Tag: nevin manimala

J Eval Clin Pract. 2025 Aug;31(5):e70226. doi: 10.1111/jep.70226.

ABSTRACT

BACKGROUND: Clinical pharmacy services have gained high recognition worldwide, but are still unevenly developed and inequitable. This study aims to explore the setting and implementation of clinical pharmacy services in county hospitals in China and to identify the associated factors, as well as the perceptions and demands of healthcare professionals.

METHODS: A national cross-sectional survey of clinical pharmacy services in county hospitals in China from April to October 2023. Data were obtained from questionnaire surveys of stakeholders including leaders of pharmacy departments, pharmacists, doctors, and nurses in county hospitals in China. Data was analyzed using descriptive statistics, chi-square test, t-test and Wilcoxon rank sum test.

RESULTS: A total of 1510 questionnaires were collected from 362 county hospitals in 15 provinces in China. The median number of clinical pharmacists in county hospitals was 3 (2-5), far less than the requirement. More than 80% of the hospitals have established working mode and procedures of clinical pharmacy services, but only around 30% of them have incentive policy and charge for services. At present, over 60% of county hospitals consistently provide prescription review. Clinical pharmacy services significantly contributed to the rational use of medication and were highly valued by both doctors and nurses.

CONCLUSION: The findings indicated that clinical pharmacy services were embedded into daily work of clinical pharmacists, which was highly recognized by healthcare professionals. However, the implementation and sustainability of these services in county hospitals are still restricted by inadequate resources, incomplete systems, and insufficient competence.

PMID:40705930 | DOI:10.1111/jep.70226

J Eval Clin Pract. 2025 Aug;31(5):e70214. doi: 10.1111/jep.70214.

ABSTRACT

AIMS AND OBJECTIVES: Understanding the perspectives of health professionals about Electronic Health Records (EHRs) is pivotal for better management of health information systems (HIS). The purpose of this study is to examine explanatory factors of usage of EHRs according to the physician and hospital manager’s evaluations.

METHODS: A survey was administered in three hospitals in the İzmir metropolitan area, and 202 physicians and hospital administrators participated in this study. The internal consistency of the questionnaire was assessed using Cronbach’s Alpha (0.74), and the suitability of the factor analytical model was assessed using KMO (0.79) and Bartlett’s test (X² = 1720.97, p < 0.001). Exploratory factor analysis was performed with Varimax rotation to determine the factors underlying the model. Then, confirmatory factor analysis (CFA) was performed to reveal the latent structure of the model.

RESULTS: The performance of CFA model is statistically significant (p < 0.0001), acceptable at moderate level (X²/df = 3,81) the goodness-of-fit indices are good (CFI = 0,87; GFI = 0,76; NFI = 0,83; AGFI = 0,70). Three factors explain the latent structure of this model and evaluations of physician and hospital managers towards the usage of EHRs named as: benefits of usage of EHRs; concerns about the usage of EHRs and the effect of EHRs on the quality of work, efficiency, access to the information and safety.

CONCLUSION: Study results highlight the necessity of comprehending the EHR from the perspectives of health professionals and managers by focusing on the advantages of EHRs, concerns towards the deployment of EHR systems, and the improvement effects of EHR in work quality, efficiency, and HIS.

PMID:40705929 | DOI:10.1111/jep.70214

Nucleic Acids Res. 2025 Jul 19;53(14):gkaf714. doi: 10.1093/nar/gkaf714.

ABSTRACT

Spatial transcriptomics (ST) has emerged as an efficient technology for mapping gene expression within tissue sections, offering informative spatial context for gene activities. However, most current ST techniques suffer from low spatial resolution, where each spatial location often contains cells of various types. Deconvolution methods are used to resolve the cell mixture within the spots, but conventional approaches rely on spot-by-spot analyses, which are limited by low gene expression levels and disregard spatial relationships between spots, ultimately reducing performance. Here, we introduce DECLUST, a cluster-based deconvolution method to accurately estimate the cell-type composition in ST data. The method identifies spatial clusters of spots using both gene expression and spatial coordinates, hence preserving the spatial structure of the tissue. Deconvolution is subsequently performed on the aggregated gene expression of individual clusters, mitigating the challenges associated with low expression levels in individual spots. We evaluate DECLUST on simulated ST datasets from a human breast cancer tissue and two real ST datasets from human ovarian cancer and mouse brain. We compare DECLUST to current methods including CARD, GraphST, Cell2location, and Tangram. The results indicate that DECLUST not only maintains the spatial integrity of tissues but also outperforms existing methods in terms of robustness and accuracy. In conclusion, DECLUST provides an effective and reliable approach for identifying cell-type compositions in ST data.

