Tag: nevin manimala

J Empir Res Hum Res Ethics. 2026 Mar 28:15562646261434107. doi: 10.1177/15562646261434107. Online ahead of print.

ABSTRACT

Including diverse populations in clinical research is essential for generalizable findings. Prior studies show lower consent rates among vulnerable populations in higher-risk studies, but whether these trends apply to minimal-risk studies has not been explored. This study investigated factors influencing consent to a musculoskeletal ultrasound study for extremity injuries in the emergency department. Demographic characteristics, injury severity, interpreter use, and researcher-patient racial concordance were compared between those who consented and declined. Patients were more likely to decline if they were admitted to the hospital (p = 0.002) or had a displaced fracture (displaced-nondisplaced: p = 0.032; displaced-no fracture: p = 0.009). Younger patients (<45 years) most often declined due to pain, while older patients (>45 years) primarily cited lack of interest (p = 0.04). Although not statistically significant, Black and Hispanic patients most often declined for lack of interest. Older adults’ lower interest highlights the need to increase research participation in this underrepresented population.

PMID:41902511 | DOI:10.1177/15562646261434107

JPEN J Parenter Enteral Nutr. 2026 Mar 28. doi: 10.1002/jpen.70087. Online ahead of print.

ABSTRACT

BACKGROUND: Parenteral nutrition is a high-alert medication with the potential for errors that result in patient harm. The American Society for Parenteral and Enteral Nutrition has published guidance to support safe parenteral nutrition practices; however, the current implementation of this guidance or improvement in clinical practice over time remains unknown.

METHODS: A cross-sectional survey on current parenteral nutrition practice was distributed to US-based clinicians. Survey items addressed multiple steps in the parenteral nutrition use process. Descriptive statistics were performed and presented as number and percentage of respondents.

RESULTS: A total of 1160 participants were included. Critical safety gaps included: prescribing practices that lack standardization and do not align with guidance; inadequate storage practices between compounding and administration; lack of adherence to specific filter type guidance; lack of adherence to the maximum hang time of separate lipid injectable emulsion infusions; limited oversight; minimal quality improvement activities; inadequate evaluation of errors; and pervasive unawareness of key institutional parenteral nutrition practices. Practice improvements included greater adoption of safety technologies and an increased use of filters during administration.

CONCLUSION: This survey of current parenteral nutrition practice reveals some improvements in clinical practice; however, it highlights several critical gaps in the adoption of guidance with ongoing unsafe practices, which can result in patient harm.

PMID:41902507 | DOI:10.1002/jpen.70087

Disabil Rehabil. 2026 Mar 28:1-18. doi: 10.1080/09638288.2026.2647648. Online ahead of print.

ABSTRACT

PURPOSE: To assess participation levels of fathers and siblings in home-based rehabilitation for children with neuro-developmental delay (NDD) in Bulawayo, Zimbabwe, and identify facilitators and barriers.

MATERIALS AND METHODS: A concurrent mixed-methods cross-sectional design with a dominant quantitative component and a supplementary qualitative component was used. Data were collected from 196 fathers of children with NDD at two hospitals using a questionnaire. Quantitative data were analysed using descriptive statistics and logistic regression (α = 0.05) in Stata 17.0, while open-ended responses were thematically analysed in NVivo 12 using a deductive approach informed by the Social Ecological Model.

RESULTS: Only 35 (17.9%) fathers and 20 (10.2%) siblings consistently participated. Fathers with tertiary education participated more (AOR = 6.4; 95% CI: 1.9-22.1; p = 0.003), as did fathers of male children (AOR = 2.8; 95% CI: 1.3-6.1; p = 0.009). Facilitators included ability to manage disability-related challenges and access to information. Barriers included emotional strain, work demands, and exclusion from sessions. Sibling participation was facilitated by parental supervision, play-based activities, and professional support, while barriers included school obligations and cultural norms.

CONCLUSIONS: Modifiable factors affect father and sibling participation, highlighting the need for inclusive family-centred rehabilitation policies and practices.

PMID:41902491 | DOI:10.1080/09638288.2026.2647648

J Cachexia Sarcopenia Muscle. 2026 Apr;17(2):e70263. doi: 10.1002/jcsm.70263.

