Nevin Manimala

Adv Simul (Lond). 2025 May 4;10(1):26. doi: 10.1186/s41077-025-00355-1.

ABSTRACT

BACKGROUND: Simulation-based medical education (SBME) is a critical training tool in healthcare, shaping learners’ skills, professional identities, and inclusivity. Leadership demographics in SBME, including age, gender, race/ethnicity, and medical specialties, influence program design and learner outcomes. Artificial intelligence (AI) platforms increasingly generate demographic data, but their biases may perpetuate inequities in representation. This study evaluated the demographic profiles of simulation instructors and heads of simulation labs generated by three AI platforms-ChatGPT, Gemini, and Claude-across nine global locations.

METHODS: A global cross-sectional study was conducted over 5 days (November 2024). Standardized English prompts were used to generate demographic profiles of simulation instructors and heads of simulation labs from ChatGPT, Gemini, and Claude. Outputs included age, gender, race/ethnicity, and medical specialty data for 2014 instructors and 1880 lab heads. Statistical analyses included ANOVA for continuous variables and chi-square tests for categorical data, with Bonferroni corrections for multiple comparisons: P significant < 0.05.

RESULTS: Significant demographic differences were observed among AI platforms. Claude profiles depicted older heads of simulation labs (mean: 57 years) compared to instructors (mean: 41 years), while ChatGPT and Gemini showed smaller age gaps. Gender representation varied, with ChatGPT and Gemini generating balanced profiles, while Claude showed a male predominance (63.5%) among lab heads. ChatGPT and Gemini outputs reflected greater racial diversity, with up to 24.4% Black and 20.6% Hispanic/Latin representation, while Claude predominantly featured White profiles (47.8%). Specialty preferences also differed, with Claude favoring anesthesiology and surgery, whereas ChatGPT and Gemini offered broader interdisciplinary representation.

CONCLUSIONS: AI-generated demographic profiles of SBME leadership reveal biases that may reinforce inequities in healthcare education. ChatGPT and Gemini demonstrated broader diversity in age, gender, and race, while Claude skewed towards older, White, and male profiles, particularly for leadership roles. Addressing these biases through ethical AI development, enhanced AI literacy, and promoting diverse leadership in SBME are essential to fostering equitable and inclusive training environments.

TRIAL REGISTRATION: Not applicable. This study exclusively used AI-generated synthetic data.

PMID:40320548 | DOI:10.1186/s41077-025-00355-1

Matern Health Neonatol Perinatol. 2025 May 5;11(1):13. doi: 10.1186/s40748-025-00211-0.

ABSTRACT

BACKGROUND: Preventing infection in primary sutured perineal tears after childbirth is crucial to avoid systemic antibiotic use and potential complications from poor healing. This study aimed to investigate the efficacy of an antibacterial, triclosan-coated suture (VicrylPlus^®) in reducing infection in primary sutured childbirth-related perineal tears.

METHODS: The PLUS study was a single-center, single-blinded, adaptive parallel-group randomized trial conducted at Lund University Hospital, Sweden. Women aged ≥ 18 years with a perineal tear at childbirth were randomly assigned in a 1:1 ratio to either the control group (conventional-absorbable suture, Vicryl^®) or the intervention group (triclosan-coated- absorbable suture, VicrylPlus^®).

RESULTS: Out of 1921 eligible women, 1890 were randomized to either Vicryl^® (n = 953) or VicrylPlus^® (n = 937). There were no significant demographic differences between the groups. The most common type of tear in both groups was a second-degree tear (Vicryl^® 66.2% (n = 625), VicrylPlus^® 67.5% (n = 625)). Encompassing all types of deeper tears in the analysis there was a significantly decrease in infection after suturing with VicrylPlus^® 4% (n = 28) versus Vicryl^® 6.8% (n = 47); (OR 0.57, 95% CI 0.35-0.91, P = 0.024). When analyzing different tears separately, there was a non-significant increase in infection for first-degree tears with VicrylPlus^® 0.8% (n = 2) versus Vicryl^® 3.9% (n = 8); (OR 4.75, 95% CI 1.00-22.63, P = 0.050). However, for second-degree tears, the infection rate was significantly reduced with VicrylPlus^® 4.4% (n = 27) versus Vicryl^® 7.2% (n = 44); (OR 0.63, 95% CI 0.36-0.98, P = 0.05) and for third-degree and unclassified tears there was a non-significant decrease in infections with VicrylPlus^® 5.3% (n = 1) versus Vicryl^® 14.3% (n = 2); (OR 0.33, 95% CI 0.03-4.10, P = 0.561), respectively, VicrylPlus^® 0% versus Vicryl^® 1.7% (n = 1); (OR 0.98, 95% CI 0.95-1.02, P = 0.462).

