Nevin Manimala

BMC Med Inform Decis Mak. 2025 May 27;25(1):199. doi: 10.1186/s12911-025-03016-5.

ABSTRACT

BACKGROUND: This study explored workflow pathways followed by patients seeking secondary healthcare services at a local hospital in a rural part of Turkey using process mining to improve hospital resource management.

METHODS: The study used process mining to discover process flows as patient pathways implied by hospital records for in-patient, out-patient, biochemical laboratory, and radiology services. Utilizing its flexibility, visualizations and robustness, authors implemented fuzzy-miner algorithm. First, we processed the relevant data from patient records. Then, this data was transformed into event and activity logs. Subsequently, all data components were collected into a data warehouse, and the process mining algorithm was applied. The process mining specified resource usage levels and workload, service waiting times, associated bottlenecks in hospital services, and related statistics/measures.

RESULTS: The results from the proposed process mining analysis offer insights and decision support to improve hospital resource management. For example, the resulting statistics indicate the high waiting times (e.g., median of waiting times around 2 h within the selected time period) in the General Surgery and Cardiology services, whose resources were highly utilized (2,699 and 6,162 times). Overloads at laboratories and radiological imaging seem to be contributing to these long waiting times, and capacities for the associated services may need to be improved. Waiting times and resource workloads are higher on specific dates related to local commercial and social activities.

CONCLUSIONS: Process mining successfully identified the real work flows, bottlenecks, and long waiting times at services within the considered local hospital and provided insights to the hospital management for improving their practices. Moreover, the analyses revealed unique challenges in providing care at a local hospital located far from the city center, emphasizing the potential of process mining to improve healthcare delivery tailored to the specific hospital environment.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40426129 | DOI:10.1186/s12911-025-03016-5

BMC Med Educ. 2025 May 27;25(1):786. doi: 10.1186/s12909-025-07387-1.

ABSTRACT

BACKGROUND: Exploring the impact of professional identity on the academic performance of students is crucial for improving teaching effectiveness and educational outcomes in this field. Forensic medicine is a niche interdisciplinary discipline in the medical system. However, current educational literature on professional identity development does not adequately address forensic medicine students.

AIM: This study aimed to assess the professional identity among forensic medicine students, explore factors associated with professional identity, and determine the role of professional identity in shaping students’ learning engagement and their subsequent academic achievements.

METHODS: A cross-sectional study was executed for forensic medicine students from a medical university in Jiangsu Province, East China between November and December 2023. Using the method of cluster sampling, 159 undergraduates majoring in forensic medicine were investigated. Data were collected using the demographic questionnaire, and the scales of professional identity, learning engagement, and academic achievement. Linear regression was used to explore professional identity-associated factors. Pearson correlation and mediation analysis were used to analyze the relationship between professional identity, learning engagement, and academic achievement.

RESULTS: The mean score of professional identity was 3.85. Grade (senior: β = 0.353, P = 0.004; fifth-year: β = 0.392, P = 0.001), student leader experience (β = 0.157, P = 0.037), specialty selection (major assignment: β=-0.215, P = 0.014), knowledge of the specialty before enrollment (β = 0.095, P = 0.033), and current knowledge of the specialty (β = 0.245, P = 0.000) were the statistically significant factors influencing professional identity. Professional identity, learning engagement, and academic achievement were positively correlated (P < 0.001). Learning engagement played an intermediate role between professional identity and academic achievement, accounting for 49.445% of the total effect.

CONCLUSION: These findings highlight the pivotal role of professional identity as a strategic mechanism for improving academic achievement in forensic medicine education, with learning engagement serving as the primary mediating factor. As a multifaceted and evolving construct, professional identity is shaped by an interplay of personal, specialty and perception factors. Generating awareness and taking measures among forensic educators to enhance students’ professional identity across stages may be crucial for promoting the quality of forensic talent training.

PMID:40426126 | DOI:10.1186/s12909-025-07387-1

BMC Musculoskelet Disord. 2025 May 27;26(1):525. doi: 10.1186/s12891-025-08776-9.

