Tag: nevin manimala

J Am Geriatr Soc. 2025 Jun 9. doi: 10.1111/jgs.19569. Online ahead of print.

ABSTRACT

BACKGROUND: Antipsychotic medications (APMs) are frequently prescribed for persons living with dementia despite limited benefits and increased risks. This study examined patient characteristics of those prescribed APMs, indications for initiation, and survival outcomes.

METHODS: This retrospective cohort study of community-dwelling patients enrolled in a comprehensive dementia care program (2012-2014) focused on 190 patients not on an APM at baseline, with survival analyses including 200 additional patients on an APM at program entry. Patients were followed for 2 years for APM initiation and until January 2024 for mortality. Baseline measures included patient and caregiver demographics, Mini-Mental State Exam (MMSE), Functional Activities Questionnaire (FAQ), Modified Caregiver Strain Index (MCSI), caregiver Patient Health Questionnaire-9 (PHQ-9), and Neuropsychiatric Inventory Questionnaire (NPI-Q). Indications for APM initiation were abstracted from electronic health records. Logistic regression models examined associations between baseline characteristics and APM initiation. Survival was assessed using Kaplan-Meier estimates and Cox proportional hazards models.

RESULTS: Among 190 patients (mean [SD] age, 81.2 [8.4] years; 60% female, and 80% Alzheimer’s or dementia not otherwise specified) who were not on APMs at program enrollment, 65 (34%) initiated and 125 (66%) did not initiate an APM. NPI-Q severity (AOR 1.10, 95% CI 1.04-1.16) and NPI-Q distress (AOR 1.06, 95% CI 1.02-1.10) were associated with APM initiation. Agitation and psychotic symptoms were the most common indications, with quetiapine being the most frequently prescribed APM. Median survival was 37.8 months (IQR 19.3-63.2) for patients on an APM at baseline, 63.1 months (IQR 28.4-86.8) for patients initiating an APM, and 68.9 months (IQR 50-97.9) for patients not initiating an APM (p < 0.001).

CONCLUSIONS: APM initiation was common despite enrollment in a comprehensive dementia care program that prioritizes non-pharmacologic strategies. Survival differences underscore the need for risk-benefit discussions of APMs and goals of care discussions with caregivers.

PMID:40485369 | DOI:10.1111/jgs.19569

Indian J Pathol Microbiol. 2025 Jun 7. doi: 10.4103/ijpm.ijpm_217_24. Online ahead of print.

ABSTRACT

OBJECTIVES: 1) To perform a retrospective histological evaluation of renal allograft biopsies diagnosed as recurrent/denovo IgA nephropathy from January 2011 to January 2019 and calculate individual MESTC scores and Banff scores for all cases. 2) To perform clinicopathological and statistical evaluation of histological variables of the updated oxford scoring system with variables of estimated glomerular filtration rate, proteinuria, and serum creatinine, recorded at the time of the last follow-up.

MATERIALS AND METHODS: This was a retrospective cohort study conducted at a tertiary hospital. 53 cases of IgA nephropathy were selected including 11 cases of recurrent disease and 42 cases which arose denovo, including those with unknown native kidney disease. The updated oxford score and Banff criteria were applied to all cases and correlated with clinical data and transplantation details available from the online database using univariate and multivariate analysis. Statistical analysis was done using STATA version 16.0.

RESULTS: Patients with interstitial fibrosis/tubular atrophy were associated with significantly higher creatinine, proteinuria, and lower eGFRs at the time of biopsy. Cox hazard ratio showed that patients with interstitial fibrosis/tubular atrophy had a significantly higher chance of progressing to end-stage kidney disease. Patients with either endocapillary hypercellularity, interstitial fibrosis/tubular atrophy, or multiple lesions also progressed significantly faster to end-stage kidney disease.

CONCLUSION: Interstitial fibrosis/tubular atrophy and segmental sclerosis were indicators of poor graft survival. Patients with combined lesions, particularly chronic lesions progress significantly faster to end-stage kidney disease. Patients with endocapillary hypercellularity had improved outcomes when treated with adequate immunosuppression. We conclude that the updated oxford classification be used for prognostication in addition to the Banff criteria being already in use.

PMID:40485360 | DOI:10.4103/ijpm.ijpm_217_24

Work. 2025 Jun 9:10519815251346421. doi: 10.1177/10519815251346421. Online ahead of print.

