Sample size estimation in mixed methods healthcare research combines quantitative and qualitative traditions, yet guidelines remain limited. Historically, quantitative studies have used statistical power and effect size calculations to determine sample sizes. In contrast, qualitative studies have relied on concepts such as saturation, typically with much smaller, purposive samples. Mixed methods designs must reconcile these approaches. One pragmatic strategy is to set the combined sample at the larger of the two required by each component, or as the minimum that satisfies both. Theoretical frameworks and research paradigms (eg, pragmatism, transformative approaches) influence sample decisions. In practice, mixed-methods studies in biomedical fields face challenges such as coordinating distinct sampling frames, ethical review of open-ended sample sizes and balancing breadth with depth. For example, one recent study paired a large survey (N=632) with a series of focus groups (five groups of five to seven participants) to achieve thematic saturation. Key factors affecting sample size choices include study design (sequential vs concurrent, embedded vs convergent), integration strategy (eg, connecting vs building phases), research questions and logistical constraints. This article reviews the historical context, conceptual foundations, practical methods and examples of determining sample size in mixed-methods biomedical research.

An appropriate sample size is essential to determine methodological steps that underpin the scientific validity, ethical integrity, and practical feasibility of biomedical and health research. Inadequate estimation may lead to underpowered studies or unnecessary resource use and participant exposure. This article provides a practical overview of statistical power analysis and sample size determination using the G*Power software (version 3.1.9.7), which is a freely available tool for researchers. The Core statistical concepts, including hypothesis formulation, effect size estimation, significance level (α), statistical power (1-β), and their dynamic interrelationship, are outlined. The article further describes the G*Power software ecosystem, its graphical user interface, supported statistical test families, and the distinct modes of power analysis. Step-by-step methods with realistic research scenarios demonstrate sample size calculation for commonly used statistical tests, including independent and paired t-tests, z-tests for proportions, one-way ANOVA, correlation analysis, and multiple linear regression. The article also highlights common pitfalls, limitations of G*Power, and advanced considerations in sample size estimation. This article aims to provide researchers with a structured framework for accurate sample size estimation, thereby enhancing study quality, reproducibility, and ethical responsibility in biomedical research.

Air pollution, particularly fine particulate matter (PM₂.₅), poses a significant global health risk, contributing to respiratory, and cardiovascular diseases. While personal-level interventions such as air purifiers and respirators are commonly used to reduce exposure, their effectiveness in improving clinical outcomes remains uncertain. This systematic review and meta-analysis evaluated the efficacy of such measures in reducing adverse respiratory and cardiovascular outcomes. A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted up to February 2025. Randomized controlled trials (RCTs) assessing the use of air purifiers or respirators in non-occupational settings were included. Meta-analyses were performed using fixed or random-effects models, and effect sizes were expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Twenty-seven RCTs were included. Personal-level interventions significantly reduced indoor PM₂.₅ (SMD = -2.27; 95% CI: -2.98 to -1.55) and PM₁₀ (SMD = -3.87; 95% CI: -4.59 to -3.16) levels. However, no significant improvements were observed for forced expiratory volume in one second (FEV₁) (SMD = 0.04; 95% CI: -0.07 to 0.15), peak expiratory flow (PEF), forced vital capacity (FVC), respiratory symptoms, or blood pressure. Sensitivity analysis showed a significant reduction in FeNO (SMD = -0.16; 95% CI: -0.28 to -0.04). While effective in reducing particulate matter, personal-level interventions showed limited clinical benefits for respiratory or cardiovascular health.

