Nevin Manimala

Med Educ Online. 2026 Dec 31;31(1):2661455. doi: 10.1080/10872981.2026.2661455. Epub 2026 Apr 21.

ABSTRACT

OBJECTIVE: Ageism negatively affects older people’s health, well-being, and quality of care. Identifying ageism and attitudes toward older adults may help identify medical students motivated to work with a growing older population. We conducted a systematic review of interventions to reduce ageism among medical students.

METHODS: We conducted a systematic literature retrieval in Medline, the Cochrane Library, Epistemonikos and PubMed via Ovid, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, from database inception to August 23rd, 2024. We searched for studies examining medical students’ attitudes towards older persons, including interventions to influence these attitudes.

RESULTS: The systematic review included 21 studies. Study samples ranged between 29 and 415, with a pooled total of 3940 medical students, the majority conducted in the USA. The meta-analysis of students’ attitudes before and after all interventions included a total of 2004 students, yielding a non-significant standardized mean difference (SMD) of 0, 12 (95% CI -0, 01 to 0, 26). The meta-analysis of students’ attitudes before and after all interventions (35-37, 39, 41, 45, 48, 50), after removing UCLA-GAS and R-GAS, included a total of 1344 students with a standardized mean difference of 0, 23 (95% CI 0, 06 to 0, 40). Analysis of empathy-based teaching interventions included 1652 students, and showed a statistically significant effect, SMD 0, 18 (95% CI 0, 01 to 0, 34). Analysis of 352 students receiving traditional teaching methods yielded no effect on ageism, with an SMD -0, 13 (95% CI -0, 81 to 0, 54). High heterogeneity (I² 75-85%) affects our confidence in the effect estimates.

CONCLUSION: Empathy-based interventions seem to improve medical students’ attitudes towards older persons. Traditional teaching methods may increase negative attitudes. Considering the high heterogeneity, the results should be interpreted cautiously. Adding empathy-based components to medical curricula could combat ageism. More studies are needed to examine whether the results of studies from North America are valid globally.

PMID:42012144 | DOI:10.1080/10872981.2026.2661455

Diagnosis (Berl). 2026 Apr 16. doi: 10.1515/dx-2026-0001. Online ahead of print.

ABSTRACT

OBJECTIVES: Traditional diagnostic accuracy metrics – sensitivity, specificity, predictive values, likelihood ratios, and global indices such as Youden’s J and the diagnostic odds ratio – describe important statistical properties of diagnostic tests but do not express benefit-harm balance in a single, prevalence-sensitive measure. The Diagnostic Efficiency Ratio (DER) is introduced as a composite metric designed to quantify diagnostic discriminative efficiency.

METHODS: DER is defined as the ratio of the number needed to misdiagnose (NNM) to the number needed to diagnose (NND), where NND=1/(Sn + Sp – 1) and NNM=1/[(1 – Sp) + Pr × (Sp – Sn)]. Closed-form derivation was performed analytically and verified using independent algebraic tools. Hypothetical scenarios spanning plausible ranges of sensitivity, specificity, and prevalence were constructed to illustrate DER behavior, and an empirical illustration using published neonatal sepsis biomarker studies was conducted.

RESULTS: Across hypothetical scenarios, DER demonstrated mathematically coherent and clinically intuitive behavior. High DER values occurred only when sensitivity and specificity were jointly strong and balanced. DER declined as specificity decreased or prevalence increased, with small values indicating contexts in which misdiagnoses consume a larger share of testing effort. In the empirical neonatal sepsis examples, DER differentiated biomarkers and settings in a manner consistent with its structural formulation, highlighting context-dependent diagnostic efficiency.

CONCLUSIONS: DER provides a prevalence-sensitive, frequency-based representation of diagnostic benefit relative to harm, reframing diagnostic accuracy in efficiency-oriented terms by expressing how effectively testing effort is converted into discriminative gain beyond chance relative to misclassification burden. This conceptual and illustrative evaluation supports DER’s coherence and potential stewardship utility as a complement to traditional diagnostic accuracy metrics. Ultimately, the DER helps to recast diagnostic performance as an efficiency problem, aligning it with modern value-based healthcare and stewardship priorities.

