Category: Nevin Manimala

J Pediatr Urol. 2025 Sep 20:S1477-5131(25)00467-X. doi: 10.1016/j.jpurol.2025.09.002. Online ahead of print.

ABSTRACT

INTRODUCTION: Penile curvature often accompanies hypospadias, and numerous techniques have been described for its correction; however, in some cases, an abnormal erection angle may also be present, further exacerbating the perception of curvature.

OBJECTIVE: This study investigates the significance of the erection angle in hypospadias cases and its correlation with the severity of the anomaly.

STUDY DESIGN: A retrospective analysis of intraoperative photographs of hypospadias cases operated between 2019 and 2023 was performed. Erection angle was measured with a digital goniometer during a full artificial erection. Erection angles in proximal and distal hypospadias cases were analyzed and compared to data from Kinsey’s subgroups representing healthy male erection angles.

RESULTS: This study involved images of 68 patients, with 31 having proximal and 37 distal hypospadias. The median age of the whole group was 11 months (6-156, IQR 9). Median erection angle was 91 (63-119, IQR 11) for distal cases, whereas it was 96 (75-138, IQR 21) for proximal cases. The difference was statistically significant (p = 0.009). The erection angle distribution in our cohort, including both proximal and distal hypospadias cases, skewed toward wider angles, highlighting a distinct pattern compared to data constituted by Kinsey and Sparling.

DISCUSSION: Our findings indicate that the erection angle in hypospadias is significantly wider in proximal cases, suggesting a correlation between erection angle and severity of the hypospadias. While we acknowledge the limitation of comparing our prepubertal cohort with Kinsey’s adult data, the absence of evidence suggesting significant post-pubertal changes in erection angle justifies this approach. Additionally, the use of digital images for angle assessment is not a standardized technique in hypospadias evaluation; these images were initially captured for curvature assessment. Despite these limitations, our study provides novel insights into seldom mentioned association with hypospadias – a wide erection angle, emphasizing the need for further research on its implications for surgical planning and long-term outcomes.

CONCLUSION: This study introduces a wider erection angle as an additional characteristic of hypospadias particularly pronounced in proximal cases. To our knowledge, this is the first focused investigation on addressing this aspect of the condition. It emphasizes the need for further research on adults with wide post-repair erection angles to explore its long-term impact on sexual function and aesthetics.

PMID:40976740 | DOI:10.1016/j.jpurol.2025.09.002

J Natl Med Assoc. 2025 Sep 20:S0027-9684(25)00315-3. doi: 10.1016/j.jnma.2025.09.002. Online ahead of print.

ABSTRACT

Black doctors have long navigated a medical field marked by exclusion, resistance and resilience. From legalized hospital segregation in the 19th and early 20th centuries to enduring racial and gender biases in contemporary residency programs, systemic barriers continue to drive the underrepresentation of Black physicians across specialties. Situating personal testimony within this historical context, this narrative examines statistical patterns in Black physician representation and the present-day challenges faced by Black residents through the lens of the Black narrative tradition of bearing witness and asserting truth. It honors the legacies of pioneering physicians-Drs. Daniel Hale Williams, Thomas R. Peyton, and Isabella Vandervall-whose lives exemplify both the persistence of structural inequality and a blueprint for achieving justice in medicine. Their influence resonates in the work of Black doctors today, who develop programs and initiatives (e.g., pipeline programs, racial affinity groups, and global health exchanges) that expand access, foster inclusion, and promote cross-cultural collaboration in medical education and training. By highlighting historical and contemporary strategies for overcoming systemic barriers, this article emphasizes the critical role of justice-oriented initiatives in transforming medical institutions and advancing equity, representation, and belonging across the profession.

PMID:40976718 | DOI:10.1016/j.jnma.2025.09.002

Environ Health Prev Med. 2025;30:74. doi: 10.1265/ehpm.25-00194.

ABSTRACT

BACKGROUND: Supporting the mental health of researchers is essential to maintaining human resources and advancing science. This study investigated the association between Japanese medical researchers’ perceptions of research evaluation processes and their psychological well-being.

