Category: Nevin Manimala

BMC Health Serv Res. 2026 Jul 3. doi: 10.1186/s12913-026-14901-8. Online ahead of print.

ABSTRACT

BACKGROUND: This cross-sectional study investigates healthcare practitioners’ perceptions of the implementation of artificial intelligence (AI) to enhance patient safety culture in Riyadh, Saudi Arabia, conducted from March to June 2025. The focus is on understanding how AI is perceived in the context of improving patient safety culture and aligning with Saudi Vision 2030 goals.

METHODS: The study employed a cross-sectional design and administered self-administered online surveys via convenience sampling among healthcare practitioners across multiple healthcare settings in Riyadh. The study targeted a population including doctors, nurses, and allied health professionals. A structured questionnaire was developed to assess perceptions of AI, including key variables such as perceived AI benefits, concerns about data privacy, and the necessity of training. Descriptive statistics were computed to characterize the sample, including age, gender, and profession.

RESULTS: Findings revealed that most participants perceived AI as supportive of patient safety through improved diagnostic accuracy, reduced medical errors, and streamlined workflows, which participants believed may contribute to a stronger patient safety culture. Descriptive analyses suggested variation in perceptions across professional groups.

DISCUSSION: The study found that healthcare practitioners in Riyadh generally perceived AI as a potentially valuable tool for supporting patient safety culture, particularly through improving diagnostic accuracy and reducing errors; however, concerns about data privacy and insufficient training remain significant barriers that must be addressed to ensure effective and safe AI integration.

CONCLUSIONS: This study highlighted healthcare practitioners’ positive perception of AI’s role in enhancing patient safety culture in Riyadh. While AI is seen as beneficial in improving accuracy and reducing errors, challenges such as data privacy concerns and a lack of training were identified as barriers to its implementation.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42399990 | DOI:10.1186/s12913-026-14901-8

BMC Sports Sci Med Rehabil. 2026 Jul 3. doi: 10.1186/s13102-026-01838-y. Online ahead of print.

ABSTRACT

BACKGROUND: Exercise-induced hypoalgesia (EIH) is vital for rehabilitation, but its efficacy in patients with knee pain remains controversial. Blood flow restriction (BFR) might augment analgesia through metabolic accumulation. This study aimed to investigate the acute analgesic impact of a low-intensity warm-up with or without BFR and to compare EIH responses between healthy individuals and patients with persistent knee pain.

METHODS: Forty-six participants (healthy controls: n = 26; participants with persistent knee pain: n = 20) were enrolled in a single-session, within-subject split-body protocol. BFR at 70% arterial occlusion pressure was applied to one limb during a 5-min low-intensity warm-up. The BFR-treated limb was randomized in healthy controls, whereas in participants with persistent knee pain, BFR was consistently applied to the symptomatic limb, with the contralateral asymptomatic limb serving as the within-subject comparison. Pressure pain thresholds (PPT) were measured at three peri-patellar sites pre- and post-condition using a Latin Square design. Data were analyzed via Linear Mixed Models.

RESULTS: Healthy controls showed a robust increase in PPT after warm-up (+ 5.55 N, 95% CI, 4.20 to 6.90), whereas participants with persistent knee pain showed no clear increase (+ 0.15 N, 95% CI, -1.39 to 1.69). The between-group difference in EIH was significant (+ 5.40 N, 95% CI, 3.36 to 7.45, p < 0.001). The EIH response was markedly attenuated in participants with persistent knee pain, a finding consistent with altered endogenous pain modulation. However, the present data do not directly identify the central or peripheral mechanisms underlying this attenuation. The additional BFR effect was small and not statistically significant (-0.14 N; 95% CI, -2.18 to 1.91; p = 0.894), suggesting the tested BFR protocol did not demonstrate statistically superior additional hypoalgesic effects compared with the non-BFR condition.

CONCLUSION: A brief low-intensity warm-up induced a clear EIH response in healthy controls, whereas participants with persistent knee pain showed a markedly attenuated response. The tested BFR protocol did not demonstrate statistically superior additional hypoalgesic effects compared with the non-BFR condition. These exploratory findings warrant further investigation using adequately powered, prespecified, and mechanistically informed studies.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2300069386 (https://www.chictr.org.cn/, registered on 15 March 2023).

