Tag: nevin manimala

BMJ Open. 2025 Sep 21;15(9):e095290. doi: 10.1136/bmjopen-2024-095290.

ABSTRACT

OBJECTIVES : To provide a contemporary, postpandemic description of UK occupational therapy and physiotherapy practice to rehabilitate the upper limb after stroke. SETTING : A national online survey, first undertaken in 2018 (prepandemic), was readministered to describe postpandemic practice.

PARTICIPANTS: The survey was distributed to UK-based occupational therapists and physiotherapists working with people after stroke, via professional and social networks.

PRIMARY MEASURES: Shaped by the Template for Intervention Description and Replication Checklist, the survey collected and subsequently analysed the content, frequency and duration of upper limb rehabilitation after stroke.

RESULTS: A total of 122 occupational therapists (n=42) and physiotherapists (n=80) currently working clinically, across in-patient, out-patient and community settings, in the UK completed the survey. Respondents reported treating the upper limb a median of three times a week (IQR 2-4; range 0-6) for a median of 25 min (IQR: 20-35; range 3-60; n=119). Repetitive, functionally-based activities were the most commonly reported interventions for mild (n=93; 81%) and moderate (n=72; 64%) impairment. Stretching (n=73; 66%) and positioning (n=49; 45%) were most frequently reported for severe impairment. In each of the three impairment categories, a larger number of interventions were reported than in the 2018 survey.

CONCLUSIONS: While the pandemic promoted the use of virtual interventions, most therapists had returned to face-to-face interventions. The findings highlight that the current reported provision of upper limb therapy continues to be markedly less than the dose shown to be effective. The study provides important data which can be used to judge the success of attempts to align practice with new guidelines and inform ‘usual therapy’ for the upper limb after stroke in comparative studies.

PMID:40976671 | DOI:10.1136/bmjopen-2024-095290

BMJ Open. 2025 Sep 21;15(9):e102812. doi: 10.1136/bmjopen-2025-102812.

ABSTRACT

BACKGROUND: Acute decompensated heart failure (ADHF), characterised by rapid deterioration of cardiac function, imposes substantial clinical and economic burdens due to high mortality (10%), frequent rehospitalisations (30% within 3 months) and impaired health-related quality of life. While exercise-based cardiac rehabilitation (ExCR) is a guideline-recommended intervention for stable heart failure, its utilisation remains critically low (11%) in ADHF populations, particularly during the vulnerable period spanning 90 days post-discharge-a high-risk phase marked by elevated mortality and morbidity. Current evidence gaps persist regarding optimal ExCR timing, dosage and efficacy during this critical window. This randomised controlled trial investigates the feasibility and impact of early ExCR initiation in the ADHF vulnerable period, evaluating outcomes in physical capacity, cardiac function and quality of life to inform evidence-based exercise protocols for this high-risk population.

METHODS: This prospective, non-inferiority, randomised controlled trial will recruit 88 patients with ADHF. Participants will be randomised 1:1 to a 12-week personalised ExCR group or a traditional health education-based CR control group. Assessments will occur at baseline and 1, 2 and 3 months. The primary outcome is the change in 6 min walk distance post-intervention. Secondary outcomes include changes in grip strength, New York Heart Association Classification(NYHA class), brain natriuretic peptide, left ventricular ejection fraction, hospital stay, Short Physical Performance Battery score, Activities of Daily Living, Minnesota Living with Heart Failure Questionnaire score, and frailty status. Safety measures include all-cause readmission and mortality within 3 months post-discharge, as well as adverse events during the trial.

ETHICS AND DISSEMINATION: The study protocol was approved by the Peking University First Hospital Ethics Committee (Approval No. 2024yan180-002) in accordance with the Declaration of Helsinki. All participants will provide written informed consent prior to enrolment. The findings will be disseminated via peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER: This study protocol was registered at ClinicalTrials.gov (Identifier: NCT06795737, https://www.

CLINICALTRIALS: gov/.) on 26 January 2025.

PMID:40976670 | DOI:10.1136/bmjopen-2025-102812

BMJ Open. 2025 Sep 21;15(9):e106708. doi: 10.1136/bmjopen-2025-106708.

ABSTRACT

INTRODUCTION: The WHO has declared climate change the defining public health challenge of the 21st century. Incorporating climate and environmental outcomes in randomised trials is essential for enhancing healthcare treatments’ sustainability and safeguarding global health. To implement such outcomes, it is necessary to establish a framework for unbiased and transparent planning and reporting. We aim to develop extensions to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT 2025) and Consolidated Standards of Reporting Trials (CONSORT 2025) statements by introducing guidelines for reporting climate and environmental outcomes.

