Nevin Manimala

BMC Nurs. 2025 May 12;24(1):515. doi: 10.1186/s12912-025-03062-4.

ABSTRACT

BACKGROUND: Despite numerous shared health challenges during treatment and recovery, the interdependence of health between patients with colorectal cancer and their family caregivers remains underexplored. This study applied the actor-partner interdependence model (APIM) to examine this dyadic relationship.

METHODS: This descriptive correlational survey involved patients with colorectal cancer who visited the outpatient department for postoperative follow-up, along with their family caregivers. From 343 consenting participants, responses from 100 matched patient-caregiver pairs were analyzed. Data collection occurred at J Hospital from August 2023 to May 2024. Key variables included the psychological health and quality of life (QoL) of both patients and caregivers, patient self-care, and caregiver contribution to self-care. Statistical analysis was performed using Stata 16.1, with structural equation modeling.

RESULTS: The mean age of patients was 65.57 years; 51% were male, 66% had colon cancer, and 34% rectal cancer. The caregivers’ mean age was 56.11 years; 55% were female, and 66% were spouses. The analysis of actor effects showed that the psychological health and QoL of both patients and caregivers independently influenced their respective outcomes. The analysis of partner effects revealed mutual influences between the psychological health of patients and caregivers; moreover, the psychological health of caregivers impacted patients’ self-care. While there was a correlation between the QoL of patients and caregivers, it was not statistically significant in the structural equation modeling.

CONCLUSIONS: This study underscores the profound interdependence of health between patients with colorectal cancer and their caregivers, revealing significant mutual impacts on psychological health and, to a lesser extent, self-care. These insights suggest the need for targeted interventions to improve both patient recovery and caregiver support, even where some correlations lack statistical significance.

TRIAL REGISTRATION: Prospectively registered with the Clinical Research Information Service (CRIS) under the Clinical Trial Number KCT0008743 (Registration Date: 2023.08.25).

PMID:40355918 | DOI:10.1186/s12912-025-03062-4

BMC Med Educ. 2025 May 12;25(1):694. doi: 10.1186/s12909-025-07265-w.

ABSTRACT

BACKGROUND: With technological advancements, health education has predominantly focused on technical aspects, neglecting human values. Palliative care (PC), seeking holistic care, becomes crucial in this context, and for its development, the World Health Organization has defined its education and teaching as one of the essential pillars. PC emphasizes patient dignity, autonomy, and holistic well-being, reflecting Thomasma and Pellegrino’s beneficence-in-trust model, fostering trust and ethical care.The aim of this research was to analyze, through the bioethics perspective, the acquisition of PC competencies among medical students.

METHODS: This cross-sectional, quantitative study assessed 360 medical students from a public university in Paraná, using the Pallicomp tool questionnaire to evaluate PC competencies. Data were analyzed using statistical methods, comparing scores across academic cycles and prior PC coursework. Findings were interpreted through bioethical principles and Pellegrino and Thomasma’s beneficence-in-trust model.

RESULTS: Basic cycle students presented a higher overall score than those in the internship, with statistical difference, and the individual analysis of competencies did not reveal an increase throughout the course. When considering the overall score between students who took PC courses and those who did not, there was no statistically significant difference. Deficiencies were observed in key areas involving bioethical principles, including symptom management, compassionate communication, spirituality, and interdisciplinary teamwork.

CONCLUSIONS: This study revealed gaps in PC education among medical students, with scores below 70% across academic cycles and a decline from basic to internship levels. The findings highlight deficiencies in holistic, patient-centered competencies, including psychological and spiritual care, interdisciplinary teamwork, and communication. Addressing these gaps requires integrating bioethical principles and practical training throughout medical education to foster ethical, humanized, and comprehensive care, aligning with the beneficence-in-trust model.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40355916 | DOI:10.1186/s12909-025-07265-w

BMC Med Educ. 2025 May 12;25(1):697. doi: 10.1186/s12909-025-07231-6.

ABSTRACT

BACKGROUND AND OBJECTIVES: Outcome-based medical education is the latest focus in the past decade, and Entrustable Professional Activities(EPAs) have emerged as efficient vehicles to assess physicians. However, few studies have discussed the use of EPAs for residency training in pediatric medicine and its subspecialties. We conducted a pilot study to examine the feasibility of EPAs as a component of the clinical program of assessment in pediatric standardized residency training.