Introduction: Despite effective vaccines and post-exposure prophylaxis (PEP), gaps in awareness and practices hinder Rabies control efforts. This study assessed knowledge, attitudes, practices, and perception of healthcare professionals and community members regarding rabies control. Methods: A cross-sectional study was conducted from May 2024 to April 2025 among community people who presented to emergency department (ED) with animal bite and health care professionals who were working in EDs of 4 Hospitals in Sari, Iran. Data were collected using validated questionnaires and analysed with descriptive and inferential statistics. The correlation between studied variables and knowledge, attitudes, practices, and perception of healthcare professionals and community members regarding rabies control were evaluated. Results: 766 participants (383 healthcare professionals, 383 community members) were included. Community knowledge was low, with only 20.1% aware that animal bites can transmit rabies, compared to 98.7% of healthcare workers. Awareness of wound washing with soap and water was inadequate (31.3% among community members; 61.1% among healthcare professionals). Misconceptions about rabies hosts were common. A minority in both groups still relied on traditional healers, delaying appropriate care. Education, pet ownership, and access to clinics were positively correlated with higher knowledge, attitude and practice (KAP) scores. Conclusions: The study found significant shortcomings among healthcare professionals as well as severe gaps in rabies-related knowledge and essential preventive behaviors, especially among community members. Inadequate wound-washing techniques and a lack of knowledge about the routes of transmission underscore the critical need for focused education and ongoing professional training to enhance rabies control.

Coronary artery disease (CAD) continues to be a major global health burden, and its effective management depends on optimal treatment adherence, realistic illness perception, and adequate acceptance of illness. However, evidence examining these psychosocial and behavioral factors remains limited. This study assessed treatment adherence, illness perception, and acceptance of the illness and explored their associations among CAD patients. A descriptive correlational cross-sectional study was conducted among 250 CAD patients selected through convenience sampling. Data were collected using standardized tools: the Morisky Medication Adherence Scale (MMAS-8), the Brief Illness Perception Questionnaire (IPQ-B), and the Acceptance of Illness Scale (AIS) with the relative ranges (MMAS-8: 0-8, IPQ-B: 0-80, AIS: 8-40). Descriptive statistics (mean, standard deviation, frequency, and percentage) were used to summarize the data, Pearson's correlation was applied to examine relationships among variables, and the chi-square test was used to assess associations between outcome variables and selected sociodemographic factors. Treatment adherence was predominantly low (59%), with a mean score of 5.69±1.58. Illness perception scores indicated that most participants (82%) experienced a high perceived illness threat (mean = 54.93±8.78). Acceptance of illness was moderate in 57.6% of participants, with a mean score of 25.09±6.07. A weak but statistically significant positive correlation was observed between acceptance of illness and treatment adherence (r=0.245, p<0.001). Illness perception showed no significant relationship with other variables. Significant associations were identified between treatment adherence and socioeconomic status (χ²=19.97, p=0.003); acceptance of illness and educational status (p<0.001), physical activity (χ²=12.98, p=0.011), and past medical history (χ² =29.51, p=0.003); and illness perception with socioeconomic status (χ²=16.18, p=0.013) and area of residence (χ²=16.88, p=0.002). CAD patients showed low treatment adherence, high perceived illness threat, and moderate illness acceptance. Strengthening patient education, addressing illness perceptions, and enhancing psychological support may improve adherence and long-term disease management.

Sustainability-oriented innovation approaches to geriatric care are becoming increasingly essential as the number of older people is advancing at a breakneck pace. Artificial intelligence (AI) and robotic devices are being used more nowadays to address concerns related to multimorbidity, cognitive decline, functional disability, and social isolation in older populations. This commentary highlights specific approaches and applications by outlining key findings on the use of robots and AI in the care of the elderly. Application of robotic technologies, such as socially assistive service and rehabilitation robots, helps in improving psychosocial well-being, functional recovery, and decreasing the burden of caregivers. Many of the recent AI-based systems have proven helpful in risk prediction, dementia screening, telegeriatrics, and fall detection among the elderly. PARO (AIST, Japan), ElliQ (Intuition Robotics, Israel), wearable fall detection approaches, speech-based AI models, and rehabilitation exoskeletons are a few examples of social robotic technologies that demonstrate the translational potential of these advancements. Ethical problems, data bias, privacy risks, and implementation difficulties persist despite such promising results. The future study should focus on age-inclusive AI, essential clinical validation, and incorporating these technologies into individual-centric geriatric care.

