Tag: nevin manimala

Can J Urol. 2025 Mar 18;32(1):21-27. doi: 10.32604/cju.2025.064705.

ABSTRACT

PURPOSE: While the mental health impact of a prostate cancer diagnosis, including low-risk prostate cancer, is well-documented, the effect of pre-existing anxiety and/or depression on adherence to active surveillance protocols in low-risk prostate cancer patients remains unclear. This study assessed the association between prior anxiety and/or depression and active surveillance adherence in men with low-risk prostate cancer.

METHODS: We conducted a retrospective, multicenter study involving 426 men diagnosed with low-risk prostate cancer who were recommended active surveillance as the primary management strategy. Active surveillance adherence was defined by completion of both a prostate-specific antigen test and a prostate biopsy within 18 months of diagnosis. Premature treatment was identified as definitive treatment, either through radiation therapy or radical prostatectomy.

RESULTS: Men with a prior mental health diagnosis were significantly less likely to adhere to active surveillance than those without such a diagnosis (27.6% vs. 49.5%, p = 0.006). These individuals had lower adherence rates for prostate-specific testing (58.6% vs. 73.4%) and biopsy (27.6% vs. 50.0%) and were more likely to abandon active surveillance in favor of immediate treatment (39.7% vs. 25.0%, p = 0.005). No significant differences were observed between patients with both anxiety and depression versus those with a single diagnosis.

CONCLUSIONS: Pre-existing anxiety and/or depression is associated with reduced active surveillance adherence and a greater likelihood of premature treatment in men with low-risk prostate cancer. These findings highlight the importance of addressing psychiatric factors in low-risk prostate cancer management and suggest avenues for future research.

PMID:40194932 | DOI:10.32604/cju.2025.064705

Can J Urol. 2025 Mar 18;32(1):15-19. doi: 10.32604/cju.2025.064708.

ABSTRACT

INTRODUCTION: Holmium Laser Enucleation of the Prostate (HoLEP) is a size-independent, endoscopic management option for benign prostatic hyperplasia (BPH). HoLEP offers a distinct advantage for patients who are at high-risk for bleeding whilst preserving prostatic tissue for pathology analysis, unlike photoselective vaporization. Further, HoLEP avoids the need for cystotomy, unlike simple open and robotic prostatectomy, by using intravesical morcellation. We report our experience with the first 1000 HoLEP procedures at our institution.

MATERIALS AND METHODS: We performed a retrospective review of all HoLEP procedures performed at our institution from 2013-2021 to capture patient demographics, procedure details, and outcomes. Unpaired two sample t-tests were used to compare outcomes, p < 0.05 considered statistically significant.

RESULTS: The average patient age and BMI were 71.1 y (±8.1 y) and 27.9 kg/m² (±4.9 kg/m²), respectively. 69.4% of patients were on an alpha blocker and 33.3% of patients were on a 5-alpha reductase inhibitor preoperatively. 11.2% of cases were redo outlet procedures including after prior Urolift®. Average prostate volume was 108.0 mL (±66.5 mL) and average enucleation time was 119.7 min (±56 min). On average, 65 g (±53.2 g) prostate tissue was resected. Pre-operative and post-operative flow, post-void residual (PVR), AUA symptom score (AUA-SS), and quality of life (QoL) score showed notable improvement. Complication rates remained low, with the most common including blood transfusion (2.8%), urethral stricture (1.9%), and persistent stress urinary incontinence (1.3%).

CONCLUSIONS: HoLEP is emerging as the new surgical gold standard for BPH. A steep learning curve remains for urologists. Nonetheless, this procedure holds great promise in improving patient experiences with BPH.

PMID:40194931 | DOI:10.32604/cju.2025.064708

Int J Psychol. 2025 Jun;60(3):e70045. doi: 10.1002/ijop.70045.

ABSTRACT

The aim of this meta-analysis was to assess the effectiveness of cognitive behavioural therapy (CBT) in reducing negative symptoms in patients with schizophrenia. The search period was from the beginning of the database creation to 30 September 2022. An initial search of 169 articles was conducted through database searches and other means. After applying inclusion and exclusion criteria, seven randomised controlled studies were included in the final analysis. The intervention group included a total of 293 patients with schizophrenia, and the control group included 291 patients with schizophrenia. Meta-analysis showed that there was a statistically significant difference in negative symptom reduction between the CBT intervention group [SMD = -0.26,95% CI (-0.45, -0.07), p = 0.006] and the control group. We analysed the effectiveness of CBT based on previous studies and found that CBT was effective in improving negative symptoms in patients with schizophrenia.

PMID:40194927 | DOI:10.1002/ijop.70045

BMJ Paediatr Open. 2025 Apr 7;9(1):e003143. doi: 10.1136/bmjpo-2024-003143.