ABSTRACT

BACKGROUND: Treatment options for spiral/oblique metacarpal shaft fractures (MSFs) include both operative and non-operative approaches. Non-operative treatment with early mobilization has been shown to reduce treatment costs and sick leave, while maintaining grip strength despite metacarpal shortening. However, the impact of metacarpal shortening on strength at the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joints remains unclear. This study aimed to evaluate whether a shortening of more than 2 mm in spiral/oblique MSFs affects the strength of a single finger.

METHODS: A total of 23 patients with metacarpal shortening greater than 2 mm following a spiral/oblique MSF were included. The primary outcomes were flexion and extension strength in the MCP and PIP joints, compared to the uninjured hand. Secondary outcomes included range of motion, grip strength, metacarpal shortening, DASH score, patient satisfaction, pain levels, and return to work.

RESULTS: There were no differences observed in grip strength, range of motion, or MCP joint extension. However, PIP joint flexion and extension, as well as MCP joint flexion, were significantly reduced. The DASH scores were generally low (mean 4, range 0-23), with patients reporting no pain and high satisfaction.

CONCLUSIONS: In conclusion, finger strength was statistically significantly reduced, but its clinical relevance remains unclear. Despite these findings, the low DASH scores and high patient satisfaction suggest that the functional impact of these changes may be minimal for most patients. We recommend discussing these findings with individuals who heavily rely on dexterity, such as professional musicians or other precision skill workers.

LEVEL OF EVIDENCE: IV.

PMID:40426125 | DOI:10.1186/s12891-025-08776-9

BMC Health Serv Res. 2025 May 27;25(1):753. doi: 10.1186/s12913-025-12915-2.

ABSTRACT

BACKGROUND: Health research projects can be complex challenges for those who undertake them and include substantial work that is not, in itself, a part of the scientific discipline. This work relates to the ever-evolving requirements of legislation, administration, and secure IT facilities, and the tasks can prove to be a significant barrier for researchers with inadequate access to research infrastructure and resources. Additionally, inappropriately applied study designs or statistical methods may result in studies which add little value to their field, but these issues may be avoidable if the necessary infrastructure and support is available. The aim of this paper is to describe the structure of a research support unit in the Region of Southern Denmark and how the unit has grown over time, followed by a discussion addressing challenges which may arise when building such research infrastructure.

METHODS: This paper presents a descriptive case on the structure of the research support unit OPEN (Open Patient data Explorative Network). It outlines the establishment, growth, and challenges through semi-structured interviews with founders and users of OPEN, user experience surveys, internal and official documents, and internal database reports on projects that have used or are going to use OPEN’s facilities.

RESULTS: OPEN was established in 2008 to support researchers in collecting and storing data and biological material from research projects, and has since evolved and grown, providing support and infrastructure in nearly all aspects of the research process, and continuously adapting to meet the changing needs of the researchers. From 2008 to 2022, a total of 1814 health research projects have received support from OPEN, with 255 of these being admitted as new projects in 2022. User satisfaction surveys and interviews showed high levels of satisfaction in support and services, but also highlighted areas of infrastructure which can be developed further.

CONCLUSIONS: OPEN has experienced significant growth since it was founded, evolving into a one-stop shop for research support. A flexible framework and agile adaptation to user needs have been important factors in this expansion. The challenges and successes of this process may inspire others working with health administration and research infrastructure.

PMID:40426119 | DOI:10.1186/s12913-025-12915-2

BMC Pregnancy Childbirth. 2025 May 27;25(1):615. doi: 10.1186/s12884-025-07647-4.

ABSTRACT

BACKGROUND: Missed nursing care is a newly defined concept and refers to any aspect of required patient care that is omitted or delayed. This study aimed to determine the effectiveness of electronic reminders on missed care in NICU.

METHOD: This is a two groups (before and after) quasi experimental study. A random sampling technique was employed to collect a sample of 70 nurses among two NICUs in an educational hospital in the south east of Iran. Miss care questionnaire was used to determine Missed care before, immediate, and one month after the intervention. The study intervention includes sending electronic reminders regarding nursing care of NICU hospitalized neonate. Data were analysed using SPSS₂₀ software, descriptive (frequency, percentage, mean, and standard deviation), and analytical statistics. The level of significance was considered as 0.05.

