Tag: nevin manimala

BMJ Open Qual. 2025 Mar 23;14(1):e002959. doi: 10.1136/bmjoq-2024-002959.

ABSTRACT

Eating disorders are serious mental health conditions associated with significant morbidity and mortality. High levels of demand on services have led to increases in wait times to access support. Early intervention of eating disorders is critical to prevent entrenchment of illness and improve prognosis, with long wait times associated with higher rates of relapse.The East London Community Eating Disorder Service has seen an increase in wait time for routine referral from the 2-week local target to 17 weeks. Additionally, there have been long wait times to access treatment, including therapy and psychiatry support.A quality improvement (QI) framework was used in June 2022 to tackle the issues with capacity and flow with an aim to reduce wait times for routine referral from 17 weeks to 2 weeks in 12 months.A QI project team was formed which sought to understand the demands and capacity of the system using process mapping.From this, the team created a driver diagram and used Plan, Do, Study, Act cycles to test change iteratively. Measurements and data were displayed on control and run charts to help learn from the change ideas tested.Improvements were made and sustained, including reduction of routine referral wait time from 17 weeks to 2 weeks in 12 months. Additionally, internal wait lists reduced from 73 patients on the psychiatry list to 0 in 3 months and from 50 families waiting for therapy to 0 in 7 months.A number of inactive cases reduced from 65 to 0 during testing, thus contributing to improved flow through the service. A striking £130 233.21 annual savings in agency staff expenditure was achieved by January 2023.This has enabled a positive culture shift in the service.

PMID:40122574 | DOI:10.1136/bmjoq-2024-002959

BMJ Open Qual. 2025 Mar 23;14(1):e002277. doi: 10.1136/bmjoq-2023-002277.

ABSTRACT

BACKGROUND: The quality of care provided during the first golden hour after birth in preterm neonates significantly impacts both short- and long-term outcomes. However, implementation of these care processes varies across centres, is not standardised and affects the quality of care.

AIM: To improve the quality of care provided during the first golden hour in neonates born at <34 weeks’ gestation.

METHODS: This quality improvement initiative was conducted in a 30-bedded tertiary care teaching hospital in southern India over 28 months (April 2019-July 2021). Evidence-based interventions to improve admission temperature, respiratory care and administering parenteral nutrition and antibiotics during the golden hour were implemented through Plan-Do-Study-Act cycles in four phases for eligible neonates. The effect of these practice changes on clinical outcomes, including intraventricular haemorrhage, necrotising enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia and survival ratewere studied.

RESULTS: A total of 311 eligible neonates were included in the study. Admission hypothermia significantly reduced from 79% to 22% (p=0.003), and adherence to the respiratory bundle improved from 13% to 77% (p<0.001). The time taken for administration of parenteral nutrition improved from 102±23 min to 62.5±26.7 min (mean±SD) (p<0.001). The median time for administration of antibiotics improved from 162 (135, 173) min to 74 (69, 102) min (median±IQR) (p=0.001) and improvement in mean blood glucose from 35 (12) mg/dL to 54 (14) mg/dL (mean±SD) (p<0.001) at neonatal intensive care unit (NICU) admission, and admission time to NICU from 66.4±16 min to 41±13.8 min (p<0.001).

CONCLUSION: Quality improvement project of improving care in the golden hour after birth in < 34 weeks neonates reduces admission hypothermia and hypoglycaemia and improves the time of admission to NICU, and time of administration of parenteral nutrition and antibiotics.

PMID:40122573 | DOI:10.1136/bmjoq-2023-002277

BMJ Open. 2025 Mar 22;15(3):e090614. doi: 10.1136/bmjopen-2024-090614.

ABSTRACT

OBJECTIVE: Despite increasing incidence of genital gender-affirming surgery (GGAS), there is no systematic method of evaluating patient perspectives. The objective of this study is to elucidate transgender and non-binary patient perspectives on gender-affirming phalloplasty/metoidioplasty via structured focus groups and determine convergent themes as the first step towards the development of a GGAS patient-reported outcome measure.

DESIGN: We conducted a systematic qualitative study using a thematic content analysis of four focus groups from April 2021 to April 2022 comprising 8 patients undergoing phalloplasty/metoidioplasty and 10 patients post-phalloplasty/metoidioplasty. Focus groups were hosted virtually and recorded and transcribed. Discussions were guided by participant input and focused on goals, experiences, outcomes, satisfaction, and quality of life.

SETTING: This volunteer but purposive sample of patients was recruited directly in clinic, via email, and via social media at NYU Langone Health (primary site), Callen-Lorde Community Health Center (New York, New York, USA) and the San Francisco Community Health Center.