PMID:40705925 | DOI:10.1093/nar/gkaf714

J Eval Clin Pract. 2025 Aug;31(5):e70211. doi: 10.1111/jep.70211.

ABSTRACT

AIM: This study aimed to investigate how COVID-19 lockdowns in Türkiye influenced parents’ actions when their child was ill or injured and how they perceived the impact of the lockdown on the severity of their child’s illness and the treatment received.

METHODS: This descriptive, and cross-sectional mixed method was conducted with 104 parents whose children experienced illness or injury during the pandemic lockdowns between July and September 2022. Data was collected through online survey using snowball sampling method. Descriptive statistics and pearson’s chi-square test were used for statistical analysis, while free-text data was subjected to thematic analysis.

RESULTS: Of the parents who sought medical help, 51.7% reported their child being admitted to hospital, and 29.8% noted their child had a chronic health illness. These parents were more likely to report that changes in health services affected their child’s treatment compared to those with children without a long-term health issue (45.1% vs. 12.3%, p < 0.001). The experiences of parents seeking help for their sick or injured child during the lockdown were categorized into three main themes: the lockdown’s impact on the child, health service accessibility during the lockdown, and parental help-seeking behavior during lockdown.

CONCLUSION: It is concluded in this study that during COVID-19 lockdowns, pediatric nurses should guide parents regarding when and where to seek medical assistance to mitigate potential complications resulting from reduced parental help-seeking behavior.

PRACTICE IMPLICATIONS: To ensure the uninterrupted monitoring and treatment of children with chronic health issues during lockdowns, it is advisable to expand telemedicine practices.

PMID:40705916 | DOI:10.1111/jep.70211

Eur Endod J. 2025 Jul;10(4):285-295. doi: 10.14744/eej.2025.75547.

ABSTRACT

Objectives The trial was conducted to assess the impact of passive ultrasonic irrigation, XP endo finisher, AF max file, and manual dynamic agitation on postoperative pain and analgesic consumption at 6 h., 12 h., 24 h., 48 h., 72 h., and a week later on single-rooted lower premolar teeth with acute irreversible pulpitis and apical periodontitis. Methods. Seventy patients were contributed in the trial. A total of 64 eligible patients were randomized into four equal groups (n=16 per group). Considering the irrigation activation approach, participants were separated into four groups as follows: Group 1: passive ultrasonic irrigation. Group 2: XP-endo Finisher. Group 3: Fanta AF max file Group 4: Manual dynamic agitation. Following the root canal procedure, the intensity of postoperative discomfort was measured by a verbal rating scale. The frequency and quantity of analgesics used were recorded. Results. Using an analysis of variance (ANOVA), there was a statistically significant difference between the percentage of preoperative and postoperative pain at most of the follow-up period (p<0.001**) in each group. Additionally, a significant difference (p<0.05) in the postoperative pain level and analgesic consumption was found among groups and most of the time intervals. Shapiro-Wilk and Kolmogorov-Smirnov tests, the Chi-square test, Fisher’s exact test, and the McNemar test were used. The excessive percentage of postoperative pain and analgesic intake was found in the MDA group, followed by the Max file and the XPF, while the lowest postoperative pain and analgesic intake were related to the PUI group. There was a significant difference (p<0.05) between the PUI and MDA groups in the degree of pain severity and increase in analgesic intake at 72 h. Regarding the percentage of swelling, there was a statistically notable difference (p<0.05) between groups after 24 h time intervals. Conclusions Minimal postoperative pain and minimal analgesic intake were significantly accompanied by passive ultrasonic irrigation, while PUI and analgesic intake were increased in MDA. (EEJ-2025-03-041).

PMID:40705453 | DOI:10.14744/eej.2025.75547

Eur Endod J. 2025 Jul;10(4):296-306. doi: 10.14744/eej.2025.27132.

ABSTRACT

AIM: This study aimed to evaluate the effectiveness of the Er,Cr: YSGG 2780 nm laser pulse duration during root canal retreatment using the laser-activated irrigation method (PIPS).

METHODS: The study investigated the cleanliness of root canal walls in single-rooted premolars using PIPS. Teeth were initially instrumented, filled with bioceramic (BC) sealer and gutta-percha, and then retreated using nickel-titanium (NiTi) retreatment rotary files. The teeth were randomly assigned to four equal groups: control (manual irrigation), ultrasonic irrigation (UI), laser-activated irrigation with a 60 µs pulse duration, and laser-activated irrigation with a 700 µs pulse duration. Irrigation solutions consisted of 17% EDTA and 2.5% sodium hypochlorite. Statistical analysis was performed using SPSS version 21.0. Normality was checked using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Group comparisons were conducted using Dunnett’s t-test and the LSD test, with a significance level set at p ≤ 0.05.

