Nevin Manimala

BMC Health Serv Res. 2025 Apr 17;25(1):566. doi: 10.1186/s12913-025-12644-6.

ABSTRACT

BACKGROUND: Healthcare professionals often face substantial work-related burdens. A large body of evidence has shown that poor working conditions can lead to low levels of job satisfaction, increased emotional stress and burnout. While symptom targeted interventions take effect after symptoms become manifest, preventive interventions are required to reduce the risk of work-related diseases. Therefore, the UPGRADE-trial aimed to evaluate the effectiveness of Creative Strengthening Groups as a potential intervention to enhance job satisfaction and work-related health. The German Innovation Fund (Innovationsfonds) funded the project.

METHODS: We conducted a randomized controlled trial and randomly assigned healthcare professionals to either the intervention or the control group. The intervention – Creative Strengthening Groups – consisted of two one-day classes. We evaluated the primary outcome job satisfaction and further work-related outcomes using standardized questionnaires. We collected data at baseline as well as after three and six months. The study was conducted between October 2019 to March 2023, including the pandemic period.

RESULTS: We enrolled 196 participants (intervention n = 88, control n = 108) with a mean age of 46.2 ± 12.1 years (84.5% female). 43.7% were nursing professionals. Job satisfaction in the intervention group increased from 55.47 ± 10.23 to 57.07 ± 11.65 after three months and decreased in the control group from 56.29 ± 19.69 to 53.47 ± 20.09. The difference between groups did not reach statistical significance. Additionally, change in patient-related stress significantly differed between groups (intervention: -3.9 ± 12.16 vs. control: 5.17 ± 17.43; p =.027) as well as personal burnout (intervention: -5.25 ± 13.1 vs. control: 4.35 ± 16.24; p =.011). Within the intervention group, we observed a greater improvement concerning work-related burnout in nursing staff in geriatric care than in hospitals (-15.27 ± 13.5 vs. +3.28 ± 13.7; p =.003).

CONCLUSION: Though the Covid-19 pandemic worsened working conditions for healthcare professionals, our results indicate that intervention has the potential to enhance job satisfaction and work related health. Notably, due to the overall workload and the pandemic restrictions, a high number of participants did not continually participate in both classes of the intervention and some did not return all questionnaires. As long as healthcare professionals in Germany are facing exceedingly bad working conditions, it is very difficult to support their resources such as self-efficacy, self-esteem, and optimism by health promotion interventions.

TRIAL REGISTRATION: The trial has been registered at the German Clinical Trials Register (DRKS; ID: DRKS00020908). Date of Registration: 2020-03-16.

PMID:40247351 | DOI:10.1186/s12913-025-12644-6

BMC Psychol. 2025 Apr 17;13(1):395. doi: 10.1186/s40359-025-02691-3.

ABSTRACT

BACKGROUND: Aging has become a global trend, and depression, as an accompanying issue, poses a significant threat to the health of middle-aged and older adults. Existing studies primarily rely on statistical methods such as logistic regression for small-scale data analysis, while research on the application of machine learning in large-scale data remains limited. Therefore, this study employs machine learning methods to explore the risk factors for depression among middle-aged and older adults in China.

METHODS: Using a two-step hybrid model combining long short-term memory (LSTM) and machine learning (ML), we compared 20 depression risk/protective factors in a balanced panel dataset of middle-aged and elderly Chinese adults (N = 3706; aged 45-94; 64.65% female; 41.20% middle-aged) from the China Health and Retirement Longitudinal Study (CHARLS). Data were collected across five waves (2011, 2013, 2015, 2018, and 2020). The LSTM model predicted risk factors for the fifth wave via data from the preceding four waves. Five ML models were then used to classify depression (yes/no) based on these factors, which included demographic, lifestyle, health, and socioeconomic variables.

RESULTS: The LSTM model effectively predicted depression-related variables (mean square error = 0.067). The average AUC of the five ML models ranged from 0.78 to 0.82. The key predictive factors were disability, life satisfaction, activities of daily living (ADL) impairment, chronic diseases, and self-reported memory. For the middle-aged group, the top three factors were disability, life satisfaction, and chronic diseases; for the Older people group, they were life satisfaction, chronic diseases, and ADL impairment.

CONCLUSION: The two-step hybrid model (“LSTM + ML”) effectively predicted depression over 2 years via demographic and health data, aiding early diagnosis and intervention.

PMID:40247342 | DOI:10.1186/s40359-025-02691-3

J Orthop Surg Res. 2025 Apr 17;20(1):384. doi: 10.1186/s13018-025-05682-7.