ABSTRACT

BackgroundPrivacy is one of the most important principles that should be protected during nursing interventions. It is also very important for maintaining a professional stance in professional life.ObjectiveThe aim of this study was to determine the privacy awareness levels of nurses and nursing students and the factors affecting them.MethodThe sample of the study consisted of 157 nurses and 342 nursing students. Data were collected using Personal Information Form and Privacy Awareness Scale. Data were analyzed using descriptive statistics, chi-square, Mann-Whitney U, Kruskal-Wallis test, Dunn test and multiple linear regression analysis.ResultsThe mean privacy awareness score of the nurses was 50.20 ± 4.71 and that of the students was 49.94 ± 4.88, and no significant difference was found between nurses and students in terms of privacy awareness levels (p < 0.05). Privacy awareness towards oneself was higher in female nurses and privacy awareness towards others was higher in nurses in their 30 s and married women. Total privacy awareness was highest in nurses aged 30-39 years, followed by nurses aged 20 and 40 years. The level of behavior to protect the privacy of others was higher in second-year students than in third-year students.ConclusıonsIn order to keep the privacy awareness of nurses high, appropriate physical conditions, educational opportunities, evaluation of requests and wishes by the institution, and emphasizing that students have the same moral responsibility as nurses in all professional course practices are necessary.

PMID:40485351 | DOI:10.1177/10519815251346421

Head Neck. 2025 Jul;47(7):1807-1815. doi: 10.1002/hed.28092. Epub 2025 Jan 31.

ABSTRACT

BACKGROUND: Time from surgery to initiation of postoperative radiation therapy (PORT) of less than 6 weeks was recently instituted as the first quality metric within head and neck cancer care.

METHODS: We performed a retrospective single institution cohort study to investigate predictors of PORT delay and the impact of PORT delay on survival.

RESULTS: PORT delay rate was 73.2%, with a median time to treatment initiation of 51 days. Outside radiation facility treatment was independently associated with increased likelihood of PORT delay (OR 1.94, 95% CI 1.03-3.74, p = 0.043). PORT delay and location of radiation treatment did not impact OS or PFS.

CONCLUSIONS: In this single institution study, most patients experienced PORT delay. Patients that were treated at outside radiation facilities were more likely to experience delay. However, PORT delay did not result in statistically significant difference in OS and PFS which contrasts with the current literature.

PMID:40485334 | DOI:10.1002/hed.28092

Biom J. 2025 Jun;67(3):e70062. doi: 10.1002/bimj.70062.

ABSTRACT

Outlying studies are prevalent in meta-analyses of diagnostic test accuracy studies and may lead to misleading inferences and decision-making unless their negative effect is appropriately dealt with. Statistical methods for detecting and down-weighting the impact of such studies have recently gained the attention of many researchers. However, these methods dichotomize each study in the meta-analysis as outlying or non-outlying and focus on examining the effect of outlying studies on the summary sensitivity and specificity only. We developed and evaluated a robust and flexible random-effects bivariate finite mixture model for meta-analyzing diagnostic test accuracy studies. The proposed model accounts for both the within- and across-study heterogeneity in diagnostic test results, generates the probability that each study in a meta-analysis is outlying instead of dichotomizing the status of the studies, and allows assessing the impact of outlying studies on the pooled sensitivity, pooled specificity, and between-study heterogeneity. Our simulation study and real-life data examples demonstrated that the proposed model was robust to the existence of outlying studies, produced precise point and interval estimates of the pooled sensitivity and specificity, and yielded similar results to the standard models when there were no outliers. Extensive simulations demonstrated relatively better bias and confidence interval width, but comparable root mean squared error and lesser coverage probability of the proposed model. Practitioners can use our proposed model as a stand-alone model to conduct a meta-analysis of diagnostic test accuracy studies or as an alternative sensitivity analysis model when outlying studies are present in a meta-analysis.

PMID:40485332 | DOI:10.1002/bimj.70062

NeuroRehabilitation. 2025 Jun 9:10538135251344930. doi: 10.1177/10538135251344930. Online ahead of print.

ABSTRACT

BackgroundPrimary intracerebral hemorrhage (ICH) carries high mortality and disability risks. Although early mobilization is beneficial, concerns about physiological instability often delay mobilization.ObjectiveTo evaluate whether a structured early mobilization protocol improves functional mobility and reduces adverse events in critically ill ICH patients.MethodThis retrospective pre-post study included 192 patients with ICH (ICH score 0-4) admitted to a dedicated stroke center. In the pre-implementation phase in 2022, patients received standard care. In the post-implementation phase in 2023, a standardized mobility protocol, incorporating time-based stratification, neurological thresholds, and safety criteria to guide activity progression, was introduced. Primary outcomes included the Modified ICU Mobility Scale (MIMS) score at intensive care unit (ICU) discharge and the occurrence of adverse events.ResultsThe post-implementation group (99 patients) showed higher MIMS scores at ICU discharge, with a greater proportion achieving out-of-bed sitting during their ICU stay compared to the pre-implementation group (93 patients). Non-serious adverse events in the former decreased significantly; ICU and hospital lengths of stay were shorter but not statistically significant.ConclusionThe structured pathway enabled safer, earlier mobilization and improved ICU functional outcomes. While mobility benefits were observed, caution is warranted in interpreting non-significant trends in length of stay.

