Tag: nevin manimala

BMJ Glob Health. 2025 Mar 15;10(3):e017206. doi: 10.1136/bmjgh-2024-017206.

ABSTRACT

PURPOSE: This study longitudinally assessed the quality of life (QoL) in patients who completed chemoradiation (CRT) for cervical cancer in Botswana and compared the QoL for those living with and without HIV infection.

METHODS: Patients with cervical cancer recommended for curative CRT were enrolled from August 2016 to February 2020. The European Organisation for Research and Treatment of Cancer Core Quality-of-Life (QLQ-C30) and cervical cancer-specific (QLQ-Cx24) questionnaires, translated into Setswana, were used to assess the QoL of patients prior to treatment (baseline), at the end of treatment (EOT) and in 3 month intervals post-treatment for 2 years, and statistical analyses were performed.

RESULTS: A total of 294 women (median age: 46 years) were enrolled and followed up for an average of 16.4 months. Of women with recorded staging, most had FIGO stage III/IV disease (64.4%). Women living with HIV (WLWH; 74.1%) presented at earlier ages than those without HIV (44.8 years vs 54.7 years, p<0.001). The QoL for all domains did not differ by HIV status at baseline, EOT or 24 month follow-up. Per QLQ-C30, the mean global health status score (72.21 vs 78.37; p<0.01) and the symptom (12.70 vs 7.63; p=0.04) and functional scales (88.34 vs 91.85; p<0.01) improved significantly from the EOT to the 24 month follow-up for all patients; however, using the QLQ-Cx24 survey, no significant differences in the symptom burden (12.53 vs 13.67; p=0.6) or functional status (91.23 vs 89.90; p=0.53) were found between these two time points.

CONCLUSION: The QoL increased significantly for all patients undergoing CRT, underscoring the value of pursuing curative CRT, regardless of the HIV status.

PMID:40090695 | DOI:10.1136/bmjgh-2024-017206

BMJ Open. 2025 Mar 15;15(3):e088507. doi: 10.1136/bmjopen-2024-088507.

ABSTRACT

OBJECTIVE: This study aimed to assess the prevalence of diabetic macular oedema and its associated factors among adult patients with diabetes attending comprehensive specialised hospitals in Northwest Ethiopia in 2023.

DESIGN: An institution-based, cross-sectional study.

SETTING: The study was conducted at the University of Gondar, Felege Hiwot and Debre Markos comprehensive specialised hospitals in Northwest Ethiopia from 8 May to 15 June 2023.

PARTICIPANTS: This study was conducted on 890 adult patients with diabetes selected using a systematic random sampling technique.

OUTCOME MEASURES: Participants with diabetic macular oedema were assessed using slit lamp biomicroscopy with a +90 dioptre Volk lens. Blood glucose levels were measured by fasting blood sugar tests. Data were collected through physical examination, review of medical records and face-to-face interview.

RESULTS: Among a total of 890 study participants, the prevalence of diabetic macular oedema was 25.8% (95% CI 23.1 to 28.8). Peripheral neuropathy (adjusted OR (AOR)=3.02, 95% CI 1.76 to 5.29), hypertension (AOR=1.98, 95% CI 1.24 to 3.17), poor blood glucose control (AOR=5.06, 95% CI 2.95 to 8.67), obesity (AOR=5.03, 95% CI 2.50 to 10.13), longer duration of diabetes mellitus (AOR=3.78, 95% CI 2.21 to 6.24) and poor adherence to diabetic medication (AOR=2.06, 95% CI 1.32 to 3.28) were significantly associated with diabetic macular oedema.

CONCLUSION: In Northwest Ethiopia, a quarter of patients with diabetes were found to have diabetic macular oedema. Factors such as peripheral neuropathy, hypertension, poor blood glucose levels, obesity, long duration of diabetes mellitus and poor adherence to diabetic medications were significantly associated with diabetic macular oedema. Improvement of glucose control and exercise for optimal body weight maintenance are recommended to prevent the development of diabetic macular oedema.

