Nevin Manimala

BMC Med Educ. 2025 Jan 28;25(1):138. doi: 10.1186/s12909-025-06706-w.

ABSTRACT

OBJECTIVE: Despite the growth of Emergency Medicine (EM) globally, shortages of EM-trained physicians persist in many countries, disproportionately affecting lower middle/low-income countries (LMIC/LIC). This study examines the career paths of graduates of an Emergency Medicine residency-training program established in Lebanon with the aim of building local capacity in EM.

DESIGN AND PATIENTS: This descriptive study utilizes secondary data sourced from an alumni database that includes nine cohorts of graduates from an Emergency Medicine residency program at the American University of Beirut Medical Center in Lebanon.

MEASUREMENTS AND MAIN RESULTS: Within 12 years since the EM residency program establishment a total of 9 cohorts, including 44 physicians had completed their residency training in EM, with 40.9% being female and 95.5% Lebanese citizens. After graduation, almost half of our graduates (47.7%) enrolled in fellowship training programs and 40.9% joined the workforce. Fellowships in Trauma (19%) and Oncologic Emergencies (19%) were the most commonly pursued. Initial employment destinations predominantly included Lebanon, the United Arab Emirates and the Kingdom of Saudi Arabia, (61.1, 33.3 and 5.6% respectively). However, retention within the local market declined with time, with a median time spent in Lebanon of 1 year and a mean of 3.3 years of practice in Lebanon prior to emigration. Presently, graduates are mostly dispersed across the Gulf Cooperation Council region (38.6%), the USA (25%), and Lebanon (20.5%).

CONCLUSION: Building Emergency Medicine expertise to match the growing population needs for specialized acute care remains a challenge globally, especially in low-middle income and low-income countries. Our study highlights the challenge of retaining specialized medical graduates in LMIC. Understanding and addressing the root-causes of out-migration of highly specialized medical workforce is an essential component of addressing local workforce challenges that needs to be coupled with capacity building initiatives for meaningful impact.

PMID:39875967 | DOI:10.1186/s12909-025-06706-w

BMC Health Serv Res. 2025 Jan 29;25(1):172. doi: 10.1186/s12913-024-12074-w.

ABSTRACT

BACKGROUND: Inadequate medication knowledge and medication nonadherence by patients are considered an issue in healthcare, as they can lead to negative outcomes, such as therapeutic failures and hospitalization. Even though drug dispensing, which has pharmacist counseling as a core element, is a service traditionally performed by pharmacists, there is still no evidence about the influence of this service on these health outcomes.

OBJECTIVE: To evaluate the influence of drug dispensing on patients’ medication knowledge and medication adherence.

METHODS: A systematic review was conducted in which a literature search was performed in the PubMed/Medline, Biblioteca Virtual da Saúde, Web of Science, and Embase databases, as well as in gray literature. Two reviewers read the titles, abstracts and complete texts according to the eligibility criteria and extracted the data from the included articles. Original studies-of any design-evaluating the influence of drug dispensing on patients’ medication knowledge and/or adherence in community pharmacies were included. The methodological quality was assessed through the tools provided by the JBI Institute. The data was analyzed through qualitative synthesis and a meta-analysis was conducted for randomized controlled trials which used the outcome of medication adherence using the RStudio version 4.3.3 program.

RESULTS: A total of 7,590 studies were identified in the initial search, of which 11 articles met the eligibility criteria and were included in this systematic review. The studies were published in Africa, Latin America, Asia, Europe and Australia. Most of the studies were interventional (n = 7). Four studies evaluated the influence of drug dispensing on the patient’s medication knowledge, and all showed that knowledge increased after dispensing. Eight studies evaluated the influence of dispensing on medication adherence. Three studies were included in the meta-analysis, which showed moderate heterogeneity (I² = 44%, p = 0.17). The results indicated that there was no statistically significant difference in medication adherence post-dispensing (RR: 1.19; 95%CI 0.99 to 1.43, p = 0.07). Six studies met more than 70% of the quality assessment criteria.

CONCLUSION: This systematic review demonstrated that patient’s medication knowledge can be increased through drug dispensing. However, the meta-analysis indicated that drug dispensing does not have an impact on medication adherence. Our findings can support evidence-based decisions, guiding the planning and development of public policies and interventions which improve drug dispensing for patients, families, and communities.