PARTICIPANTS: We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. PRIMARY AND SECONDARY OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Transcripts were uploaded into ATLAS.ti, a qualitative data analysis software that facilitates coding for thematic content analysis. We performed deductive and inductive coding to identify the themes that were clustered into overarching domains.

RESULTS: The mean duration of focus groups was 81.5 min. Seven themes and 19 subthemes were constructed. The major themes were (1) goals, expectations, and priorities before/after surgery; (2) sexual function; (3) urinary function; (4) peer support; (5) decision-making; (6) mental health and quality of life; and (7) gender dysphoria. Of the major themes, those determined before the study included themes 1-3 and 6-7. Limitations include small sample size and bias in patient selection.

CONCLUSIONS: We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. Mental health, quality of life, functional, and aesthetic outcomes are all critical to patients. Phalloplasty/metoidioplasty impact numerous aspects of patients’ lives. Experiential components of the surgical process, mental health, and quality of life are important metrics to consider in addition to functional and aesthetic outcomes.

PMID:40122562 | DOI:10.1136/bmjopen-2024-090614

BMJ Open. 2025 Mar 22;15(3):e091212. doi: 10.1136/bmjopen-2024-091212.

ABSTRACT

INTRODUCTION: Domestic violence (DV) is a major public health problem for women around the world, and more commonly for women in Latin American countries (LACs). DV poses a threat to women’s health and can have more severe effects in women at midlife and older (aged 50 and above), including a decline in physical and mental abilities leading to a reduced independence. Low- and middle-income countries, including LACs, are projected to experience the greatest population growth in women at midlife and older worldwide over the next few decades. Current LAC literature about DV in relation to women at midlife and older is predominantly prevalence focused. The objective of this review is to identify what is known about DV among women at midlife and older in LACs.

METHODS AND ANALYSIS: This review will be conducted in accordance with JBI scoping review methodology. This includes a three-step search strategy: first, a search to identify articles from databases in MEDLINE, Scopus and LILACS; then, a second search using all key words and index terms identified from the articles in step one across select databases; and third, screening the reference lists of included studies and reports for additional studies. All studies which focus on DV in LACs among women at midlife and older will be eligible for inclusion, including those related to definitions, frameworks, cultural norms, risk factors, interventions, evaluations, measurement tools, and health and social consequences. Titles, abstracts and full texts will be assessed by two independent reviewers. A data extraction tool will be used, and findings will be presented in a narrative accompanied by diagrams and tables that address the review questions.

ETHICS AND DISSEMINATION: Ethics approval is not required for this review. Findings will be disseminated through a range of traditional approaches, including publication in a peer-reviewed publication and conference presentations.

TRIAL REGISTRATION: This review has been registered with Open Science Framework https://doi.org/10.17605/OSF.IO/SZMF7.

PMID:40122559 | DOI:10.1136/bmjopen-2024-091212

Med Oral Patol Oral Cir Bucal. 2025 Mar 23:26799. doi: 10.4317/medoral.26799. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the comprehensive classifications provided by the WHO, the most common lesions include radicular cysts, dentigerous cysts, odontogenic keratocysts, ameloblastomas, and odontomas. The piezoelectric technique has shown effectiveness in removing intraosseous pathologies by relying on ultrasonic microvibrations, which help preserve soft and vascular tissues. Precision in manipulating intraosseous pathology can impact the prognosis and improve the surgical procedure by controlling hemorrhage and promoting microscopic benefits. While previous research has compared the advantages of piezoelectric surgery and rotational methods, a systematic review is needed to consolidate the available information on this specific clinical issue.

MATERIAL AND METHODS: A search strategy was developed with de PRISMA statement. PubMed, Web of Science, Scopus, and Embase electronic databases were searched. The bibliographic search was conducted in December 2023. The methodological quality of the studies followed the Joanna Briggs Institute (JBI) critical evaluation tool for randomized clinical trials.

RESULTS: The final sample comprised 5 clinical trials, involving 231 cysts and 120 tumors in the experimental group. The mean age of participants was 30.6 years, with 196 men and 141 women included in the study. However, conventional surgery is faster than piezosurgery, both techniques exhibited similarities in epithelial perforation, soft tissue damage, edema, postoperative infections, and occurrences of paresthesia. Regarding recurrence, no statistically significant difference was observed between the two techniques (p-value=0.339; 95% confidence interval, -0.093-0.270).

CONCLUSIONS: The surgical removal of benign odontogenic cysts and tumors in the jaws using piezosurgery yielded slight intraoperative and postoperative advantages compared to conventional rotary surgery, except for the duration of surgical procedures. It shows reduced intraoperative hemorrhage and postoperative pain but similar outcomes in other variables. The results should be interpreted with caution, more studies are needed to obtain a more robust result.