PMID:40090690 | DOI:10.1136/bmjopen-2024-088507

BMJ Open. 2025 Mar 15;15(3):e087808. doi: 10.1136/bmjopen-2024-087808.

ABSTRACT

INTRODUCTION: Type 2 Diabetes Mellitus (T2DM) and its complications significantly increase the risk of premature mortality and disability among patients, placing a considerable burden on socioeconomic development. Evidence has shows that effective transitional care can improve health outcomes for patients with T2DM. However, T2DM transitional care faces challenges including service discontinuity, communication breakdowns and a lack of personalised design, leading to potential issues of undertreatment and overtreatment, increasing the risk of improper blood sugar management. To address these challenges, our research team developed the Hospital-Community-Home Tiered Transitional Care (HCH-TTC) programme for patients with T2DM, aiming to evaluate its effectiveness and feasibility through a randomised controlled trial (RCT).

METHOD AND ANALYSIS: The multicentre, pragmatic, double-blind RCT will enrol 180 patients with T2DM from the Jinqiao Medical Union in Pudong New Area, Shanghai, China. Participants will be randomly assigned to either the experimental group or the control group. The experimental group will participate in a 6-month HCH-TTC programme, which provides personalised transitional care strategies tailored to patients’ evolving health conditions and nursing needs. This tiered management approach includes follow-up, health education, personalised guidance and health monitoring, with variations in intensity, frequency and type based on individual requirements. The control group will receive Hospital-Community-Home Routine Transitional Care programme, consisting of routine follow-up, health education and health monitoring during the same period. Data collection will be conducted at baseline, 1 month postintervention, 3 months and 6 months. The primary outcomes are glycated haemoglobin (HbA1c). Secondary outcomes include fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2hPPG), diabetes knowledge level, diabetes self-management ability, diabetes treatment adherence, nursing service satisfaction, diabetes complications rate and unplanned readmission rate. Statistical analysis will employ independent sample t-tests and repeated measures analysis of variance.

ETHICS AND DISSEMINATION: The Gongli Hospital Ethics Committee (GLYY1s2021-010) approved the study. Results will be disseminated through publication in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry ChiCTR2200063322.

PMID:40090689 | DOI:10.1136/bmjopen-2024-087808

Pak J Pharm Sci. 2025 Jan-Feb;38(1):37-44.

ABSTRACT

Upper limb spasticity is a common and serious sequelae in patients with hemiplegia after stroke. Radial extracorporeal shock wave therapy (rESWT) can improve upper limb dysfunction and relieve pain in patients, However, its efficacy as a single treatment is limited. In traditional Chinese medicine, Tetramethylpyrazine (TMP) is the main pharmacological component of Ligusticum chuanxiong. It exhibits significant effects on the prevention and treatment of ischemic cerebrovascular diseases, protecting against cascade reaction-induced damage. This study encompassed 120 stroke patients with upper limb spasticity and limited elbow mobility who were admitted to the Second Rehabilitation Hospital of Shanghai from March 2021 to March 2023. They were divided into 3 groups: A rESWT group received rESWT, a TMP group received TMP and a Coalition group received TMP combined with rESWT. Statistical analysis and evaluation were conducted using SPSS 29.0. The research findings revealed that compared with the rESWT group and TMP group, the Coalition group showed more significant improvements in FMA, MAS, VAS scores, spasticity of elbow flexors, NIHSS and BI scores after 4 weeks of treatment. The combination of rESWT and TMP can enhance spasticity in stroke patients with upper limb spasticity, alleviated pain, and improved motor function and neurological functions.

PMID:40089928

Med J Aust. 2025 Mar 17;222(5):240-248. doi: 10.5694/mja2.52613.

ABSTRACT

OBJECTIVE: To examine the accuracy of the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), the population-based clinical quality registry for people with kidney failure, in identifying Aboriginal and/or Torres Strait Islander people.

DESIGN: Population-based cohort study of reporting accuracy.

