Tag: nevin manimala

Acta Otorhinolaryngol Ital. 2025 Aug;45(4):261-268. doi: 10.14639/0392-100X-N3125.

ABSTRACT

OBJECTIVE: To analyse the cost-effectiveness of unilateral cochlear implant (CI) surgery in Italian adults with post-lingual deafness, focusing on direct costs, Health Utilities Index (HUI), Quality-Adjusted Life Years (QALY), and Incremental Cost-Effectiveness Ratio (ICER).

METHODS: The analysis, from the Italian healthcare system perspective, included preoperative, surgical, hospitalisation, and postoperative costs. QALYs were estimated using the Italian Nijmegen Cochlear Implant Questionnaire (I-NCIQ) and Ontario Health Utilities Index Mark 3 (HUI-3). HUI-3 score changes were analysed with regression models in Stat View (v5.0.1, SAS Institute Inc). ICER was calculated as the incremental cost per QALY (in Euros/QALY) over the average patient’s lifetime.

RESULTS: CI significantly improved I-NCIQ (p < 0.001) and HUI-3 scores (p < 0.0001). Average life expectancy at surgery was 21.2 years; the degrade factor was 0.97, yielding a lifetime gain of 2.717 QALYs. Direct costs amount to €19,467.65. Cost-utility analysis showed €7,165.13 per QALY, below the €30,000/QALY ICER threshold.

CONCLUSIONS: CI surgery is cost-effective based on QALY analysis. Although cost-effectiveness decreases with age, quality of life and health benefits are comparable to younger patients.

PMID:40985093 | DOI:10.14639/0392-100X-N3125

Acta Otorhinolaryngol Ital. 2025 Aug;45(4):231-236. doi: 10.14639/0392-100X-N3165.

ABSTRACT

OBJECTIVE: The Host-index (H-index) is a value obtained using blood laboratory parameters. Elevated H-index is a negative prognostic factor in patients with head and neck squamous cell carcinoma (HNSCC). The purpose of our study was to assess the prognostic impact of the H-Index in patients with locally advanced tumours who underwent reconstructive surgery with free flaps.

METHODS: We performed a retrospective study on a cohort of patients referred to our center from January 2013 to October 2018. We assessed the prognostic role of H-index in terms of disease-free (DFS) and overall survival (OS).

RESULTS: A total of 99 patients were studied, with a median age of 66 years. After a median follow-up of 46.5 months (range, 1.4-121.9), 5-year OS was 59.6% (CI 29.3-57.5) and 5-year DFS 47.5% (CI 16.7-49.2). The H-index showed a statistically significant correlation with a shorter DFS (HR 1.2, 95% CI 1.1-1.4, p = 0.006). No correlations were found between surgical complications and the H-index.

CONCLUSIONS: This study confirmed that the H-index is an independent prognostic factor for DFS in patients with HNSCC undergoing microvascular reconstructive surgery and should be used to better stratify the risk of mortality and recurrence, with the aim of improving patient management.

PMID:40985089 | DOI:10.14639/0392-100X-N3165

J Intellect Disabil Res. 2025 Sep 23. doi: 10.1111/jir.70047. Online ahead of print.

ABSTRACT

INTRODUCTION: Outcomes for people with intellectual and developmental disabilities, particularly those with more severe and complex needs, depend on the quality of support they receive from staff. This paper explores staff perspectives on skilled support and relationships with training and experience.

METHODS: Questionnaires were received from 93 staff working in 28 supported accommodation services in which observations of the quality of support had also been conducted. Staff were asked about experience, training and views on skilled support. Content analysis was used to code written responses. Statistical analysis explored relationships between staff responses, and the quality of support was observed.

RESULTS: Staff perceived improving the quality of life of people they supported as key. All staff considered themselves as being at least partially skilled, with the majority associating being skilled with length of experience and attendance at training. Specific training was rarely mentioned, and receipt of training was not associated with the provision of better quality of support. Practice leadership was rarely mentioned.

CONCLUSIONS: In most cases, staff showed awareness of the principles set out in policy, but their reflections did not match observed practice.

PMID:40985050 | DOI:10.1111/jir.70047

Indian J Psychol Med. 2025 Sep 19:02537176251376317. doi: 10.1177/02537176251376317. Online ahead of print.

ABSTRACT

BACKGROUND: Alcohol use disorder (AUD) is accompanied by cognitive impairments, including attentional bias towards cues linked to alcohol. Most studies on attentional biases have focused on participants in intoxicated states, with limited research on differences between chronic and occasional users. This study aimed to examine attentional biases in chronic alcohol users compared to occasional users using eye-tracking.