ABSTRACT

INTRODUCTION: Knee osteoarthritis (KOA) is a prevalent chronic joint disease. Due to the risks of opioid use and limited pharmacological effectiveness, mind-body exercise (MBE) therapy and other non-pharmacological interventions have emerged as first-line treatments for this condition. However, the optimal MBE modes for KOA remain undetermined. This systematic review and network meta-analysis (NMA) aims to compare the efficacy of different MBE modes, including Pilates, Tai Chi, Yoga, and Qigong, in managing KOA.

METHODS: We searched PubMed, Embase, Cochrane Library, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Database from inception to 25 April 2024. Randomized clinical trials comparing MBE interventions for pain, physical function and quality of life (QoL) in KOA patients were eligible. The Cochrane Risk-of-Bias Tool 2.0 and Grading of Recommendations, Assessment, Development & Evaluation (GRADE) approach were used to assess literature quality and evidence certainty for each outcome.

RESULT: A total of 38 studies (N = 2561) were included, with 38 for pain, 36 for physical function, and 12 for QoL in the NMA. With moderate-certainty, both Pilates and TC showed significant improvements in pain reduction [Pilates: standardized mean difference (SMD) = – 1.19, 95% confidence intervals (95% CI): – 1.92 to – 0.46; TC: SMD = – 0.78, 95% CI – 0.97 to – 0.59] and physical function (Pilates: SMD = – 1.37, 95% CI – 2.13 to – 0.50; TC: SMD = – 0.85, 95% CI – 1.08 to – 0.63) compared to the usual care group, while TC [SMD = – 0.57, 95% CI = (- 1.07 to – 0.06)] showed statistically significant efficacy in improving QoL compared to the usual care group.

CONCLUSION: There is moderate-certainty evidence that Pilates and Tai Chi may be the most effective mind-body exercises for improving pain and physical function in knee osteoarthritis, while Tai Chi may be the best for improving quality of life. These findings may help clinicians guide their prescription of exercise types with respect to treatment outcomes. The limited number of large sample studies and the few studies with low bias risk are limitations. Trial registration The protocol for NMA has been registered with PROSPERO (CRD42024531878).

PMID:40247321 | DOI:10.1186/s13018-025-05682-7

BMC Med Educ. 2025 Apr 17;25(1):570. doi: 10.1186/s12909-025-07084-z.

ABSTRACT

BACKGROUND: With the integration of Artificial Intelligence (AI) into educational systems, its potential to revolutionize learning, particularly in content personalization and assessment support, is significant. Personalized learning, supported by AI tools, can adapt to individual learning styles and needs, thus transforming how medical students approach their studies. This study aims to explore the relationship between the use of AI for self-directed learning among undergraduate medical students in the UK and variables such as year of study, gender, and age.

METHODS: This cross-sectional study involved a sample of 230 undergraduate medical students from UK universities, collected through an online survey. The survey assessed AI usage in self-directed learning, including students’ attitudes towards AI accuracy, perceived benefits, and willingness to mitigate misinformation. Data were analyzed using descriptive statistics and linear logistic regression to examine associations between AI usage and demographics.

RESULTS: The analysis revealed that age significantly influenced students’ willingness to pay for AI tools (p = 0.012) and gender was linked to concerns about AI inaccuracies (p = 0.017). Female students were more likely to take steps to mitigate risks of misinformation (p = 0.045). The study also found variability in AI usage based on the year of study, with first-year students showing a higher reliance on AI tools.

CONCLUSION: AI has the potential to greatly enhance personalized learning for medical students. However, issues surrounding accuracy, misinformation, and equitable access need to be addressed to optimize AI integration in medical education. Further research is recommended to explore the longitudinal effects of AI usage on learning outcomes.

PMID:40247306 | DOI:10.1186/s12909-025-07084-z

BMC Public Health. 2025 Apr 17;25(1):1442. doi: 10.1186/s12889-025-22567-w.

ABSTRACT

BACKGROUND: Strengthening health systems and ensuring equity and access to human resources can significantly reduce maternal and child mortality and improve maternal and child health outcomes. This mixed-methods study aimed at the quantity, quality, and equity of the allocation of human resources for health (HRH) in Chinese maternal and child healthcare institutions from 2002 to 2021 while providing a reference for optimally allocating HRH in the new era.

