Tag: nevin manimala

Surg Laparosc Endosc Percutan Tech. 2025 Jan 28. doi: 10.1097/SLE.0000000000001200. Online ahead of print.

ABSTRACT

OBJECTIVE: Endoscopic papillary balloon dilation (EPBD), small endoscopic sphincterotomy (EST), and small EST plus EPBD are commonly used as rescue techniques to remove bile duct stones. However, we often encountered challenging cases with non-dilated distal bile ducts, especially in those undergoing EPBD. We aimed to explore the reasons by assessing whether patients without the dilated bile duct had a higher risk of early complications and whether it was impacted by the rescue techniques.

METHODS: We performed a retrospective cohort study by frequency matching design in patients diagnosed with stones in non-dilated distal bile duct who received rescue techniques from July 2016 to June 2022. Besides, patients with stones and without dilatation of the distal bile duct (DDBD) were divided into 3 subgroups according to the rescue technique received. Outcomes were compared between the subgroups.

RESULTS: The non-DDBD group was more likely to develop post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and hyperamylasemia (HP) than the DDBD group (P < 0.05). Some cases had mild or moderate pancreatitis, but no one in either group developed severe pancreatitis. For subgroup analysis, each technique resulted in complete stone removal; the EPBD group had a higher HP rate than the other subgroups and reached statistical significance: the EPBD group versus the small EST group (P = 0.013) and the EPBD group versus the EPBD plus small EST group (P = 0.008). Although there was no statistical significance, PEP incidence in the EPBD group was 13.7% higher than in other subgroups (P > 0.05/3).

CONCLUSION: Non-DDBD patients have a higher risk for endoscopic retrograde cholangiopancreatography-related pancreatic inflammation. EPBD should be used cautiously due to the significant association with increased rates of PEP and HP. Conversely, small EST and combination therapy are suitable for non-dilated bile duct stones because of their high safety profile and efficacy.

PMID:39895510 | DOI:10.1097/SLE.0000000000001200

Age Ageing. 2025 Feb 2;54(2):afae282. doi: 10.1093/ageing/afae282.

ABSTRACT

BACKGROUND: Medication review is integral in the pharmacological management of older inpatients.

OBJECTIVE: To assess the association of in-hospital medication changes with 28-day postdischarge clinical outcomes.

METHODS: Retrospective cohort of 2000 inpatients aged ≥75 years. Medication changes included the number of increases (medications started or dose-increased) and decreases (medications stopped or dose-decreased) for (i) all medications, (ii) Drug Burden Index (DBI)-contributing medications and (iii) Beers Criteria 2015 medications (potentially inappropriate medications, PIMs). Changes also included differences in (i) the number of medications, (ii) the number of PIMs and (iii) DBI score, at discharge versus admission. Associations with clinical outcomes (28-day ED visit, readmission and mortality) were ascertained using logistic regression, adjusted for age, gender and principal diagnosis. For mortality, sensitivity analysis excluded end-of-life patients due to higher death risk. Patients were stratified into : (i) ≤4, (ii) 5-9 and (iii) ≥10 discharge medications.

RESULTS: The mean age was 86 years (SD = 5.8), with 59.1% female. Medication changes reduced ED visits and readmission risk for patients prescribed five to nine discharge medications, with no associations in patients prescribed ≤4 and ≥ 10 medications. In the five to nine medications group, decreasing PIMs reduced risks of ED visit (adjusted odds ratio, aOR 0.55, 95% CI 0.34-0.91, P = .02) and readmission (aOR 0.62, 95% CI 0.38-0.99, P = .04). Decreasing DBI-contributing medications reduced readmission risk (aOR 0.71, 95% CI 0.51-0.99, P = .04). Differences in PIMs reduced ED visit risk (aOR 0.65, 95% CI 0.43-0.99, P = .04). There were no associations with mortality in sensitivity analyses in all groups.

DISCUSSION: Medication changes were associated with reduced ED visits and readmission for patients prescribed five to nine discharge medications.

PMID:39895509 | DOI:10.1093/ageing/afae282

Circ Cardiovasc Qual Outcomes. 2025 Feb 3:e011414. doi: 10.1161/CIRCOUTCOMES.124.011414. Online ahead of print.

ABSTRACT

BACKGROUND: The PRECISE (Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization) trial compared an investigational precision diagnostic testing strategy (n=1057) with usual testing (n=1046) in patients with stable chest pain and suspected coronary artery disease. Quality of life (QOL) outcomes were a prespecified secondary end point.

