Tag: nevin manimala

Can J Rural Med. 2026 Jan 1;31(1):7-14. doi: 10.4103/cjrm.cjrm_87_24. Epub 2026 Feb 9.

ABSTRACT

INTRODUCTION: The COVID-19 pandemic significantly disrupted primary care delivery, amplifying challenges in resource stewardship. Choosing Wisely Canada (CWC) guidelines aim to reduce unnecessary interventions. However, barriers to their implementation persist, particularly in rural settings where access to resources is limited and patient expectations often conflict with evidence-based care. Our study explored primary care physicians’ awareness of, utilisation of and barriers to implementing CWC guidelines in a post-pandemic context, focusing on challenges, quality improvement opportunities and innovative approaches to reduce low-value care.

METHODS: An online survey of primary care physicians across Canada was used to collect demographic data, practice habits and perspectives on CWC guidelines. Quantitative analysis measured trends, while qualitative analysis of open-ended responses identified recurring themes.

RESULTS: One hundred and twenty-seven primary care physicians responded to the survey. Results revealed high awareness of CWC guidelines (97.6%) but low familiarity with post-pandemic adaptations (36.2%) and patient-facing materials (61.4%). Key barriers included time constraints, fear of missed diagnoses and limited rural resources. Physicians highlighted the need for tailored approaches in rural settings, where deviations from guidelines are often necessary because of challenges related to healthcare access. Participants identified several opportunities for improvement, including integrating guidelines into electronic medical records and developing mobile applications to support decision-making. Enhanced patient education emerged as critical for addressing demands for unnecessary tests, often fuelled by misinformation from social media.

CONCLUSION: Targeted medical and patient education, interprofessional collaboration and technology integration are essential for improving CWC adoption. Tailored solutions that address rural-specific challenges and systemic barriers are pivotal for achieving sustainable resource stewardship in primary care.

INTRODUCTION: La pandémie de COVID-19 a profondément bouleversé l’organisation des soins primaires, accentuant les défis liés à l’utilisation judicieuse des ressources. Les recommandations de Choisir avec soin visent à réduire les interventions inutiles, mais leur mise en œuvre demeure difficile, surtout en milieu rural où l’accès aux services est restreint et où les attentes des patients s’harmonisent parfois mal avec les pratiques fondées sur les données probantes. Notre étude examine la connaissance, l’utilisation et les obstacles à l’intégration des recommandations de Choisir avec soin chez les médecins de famille en contexte postpandémique, en mettant l’accent sur les défis rencontrés, les occasions d’amélioration de la qualité des soins et les approches innovantes pour diminuer les actes à faible valeur.

MTHODES: Une enquête en ligne a été distribuée à des médecins de soins primaires partout au Canada. Le questionnaire recueillait des données démographiques, des informations sur les habitudes de pratique et des perceptions par rapport aux recommandations de Choisir avec soin. L’analyse quantitative a permis d’identifier les tendances, tandis que l’analyse qualitative des réponses ouvertes a fait ressortir des thèmes récurrents.

RSULTATS: Cent vingt-sept médecins y ont répondu. Bien que la grande majorité connaissait les recommandations de Choisir avec soin (97.6%), peu étaient au fait des adaptations postpandémiques (36.2%) ou des outils destinés aux patients (61.4%). Les obstacles principaux mentionnés incluaient le manque de temps, la crainte de passer à côté d’un diagnostic important et le manque de ressources en région. Les médecins ont souligné la nécessité d’approches adaptées aux réalités rurales, où il faut parfois s’éloigner des recommandations en raison de contraintes d’accès aux services. Les participants ont également mis de l’avant plusieurs pistes d’amélioration, comme l’intégration des recommandations dans les dossiers médicaux électroniques et la création d’applications mobiles pour soutenir la prise de décision. Une meilleure éducation des patients a été identifiée comme essentielle pour répondre aux demandes d’examens inutiles, souvent alimentées par la désinformation circulant sur les réseaux sociaux.

CONCLUSION: Le renforcement de la formation clinique et de l’éducation du public, la collaboration interprofessionnelle et l’intégration de solutions technologiques sont essentiels pour augmenter l’adoption des recommandations de Choisir avec soin. Des stratégies adaptées aux réalités des milieux ruraux et aux obstacles systémiques sont indispensables pour assurer une gestion durable et responsable des ressources en soins primaires.

PMID:41652986 | DOI:10.4103/cjrm.cjrm_87_24

J Perioper Pract. 2026 Feb 7:17504589251413465. doi: 10.1177/17504589251413465. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to evaluate the occurrence of postoperative sore throat, hoarseness, and cough after inflating the cuff using a manometer versus the traditional syringe-assisted cuff inflation method.

METHODS: This study involved 56 patients of the American Society of Anesthesiologists (ASA) physical status (PS) classification system I and II undergoing elective laparoscopic surgeries under general anaesthesia. After obtaining ethics committee approval and informed consent, the patients were divided into two groups. In group A, cuff pressure was set to 25 cmH₂O using a Portex^® cuff inflator. In group B, the cuff was inflated with room air using a 10-ml syringe; adequacy was assessed by palpation and auscultation. Postoperatively, the patients were monitored for sore throat, hoarseness, and cough, graded using the Harding and McVey scoring system.

