Tag: nevin manimala

CJEM. 2025 May 21. doi: 10.1007/s43678-025-00935-0. Online ahead of print.

ABSTRACT

OBJECTIVE: In 2018, Royal College emergency medicine residency programs shifted to a competency-based medical education framework. This study sought to explore the impact of this transition on simulation-based education activities, including the use of simulation for assessment, in emergency medicine programs across Canada.

METHODS: An interview guide was created by the authors evaluating the current role of simulation in emergency medicine programs based on the Core Components framework of competency-based medical education. Semi-structured interviews of emergency medicine simulation directors across Canada were conducted virtually between May 2022 and December 2022. Descriptive statistics of quantitative data are reported and qualitative responses were analyzed using thematic analysis.

RESULTS: Interviews represented 11/14 (78.5%) emergency medicine programs in Canada. Competency-based medical education national standards were commonly used to identify gaps in training experiences, particularly with high acuity low opportunity scenarios that could be addressed using simulation. Furthermore, competency-based medical education provided a framework where simulation curricula were revised and allowed for mapping of simulation scenarios to specific required training experiences and assessment requirements. All programs reported a new role of assessment in simulation largely in the form of entrustable professional activity assessments to satisfy the requirement of competency-based medical education. However, concerns were raised around the increasing role of assessment and its impact on psychological safety of the simulation learning environment.

CONCLUSION: The introduction of competency-based medical education has elevated the role of simulation as a means of assessing learner competencies. This shift has been largely positive, by facilitating resident assessment of required training experiences, but with some possible negative consequences related to the impact of assessments on the psychological safety traditionally afforded by the simulation environment. As such, educators must be intentional in how simulation is used in their program with particular attention given to the validity of assessments and the impact on safety of the learning environment.

PMID:40397303 | DOI:10.1007/s43678-025-00935-0

Curr Med Sci. 2025 May 21. doi: 10.1007/s11596-025-00063-x. Online ahead of print.

ABSTRACT

OBJECTIVE: Heat wave exposure significantly impacts human health. Nevertheless, studies on the long-term effects of heat wave exposure during adolescence on adverse pregnancy outcomes (APOs) are rare. This study aimed to investigate the relationship between the long-term effects of heat wave exposure during adolescence and APOs.

METHODS: We analyzed data from 3,376 female and 3,013 male participants across 31 provinces in China. All adolescents (10-19 years old), early adolescents (10-14), and late adolescents (15-19) were chosen as exposure windows. Heat waves were defined as periods lasting 2‒4 consecutive days with the daily temperature exceeding the 75th, 90th, and 92.5th percentiles. We employed multivariate logistic regression models to assess the associations between exposure to heat waves during adolescence and APOs.

RESULTS: The results revealed significant associations between male exposure to heat wave events during late adolescence and spontaneous abortion (P < 0.05), which was more pronounced in South China. In contrast, no statistically significant associations were detected between males’ exposure to heat wave events during adolescence and their partners’ preterm birth (P > 0.05 for all comparisons). The exposure of females to heat waves during adolescence was not significantly associated with subsequent spontaneous abortion or preterm birth (P > 0.05 for all comparisons).

CONCLUSIONS: This study demonstrates that spontaneous abortion in females is associated with heat wave exposure in their male partner during adolescence.

PMID:40397301 | DOI:10.1007/s11596-025-00063-x

Int J Clin Pharm. 2025 May 21. doi: 10.1007/s11096-025-01916-0. Online ahead of print.

ABSTRACT

BACKGROUND: Anticoagulation therapy presents a high risk of adverse drug events (ADEs) in hospitalized patients, highlighting the need for effective detection strategies in clinical practice.

AIM: The review aimed to identify triggers for detecting anticoagulation-associated ADEs in hospitalized patients and describe the performance of these triggers.

METHOD: PubMed, Cochrane, and Embase were queried until April 19, 2024. We included studies on trigger tools for detecting anticoagulation-related ADEs in hospitalized patients. The study quality was assessed using the Quality Assessment Trigger framework based on the QUADAS-2 tool for diagnostic accuracy. We performed random-effects meta-analyses to pool positive predictive values (PPV), with heterogeneity assessed via I² statistic and Cochran’s Q test.