METHODS: We conducted a cross-sectional study for standardized residency training in different subspecialties within pediatric medicine at Qilu Hospital of Shandong University. Totally 65 residents and 35 directors joined in this study. An electronic EPA survey using 8 scales composed of 15 categories was distributed among residents and directors. Kruskal-Wallis test and Mann-Whitney U test were applied for comparing the self-assessments and director-assessments. Generalized estimated equation (GEE) was used to analyze the effect of postgraduate year(PGY), gender, and position on the EPA scores of director assessments.

RESULTS: A total of 401 director-assessment and 65 residents’ self-assessment ( response rate 100%) questionnaires were collected, both demonstrating rising trends in scores across PGYs. Significant differences were found between PGY1 and PGY2 (p < 0.01) and between PGY1 and PGY3 (p < 0.01), but not between PGY2 and PGY3 (p > 0.01). With an effect analysis of PGY, gender, and position on EPA scores performed, PGY had a significant effect on 13 out of 15 EPA scores, while gender affected only four EPA scores significantly, and position affected only three EPA categories. Meanwhile, some EPA categories revealed significant differences across various pediatric subspecialties (p < 0.01).

CONCLUSIONS: The study findings suggest that EPA assessments is feasible among different PGYs in standardized Chinese residency training in pediatric medicine and its subspecialties. Postgraduate year had a significant impact on EPA scores, while gender and resident position also affected EPA scores to a certain extent. Improved stratified teaching programs are required for better subspecialty consistency.

PMID:40355914 | DOI:10.1186/s12909-025-07231-6

BMC Nurs. 2025 May 12;24(1):516. doi: 10.1186/s12912-025-02947-8.

ABSTRACT

BACKGROUND: Pressure injuries can greatly affect a patient’s health, safety, and quality of life. The knowledge and attitudes of nurses towards preventing pressure injuries are vital for providing safe, high-quality healthcare. Nursing in Kuwait suffers from a research gap on this topic.

METHODS: This was a cross-sectional study conducted in the public general hospitals of Kuwait to assess nurses’ knowledge and attitudes and to measure the point prevalence of pressure injuries and prevention measures. An online form, a Modified Pieper’s Pressure Ulcer Knowledge Test and the Moore and Price scale were used to gather data, covering variables related to hospitals, nurses, patients, pressure injuries, and prevention practices. We processed and analysed data using Microsoft Excel and SPSS 23.

RESULTS: The median score of nurses’ knowledge on preventing pressure injuries was 73.2% (IQR: 68.3-78.0), and only 31.7% of the knowledge test items were answered correctly by 90% of participants or more. The median attitude score was 41.0 (IQR: 37.0-44.0). There were statistically significant strong positive correlations between nurses’ age, years of work experience, attitude score, and the percentage of trained staff complying with measures against pressure injury. Attitude score had a statistically significant and strongly negative correlation with the rate of hospital-acquired pressure injury. The predictors of knowledge score were age, sex, and years since the most recent training was undertaken. Knowledge and a nurse’s highest level of education were predictors of attitude scores.

CONCLUSIONS: This study offers inestimable insights into the field. The study’s results reveal that nurses’ knowledge is unsatisfactory to borderline satisfactory, whereas attitudes are positive. Despite this, the positive attitude is neither reflected in staff compliance with practices aimed at preventing pressure injury nor the rate of hospital-acquired pressure injury. We recommend implementing effective training programmes to bridge these gaps.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40355899 | DOI:10.1186/s12912-025-02947-8

BMC Med Educ. 2025 May 12;25(1):698. doi: 10.1186/s12909-025-07283-8.

ABSTRACT

BACKGROUND: The emigration of healthcare professionals significantly contributes to brain drain within Nigeria’s healthcare sector, exacerbating existing workforce shortages. This study investigates the emigration intentions of Nigerian medical and nursing students, focusing on preferred destinations, key motivating factors, and the potential long-term consequences for the nation’s healthcare system.

METHODS: A cross-sectional study was conducted among undergraduate medical and nursing students from six universities, purposefully selected to represent Nigeria’s geopolitical zones. A total of 2,152 students (Medicine and Surgery = 1254; Nursing = 898) participated in the study. Data were collected using a structured, self-administered online questionnaire and analysed with IBM SPSS version 27. Descriptive statistics, chi-square tests, and binary logistic regression were applied, with statistical significance set at p < 0.05.

