Category: Nevin Manimala

BMC Med Educ. 2026 Mar 4. doi: 10.1186/s12909-026-08915-3. Online ahead of print.

ABSTRACT

BACKGROUND: Emergency medicine residents perform invasive procedures under time pressure, clinical uncertainty, and medico-legal risk, which can generate substantial anxiety among residents themselves. In this study, anxiety refers specifically to the practitioners’ own emotional and cognitive responses while performing invasive procedures, rather than to patient-related anxiety. Although fear of malpractice and general anxiety have been studied, their relationship with procedure-specific anxiety and perceived clinical competence has not been examined in an integrated manner among emergency medicine residents.

METHODS: This two-phase cross-sectional study included 168 emergency medicine residents from emergency departments across Türkiye. An online survey assessed procedure-related anxiety, perceived procedural difficulty, procedural self-efficacy, fear of malpractice, and trait anxiety across nine invasive procedures. Descriptive statistics were calculated, gender differences were examined using independent samples t-tests, and associations among variables were analyzed using Pearson correlation coefficients.

RESULTS: Higher perceived procedural difficulty was strongly associated with higher procedure-related anxiety, while higher self-efficacy was strongly associated with lower anxiety. Greater training duration was linked to lower perceived difficulty and anxiety and to higher self-efficacy. Trait anxiety showed moderate positive associations with perceived difficulty and procedure-related anxiety and a negative association with self-efficacy. Fear of malpractice was only weakly associated with procedure-related anxiety and was unrelated to training duration or self-efficacy. Female residents reported higher general and procedure-specific anxiety than male residents. Lack of experience and fear of complications were the most frequently reported sources of anxiety, and supervision by more experienced physicians was the most commonly used and valued coping strategy.

CONCLUSIONS: Procedure-related anxiety among emergency medicine residents is closely related to perceived difficulty, self-efficacy, and clinical experience, whereas fear of malpractice appears to be a relatively stable background concern. These findings suggest that procedural anxiety is a modifiable educational outcome that can be addressed through structured supervision, simulation-based training, and supportive learning environments.

TRIAL REGISTRATION: Not applicable. This study is an observational cross-sectional survey and was not registered.

PMID:41781925 | DOI:10.1186/s12909-026-08915-3

BMC Gastroenterol. 2026 Mar 4. doi: 10.1186/s12876-026-04714-8. Online ahead of print.

ABSTRACT

BACKGROUND: Biliary tract cancers (BTCs) in East Asia have traditionally been linked to inflammation-related etiologies. However, metabolic risk factors are increasingly contributing to BTC development. Temporal trends in BTC epidemiology remain underexplored in the Korean population. This study aimed to review 13-year trends in BTCs, focusing on metabolic and inflammatory comorbidities, in a southeastern Korean cancer center historically characterized by a high incidence of inflammation-related BTCs.

METHODS: This retrospective observational study analyzed 2,001 patients diagnosed with BTC at a southeastern Korean cancer center between 2009 and 2021. Data on general demographics (age, sex, smoking, alcohol), metabolic factors (hypertension, body mass index (BMI) ≥ 25 kg/m², diabetes mellitus, hyperlipidemia), and inflammatory conditions (viral hepatitis, liver cirrhosis, bile duct stone, liver fluke infection) were collected from electronic medical records. Annual trends in clinical and demographic variables were evaluated using the Cochran-Armitage trend test.

RESULTS: The cohort comprised 680 patients with gallbladder cancers and 586 patients with intrahepatic, 367 patients with perihilar, and 368 patients with distal cholangiocarcinomas. Gallbladder cancer was more common in females, whereas intrahepatic and distal cholangiocarcinomas were more prevalent in males. Over 13 years, the prevalence of hypertension and BMI ≥ 25 kg/m² significantly increased (both p < 0.001). The prevalence of diabetes mellitus remained stable at approximately 26%. Although the proportion of patients with inflammatory factors increased from 38.9% to 49.7%, this trend was not statistically significant (p = 0.646).

CONCLUSIONS: These findings indicate an ongoing epidemiological transition in BTC risk profiles in Korea, with metabolic factors, such as hypertension and obesity, playing an increasingly prominent role.

PMID:41781899 | DOI:10.1186/s12876-026-04714-8

BMC Infect Dis. 2026 Mar 4. doi: 10.1186/s12879-026-13000-7. Online ahead of print.