METHODS: In this cross-sectional study, 71 male participants (36 chronic users and 35 occasional users) were recruited from a tertiary care center in India. Eye-tracking assessments were conducted using free-viewing of emotional and landscape images, and viewing of alcohol related stimuli. For each task, variables such as the number of fixations, fixation duration, scan path, and anti-saccade rates were calculated.

RESULTS: No statistically significant difference was found between chronic alcohol users and occasional users in fixation metrics, scan path length, or anti-saccade rates for emotional, landscape, or alcohol related stimuli. Chronic alcohol users had slightly longer fixation durations and greater scan path lengths on alcohol-related stimuli, but these differences were not significant (p > .05).

CONCLUSIONS: Our findings suggest that chronic alcohol users may not always display prominent attentional biases in a sober state. The prolonged abstinence duration (>2 months) contributed to the absence of significant biases in our study. The slightly longer scan path length for alcohol-related images among chronic users may indicate that they were possibly avoiding these images. The findings also highlight the need for a state-dependent approach and the importance of assessing variables like craving in future research.

PMID:40985043 | PMC:PMC12450205 | DOI:10.1177/02537176251376317

Indian J Psychol Med. 2025 Sep 20:02537176251371784. doi: 10.1177/02537176251371784. Online ahead of print.

ABSTRACT

BACKGROUND: The mental health (MH) treatment gap in India is particularly pronounced in underserved and rural areas. Community Health Officers (CHOs) play a crucial role in addressing this gap at the primary care level. A pan India digitally driven MH capacity-building program was designed to integrate MH care into primary care settings by training CHOs and supporting them through Collaborative Video Consultations (CVCs). We aimed to examine the profile of MH cases through CVCs by CHOs trained under a pan-India, digitally enabled MH capacity-building program, and to describe the diagnostic patterns and types of handholding provided across three Indian states.

METHODS: This cross-sectional study analyzed 591 CVC records from CHOs of Karnataka, Maharashtra and Bihar from November 15, 2022 to July 31, 2024, who underwent a six-session online training program on MH care, followed by real-time video consultations with MH professionals for case discussions and patient management. Descriptive statistics and crosstabulations were used for data analysis.

RESULTS: Most CVCs were from adult patients aged 19-60 years (79.69%), with women more frequently identified with common mental disorders (CMD) (25.42%) and men more commonly having severe mental disorders (SMD) (12.20%) and substance use disorders (SUD) (16.61%). Among states, Bihar had the highest number of CVCs (38.92%). CHOs provided handholding through referrals, counseling, and follow-ups.

CONCLUSIONS: The program demonstrated the effectiveness of CVCs in empowering CHOs to identify and manage MH conditions. The consultation-based collaborative model facilitated accurate diagnoses and timely interventions, bridging the MH treatment gap in rural and underserved regions. Continued investment in CHO training, digital infrastructure, and follow-up care is essential for sustaining the program’s impact on primary MH care.

PMID:40985042 | PMC:PMC12450207 | DOI:10.1177/02537176251371784

Ther Adv Psychopharmacol. 2025 Sep 20;15:20451253251339378. doi: 10.1177/20451253251339378. eCollection 2025.

ABSTRACT

BACKGROUND: Postoperative delirium (POD) is associated with higher risks of postoperative complications ‌and‌ mortality (2- to 3-fold increase). Studies investigating the effect of intraoperative ketamine on POD risk have yielded conflicting results. This study aimed to assess the effects of intraoperative ketamine and its more potent version, esketamine, on POD.

DESIGN: Systematic review and meta-analysis.

OBJECTIVE: To evaluate the effect of intraoperative ketamine/esketamine on the incidence of POD.

METHODS: We adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and searched the PubMed, Embase, Medline (Ovid), Cochrane, Scopus, and Web of Science databases for the MeSH terms “ketamine” and “emergence delirium” from database inception to July 10, 2024. The primary outcome was POD incidence following general anesthesia. Data were analyzed using a common effects model, with between-study heterogeneity tested using the I ² statistic, and relative risk (RR) with 95% confidence intervals (CIs) for dichotomous data was used as the effect measure.