PMID:39875964 | DOI:10.1186/s12913-024-12074-w

BMC Nurs. 2025 Jan 28;24(1):104. doi: 10.1186/s12912-025-02754-1.

ABSTRACT

BACKGROUND: Pressure injuries are costly and can lead to mortality and psychosocial consequences if not managed effectively. Proper management of pressure injuries is crucial for quality nursing care. However, there is limited research on nurses’ knowledge and practices in preventing and managing pressure injuries among critically ill patients in Rwanda. In addition, barriers affecting nurses’ practices in this area also need further investigation in order to inform the interventions to improve nursing care of patients with pressure injuries in Rwandan hospitals.

METHODOLOGY: A cross-sectional study involving 129 health nurses was conducted to determine their knowledge and practice levels regarding the prevention of pressure injuries in critically ill patients, and barriers impeding practice in this area. The research modified the Pieper-Zulkowski Pressure Ulcer Knowledge Test to evaluate the knowledge of nurses concerning the prevention of pressure injuries. A 33-item instrument drawn from pressure ulcer risk assessment and prevention toolkits established by the Agency for Healthcare Research and Quality was used to assess nurses’ practices. Additionally, barriers influencing nurses’ knowledge and practices related to the prevention of pressure injuries were evaluated through questions derived from a comparable study conducted in Ethiopia. Descriptive statistics were computed for each variable. Mean scores were computed to categorize nurses’ level of knowledge and practice. Logistic regression analysis was employed to examine the influence of sociodemographic factors and training on the nurses’ knowledge and practice, with a statistical significance set at a p-value less than 0.05.

RESULTS: The study found that 40.0% of nurses had inadequate knowledge towards pressure injury prevention, and 60.0% reported that they inadequately practiced pressure injury prevention among critically ill patients. Nurses who have not been trained in pressure injury prevention have a 52.4% reduction in the odd of having adequate practice compared to those who have been trained (OR 0.476; 95% CI 0.211-0.996). Heavy workload, inadequate staff, shortage of equipments, presence of other priorities than pressure injury prevention, inadequate training coverage of pressure injury prevention were the most prevalent barriers reported.

CONCLUSION: The evaluation of nurses’ knowledge and practices on pressure injury prevention in critically ill patients at the study setting found that while nurses have satisfactory knowledge, their practical application is lacking due to factors like high workloads and insufficient staffing. The study recommends caution in interpreting the results due to a limited sample size, suggesting further research to guide improvements in nursing practices.

PMID:39875962 | DOI:10.1186/s12912-025-02754-1

BMC Health Serv Res. 2025 Jan 28;25(1):166. doi: 10.1186/s12913-024-12139-w.

ABSTRACT

INTRODUCTION: Several adverse drug reactions (ADRs) go unreported within a healthcare setting despite the risks they cause. We therefore decided to conduct this study in order to recognize the obstacles that hinder the healthcare professionals (HCPs) in a tertiary care hospital in Kattankulathur, Tamil Nadu from reporting ADRs and what strategies ought to be implemented.

METHODS: We carried out a cross-sectional study among the HCPs such as doctors, pharmacists and nurses within our institution. A pre-validated questionnaire was used to collect data on the socio-demographics, barriers and facilitators in reporting ADR. A 2 weeks timeline was given to the HCPs to fill the questionnaire forms. Out of the 107 forms distributed, we received 80 of them that were duly filled. Data was analyzed using IBM SPSS version 26.

RESULTS: Out of the 80 HCPs, only 22 of them had reported any ADRs in their career. 52% of our HCPs reported the lack of understanding of ADR reporting mechanism as their main hindrance. Additionally, 25 (31%) of the HCPs stated that reporting ADRs is time consuming. 18 (22%) of them reported a fear of legal liability. 13 (16%) of them stated that the reporting from is complicated and 29 (36%) stated a lack of motivation as the reason for not reporting ADR. Majority of our HCPs 76 (95%) recommended the need for continuous medical education and training as the best strategy to improve ADR reporting.

CONCLUSION: Barriers such as time constraints, workload pressures and competing priorities often hinder HCPs from dedicating adequate attention to ADR reporting. The inclusion of topics related to ADR reporting in the curriculum (i.e. clinical pharmacology) and increased awareness from the ADR monitoring centre were seen to be significant facilitators to enhance ADR reporting among health care practitioners.