ABSTRACT

BACKGROUND: Diabetes increases susceptibility to infectious respiratory diseases, but the impact of underweight status on mortality from these conditions remains unclear. We evaluated the association between low body mass index (BMI) and respiratory infection-related mortality in a large nationwide cohort of individuals with diabetes.

METHODS: We conducted a population-based cohort study using linked Korean national health and mortality data, including 2 508 409 adults with type 2 diabetes. Participants were stratified by BMI and followed for cause-specific mortality from influenza/pneumonia, tuberculosis and COVID-19. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs), accounting for demographics, lifestyle factors, comorbidities and competing risks.

RESULTS: Over a median follow-up of 6 years, 18 024 (0.72%) participants died due to respiratory infections. Compared to individuals with BMI ≥ 18.5 kg/m², the aHRs for respiratory mortality were 7.27 (95% CI, 6.31-8.38), 4.79 (4.25-5.41) and 3.15 (2.93-3.38) for BMI < 16, 16-16.9 and 17-18.4 kg/m², respectively (all p < 0.001) with a progressive risk gradient. Underweight status amplified the risk of tuberculosis-related mortality most markedly (aHR, 9.93 for BMI < 16 kg/m², p < 0.001). Mortality risks in underweight individuals exceeded those for BMI ≥ 35 kg/m² relative to the reference group (25-29.9 kg/m²). Associations were more pronounced in individuals under 65 years and those without cardiovascular or kidney disease.

CONCLUSIONS: Underweight status is a strong, independent predictor of respiratory infection-related mortality in individuals with diabetes. Recognition of low BMI as a marker of vulnerability may improve targeted preventive strategies in diabetes care.

PMID:41902484 | DOI:10.1002/jcsm.70263

Ideggyogy Sz. 2026 Mar 30;79(3-4):103-109. doi: 10.18071/isz.79.0103.

ABSTRACT

BACKGROUND AND PURPOSE: In the last two decades, the quality of life and life expectancy of multiple sclerosis (MS) patients have improved, related to the growing number and efficacy of disease-modifying drugs (DMD). Due to multifactorial causes, the prevalence of MS has also increased. Our aim was to assess and quantify the changes of patient management in clinical practice in the last 17 years.

METHODS: Of all out- and inpatients seen at the Department of Neurology, Semmelweis University, we have screened those who have at least once received the diagnostic code of MS (G35 in ICD-10) in calendar years of 2006, 2012, 2016, and 2022. After reviewing their medical documents, we have validated the MS diagnosis and examined the duration of inpatient stays, the number of outpatient consultations and type of DMD.

RESULTS: The yearly number of MS patients seen at the Department has grown from 139 in 2006 to 514 in 2022. The proportion of patients who have received at least one type of DMD in the given year has changed from 21.6% to 76.8% respectively. While in 2006, 54.7% of patients had to be hospitalized at least once in relation with MS, in 2022 only a minority (6%) needed inpatient care, but with a difference between treated and untreated patients (3.8% vs 13.4%). Regarding outpatient consultations, not only its absolute yearly number, but also the yearly number per patient has grown (from 1.7 in 2006 to 5.1 in 2022), especially among treated subjects.

CONCLUSION: In accordance with international and Hungarian guidelines, the ratio of MS-patients receiving DMD has greatly increased, and – probably not independently of this trend – the need for hospitalization has diminished. Paralelly, the outpatient management load multiplied. These changes should be considered when allocating resources.

PMID:41902458 | DOI:10.18071/isz.79.0103

J Vasc Access. 2026 Mar 28:11297298261435727. doi: 10.1177/11297298261435727. Online ahead of print.

ABSTRACT

INTRODUCTION: The use totally implantable venous access devices (TIVAD) has significantly improved the quality of care and comfort of life of oncology patients.

AIM: The aim of this study was to retrospectively analyze the incidence and etiology of infections in patients with TIVAD, with a distinction between oncology and hematology patients. In addition, the influence of age, tumour type, presence of neutropenia and palliative status on the prevalence of specific pathogens was assessed.

MATERIALS AND METHODS: The medical records of patients hospitalized in the oncology and haematology departments of the municipal hospital in Warsaw between 2022 and 2023 were retrospectively analysed. IBM SPSS Statistics 29 software was used for data analysis. Infection characteristics, age of patients, type of bacteria by type of cancer, type of bacteria versus age of patients, type of bacteria versus patient status are presented in tables.