RESULTS: Twenty-three studies were included. Seventeen triggers were reported and categorized into three modules: abnormal laboratory values (11 triggers), medications or antidotes (three triggers), and care (three triggers). Elevated international normalized ratio (INR) was the most prevalent trigger (16 studies) with a PPV of 0.539 (95% Confidence Interval [CI] 0.310-0.768). Other triggers exhibited lower pooled PPVs than elevated INR, including vitamin K administration (15 studies, PPV 0.222, 95% CI 0.153-0.290), abrupt medication cessation (14 studies, PPV 0.418, 95% CI 0.169-0.667), and activated partial thromboplastin time > 100 s (11 studies, PPV 0.336, 95% CI 0.173-0.498). Importantly, in-hospital stroke (three studies) had the highest pooled PPV of 0.964 (95% CI 0.803-1.000).

CONCLUSION: This review demonstrated the variability in PPVs of triggers for anticoagulation-associated ADEs, emphasizing the necessity for a specialized trigger tool for hospitalized patients on anticoagulants.

PMID:40397288 | DOI:10.1007/s11096-025-01916-0

Saudi Dent J. 2025 Apr 15;37(1-3):3. doi: 10.1007/s44445-025-00002-5.

ABSTRACT

Adhesives are essential for attaching orthodontic brackets to the tooth surface and ensuring safe removal during debonding. ACTIVA™ BioACTIVE-Restorative (ABR) is a bioactive composite with potential advantages. The purpose of this study was to evaluate the shear bond strength (SBS) and adhesive remnant index (ARI) of ACTIVA™ BioACTIVE-Restorative (ABR) with conventional adhesives, including Transbond XT™ (TXT) and Orthocem™ (OC). A total of 51 human maxillary premolars were distributed randomly into three groups (n = 17). Each group was bonded with one adhesive following the manufacturer’s protocols. Then were subjected to 5000 thermocycles to simulate oral conditions. SBS was measured using a universal testing machine, and ARI scores were visually analysed under magnification. Statistical analysis was conducted using one-way ANOVA and chi-squared tests, with a 0.05 level of significance. Mean SBS values were 11.26 MPa, 12.52 MPa, and 12.96 MPa for ABR, TXT, and OC, respectively, with no significant differences (p = 0.513). ARI analysis revealed significant differences (p = 0.009) as ABR predominantly exhibited ARI 3 scores, indicating no adhesive remnants on enamel. In contrast, TXT and OC groups showed higher adhesive retention. ABR demonstrated shear bond strength comparable to conventional adhesives, meeting the clinical thresholds for orthodontic use. But demonstrated more complete adhesive failure in the enamel-adhesive interface rather than cohesive failure within the adhesive material like in TXT and OC.

PMID:40397265 | DOI:10.1007/s44445-025-00002-5

OTJR (Thorofare N J). 2025 May 21:15394492251324915. doi: 10.1177/15394492251324915. Online ahead of print.

ABSTRACT

There is an increasing need for assistive robots to support independent living for people with physical disabilities, but few are commercially accessible to users in their homes. Our objective was to investigate how the functional performance of everyday activities improved the performance of an individual with quadriplegia using the Stretch robot. We implemented a participatory design approach using a single subject volunteer sampling. Point-in-time evaluations included Stroke Specific Quality of Life Scale (SS-QOL) and Stroke Impact Scale (SIS). Pre- and post-measures included the Goal Attainment Scale (GAS) to assess intervention effectiveness on personalized goals. There was a statistically significant improvement in baseline GAS scores based on the individual’s goals in grooming (+2), self-feeding (+2), social participation (+2 giving a rose, +0 playing cards), and meal planning (+2) along with a T-scale score of 74.43. The individual’s functional performance in daily activities improved with Stretch while reducing care partner assistance, contributing positively to their experiences.

PMID:40396342 | DOI:10.1177/15394492251324915

Int J Eat Disord. 2025 May 21. doi: 10.1002/eat.24469. Online ahead of print.