PMID:42012142 | DOI:10.1515/dx-2026-0001

J R Soc Med. 2026 Apr 21:1410768261438374. doi: 10.1177/01410768261438374. Online ahead of print.

NO ABSTRACT

PMID:42012125 | DOI:10.1177/01410768261438374

Trauma Violence Abuse. 2026 Apr 21:15248380261433012. doi: 10.1177/15248380261433012. Online ahead of print.

ABSTRACT

This systematic review aims to synthesize what protective factors have been identified to promote resilience in adults who have experienced potentially traumatic events (PTEs). APA PsychInfo and PubMed were searched to identify literature published between 2014 and 2024 that studied resilience in trauma-exposed adults. Studies were included if: the PTEs experienced by participants met Criterion A for events preceding posttraumatic stress disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-V TR); the study measured modifiable protective factors; and the study included a measure of resilience. Two independent reviewers used standardized data extraction forms and assessed risk of bias with the Mixed Methods Appraisal Tool. Of 991 unique references, 13 articles met inclusion after full-text review. A social-ecological framework guided the synthesis and categorization of factors bolstering resilience. At the interpersonal level, protective factors identified included social support and religious attendance. At the institutional or organizational level, employment, length of employment, and workplace belongingness were identified as promoting resilience. At the community level, access to social resources to help meet basic needs was found to strengthen resilience. Finally, at the public policy level, employee assistance supported resilience. This review identified critical gaps in current resilience literature. Future research should define the type, timing, and duration of PTEs exposure, as well as specify the time lapsed between data collection and the PTEs exposure. Resilience conceptualizations and interventions should focus on tracing resilience across time and on multisystemic resilience-oriented interventions that include the individual, interpersonal, institutional/organizational, community, and public policy levels.

PMID:42012092 | DOI:10.1177/15248380261433012

JMIR AI. 2026 Apr 17;5:e80173. doi: 10.2196/80173.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) can enhance diagnostic accuracy, efficiency, and decision-making in health care, but real-world impact depends on practitioners’ acceptance and readiness to use AI in clinical workflows. The United Arab Emirates offers a policy-driven context to study these factors, given active national AI strategies and rapid health system digitization.

OBJECTIVE: This study aimed to develop and validate a model explaining how trust, perceptions, perceived risk, and perceived benefit shape practitioners’ acceptance of AI and, in turn, their readiness to implement AI in clinical practice. The model integrates the Technology Acceptance Model, the Unified Theory of Acceptance and Use of Technology, and the Theory of Trust and Acceptance of Artificial Intelligence Technology.

METHODS: We conducted a cross-sectional online survey of 182 United Arab Emirates-based health care practitioners (physicians, nurses, dentists, and allied health staff). Constructs included trust, perception, perceived risk, perceived benefit, acceptance, and readiness. Knowledge of AI was also assessed using true or false statements. We performed confirmatory factor analysis and structural equation modeling, reporting standard fit indices. The survey adhered to the Checklist for Reporting Results of Internet E-Surveys guidelines, and ethics approval and electronic consent were obtained.

RESULTS: Trust was positively associated with perception (β=.704; P<.001) and perceived benefit (β=.191; P=.02) and negatively associated with perceived risk (β=-.301; P<.001). Acceptance was positively associated with trust (β=.452; P<.001), perception (β=.459; P<.001), and perceived benefit (β=.168; P=.002), and negatively associated with perceived risk (β=-.140; P=.009). Acceptance strongly predicted readiness (β=.874; P<.001). The model fit indices are standardized root-mean-square residual of 0.068, root-mean-square error of approximation of 0.0913, goodness-of-fit index of 0.802, adjusted goodness-of-fit index of 0.763, and comparative fit index of 0.906. Our knowledge assessment found notable gaps among participants, underscoring a need for education and training. Our study sample was predominantly drawn from Dubai-based health care settings (103/182, 57%) and nursing roles (71/182, 39%); therefore, these findings primarily reflect the Dubai health regulatory environment and nursing workflows and may not generalize to the broader federal health care system across all Emirates.