This narrative review explores the transformative role of artificial intelligence (AI) in the management of hearing loss, a highly prevalent global health concern. It synthesizes recent advancements across the hearing care continuum, from AI-enhanced screening tools that improve accessibility and efficiency, to diagnostic applications in audiometric analysis, otoscopy, and radiology that achieve specialist-level accuracy. The review details how AI enables highly personalized treatment through smart hearing aids and cochlear implants that adapt in real-time, and how it powers adaptive rehabilitation programs, immersive training environments, and remote monitoring platforms. Despite this promising progress, the integration of AI into clinical audiology faces significant challenges, including issues of data quality, model interpretability, regulatory hurdles, and ethical concerns regarding bias and privacy. The future of AI in hearing care hinges on developing explainable, federated learning models, creating multimodal datasets, and fostering interdisciplinary collaboration. Ultimately, a synergistic human-AI partnership is envisioned to advance hearing healthcare, making it more precise, efficient, and accessible worldwide.

The study examines the relationships of general health, mental health and quality of life among individuals in Northern Iran following total knee arthroplasty (TKA). It also explores the effect of post-surgical insomnia on mental health and general health among the TKA patients. A longitudinal survey was conducted using self-reported data from 270 patients who were assessed for depression, mental health, quality of life, and insomnia at one week (T1), one month (T2), and three months (T3) post-surgery. Structural equation modelling (SEM) was used to analyse the data. The study revealed that general health was positively related to mental health over time (0.21, p < 0.01; 0.25, p < 0.01; 0.27, p < 0.001). General health showed significant relationship with quality of life during the second time period (one month) 3(0.13, p < 0.001; 0.17, p < 0.01). Mental health was also seen to positively influence quality of life (0.17, p < 0.01; 0.19, p < 0.001;0.22, p < 0.001). Insomnia negatively moderated the relationship between general health and mental health. Furthermore, mental health mediated the relationship between general health and quality of life during T2 and T3. The study underscores the intricate interplay between general health, mental health, and quality of life, with insomnia as a moderating factor in TKA patients. General health contributed to improved mental health and quality of life over time. This study sheds light on the complex factors influencing TKA outcomes, providing valuable insights for healthcare providers to enhance patient care and overall well-being.

Background:Academic publication is a cornerstone of advancing nursing science, as it provides evidence-based research that guides clinical practice and education. However, the pressure to publish for career advancement has led to concerns about behaviours such as the 'urge to publish' and 'panic publishing'. The perception behind these trends remains unclear. This study aimed to assess the perception of Indian nurse academicians on academic publications. Methodology:This cross-sectional study surveyed Indian nurse academicians from Institutes of National Importance (INIs) of India who were selected convenient sampling technique. Data was collected through an online self-structured questionnaire. The survey covered socio-demographic details and perceptions for publishing in academic publications. Data analysis was performed using SPSS Version 26.0, with descriptive and inferential statistics. A significance level (p < 0.05) was used for statistical associations. Results:Of the respondents, 66.8% were female, and 92.3% had published before [median 12 (IQR 7-38) articles], with 21.7% preferring PubMed-indexed journals. More than two-thirds of participants (64.7%) spent an excessive amount of time on the publication process. There were differences by gender as men were more prone to assess publication metrics (p<0.05), ignore other facets of life for publishing (p=0.005), and self-reported publication addiction-like behaviors (18% compared to 4% for women). Conclusion:Academic publishing is a crucial but stress-inducing aspect of nurse academicians' careers. These findings underscore the need for a balanced approach that values quality over quantity in academic publishing. Institutions should promote ethical research practices, provide support to manage publication pressures and foster a more sustainable academic environment.