ABSTRACT

OBJECTIVE: Cognitive-behavioral therapy (CBT) is the most well-established treatment for binge-eating disorder (BED), but the mechanisms of change remain poorly understood. This study investigated in CBT for BED the effects of overvaluation of shape and weight and dietary restraint on subsequent objective binge-eating episodes (OBEs).

METHOD: In a multicenter randomized-controlled trial, 84 patients diagnosed with full- or subsyndromal BED were offered 20 individual sessions of CBT over 4 months. Dynamic structural equation modeling (DSEM) was used to disentangle within- and between-patient associations of overvaluation of shape and weight, dietary restraint, and OBEs.

RESULTS: Between the first and last week of therapy, there were significant reductions in overvaluation of shape and weight, dietary restraint, and OBEs. DSEM showed significant within-patient effects of overvaluation of shape and weight on the subsequent number of OBEs. Weeks with lower overvaluation of shape and weight levels were followed by weeks with fewer OBEs. Although no within-patient effect of dietary restraint on OBEs was found, within-patient dietary restraint levels positively predicted subsequent overvaluation of shape and weight levels.

DISCUSSION: The findings suggest that reductions in overvaluation of shape and weight may precede improvements in binge eating during CBT for BED, supporting its role as a potential mechanism of change. While dietary restraint did not show a direct temporal link to binge eating, its association with overvaluation points to a potential indirect role. These results underscore the value of targeting cognitive features of BED in CBT and highlight the need for more temporally sensitive assessments in mechanisms research.

PMID:40396334 | DOI:10.1002/eat.24469

Curr Eye Res. 2025 May 21:1-8. doi: 10.1080/02713683.2025.2504569. Online ahead of print.

ABSTRACT

PURPOSE: To assess the usability of a smartphone-based augmented reality tool for capsulorhexis training.

METHODS: This is a single-center, prospective, clinical study conducted at the Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany. Surgery-naïve residents were included and divided into three subgroups: (1) augmented reality supported by the Custom Surgical MicroREC system during their capsulorhexis procedures; (2) Expert support supported by an experienced cataract surgeon; (3) No support without support. Capsulorhexis quality was graded by circularity, centration, and radius.

RESULTS: Twenty-one (n_total = 21) participants were enrolled. The augmented reality group was statistically significantly better in terms of circularity than the Expert support (Mann-Whitney’s U-test: p = .00175) and the No support group (Mann-Whitney’s U-test: p = .00268). The procedure duration decreased statistically significantly for all three groups when try 1 and 10 were compared (augmented reality: p < .0001; Expert support: p = .0099; No support: p < .0001). The other parameters did not differ statistically significantly. The questionnaires handed to the augmented reality and No support group before and after the wet lab revealed a high importance of wet lab trainings to all polled participants. The provided wet lab setup was considered adequate by both groups.

CONCLUSION: Augmented reality can assist in cataract training. The Custom Surgical MicroREC system can have a positive influence on capsulorhexis quality in a training environment. Automated quality metrics measured by the augmented reality software provide an objective quality score of the performed surgical procedure. As the tested augmented reality system can be used in training as well as in a real-world setting, this will be a useful tool for trainees and expert surgeons alike.

PMID:40396333 | DOI:10.1080/02713683.2025.2504569

Curr Alzheimer Res. 2025 May 19. doi: 10.2174/0115672050388220250511174043. Online ahead of print.

ABSTRACT

INTRODUCTION/OBJECTIVE: Given the role of inflammation in the development of both Alzheimer’s disease (AD) and periodontal disease, it is plausible that periodontal disease may influence the progression of AD. Complete blood count (CBC) parameters may also serve as predictive indicators for this condition. This study investigated the predictive value of CBC parameters on the progression of AD in patients with periodontal disease.

METHODS: Data from a prospective cohort study (n=90) with 6-month follow-up was analyzed. AD was assessed based on the Clinical Dementia Rating Scale. Records of C-reactive Protein (CRP) levels and CBC parameters measured within the 6 months preceding the participation date were evaluated. Cognitive assessments at the initial and 6th-month follow-up were performed using the Standardized Mini-Mental Test (SMMT). All patients underwent clinical periodontal examination.