RESULTS: 72.9% of students expressed intentions to practice abroad, primarily seeking specialist training within the first five years post-graduation (97.7%). Alarmingly, 32.7% had no intention of ever returning to Nigeria, while only 11.7% of those intending to stay intend to leave after completing specialist training. The top three emigration destinations were the United States (28.5%), the United Kingdom (24.6%), and Canada (23.1%). The main drivers of emigration included better training opportunities (75.2%), access to advanced equipment (61.1%), and improved career prospects (56.7%). Respondents predicted negative impacts on Nigeria’s healthcare system, including increased mortality rates and potential system collapse.

CONCLUSION: The findings reveal a high propensity for emigration among Nigerian medical and nursing students, with significant implications for the country’s healthcare system. The study underscores the urgent need for policy interventions that address systemic challenges such as inadequate resources, poor working conditions, remuneration and career development opportunities. Strengthening local training conditions and offering competitive incentives may help mitigate the brain drain and ensure a sustainable healthcare workforce in Nigeria.

PMID:40355893 | DOI:10.1186/s12909-025-07283-8

Scand J Trauma Resusc Emerg Med. 2025 May 12;33(1):81. doi: 10.1186/s13049-025-01401-7.

ABSTRACT

BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has served as a crucial intervention for critically ill patients with persistent cardiopulmonary failure. A standardized approach improves VA ECMO outcomes, which is why ECMO is currently limited to specialized centers. However, transferring critically ill patients to these ECMO centers is not without risk. Portable ECMO devices allow implantation in out-of-center settings prior to transportation. Despite efforts to standardize decision-making, significant variability remains, particularly in out-of-center (OoC) settings with limited data. Due to persistently high mortality, accurate indications are needed to optimize outcomes. This study aims to identify key factors associated with favorable outcomes in OoC VA ECMO and to develop practical decision-making tools for clinicians in these settings.

METHODS: We retrospectively investigated the outcomes of VA ECMO implantation in out-of-center settings between 2006 and 2022 at our institution. Parameters assessed prior to VA ECMO implantation, including organ failure count, mean arterial pressure (MAP), and laboratory data, were analyzed. Follow-up data were collected to evaluate functional (Eastern Cooperative Oncology Group [ECOG] performance status) and neurological (cerebral performance category score [CPC]) (outcomes. Statistical analyses were performed using non-parametric methods and SHAP importance analysis.

RESULTS: A total of 56.5% (195 of 345 patients) who underwent VA ECMO implantation in OoC survived, and 43.8% had a favorable neurological outcome (CPC 1). 37.6% of patients had good functional outcomes (ECOG 0-1). Patients with a MAP > 54 mmHg had better long-term functional outcomes, and those with a MAP > 64 mmHg had better mid-term neurological outcomes. Poor outcomes were associated with reduced coagulation activity and increased thrombogenicity. Renal and multi-organ failure prior to VA ECMO implantation were associated with poor neurological and functional outcomes.

CONCLUSIONS: Through importance analyses, we identified key and secondary factors associated with favorable outcomes in OoC VA ECMO. The extent and severity of organ failure prior to VA ECMO implantation are crucial in determining outcomes. Hemodynamic status, as reflected by MAP, along with organ failure prior to VA-ECMO implantation, significantly influences neurological and functional outcomes. Patients with better hemodynamic stability and coagulation profiles had significantly improved chances of survival with favorable neurological and functional outcomes.

PMID:40355890 | DOI:10.1186/s13049-025-01401-7

BMC Med Inform Decis Mak. 2025 May 12;25(1):181. doi: 10.1186/s12911-025-02858-3.

ABSTRACT

BACKGROUND: Electronic medical record (EMR) systems have significantly transformed how healthcare data is created, managed, and utilized, offering improved legibility, accessibility, and support for clinical decision-making compared to paper records. In Lesotho, the system was implemented to enhance patient care, track patients, and generate reports for evidence-based programming. It is imperative to understand how healthcare workers (HCWs) perceive the system as frontline end-users; thus, the aim of the study was to explore HCWs’ perceptions of the system, focusing on perceived usefulness (PU) and perceived ease of use (PEU) and factors influencing acceptance and utilization in Mafeteng district.