RESULTS: The incidence of sore throat in the cuff manometer group was higher than in the syringe group at zero hour, possibly due to various factors. However, over time, the manometer group had more patients reporting no sore throat. A notable statistical and clinical difference was found between groups in sore throat and hoarseness. No statistical difference in cough was observed.

CONCLUSION: Continuous cuff pressure monitoring during surgery reduces postoperative sore throat and hoarseness.

PMID:41652922 | DOI:10.1177/17504589251413465

New Phytol. 2026 Feb 6. doi: 10.1111/nph.70977. Online ahead of print.

ABSTRACT

Rapid environmental change reshapes both abiotic stress and biotic interactions, yet it remains unclear how these combined forces structure plants’ genomic adaptation. In particular, the joint influence of temperature and pollinator identity, two ecological axes undergoing simultaneous global shifts, has rarely been quantified at genomic resolution. We resequenced Brassica rapa L. plants after a six-generation evolution experiment, combining two temperature regimes (ambient vs hot) with three pollination treatments (bumblebee, butterfly, and mixed bumblebee-butterfly), and glasshouse control, to assess how these factors shape genomic responses. Using multiple complementary statistics (allele-frequency trajectories, F_ST outliers, Cochran-Mantel-Haenszel tests, and local score analyses), we found that adaptive genomic responses differed sharply among pollinators and temperatures: warming strengthened selection in community-level pollination, yielding the clearest signals in the hot-generalised treatment; bumblebee pollination showed strong but drift-obscured genomic change; and butterfly treatments exhibited minimal genomic response. Our findings demonstrate that pollinator identity and temperature interact nonadditively to produce distinct, highly context-dependent adaptive trajectories. This work highlights the importance of accounting for demographic variation and ecological complexity when predicting evolutionary responses to climate-driven shifts in species interactions.

PMID:41652900 | DOI:10.1111/nph.70977

J Natl Cancer Inst. 2026 Feb 6:djag028. doi: 10.1093/jnci/djag028. Online ahead of print.

ABSTRACT

Surveillance, Epidemiology, and End Results (SEER) multiple myeloma (MM) survival statistics (https://seer.cancer.gov/statfacts/html/mulmy.html) that have been used to guide MM management and control have been systematically overestimated due to the inclusion of smoldering multiple myeloma (SMM), a premalignant condition of MM. Using the latest SEER release, we estimated the extent of such overestimation in the survival statistics. In 2016, 77.9% out of 5,495 patients reported as overall MM were symptomatic MM and 10.9% were SMM. Median survival was 65.8 months for overall MM versus 56.8 months for symptomatic MM (p < .001). Inclusion of SMM overestimated MM survival by 9 months. Five-year relative survival estimates from 2015-2021 were 61.6% for overall MM, 57.9% for symptomatic MM, and 88.3% for SMM, versus SEER’s reported 62.4%. Survival statistics for symptomatic MM and SMM should be reported separately to guide MM management and prevention at the population level.

PMID:41652897 | DOI:10.1093/jnci/djag028

Int J Gynaecol Obstet. 2026 Feb 6. doi: 10.1002/ijgo.70819. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the association between household air pollution (HAP) exposure and adverse maternal and perinatal outcomes among mothers in Ghana using evidence from the 2022 Demographic and Health Survey.

METHODS: A retrospective secondary analysis was conducted using data from the 2022 Ghana Demographic and Health Survey (GDHS). The study included women aged 15-49 years with a recent pregnancy outcome. HAP exposure was proxied using unclean cooking fuel. Outcomes assessed were maternal anemia (hemoglobin <11.0 g/dL), low birth weight (LBW) (<2500 g), preterm birth (<37 weeks), and stillbirth. Multivariable logistic regression models were fitted to estimate associations between HAP exposure and outcomes. Statistical significance was set at P < 0.05.

RESULTS: Unclean cooking fuel use was highly prevalent (88.2%), especially in rural households (95.7%) and among the poorest households (99.8%). After adjustment, unclean fuel use was associated with higher odds of LBW (adjusted odds ratio [aOR] 1.47; 95% CI 1.10-1.96; P < 0.008). Anemia, cesarean section and prolonged length of hospital stay after delivery were associated with HAP.

CONCLUSION: HAP remains a significant risk factor for adverse maternal and perinatal outcomes in Ghana, underscoring the need to accelerate adoption of clean cooking technologies.

PMID:41652887 | DOI:10.1002/ijgo.70819

J Anal Toxicol. 2026 Feb 6:bkag008. doi: 10.1093/jat/bkag008. Online ahead of print.