SETTING: New South Wales, 2006-2020.

PARTICIPANTS: Incident kidney failure patients.

MAIN OUTCOME MEASURES: Sensitivity and specificity of identification of Aboriginal and/or Torres Strait Islander people in ANZDATA compared with identification with Enhanced Reporting of Aboriginality (ERA) methods using linked health datasets.

RESULTS: Of 11 708 patients, 693 (5.9%) were identified as Aboriginal and/or Torres Strait Islander people using ERA methods, with 484 recognised in ANZDATA. Overall ANZDATA sensitivity was 67.0% (95% CI, 63.3-70.5%), with high specificity (99.8%; 95% CI, 99.7-99.9%). Sensitivity was lowest for males (63.8%; 95% CI, 58.7-68.6), people aged under 18 years (45.0%; 95% CI, 23.1-68.5%) or over 65 years (61.7%; 95% CI, 53.8-69.2%), and those with greater socio-economic advantage (56.6%; 95% CI, 46.6-66.2%), living in major cities (53.8%; 95% CI, 48.0-59.5%) and with no comorbidities (47.7%; 95% CI, 37.0-58.6%). Aboriginal and/or Torres Strait Islander people identified in ANZDATA had lower rates of waitlisting for kidney transplantation (17.8% v 25.3%; P = 0.016) and receiving a kidney transplant (12.2% v 23.1%; P < 0.001) and a higher rate of death (56.0% v 44.5%; P = 0.004) compared with those not recognised in ANZDATA.

CONCLUSION: Aboriginal and/or Torres Strait Islander people were under-reported in ANZDATA. There were multiple biases in characteristics and outcomes for people identified in ANZDATA compared with those identified by ERA using linked data. This highlights the importance of data integration as a quality improvement mechanism and identifying barriers to disclosure.

PMID:40089918 | DOI:10.5694/mja2.52613

Probl Endokrinol (Mosk). 2024 Nov 2;71(1):40-49. doi: 10.14341/probl13535.

ABSTRACT

BACKGROUND: Self-monitoring of blood glucose (SMBG) is the main tool to achieve carbohydrate metabolism targets in patients with type 1 diabetes mellitus (DM). Remote monitoring of SMBG in Russia appeared relatively recently and needs to be evaluated for effectiveness.

AIM: To evaluate the effect of remote monitoring of SMBG on carbohydrate metabolism and quality of life in patients with type 1 DM in order to form new therapeutic approaches.

MATERIALS AND METHODS: Patients with type 1 DM with glycated hemoglobin (HbA1c) from 8.0 to 12.0% were divided into the main (n=107) and control group (n=20). Patients from the main group performed SMBG using glucometers with the possibility of remote data transmission, patients from the control group continued the traditional SMBG. The dynamics of HbA1c, derived time spent in the target ranges, recognition of hypoglycemia (GOLD scale, Clarke questionnaire), quality of life according to the SF-36 questionnaire were evaluated. The statistical analysis was carried out in the SPSS Version 26.0 program (IBM, USA).

RESULTS: In the main group (n=88) the HbA1c was statistically significant decreased after 6 months from 9.0% [8.4; 9.9] to 8.1% [7.4; 9.2] (p&lt;0.001), with SMBG more than 4 times a day – up to 7.3% [7.0; 7.8] (p=0.001). In the control group (n=20), by the 6th month, HbA1c increased to 10.1% [8,9; 11,2] (p=0,010). Derived Time In Range in the main group increased to 69.9±13.0 (95% CI 65.73-74.03; p&lt;0.001); derived Time Above Range significantly decreased to 9.5% [6.4; 15.0] (p&lt;0.001), derived Time Below Range – to 6.7% [2.8; 12.2] (p=0.044); Coefficient of Variation reached 36.3±7.9 (95% CI 33.7-38.8; p&lt;0.001). According to the results of SF-36, the physical and psychological components of the quality of life in the main group significantly improved (p&lt;0.001). Recognition of hypoglycemia improved in the intervention group (-4.5% of patients (p=0.046) according to the Clarke questionnaire; -8% (p=0.008) on the GOLD scale).