PMID:39875957 | DOI:10.1186/s12913-024-12139-w

Syst Rev. 2025 Jan 28;14(1):27. doi: 10.1186/s13643-025-02768-5.

ABSTRACT

INTRODUCTION: Head and neck cancers (HNC) are devastating, thus imposing a negative impact on the appearance of an individual as well as vital activities such as eating, swallowing, speaking, and breathing. Therefore, HNC patients undergo distress, while their caregivers become overburdened. Religion and spirituality can be helpful for patients and their caregivers from diverse cultural backgrounds to cope with cancer. Though well established in palliative care, religion and spirituality are rarely incorporated into usual early oncological care. Despite the availability of heterogeneous literature examining the influence of religion and spirituality on cancer patients, there is notably limited research on this topic across the HNC trajectory. Therefore, this scoping review attempts to answer “What is the influence of religion or spirituality on HNC patients and their caregivers in different contexts?” and will map the evidence on the influence of religion and spirituality on HNC patients and their caregivers in different contexts including geographical areas, cultures, health care systems, and different study settings.

METHODS: This scoping review was formulated using the guidelines of Joanna Briggs Institute (JBI) manual for evidence synthesis: scoping reviews and will be reported confirming to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR checklist). A comprehensive search strategy will include Embase, CINAHL, Scopus, and APA PsycINFO. The OPENGREU.EU and Google Scholar will be used as gray literature sources complimented by manual searches. Our eligibility criteria follow the population, concept, and context (PCC) framework. Patients aged ≥ 18 years diagnosed with HNC and their informal, nonpaid caregivers aged > 18 years will be included. The data will be extracted using piloted data extraction form on sociodemographic, disease-related, and treatment-related factors and outcomes, and the data will be analyzed through descriptive statistics and thematic analysis. The results will be narratively synthesized.

CONCLUSIONS/DISCUSSION: This review will aim to explore existing literature and summarize the findings of studies that examine the influence of religion and spirituality among HNC patients and their caregivers and vice versa over a range of physical, psychological, and social outcomes including quality of life. We also aim to identify existing research gaps. The findings of this review would generate evidence to better inform health care providers in countries and cultures in the management of patients diagnosed with HNC in usual oncological care with due consideration to caregivers.

PMID:39875944 | DOI:10.1186/s13643-025-02768-5

Ital J Pediatr. 2025 Jan 28;51(1):18. doi: 10.1186/s13052-025-01859-2.

ABSTRACT

BACKGROUND: Severe pulmonary infection is the primary cause of death in children aged < 5 years. The early identification of pathogenic bacteria and targeted anti-infective therapies can significantly improve the prognosis of children with severe infections. This study aims to provide a reference for the rational use of antibiotics at an early stage in children with severe pulmonary infections.

METHODS: A retrospective, single-center longitudinal study included children with severe pulmonary infections between January 2017 and December 2022 by obtaining their bacterial culture results of bronchoalveolar lavage fluid.

RESULTS: This study included 4080 samples. The age of onset for severe pulmonary infection increased annually. The proportion of severe pulmonary infections across the different age groups and years was statistically significant (p < 0.001). Among children with severe pulmonary infections, bacilli were the most prevalent, followed by cocci and fungi. The predominant bacilli were Acinetobacter baumannii and Klebsiella pneumoniae. The predominant cocci identified in this study were Streptococcus pneumoniae and Staphylococcus aureus. The primary fungi included Candida albicans and Aspergillus fumigatus, which showed significant differences (p < 0.05). The incidence of drug-resistant bacteria has gradually declined, with infection rates of multidrug-resistant bacteria and extended-spectrum beta-lactamases consistently decreasing annually. For carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, the infection rates peaked in 2018, with statistical significance (p < 0.001).

CONCLUSIONS: Severe pulmonary infections in children are significantly associated with age and types of infectious pathogens. Gram-negative bacteria are the primary cause of severe pulmonary infections in children. Clinicians should rationally use antibiotics according to the local distribution and drug resistance of pathogens, thereby enhancing therapeutic outcomes.

