economic disparities and determinants of continuum of care uptake in Bangladesh.

METHODS: A total of 28,260 samples were analysed. Continuum of care was considered as the outcome variable. District, wealth index, and several socio-demographic factors were included as explanatory variables. Trends of the continuum of care estimates were illustrated over survey years using descriptive statistics. Additional exploration of inequality was conducted across wealth quintiles, educational attainment and urban-rural residence through Equiplot. Finally, a multilevel multinomial logistic regression model was used to assess the factors associated with continuum of care.

RESULTS: The study revealed a significant increase in the highest level of continuum of care, rising from 6.0% in 2004 to 30.5% in 2017/2018, before declining to 24.8% in 2022. However, notable dropouts from the continuum of care were observed, particularly during the transitions from Antenatal Care to Skilled Birth Attendant and from Skilled Birth Attendant to postnatal Care. The analysis also identified district-level variations, urban-rural disparities and differences across wealth quintiles. Maternal socio-demographic characteristics, such as higher education and belonging to a higher wealth quintile, were associated with increased likelihoods of achieving moderate to the highest levels of continuum of care. In contrast, higher parity and rural residence were associated with lower likelihoods of attaining these levels of care.

CONCLUSION: The findings underscore substantial progress in maternal healthcare services uptake in Bangladesh over the years, alongside persistent challenges in ensuring continuous care throughout the maternal healthcare continuum and district-level variations. Addressing district-level disparities and socioeconomic inequalities is crucial, necessitating tailored, area-specific policies and programmes to achieve universal access to quality maternal healthcare services across the country.

PMID:40905197 | DOI:10.1111/tmi.70024

J Med Econ. 2025 Sep 4:1-14. doi: 10.1080/13696998.2025.2555138. Online ahead of print.

ABSTRACT

BACKGROUND: Ulcerative colitis (UC) imposes persistent clinical and economic burden on patient and healthcare management in Japan.

PURPOSE: To evaluate impact of prolonged oral corticosteroid (OC) use on healthcare resource utilization (HCRU) and treatment-related costs, and to assess discontinuation patterns of 5-amino salicylic acid (5-ASA), immunomodulators (IMs), and OCs in Japanese UC patients after biologic initiation.

METHODS: Data were extracted from the Japan Medical Data Centre for patients diagnosed with UC with ≥1 prescription of OC with 5-ASA and/or IM, prior or at the index date (first biologic initiation) between 2016-2022, grouped by </≥180 days of OC use, and analyzed using descriptive statistics, Kaplan-Meier and linear regression.

RESULTS: For all identified patients (N = 1494; mean ± SD age: 38.6 ± 13.7 years; male: 65.3%), HCRU (inpatient and outpatient visits, length of stay, and procedures) per patient-year (PPY) declined after biologics initiation. Direct inpatient medical costs decreased throughout the study; outpatient costs increased from pre-index to the 1-year post-index period, followed by slight decreases in the 2-year and 3-year post-index. PPY costs of non-biologic UC-related drugs (OCs, 5-ASA, IMs) increased slightly during the post-index period. Overall, HCRU and costs dynamics were similar in patients with <180 days and those with ≥180 days OC use. Patients with <180 days OC use had shorter median time to OC discontinuation after biologic initiation compared with ≥180 days group (3.1 months vs 9.5 months).

CONCLUSIONS: Biologic initiation was associated with reduced HCRU and inpatient costs, with similar trends observed regardless of prolonged or shorter OC use duration.

PMID:40905194 | DOI:10.1080/13696998.2025.2555138

Addiction. 2025 Sep 4. doi: 10.1111/add.70184. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Several randomised controlled trials (RCTs) have demonstrated that delivering approach bias modification (ApBM) during residential alcohol use disorder (AUD) treatment helps prevent post-treatment relapse. However, few studies have examined ApBM’s efficacy for AUD in outpatients. We trialled a personalised ApBM smartphone app in individuals receiving outpatient AUD treatment.

DESIGN: This double-blind RCT randomised participants to receive ApBM or sham training, adjunctive to treatment as usual.

SETTING: Participants were recruited from alcohol and other drug treatment services in Melbourne, Australia.

PARTICIPANTS: 79 participants (mean age 46.6 years; 45 male, 34 female) installed the app between May 2022 and January 2024.

INTERVENTION AND COMPARATOR: In the ApBM condition, the app delivered personalised, gamified ApBM. Notifications prompted participants (n = 39) to complete 2 ApBM sessions weekly for 4 weeks. The control version prompted participants (n = 40) to complete a weekly sham-training task for 4 weeks.

MEASUREMENTS: The primary outcome was number of standard drinks (10 g pure alcohol) consumed in week 4 of the intervention period, self-reported in the app. Secondary outcomes included past-week standard drinks at 8-week and 16-week follow-ups, past-week drinking days, past-week heavy drinking days (HDDs; days when ≥5 standard drinks were consumed) and questionnaire measures of AUD severity, quality of life and alcohol craving. Primary analyses followed an intention-to-treat (ITT) approach, with secondary complete-case sensitivity analyses also conducted for all outcomes.