RESULTS: The difference in SMMT score change (ΔSMMT) and platelet distribution width (PDW) value between groups with and without periodontitis was statistically notable (p<0.05). The presence of periodontitis was found to be significantly associated with age, ΔSMMT, and PDW values using the multivariate logistic regression model (p<0.05). Furthermore, having Stage II and Stage III AD, periodontitis, age factor, and mean platelet volume (MPV) value had a notable impact on ΔSMMT (p<0.05).

CONCLUSION: PDW and MPV levels may have a predictive significance in clarifying the association between periodontitis and AD progression.

PMID:40396318 | DOI:10.2174/0115672050388220250511174043

J Bronchology Interv Pulmonol. 2025 May 21;32(3):e01015. doi: 10.1097/LBR.0000000000001015. eCollection 2025 Jul 1.

ABSTRACT

BACKGROUND: The convex-probe endobronchial ultrasound (CP-EBUS) bronchoscope is widely used in clinical practice. Despite improvements, the existing CP-EBUS remains limited in accessing areas beyond the mediastinum due to its large distal end diameter, long rigid tip segment, and oblique viewing angle. To address this limitation, Olympus Medical Systems Corporation developed the thin CP-EBUS (TCP-EBUS). This study aimed to compare the accessibility and puncturing ability of TCP-EBUS with existing CP-EBUS in cadaveric models.

METHODS: Ten bronchoscopists conducted this study using 2 cadaveric models. The accessibility of TCP-EBUS was evaluated based on the number of bronchial generations that could be reached. To assess the puncturing ability of TCP-EBUS, needle punctures were performed on previously created simulated lesions in the segmental or subsegmental bronchial area, and puncture success rates were calculated.

RESULTS: TCP-EBUS demonstrated greater accessibility than CP-EBUS in all segmental bronchi, with statistically significant differences observed in several bronchi (P<0.05). Puncture success rates for simulated lesions using TCP-EBUS were also significantly higher than those using CP-EBUS in both the segmental (85.0% vs. 60.0%, P<0.001) and subsegmental bronchial areas (84.4% vs. 38.9%, P<0.001). In a questionnaire survey, TCP-EBUS was perceived as significantly superior in terms of usability (P<0.05).

CONCLUSION: TCP-EBUS has significantly improved both accessibility and puncture performance, providing an advantage over CP-EBUS in segmental and subsegmental bronchial areas. TCP-EBUS has the potential to expand the indications for endobronchial ultrasound-guided transbronchial needle aspiration.

PMID:40396305 | DOI:10.1097/LBR.0000000000001015

J Bronchology Interv Pulmonol. 2025 May 21;32(3):e01013. doi: 10.1097/LBR.0000000000001013. eCollection 2025 Jul 1.

ABSTRACT

BACKGROUND: Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by abnormal alveolar surfactant accumulation. In recent years, transbronchial cryo-biopsy (TBCB) has gradually been applied as it can obtain larger and better-quality specimens. This study aims to assess the diagnostic yield and safety of TBCB in PAP.

METHODS: This study included 78 PAP patients who underwent lung biopsy. Thirty-six of them underwent transbronchial lung biopsy (TBLB) with forceps and the other 42 underwent TBCB. Clinical data, biopsy specimen number and size, the pathologic lesion proportion of biopsied specimens, complications, and pathologic diagnosis of patients from both groups were recorded.

RESULTS: Our data show that the diagnostic yield of TBCB is significantly superior to that of TBLB (78.6% vs. 50%, P<0.05). The TBCB group exhibited a greater number and size of biopsy specimens than the TBLB group (P<0.05). As for pathologic diagnosis, the specimen size in the PAP-positive group was notably larger than in the PAP-negative group (P<0.05). According to the receiver operating characteristic curve, the specimen size of at least 2 mm2 was identified as the cut-off with a higher positive predictive value (area under the curve = 0.676, P=0.007). For complications of TBLB and TBCB, there was no statistically significant difference in the incidence of pneumothorax and bleeding.

CONCLUSION: TBCB emerges as a minimally invasive, effective, and safe technique with a higher diagnostic yield than TBLB in PAP. Augmenting the specimen size can effectively improve the diagnostic yield.

PMID:40396301 | DOI:10.1097/LBR.0000000000001013