Background and Aims: Lymphatic filariasis (LF), a tropical illness caused by mosquito-borne parasites, is a serious public health concern in endemic areas such as Jharkhand, India. The illness continues despite efforts by the World Health Organization and the Mass Drug Administration (MDA). This study aims to investigates the clinical and demographic profiles of patients with LF and assesses coverage of MDA. Methods: This cross-sectional study included 100 patients with LF who presented to the General Surgery Outpatient Department. Interviews, clinical exams, and semi-structured questionnaires were used to obtain information about sociodemographic profile, clinical symptoms and MDA coverage. Descriptive statistics and Chi-square tests were used to find the association between clinical profile, drug consumption, and sociodemographic profiles. Results: The study revealed that participants were mostly middle-aged, married (55%), from low-income families (86%), and had varied degrees of hydrocele and lymphedema, with nearly 70% experiencing scrotal enlargement. Furthermore, 44% of patients reported insufficient MDA coverage. There were significant connections found between the size of the hydrocele (P < 0.01) and actual drug consumption (P < 0.01) with socioeconomic status. Conclusions: The study highlights important clinical, sociodemographic patterns, and reveal MDA coverage gaps among patients with LF. There is a need of targeted education and enhanced treatment access to improve MDA effectiveness and achieving LF eradication by 2030.

Background:Nurses play a crucial role in the provision of genetic services, yet their capacity to deliver these services is often constrained by various barriers. Understanding these barriers and identifying facilitators is essential for optimizing genetic services delivery in nursing practice. This systematic review aimed to explore the barriers and facilitators influencing nurses' roles in providing genetic services, including genetic counseling, testing, and patient management. Methodology:A comprehensive search across multiple databases yielded 1,275 articles. After de-duplication and screening, 12 studies published between 2001 and 2024 were included. These studies, conducted in nine countries, utilized qualitative and quantitative approaches. Data was synthesized narratively, focusing on key themes related to barriers and facilitators. Results:Barriers were identified across six domains: gaps in educational preparedness, insufficient knowledge, administrative hurdles, negative attitudes, logistical difficulties, and environmental limitations. Common challenges included knowledge deficits, role ambiguity, time constraints, and cultural variations. Facilitators were grouped into five domains: educational support, role expansion, integration across specialties, positive attitudes, and policy/institutional support. Key enablers included genomic education programs, multidisciplinary teamwork, and structured institutional policies. Conclusion:Barriers and facilitators to nurses' provision of genetic services are multifaceted, spanning individual, institutional, and systemic factors. Addressing these challenges through targeted interventions, such as enhancing genomic education and fostering interdisciplinary collaboration, can significantly improve genetic services delivery in nursing practice.

Background:Research and academic publications are crucial for Indian physicians' professional growth, evidence generation, and academic advancement. It often contributes to the "publish or perish" culture. This study aims to assess Indian physicians' perceptions and self-appraisal on academic publications, for those practicing evidence-based medicine (EBM). Methodology:A cross-sectional online survey with proper consent was conducted over two months, targeting Indian physicians practicing EBM to evaluate their views on research and publications. Results:A total of 320 physicians participated (mean age 41.15 ± 8.94 years; 68.8% male). Most held post-graduate degrees (73.4%) and worked in government-run institutions (56.6%). A large proportion (88.7%) had prior publications, with a preference for PubMed/Medline-indexed journals (40.0%). Sixty-five percent balanced clinical and academic roles. Physicians were motivated by career advancement (31.6%) and professional recognition (34.7%). Behavioral patterns showed "addiction-like" tendencies, with many frequently checking publication metrics and tracking manuscript progress. Physicians with post-graduate qualifications, particularly in medicine, were more engaged in these behaviors. Those in central government teaching institutions showed even greater engagement. Conclusion:This study reveals the complex dynamics of academic publishing among Indian physicians, highlighting the pressures of the "publish or perish" culture. Institutions should focus on fostering quality over quantity in publishing, providing mentorship, and promoting ethical practices to mitigate these pressures.