FINDINGS: Groups did not statistically significantly differ in the primary outcome [values from ITT negative binomial model: ApBM = 75.49 standard drinks, control = 71.34 standard drinks, difference = 4.16, 95% confidence interval (CI) = -42.37 to 50.69, P = 0.859]. Most analyses of secondary outcomes showed statistically non-significant effects, with the only exception being past-week standard drinks at the 16-week follow-up, where ApBM participants showed statistically significantly larger decreases than controls in past-week standard drinks (reduction of 14.6, relative to baseline, versus 2.1 in controls; interaction β = -12.53, 95% CI = -23.85 to -1.22; P = 0.030). Time x group interaction effects were statistically non-significant for all other secondary outcomes (Ps > 0.069).

CONCLUSIONS: A smartphone app using approach bias modification showed no evidence for reducing alcohol use among alcohol use disorder outpatients after 4 weeks, or evidence for effects on most secondary outcomes, although 16-week follow-up results suggested that approach bias modification may have facilitated delayed/longer-term reductions in alcohol use.

PMID:40905156 | DOI:10.1111/add.70184

Rev Esp Salud Publica. 2025 Sep 4;99:e202509048.

ABSTRACT

OBJECTIVE: A high percentage of medication errors are preventable; therefore, institutions are constantly striving to try to reduce them. When errors occur with high-risk medications, the possibility of causing serious harm to the patient increases, making the implementation of safe practices essential to try to avoid them. The main objective of the study was to establish in a second-level hospital, and especially in Pediatrics, practices for the safe management of these drugs at all stages of their handling.

METHODS: The study was developed in three phases: pre-intervention, intervention and post-intervention. The implementation was quantitatively evaluated with process indicators and with items from the Hospital Medication Utilization System Safety Self-Assessment Questionnaire; the results obtained were validated by statistical analysis, using Chi-square test of homogeneity, Fisher’s exact test, chi-square goodness of fit test, Shapiro-Wilk test, and Student’s t-test.

RESULTS: Actions were implemented to allow a safer management of high-risk medications, such as creating a defined list in the hospital, eliminating unnecessary presentations, avoiding isoappearance, identifying them correctly, including alerts, among others. After implementation, the stipulated quantitative indicators improved in a statistically significant manner, demonstrating a relevant impact of the interventions performed. The median percentage improvement for the expected frequencies of indicator 3 was 83.77%. All items evaluated in the Self-Assessment Questionnaire improved.

CONCLUSIONS: This implementation serves to improve the management of high-risk medications in the hospital, increasing the safety of the processes. It can serve as a basis for other hospitals that need to add interventions to improve patient safety.

PMID:40905147

J Neonatal Perinatal Med. 2025 May;18(3):197-202. doi: 10.1177/19345798251324453. Epub 2025 Mar 14.

ABSTRACT

BackgroundDue to the scarcity of available data on the association between isolated oligohydramnios and the risk of small for gestational age (SGA), we undertook a meta-analysis to investigate this relationship.MethodsPubMed (Medline), Web of Science, Scopus, and Science Direct were systematically queried up to February 26, 2024. Analysis was conducted using the random-effects model. Heterogeneity was evaluated among studies utilizing the chi-square test (χ²) and the I² statistic. Additionally, we conducted regression tests including Egger’s and Begg’s tests to assess publication bias. We employed the modified Newcastle-Ottawa Scale (NOS) to assess the quality of observational articles. Statistical significance was set at a p-value less than 0.05 using Stata software, version 13.ResultsIn the present meta-analysis, seven studies met the inclusion criteria and were included in the present systematic review and meta-analysis. The association between isolated oligohydramnios at term and the risk of SGA in crude studies was 2.22 (95% CI: 1.49, 2.94; I² = 82.5%). Conversely, in adjusted studies, the association was 2.18 (95% CI: 1.78, 2.57; I² = 0.0%).ConclusionThe present meta-analysis indicates that isolated oligohydramnios is a significant risk factor for the SGA. Therefore, monitoring to diagnose SGA should be done in mothers with isolated oligohydramnios.

PMID:40903806 | DOI:10.1177/19345798251324453

J Prosthodont. 2025 Sep 3. doi: 10.1111/jopr.70021. Online ahead of print.

ABSTRACT

PURPOSE: Stress is a significant concern in healthcare professions, impacting both physiological and psychological well-being. In the field of dentistry, stress among practitioners is well-documented; however, there is a notable gap in understanding stress levels specifically within postgraduate prosthodontic training programs. The study hypothesis aimed to assess perceived stress levels among prosthodontic residents and, secondarily, identify associated risk factors, while exploring stress management strategies.