METHODS AND ANALYSIS: This is a protocol for SPIRIT and CONSORT extensions on reporting climate and environmental outcomes in randomised trials termed SPIRIT-Implementing Climate and Environmental (ICE) and CONSORT-ICE. The development of the extensions will consist of five phases: phase 1-project launch, phase 2-review of the literature, phase 3-Delphi survey, phase 4-consensus meeting and phase 5-dissemination and implementation. The phases are expected to overlap. The SPIRIT-ICE and CONSORT-ICE extensions will be developed in parallel. The extensions will guide researchers on how and what to report when assessing climate and environmental outcomes.

ETHICS AND DISSEMINATION: The protocol was submitted to the Danish Research Ethics Committees, Denmark in June 2025. Ethics approval is expected in September 2025. The SPIRIT and CONSORT extensions will be published in international peer-reviewed journals.

PMID:40976669 | DOI:10.1136/bmjopen-2025-106708

Sex Reprod Healthc. 2025 Sep 8;46:101145. doi: 10.1016/j.srhc.2025.101145. Online ahead of print.

ABSTRACT

BACKGROUND: Weight stigma is pervasive in society and negatively affects the quality of maternity care for women with larger bodies. Healthcare providers’ attitudes and beliefs about weight and larger bodied people contribute to experiences of weight stigma, yet the extent of weight stigma attitudes and beliefs in Australian maternity care providers is not known.

OBJECTIVE: This study aimed to explore maternity care providers’ attitudes and beliefs regarding weight and body size during pregnancy.

METHODS: A cross-sectional survey with Australian maternity care providers, using the Fat Attitudes Assessment Toolkit (FAAT), with an open-ended ‘any other comments’ text response, was undertaken. Quantitative responses were analysed using descriptive statistics and qualitative inductive content analysis.

RESULTS: Maternity care providers (n = 243) from across Australia responded to the survey. Responses indicated a strong emphasis on empathy towards larger bodied pregnant women, with providers acknowledging the socioeconomic and societal impact on the complexity of weight and body size. Responses also highlighted providers’ internalised weight stigma. Free-text responses reflected mixed views on the balance between addressing health risks and avoiding weight stigma, with a need for more resources and education on weight-inclusive care.

CONCLUSION: Maternity care providers are aware of the complexities of caring for larger bodied women. Tailored interventions that promote empathy and reduce weight-based discrimination are recommended.

PMID:40975910 | DOI:10.1016/j.srhc.2025.101145

Int J Nurs Stud. 2025 Sep 12;172:105216. doi: 10.1016/j.ijnurstu.2025.105216. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical decision-making is a core competency in emergency nursing, requiring rapid and accurate assessments. With the growing integration of Generative Artificial Intelligence in healthcare, there is a pressing need to understand its potential as a clinical decision support tool. While Generative Artificial Intelligence models show high accuracy and consistency, their ability to navigate complex, context-sensitive scenarios remains in question.

OBJECTIVES: This study aimed to compare the clinical decision-making performance of emergency nurses from Israel and Italy with Generative Artificial Intelligence models (Claude-3.5, ChatGPT-4.0, and Gemini-1.5). It evaluated differences in severity assessment, hospitalization decisions, and test selection, while exploring the influence of demographic and professional characteristics on decision accuracy.

METHODS: A prospective observational study was conducted among 82 emergency nurses (49 from Italy, 33 from Israel), each independently evaluating five standardized clinical cases. Their decisions were compared with those generated by Generative Artificial Intelligence models using a structured evaluation rubric. Statistical analyses included ANOVA, chi-square tests, logistic regression, and receiver operating characteristic curve analysis to assess predictive accuracy.

RESULTS: Generative Artificial Intelligence models exhibited higher overall decision accuracy and stronger alignment with expert recommendations. However, notable discrepancies emerged in hospitalization decisions and severity assessments. For example, in Case 2, Generative Artificial Intelligence rated severity as level 1, while Italian and Israeli nurses rated it at 1.98 and 2.23, respectively (P < 0.01, F = 199). In Case 1, only 4.1 % of Italian nurses recommended hospitalization compared to 30.3 % of Israeli nurses, whereas all Generative Artificial Intelligence models advised hospitalization. Nurses showed greater variability in test selection and severity judgments, reflecting their use of clinical intuition and contextual reasoning. Demographics such as age, gender, and years of experience did not significantly predict accuracy.

CONCLUSIONS: Generative Artificial Intelligence models demonstrated consistency and expert alignment but lacked the contextual sensitivity vital in emergency care. These results highlight the potential of Generative Artificial Intelligence as a clinical decision-support tool while emphasizing the continued importance of human clinical judgment.