PMID:40121687 | DOI:10.4317/medoral.26799

Med Oral Patol Oral Cir Bucal. 2025 Mar 23:26848. doi: 10.4317/medoral.26848. Online ahead of print.

ABSTRACT

BACKGROUND: The association between Rheumatoid arthritis (RA) and Periodontitis (PD) has been increasingly recognised, yet traditional epidemiological studies face challenges in establishing associations. Therefore, this study aims to genetically assess the association between RA and PD through Mendelian randomisation (MR) analysis, using genetic variations as instrumental variables.

MATERIAL AND METHODS: Data on RA and PD were downloaded from the EBI website. The RA data contained 8,255 cases and 409,001 controls, with a total of 24,175,266 SNPs; the chronic PD data contained 950 cases and 409,001 controls, with a total of 11,842,647 SNPs; the acute PD data contained 128 cases and 456,220 controls, with a total of 11,842,647 SNPs. Additionally, the potential association between RA and PD was investigated. The intercept between Mendelian randomisation (MR)-Egger regression, MR-PRESSO test results and funnel plots was used to analyse the horizontal pleiotropy of SNPs along with the effect of individual SNPs on inverse-variance weighting (IVW) analysis results, assessed using the leave-one-out method.

RESULTS: In total, 26 SNPs highly associated with RA were screened; MR-Egger regression (OR=1.242, 95% CI (1.032-1.494), P=0.031), WM (OR=1.190, 95% CI (1.015-1.395), P=0.032), IVW (OR=1.191, 95% CI (1.053-1.348), P=0.006) and weighted mode (OR=1.212, 95% CI (1.043-1.409), P=0.019) suggested that RA was a likelihood factor for chronic PD, whereas RA was not associated with the incidence of acute PD, and the Cochran’s Q test indicated no statistical heterogeneity between SNPs highly associated with RA. Moreover, analyses using the intercept between the MR-Egger regression, MR-PRESSO test results and funnel plot revealed no horizontal pleiotropy in SNPs highly associated with RA.

CONCLUSIONS: Rheumatoid arthritis was genetically identified as a likelihood factor for PD and the onset of chronic PD, but no association was observed between RA and acute PD.

PMID:40121685 | DOI:10.4317/medoral.26848

Med Oral Patol Oral Cir Bucal. 2025 Mar 23:26956. doi: 10.4317/medoral.26956. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this cross-sectional study was to assess the extent, severity, distribution and potential predisposing factors of gingival recession (GR), utilizing a questionnaire and clinical periodontal measurements obtained from Turkish patients.

MATERIAL AND METHODS: A total of 534 subjects were examined. Participants meeting the inclusion criteria evaluated by dental hygiene habits, educational level, smoking habit and past orthodontic treatment. Plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BOP), clinical attachment level (CAL), gingival thickness (GT), high frenum attachment, and mobility were recorded on the tooth with GR. Probe transparency (PT), crown width/crown length ratio (CW/CL), papilla height (PH) and height of gingival scallop were measured on the index tooth (#11FDI). The GR severity was categorized by using Miller’s classification.

RESULTS: Of the 534 individuals examined in this study, 376 (70.4%) had gingival recession, while 262 patients (49%) were meeting the inclusion criteria and 2,721 teeth (37%) were affected. The majority of the teeth (44.8%) showed Miller class I. The highest GR frequency was detected in incisors (39.5%), particularly in mandible. The correlation between GR and PI (p=0.025), PD (p=0.034), PH (p=0.007), CW/CL (p=0.009), CAL (p<0,001), PT (p<0,001) was found statistically significant. No statistical relation was found between tooth brushing duration (p>0,05), tooth brushing frequency (p>0,05) and gingival recession.

CONCLUSIONS: Gingival recession is a multifactorial condition significantly influenced by clinical and anatomical parameters such as PI, PH, CW/CL, PT while toothbrushing habits, including duration and frequency, appear to have a minimal impact.

PMID:40121680 | DOI:10.4317/medoral.26956

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):799-802. doi: 10.55519/JAMC-04-14150.

ABSTRACT

BACKGROUND: Firearm injuries are critically important in criminal proceedings and jurisprudence discussions. The aim of the current study was to reinforce the growing concern of firearm violence in society and authenticate findings through autopsy examinations in the casualty department of Ayub Teaching Hospital Abbottabad.

METHODS: This retrospective observational study was conducted in the casualty department of Ayub Teaching Hospital Abbottabad. Data was collected from registers spanning 1st September 2023 to 31st May 2024, after obtaining permission from the hospital administration.