PMID:40485320 | DOI:10.1177/10538135251344930

Malar J. 2025 Jun 8;24(1):182. doi: 10.1186/s12936-025-05434-2.

ABSTRACT

BACKGROUND: Installing insecticidal netting on open eaves, windows, and holes in walls of unimproved houses is a potential malaria control tool. It prevents mosquito house-entry, induces lethal and sub-lethal effects on malaria vectors, and may reduce malaria transmission. Therefore, a household epidemiological trial was conducted to assess the efficacy of insecticide-treated screening (ITS) on malaria infection and indoor vectors in Tanzania.

METHODS: In Chalinze district, Tanzania, 421 households were randomized into two arms. In June-July 2021, one group of households’ houses was fitted with ITS (incorporated with deltamethrin and piperonyl butoxide) on eaves, windows, and wall holes, while the second group did not receive screening. After installation, consenting household members (aged ≥ 6 months) were tested for malaria infection using quantitative polymerase chain reaction after the long rainy season (June/July 2022, primary outcome) and the short rainy season (January/February 2022, secondary outcome). Secondary outcomes included indoor total mosquito per trap/night (June-July 2022), adverse effects after one month of ITS installation (August 2021), and chemical bioavailability and retention of ITS samples after one year of field use (June/July 2022). At the end of the trial, the control group received ITS.

RESULTS: Malaria prevalence among residents in the ITS arm was 19.9% (50/251) and 28.3% (65/230) in the control arm after the long rains, however, this difference was not significant [adjusted odds ratio (OR) 0.67 (95% CI 0.35-1.28), p = 0.227]. Similarly, no protection was seen for ITS after the short rains, [OR 1.27 (95% CI 0.68-2.38), p = 0.452]. However, school-age children in the ITS arm had lower malaria after the long rains [OR 0.11 (95% CI 0.02-0.73), p = 0.022]. No serious adverse effects were reported. The mean number of female Anopheles mosquitoes caught per trap/night was not significantly different between arms [1.7 vs 2.4, crude relative risk: 0.71 (95% CI 0.16-3.09), p = 0.650]. ITS showed reduced chemical bioavailability and retention post-field use. The trial reported high household refusals (17-30%) in both arms in both surveys.

CONCLUSION: The trial was inconclusive because households’ refusal resulted in low power. A large cluster randomized trial of the intervention, preferably with screens treated with longer-lasting insecticides installed in houses, is needed.

TRIAL REGISTRY: The trial was registered at ClinicalTrials.gov (NCT05125133) on October 2021.

PMID:40484966 | DOI:10.1186/s12936-025-05434-2

Harm Reduct J. 2025 Jun 8;22(1):100. doi: 10.1186/s12954-025-01242-8.

ABSTRACT

BACKGROUND: The use of anabolic androgenic steroids (AAS) among male recreational gym users has become a global substance use concern. A substantial black market for these substances exists with possibly extensive counterfeiting. Drug checking services (DCS) are established harm reduction services for people who consume illicit substances. To evaluate the feasibility of implementing a novel specialized DCS for AAS, a pilot study was conducted within a pre-existing DCS in Zurich (Switzerland).

METHODS: The reporting of this pilot study follows an adapted CONSORT statement. Further aims were to characterize AAS use as well as the chemical properties of customer-provided substance samples analysed through the DCS in a Swiss context. Customers could access DCS in Zurich from August 2023 onwards by providing a voluntary user questionnaire and dispense samples of AAS. Primary feasibility outcomes for this study were customer satisfaction metrics with the DCS received (i.e., customer satisfaction score (CSAT); net promoter score (NPS)). The chemical analytical method utilized was gas chromatography-mass spectrometry (GC-MS). Descriptive statistics were used.

RESULTS: Overall, 52 clients accessed DCS over the pilot period and 71 samples were chemically assessed. Excellent results regarding customer satisfaction metrics towards DCS for AAS were achieved (NPS: 97 (integer); CSAT: 93%). The typical clients were males partaking in recreational sports, between 22 and 40 years old, working, and with a higher education. The main motivation for using AAS was for aesthetic purposes. Patterns of AAS use were complex with frequent extensive concomitant substances use. Most AAS in this sample were acquired from non-medical sources. The sample analysis revealed that over half (52%) of the user-provided samples of AAS were fake.

CONCLUSIONS: We demonstrate that the implementation of DCS for AAS was feasible with high acceptance among clients. Those clients may engage in many high-risk behaviors and the use of substances with low chemical properties may expose them to additional unexpected health risks. As a harm reduction tool, DCS for these clients and substances appears to be feasible and it may further serve as monitoring tool for public health purposes. Upon the initial study results, DCS for AAS were continued with close monitoring.