RESULTS: On the Oncology ward there were 24 infections in 21 patients, while on the haematology ward there were 43 infections in 28 patients. On the Oncology ward, TIVAD infections occurred in 57.14% of patients with gastrointestinal cancer, while on the Haematology ward they occurred in 78.57% of patients with lymphoma. The results as infection density per inpatient TIVAD in oncology department it was 1.24 per 1000 person-days of TIVAD stay. In contrast, in the hematology department results as infection density per inpatient TIVAD it was 3.40. Gram-negative infections accounted for 80.60% (n = 54) and Gram-positive infections for 19.40% (n = 13). The distribution was similar in both wards (75.00% Gram-negative in oncology, 83.72% in haematology).

CONCLUSIONS: Hematology patients were more likely to have TIVAD infections than oncology patients. In most studies, patients with solid tumours and hematological malignancies were analysed together, despite significant clinical differences. Therefore, we decided to analyze these two groups of patients separately.

PMID:41902444 | DOI:10.1177/11297298261435727

Acta Obstet Gynecol Scand. 2026 Mar 28. doi: 10.1111/aogs.70187. Online ahead of print.

ABSTRACT

INTRODUCTION: Labor epidural analgesia (LEA) is widely used for intrapartum pain management, but its effects on uterine activity (UA) remain unclear. Electrohysterography (EHG) is a promising non-invasive method for intrapartum UA monitoring. The aim of this study was to explore the effect of LEA on UA by means of EHG, to develop better understanding of labor physiology, and inform clinical decision-making.

MATERIAL AND METHODS: Patients in active labor with singleton, term pregnancies who received electrophysiological monitoring from 60 min before until 120 min after LEA initiation were included. Contraction parameters such as frequency, duration, area under the curve (AUC), baseline, and maximum amplitude were obtained from an EHG-derived tocogram using a computer-based algorithm. The primary outcome was the difference in mean uterine contraction frequency before and after initiation of LEA. Secondary outcomes included the comparison of various contraction parameters, derived from EHG, before and after LEA initiation, as well as their temporal changes over time. The effect of possible confounders on UA was examined. Mixed effects models were used for statistical analyses.

RESULTS: In total, 86 patients were included. No significant difference in mean uterine contraction frequency and contraction duration was found before and after LEA initiation. Nevertheless, start of LEA was associated with a significant reduction in AUC, baseline activity, and signal amplitude.

CONCLUSIONS: LEA initiation does not affect uterine contraction frequency or duration, but it is associated with a significant reduction in relative EHG-derived amplitude parameters (AUC, baseline tone, and maximum amplitude), which could potentially affect progression of labor. Further studies are required to explore these parameters and their clinical implications.

PMID:41902441 | DOI:10.1111/aogs.70187

Headache. 2026 Mar 28. doi: 10.1111/head.70070. Online ahead of print.

ABSTRACT

OBJECTIVES: This study was designed to examine the distribution of chronotypes among individuals with migraine and tension-type headache and to evaluate the association between chronotype and clinical headache characteristics in a population-based sample.

BACKGROUND: Although previous research has demonstrated associations between chronotype and migraine, there is limited population-level evidence regarding its relationship with tension-type headache or clinical features of these headache disorders.

METHODS: We conducted a cross-sectional analysis using baseline data from a nationwide population-based survey, conducted in the Republic of Korea in October 2020, which involved adults 20-59 years old. The chronotype was assessed using the Morningness-Eveningness Questionnaire and categorized into morning (score >58), intermediate (score 41-58), and evening (score <41) chronotypes.

RESULTS: Among 2838 participants, the evening chronotype was more prevalent in the migraine (58 of 160, 36.3%) and tension-type headache (225 of 890, 25.3%) groups than in the nonheadache control group (185 of 1005, 18.4%, p < 0.001). Among participants with migraine, depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) differed across chronotypes in the overall comparison (p = 0.035 and p = 0.047, respectively), with the morning type showing lower levels than those shown by the intermediate and evening types; however, no pairwise differences were statistically significant in the post hoc analyses. Among participants with tension-type headache, depression and anxiety differed across chronotypes in the overall comparison (Patient Health Questionnaire-9, p < 0.001 and Generalized Anxiety Disorder-7, p = 0.006), which was driven by higher levels in the evening type than in both the morning and intermediate types; however, the morning and intermediate types did not differ. In participants with migraine, a higher Morningness-Eveningness Questionnaire score (greater morningness) was marginally associated with more severe headache days per 30 days (p = 0.046), whereas no significant association was found in those with tension-type headache (p = 0.126). Headache days per 30 days, crystal-clear days per 30 days, headache intensity (Visual Analog Scale), and the impact of headache (Headache Impact Test-6) were not significantly associated with Morningness-Eveningness Questionnaire scores in participants with migraine or tension-type headache.