PMID:42399981 | DOI:10.1186/s13102-026-01838-y

J Ethnobiol Ethnomed. 2026 Jul 3. doi: 10.1186/s13002-026-00924-2. Online ahead of print.

ABSTRACT

BACKGROUND: Domestication is an evolutionary process guided by humans. It operates continuously in multiple directions, with species undergoing adaption to diverse human-influenced environments and cultural and technological contexts. Mesoamerica is among the world’s main regions of domestication and the Agave genus is widely used and managed in this region, with at least eleven domesticated and semi-domesticated species. One species, Agave americana, comprises two subspecies and four varieties, the diversification of which is hypothetically related to human management. This study explores this hypothesis by analysing morphological variation and its relation to environmental and management settings.

METHODS: Ethnobotanical studies were conducted to document uses, management practices, and targets of human selection, together with patterns of morphological variation across different ecological and cultural contexts. Semi-structured interviews were carried out with agave managers throughout the species’ distribution range in Mexico. Morphometric analyses were performed on populations occurring under contrasting environmental and management conditions. Multivariate and univariate statistical analyses were used to evaluate morphological variation in relation to geographic distribution, environmental conditions, and management regimes.

RESULTS: A. americana is used to extract sap for preparing the fermented beverage called pulque. Its stems have been used as food since prehistoric times, when they were cooked in underground ovens. This cooked matter forms the basis of current fermentation and the production of distilled mescal. The fibre of some varieties has been used to make cords and textiles. Both subspecies are managed, but the subspecies protamericana clearly has wild populations. Morphometric studies confirm the presence of traits indicative of domestication in most varieties of the subspecies americana.

CONCLUSIONS: Phenotypic variation within the Agave americana complex is associated with taxonomic identity, geographic distribution, and management intensity. The observed patterns are consistent with the effects of human selection, particularly in traits related to plant size and the reduction of defensive structures. However, further studies integrating common-garden experiments, population genetics, and phylogeographic analyses are required to clarify the evolutionary history and genetic basis of the observed variation.

PMID:42399974 | DOI:10.1186/s13002-026-00924-2

BMC Med Educ. 2026 Jul 3. doi: 10.1186/s12909-026-09845-w. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical belongingness is one of the most important needs of nursing students for optimal performance in learning environments and, therefore, is of particular importance in clinical education. The present study investigated the relationship between clinical instructors’ leadership styles and clinical belongingness among undergraduate nursing students.

METHODS: This cross-sectional study was conducted between January and February 2025 among undergraduate nursing students from the fourth to eighth semesters at two nursing schools affiliated with Zanjan University of Medical Sciences, Iran. A total of 274 eligible students were invited to participate. After excluding 21 incomplete questionnaires, data from 253 students were analyzed. Data were collected using a demographic questionnaire, the Multifactor Leadership Questionnaire (MLQ-6 S), and the Belongingness Scale-Clinical Placement Experience (BES-CPE). Data were analyzed using descriptive and inferential statistics, including independent t-test, ANOVA, Pearson correlation, and multiple regression analyses, with a significance level of 0.05.

RESULTS: The mean total score of clinical belongingness in students was 100.04 ± 20.47, which is moderate. From their perspective, the highest and lowest mean scores of clinical instructors’ leadership styles were for transactional (3.86/average per item) and transformational (1.91/average per item), respectively. Also, there was a statistically significant relationship between transformational and transactional leadership styles and clinical belongingness, and these two styles were associated with 18% of the variance in students’ clinical belongingness.

CONCLUSION: The results of this study showed a positive relationship between clinical instructors’ leadership styles and clinical belongingness among nursing students. Therefore, it is recommended to provide training opportunities that familiarize clinical instructors with different leadership styles and encourage the use of leadership approaches that are associated with higher levels of clinical belongingness among nursing students.