CONCLUSION: The use of triclosan coated sutures significantly reduces the risk of infection in primary sutured childbirth-related perineal tears by 43%, except for first-degree tears. Further research is needed to determine whether their effectiveness remains consistent across the other specific types of deeper tears in a larger study population.

TRIAL REGISTRATION: ClinicalTrials (NCT02863874), posted 11/08/2016, retrospectively registered. Approved by the regional ethical committee before start of enrollment (Dnr 2015/774).

PMID:40320545 | DOI:10.1186/s40748-025-00211-0

BMC Infect Dis. 2025 May 4;25(1):651. doi: 10.1186/s12879-025-11026-x.

ABSTRACT

BACKGROUND: The study aimed to assess the willingness of receiving tuberculosis preventive treatment (TPT) and identify influence factors on their decisions among individuals with latent tuberculosis infection (LTBI).

METHODS: Individuals diagnosed with LTBI at a designated tuberculosis (TB) hospital were recruited from July 2023 to June 2024. Data on socio-demographic characteristics, knowledge of TB, the decision to receive TPT along with the underlying reasons were collected using electronic questionnaires. Binary logistic regression analysis was employed to identify independent factors associated with the willingness of receiving TPT. A P value less than 0.05 was considered statistically significant.

RESULTS: A total of 317 individuals with LTBI were included in this study. Among them, 254 (80.13%) expressed a willingness to receive TPT, while 63 declined. Of those 254, 58 (22.83%) ultimately refused treatment. Gender (P < 0.05; OR = 1.983; 95% CI:1.052-3.738), educational level (P < 0.01; OR = 3.489; 95% CI:1.524-7.985) and knowledge of TB (P < 0.05; OR = 3.688; 95% CI:1.835-16.278) were significantly associated with willingness to receive TPT. The top three reasons for willingness to receive TPT were: concern about developing active tuberculosis (ATB), reducing the risk and severity of ATB, and doctor’s recommendation, accounting for 69.09%, 46.69%, and 42.90%, respectively. The top four reasons for refusal TPT included: fear of adverse drug reactions, perceived low risk of developing ATB, fear of adverse drug events and uncertainty about the effectiveness of TPT, accounting for 9.46%, 6.94%, 4.73%, and 4.73%, respectively.

CONCLUSIONS: TPT acceptance remained suboptimal and was influenced by gender, education level and TB knowledge. Improving LTBI patient and health care provider education on TB risks and TPT benefits could enhance adherence.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40320539 | DOI:10.1186/s12879-025-11026-x

Nutr J. 2025 May 4;24(1):71. doi: 10.1186/s12937-025-01138-0.

ABSTRACT

BACKGROUND: A posteriori dietary patterns (DPs) are critical for capturing actual dietary behaviour. However, assessing their reproducibility across (sub)populations requires novel modelling approaches beyond descriptive statistics. Multi-study factor analysis derives DPs that are shared among all studies/subpopulations and those specific to a study or subpopulation of interest. Bayesian implementation of the multi-study factor analysis (BMSFA) is more flexible than frequentist as it imposes fewer assumptions and improves factor selection.

METHODS: We applied BMSFA to 24-h dietary recalls from the baseline visit (2008-2011) of the US Hispanic Community Health Study/Study of Latinos (n = 16,415). The analysis was conducted on 42 common nutrients to identify shared and subpopulation-specific DPs. Subpopulations were defined based on the cross-classification of ethnic background (Cuban, Dominican Republic, Mexican, Puerto Rican, Central and South American) and study site (Bronx, Chicago, Miami, San Diego) resulting in 12 Ethnic Background Site (EBS) categories. Regression analysis characterized DPs in terms of food groups, overall diet quality, socio-demographic/lifestyle factors, adjusting for survey design.