CONCLUSION: Participants with migraine and tension-type headache showed a significantly higher prevalence of evening chronotype compared with the nonheadache controls. However, greater morningness was associated with more severe headache days in the migraine group but not in the tension-type headache group.

PMID:41902429 | DOI:10.1111/head.70070

ANZ J Surg. 2026 Mar 27. doi: 10.1111/ans.70633. Online ahead of print.

ABSTRACT

BACKGROUND: Minimal-invasive surgery (MIS) was proven beneficial in Crohn’s Disease (CD). Intracorporeal anastomosis (ICA) represents a further improvement as it is associated with decreased complications and shorter hospitalization. Extracorporeal anastomosis (ECA) is preferred to ICA as it allows haptic feedback of the bowel and mesentery, which is historically required for bowel resection in CD to minimize recurrences. We compared ICA and ECA in terms of recurrences and complications.

METHODS: All patients between 2016 and 2022 with Crohn’s disease who underwent a MIS ileocecectomy were identified and divided into ICA and ECA groups. Exclusion criteria were open surgery, end ileostomies, follow-up < 1 month, and ileocecectomy not due to CD.

RESULTS: 107 patients were included in the ICA group (44.9% male, mean age of 40.2 [±16.6] years), while 270 patients were in the ECA group (46.7% male, mean age of 41.9 [±17.3] years). The rate of endoscopic recurrences with a Rutgeerts score > 2, clinical recurrence, and surgical recurrence were not statistically different between the two cohorts. On the multivariable analysis for endoscopic and clinical recurrences, the ICA/ECA approach was not significant. The ECA group revealed a higher overall complication rate (30.4% versus 15.9%, p = 0.004). The median length of stay was significantly reduced in the ICA group (p < 0.001).

CONCLUSION: ICA seems to be safe in ileocecectomies for CD. The complication rate and length of stay were reduced while not affecting the endoscopic, clinical, and surgical recurrence rates. MIS technology provides enhanced visualization and haptic feedback, which could be used as surrogates for the tactile evaluation intra-operatively.

PMID:41902409 | DOI:10.1111/ans.70633

Hand (N Y). 2026 Mar 27:15589447261428585. doi: 10.1177/15589447261428585. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this prospective cohort study was to evaluate the risk of lymphedema and perioperative complications in patients undergoing elective upper-extremity surgery with a history of breast cancer and ipsilateral lumpectomy/mastectomy with axillary lymph node sampling.

METHODS: Validated volumetric measurements of the limb were obtained presurgery and postsurgery. All complications were recorded. A total of 104 patients enrolled prospectively, and 78 met inclusion criteria with 30 patients in the no tourniquet group and 48 in the tourniquet group. Patients were followed up at 2-week, 6-week, 3-month, 6-month and 12-month intervals. The median number of lymph nodes dissected was 8 (no tourniquet), compared to 7 (tourniquet). Sixty-six percent (no tourniquet) and 58% (tourniquet) had previous radiation. Twenty-eight percent (no tourniquet) and 31% (tourniquet) had previous history of lymphedema. Eight patients (9%) had been previously advised to never have surgery on the involved limb.

RESULTS: There were 3 cases of lymphedema at 2 weeks: 2 patients (no tourniquet) and 1 patient (tourniquet). One patient (no tourniquet) had lymphedema at 2 weeks; only that resolved at 6 weeks. Additional complications include 1 patient (no tourniquet) had pin displacement after distal radius fixation at 2 weeks, 1 patient (tourniquet) had postoperative hematoma after a mass excision, and 1 patient (tourniquet) had hand stiffness following carpal tunnel release. Patient satisfaction between the two groups was high and not statistically different at any time point.

CONCLUSIONS: Surgery in patients with a history of breast cancer with lymph node sampling appears to be equally safe with or without the use of a tourniquet and carries a low rate of overall complications, including exacerbation of their lymphedema.

PMID:41902407 | DOI:10.1177/15589447261428585