NO ABSTRACT

PMID:41781891 | DOI:10.1186/s12879-026-13000-7

J Radiol Prot. 2026 Mar 4. doi: 10.1088/1361-6498/ae4d57. Online ahead of print.

ABSTRACT

BACKGROUND: The Rocky Flats (RF) Plant operated from 1951-1989 as part of the U.S. Department of Energy (DOE) nuclear complex. Its primary mission was weapons component fabrication, whereby workers were potentially exposed to radioactive and non-radioactive hazards. RF worker mortality was compared to the general population, and dose-response relationships between mortality and radiation organ doses were examined.

METHODS: RF workers first employed between 1951 through 1979 for ≥30 days were identified (n=9,397). Vital status was determined using national and state death records through 2017. Organ doses from external photons and neutrons irridation and internalized plutonium, americium, and uranium were modeled as cumulative lagged total dose per year. Beryllium exposure was evaluated as an effect modifier using data from the DOE Nationwide Beryllium Medical Program. Statistical analyses included standardized mortality ratios (SMRs), Cox proportional hazard models, and excess relative risk (ERR) models.

RESULTS: Approximately 53.2% were deceased by the end of study. Nearly 90% were monitored for radiation exposure, with mean weighted absorbed dose of 59.0 mGy for lung. Nearly 45% of workers had intakes of alpha-particle emitting radionuclides, and 46.7% were monitored for neutrons. Leading causes of death included ischemic heart disease (n=999) and lung cancer (n=361). The highest SMRs were observed for berylliosis (SMR: 176.9; 95% CI: 76.2, 348.7; n<10) and asbestosis (SMR: 4.65; 95% CI: 2.23, 8.55;n=10). Dose-response analyses showed no statistical increase in risk from low-dose radiation including lung cancer (ERR per 100 mGy: -0.02; 95% CI: -0.11, 0.08; n=361) and Parkinson’s disease (ERR per 100 mGy: 0.13; 95% CI: -0.26, 0.31; n=57). Approximately 45% of workers were monitored for beryllium, with a weak non-significant indication of effect modification for lung cancer risk.

CONCLUSION: The RF cohort showed no evidence of statistically significant increase in mortality from occupational radiation exposure. However, this study was limited by low statistical power, which inhibits the ability to detect effects. Future pooling of MPS cohorts will provide further insights, particularly regarding plutonium as a carcinogen.

PMID:41780076 | DOI:10.1088/1361-6498/ae4d57

Plast Reconstr Surg. 2026 Mar 4. doi: 10.1097/PRS.0000000000012984. Online ahead of print.

ABSTRACT

In surgical research, statistical sophistication is too often mistaken for scientific rigor. Across a growing body of plastic surgery literature, adjusted odds ratios, hazard ratios, and regression coef- ficients are frequently presented without the crude event rates or absolute measures of effect that give findings clinical meaning. We describe this phenomenon as “runic statistics”: results that are statistically valid yet clinically opaque. Through examples drawn from contemporary plastic surgery studies, we highlight three recurrent interpretive flaws: reliance on statistical significance without consideration of clinical relevance, reporting of relative measures without baseline risks or absolute differences, and conflation of association with causation. We further demonstrate how case-mix imbalances can create apparent contradictions in results (Simpson’s paradox), and how identical odds ratios can translate into very different clinical implications depending on the base- line risk. To address these challenges, we propose a thirteen-step reporting framework designed to promote transparency, interpretability, and clinical applicability. Key elements include explicit definition of the estimand, presentation of both crude and adjusted data, translation of relative effects into absolute risks and patient-facing numbers, assessment of minimal clinically important differences, careful handling of confounding, and restraint in the use of causal language. By an- choring statistical reporting in clinical realities, surgical research can remain both methodologically rigorous and directly relevant to patient care. Our goal is not to simplify science, but to ensure that its communication is clear, transparent, and ultimately useful at the bedside.

PMID:41780063 | DOI:10.1097/PRS.0000000000012984

N Engl J Med. 2026 Mar 5;394(10):947-957. doi: 10.1056/NEJMoa2512854.

ABSTRACT

BACKGROUND: The nonsteroidal mineralocorticoid receptor antagonist finerenone has been reported to improve kidney and cardiovascular outcomes in persons with type 2 diabetes and chronic kidney disease (CKD). The efficacy and safety of finerenone in persons with type 1 diabetes and CKD are unknown.