ABSTRACT

Ease of access to primary care may be inversely related to non-emergency access to emergency room services (ERS). We assessed whether patients of general paediatricians working in networks have reduced the use of ERS in an Italian province. In 9 months, overall rates of visits and repeated ER visits were numerically higher for patients of solo paediatricians than for those of paediatricians working in networks. However, in our sample, the reduction of the corresponding adjusted risks was not statistically significant most of the time. Further research should assess whether organisational factors are associated with the risk of using ERS inappropriately.

PMID:40194920 | DOI:10.1136/bmjpo-2024-003143

J Obes Metab Syndr. 2025 Apr 8. doi: 10.7570/jomes24029. Online ahead of print.

ABSTRACT

BACKGROUND: Grip strength and muscle-strengthening activity (MSA) have been independently associated with type 2 diabetes mellitus (T2DM). However, analyses that consider grip strength in conjunction with MSA, while factoring in age and sex as well, are limited. Therefore, we aimed to investigate the association of relative grip strength (RGS) and MSA, separately and in combination, with T2DM, considering differences in age and sex.

METHODS: A total of 27,702 participants aged 19 years and older were included from 2014 to 2021 from the Korea National Health and Nutrition Examination Survey. The association between RGS, MSA, and T2DM was assessed using logistic regression analysis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for the independent and joint associations of RGS and MSA on T2DM prevalence.

RESULTS: Highest (Q4) RGS levels were independently associated with lower odds of T2DM (OR, 0.39; 95% CI, 0.32 to 0.46; P for trend <0.001). Similarly, engaging in MSA 2 o 3 days per week was associated with lower odds of T2DM (OR, 0.80; 95% CI, 0.66 to 0.96), although the trend was not statistically significant (P for trend=0.775). In the joint analysis, participants with normal RGS and engaging in MSA ≥2 days per week had the lowest odds of T2DM (OR, 0.60; 95% CI, 0.51 to 0.70).

CONCLUSION: Higher RGS and engaging in MSA 2 to 3 days per week are independently associated with lower likelihood of T2DM. The combined association of normal RGS and MSA 2 days or more per week shows the greatest benefit for T2DM prevention.

PMID:40194887 | DOI:10.7570/jomes24029

BMJ Open Qual. 2025 Apr 7;14(2):e003179. doi: 10.1136/bmjoq-2024-003179.

ABSTRACT

Telemedicine can improve care delivery through reducing clinic wait-time, improving accessibility to specialist care, minimising cross-infection risk at patient’s convenience. Despite these benefits, telemedicine uptake remained low within our gastroenterology department, with only four teleconsultations conducted in 6 months prior to this project’s conceptualisation. This quality improvement (QI) project aimed to improve telemedicine utilisation within our department by 20% over a 3-month period. Surveys conducted during the planning phase identified key barriers to telemedicine adoption, including high clinic load, concerns over medicolegal issues and unfamiliarity with data security protocols. To address these issues, a multistakeholder QI team introduced several key measures, including streamlining telemedicine workflow, providing clinician training and implementing patient educational posters. These interventions successfully increased the adoption of telemedicine (median 8 (IQR 2.5) vs 31 (IQR 13) teleconsultations per month, p<0.01) over the intervention period, with 84% of patients reporting positive experiences. Additionally, this project reduced carbon emissions, saving approximately 3446 kg of CO2, equivalent to 388 gallons of gasoline. This QI project highlights the potential for telemedicine to enhance healthcare delivery while promoting environmental sustainability. Key lessons include the importance of structured workflows and stakeholder engagement to overcome barriers. Future interventions should aim to refine telemedicine pricing models and expand the initiative to other departments within the hospital to ensure long-term sustainability.

PMID:40194883 | DOI:10.1136/bmjoq-2024-003179

BMJ Open Qual. 2025 Apr 7;14(2):e003175. doi: 10.1136/bmjoq-2024-003175.

ABSTRACT

INTRODUCTION: It is widely acknowledged that health disparities exist in minority populations, with ethnicity, gender, language, ability and culture emerging as critical determinants of health outcomes. At present, research is available demonstrating that patients with protected characteristics experience less favourable patient safety outcomes. However, there has been limited focus on reviewing how processes within the healthcare system contribute to this inequity of care received by minority populations. This study reviews the prevalence of incident reporting of medication errors for people with selected protected patient characteristics within an acute NHS Trust. The aim is to determine if there are unexplained variations.

METHOD: This cross-sectional study was conducted across an NHS Trust group of five hospitals, serving a diverse local population. Incidents reporting errors in medication use were obtained for the 7-month period between 1 January 2021 and 31 July 2021. The χ² test was used to assess if protected patient characteristics impacted the rate of medicine-related error reporting.

RESULT: Medication error reporting is not equitable between different gender, ethnic or age groups. The results of this study show that these characteristics were negatively related to the number of medication incidents reported.

CONCLUSION: This study demonstrates that further systematic support is required to reduce the variations in medicine error reporting for patients with key protected characteristics. Infrastructure to overcome known barriers to safe care in the mainstream such as language, culture, beliefs and lower levels of understanding needs further development.