RESULTS: The results showed that the mean score of missed care was decreased after intervention in the intervention group (6.74 ± 8.47) rather than the control group (18.57 ± 14.59) (P = 0.001). The highest and the lowest mean score of missed care before and after the intervention was in general care and oxygen therapy domains in both groups. The second time intervention was one month after did not show any significant differences in the two groups. But decreasing in missed care was shown in both groups.

DISCUSSION: Using informational technologies like WhatsApp is an easy, low cost and available method which could help nurses decrease missed nursing care. More studies with a longer duration could probably have a greater impact on reducing missed care.

PMID:40426111 | DOI:10.1186/s12884-025-07647-4

BMC Pregnancy Childbirth. 2025 May 27;25(1):617. doi: 10.1186/s12884-025-07735-5.

ABSTRACT

BACKGROUND: Malaria and anaemia in pregnancy remain public health problems because they increase the risk of adverse pregnancy outcomes. This study assessed malaria and anaemia prevalence and associated risk factors among pregnant women initiating antenatal care in selected districts of 2 regions of Ghana.

METHODS: An analytical cross-sectional study was conducted using data obtained from 5196 pregnant women at their booking antenatal care (ANC) visit. Women of any age, gestational age, parity and at any ANC visit, who consented were enrolled consecutively into the study. Data on socio-demographic and obstetric characteristics, bed net ownership and use were obtained using structured questionnaires. Haemoglobin concentration and malaria, Schistosoma and helminth infections were determined using an automated haematology analyser and microscopy, respectively. Summary statistics to describe study variables and chi-square test and logistic regression set at p < 0.05 to determine risk factors for anaemia and malaria were conducted using Stata SE14.

RESULTS: Overall malaria prevalence was 5.74% [95% CI: 5.1-6.4] and anaemia prevalence was 55.22% [ 95% CI: 53.85-56.58]. Living in Volta region (p < 0.001), being secondi- (p = 0.003) or multigravida (p < 0.001) and being of lower middle socio-economic status (p = 0.004) reduced the women’s risk of malaria parasite infection. Being anaemic (p = 0.001) and reporting a symptom (p < 0.001) increased the odds of Plasmodium infection among the women. Residing in Volta region (p < 0.001), having malaria infection (p < 0.001), and booking ANC in the 2nd (p < 0.001) and 3rd trimesters (p < 0.001) increased the odds of anaemia among the women. Age 25-34 years (p < 0.001) and ≥ 35 years (p = 0.008) and belonging to middle (p = 0.009), upper middle (p = 0.006) or upper-level (p < 0.001) quintile of wealth index reduced the odds of anaemia among the women at their booking ANC visit.

CONCLUSIONS: More than half the women were anaemic signifying a severe public health problem. Malaria prevalence, though low, was a significant risk factor for anaemia. Existing malaria and anaemia control strategies through ANC need strengthening, especially among young, first-time pregnant women. This study further highlights socio-economic status as an important risk factor for anaemia in pregnancy.

TRIAL REGISTRATION: Not applicable.

PMID:40426109 | DOI:10.1186/s12884-025-07735-5

BMC Pediatr. 2025 May 27;25(1):424. doi: 10.1186/s12887-025-05730-5.

ABSTRACT

BACKGROUND: Depressive symptoms in the perinatal period as well as difficulties developing an emotional bond towards the child have been described as potential risk factors for poor child development. Few studies have investigated the mediating role of parent-child bonding for the association between prenatal depressive symptoms and child outcomes. Research on this association is especially scarce regarding the paternal perspective. This study investigated the prospective association between both parents’ prenatal depressive symptoms and child development, taking the mediating role of parent-child bonding into account.