METHODS: We conducted a phase 3 trial involving adults who had type 1 diabetes, CKD (estimated glomerular filtration rate [eGFR], 25 to <90 ml per minute per 1.73 m² of body-surface area), and albuminuria (urinary albumin-to-creatinine ratio [with albumin measured in milligrams and creatinine measured in grams], 200 to <5000) and were receiving an angiotensin-converting-enzyme (ACE) inhibitor or an angiotensin-receptor blocker. Participants were randomly assigned to receive finerenone (10 or 20 mg per day, depending on the eGFR) or matching placebo. The primary outcome was the relative change in the urinary albumin-to-creatinine ratio over a period of 6 months.

RESULTS: A total of 242 participants underwent randomization. The median urinary albumin-to-creatinine ratio decreased from 574.6 at baseline to 373.5 at 6 months among all the participants assigned to receive finerenone and from 506.4 to 475.6 among those assigned to receive placebo. Over a period of 6 months, the urinary albumin-to-creatinine ratio decreased by 34% with finerenone (geometric mean ratio to baseline, 0.66; 95% confidence interval [CI], 0.60 to 0.73) and 12% with placebo (geometric mean ratio to baseline, 0.88; 95% CI, 0.79 to 0.98), which corresponded to a 25% greater reduction with finerenone than with placebo (geometric mean ratio for finerenone vs. placebo, 0.75; 95% CI, 0.65 to 0.87; P<0.001). The most common adverse event was hyperkalemia (in 12 participants [10.1%] with finerenone and in 4 [3.3%] with placebo); 2 participants (1.7%) discontinued finerenone because of hyperkalemia. At 6 months, the change in the eGFR was -5.6 ml per minute per 1.73 m² with finerenone and -2.7 ml per minute per 1.73 m² with placebo (difference, -2.9 ml per minute per 1.73 m²; 95% CI, -5.1 to -0.7); eGFR values approached baseline levels during the washout period.

CONCLUSIONS: In adults with type 1 diabetes and CKD, finerenone resulted in a significantly greater decrease in the urinary albumin-to-creatinine ratio than placebo. (Funded by Bayer; FINE-ONE ClinicalTrials.gov number, NCT05901831.).

PMID:41780000 | DOI:10.1056/NEJMoa2512854

J Med Econ. 2026 Dec;29(1):654-671. doi: 10.1080/13696998.2026.2630598. Epub 2026 Mar 4.

ABSTRACT

AIMS: This study compares deep learning architectures with traditional regression and tree-based models for individual-level healthcare cost prediction, with particular attention to performance differences across data contexts.

METHODS: We conducted a preregistered systematic review (PROSPERO CRD420251129440). Web of Science, PubMed, Embase, and Scopus were searched through August 2025. Eligible studies used real-world individual-level data (claims, electronic health records, or registries) to predict cost-related outcomes with at least one deep learning architecture and one classical regression comparator, and reported quantitative performance. Data were extracted on population, predictors, outcome horizon, model type, validation strategy, performance metrics, calibration, and interpretability.

RESULTS: Eight studies met inclusion criteria, spanning the United States, Europe, and Asia. In longitudinal designs-such as multi-year claims prediction and medication or hospitalization time-series forecasting-sequential deep learning models, particularly LSTM and CNN-LSTM hybrids, consistently outperformed regression and tree-based algorithms. Reported gains included approximately 10-20% reductions in RMSE/MAE, R² improvements of 0.01-0.15, and AUROC values up to 0.78 for high-risk classification. Across studies, prior costs and utilization were consistently the strongest predictors, while social determinants and free-text features were rarely incorporated. In contrast, for low-dimensional, structured, cross-sectional medical data, generalized linear models and tree-based approaches remain robust baseline models due to their interpretability and calibration stability.

LIMITATIONS: Evidence is based on a small and heterogeneous set of eight studies, with limited external or temporal validation, short prediction horizons, and sparse assessment of calibration, economic interpretability, and fairness, warranting cautious interpretation.

CONCLUSIONS: Deep learning offers clear gains for longitudinal, sequence-rich cost forecasting, whereas tree-based methods remain highly competitive for cross-sectional tabular prediction. Overall, these findings are consistent with the proposed Complexity-Performance Hypothesis, which posits that the predictive advantages of deep learning emerge primarily when model capacity is well matched to data complexity.

PMID:41779998 | DOI:10.1080/13696998.2026.2630598

J Am Acad Orthop Surg Glob Res Rev. 2026 Mar 3;10(3). doi: 10.5435/JAAOSGlobal-D-25-00432. eCollection 2026 Mar 1.