CONCLUSIONS: Trust is a central lever for advancing AI acceptance and implementation readiness among the study cohort of United Arab Emirates-based health care practitioners. Implementation programs should prioritize building institutional and technical trust (transparency, safety, and governance), reducing perceived risk (privacy, security, and reliability), and amplifying perceived benefits through hands-on demonstrations and workflow-aligned use cases. Targeted training to close knowledge gaps should accompany policy and organizational measures aligned with national AI strategies to accelerate responsible, clinician-in-the-loop adoption.

PMID:42012070 | DOI:10.2196/80173

Math Med Biol. 2026 Apr 21:dqag004. doi: 10.1093/imammb/dqag004. Online ahead of print.

ABSTRACT

An impulsive differential equation model of cancer treatment by radiation therapy (RT) is studied. Analytical results for the model’s persistence and eradication of cancer cell volumes are obtained to illuminate the dynamics between tumor growth and RT. It is also shown that, although periodic solutions may exist, they are necessarily unstable. A modified model is then proposed, assuming that RT is more effective than the first model assumes. In addition to similar results as for the original model, conditions are obtained under which periodic solution exists and is globally stable, showing the possibility that regression can occur in periodicity. Numerical simulations are provided to confirm the results.

PMID:42012065 | DOI:10.1093/imammb/dqag004

Acta Orthop Belg. 2026 Apr 20;92(1). doi: 10.52628/92.1.15163.

ABSTRACT

The use of surgical navigation using holograms provided by mixed reality glasses is already a reality in other fields of orthopaedics as the shoulder or knee. Due to this, this study aimed to develop and evaluate a mixed reality-based system for navigation in derotational radius osteotomies, focusing on its accuracy and reproducibility. To this end, a holographic computing software based on C++ language and code integrable in MRTK 2 (Microsoft, Redmond, USA) was generated to be implemented in Microsoft Hololens 2. Using the 3D Builder software, positioners and trackers, recognisable by mixed reality glasses, were designed and patented, allowing us to know the changes in spatial relationship between two trackers. A total of 41 radius biomodels were used. A hand surgery consultant and an orthopaedics resident each performed ten rotational osteotomies using freehand technique and ten with the navigation system. Afterwards, a CT scan was performed, measuring the variation achieved. The error was defined as the difference between the planned and obtained orientation in both techniques and analyzed statistically. Under these conditions, the median error of the navigated system was 1º [0-2.25°], compared to 11º [7-19.5°] with the freehand technique (p<0.05). Error did not significantly increase with greater osteotomy magnitudes. The navigated system demonstrated higher accuracy and reproducibility. No significant inter-surgeon differences were observed in either technique. In conclusion, surgical navigation based on holographic computerization improves the accuracy of radius rotational osteotomies. Due to its reproducibility and simplicity, it represents a potential technique for future surgical navigation.

PMID:42012047 | DOI:10.52628/92.1.15163

Acta Orthop Belg. 2026 Apr 20;92(1). doi: 10.52628/92.1.14713.

ABSTRACT

This meta-analysis study was conducted to evaluate the effect of education-based interventions on the development of deep vein thrombosis (DVT) in patients undergoing orthopedic surgery. In this study, the terms “deep vein thrombosis,” “orthopedic surgery,” and “patient education” were searched in Turkish and English in the relevant literature published in the last 20 years in the Web of Science, PubMed, ScienceDirect, Scopus, and Google Scholar databases. A total of 8021 studies were found as a result of the search. Six studies that met the inclusion criteria were reviewed. In the meta-analysis, the Odds Ratio (OR) was calculated as the effect size, and Cochran’s Q test and I² statistic were used for heterogeneity analysis. Publication bias was assessed using funnel plots and Egger regression tests. The meta-analysis found that the risk of developing DVT was significantly lower in groups that received educational interventions compared to control groups (OR ≈ 0.50, 95% CI: 0.37-0.69, p <0.001). Educational interventions have been effective through mechanisms such as encouraging early mobilization, increasing compliance with anticoagulant medication use, and raising awareness about DVT symptoms (p <0.05). In orthopedic surgery patients, education-based interventions applied in conjunction with pharmacological and mechanical methods are effective in preventing DVT. Systematic integration of patient education programs into clinical practice will contribute significantly to improving patient safety and reducing postoperative complications. Future studies should focus on the integration of digital health technologies and the evaluation of long-term effects. The study has been registered with PROSPERO (CRD420251047966).