Introduction: Patient contentment is pertinent for measuring the performance of health- care service delivery, which is a multidimensional construct that depends on many factors. Out-patient department (OPD) is the first point of contact of the hospital with the patient. Patient satisfaction is one of the most essential outcome indicators to be measured to evaluate the quality of services provided to the patient and also provide the opportunity to improve the quality of services. Methodology: An institution-based mixed methods study (convergent-parallel design) was conducted. Study was conducted in the outpatient departments of a tertiary care hospital. Participants was selected using convenience sampling technique. A self-structured questionnaire was used to collect data. Results: Out of 2000 patients, 1077 (54%) were highly satisfied, 845 (42%) were moderately satisfied, whereas 78 (4%) were unsatisfied. The overall satisfaction among 2000 patients was found to be 95.8025±2.21. Mean satisfaction improved over the time as the facilities improved. Conclusion: The overall contentment of patients with the services provided was good. As the institution is newly established, patients’ expectations were high and increasing day by day so a few were unsatisfied also.

This study aimed to examine patients’ attitude and information-seeking behaviour related to intra-venous (IV) fluid use for the common cold visited in emergency department. A cross-sectional analytical study was conducted from January to May 2024. A total of 365 patients aged 18 years and older presenting with cold symptoms were surveyed using a validated questionnaire. The survey assessed demographic information, attitudes towards IV fluid therapy, and the sources of information patients used. Descriptive statistics, and one-sample t-tests were performed to compare mean perceptions against a neutral score (e.g., 3 on a 5-point Likert scale) using SPSS version 21. The mean age of participants was 39.35 ± 15.48 years, with 48.5

Background:Among Indian adolescent girl's anemia remains a major public health concern due to rapid growth, menstrual blood loss, and nutritional deficiencies. This systematic review and meta-analysis aim to assess the prevalence and severity of anemia among Indian adolescent girls. Methods:This review (2004-2024) integrated data from 32 studies (14,053 persons) from PubMed, Embase, and Scopus, adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)/ Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Observational studies with the prevalence of anemia in Indian adolescent girls based on WHO criteria were included. The data was pooled using a random-effects model, and subgroup analyses were conducted by Indian region. Heterogeneity was assessed using the I2 statistic. Results:The pooled anemia prevalence was 65% (95% CI: 54%-74%), showed notable regional variations. The burden was highest in East India (81%; 39%-97%), then North India (65%), West India (61%), and South India (52%). The mean hemoglobin levels varied by region, ranging from 10.24 g/dL in the East to 11.20 g/dL in the South. Mild anemia (29%) and moderate anemia (25%) were more common than severe anemia (1%). The substantial heterogeneity (I2=98.7%) indicated differences in socioeconomic status, diet, and healthcare access. Conclusion:Anemia affects disproportionate number of Indian adolescents' girls, particularly in the country's east, which highlights the need for context-specific interventions. The initiatives must be linked to national programs like Anemia Mukt Bharat to ensure equitable progress towards India's public health objectives and to avoid long-term health and developmental consequences.

N-acetylcysteine (NAC) has been proposed as an adjuvant therapy for COVID-19, but evidence from randomized controlled trials (RCTs) remains inconclusive. This systematic review and meta-analysis evaluated NAC's efficacy in improving mortality and recovery/discharge rates. Additionally, molecular docking and molecular dynamics simulation (MDMS) studies were conducted to assess NAC's interaction with the SARS-CoV-2 main protease (Mpro), a key enzyme for viral replication. A systematic search identified 12 RCTs, with 11 trials (1125 patients) included in the mortality analysis. NAC significantly reduced mortality (RR=0.59, 95% CI 0.39-0.88, p=0.01; I²=62%), indicating a 41% decreased risk of death. Six RCTs (656 patients) showed improved recovery/discharge rates (RR=1.09, 95% CI 1.03-1.14, p=0.003; I²=0%). MDMS studies demonstrated stable NAC binding at the Mpro catalytic site, interacting with His41 and Cys145, crucial for enzymatic activity. These findings suggest NAC significantly improves clinical outcomes in COVID-19 and may inhibit viral replication by targeting Mpro. This integrated evidence substantiates NAC's potential as a critical adjuvant therapy.