METHODS: Data of 1,178 mothers and 743 fathers were drawn from the prospective longitudinal cohort study “Dresden Study on Parenting, Work, and Mental Health” (DREAM). To investigate the prospective association between depressive symptoms during pregnancy and eight weeks postpartum (self-report, Edinburgh Postnatal Depression Scale), parent-child bonding at eight weeks postpartum (self-report, Postpartum Bonding Questionnaire), and child development at 14 months postpartum (parent-report, Ages and Stages Questionnaire-3), multiple regression and mediation analyses were conducted individually for both parents, including the confounders parental age, education, child’s sex assigned at birth, prematurity, and perceived social support.

RESULTS: In both parents, a statistically significant small-sized mediating effect of parent-child bonding for the association between prenatal depressive symptoms and child development was found, with higher depressive symptoms being associated with more parent-child bonding impairment, which was associated with poorer child development. Paternal depressive symptoms were not directly associated with child development, whereas higher levels of maternal prenatal depressive symptoms were directly associated with better child development at 14 months postpartum. After additionally controlling for postpartum depressive symptoms, the association between prenatal depressive symptoms and parent-child bonding was no longer significant, and a positive association between paternal prenatal depressive symptoms and child development emerged.

CONCLUSIONS: Our results underline the importance of addressing depressive symptoms in the context of perinatal care to support parents experiencing mental health problems or struggles with the adjustment to parenthood early on. Future research on the complex dynamics of mental health, parent-child bonding, and child development is needed to replicate our findings. Our study highlights the relevance of including the perspective of both parents into research and clinical practice.

PMID:40426107 | DOI:10.1186/s12887-025-05730-5

BMC Womens Health. 2025 May 27;25(1):259. doi: 10.1186/s12905-025-03803-2.

ABSTRACT

BACKGROUND: Respectful maternity care (RMC) is an essential strategy to scale up mothers’ positive experiences during childbirth. However, few studies have been conducted to quantify the practice in Rwanda. The main objective of this study was to determine the proportion of the RMC approach in health facilities and associated factors in Musanze District in Rwanda.

METHODS: This is a health facility-based cross-sectional study conducted among 335 women who delivered at eight healthcare facilities including hospital and health centers in Musanze District between March to May 2024. We used simple random sampling to select health centers and included all participants who satisfied the inclusion criteria until the predetermined sample size was reached. The proportion of RMC as an outcome variable was calculated from the 30-item PCMC Scale, and RMC was considered to have been received if a woman responded “2 = yes, most of the time” and “3 = yes, all the time” to all the 30 items. We used multivariate logistic regression to identify factors associated with the provision of RMC such as employment status, parity, and place of delivery. The results were reported using odds ratios with the 95% CI. Variables were proved statistically significant based on p < 0.05.

RESULTS: 335 participants were enrolled in this study. The majority of respondents were between 25-34 years (54.0%) and married (74.3%). The proportion of respectful maternity care was 65.1% (95% CI: 59.7-70.2). Being employed was associated with receiving RMC [AOR = 17.75, 95%CI:8.06-39.06, p < 0.001]. Primiparous women compared to multiparous had higher odds of receiving RMC [AOR = 5.15, 95%CI:2.07-12.79, p < 0.001]. Cesarean deliveries were associated with a greater likelihood of RMC compared to those who delivered vaginally [AOR = 6.00, 95%CI:2.40-15.03, p-value = 0.003]. Women who delivered at health centers were more likely to receive RMC than those who delivered in hospitals [AOR = 3.72, 95% CI: 1.41-9.83, p = 0.008]. Daytime deliveries were more likely to receive RMC than nighttime deliveries (AOR = 3.11, 95% CI: 1.52-6.37, p = 0.002). Additionally, women with insurance other than Rwanda’s Community Based Health Insurance had higher odds of receiving RMC (AOR = 4.46, 95% CI: 1.88-10.61, p < 0.001).

CONCLUSION: The level of respectful maternity care in Musanze District was found to be 65.1%. Interventions to improve respectful maternity care should focus on training healthcare providers about its components, including dignity and respect, autonomy and communication, and social support, in addition to educating the community to request quality care. These findings call upon policy makers to involve different stakeholders to come up with interventions to improve quality of care during childbirth.