METHODS: We performed a web-based self-administered questionnaire survey. The questionnaires were distributed to each academic society through the Japanese Association of Medical Sciences from December 2022 to January 2023. These questionnaires targeted medical researchers. Exposure was the medical researchers’ perceptions of quantitative indicators for evaluating medical research and researchers. The outcome was psychological well-being, measured using the Japanese version of the World Health Organization-Five Well-Being Index (WHO-5). Multivariable-adjusted logistic regressions were conducted to investigate the association between individual attitudes toward research evaluation and psychological well-being. Stratified analyses by research fields, i.e., clinical, basic, and social medicine, were also performed.

RESULTS: A total of 3,139 valid responses were collected. After excluding 176 responses from research fields of other than clinical, basic, or social medicine, 2,963 researchers (2,185 male, 737 female, and 41 other) were analyzed. Prevalence of poor well-being (WHO-5 score <13) was 28.3% in the researchers. The highest number of medical researchers was in clinical medicine (n = 500) followed by basic medicine (n = 217) and social medicine (n = 121). Medical researchers who considered research funding slightly important/not important for researcher evaluation had poorer psychological well-being than those who considered it especially important (slightly important: adjusted odds ratio (aOR) 1.33, 95% confidence interval (CI) 1.03-1.71; not important: aOR 1.53, 95%CI 1.10-2.12). This tendency was stronger among basic medical researchers than clinical or social medical researchers. The research field significantly modified the relationship between research funding received and interaction with poor psychological well-being both additively (P = 0.030) and multiplicatively (P = 0.024).

CONCLUSIONS: The discrepancy between medical researchers’ attitudes toward research evaluation and the current state of research evaluation in their research community may worsen their psychological well-being. The influence of this discrepancy differs among clinical, basic, and social medicine. Appropriate evaluation of medical research and researchers in each field can facilitate improving their psychological well-being via the resolution of this discrepancy.

PMID:40976704 | DOI:10.1265/ehpm.25-00194

BMJ Open. 2025 Sep 21;15(9):e095532. doi: 10.1136/bmjopen-2024-095532.

ABSTRACT

INTRODUCTION: Ischaemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide. Despite strong recommendations, the implementation rate of outpatient cardiac rehabilitation (CR) in Japan remains low. Mobile health technologies, such as Personal Health Record (PHR) applications combined with wearable devices, may enhance adherence to rehabilitation programmes. This study aims to evaluate the effectiveness of a continuous support programme that integrates a PHR app and counselling services in improving the continuation rate of outpatient CR and exercise tolerance in patients with IHD.

METHODS AND ANALYSIS: This is a single-blind randomised controlled trial with a parallel-group design. A total of 72 participants with IHD will be recruited from the outpatient departments of Maebashi Red Cross Hospital, Gunma Saiseikai Maebashi Hospital, Okayama University Hospital, Okayama Red Cross Hospital, Momoyama-kai Ono Internal Clinic, Hiroshima University Hospital, Tshuyama Jifu-kai Tsuyama Chuo Hospital and Shinpu-kai Tamashima Chuo Hospital. Participants will be randomly allocated to either the intervention group, which will receive a wearable device, a PHR app, counselling services and a rehabilitation notebook, or the control group, which will receive a wearable device and a rehabilitation notebook without the PHR app and counselling. The primary outcome is the change in peak oxygen uptake from baseline to 150 days. Secondary outcomes include changes in anaerobic threshold, number of outpatient rehabilitation visits, daily steps and vital signs. Data will be analysed using a generalised estimating equations for primary outcomes and appropriate statistical tests for secondary outcomes, following an intention-to-treat approach.

ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the ethics committee of the Kyoto University Graduate School and Faculty of Medicine (C1669-1). In addition, permission to conduct the study was granted by the director of each participating institution. Participants will provide informed consent prior to participation. Findings will be disseminated through peer-reviewed journals, conferences and summary reports to stakeholders.

TRIAL REGISTRATION NUMBER: This trial is registered with the University hospital Medical Information Network (UMIN) Clinical Trials Registry (trial identifier: UMIN000055823).