Iron deficiency anemia (IDA) remains a prevalent global health issue. While oral iron therapy is the first-line treatment, the optimal dosing strategy—daily versus alternate-day—remains debated, especially for general population use. Therefore, this review aimed to compare the efficacy and tolerability of daily versus alternate-day oral iron supplementation for IDA in the general population. Searches were conducted across major databases through March 2025. Risk of bias was evaluated utilizing the Cochrane RoB 2 tool, and the certainty of evidence was graded using GRADE. The primary outcome was change in hemoglobin concentration; secondary outcomes included serum iron, ferritin, transferrin saturation, TIBC, MCV, and adverse events. R Studio software, version 4.2.3, and RevMan used for all analyses. This SRMA (systematic review and meta-analysis) included 11 RCTs involving 1014 participants. The pooled analysis found a small, statistically non-significant increase in hemoglobin with daily dosing over alternate-day (MD: 0.28, 95

BackgroundAntiphospholipid syndrome and systemic lupus erythematosus are autoimmune inflammatory conditions involving multiple organs and sharing various clinical aspects. Owing to the scarcity of data about the surgical outcomes of these autoimmune disorders, we conducted a systematic review to assess the outcomes for patients with these diagnoses undergoing heart surgery and contextualize the findings regarding high-risk cardiac surgeries.MethodsA thorough search of PubMed, Embase and Scopus used Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards to find articles that involved patients who underwent heart surgery and had antiphospholipid syndrome and systemic lupus erythematosus. Inclusion criteria concentrated on a definitive diagnosis, while case reports and studies lacking data on surgical outcomes were excluded. Using the Joanna Briggs Institute's methodologies, quality evaluation categorized studies according to their risk of bias.ResultsFourteen studies with 277 patients and a prevalence of middle-aged females met the inclusion criteria out of 6381 papers. The major preoperative comorbidity in the cohort was a history of thromboembolic events (43%). Thromboembolic complications (6%) and catastrophic antiphospholipid syndrome (2%), even with appropriate anticoagulation, were notable early post-operative outcomes. Six percent of people died within 30 days. Data from follow-up studies showed a 14% death rate and a 23% frequency of thromboembolic events.ConclusionsWith the striking exception of a high frequency of thromboembolic complications and catastrophic antiphospholipid syndrome, surgical results in patients with antiphospholipid syndrome and systemic lupus erythematosus are analogous to those in high-risk cardiac procedures. Improving surgical care for this susceptible population requires an understanding of these hazards.

Breast cancer is the most common disease in women worldwide, and it can cause serious physical and psychological problems, particularly in Iran, where it accounts for 23.6

Introduction: Effective diabetes management relies on medical treatment and self-care practices, yet many individuals face challenges in adhering to prescribed routines. With the rise of mobile health (mHealth), there is potential to enhance self-management through regular reminders, guidance, and support. This qualitative study explores patient practices in managing diabetes and the role of mHealth in influencing their behaviours and outcomes. Methodology: The study employed semi-structured, in-depth interviews with 14 individuals living with diabetes who had received SMS reminders and utilized the feedback application services as part of their diabetes management. Participants got education regarding self-care routines, including medication adherence, diet, exercise, and blood glucose monitoring. Thematic analysis was conducted to identify patterns related to diabetes management practices, patient challenges, and the role of mHealth. Results: Participants expressed positive feedback on the SMS and app-based services, which promote medication adherence and provide valuable health information. Challenges in diabetes management include physical limitations, social pressures leading to dietary lapses, time constraints, and concerns about receiving spam or misleading information via SMS. However, they recommended improvements, such as guidance on treatment, dietary advice, and the inclusion of interactive features like sugar level tracking. Conclusion: mHealth has the potential to enhance diabetes self-management significantly, and patient feedback suggests a need for more personalised, interactive, and comprehensive support. Addressing these recommendations alongside patients' physical, social, and financial challenges could improve health outcomes and foster more effective diabetes management.