METHODS: A descriptive cross-sectional study design was conducted; 145 healthcare workers from 17 health facilities were invited to participate. The Technology Acceptance Model was incorporated into a self-administered questionnaire. The analysis employed descriptive statistics and the constructs of PU and PEU using Stata/BE 18.0. Multiple regression examined HCWs’ perceptions, while verbatim text from participants clarified quantitative findings.

RESULTS: The study had a 49% response rate (n = 71). Most participants were female (70.42%; n = 50), with registered nurse midwives as the most common profession (45.07%; n = 32). A large proportion reported ‘good’ or ‘very good’ computer skills (43.66%; n = 31). For PU, 87.32% found the EMR system useful, 83.1% agreed it improves job performance, and 83.1% said it saves time. For PEU, 85.91% found the system easy to use, 81.69% could recover from errors, and 85% could remember task procedures. Network connectivity and electricity supply were cited as barriers to the effective use of the EMR system in health facilities, resulting in interruptions in service delivery. The characteristics of sex and profession had no significant impact on PU and PEU, while both qualification (p = 0.035) and computer skills (p = 0.007) were significant, indicating a positive association with greater PEU of the EMR system.

CONCLUSION: HCWs in the Mafeteng District exhibited positive attitudes toward the EMR system, recognising its usefulness, ease of use, and efficiency. Sustaining computer literacy and addressing infrastructural challenges could further enhance the successful implementation and adoption of the system, ultimately improving patient care outcomes.

PMID:40355887 | DOI:10.1186/s12911-025-02858-3

Thromb J. 2025 May 12;23(1):47. doi: 10.1186/s12959-025-00729-5.

ABSTRACT

BACKGROUND: Prognostic significance of stress hyperglycemia ratio (SHR) has not been well studied in patients with type 2 diabetes mellitus (T2DM) and acute coronary syndromes (ACS).

METHODS: We prospectively measured admission fasting blood glucose (AFBG) and glycated hemoglobin A1c (HbA1c), and retrospectively calculated the stress hyperglycemia ratio (SHR, = AFBG/[1.59 × HbA1c (%) – 2.59]) in 791 patients with T2DM and ACS undergoing percutaneous coronary intervention (PCI). The primary endpoint was defined as major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause mortality, non-fatal stroke, non-fatal myocardial infarction, and unplanned repeat coronary revascularization.

RESULTS: The mean age of the study population was 61 ± 10 years, and 72.8% were male. Over a median follow-up of 927 days, 194 patients developed at least one primary endpoint event. The follow-up incidence of MACCE increased in parallel with SHR tertiles (15.6%, 21.9%, and 36.1%, respectively; P for trend < 0.001). The Cox proportional hazards regression analysis adjusted for multiple confounding factors showed hazard ratios for MACCE of 1.525 (95% CI: 1.009-2.305; P = 0.045) for the middle tertile and 2.525 (95% CI: 1.729-3.687; P < 0.001) for the highest tertile of SHR, with the lowest tertile as the reference. The addition of SHR to the baseline reference prediction model improved model predictive performance markedly (C-statistic: increased from 0.704 to 0.721; cNRI: 0.176 [95% CI: 0.063-0.282], P = 0.002; IDI: 0.030 [95% CI: 0.009-0.063], P = 0.002).

CONCLUSION: SHR was independently and significantly associated with adverse cardiovascular outcomes in T2DM and ACS patients who underwent PCI, and had an incremental effect on the predictive ability of the baseline reference prediction model.

PMID:40355885 | DOI:10.1186/s12959-025-00729-5

Scand J Trauma Resusc Emerg Med. 2025 May 12;33(1):83. doi: 10.1186/s13049-025-01387-2.

ABSTRACT

BACKGROUND: Dispatch priority assessments in emergency medical communication centres (EMCC) play a crucial role in determining how quickly emergency medical services reach the scene after an injury. Consequently, accurate prioritization of resources is important in ensuring that patients requiring specialized care receive timely treatment to optimize their outcome. Both dispatch under-triage, where patients with severe injuries receive low priority, and dispatch over-triage, which unnecessarily allocates limited emergency resources, can impact patient outcomes and system efficiency. This study aimed to assess dispatch priority in the EMCC for a cohort of trauma patients in Norway.