RESULTS: A total of 18 studies with a total of 1571 participants met eligibility criteria. A meta-analysis of all studies suggests that the intraoperative use of ketamine/esketamine may reduce the incidence of POD (RR = 0.71, 95% CI: 0.56, 0.90, p < 0.01). In the drug subgroup, esketamine demonstrated enhanced efficacy in preventing POD compared to ketamine (RR = 0.59, 95% CI: 0.38, 0.90, p = 0.02). In addition, subanesthetic doses of ketamine/esketamine (⩽0.5 mg/kg) contributed to POD prevention (RR = 0.52, 95% CI: 0.34, 0.79, p < 0.01), whereas higher doses (>0.5 mg/kg) showed no statistically significant effect (RR = 0.89, 95% CI: 0.66, 1.21, p = 0.46). Further analysis revealed additional benefits of ketamine/esketamine in reducing POD incidence in cardiac surgery (RR = 0.46, 95% CI: 0.31, 0.68, p < 0.01), in the elderly (RR = 0.68, 95% CI: 0.52, 0.91, p < 0.01), and in the first 24 h post-surgery (RR = 0.52, 95% CI: 0.29, 0.94, p = 0.03).

CONCLUSION: Our findings suggest that perioperative administration of ketamine/esketamine had a protective effect against the incidence of POD, with esketamine demonstrating superior efficacy compared to ketamine. The treatment effect exhibited a dose-response relationship, with subanesthetic doses showing greater efficacy. Furthermore, ketamine/esketamine may offer additional benefits for patients with specific risk factors.

PMID:40985036 | PMC:PMC12450268 | DOI:10.1177/20451253251339378

J Public Health Res. 2025 Sep 20;14(3):22799036251376881. doi: 10.1177/22799036251376881. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Dengue fever, a viral infection transmitted by Aedes mosquitoes, has emerged as a global public health concern according to the World Health Organization (WHO). Given the geographical proximity of Iran to countries that have reported outbreaks of this disease in recent years, this issue needs careful attention.

DESIGN AND METHODS: The present study aims to identify the knowledge, attitudes, and practices of rural populations concerning dengue fever in Fars Province, southern Iran.

METHODS: A cross-sectional study was conducted over 2 months, from October to December 2024, involving 17 rural regions and encompassing a total of 653 households. The data were collected using a questionnaire designed to assess knowledge, attitudes, and practices regarding dengue fever.

RESULTS: Of the 653 individuals participating in the study, 370 were male and 283 were female. The overall average scores, along with their standard deviations, for the rural population’s knowledge (10.76 ± 2.10 out of 15), attitude (13.65 ± 2.90 out of 20), and practice (8.24 ± 1.70 out of 12) regarding dengue fever were at moderate levels. Pearson’s correlation coefficient analysis indicated a direct and statistically significant relationship between knowledge, attitudes, and practices. The findings revealed a substantial positive association between the participants’ knowledge and their attitudes (r = 0.47, p < 0.001), as well as a strong direct relationship between knowledge and practices (r = 0.51, P<0.001). Furthermore, a notable positive correlation was observed between attitudinal variables and practical behaviors (r = 0.45, p < 0.001).

CONCLUSION: Overall, the knowledge, attitude, and practice of the rural population regarding dengue fever were found to be moderate. Therefore, it is recommended that health system policymakers should adopt suitable approaches, such as ensuring comprehensive public health education for all, creating educational materials, and enhancing awareness campaigns. Effective strategies for mitigating and controlling the spread of dengue fever depend on public knowledge and attitude changes, along with appropriate measures for successful disease control.

PMID:40985017 | PMC:PMC12450256 | DOI:10.1177/22799036251376881

Eur Heart J Digit Health. 2025 Jun 30;6(5):1084-1093. doi: 10.1093/ehjdh/ztaf075. eCollection 2025 Sep.

ABSTRACT

AIMS: Personalized risk assessment tools (PRTs) are recommended by cardiovascular guidelines to tailor prevention, diagnosis, and treatment. However, PRT implementation in clinical routine is poor. ACRIBiS (Advancing Cardiovascular Risk Identification with Structured Clinical Documentation and Biosignal Derived Phenotypes Synthesis) aims to establish interoperable infrastructures for standardized documentation of routine data and integration of high-resolution biosignals (HRBs) enabling data-based risk assessment.

METHODS AND RESULTS: Established cardiovascular risk scores were selected by their predictive performance and served as basis for building a core cardiovascular dataset with risk-relevant clinical routine information. Data items not yet represented in the Medical Informatics Inititative (MII) Core Dataset (CDS) FHIR profiles will be added to an extension module ‘Cardiology’ allowing for maximum interoperability. HRB integration will be implemented at each site through a modular infrastructure for electrocardiography (ECG) processing. Predictive performance of PRTs and their dynamic recalibration through HRB integration will be evaluated within the ACRIBiS cohort consisting of 5250 prospectively recruited patients at 15 German academic cardiology departments with 12-month follow-up. The potential of visualising these risks to improve patient education will also be assessed and supported by the development of a self-assessment app.