METHODS: We assessed QOL by structured interviews in all trial participants at baseline and 45 days, 6 months, and 12 months postrandomization. QOL assessments included angina-related QOL (19-item Seattle Angina Questionnaire [SAQ-19]), generic health status (EQ-5D), and a 4-item care satisfaction survey (at 45 days only). The prespecified primary comparison was the 6-month SAQ Summary score outcomes (scale, 0 to 100; higher scores indicate greater health status). QOL data collection rates were high, with 99% complete baseline SAQ scores and 86.5% complete at the 6-month primary comparison follow-up. All comparisons were made as randomized.

RESULTS: At baseline, mean SAQ Summary scores were 70.9 in the Precision Strategy group (n=1050) and 70.4 in the Usual Testing group (n=1042). By 6 months, mean SAQ Summary scores had improved to 89.9 in the Precision Strategy group and 89.2 in the Usual Testing group, with a mean adjusted difference of 0.8 (95% CI, -0.3 to 2.0). The SAQ component scores showed similar improvement from baseline in both groups and no statistically significant or clinically meaningful differences between the 2 groups at any follow-up time point. By 6 months, 66% of patients in both groups were chest pain-free. EQ-5D visual analog scores also improved from baseline and showed no difference between groups during follow-up. Care satisfaction scores were high and similar at 45 days.

CONCLUSIONS: In stable patients with symptoms suggesting coronary artery disease, angina-related and overall QOL improved substantially over the initial 6 months independent of the testing strategy assigned.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03702244.

PMID:39895494 | DOI:10.1161/CIRCOUTCOMES.124.011414

Diabetes Obes Metab. 2025 Feb 3. doi: 10.1111/dom.16224. Online ahead of print.

ABSTRACT

AIMS: Fibroblast growth factor (FGF) 23 is a bone-derived phosphaturic hormone that participates in the regulation of mineral metabolism and the development of chronic kidney disease. This study aimed to investigate the association between FGF23 and diabetic kidney disease (DKD) in a community-based prospective cohort.

MATERIALS AND METHODS: Of 7230 individuals who completed a 4.6-year follow-up survey, 1614 individuals with diabetes at baseline were included in this study. Baseline serum FGF23 levels were measured by enzyme-linked immunosorbent assay. Multiple and ordinal logistic regression analyses were used to examine the predictive performance of baseline FGF23 for incident DKD.

RESULTS: Baseline serum FGF23 levels exhibited an earlier elevation in the course of DKD and a gradual increase with the progressive stages of DKD (p < 0.05), while no statistical changes were observed in serum calcium and phosphorus levels. Over a 4.6-year follow-up, 198 individuals with diabetes developed incident DKD. Baseline FGF23 was significantly associated with the incidence of DKD (odds ratio 1.290 [95% CI 1.063, 1.565]) after adjusting for conventional DKD risk factors, especially in individuals with lower body mass index (<24 kg/m²), worse glycaemic control (HbA1c ≥7%), and shorter duration of diabetes (<5 years). Moreover, FGF23 models exhibited great performances in DKD risk prediction and yielded increments compared to traditional DKD risk factors (p < 0.05).

CONCLUSIONS: Serum FGF23 level increased at early stages of DKD, and it was an independent predictor of incident DKD, suggesting its potential for early identification of individuals at risk.

PMID:39895483 | DOI:10.1111/dom.16224

Biochem Mol Biol Educ. 2025 Feb 3. doi: 10.1002/bmb.21886. Online ahead of print.

ABSTRACT

Traditional didactic teaching methods in medical education, while foundational, often lead to passive learning and insufficient engagement. “Pancreata-The Keto Struggle,” an educational tale-based game for diabetic ketoacidosis (DKA), was developed to address these challenges by promoting collaborative learning, enhancing student engagement, and improving knowledge retention through an interactive and narrative-driven approach. This study involved 150 first-year medical students divided into 25 small groups of 6 each. Participants were assessed before and after engaging with the game through a structured formative assessment, a validated questionnaire measuring engagement and learning effectiveness, and a confidence level questionnaire. In-depth small-group interviews were also conducted for qualitative feedback and thematic analysis was performed. Statistical analyses were performed using SPSS version 17. The introduction of “Pancreata-The Keto Struggle” resulted in significant improvements in students’ formative assessment scores, from a mean of 19.2 ± 1.9 before the game to 39.3 ± 2.2 out of 50 after the game (p < 0.0001). Notably, students demonstrated the highest confidence gains in managing DKA and interpreting laboratory results. Qualitative analysis identified seven common themes reflecting the game’s impact on learning: collaboration, retention of concepts, internal drive, self and peer assessment, joyful learning, beyond books, and aesthetic content. Over 95% of students reported increased engagement and learning effectiveness due to the game’s intrinsic motivation, narrative, and group learning mechanics. “Pancreata-The Keto Struggle” effectively revitalizes collaborative learning in medical education by integrating game-based learning with traditional teaching methods. The game not only facilitates a deeper understanding of complex clinical conditions like DKA but also broadly improves students’ clinical management skills and confidence. These findings underscore the potential of educational tale based games to enrich medical education and advocate for their broader application across curricula.