METHODS: This registry-based study included 3633 patients from the Norwegian Trauma Registry and Oslo EMCC during 2019-2020. We assessed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false negative rate (dispatch under-triage rate), false positive rate (dispatch over-triage rate), and accuracy of dispatch priority. The New Injury Severity Score (NISS) > 15 was used as a reference standard. Differences in dispatch priority assessments were analysed using descriptive statistics. Two logistic regression models were used to examine the relationship between dispatch priority and factors associated with the assessment.

RESULTS: Our analysis revealed the following dispatch metrics: sensitivity (85%), specificity (11%), PPV (38%), NPV (53%), dispatch under-triage rate (15%), dispatch over-triage rate (89%), and overall accuracy (40%). Under-triaged dispatches frequently involved elderly trauma patients (53%) and patients with low-energy falls (51%). Elderly trauma patients had more than 7 times the odds of receiving inappropriately low dispatch priority compared to children and nearly twice the odds compared to adults, after accounting for factors such as injury mechanism. Similarly, female patients had 81% higher odds of receiving inappropriately low dispatch priority compared to male patients, when controlling for factors like age and injury mechanism. Among over-triaged dispatches, transport-related injuries accounted for half of the cases (50%).

CONCLUSION: This study primarily evaluated the national trauma system’s dispatch priority criteria. Our findings indicate that elderly trauma patients, those with low-energy falls and female patients were often assigned inadequate priority by current criteria, indicating a need to reassess the current criteria to better address these patients’ needs. Additionally, we found that patients involved in transport-related accidents were overrepresented among over-triaged dispatches, highlighting a potential misallocation of resources.

PMID:40355880 | DOI:10.1186/s13049-025-01387-2

Thyroid Res. 2025 May 13;18(1):21. doi: 10.1186/s13044-025-00229-8.

ABSTRACT

BACKGROUND: Thyroid disorders affect the physical, behavioural, and psychological aspects of an individual, leading to poor self-rated health (SRH). Hence, we aimed to determine the prevalence of poor SRH and the factors associated with it among thyroid disorder patients.

METHODS: This is an observational study consisting of 2336 thyroid disorder patients from LASI, 2017-19. Descriptive statistics were employed to calculate prevalence. The association between poor SRH and socio-demographic variables was evaluated using regression analysis, with results expressed as (AOR) and 95% CI.

RESULTS: The findings showed poor self-rated health predictors among thyroid disorder patients, where 25% rated their health as poor. Significant predictors included older age, with patients aged ≥ 75 years having a higher likelihood of reporting poor health (aOR = 2.36, 95% CI = 1.32-4.22, p = 0.004), and rural residence (aOR = 1.34, 95% CI = 1.07-1.67, p = 0.011). Belonging to the OBC caste (aOR = 1.57, 95% CI = 1.23-2.00, p < 0.001) and practicing Christianity (aOR = 1.90, 95% CI = 1.25-2.89, p = 0.003) were also associated with increased odds of poor SRH. Previous employment (aOR = 1.65, 95% CI = 1.20-2.25, p = 0.002), co-morbidities (aOR = 2.59, 95% CI = 1.88-3.59, p < 0.001), and lower education levels (aOR = 1.50, 95% CI = 1.06-2.13, p = 0.022) were significant. Limitations in activities of daily living and instrumental activities of daily living were linked to poorer health outcomes (aOR = 1.76, 95% CI = 1.33-2.31, p < 0.001; IADL: aOR = 1.41, 95% CI = 1.11-1.79, p = 0.004). Depression (aOR = 1.84, 95% CI = 1.32-2.56, p < 0.001) and healthcare utilization in the past year (aOR = 1.86, 95% CI = 1.33-2.58, p < 0.001) also predicted poor SRH, with most healthcare utilization (79.8%) occurring in private facilities.

CONCLUSION: The study highlights a high prevalence of poor SRH among patients, with significant associations observed with age, residence, comorbidity, and healthcare utilization. Targeted interventions focusing on healthcare access, physical activity, and mental health support are crucial to improve SRH.

PMID:40355879 | DOI:10.1186/s13044-025-00229-8