PMID:40976676 | DOI:10.1136/bmjopen-2024-095532

BMJ Open. 2025 Sep 21;15(9):e093304. doi: 10.1136/bmjopen-2024-093304.

ABSTRACT

OBJECTIVE: This paper examines the impact of India’s National Publicly Funded Health Assurance Scheme, Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PM-JAY), in Haryana on out-of-pocket (OOP) expenses and catastrophic health expenditure (CHE).

DESIGN: We conducted a case-control study using a stratified random sampling approach.

SETTINGS: Six districts in Haryana, based on utilisation, were selected: Mewat, Faridabad, Sonipat, Ambala, Kurukshetra and Karnal.

PARTICIPANTS: A total sample size of 772 individuals, that is, 386 PM-JAY beneficiaries (cases) and non-beneficiaries (controls) each.

INTERVENTION: Data were collected using a semistructured questionnaire covering household demographics and expenditure details. The interview gathered information on hospitalisation within the past year, types of ailments, the type of empanelled facility visited, expenditure details and borrowing/selling of assets for treatment.

PRIMARY AND SECONDARY OUTCOMES: Mean OOP expenditure was calculated for beneficiaries and non-beneficiaries based on the type of healthcare provider. The impact of PM-JAY on OOP expenditure was analysed using a generalised linear model controlling for religion, caste, type of house, type of family, morbidity patterns, type of disease, type of health facility, hospital stay duration, average distance to the facility and travel time. CHE was defined as OOP payments ≥30% of household income. Logistic regression was used to assess the determinants of CHE.

RESULTS: We found that direct medical expenses incurred for hospitalisations were 65% lower for beneficiaries (11 131 rupees) compared with non-beneficiaries (31 675 rupees). While OOP expenditures are similar for both groups in public empanelled hospitals, non-beneficiaries incur OOP costs three times higher than PM-JAY beneficiaries in private empanelled hospitals. Factors, including the disease type, average distance from home to the facility, average travel time and type of hospital, significantly influence these expenses. Furthermore, the prevalence of CHE is significantly lower among PM-JAY beneficiaries (13.3%) compared with non-beneficiaries (45.9%), with an OR of 7.15 (95% CI: 4.74 to 10.80; p<0.01).

CONCLUSIONS: Our analysis shows the scheme’s impact on decreasing OOP expenditure and CHE. To enhance the scheme’s effectiveness, the study highlights the necessity of addressing non-medical expenses and expanding coverage for indirect costs, such as food, accommodation and transportation. Additionally, strengthening the supply side through improved drug availability at healthcare facilities is crucial for enhancing financial protection and access to care.

PMID:40976675 | DOI:10.1136/bmjopen-2024-093304

BMJ Open. 2025 Sep 21;15(9):e095290. doi: 10.1136/bmjopen-2024-095290.

ABSTRACT

OBJECTIVES : To provide a contemporary, postpandemic description of UK occupational therapy and physiotherapy practice to rehabilitate the upper limb after stroke. SETTING : A national online survey, first undertaken in 2018 (prepandemic), was readministered to describe postpandemic practice.

PARTICIPANTS: The survey was distributed to UK-based occupational therapists and physiotherapists working with people after stroke, via professional and social networks.

PRIMARY MEASURES: Shaped by the Template for Intervention Description and Replication Checklist, the survey collected and subsequently analysed the content, frequency and duration of upper limb rehabilitation after stroke.

RESULTS: A total of 122 occupational therapists (n=42) and physiotherapists (n=80) currently working clinically, across in-patient, out-patient and community settings, in the UK completed the survey. Respondents reported treating the upper limb a median of three times a week (IQR 2-4; range 0-6) for a median of 25 min (IQR: 20-35; range 3-60; n=119). Repetitive, functionally-based activities were the most commonly reported interventions for mild (n=93; 81%) and moderate (n=72; 64%) impairment. Stretching (n=73; 66%) and positioning (n=49; 45%) were most frequently reported for severe impairment. In each of the three impairment categories, a larger number of interventions were reported than in the 2018 survey.