PMID:42399972 | DOI:10.1186/s12909-026-09845-w

BMC Oral Health. 2026 Jul 3. doi: 10.1186/s12903-026-08968-2. Online ahead of print.

ABSTRACT

OBJECTIVES: This in vitro study compared the shear bond strength (SBS) and failure mode of laser-sintered orthodontic metal specimens bonded to enamel using different bonding protocols (with or without enamel sandblasting and four adhesive systems).

METHODS: Two hundred and forty bovine teeth were randomly allocated to no sandblasting (control) or sandblasting (50 µm, 1 bar) and bonded with 3D-printed Co-Cr discs using either light-curing orthodontic adhesives (Transbond XT, Transbond LR) or dual-curing resin cements (RelyX Unicem 2 Automix, Panavia SA Cement Universal Automix) (2 × 4 design; n = 30/group). After SBS testing, the failure mode was documented. Welch’s ANOVA was used to compare SBS across groups (S, C, and subgroups); p < 0.05 was considered significant.

RESULTS: Dual-curing adhesives (RX, PA) showed higher SBS than light-curing adhesives (XT, LR) (p = 0.001). The highest SBS was observed in RX (33 MPa), and the lowest in XT (18 MPa). A surface treatment × adhesive effect was found, although not statistically significant (p = 0.21). Failures occurred mainly on the metal side (> 50%; 140/240).

CONCLUSIONS: Dual-curing adhesives showed higher SBS when bonding laser-sintered Co-Cr appliances to bovine enamel, with failures predominantly occurring on the metal side. Sandblasting of enamel did not increase SBS under the conditions tested. As SBS values exceeded the clinically acceptable range, additional enamel sandblasting may not be clinically necessary.

CLINICAL SIGNIFICANCE: For bonding laser-sintered Co-Cr appliances, dual-curing adhesives may provide clinically acceptable SBS, but higher values could increase enamel damage risk during debonding. Enamel sandblasting showed no SBS benefit in this protocol.

PMID:42399964 | DOI:10.1186/s12903-026-08968-2

J Transl Med. 2026 Jul 3. doi: 10.1186/s12967-026-08546-8. Online ahead of print.

ABSTRACT

BACKGROUND: Gynecologic cancers remain a substantial clinical challenge, particularly in advanced stages, where treatment options are often associated with limited efficacy and poor prognosis. Given the emerging success of HER2-targeted antibody-drug conjugates (ADCs) across solid tumors, accurate evaluation of HER2 status is essential. This study investigated intratumoral HER2 heterogeneity in gynecologic cancers to refine detection accuracy and improve patient stratification for targeted therapy.

METHODS: A retrospective cohort of 416 patients with gynecologic malignancies was analyzed using immunohistochemistry (IHC) testing on separate dual formalin-fixed paraffin-embedded (FFPE) tumor blocks. HER2 expression was scored according to ASCO/CAP gastric criteria, and heterogeneity was defined as discordant IHC scores across blocks. Statistical analyses were performed using McNemar’s test, and clinical predictors of discordance were identified through multivariate logistic regression.

RESULTS: Across all tumors, HER2 IHC scores were distributed as 0 (49.5%), 1+ (33.9%), 2+ (15.6%), and 3+ (1.0%). HER2 overexpression was most frequent in uterine serous carcinoma, uterine endometrioid carcinoma, and ovarian clear cell carcinoma in our cohort. Intratumoral discordance was observed in 20.7% of cases, with the highest rates in uterine (23.9%, 21/88), ovarian (21.4%, 39/182), and cervical (18.2%, 26/143) tumors. Dual-block assessment revealed that most discrepancies resulted from incremental shifts in HER2 expression, primarily from 0 to 1 + or 1 + to 2+. This approach reclassified 13.5% of tumors originally reported as HER2-0 to HER2 expression.

CONCLUSION: Intratumoral HER2 heterogeneity is common in gynecologic cancers and frequently results in underestimation of HER2 expression when single-block assessment is used. Dual-block evaluation improves detection sensitivity and may refine patient selection for HER2-targeted antibody-drug conjugates.