RESULTS: Statistical analysis of scanning electron microscopy (SEM) images revealed superior cleaning efficiency in both laser groups, with a significant improvement in cleanliness rates compared to the other groups. Group 4 (700 µs) achieved the highest percentage of open dentinal tubules (>75%) in the coronal and middle thirds, while Group 3 (60 µs) showed 50- 75% tubule openness. Groups 1 and 2 showed significantly lower cleaning effectiveness, particularly in the apical third.

CONCLUSION: The pulse duration plays a crucial role in the activation of laser irrigants during root canal retreatment. The 700 µs PIPS activation resulted in better cleaning outcomes compared to the 60 µs laser activation. (EEJ-2025-02-025).

PMID:40705451 | DOI:10.14744/eej.2025.27132

Eur Endod J. 2025 Jul;10(4):312-318. doi: 10.14744/eej.2025.69926.

ABSTRACT

OBJECTIVE: This study investigated the intratubular decontamination promoted by high-power sonic and ultrasonic devices using either a stepwise intraoperative activation (SIA) technique or a final conventional activation (CA) approach during root canal chemomechanical preparation.

METHODS: Fifty human lower premolars were contaminated with Enterococcus faecalis and assigned into five groups (n=8): conventional syringe irrigation (CSI); final ultrasonic activation (FUA) using the ultrasonic insert 25/25 IRRI S; final sonic agitation (FSA) using the high-power sonic insert 20/28 Eddy system (both CA techniques); stepwise ultrasonic activation (SUA); and stepwise sonic agitation (SSA) using the same devices during and after canal preparation (SIA techniques). Remaining specimens served as controls. Root canal preparation was performed with the Reciproc system and 5.25% NaOCl, followed by final irrigation with 17% EDTA. Bacterial viability was assessed via confocal microscopy with Live/Dead technique. Statistical analysis was employed using non-parametric tests (α=0.05).

RESULTS: SUA showed the lowest bacterial viability, followed by FSA, both statistically similar. SSA and FUA were similar but less effective than SUA and FSA (p<0.05). The CSI group had significantly higher bacterial viability compared to all other groups (p<0.05).

CONCLUSION: High-power sonic agitation and ultrasonic activation enhanced intratubular decontamination against E. faecalis. The SIA technique, using IRRI S or Eddy systems, effectively reduced bacterial viability and represents a promising approach for root canal disinfection. (EEJ-2024-11-185).

PMID:40705447 | DOI:10.14744/eej.2025.69926

Eur Endod J. 2025 Jul;10(4):326-332. doi: 10.14744/eej.2025.85866.

ABSTRACT

OBJECTIVE: The objective of this investigation was to assess and compare the fracture resistance of roots filled with AH Plus, Total Fill and AH Plus bioceramic sealers using single cone, warm vertical compaction (WVC), and soft-core techniques.

METHODS: This study utilized the palatal root canals of eighty extracted human maxillary first molars. All roots were sectioned to maintain a uniform root length of 11 mm. The samples were mechanically prepared using EdgeFile X7 rotary files to size 40/0.04. Eight teeth were left unfilled as a control group, while the remaining teeth were classified into three primary categories according to the sealer utilized for obturation; AH plus, TotallFill and AH Plus Bioceramic (BC). Each group was divided into three subgroups (n = 8) based on the obturation technique; single-cone, WVC and soft-core. Every tooth was set into blocks of acrylic resin, and a universal testing equipment (Instron Corp) with a metal-like spreader tip was used to measure the fracture force at a speed of 0.5 mm/min. The collected data were examined utilizing ANOVA, succeeded by Tukey’s test.

RESULTS: The control group’s fracture resistance values were significantly less than the obturated groups in study. Overall, the fracture resistance of AH Plus and AH Plus BC were significantly higher than that of Total Fill BC sealers. The WVC and soft-core were significantly higher than single cone techniques. The obturation technique did not significantly influence the fracture resistance of AH Plus and Total Fill. While the fracture resistance of AH Plus BC was significantly impacted., WVC was significantly higher than single cone group. When roots were obturated with WVC technique, AH Plus BC exhibited statistically significant higher values of fracture resistance than AH plus and Total Fill. There was no significant difference between the three sealers when single cone and soft-core were used.

CONCLUSION: According to this in vitro investigation, Obturation with AH Plus and AH Plus BC sealers enhanced the fracture resistance of the roots more significantly than TotalFill BC sealer, while obturation with WVC and soft-core yielded greater fracture resistance compared to the single cone approach. (EEJ-2024-11-170).

PMID:40705445 | DOI:10.14744/eej.2025.85866

Eur Endod J. 2025 Jul;10(4):278-284. doi: 10.14744/eej.2024.71473.