PMID:42012043 | DOI:10.52628/92.1.14713

Acta Orthop Belg. 2026 Apr 20;92(1). doi: 10.52628/92.1.15273.

ABSTRACT

PURPOSE: This study aimed to validate potential clinical and radiological features for distinguishing enchondromas from atypical cartilaginous tumours (ACT) and to analyse the association between maximum tumour diameter and local recurrence of enchondromas. It is important to note that this research serves as a validation cohort rather than proposing a new diagnostic framework.

MATERIALS AND METHODS: This retrospective study reviewed the clinical data of 50 patients pathologically diagnosed with enchondroma or ACT and treated in our center between 1 January 2015 and 1 June 2024. Imaging characteristics, recurrence outcomes and other variables were compared among patients, and chi-square tests were used to assess the influence of maximum tumour diameter and other relevant factors on the recurrence rate. This study has been approved by the ethics committee of our institution.

RESULTS: Patients with a maximum tumor diameter ≥ 5 cm exhibited a higher recurrence risk (recurrence 8 % vs. non-recurrence 0 %, P = 0.01, P < 0.05). This difference is statistically significant and may aid in distinguishing enchondroma from ACT. Moreover, all recurrent cases exhibited cortical bone destruction, which further validates the importance of this imaging feature as a key differentiating point. The primary treatment consisted of curettage combined with bone grafting, yielding an overall favorable prognosis.

DISCUSSION: A maximum tumor diameter of ≥5 cm and cortical bone destruction can be considered important predictive factors for local recurrence, and they may also assist in differentiating between atypical cartilaginous tumors (ACTs) and enchondromas. Based on our findings, we are more inclined to consider lesions ≥5 cm as ACTs, particularly when accompanied by cortical destruction, as these features suggest a more aggressive biological behavior. Therefore, we recommend performing extended curettage combined with intraoperative electrocautery or other effective local adjuvant techniques in such cases to achieve adequate tumor control and reduce the risk of recurrence.

PMID:42012039 | DOI:10.52628/92.1.15273

Acta Orthop Belg. 2026 Apr 20;92(1). doi: 10.52628/92.1.15247.

ABSTRACT

This study aimed to evaluate the feasibility of proximal femoral nailing (PFN) in the lateral decubitus position using a standardized, limb-based approach without a traction table and to report early postoperative (24-72 hours) radiographic and technical outcomes, focusing on lag screw position and tip- apex distance (TAD). This single-center retrospective study included 52 adult patients (>18 years) who underwent PFN in the lateral decubitus position according to a standardized algorithm between January 2021 and December 2024. Demographic characteristics, fracture classification, operative parameters, early postoperative (24-72 hours) radiographic measurements (TAD and Cleveland-Bosworth quadrant position), and postoperative complications recorded during available follow-up were collected. Evans and Boyd-Griffin classifications were used for fracture typing. Statistical analyses evaluated the association between fracture stability and operative duration; analyses involving cut-out were interpreted descriptively due to the low event count. The mean age was 70.5 ± 13.4 years, and 59.6% of patients were male. According to the Evans classification, 69.2% of fractures were stable, 23.1% were unstable, and 7.7% were reverse oblique. The mean operative preparation time was 10.4 ± 1.8 minutes, and the mean operative duration was 43.6 ± 7.9 minutes; operative duration was longer in unstable fractures (p < 0.001). According to the Cleveland-Bosworth system, 73.1% of lag screws were positioned central- central, and no screws were placed in the superior-posterior quadrant. The mean TAD was 17.7 mm, and 96.2% of patients had TAD < 25 mm. Cut-out occurred in two patients (3.8%) and was observed among patients with higher TAD values; this observation was considered exploratory. We present a novel standardized, limb-based lateral decubitus PFN algorithm without a traction table. The approach yielded reproducible early postoperative radiographic parameters (24-72 hours), including acceptable TAD values and favorable Cleveland-Bosworth screw placement.

PMID:42012036 | DOI:10.52628/92.1.15247