PMID:42399958 | DOI:10.1186/s12967-026-08546-8

Chiropr Man Therap. 2026 Jul 3. doi: 10.1186/s12998-026-00665-9. Online ahead of print.

ABSTRACT

BACKGROUND: The Imposter Phenomenon (IP)-doubting one’s abilities despite clear achievements-is well-documented among healthcare professionals but has never been studied among practicing chiropractors, who face unique challenges including professional isolation and ambiguous healthcare identity. This study aimed to determine IP prevalence among South African chiropractors and investigate associations with age, gender, years of experience, and province.

METHODS: A cross-sectional survey using the validated Clance Imposter Phenomenon Scale (CIPS) was distributed via email to all 960 chiropractors registered with the Allied Health Professions Council of South Africa. Data were collected online from 25 March to 17 May 2024. Descriptive statistics, independent-samples t-tests, and one-way ANOVA were used; results are interpreted through effect sizes (Cohen’s d) and 95% confidence intervals, with exact p-values reported as continuous evidence measures. Cronbach’s alpha assessed reliability. The study followed STROBE and CHERRIES guidelines.

RESULTS: Of 159 chiropractors (16.6% response rate), mean age was 37.8 years (SD = 10.8); 61.6% were female. Mean CIPS score was 50.78 (SD = 16.82), indicating moderate IP. Severity distribution: 33.3% few, 39.0% moderate, 22.6% frequent, 5.0% intense IP (66.6% at or above moderate threshold). Females scored higher than males (55.66 vs. 42.93; t(147.69)= – 5.25, p < 0.001; d = 0.85). Chiropractors ≤ 35 years scored higher than those > 35 years (53.52 vs. 47.95; t(152) = 2.05, p = 0.042; d = 0.33). Chiropractors with ≤ 10 years of experience showed a non-significant trend toward higher IP scores than those with > 10 years (52.90 vs. 47.94; two-tailed p = 0.066; d = 0.30). No provincial differences were found (F(3,155) = 0.62, p = 0.601). Cronbach’s α was 0.94.

CONCLUSIONS: Moderate to intense IP affects two-thirds of chiropractors in this South African sample, particularly females and early-career practitioners. These findings highlight the need for targeted mental health interventions, mentorship, and peer support. This first study of IP among practicing chiropractors provides evidence for practitioner well-being initiatives with implications for chiropractic education, professional development, and retention.

PMID:42399952 | DOI:10.1186/s12998-026-00665-9

BMC Med Educ. 2026 Jul 3;26(1):1070. doi: 10.1186/s12909-026-09247-y.

ABSTRACT

Early obstacles to career progression of women in surgery present a major challenge in a variety of surgical subspecialties. Although there is a variety of literature on the attitudes and needs of female residents and trainees to foster interest in a career as a surgeon, there is a lack of research about the perspectives of female medical students about a possible career as a surgeon. In this paper, we report the results of a multicentric study on the evolving needs of female medical students to consider a career as a surgeon in Germany. We confirm several results mentioned in the available literature on the topic, but also add novel insights, in particular, which attitudes and obstacles already shape earlier than during trainee programmes or residency, namely, during medical school. Our results indicate that a curriculum to foster interest in surgical careers has to incorporate three core ingredients: (1) Effective concepts against gender discrimination, (2) measures to work towards more flexible work times and better work-life-balance of female surgeons and (3) an increase in female role models and mentoring programmes, tailored specifically for female medical students.

PMID:42399949 | DOI:10.1186/s12909-026-09247-y

BMC Med. 2026 Jul 3. doi: 10.1186/s12916-026-05033-1. Online ahead of print.

ABSTRACT

BACKGROUND: Gestational diabetes mellitus (GDM) is a well-established risk factor for subsequent type 2 diabetes mellitus (T2DM). However, its long-term association with diabetic microvascular complications, particularly diabetic retinopathy (DR), and the joint role of polycystic ovary syndrome (PCOS) remain incompletely understood.