CONCLUSIONS: While the pandemic promoted the use of virtual interventions, most therapists had returned to face-to-face interventions. The findings highlight that the current reported provision of upper limb therapy continues to be markedly less than the dose shown to be effective. The study provides important data which can be used to judge the success of attempts to align practice with new guidelines and inform ‘usual therapy’ for the upper limb after stroke in comparative studies.

PMID:40976671 | DOI:10.1136/bmjopen-2024-095290

BMJ Open. 2025 Sep 21;15(9):e102812. doi: 10.1136/bmjopen-2025-102812.

ABSTRACT

BACKGROUND: Acute decompensated heart failure (ADHF), characterised by rapid deterioration of cardiac function, imposes substantial clinical and economic burdens due to high mortality (10%), frequent rehospitalisations (30% within 3 months) and impaired health-related quality of life. While exercise-based cardiac rehabilitation (ExCR) is a guideline-recommended intervention for stable heart failure, its utilisation remains critically low (11%) in ADHF populations, particularly during the vulnerable period spanning 90 days post-discharge-a high-risk phase marked by elevated mortality and morbidity. Current evidence gaps persist regarding optimal ExCR timing, dosage and efficacy during this critical window. This randomised controlled trial investigates the feasibility and impact of early ExCR initiation in the ADHF vulnerable period, evaluating outcomes in physical capacity, cardiac function and quality of life to inform evidence-based exercise protocols for this high-risk population.

METHODS: This prospective, non-inferiority, randomised controlled trial will recruit 88 patients with ADHF. Participants will be randomised 1:1 to a 12-week personalised ExCR group or a traditional health education-based CR control group. Assessments will occur at baseline and 1, 2 and 3 months. The primary outcome is the change in 6 min walk distance post-intervention. Secondary outcomes include changes in grip strength, New York Heart Association Classification(NYHA class), brain natriuretic peptide, left ventricular ejection fraction, hospital stay, Short Physical Performance Battery score, Activities of Daily Living, Minnesota Living with Heart Failure Questionnaire score, and frailty status. Safety measures include all-cause readmission and mortality within 3 months post-discharge, as well as adverse events during the trial.

ETHICS AND DISSEMINATION: The study protocol was approved by the Peking University First Hospital Ethics Committee (Approval No. 2024yan180-002) in accordance with the Declaration of Helsinki. All participants will provide written informed consent prior to enrolment. The findings will be disseminated via peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER: This study protocol was registered at ClinicalTrials.gov (Identifier: NCT06795737, https://www.

CLINICALTRIALS: gov/.) on 26 January 2025.

PMID:40976670 | DOI:10.1136/bmjopen-2025-102812

BMJ Open. 2025 Sep 21;15(9):e106708. doi: 10.1136/bmjopen-2025-106708.

ABSTRACT

INTRODUCTION: The WHO has declared climate change the defining public health challenge of the 21st century. Incorporating climate and environmental outcomes in randomised trials is essential for enhancing healthcare treatments’ sustainability and safeguarding global health. To implement such outcomes, it is necessary to establish a framework for unbiased and transparent planning and reporting. We aim to develop extensions to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT 2025) and Consolidated Standards of Reporting Trials (CONSORT 2025) statements by introducing guidelines for reporting climate and environmental outcomes.

METHODS AND ANALYSIS: This is a protocol for SPIRIT and CONSORT extensions on reporting climate and environmental outcomes in randomised trials termed SPIRIT-Implementing Climate and Environmental (ICE) and CONSORT-ICE. The development of the extensions will consist of five phases: phase 1-project launch, phase 2-review of the literature, phase 3-Delphi survey, phase 4-consensus meeting and phase 5-dissemination and implementation. The phases are expected to overlap. The SPIRIT-ICE and CONSORT-ICE extensions will be developed in parallel. The extensions will guide researchers on how and what to report when assessing climate and environmental outcomes.