ABSTRACT

INTRODUCTION: Hospitals contribute to substantial environmental waste and greenhouse gas emissions, with operating rooms accounting for 50% to 70% of hospital waste. Arthroscopic rotator cuff repair (RCR), a commonly performed procedure, typically uses disposable instruments to minimize infection risk. There is limited evidence regarding the clinical safety and effectiveness of disposable instruments compared with reusable instruments. We aimed to evaluate whether reusable instrumentation for arthroscopic RCR affects clinical outcomes.

METHODS: This was a retrospective cohort study involving 191 patients undergoing primary arthroscopic RCR. Patients were divided into reusable (N = 89) and disposable (N = 102) instrumentation cohorts. Primary outcomes included rates of postoperative soft-tissue infection and septic revision within 1 year postoperatively. Data were analyzed using frequentist and Bayesian statistical methods.

RESULTS: Infection rates and septic revisions were similar between reusable and disposable instrumentation groups, with one septic revision in each cohort (P = 1.0). Aseptic revision rates were also similar (P = 0.50). Surgical times did not significantly differ between groups (reusable: 1.50 ± 0.33 hours; disposable: 1.61 ± 0.41 hours; P = 0.076). Bayesian analysis supported these findings, demonstrating no meaningful difference in infection risks between groups, with median odds ratios close to 1.0 and credible intervals including 1.0.

CONCLUSION: Observed proportions of revision and infection were similar in magnitude. These findings suggest that reusable instruments have the potential to be a safe and sustainable alternative to single-use instruments in arthroscopic RCR. However, owing to the rarity of infection and revision, future multisite studies are necessary to assess whether risk of these outcomes is noninferior to nonreusable instruments.

PMID:41779932 | DOI:10.5435/JAAOSGlobal-D-25-00432

J Contin Educ Nurs. 2026 Mar;57(3):130-136. doi: 10.3928/00220124-20251204-01. Epub 2026 Mar 1.

ABSTRACT

BACKGROUND: Discrepancies between nurses’ ideal and actual roles can undermine job satisfaction, role identity, and care quality. This study explored how registered nurses in Jordan perceive their ideal versus actual roles and how these perceptions differ by demographic and organizational factors.

METHOD: A descriptive cross-sectional design was used with 357 nurses from governmental, educational, and private hospitals. Data were collected with a sociodemographic questionnaire and the Pieta Nursing Role Conception tool, which evaluates service, professional, and bureaucratic roles. Analyses included descriptive statistics, t tests, and analysis of variance.

RESULTS: A significant overall discrepancy was found (mean difference = 0.52, p < .001), with the largest gaps in service (0.96) and professional roles (0.72). Bureaucratic roles were practiced more than desired (-0.08). Role discrepancies varied by age, hospital type, education, experience, and practice area.

CONCLUSION: The findings highlight the need for continuing education, leadership development, and policy reforms to align nursing roles with professional expectations and improve workforce outcomes.

PMID:41779906 | DOI:10.3928/00220124-20251204-01

J Proteome Res. 2026 Mar 4. doi: 10.1021/acs.jproteome.5c01075. Online ahead of print.

ABSTRACT

Mass spectrometry-based single-cell proteomics emerges as the most promising method for studying cellular heterogeneity at the global proteome level with unprecedented depth and coverage. Its widespread application remains limited due to robustness, reproducibility, and throughput requirements, still difficult to meet as analyzing large cohorts of single cells is necessary to ensure statistical confidence. In this context, we conducted method optimizations at three levels. First, we benchmarked three distinct workflows compatible with the nanoElute2 platform using different sample collection/preparation plate supports (EVO96 oil-free, LF48 oil-based, and LF48 oil-free, a streamlined automated sample resuspension, and direct injection protocol). Then, we compared the optimized EVO96 workflow on nanoElute2 with Evosep-based separations operating at two analytical throughputs (80 and 120 samples per day). Subsequently, we evaluated digestion efficiency using a range of enzyme/protein ratios (1:1; 10:1; 20:1; 50:1) to maximize peptide recovery. Finally, the chromatographic setup was refined to determine the best compromise between throughput and robustness. Altogether, these optimizations allowed to establish a robust workflow quantifying up to 5000 proteins in 10 min gradient time per single HeLa cell at a 55 samples-per-day throughput.

PMID:41779902 | DOI:10.1021/acs.jproteome.5c01075