METHODS: Using the Korean National Health Insurance Service database, we conducted a nationwide retrospective cohort study including 406,309 women who had their index delivery between 2005 and 2012. Standard Cox proportional hazards models were used to evaluate the incidence of T2DM and systemic complications. For DR and vision-threatening DR (VTDR), time-varying covariate Cox models were applied in the full cohort, with incident T2DM treated as a time-dependent variable. Sensitivity analyses restricted to women who developed T2DM were also performed. Stratified analyses evaluated the joint and independent effects of coexisting PCOS.

RESULTS: During follow-up, women with prior GDM had a higher risk of developing T2DM (adjusted hazard ratio [aHR] 3.52; 95% CI 3.26-3.80). In time-varying analyses, prior GDM was associated with an increased risk of vision-threatening DR (VTDR) (aHR 2.28; 95% CI 1.06-4.92), whereas overall DR did not show a consistent positive association across analysis. Women with both GDM and PCOS had the highest risk of T2DM and VTDR compared with those with neither condition (aHR 4.96 and 31.90, respectively). In contrast, although some macrovascular outcomes showed statistically significant associations, the overall magnitude of risk increase was modest.

CONCLUSIONS: A history of GDM was associated with an increased long-term risk of severe diabetic retinal outcomes, particularly VTDR, after the onset of T2DM. The coexistence of PCOS is associated with a higher overall risk burden, with women having both conditions showing the highest risks. These findings support the need for individualized metabolic and ophthalmic surveillance in women with prior GDM, particularly those with coexisting PCOS.

PMID:42399945 | DOI:10.1186/s12916-026-05033-1

BMC Health Serv Res. 2026 Jul 3. doi: 10.1186/s12913-026-14905-4. Online ahead of print.

ABSTRACT

BACKGROUND: Effective pain management and safe opioid prescribing remain major challenges in healthcare delivery. Prior research demonstrates that clinicians often manage chronic pain with little or no formal training in pain management, contributing to low confidence and apprehension when prescribing opioids. Surveys also show that insufficient knowledge and inadequate preparation are among the most common barriers to adopting evidence-based opioid-prescribing practices. This study examined Clinicians’ beliefs, knowledge, and experiences regarding pain management and opioid prescribing at a large academic health system.

METHODS: A cross-sectional survey was administered to about 500 clinicians across multiple specialties including internal medicine, general pediatrics, surgery, family medicine and others at Loma Linda University Health (LLUH) in Spring 2018. A 54-item survey instrument developed primarily from existing medical and pharmacy education literature was used to assess clinicians’ beliefs, knowledge, and experiences related to pain management. Descriptive statistics summarized demographic and clinical characteristics. Independent t-tests and correlation analyses evaluated associations between clinicians’ beliefs, knowledge and experiences regarding pain management and opioid prescribing.

RESULTS: Of 262 surveys returned, 255 complete responses were included for a 51% response rate. Respondents averaged 8.3 years in clinical practice and worked approximately 48 h weekly. Only 34.6% reported receiving formal pain-management training. Most clinicians (76.1%) believed opioid misuse is a major community problem, and 71.4% agreed that medical education devotes insufficient time to pain-management topics. Confidence in opioid-related counseling was low; however, fewer than half felt adequately trained or knowledgeable to manage chronic pain safely. Clinicians with formal training reported significantly higher confidence in counseling about pain, opioid use, and opioid misuse (p < 0.001). Residents were more likely than attending physicians to view their institution’s pain-management resources positively, while attendings rated their own knowledge and training more favorably. Years of clinical experience correlated positively with perceived adequacy of training (r = 0.206, p = 0.001) and knowledge (r = 0.176, p = 0,006), but negatively with perceived need for more education on opioid misuse (r=-0.241, p < 0.001).

CONCLUSIONS: Within a single academic health system, pain management beliefs and perceived knowledge differed significantly between attending physicians and residents, underscoring the influence of training stage. Formal education emerged as a key determinant of preparedness, while persistent educational gaps highlight the need for system-level improvement. Addressing these challenges will require integrated strategies that combine targeted education, workflow-embedded supports, and institutional commitment to evidence-based, comprehensive pain care.

PMID:42399944 | DOI:10.1186/s12913-026-14905-4