PMID:40194882 | DOI:10.1136/bmjoq-2024-003175

BMJ Open. 2025 Apr 7;15(4):e094667. doi: 10.1136/bmjopen-2024-094667.

ABSTRACT

OBJECTIVE: The study was conducted to determine the immunisation status of children under 2 years of age, assess the determinants of non-immunisation and evaluate the association between immunisation status and various sociodemographic factors.

METHODS: A cross-sectional questionnaire-based study was conducted at the outpatient department of Khyber Teaching Hospital, Peshawar, over a period of 4 months. A convenience sampling technique was used and the sample size was calculated using the WHO sample size formula, resulting in n=363. A semistructured questionnaire was used to measure the primary outcome, which was the immunisation status of children under 2 years of age. Immunisation data were verified through vaccination cards to ensure accuracy and minimise recall bias. The questionnaire also collected information on sociodemographic factors, including maternal education, place of residence and household income. Statistical analysis was done at the end of the study using SPSS (V.25).

RESULTS: According to the vaccination card, it was found that 43.3% of the children were fully immunised, 32.5% of the children were partially immunised and the percentage of unimmunised children was 24.2.

CONCLUSION: We found that the immunisation status of children was not satisfactory. Sustained efforts are required to achieve universal coverage of immunisation. Significant interventions are required, especially in areas that are more rural and less educated.

PMID:40194881 | DOI:10.1136/bmjopen-2024-094667

BMJ Open. 2025 Apr 7;15(4):e098838. doi: 10.1136/bmjopen-2025-098838.

ABSTRACT

OBJECTIVE: To evaluate the association between the use of medical information applications and urgent emergency room consultation behaviour among parents who visited the emergency department (ED) of their children.

DESIGN: Cross-sectional survey.

SETTING: A primary-level paediatric emergency medical facility in Nagano Prefecture.

PARTICIPANTS: Parents of children aged 8 years or younger who had visited the medical facility between December 2023 and March 2024.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was defined as an association between the urgency of ED visits and parental use of mobile applications. The secondary outcome was the association between the urgency of ED visits and app evaluations among parents using the app. The urgency of the ED visits was classified according to the Japan Triage and Acuity Scale.

RESULTS: In total, 386 parents participated in this study (response rate: 91%). Among these, 77% were mothers and the median age was 36.3 years. Of the ED visits by app users, 63.7% were classified as urgent, compared with 41.7% of visits by non-users (adjusted OR: 2.8, 95% CI: 1.7 to 4.7, p<0.001). Among the participants who used the app, 94.4% answered that they would recommend the app and 87.0% answered that the app made it easier to decide whether to visit the hospital. In addition, the proportion of children who revisited the ED within 6 months was higher for children with a medical history than for those without such a history. There were no significant associations between the urgency of ED visits and parental education, self-reported financial status, or whether the parent was a healthcare professional.

CONCLUSIONS: The use of the medical information app was significantly associated with parental ED urgency. These findings suggest that such apps may support informed decision-making in paediatric emergency care. Future research should investigate the effect of this app on a broader population, including cases involving ambulance transport.

PMID:40194878 | DOI:10.1136/bmjopen-2025-098838

BMJ Open. 2025 Apr 7;15(4):e095173. doi: 10.1136/bmjopen-2024-095173.

ABSTRACT

OBJECTIVE: Healthcare professionals must possess statistical literacy to provide evidence-based care and engage patients in decision-making. However, there have been concerns about healthcare professionals’ inadequate understanding of health statistics. As an initial step in addressing the issue, we assessed the statistical literacy of medical students and doctors in South Korea by evaluating their comprehension of four statistical concepts: (a) single-event probability, (b) relative risk reduction, (c) positive predictive value and (d) 5-year survival rate.

DESIGN: Cross-sectional survey study.

SETTING: The survey was conducted from October 2018 to January 2019 in one medical school and its affiliated teaching hospital in Seoul, South Korea.

PARTICIPANTS: 303 medical students from all six grades and 291 doctors from various specialties.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the correct answer rate for each question. The secondary outcome measure was the mean number of correct answers across the four statistical literacy questions, calculated for each individual.

RESULTS: The correct answer rates for basic numeracy questions were close to 100%. Regarding statistical literacy, 95.5% and 83.2% of the participants accurately understood single-event probability and relative risk reduction, respectively. However, only 49.3% and 49.2% of the participants accurately understood the positive predictive value and 5-year survival rate, respectively. The correct answer rates for the question about the 5-year survival rate differed significantly between students (40.9%) and doctors (57.7%) (p<0.001). There were no statistically significant differences in the correct answer rates for other questions, regardless of the student’s grade level or the doctor’s specialty.

CONCLUSIONS: Medical students and doctors have weaker statistical literacy than their basic numeracy. Therefore, it is essential to implement medical education and professional development programmes that focus on improving their statistical literacy. These programmes should specifically address measures of medical test accuracy and the distinction between a 5-year survival rate and mortality.

PMID:40194877 | DOI:10.1136/bmjopen-2024-095173