RESULTS: We identified four shared DPs across all EBS categories: Plant-based foods, Processed foods, Dairy products, and Seafood. Additionally, twelve EBS-specific DPs were identified-one for each EBS category. Most EBS-specific DPs were further grouped into overarching profiles: Animal vs. vegetable source, Animal source only, and Poultry vs. dairy products, to capture nuances within animal-based DPs. Puerto Rican background participants from Chicago expressed a strikingly different DP from all others (i.e., high on beta-carotene and low on starch/iron/thiamin). Higher overall diet quality was observed with increasing categories of Plant-based foods, Seafood, and the “Puerto Rican background – Chicago” EBS-specific DP, whereas increasing categories of Dairy products, Processed foods, and the remaining EBS-specific DPs were related to lower diet quality. Compared to non-US-born participants, US-born individuals had significantly higher adjusted mean scores in absolute value for most DPs. Specifically, they exhibited lower adherence to the Plant-based foods and Dairy products DPs but higher adherence to Processed foods, Seafood, and six EBS-specific DPs.

CONCLUSIONS: The BMSFA successfully captured sources of dietary homogeneity and heterogeneity among US Hispanic/Latino adults across ethnic backgrounds and study sites. The study highlighted the crucial role of nativity on DPs.

PMID:40320535 | DOI:10.1186/s12937-025-01138-0

BMC Palliat Care. 2025 May 4;24(1):125. doi: 10.1186/s12904-025-01761-y.

ABSTRACT

BACKGROUND: In palliative care, alternative routes for drug application besides the oral and intravenous administration are frequently necessary. Up-to-date, very little is known about the familiarity, use and perceived relevance of inhalative medications for symptom control among palliative care practitioners.

METHODS: We conducted an anonymous online survey among palliative care physicians throughout Germany between 09/2021 and 04/2022. The questionnaire covered participants’ sociodemographics, as well as familiarity, perceived relevance and prescription practices regarding 21 nebulised drugs. Analysis was performed using methods of descriptive statistics.

RESULTS: 108 fully completed questionnaires were analysed. Most of the participants were employed in palliative care for 5 + years. The administration of normal saline, mucoactive drugs, bronchodilators and steroids via nebulisation was a widely known and frequently used technique among the participants, as evidenced by its regular use in clinical routine. About 50% of the participants reported to know epinephrine and tranexamic acid for anti-oedematous or haemostyptic effects, respectively. Both drugs were considered “relevant” by more than 60% of the prescribers. Only a minority of participants reported to know and use nebulised opioids, iloprost, several antibiotics, heparin, ketamine and lidocaine.

CONCLUSIONS: Our survey shows that nebulised drugs are prescribed and considered relevant in palliative care. However, for several of the mentioned medications only limited data is available regarding use and effectivity. There is also uncertainty to what extent the existing data may be transferable into routine palliative care setting. Therefore, more evidence should be generated.

TRIAL REGISTRATION: Not applicable.

PMID:40320522 | DOI:10.1186/s12904-025-01761-y

Health Qual Life Outcomes. 2025 May 4;23(1):47. doi: 10.1186/s12955-025-02377-9.

ABSTRACT

BACKGROUND: Hip fractures are a significant public health concern due to increasing numbers, high mortality and negative impact on health-related quality of life (HRQoL). Socioeconomic position (SEP) affects various health outcomes, but the specific impact on HRQoL and satisfaction after hip fracture remains underexplored. This study assesses whether education and household income influence patient-reported outcome measures (PROMs) after hip fractures, measured by three visual analog scales: EQ-VAS, pain-VAS, and satisfaction-VAS.

METHODS: This was a nationwide retrospective cohort study using linked data from the Norwegian Hip Fracture Register and Statistics Norway. PROMs assessed at 4, 12, and 36 months postoperatively in 35,206 hip fracture patients from 2015 to 2018 were included. The SEP data included household income and education levels. Covariance analyses were conducted to evaluate differences in mean VAS scores for general health (EQ-VAS), pain from the operated hip (Pain-VAS), and satisfaction with the result of the operation (Satisfaction-VAS). Analyses adjusted for age, sex, vital status, cognitive impairment, treatment type, and education or income when not used as independent variable.