ABSTRACT

This double-blinded randomised clinical trial aimed to compare the efficacy of lignocaine, diclofenac sodium and ketorolac tromethamine as supplemental intraligamentary injections for intra-appointment pain in normotensive and hypertensive patients with moderate to severe symptomatic irreversible pulpitis.

METHODOLOGY: Ethical clearance was obtained, and the trial was registered on the Clinical Trial Registry India (CTRI/2020/09/027635; Registered on 07/09/2020). A total of 198 patients were divided into two groups-hypertensive group (Group 1; n=99) and normotensive (healthy) group (Group 2; n=99). After computerised randomisation and double blinding, participants were subdivided into three subgroups-1A/2A: lignocaine (n=33), 1B/2B: diclofenac sodium (n=33) and 1C/2C: ketorolac tromethamine (n=33). The preoperative visual analogue scale (VAS) scores was recorded. For the hypertensive group, blood pressure was recorded, and inferior alveolar nerve block (IANB) comprising 1.8ml of 2% lignocaine without adrenaline was administered. For the normotensive group, IANB with 1.8ml of 2% lignocaine with adrenaline was administered. A supplemental intraligamentary injection comprising one of the experimental drugs was injected to both the groups. Endodontic access was gained, and the intraoperative VAS score was recorded. As part of the statistical analysis, paired t-tests, Tukey’s post hoc test and ANOVA were performed using SPSS software version 20.

RESULTS: Supplemental intraligamentary injections of diclofenac sodium and ketorolac tromethamine showed a statistically significant difference (p<0.05) compared to lignocaine in the reduction of intraoperative pain with no side effects in hypertensive and healthy individuals.

CONCLUSION: Supplemental injections of both NSAIDs performed better than lignocaine in reducing intraoperative pain among healthy and hypertensive individuals. (EEJ-2023-06-076).

PMID:40705444 | DOI:10.14744/eej.2024.71473

JMIR Med Inform. 2025 Jul 24;13:e66476. doi: 10.2196/66476.

ABSTRACT

BACKGROUND: The American Medical Association recommends that electronic health record (EHR) notes, often dense and written in nuanced language, be made readable for patients and laypeople, a practice we refer to as the simplification of discharge notes. Our approach to achieving the simplification of discharge notes involves a process of incremental simplification steps to achieve the ideal note. In this paper, we present the first step of this process. Large language models (LLMs) have demonstrated considerable success in text summarization. Such LLM summaries represent the content of EHR notes in an easier-to-read language. However, LLM summaries can also introduce inaccuracies.

OBJECTIVE: This study aims to test the hypothesis that summaries generated by LLMs from highlighted discharge notes will achieve increased accuracy compared to those generated from the original notes. For this purpose, we aim to prove a hypothesis that summaries generated by LLMs of discharge notes in which detailed information is highlighted are likely to be more accurate than summaries of the original notes.

METHODS: To test our hypothesis, we randomly sampled 15 discharge notes from the MIMIC III database and highlighted their detailed information using an interface terminology we previously developed with machine learning. This interface terminology was curated to encompass detailed information from the discharge notes. The highlighted discharge notes distinguished detailed information, specifically the concepts present in the aforementioned interface terminology, by applying a blue background. To calibrate the LLMs’ summaries for our simplification goal, we chose GPT-4o and used prompt engineering to ensure high-quality prompts and address issues of output inconsistency and prompt sensitivity. We provided both highlighted and unhighlighted versions of each EHR note along with their corresponding prompts to GPT-4o. Each generated summary was manually evaluated to assess its quality using the following evaluation metrics: completeness, correctness, and structural integrity.

RESULTS: We used the study sample of 15 discharge notes. On average, summaries from highlighted notes (H-summaries) achieved 96% completeness, 8% higher than the summaries from unhighlighted notes (U-summaries). H-summaries had higher completeness in 13 notes, and U-summaries had higher or equal completeness in 2 notes, resulting in P=.01, which implied statistical significance. Moreover, H-summaries demonstrated better correctness than U-summaries, with fewer instances of erroneous information (2 vs 3 errors, respectively). The number of improper headers was smaller for H-summaries for 11 notes and U-summaries for 4 notes (P=.03; implying statistical significance). Moreover, we identified 8 instances of misplaced information in the U-summaries and only 2 in the H-summaries. We showed that our findings supported the hypothesis that summarizing highlighted discharge notes improves the accuracy of the summaries.

CONCLUSIONS: Feeding LLMs with highlighted discharge notes, combined with prompt engineering, results in higher-quality summaries in terms of correctness, completeness, and structural integrity compared to unhighlighted discharge notes.

PMID:40705416 | DOI:10.2196/66476