PMID:39875941 | DOI:10.1186/s13052-025-01859-2

BMC Oral Health. 2025 Jan 28;25(1):146. doi: 10.1186/s12903-025-05499-0.

ABSTRACT

OBJECTIVE: The aim of this study was to establish a three-dimensional finite element (FE) hydraulic pressure technique model and compare the biomechanical characteristics of the osteotome technique and the hydraulic pressure technique using three-dimensional finite element analysis (FEA).

METHODS: Three FE models were created: the hydraulic pressure technique (M1), the osteotome technique with a Ø 1.6-mm osteotome (M2), and the osteotome technique with a Ø 3.0-mm osteotome (M3) models. Three models were simulated via computer-aided design software, with the sinus membrane elevated to 1, 3 and 5 mm, after which the required loading force was recorded. Stress distribution, including the equivalent von Mises stress, tensile stress, compressive stress, shear stress, as well as strain (i.e., sinus membrane displacement in horizontal dimensions) of the three models were subsequently examined and statistically compared.

RESULTS: Overall, the required loading force, stress and strain increased as the elevation height increased. The loading force required to elevate the sinus membrane to 1,3 and 5 mm in M1 was 24.9 kPa, 77.1 kPa and 130 kPa, comparing 32.5 kPa, 112. 9 kPa and 200.8 kPa in M2 as well as 54.5 kPa, 160.6 kPa and 273.2 kPa in M3. Under the same elevation height, M1 exhibited the least von Mises stress (P<0.001), as well as the largest horizontal sinus membrane displacement (P<0.001).

CONCLUSIONS: It can be seen from the FEA results that the hydraulic pressure technique enables a greater portion of the sinus membrane to detach from the sinus floor while exerting less stress on the mucosa when the sinus membrane is elevated up to 5 mm. Based on this study, the hydraulic pressure technique was found to be safer and more effective than the osteotome technique under the same elevation height.

PMID:39875935 | DOI:10.1186/s12903-025-05499-0

Ital J Pediatr. 2025 Jan 29;51(1):19. doi: 10.1186/s13052-025-01843-w.

ABSTRACT

BACKGROUND: Attention-Deficit Hyperactivity Disorder (ADHD) is a complex disease that negatively impacts the social and academic/occupational activities of children and is more common in boys than in girls.

METHODS: This case-control study aimed to assess the association between some environmental risk factors and ADHD among children in Alexandria, Egypt. It was carried out at the outpatient clinics of El Shatby Pediatric University Hospital in Alexandria, Egypt, with 252 children (126 cases and 126 controls). Hair samples were collected for analysis of lead and manganese levels using Atomic Absorption Spectrophotometer. A pre-designed interview questionnaire was used to determine the important environmental risk factors that may be related to ADHD.

RESULTS: Children from parents with low levels of education, living in crowded houses, and occupational exposure to chemical agents were found to be risk factors for ADHD. The mean ± SD hair lead level in ADHD children was 2.58 ± 1.95, while in controls was 1.87 ± 0.92, with a statistically significant difference (p < 0.001). The mean ± SD hair manganese level in ADHD children was 2.10 ± 1.54, while in controls was 1.11 ± 0.69, with a statistically significant difference (p < 0.001). The logistic regression model revealed that six factors had a significant association with ADHD: using of newspapers to wrap food 3 or more times a week (adjusted odds ratio (AOR) = 105.11, 95% CI: 11.18-988.26), daily TV watching by child for more than 5 h (AOR = 63.96, 95% CI: 2.56-1601.32), child’s eating commercially packed noodles 3 times or more per week (AOR = 57.73, 95% CI: 3.77-593.93), using unpackaged flour in cooking (AOR = 44.47, 95% CI: 1.83-629.80), eating sweets daily by child (AOR = 6.82, 95% CI: 1.23-37.94), and lastly elevated hair Manganese level (AOR = 3.57, 95% CI: 1.24-10.29).

CONCLUSIONS: ADHD is a multi-factorial disorder, where many environmental risk factors contribute to its development. Future efforts to determine the best preventive strategy in Egypt must be based on a better knowledge of the role of environmental risk factors in the etiology of the disorder. Eliminating non-essential uses of lead and providing public education regarding the importance of safe disposal of lead-acid batteries and computers are necessary.