RESULTS: The study included 23,649 women (67.2%) and 11,557 men (32.8%) with median age 83 years. Lower education was linked to worse EQ-VAS and Pain-VAS scores at all follow-ups and to lower Satisfaction-VAS at 12 and 36 months in both unadjusted and adjusted analyses. Lowest level of income had significant lower EQ-VAS at all follow-ups, lower Pain-VAS at 12 months, and lower Satisfaction-VAS at 4 months. There were increasing differences in mean VAS-scores during follow-up. At 36 months the adjusted differences in mean EQ-VAS between highest and lowest level of income was – 2,51 (-4.04 -0.99). Differences across education levels were even stronger associated; -3.58 (-5.19 to -1.98). Mean differences in Pain-VAS between medium and low education compared to high were 4.30 (2.91 to 5.69) and 5.58 (4.08 to 7.08), respectively. Lower levels of education also had significant negative differences in Satisfaction-VAS at 36 months follow-up -4.06(-5.86 to -2.26).

CONCLUSIONS: Lower education and income were significantly associated with worse HRQoL and satisfaction after hip fracture. The clinical relevance of these findings warrants further investigation. Addressing SEP disparities should be integral to hip-fracture care strategies aiming to improve postoperative outcomes.

PMID:40320519 | DOI:10.1186/s12955-025-02377-9

Probiotics Antimicrob Proteins. 2025 May 5. doi: 10.1007/s12602-025-10544-z. Online ahead of print.

ABSTRACT

Food allergies are common, affecting a sizable portion of children and adults in the Western world. In recent years, a promising treatment known as allergen immunotherapy (AIT) has emerged. This technique aims to address the fundamental immune system dysfunction that underlies food allergies. The study’s objective was to evaluate the safety of combining probiotics with AIT, compared to placebo in treating patients with food allergies. A comprehensive literature search in several databases was conducted. All included studies were randomized controlled trials(RCTs). Meta-analyses were performed using R software. Statistical tests to assess safety outcomes and risk of bias were used. After reviewing 519 studies, three studies were included in the systematic review and meta-analysis, involving a total of 258 patients (141 in the probiotics group, 144 in the placebo group). The evaluation of the safety profile of the integrated probiotic therapy revealed an overall favorable outcome, with no significant differences in adverse events compared to placebo for most organ systems examined. However, a potential increase in oral adverse effects was observed in the probiotics group (RR = 1.7573, 95% CI: 0.3941 to 7.8359), although this result did not reach statistical significance. The combination of probiotics and allergen-specific immunotherapy appears to be generally safe and shows promise as a valuable treatment approach.

PMID:40320506 | DOI:10.1007/s12602-025-10544-z

Support Care Cancer. 2025 May 5;33(5):447. doi: 10.1007/s00520-025-09492-9.

ABSTRACT

PURPOSE: Many cancer patients undergoing radiation therapy report unmet psychosocial needs, which can negatively impact their treatment outcomes and quality of life. This study explored the current practices and perceptions of radiation therapists (RTs) practicing in Canada and Norway with respect to addressing the psychosocial and supportive care (PSSC) needs of their patients.

METHODS: A cross-sectional study was conducted using an online evidence-informed survey of RTs in Canada and Norway that focused on (1) demographics, (2) RTs’ confidence level and perceptions related to PSSC, and (3) RTs’ current practices related to PSSC. Descriptive statistics, chi-square tests, and Mann-Whitney U tests were used to summarize the sample and compare differences between countries.

RESULTS: A total of 210 RTs completed the survey (Canada, n = 79; Norway, n = 131). RTs in both countries identified PSSC as an important aspect of quality care. Canadian RTs expressed a greater desire to expand their scope of practice in PSSC (p = 0.001). Norwegian RTs reported spending more time providing PSSC (mean: 8.3 h vs. 3.8 h; p < 0.001) and were satisfied with their current capacity. Barriers common to both countries included a lack of training and time constraints. Canadian RTs additionally reported limited institutional support.