PMID:40484965 | DOI:10.1186/s12954-025-01242-8

Cancer Imaging. 2025 Jun 8;25(1):69. doi: 10.1186/s40644-025-00890-0.

ABSTRACT

BACKGROUND: The aim of this study was to investigate the prediction value of metabolic response using gallium 68 (⁶⁸Ga) labeled fibroblast-activation protein inhibitor (⁶⁸Ga-FAPI) positron emission tomography-computed tomography (PET/CT) in Non-Hodgkin lymphoma (NHL) patients receiving (cyclophosphamide-doxorubicin HCl-vincristine[Oncovin]- prednisone) CHOP-like chemotherapy.

METHOD: This single-center prospective study was conducted in our hospital and enrolled participants who was initially diagnosed with NHL and received CHOP-like chemotherapy. ⁶⁸Ga-FAPI PET/CT was performed before chemotherapy. Metabolic response was assessed by fluorine 18 (¹⁸F) labeled fluorodeoxyglucose (¹⁸F-FDG) PET/CT. Quantitative analysis included measurement of the maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), peak standardized uptake value (SUVpeak), metabolic tumor volume (MTV) and total lesion FAP (TLF). The SUVmax value of the lesion is divided by SUVmean of normal tissue to calculate the target-to-background ratio (TBRblood and TBRmuscle). Depending on the response, participants were categorized as responders and non-responders. Mann-Whitney U-test was used to compare the ⁶⁸Ga-FAPI PET/CT parameters of responders with that of non-responders. Logistic regression analyses were performed to determine the relationship between clinical characteristics, ⁶⁸Ga-FAPI PET/CT parameters, and efficacy of chemotherapy. Receiver operating characteristic curve analysis was used to identify the accuracy of ⁶⁸Ga-FAPI PET/CT parameters for response prediction.

RESULTS: From October 2022 to May 2023, 18 participants (10 men and 8 women; median age: 56 years [interquartile range: 47-67 years]) with pathologically confirmed diagnosis of non-Hodgkin’s lymphoma were recruited in our hospital and enrolled in this study. The mean values of SUVmax, TBRblood, and TBRmuscle were significantly higher in responders than those in non-responders (8.41[Formula: see text]3.90 vs. 3.98[Formula: see text]2.81 P=0.025; 7.93[Formula: see text]3.31 vs. 3.69[Formula: see text]2.36 P=0.035; 7.04[Formula: see text]3.22 vs. 3.09[Formula: see text]1.73 P = 0.025; respectively). The area under the curve (AUC) of SUVmax, TBRblood, and TBRmuscle were statistically significant (0.875, P = 0.025; 0.857, P=0.034; 0.875, P = 0.026, respectively). SUVmax (OR=0.592, P = 0.041) is a significant factor in the prognosis of these participants.

CONCLUSION: Low radiotracer uptake on ⁶⁸Ga-FAPI PET/CT indicated poor metabolic response of NHL patients received CHOP-like therapy. SUVmax could be used to screen sensitive patients.

PMID:40484962 | DOI:10.1186/s40644-025-00890-0

BMC Health Serv Res. 2025 Jun 8;25(1):813. doi: 10.1186/s12913-025-12846-y.

ABSTRACT

OBJECTIVE: The aim of the study is to measure the readiness levels of medical artificial intelligence and the perception of openness to organizational change of healthcare professionals working in a university hospital in Istanbul. Additionally, the study seeks to identify the relationships between medical AI readiness and perceptions of organizational change openness, as well as to examine differences based on demographic variables.

METHOD: The research was conducted with 195 healthcare workers. The research is a cross-sectional descriptive quantitative research. The construct validity of the scales was checked using statistical analysis.

RESULT: As a result of the research, it was determined that healthcare workers’ are prepared for the use of medical artificial intelligence in healthcare institutions and perceive organizational change positively. A significant but low-level positive relationship was found between healthcare workers’ level of readiness for medical artificial intelligence and their perception of openness to organizational change. The level of readiness for medical artificial intelligence among healthcare workers’ was found to be high among males, doctors and internal sciences, while the perception of openness to organizational change was found to be high among postgraduate/doctoral graduates, surgical sciences, nurses.

CONCLUSION: The study determined that healthcare workers’ are ready to use medical artificial intelligence and perceive organizational change positively. The study contributes to the formation of the institution’s healthcare policies and practices and to the development, well-being and change of healthcare workers’. It is recommended that employees be made aware of the benefits of using artificial intelligence in healthcare institutions and that necessary training activities be planned.

PMID:40484945 | DOI:10.1186/s12913-025-12846-y