ABSTRACT

The aim of this study was to develop and validate a quantitative method for the analysis of designer benzodiazepines in postmortem blood samples using micro-QuEChERS extraction and liquid chromatography tandem mass spectrometry (LC-MS/MS). A comprehensive optimization of the method was performed using a multivariate statistical approach, incorporating validation criteria in line with established practices for method validation in forensic toxicology. The method showed linearity between 1 and 200 ng/mL (r2>0.990), with good imprecision (<9.8%) and inaccuracy (<11.1%) evaluated at three different quality control concentrations. Matrix effects and recovery rates were found to be better than 58% and 77.5%, respectively. No carryover or interferences were detected during the analysis. The method was effectively utilized on two real forensic postmortem blood samples, both of which tested positive for bromazolam, showing concentrations of 31 ng/mL and 40 ng/mL. The micro-QuEChERS extraction method demonstrated satisfactory analytical performance and is an environmentally sustainable option, minimizing the use of solvents and reagents, with potential for application in both clinical and forensic analyses, aligning with green analytical toxicology principles.

PMID:41652886 | DOI:10.1093/jat/bkag008

J Public Health (Oxf). 2026 Feb 7:fdag006. doi: 10.1093/pubmed/fdag006. Online ahead of print.

ABSTRACT

INTRODUCTION: Green spaces are increasingly recognized as critical to public health. This study examines English local planning authorities’ green infrastructure strategies, evaluating how health improvement and inequality reduction goals are integrated.

METHODS: A quantitative content analysis was conducted on publicly accessible green infrastructure strategy documents. Of 305 potential authorities, 133 (44%) were included based on eligibility criteria. Only strategies published from 2012 onwards were included. Data were coded across themes: health policy and actors, health outcomes, demographics and inequalities, environmental change and health. A scoring system quantified consideration of health and inequality, with descriptive statistics summarizing thematic presence, frequency, regional variation, and temporal trends.

RESULTS: The integration of health and inequality varied substantially. Most strategies referenced general health outcomes, but fewer detailed actions targeting health inequalities or specific demographic groups. Regional differences were observed, and methods for monitoring health impacts were limited.

CONCLUSION: Local green infrastructure strategies in England increasingly recognize their health improvement potential, but inconsistent integration of health and inequality may limit impact. Stronger collaboration between planning and public health is needed to create equitable, accessible, health-promoting environments. Future research should explore longitudinal health impacts and identify best practices for integrating health equity in spatial planning.

PMID:41652877 | DOI:10.1093/pubmed/fdag006

Clin Exp Dermatol. 2026 Feb 7:llag059. doi: 10.1093/ced/llag059. Online ahead of print.

NO ABSTRACT

PMID:41652870 | DOI:10.1093/ced/llag059

Contact Dermatitis. 2026 Feb 6. doi: 10.1111/cod.70107. Online ahead of print.

ABSTRACT

BACKGROUND: Fragrance allergy is difficult to define, with thousands of known fragrance-related compounds. Whether certain botanicals should be considered ‘fragrance’ and whether fragrance-allergic patients should avoid these ingredients remains unclear, with minimal published data on the topic.

OBJECTIVES: This study aimed to evaluate whether there is cross-reactivity between fragrance and various botanicals commonly found in personal-care products, such as aloe, coconut oil and shea butter, among others.

METHODS: A cohort of fragrance-allergic patients was identified using data from 2038 patients patch-tested at a tertiary referral centre from 2020-2024. Cross-reactivity rates to botanicals commonly found in personal-care products were calculated, and statistical significance was determined using Fisher’s exact test. Cross-reactivity was defined as > 10% reaction incidence.

RESULTS: In patients with fragrance allergy, there was no significant cross-reactivity to any of the investigated botanical compounds.

CONCLUSIONS: The low concomitant rates of reaction between fragrance and the investigated substances suggest that patients allergic to fragrance do not need to avoid certain common botanicals. Many products contain these compounds, including ones marked as ‘fragrance-free’. Dermatologists can safely reassure fragrance-allergic patients of the safety of many botanicals commonly used in personal-care products.

PMID:41652868 | DOI:10.1111/cod.70107

Nurs Health Sci. 2026 Mar;28(1):e70300. doi: 10.1111/nhs.70300.

ABSTRACT

Nurse-caregiver communication at discharge is critical to ongoing care of the patient but is often hindered by system-level barriers. Meaningful interpersonal encounters, or presence, are known to enhance clinical interactions amidst system-level demands. Nursing students (16) were randomly assigned to an intervention or control arm of the study. Nursing students in the intervention group participated in Presence Circles and a simulated discharge conversation with a standardized caregiver. Nursing students in the control arm participated in the simulated discharge conversation only. Nursing students completed pre-post surveys and standardized caregivers completed post-conversation surveys. Pre versus post, nursing students in the intervention group reported increases in presence behaviors but no difference in effective communication. Compared to the control group, nursing students in the intervention group identified themselves as engaging in more effective communication. Caregivers also reported more presence behaviors and effective communication when compared to nursing students. Results point to a possible shift in more presence behaviors following the intervention; however, a larger study is needed to demonstrate substantial behavior change.

PMID:41652866 | DOI:10.1111/nhs.70300