ETHICS AND DISSEMINATION: The protocol was submitted to the Danish Research Ethics Committees, Denmark in June 2025. Ethics approval is expected in September 2025. The SPIRIT and CONSORT extensions will be published in international peer-reviewed journals.

PMID:40976669 | DOI:10.1136/bmjopen-2025-106708

Sex Reprod Healthc. 2025 Sep 8;46:101145. doi: 10.1016/j.srhc.2025.101145. Online ahead of print.

ABSTRACT

BACKGROUND: Weight stigma is pervasive in society and negatively affects the quality of maternity care for women with larger bodies. Healthcare providers’ attitudes and beliefs about weight and larger bodied people contribute to experiences of weight stigma, yet the extent of weight stigma attitudes and beliefs in Australian maternity care providers is not known.

OBJECTIVE: This study aimed to explore maternity care providers’ attitudes and beliefs regarding weight and body size during pregnancy.

METHODS: A cross-sectional survey with Australian maternity care providers, using the Fat Attitudes Assessment Toolkit (FAAT), with an open-ended ‘any other comments’ text response, was undertaken. Quantitative responses were analysed using descriptive statistics and qualitative inductive content analysis.

RESULTS: Maternity care providers (n = 243) from across Australia responded to the survey. Responses indicated a strong emphasis on empathy towards larger bodied pregnant women, with providers acknowledging the socioeconomic and societal impact on the complexity of weight and body size. Responses also highlighted providers’ internalised weight stigma. Free-text responses reflected mixed views on the balance between addressing health risks and avoiding weight stigma, with a need for more resources and education on weight-inclusive care.

CONCLUSION: Maternity care providers are aware of the complexities of caring for larger bodied women. Tailored interventions that promote empathy and reduce weight-based discrimination are recommended.

PMID:40975910 | DOI:10.1016/j.srhc.2025.101145

Int J Nurs Stud. 2025 Sep 12;172:105216. doi: 10.1016/j.ijnurstu.2025.105216. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical decision-making is a core competency in emergency nursing, requiring rapid and accurate assessments. With the growing integration of Generative Artificial Intelligence in healthcare, there is a pressing need to understand its potential as a clinical decision support tool. While Generative Artificial Intelligence models show high accuracy and consistency, their ability to navigate complex, context-sensitive scenarios remains in question.

OBJECTIVES: This study aimed to compare the clinical decision-making performance of emergency nurses from Israel and Italy with Generative Artificial Intelligence models (Claude-3.5, ChatGPT-4.0, and Gemini-1.5). It evaluated differences in severity assessment, hospitalization decisions, and test selection, while exploring the influence of demographic and professional characteristics on decision accuracy.

METHODS: A prospective observational study was conducted among 82 emergency nurses (49 from Italy, 33 from Israel), each independently evaluating five standardized clinical cases. Their decisions were compared with those generated by Generative Artificial Intelligence models using a structured evaluation rubric. Statistical analyses included ANOVA, chi-square tests, logistic regression, and receiver operating characteristic curve analysis to assess predictive accuracy.

RESULTS: Generative Artificial Intelligence models exhibited higher overall decision accuracy and stronger alignment with expert recommendations. However, notable discrepancies emerged in hospitalization decisions and severity assessments. For example, in Case 2, Generative Artificial Intelligence rated severity as level 1, while Italian and Israeli nurses rated it at 1.98 and 2.23, respectively (P < 0.01, F = 199). In Case 1, only 4.1 % of Italian nurses recommended hospitalization compared to 30.3 % of Israeli nurses, whereas all Generative Artificial Intelligence models advised hospitalization. Nurses showed greater variability in test selection and severity judgments, reflecting their use of clinical intuition and contextual reasoning. Demographics such as age, gender, and years of experience did not significantly predict accuracy.

CONCLUSIONS: Generative Artificial Intelligence models demonstrated consistency and expert alignment but lacked the contextual sensitivity vital in emergency care. These results highlight the potential of Generative Artificial Intelligence as a clinical decision-support tool while emphasizing the continued importance of human clinical judgment.

PMID:40975905 | DOI:10.1016/j.ijnurstu.2025.105216