CONCLUSION: Remote monitoring of SMBG is a prospective therapeutic approach due to its positive effect on carbohydrate metabolism and quality of life in patients with type 1 DM.

PMID:40089884 | DOI:10.14341/probl13535

Probl Endokrinol (Mosk). 2024 Mar 6;71(1):32-39. doi: 10.14341/probl13416.

ABSTRACT

BACKGROUND: Obesity generally determines the metabolic basis for the development of type 2 diabetes. Therefore the analysis of glycemic variability in obese individuals, especially in its different phenotypes, acquires particular relevance.

AIM: To investigate the features of glycemic variability in men with different adipose tissue distribution topography within usual dietary conditions.

MATERIALS AND METHODS: The study enrolled 43 men aged 25-65 years. Group 1 (n=17) represented obese men with subcutaneous fat distribution (SFD) while group 2 (n=16) consisted of obese men with abdominal fat distribution (AFD) and group 3 (comparator) included 10 male subjects with normal body weight (NBW). A 2-day continuous glucose monitoring (CGM) under condition of usual diet, work and physical activity was performed in each study subject. A number of parameters, indices and ratios had been assessed describing glycemic variability (GV) for daytime (6.00-23.59) and night (0.00-5.59) hours.

RESULTS: Comparative analysis of key parameters and indices describing daytime and night GV in NBW and obese men without fat distribution adjustment did not reveal statistically significant differences. After fat distribution adjustment significantly higher mean glucose levels, standard deviation of glycemic levels and coefficient of variation were found in AFD group; also statistically significant differences were revealed in CONGA index and J-index. An analysis of the LBGI and HBGI indices that are respectively reflecting the risks of hypo- and hyperglycemia showed that the LBGI index was higher in obese men with SFD while the НBGI index was higher in men with AFD. A comparative analysis of GV parameters showed that daytime indicators values were significantly higher relative to nighttime. However the ambiguous changes in the mean glucose levels was found between study groups. Specifically in NBW men daytime and nighttime glycemia didn’t differ, whereas in AFD group there was a trend to decrease in night glucose levels (p = 0.08) while in men with SFD night decrease in glycemia became statistically significant (p=0.005).

CONCLUSION: Results of glycemic variability assessment in obese men suggest that abdominal and subcutaneous types of fat distribution are associated with specific features of carbohydrate metabolism and determine different risk levels for developing type 2 diabetes in patients with AFD and SFD.

PMID:40089883 | DOI:10.14341/probl13416

Clin Exp Optom. 2025 Mar 16:1-7. doi: 10.1080/08164622.2025.2475202. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: The tear break-up time (BUT) test is important in diagnosing and monitoring tear film stability, and understanding potential changes in tear film dynamics during repeated measurements could improve the accuracy and reliability of the test in clinical practice.

BACKGROUND: The study aimed to examine the changes in BUT value caused by subsequent measurements made in BUT test.

METHODS: A total of 120 female participants were divided into groups (30 individuals each). Participants were divided into four groups based on the interval between two non-invasive tear break-up time (NI-BUT) tests: Group 1 (1-minute interval), Group 5 (5-minute interval), Group 10 (10-minute interval), and Group 15 (15-minute interval). The first NI-BUT test was called Initial NI-BUT (NI-BUT_(I)), and the second test was called Subsequent NI-BUT (NI-BUT_(S)). The first BUTvalue (BUT_1st), the second BUT value (BUT_2nd), the third BUT value (BUT_3rd), the fourth BUT value (BUT_4th), the fifth BUT value (BUT_5th), and the average value of the first three BUTs (BUT_A3) were compared between the NI-BUT₍₁₎ and NI-BUT_(S) tests.