PMID:40975905 | DOI:10.1016/j.ijnurstu.2025.105216

Diagn Cytopathol. 2025 Sep 21. doi: 10.1002/dc.70025. Online ahead of print.

ABSTRACT

BACKGROUND: Although core needle biopsy is widely preferred for evaluating renal lesions, fine needle aspiration (FNA) combined with rapid on-site evaluation (ROSE) remains a valuable diagnostic method in selected cases. This study aims to assess the diagnostic efficacy of renal FNA and highlight the impact of ROSE on achieving definitive diagnoses.

METHODS: This retrospective study included 273 patients who underwent ultrasound- or CT-guided FNA for renal lesions between 2010 and 2018 at Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. Lesions were evaluated based on size, radiologic features, localization, ROSE status, and number of smears. Cytopathological results were categorized as nondiagnostic, limited, non-neoplastic, or neoplastic. Histopathological correlation was assessed in available cases. Statistical analyses were performed using SPSS v25.0, with p < 0.05 considered significant.

RESULTS: Of the 273 cases, 218 (79.8%) yielded diagnostic results. Definitive diagnosis rates increased with lesion size and were significantly higher in solid (86.3%) and mixed (91.4%) lesions compared to cystic lesions (60%) (p = 0.001). ROSE was performed in 177 cases, significantly improving diagnostic yield compared to cases without ROSE (85.8% vs. 68.7%, p = 0.001). Histopathological follow-up was available in 119 cases, with an overall cytological-histological concordance of 84%, reaching 98% in cases with adequate material.

CONCLUSION: Renal FNA remains a reliable and accurate diagnostic method when combined with ROSE, especially in well-sampled cases. It aids in identifying both primary and metastatic tumors and can guide clinical decision-making, particularly when surgery is not feasible.

PMID:40975883 | DOI:10.1002/dc.70025

J Eval Clin Pract. 2025 Sep;31(6):e70279. doi: 10.1111/jep.70279.

ABSTRACT

BACKGROUND: Older populations are prone to various chronic diseases and takes polypharmacy, which can lead to potentially inappropriate medications (PIMs), causing several complications. This research aimed to estimate PIMs and potential prescribing omissions (PPOs) in older adults via the STOPP/START criteria, version 3.

METHODS: This multicentric retrospective observational study was executed among subjects aged ≥ 65 years, who were hospitalized at two Ministry hospitals from July 2023 to June 2024. The medicines of the geriatric population were assessed for PIMs/PPOs via the STOPP/START criteria, version 3. The data were scrutinized via SPPSS 27. Descriptive statistics were performed for qualitative and quantitative data. Multinomial logistic regression was applied to evaluate the effects of sex, age, comorbidities and medicines on PIMs and PPOs. Multiple linear regression analysis was conducted to evaluate potential multicollinearity among the predictors associated with PIMs and PPOs.

RESULTS: In total, 385 subjects were included in this study. The participants’ mean age was 75.7 ± 8.76 years and 50.13% were male. Among the study population, 48.83% had potentially inappropriate prescriptions, 37.66% with PIMs and 20.52% with PPOs. In total, 190 PIMs and 108 PPOs were identified, and the most frequently prescribed PIM was calcium channel blockers (20%). Comorbidities were significantly associated with PIMs and PPOs.

CONCLUSION: Overall, 48.83% of the prescriptions were potentially inappropriate. The percentage of PIMs/PPOs is lower in our population than in previous versions of the STOPP/START criteria. However, scheduled audits should be performed to keep the PIMs/PPOs at the lowest range. A comprehensive list of medications that are appropriate or inappropriate for use in older adults should be established, and prescribers should consult this list before prescribing to help prevent potentially inappropriate prescriptions.

PMID:40975859 | DOI:10.1111/jep.70279

Matern Child Nutr. 2025 Sep 21:e70108. doi: 10.1111/mcn.70108. Online ahead of print.

ABSTRACT

We evaluated the association between the inflammatory potential of the maternal diet during pregnancy and levels of inflammatory biomarkers measured in cord blood and maternal serum at birth. Dietary inflammatory potential was calculated using the energy-adjusted dietary inflammatory index (E-DII) in the French EDEN and ELFE birth cohorts. Biomarkers of inflammation (interleukin [IL]-1β, IL-6, IL-10, tumor necrosis factor α [TNF-α]) were measured from cord blood (EDEN [n = 758]; ELFE [n = 899]) and maternal serum (in ELFE only; [n = 911]) collected at birth. Additionally, leptin was also measured from cord blood in EDEN (n = 1202) and C-reactive protein was measured from cord blood in ELFE (n = 895). Linear regression models, adjusted for confounders, were used to investigate the association between tertiles of the E-DII score and each log-transformed biomarker. There were no significant associations between the E-DII score and maternal or cord blood biomarkers in either cohort. The energy-adjusted dietary inflammatory index score during pregnancy was not associated with concentrations of inflammatory biomarkers in either maternal serum or cord blood at birth.