PMID:39875928 | DOI:10.1186/s13052-025-01843-w

BMC Pediatr. 2025 Jan 28;25(1):69. doi: 10.1186/s12887-025-05431-z.

ABSTRACT

BACKGROUND: Early and continuous exposure to painful stimuli in premature infants leads to short-and long-term complications. Listening to white noise is an accessible and inexpensive non-invasive method that can be used as a safe nursing intervention in hospitals. This study aimed to assess white noise’s effect on premature Infants’ physiological parameters during peripheral intravenous catheter insertion.

METHODS: The present experimental study was conducted on 40 premature Infants. From 5 min before Indwelling catheters to 10 min after, white noise was played through headphones to infants at a controlled volume in the test group. Using a monitor, physiological parameters were recorded from 10 min before to 30 min after the Indwelling catheter. Statistical analysis was done through the SPSS version 27 software program.

RESULTS: Regarding respiratory rate, there was no statistically significant difference between the two groups in the first, second, and sixth stages (p < 0.05). However, in the third, fourth, and fifth stages, RR in the control group was significantly higher than the test group (p ≤ 0.05). In terms of mean arterial blood pressure, there was no statistically significant difference between the two groups in any of the stages (p < 0.05). In terms of heart rate, there was no statistically significant difference between the two groups in the first, second, and sixth stages (p < 0.05). However, in the third, fourth, and fifth stages, HR in the control group was significantly higher than the test group (p ≤ 0.05). Regarding oxygen saturation percentage, there was no statistically significant difference between the two groups in the first, second, third, and sixth stages (p < 0.05). In contrast, in the fourth and fifth stages, the oxygen saturation percentage in the test group was significantly higher than in the control group (p < 0.05).

CONCLUSIONS: Although in both groups the painful procedure led to an increase in physiological variables (respiratory rate, heart rate, mean arterial blood pressure) and a decrease in blood oxygen saturation, in the test group these variables approached their initial state more quickly within half an hour after exposure to white noise. This confirms that the effect of white noise on the improvement of physiological variables is gradual.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:39875927 | DOI:10.1186/s12887-025-05431-z

Lipids Health Dis. 2025 Jan 28;24(1):29. doi: 10.1186/s12944-025-02439-3.

ABSTRACT

BACKGROUND: The metabolic score for visceral fat (METS-VF) is a recently identified index for evaluating visceral fat, also referred to as abdominal obesity. The skeletal muscle mass index (SMI) serves as a critical measure for assessing muscle mass and sarcopenia. Both obesity and the reduction of muscle mass can significantly affect human health. However, research exploring the relationship between METS-VF and SMI remains limited. This study aims to investigate whether a association exists between these two indices, and if so, to elucidate the nature of their interactions.

METHODS: We conducted a cross-sectional study using data from the NHANES database, focusing on U.S. adults aged 20 years and older from 2013 to 2018. Controlling for relevant covariables, we primarily investigated the association between METS-VF and SMI values utilizing weighted multivariable linear regression models. Additionally, we assessed the diagnostic efficacy of METS-VF for sarcopenia.

RESULTS: A total of 3,594 participants were included in this study for analysis. The final adjusted model from the weighted multivariable linear regression indicated that METS-VF was negatively associated with SMI, with a coefficient of β = -0.13 (95% CI: -0.14, -0.12; P < 0.001). Subgroup analyses further demonstrated that this negative association was consistent across different populations. Notably, the negative association varied significantly between diabetic and nondiabetic population, as well as among populations classified by different BMI categories. Additionally, threshold effect analysis identified a significant inflection knot at 6.33. The characteristic curves of the subjects’ work illustrated that, compared to other indicators, METS-VF exhibited excellent diagnostic efficacy for sarcopenia, with an area under the curve (AUC) of 0.825.

CONCLUSION: Our results indicate that METS-VF is negatively correlated with SMI among adults in the United States, suggesting that visceral obesity exerts a detrimental effect on muscle mass. Furthermore, METS-VF shows potential as a valuable indicator for assessing SMI and sarcopenia. These findings underscore the importance of considering lipid metabolism disorders in the context of muscle health and highlight the potential for developing prevention strategies for sarcopenia.

PMID:39875924 | DOI:10.1186/s12944-025-02439-3