RESULTS: Participant ages ranged from 18 to 36 years, with a mean of 25.1 ± 3.2 years. The mean values of BUT_1st, BUT2_nd, BUT3_rd, BUT4_th, BUT5_th, and BUT_A3 in the NI-BUT_(I) test were statistically significantly shorter than those in the NI-BUT_(S) test for all groups (p < 0.05). The changes in the parameters were statistically significantly greater in Group 1 compared to the other groups (p < 0.05).

CONCLUSIONS: Subsequent measurements cause increased BUT values. The longer the interval between two measurements, the smaller the differences between the subsequent measurements. When performing the BUT test, a single measurement should be preferred if possible. If the clinician finds the results of a single measurement unsatisfactory and wishes to consider the average of multiple measurements, the interval between tests should be longer than 15 minutes.

PMID:40089876 | DOI:10.1080/08164622.2025.2475202

J Man Manip Ther. 2025 Mar 16:1-14. doi: 10.1080/10669817.2025.2476670. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite the recommendations to use a bio-psycho-social framework, many physiotherapists still manage their patients mainly from a biomedical point of view. The purpose of this study is to analyze the impact of two different e-learning interventions on knowledge, attitudes, and clinical decision-making of physiotherapists managing low back pain (LBP) to increase guideline-consistent care.

METHODS: Physiotherapists were allocated (1/1) either to an experimental or a traditional e-learning intervention. Baseline and post-intervention assessment included the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS), Back Pain Attitudes Questionnaire (Back-PAQ), Neurophysiology of Pain Questionnaire (NPQ), and a clinical vignette. Participants had 2 weeks to complete the post-intervention assessment. Statistics were processed using ANCOVA and Fisher’s t-tests.

RESULTS: Four hundred nineteen physiotherapists were included in the analysis. Mean scores of HC-PAIRS, Back-PAQ, and NPQ significantly improved post-intervention in both groups. There was a significant effect of the intervention type (experimental versus traditional) on the scores of HC-PAIRS (p < .001; η²_p = .243) and Back-PAQ (p < .001; η²_p = .135) but not on NPQ scores. Return to work, recommendations assessed with the clinical vignette were significantly more guideline-consistent in the experimental group (p < .001) post-intervention.

CONCLUSION: An interactive e-learning intervention which includes concrete clinical examples and focused on patient’s reassurance, self-management, and importance of screening psycho-social factors had more impact than a traditional e-learning intervention to enhance physiotherapists’ knowledge, attitudes, and clinical decision-making regarding LBP.

PMID:40089875 | DOI:10.1080/10669817.2025.2476670

J Prim Care Community Health. 2025 Jan-Dec;16:21501319251327849. doi: 10.1177/21501319251327849. Epub 2025 Mar 16.

ABSTRACT

The Model for Understanding Success in Quality (MUSIQ) is a framework designed to understand the contextual factors that can influence healthcare quality improvement (QI) initiative implementation. The MUSIQ calculator was originally developed to help clinics identify contextual factors that may affect QI success. This retrospective study adapted the MUSIQ calculator to serve as an evaluative tool for practice facilitators engaged in a colorectal cancer screening initiative. Eight primary care clinics were scored in 6 contextual factors categories using the adapted MUSIQ calculator. Average MUSIQ scores were used to identify high and low contextual factors clinics, and their colorectal cancer screening rates were assessed across a 4-year period of active engagement with the colorectal cancer screening initiative. There were statistically significant, strong, correlations between overall contextual factors scores and colorectal cancer screening rates across all 4 years. There was a statistically significant difference between screening rate changes during the period of active engagement and high or low contextual factors scores (P = .047). There were statistically significant correlations between 3 contextual factors and colorectal cancer screening rate changes with “Microsystem” and “QI Support” having the strongest associations (P < .001). Low or high contextual factors classification statistically significantly predicted colorectal cancer screening rate changes across the observed timeframe (P = .047). By adapting existing tools with a strong track record of success, like MUSIQ, practice facilitators can identify potential challenges earlier in the QI process providing an important opportunity to intervene to prompt greater success.

PMID:40089872 | DOI:10.1177/21501319251327849