DISCUSSION: The ACRIBiS project presents an innovative concept to harmonize clinical data documentation and integrate ECG data, ultimately facilitating personalized risk assessment to improve patient empowerment and prognosis. Importantly, the consensus-based documentation and interoperability specifications developed will support the standardisation of routine patient data collection at the national and international levels, while the ACRIBiS cohort dataset will be available for broad secondary use.

TRIAL REGISTRATION: The study is registered at the German study registry (DRKS): #DRKS00034792.

PMID:40984993 | PMC:PMC12450505 | DOI:10.1093/ehjdh/ztaf075

Eur Heart J Digit Health. 2025 Jun 19;6(5):1015-1023. doi: 10.1093/ehjdh/ztaf071. eCollection 2025 Sep.

ABSTRACT

AIMS: Smartphone-based digital screening was shown to increase the detection rate of atrial fibrillation (AF) requiring oral anticoagulation (OAC) compared with usual care. In this pre-specified subgroup analysis of the eBRAVE-AF trial, we explored sex-specific differences in digital AF-screening.

METHODS AND RESULTS: In eBRAVE-AF (NCT04250220), participating policyholders of a German health insurance company were randomly assigned to a 6-month digital or conventional AF-screening strategy. For digital screening, participants used smartphone-based photoplethysmography (PPG) to detect pulse wave irregularities, which were confirmed using 14-day external ECG-recorders. The primary endpoint was newly diagnosed AF treated with OAC. After 6 months, participants were assigned to a second, cross-over study-phase. The efficacy of AF-screening in women and men was assessed by Cox-regression analysis. 5551 (31% females; 55% ≥ 65 years) of 67 488 invited policyholders free of AF participated in the study and were randomly assigned to digital screening (n = 2860) or usual care (n = 2691). Participation rate was significantly higher among men than women (8.7% vs. 7.3%; P < 0.001). Male sex was a significant predictor for reaching the primary endpoint (HR 1.74; 95% CI: 1.08-2.82, P = 0.023), which was pronounced in patients undergoing digital screening (HR 2.48; 95% CI: 1.52-4.05, P < 0.001). Digital screening did not significantly increase the detection rate of AF requiring OAC in women (HR 1.83; 95% CI: 0.74-4.54; P = 0.193; P-interaction = 0.563).

CONCLUSION: Men showed higher willingness to participate in this digital study and digital AF-screening was effective for them. While digital screening increased the detection rate of AF with OAC in women, the effect was not statistically significant, likely due to limited power.

PMID:40984986 | PMC:PMC12450515 | DOI:10.1093/ehjdh/ztaf071

Int J Gen Med. 2025 Sep 17;18:5581-5589. doi: 10.2147/IJGM.S513034. eCollection 2025.

ABSTRACT

OBJECTIVE: To investigate the predictive value of preoperative [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG) positron emission tomography/computed tomography (PET/CT)-derived heterogeneity index (HI) for occult lymph node metastasis (OLM) in clinical N0 gastric adenocarcinoma.

METHODS: This retrospective study included 83 patients with clinical N0 gastric adenocarcinoma who underwent [¹⁸F]FDG PET/CT scans before radical surgery between March 2018 and June 2024. Patients were classified as OLM-positive (n=40) or OLM-negative (n=43) based on postoperative pathology. Clinical characteristics, PET/CT metabolic parameters [maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), peak standardized uptake value (SUVpeak), tumor-to-liver ratio (TLR), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)], and heterogeneity indices (HI-1 and HI-2) were analyzed. Univariate and multivariate logistic regression models were applied to identify independent predictors of OLM. ROC curve analysis was performed to assess diagnostic performance. Statistical analysis was conducted using SPSS version 26.0, with P<0.05 considered statistically significant.

RESULTS: Gender, tumor differentiation, and pathological T stage differed significantly between the two groups (P<0.05). HI-2 was significantly higher, while SUVmax, SUVmean, and HI-1 were significantly lower in the OLM-positive group (P<0.05). Multivariate analysis identified pathological T stage (T3-T4, OR=4.778, P=0.022) and HI-2 >4.959 (OR=6.887, P=0.002) as independent predictors of OLM. ROC analysis revealed that HI-2 had an AUC of 0.711 (95% CI: 0.596-0.824, P=0.001), with 52.5% sensitivity and 88.37% specificity at the optimal threshold.

CONCLUSION: HI-2 derived from preoperative [¹⁸F]FDG PET/CT is a significant independent predictor of OLM in clinical N0 gastric adenocarcinoma patients, alongside pathological T stage.

PMID:40984973 | PMC:PMC12450381 | DOI:10.2147/IJGM.S513034