RESULTS: Data from 56 cases were analyzed using SPSS 22. Among these, 50% suffered from firearm injuries, while the remaining 50% died due to sharp weapons, blunt weapons, poisoning, hanging, strangulation, road traffic accidents, electric shocks, or unknown causes. Of the total cases, 45 (80.4%) were male and 11 (19.6%) were female. The most affected age group was 20-40 years, comprising 36 (64.2%) cases. Furthermore, 42 (75%) cases were homicidal, 2 (3.6%) were suicidal, and 12 (21.4%) were accidental.

CONCLUSIONS: The most common weapon used in homicidal deaths is firearms. Firearm violence should be prioritized as a critical issue in global health discussions.

PMID:40121646 | DOI:10.55519/JAMC-04-14150

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):793-798. doi: 10.55519/JAMC-04-13811.

ABSTRACT

BACKGROUND: Diabetes mellitus is a leading cause of morbidity and mortality, with many ocular severe complications. This cross-sectional study determined adherence to proper eye care recommendations and regular eye examinations among local diabetic patients and factors associated with non-adherence.

METHODS: This cross-sectional survey assed the knowledge, attitude, and practices of 200 type I and II diabetic patients. The frequency of patients’ regular eye examinations, good knowledge of diabetic eye disease, and measures of the association of periodic eye examination with different variables were calculated.

RESULTS: There were 116 (58%) males and 84 (42%) females (mean age=55.28 years, SD=13.928 years). The majority belonged to the lower socioeconomic group with little education. 114 (57%) had never had any eye examination. 107 were unaware of the importance of eye examination. Only 35 (17.5%) had good knowledge, and 146 (73%) patients had poor attitudes towards diabetes. Periodic eye examination was significantly associated with occupation, area of residence, and overall knowledge of diabetic eye complications. In contrast, it had no significant association with gender, type of diabetes, presence of eye symptoms, or presence of other diabetes complications.

CONCLUSIONS: The knowledge of our local population about diabetic eye disease is very deficient. An extensive campaign of educating diabetic patients about ocular complications is necessary to address this.

PMID:40121645 | DOI:10.55519/JAMC-04-13811

J Ayub Med Coll Abbottabad. 2024 Oct-Dec;36(4):783-787. doi: 10.55519/JAMC-04-14046.

ABSTRACT

BACKGROUND: The occurrence of a single beta thalassaemia allele is frequently related with microcytic hypochromic red blood cells and a rise in HbA2 levels. In some beta thalassaemia carriers, the outcome of this allele or its collaboration with other acquired or genetic defects may result in normal or borderline Haemoglobin bA2 levels. Objective was to establish the importance of molecular analysis in borderline HbA2 individuals and its significance in a population screening program.

METHODS: It was a cross-sectional study conducted over a period of six months, from July-December 2023. All 123 individuals with borderline HbA2 levels between (3‒3.9%) diagnosed by High-performance liquid chromatography (HPLC)/Capillary Zone Electrophoresis underwent molecular testing using multiplex amplification refractory mutation system-Polymerase Chain Reaction (ARMS-PCR) to detect common beta thalassaemia mutations: Fr8-9, IVS1-5, Fr41-42, Cd15, Cd5, IVS1-1, IVS1-1, Cd30, Cd30, Fr16, IVSII-1, Del619, and CAP+1 in the Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi .Statistical tests were applied to compare Red Blood Cell indices and Haemoglobin A2 values among beta thalassaemia carriers and non-carriers.

RESULTS: Among those tested, 47.1% (n=58) were found to carry Beta thalassaemia mutations. The most prevalent mutations were IVS1-5 (n=19,15.4%) and Fr8-9 (n=19,15.4%) followed by Fr41-42 (n=08,6.5%). Subjects with mutations exhibited significantly lower mean corpuscular volume and mean corpuscular haemoglobin compared to those without mutations (p-value= <0.001). Beta thalassaemia mutations were seen more frequently when HbA2 was in range of 3.5-3.9% (n=37,63.8%), as compared to HbA2 that was 3-3.4% (n=21,36.2%) and this difference was found to be significant (p-value= <0.001). The CAP+1 mutation was associated (n=02,1.6%) with normal mean MCV and MCH compared to other identified mutations.

CONCLUSIONS: It is concluded that molecular study for the common beta thalassaemia mutations in Pakistani population plays a pivotal role in confirmation of borderline HbA2 thalassaemia carriers, specifically in areas with a high prevalence of the disease. Molecular testing for beta thalassaemia should be offered to all individuals with borderline HbA2 with values especially between 3.4‒3.9% and having microcytic hypochromic indices.

PMID:40121643 | DOI:10.55519/JAMC-04-14046