PMID:39895468 | DOI:10.1002/bmb.21886

Prehosp Disaster Med. 2025 Feb 3:1-13. doi: 10.1017/S1049023X25000020. Online ahead of print.

ABSTRACT

INTRODUCTION: The human health impacts of disaster are predicted to increase in frequency and severity due to the effects of climate change. This has impacts on all nations, but understanding disaster-related health impacts in highly populous nations, such as India, will help to inform risk preparedness and reduction measures for large proportions of the global population.

PROBLEM: Disaster-related human health impacts in India were examined via the use of survey data to inform risk reduction.

METHODS: A cross-sectional analysis of Wave 1 (2017-2018) data from the Longitudinal Aging Study India (LASI) was conducted to explore the impact of both natural and human-induced disasters on the self-reported health of people 45 years and above, as well as their partners (irrespective of age). Descriptive statistics, chi square tests of association, odds ratio, and logistic regression were used to analyze the data by socio-demographics, geographic location, and health concern type.

RESULTS: Out of a total 72,250 respondents, 2,301 (3.5%) reported disaster-related health impacts, of which 90.1% were significant. Rural residents and those with no education were more likely to be affected. Droughts were most commonly responsible for affecting human health (41.7%), followed by floods (24.0%). Two-thirds of the sample reported psychological trauma and one-in-five experienced chronic illness.

DISCUSSION: The LASI study presents an important first understanding of the self-reported human health impacts of disasters, both natural and human-induced in India. Findings indicate social determinants such as education level and rurality impact risk of disaster-related health impacts, while mental health concerns represent the biggest disaster-related health concern.

CONCLUSION: Future waves of LASI should be examined to determine if human health impacts are increasing due to the effects of climate change, as well as the vulnerability of an aging cohort.

PMID:39895456 | DOI:10.1017/S1049023X25000020

J Adv Nurs. 2025 Feb 3. doi: 10.1111/jan.16791. Online ahead of print.

ABSTRACT

AIM: To examine how colleague violence affects professional image and career decisions among nursing students.

DESIGN AND SETTING: This cross-sectional study was conducted from February 1 to March 1, 2023, at two public universities in Turkey.

SAMPLE AND METHODS: All nursing students who met the inclusion criteria and voluntarily agreed to participate were included without any special sample calculation, and a final sample of 357 students was obtained. Data were collected between February 1 and March 1, 2023. Data were collected using a survey form that included questions on sociodemographic characteristics, as well as three scales: the Exposure to Colleague Violence Scale (ECVS) scale, the Image of Nursing Profession Scale (INPS) scale, and the Career Decision Scale (CDS). Data analysis included descriptive statistics, t-tests, ANOVA, Pearson correlation, and regression analyses.

RESULTS: The mean ECVS score was 45.43 (20.80), the mean INPS score was 147.15 (13.51), and the mean CDS score was 79.67 (17.34). A weak negative correlation was found between colleague violence and nursing image, a weak positive correlation between colleague violence and career decision, and a moderate negative correlation between nursing image and career decision.

CONCLUSION: This study highlights the negative impact of exposure to colleague violence on nursing students, affecting both their professional image and career decision-making. Greater exposure to colleague violence correlates with more negative perceptions of the nursing profession and increased uncertainty in career choices. Implementing targeted interventions to reduce and prevent colleague violence, especially in clinical practice settings, is essential for promoting a positive professional image and supporting informed career decisions among nursing students.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Addressing and reducing colleague violence among nursing students can enhance their professional image and decision-making regarding their careers, which, in turn, may lead to improved patient care and more significant long-term commitment to the nursing profession.

REPORTING METHOD: This study adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public involvement in this study.

PMID:39895454 | DOI:10.1111/jan.16791

JACC Clin Electrophysiol. 2025 Jan 17:S2405-500X(24)01012-0. doi: 10.1016/j.jacep.2024.12.002. Online ahead of print.

ABSTRACT

BACKGROUND: Limited empirical evidence informs fitness-to-drive recommendations after implantable cardioverter-defibrillator (ICD) implantation. Cohort designs can be deceptive because ICD recipients differ from control individuals and may temporarily cease driving after implantation.

OBJECTIVES: This study sought to generate evidence to inform medical driving restrictions after ICD implantation.

METHODS: We used population-based data to identify all drivers involved in a serious motor vehicle crash in British Columbia, Canada, from 1997 to 2019. Exposure was defined as ICD implantation in the 6 months before a crash. One analysis used a case-crossover design to control for relatively fixed individual characteristics like driving experience. Another analysis used a responsibility design to account for road exposure (miles of driving per week). Both analyses used logistic regression with adjustment for potential confounders.