PMID:40426106 | DOI:10.1186/s12905-025-03803-2

Burns. 2025 May 19;51(6):107549. doi: 10.1016/j.burns.2025.107549. Online ahead of print.

ABSTRACT

BACKGROUND: Tranexamic acid (TXA) has gained increasing recognition for its efficacy in minimizing blood loss, ecchymosis, and edema.

METHODS: This study investigates whether local infiltration of TXA during tissue expander insertion safely reduces postoperative drainage. A single-surgeon retrospective cohort study was performed to analyze patients undergoing tissue expander insertion between 2021 and 2023. Following expander insertion, patients in the intervention group received 5 mL of TXA (0.25 g in NaCl 0.9 %) infiltrated into the dissection area, whereas the historical controls did not. Patient demographics, drainage volume and duration, surgical complications, and adverse events were examined. The impact of various factors on the drainage volume and duration was evaluated by multiple linear regression analysis. Using inverse probability weighting (IPW), a statistical method that applies weights to account for confounding factors in observational studies, the drainage volume and duration between the two groups were compared.

RESULTS: A total of 127 expander insertion procedures were reviewed, with 42 receiving TXA and 85 not. Complications were similar between the groups, and no severe adverse effects of TXA were observed. Regression analysis indicated that the use of TXA and limb location were negatively correlated with postoperative drainage duration and drainage volume unit area of the first postoperative day. Due to the imbalance in the layer of expander insertion between the two groups, IPW was applied. After IPW, the TXA group had significantly reduced drainage duration (P = 0.002) and drainage volume on the first postoperative day (P = 0.008) compared to the no-TXA group.

CONCLUSIONS: Local infiltration of TXA during expander insertion is associated with reduced drainage.

PMID:40424669 | DOI:10.1016/j.burns.2025.107549

EBioMedicine. 2025 May 26;116:105744. doi: 10.1016/j.ebiom.2025.105744. Online ahead of print.

ABSTRACT

BACKGROUND: Despite decades of research on the influenza virus, we still lack a predictive understanding of how vaccination reshapes each person’s antibody response, which impedes efforts to design better vaccines. Models using pre-vaccination antibody haemagglutination inhibition (HAI) titres against the vaccine strain alone poorly predict post-vaccination responses.

METHODS: We combined fifteen prior H3N2 influenza vaccine studies from 1997 to 2021, collectively containing 20,000 data points, and develop of a machine learning model that uses pre-vaccination HAI titres against multiple influenza variants to predict post-vaccination responses. To further test the model, four new vaccine studies were conducted in 2022-2023 spanning two geographic locations and three influenza vaccine types.

FINDINGS: The most predictive pre-vaccination features were HAI titres against the vaccine strain and against historical influenza variants, with smaller predictive power derived from age, sex, vaccine dose, and geographic location. The resulting model predicted future responses even when the vaccine strain or vaccine formulation changed. A pre-vaccination feature-the time between peak HAI across recent variants-distinguished large versus small post-vaccination responses with 73% accuracy. Model predictions against prior vaccine studies had 2.4-fold error (95% CI: 2.34-2.40x, no large outliers with >4-fold error), yielding more accurate and robust predictions than a null model with 3.2-fold error (95% CI: 3.12-3.21x, 12% large outliers). The four new vaccine studies presented here were predicted with comparable accuracy to the intrinsic 2-fold error of the experimental assay.

INTERPRETATION: A person’s pre-vaccination influenza HAI titres using multiple variants are highly predictive of their post-vaccination response. Many individuals exhibited little-to-no vaccine response, as exhibited by the null model’s accuracy, yet the machine learning model identified and accurately predicted both weak and strong responses with statistical superiority. Taken together, this approach paves the way to better utilise current influenza vaccines, especially for individuals that exhibit the weakest responses.

FUNDING: NIAID, UCSD PREPARE Institute, LJI & Kyowa Kirin, Inc. (KKNA-Kyowa Kirin North America), UGA, Cleveland Clinic, the Georgia Research Alliance, and the Bodman family.

PMID:40424667 | DOI:10.1016/j.ebiom.2025.105744