MATERIALS AND METHODS: A cross-sectional, mixed-methods design was employed, utilizing a modified version of the Graduate Dental Environment Stress (GDES) survey along with qualitative open-ended questions. REDCap (Research Electronic Data Capture), a secure, web-based software platform designed to support data capture for research studies, was used for instrument design, data management, and storage. A REDCap Survey link was distributed to prosthodontic program directors across North America, with the intention of distributing it to their residents. Responses were recorded via a Likert scale for the quantitative assessment and through narrative responses for the qualitative assessment. A score of 76 was determined to be the threshold value at or above which the participants were considered stressed. Descriptive summaries were used to characterize the participants. The main study outcome was presented as a percentage of the corresponding 95% confidence interval (CI). The assessment of risk factors of stress among the study population was done by using a logistic regression model, and coping mechanisms were tagged via open coding and presented as themes. SAS statistical software package was used.

RESULTS: A response rate of 13.2% indicated that over a third of postgraduate prosthodontic residents experienced high levels of stress, as defined by a GDES score ≥76. A risk factor for stress was identified as the year of study. Qualitative analysis revealed common themes in stress management strategies, with exercise, socializing, and spending time with family members being the most prevalent.

CONCLUSION: The findings of high perceived stress among prosthodontic residents included “Lack of time for leisure activities” followed by “Lack of adequate staff in the clinics” and “Neglect of personal life” being the highest reported stressors. Stress management strategies such as “Self-care,” “Time management,” and “Connecting with others” highlight the importance of proactive strategies to manage stress. By understanding the factors contributing to stress and effective coping mechanisms, stakeholders can better support their residents.

PMID:40903804 | DOI:10.1111/jopr.70021

Eur J Med Res. 2025 Sep 3;30(1):841. doi: 10.1186/s40001-025-03086-1.

ABSTRACT

OBJECTIVES: The study aimed to investigate the relationship between serum nuclear factor erythroid 2-related factor 2 (NRF2) levels and the severity of diabetic foot ulcers (DFU) and to identify potential risk factors in severe DFU patients. Understanding this relationship could offer insights into mechanisms underlying DFU progression and inform diagnostic and therapeutic strategies.

METHODS: This prospective observational study included 195 DFU patients from January 2023 to May 2024, categorized into mild and severe groups using the Wagner classification system. Serum NRF2 and C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-17 (IL-17), and tumor necrosis factor-alpha (TNF-α) levels were measured at multiple timepoints during treatment. Statistical analyses, including logistic regression and receiver operating characteristic (ROC) curve analysis, were performed to evaluate NRF2’s diagnostic value and its association with DFU severity.

RESULTS: We found that severe DFU patients had significantly lower serum NRF2 levels and higher serum IL-6, IL-17, and CRP levels compared to those in the mild group. NRF2 levels were negatively correlated with IL-6 levels. ROC curve analysis demonstrated that NRF2 was a reliable screening biomarker for severe DFU, with notable sensitivity and specificity. In addition, logistic regression identified reduced NRF2 levels as an independent risk factor for severe DFU.

CONCLUSIONS: Serum NRF2 levels could serve as a valuable screening biomarker for identifying severe DFU cases. Integrating NRF2 measurements with other biomarkers could improve patient stratification and clinical outcomes. Further research is needed to validate its role and therapeutic potential in DFU management.

PMID:40903783 | DOI:10.1186/s40001-025-03086-1

Matern Health Neonatol Perinatol. 2025 Sep 4;11(1):29. doi: 10.1186/s40748-025-00220-z.

ABSTRACT

BACKGROUND: Women who do not gain enough weight during pregnancy had increased risk of preterm delivery, low birth weight, prematurity, a longer hospital stay, and consequently, higher health-related costs. However, research on gestational weight gain and its determinants is scarce in developing countries, including Ethiopia. Therefore, this study aimed to assess adequate gestational weight gain and its determinant factors among pregnant women who had ANC follow-up visits at public health facilities in Debre Markos town, Northwest Ethiopia.

METHODS: An institutional-based cross-sectional study was conducted from January 1, 2023 to June 30, 2023. The Ethiopian National Antenatal Guideline (ENAG) was used to define Gestational Weight Gain (GWG). A systematic random sampling technique was employed to select 532 study participants. Data was entered into Epidata Version 3.1 and exported into SPSS Version 25 for statistical analysis. Bivariable and multivariable binary logistic regression analyses were conducted to examine the association between the outcome variable and independent variables. An adjusted odds ratio with a 95% confidence interval was used to report the strength of the association.

RESULTS: This study found that 30.9% (95% CI: 27.0, 34.7) of women gained adequate gestational weight. Number of ANC visits (AOR = 5.9, 95% CI: 3.02, 14.7), Meal frequency (AOR = 3.2, 95% CI: 1.56, 6.67), and consumption of animal source foods at least once per week (AOR = 2.7, 95% CI: 1.47, 4.90) were statistically associated with adequate weight gain.

CONCLUSION AND RECOMMENDATION: Nearly one-third of pregnant women gain adequate gestational weight. Women who had frequent ANC visits, meal frequency, and consumption of animal source foods at least once per week were significantly associated with adequate gestational weight gain. Women centered nutritional counseling and support is essential to improve weight gain during pregnancy.

PMID:40903780 | DOI:10.1186/s40748-025-00220-z