RESULTS: In the case-crossover analysis of crash-involved ICD recipients, ICD implantation occurred in 212 of 3,299 precrash intervals and in 485 of 6,598 control intervals, suggesting no temporal association between ICD implantation and subsequent crash (6.4% vs 7.4%; adjusted odds ratio [aOR]: 0.86; 95% CI: 0.71-1.03; P = 0.11). In the analysis of all crash-involved drivers with determinate crash responsibility, 14 of 22 drivers with recent ICD implantation and 532,741 of 1,035,433 drivers without recent ICD implantation were deemed responsible for their crash, suggesting no association between ICD implantation and crash responsibility (crude proportion responsible, 64% vs 51%; aOR: 2.20; 95% CI: 0.94-5.30; P = 0.08).

CONCLUSIONS: The 6-month interval after ICD implantation is not associated with increased odds of crash nor with increased likelihood of crash responsibility. Contemporary driving restrictions in the first weeks after ICD implantation appear to adequately mitigate the potential increase in crash risk.

PMID:39895447 | DOI:10.1016/j.jacep.2024.12.002

J Pediatr Orthop. 2025 Feb 3. doi: 10.1097/BPO.0000000000002917. Online ahead of print.

ABSTRACT

BACKGROUND: Shoulder dislocation can be seen early in infancy and can be diagnosed by shoulder ultrasound. Botulinum toxin injection in the internal rotators of the shoulder can be used to as an adjunct to relieve the internal rotation contracture. The aim of this study was to evaluate the intermediate-term outcomes of shoulder dislocations treated with injection botulinum toxin and to identify the factors determining the outcomes of the procedure.

METHODS: Eighty-six children with ultrasound diagnosed shoulder dislocation underwent injection BTX-A between 2011 and 2022. Children who underwent nerve surgeries and the ones with inadequate follow-up were excluded. Sixty-two children were followed up for a mean duration of 36 months. Injection botulinum toxin A 2 U/kg body weight was injected each into the subscapularis and the pectoralis major. After manual stretching of contracted anterior soft tissue and shoulder capsule, a shoulder spica was applied for 3 weeks. Hospital for Sick Children Active Movement Scale (HSC-AMS) score and active and passive shoulder was recorded before and after the procedure and the requirement for further interventions was noted.

RESULTS: Outcomes were divided into 3 categories: group A-27 (44%) children who did not require any further surgery in our follow-up period; group B-27 (44%) needed further procedure for recurrence of IR contracture; and group C-8 (12%) developed external rotation contracture later. Children in group A had statistically significant higher preinjection HSC-AMS score for elbow flexion and shoulder abduction than the other groups. Children in group C had greater passive external rotation and weak elbow extension and wrist dorsiflexion as compared with the other 2 groups.

CONCLUSIONS: Injection botulinum toxin A is effective in treating shoulder dislocations in children with early recruitment of C5 to 6 muscles, while children with involvement of C7 muscles may develop an external rotation contracture subsequently, hence this procedure should be avoided.

LEVEL OF EVIDENCE: Level IV-therapeutic.

PMID:39894942 | DOI:10.1097/BPO.0000000000002917

Cleft Palate Craniofac J. 2025 Feb 2:10556656251314264. doi: 10.1177/10556656251314264. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the reliability of different digitizing methods not only among themselves but also with direct measurements from facial plaster models of unoperated cleft babies.

DESIGN: Single-center retrospective study.

SETTING: The study consisted facial models of babies with unilateral (UCLP, n = 65) and bilateral (BCLP, n = 65) cleft lip and palate from the archives of the Department of Orthodontics, Marmara University, Istanbul, Turkey. Those models were digitized using Medit i600, iTero Element 2 (Align Technology), and E3 3Shape scanning devices. A digital caliper with a 0.03 precision (INSIZE Digital Caliper) was used for manual measurements on plaster models. 3Shape Ortho Analyzer software was used for digital measurements.

RESULTS: All scanning methods were reliable and compatible with a rate of 90% or more compared to manual measurements. The E3 3Shape device showed the lowest deviations (UCLP, between 0.04 and 0.11 mm; BCLP, between 0.04 and 0.25 mm) from manual measurements. In the UCLP group, Medit i600 presented the highest deviation (0.15-0.58 mm) whereas Itero Element 2 showed the highest deviation in the BCLP group (0.16-0.46 mm). Although there were statistically significant differences in the deviations of digital measurements, the values were still within clinically acceptable limits.

CONCLUSION: Intraoral scanners were less reliable in topographic measurements, especially in cases with increased depth. Although the highest compatible results were found with E3 3Shape model scanner, iTero Element 2 and Medit i600 were promising and advisable for digitizing and archiving the plaster models of babies with cleft lip and palate.

PMID:39894926 | DOI:10.1177/10556656251314264