PMID:40975853 | DOI:10.1111/mcn.70108

J Eval Clin Pract. 2025 Sep;31(6):e70278. doi: 10.1111/jep.70278.

ABSTRACT

BACKGROUND: Nonattendance at new patient appointments leads to missed opportunities for engagement in care, lost revenue, and suboptimal resource utilization.

OBJECTIVE: To assess the effectiveness of outreach calls to new patients, prioritized by a no-show predictive algorithm and conducted by volunteers, on visit attendance.

DESIGN: Rapid randomized quality improvement project.

PARTICIPANTS: Patients with new patient appointments at an urban safety-net adult primary care clinic scheduled to occur between August 1, 2024 and September 30, 2024.

INTERVENTION: Estimated probability of visit no-show for patients was calculated using a predictive algorithm embedded in the electronic health record and used to sort lists of patients with upcoming appointments. Every other patient received an outreach call from a trained volunteer within 3 business days of their appointment plus usual automated reminder messages versus usual automated reminder messages alone.

MAIN MEASURES: New patient visit attendance compared between intervention and control groups. We conducted subgroup analyses of attendance by visit modality (in-person vs. telehealth), preferred language, and quartile of predicted no-show probability.

KEY RESULTS: Patients in the intervention group (n = 281) had higher visit attendance than those in the control group (n = 280): 68.0% versus 54.1% (p < 0.01). There was a significant difference in attendance for in-person (70.7% vs. 51.7%; p < 0.01) but not telehealth (60.6% vs. 61.2%; p = 0.94) visits. Patients who preferred English had the biggest increase in attendance (17.2%; p < 0.01). Patients in the second and third quartiles of predicted no-show probability (31%-38% and 39%-45% predicted probability) had the biggest increases in attendance (22.2% [p = 0.01] and 15.4% [p = 0.05]).

CONCLUSIONS: Outreach calls for new patients, prioritized by a no-show predictive algorithm and conducted by volunteers, can be a feasible and effective approach to improving visit attendance in a targeted fashion. Further investigation is needed to understand how to better support non-English preferring patients and patients with telehealth appointments.

PMID:40975847 | DOI:10.1111/jep.70278

Int Urol Nephrol. 2025 Sep 21. doi: 10.1007/s11255-025-04795-6. Online ahead of print.

ABSTRACT

BACKGROUND: Peritoneal dialysis-associated peritonitis (PDAP) remains a major complication in patients undergoing peritoneal dialysis (PD), often leading to technique failure, hospitalization, and increased mortality. This study aims to systematically evaluate and compare existing risk prediction models for PDAP and quantify their overall performance and key predictors.

METHODS: Following PRISMA guidelines, eight databases were systematically searched including PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Journal Database (VIP), Wanfang, and SinoMed, covering literature from their inception to March 19, 2025. Data extraction focused on study design, participant characteristics, sample size, outcome definitions, predictors, and model performance. The bias risk assessment tool for prediction model studies (PROBAST) was employed to assess bias risk and applicability, while Stata 17.0 facilitated meta-analysis.

RESULTS: Eleven studies involving 11 logistic regression models were included. The reported area under the curve (AUC) values ranged from 0.659 to 0.997, with a combined AUC of 0.88 (95% CI 0.83-0.93), indicating robust predictive performance. Four predictors associated with peritonitis were albumin (Alb) (OR = 0.672; 95% CI 0.475-0.868; P < 0.001), C-reactive protein (CRP) (OR = 2.568; 95% CI 1.081-4.055; P < 0.001), neutrophil-to-lymphocyte ratio (NLR) (OR = 1.377; 95% CI 1.065-1.689; P < 0.001), and diabetes mellitus (DM) (OR = 3.549; 95% CI 1.272-5.825; P < 0.002).

CONCLUSIONS: Despite demonstrating strong predictive capabilities, the models exhibited high bias risks, primarily due to data sources and statistical methods. Future research should prioritize large-scale, multicenter studies with rigorous designs and external validation to enhance reliability and clinical applicability.

PMID:40975843 | DOI:10.1007/s11255-025-04795-6