CONCLUSION: Significant differences exist in the current practices and perceptions of RTs in Canada and Norway regarding PSSC delivery. However, Canadian and Norwegian RTs agree that engaging in PSSC ensures the best care for patients undergoing radiation therapy. With enhanced training, knowledge translation of resources, and institutional support, RTs can better address the PSSC needs of their patients.

PMID:40320500 | DOI:10.1007/s00520-025-09492-9

World J Urol. 2025 May 4;43(1):266. doi: 10.1007/s00345-025-05545-0.

ABSTRACT

OBJECTIVE: To quantify the effect of chemotherapy (CHT) in locally advanced female primary urethral cancer (fPUC).

METHODS: In the Surveillance, Epidemiology and Ends Results (SEER) database (2000-2021), we identified 295 fPUC patients with locally advanced stage treated with local therapy (surgery or radiation or both) with or without CHT. Multivariable Cox regression models addressed cancer specific mortality free survival (CSM). Sample power analyses were computed.

RESULTS: Of 295 fPUC patients, 141 (48%) underwent CHT. CHT rates increased from 40 to 61% (Δ22%) over the study span (2000-2021). Five-year CSM rates of CHT exposed vs. CHT-naïve patients were 58 vs. 43% (Δ15%). In multivariable Cox regression models (age and histology adjusted) CHT independently predicted lower CSM (HR = 0.67, p = 0.027). In squamous cell carcinoma (SCC) subgroup, CHT also independently predicted lower CSM (HR = 0.64, p = 0.01). In urothelial carcinoma (HR = 0.63, p = 0.2) and adenocarcinoma (HR = 0.7, p = 0.7) independent predictor status could not be demonstrated. Small sample sizes in urothelial carcinoma subgroup (UC) and adenocarcinoma subgroup (ADK) undermined the power of the analyses to as low as 48% in UC and 46% in ADK, respectively, versus ideal 80% power.

CONCLUSION: In fPUC patients, CHT independently predicts lower CSM. This effect is generalizable to SCC patients. The same relationship between CHT status and CSM is also operational in UC and ADK subgroups, but limited power undermined confirmation of its’ statistical significance.

PMID:40320496 | DOI:10.1007/s00345-025-05545-0

Virchows Arch. 2025 May 5. doi: 10.1007/s00428-025-04104-7. Online ahead of print.

ABSTRACT

Tubo-ovarian high-grade serous carcinoma (HGSC) with proficient homologous recombination (HR) DNA repair (HRP) accounts for approximately 50% of cases and is associated with platinum-resistance and poor prognosis. We hypothesize that the acquisition of hybrid phenotypes displaying both epithelial and mesenchymal (E/M) features may be involved in the malignant transformation and tumour dissemination in this subgroup. Therefore, we analysed, by digital pathology, the expression and prognostic significance of 3 classic cadherins (E-cadherin, epithelial marker; N-cadherin, mesenchymal marker; and P-cadherin, candidate marker of hybrid E/M) in 577 formalin-fixed paraffin-embedded human samples representing the putative stepwise serous carcinogenesis in the Fallopian tube epithelium (FTE). We observed a non-canonical N-to-P-cadherin switch along the carcinogenic progression, with a statistically significant overexpression of P-cadherin in pre-malignant and malignant samples, compared to the control FTE. Interestingly, this overexpression was most pronounced in precursor lesions and HGSC cells from malignant ascites. Tumours with high P-cadherin expression were significantly associated with worse overall survival, especially in the subgroup without BRCA1/2 mutations. Transient P-cadherin knock-down resulted in in vitro significant reduction of functional hybrid E/M hallmarks, namely decreased anoikis resistance, reduced collective migration and invasion in a representative platinum-resistant HRP cell line. Taken together, our results suggest that P-cadherin overexpression is an early event in the serous carcinogenesis and may be involved in hybrid E/M activation in HRP-HGSC, further supporting this adhesion molecule as a promising biomarker for this poor prognostic subgroup.

PMID:40320493 | DOI:10.1007/s00428-025-04104-7