METHODS: Relying on health-related data obtained from statistical yearbooks in 2003-2022, the study analysed the allocation status using descriptive statistics, examined the allocation equity with the Gini coefficient and the Health resource agglomeration degree/Health resource population agglomeration degree (HRAD/HRPAD). Finally, the study predicted the future allocation trend by compiling a grey prediction model GM (1,1).

RESULTS: HRH quantity in Chinese maternal and child healthcare institutions experienced steady growth. However, the composition of educational background and professional titles was unreasonable. The quality structure needs to be further optimized. The equity of demographic allocation (Gini < 0.2) was superior to the geographic allocation (Gini = 0.631-0.678), with significant regional differences. The HRAD values of HRH in different regions were as follows: eastern region (3.50-3.70) > central region (1.69-1.92) > western region (0.36-0.44); HRPAD (2021): western region (1.150) > central region (0.991) > eastern region (0.912). The equity of sparsely populated regions was superior to that of densely populated regions. The HRH future allocation trend is positive.

CONCLUSIONS: Emphasis should be placed on the status quo of unreasonable allocation and unbalanced distribution. Careful consideration must be given to factors like service population, service radius, economic development, and population mobility while considering demographic and geographic equity to promote the reasonable allocation and full utilisation of HRH.

PMID:40247304 | DOI:10.1186/s12889-025-22567-w

BMC Med Genomics. 2025 Apr 17;18(1):74. doi: 10.1186/s12920-025-02143-2.

ABSTRACT

BACKGROUND: Recent observational studies have revealed an inconclusive correlation between inflammatory bowel disease (IBD) and sepsis, accompanied by an uncertain understanding of the causal relationship between the two. To investigate the causality between IBD and sepsis, we employed a two-sample Mendelian randomization (MR) approach.

METHODS: A genome-wide significant threshold (P < 5 × 10^-8) was achieved in order to identify single nucleotide polymorphisms (SNPs) as instrumental variables (IVs) for two types of IBD, such as Crohn’s disease (CD) and ulcerative colitis (UC). Subsequently, the selected SNPs were assessed in relation to three categories of sepsis, namely sepsis, sepsis (critical care), and sepsis (28-day death in critical care). An inverse-variance weighted (IVW) estimation of MR was conducted, followed by sensitivity analysis on multiple dimensions.

RESULTS: There was a significant association between genetic liability to CD (IVW: OR, 1.246; 95% CI, 1.090-1.423; P = 0.0012) with sepsis (28-day death in critical care), but not with sepsis (critical care) and sepsis. Whereas UC showed slightly, yet statistically insignificant, higher risk for sepsis (IVW: OR, 1.031; 95% CI, 0.988-1.064; P = 0.064).

CONCLUSION: Our study offers genetic evidence that supports a substantial causal relationship between CD and sepsis (28-day death in critical care). To enhance the specificity and objectivity of future research findings, it is recommended to specify the types of IBD and the severity of sepsis. Furthermore, the genetic risk loci related may become potential drug development targets.

PMID:40247302 | DOI:10.1186/s12920-025-02143-2

BMC Med Educ. 2025 Apr 17;25(1):564. doi: 10.1186/s12909-025-07144-4.

ABSTRACT

BACKGROUND: Bridging the gap between laboratory discoveries and patient care relies heavily on the physician-scientist workforce, which has historically served as a cornerstone in advancing biomedical sciences. However, the past decade has witnessed a remarkable decline in the number of emerging physician-scientists, raising concerns about the future of this vital community. This study aimed to evaluate the current state of early career physician-scientists on a national scale and explore challenges that hinder its growth, thereby limiting potential scientific innovation and progress.

METHODS: A survey was conducted in the United States and distributed to 110 nationally representative institutions using an online platform (SurveyMonkey), targeting physician-scientists at their late stage of clinical training (residents/fellows) and graduates of training programs within the past 10 years. 265 submitted results but after filtering for incomplete responses, a total of 230 survey results were used in the analysis. The survey evaluated scientific career trajectories, challenges encountered, and top priorities. Statistical analyses, including Chi-square and Fisher’s exact tests, were used to compare differences between groups.

RESULTS: A total of 230 physician-scientists completed the survey. The respondents were predominantly assistant professors (46%), while 27% were still enrolled in career training programs. Nearly half of the participants reported considering leaving their research career within the next two years. The primary reasons cited for this included burnout and unhappiness (35%), stress (35%), and lack of funding (30%). The most frequently reported career challenges were achieving a balance between clinical and educational responsibilities (63%) and maintaining work-life balance (53%), followed by insufficient research funding (41%). Additionally, participants underscored key factors they prioritize when seeking employment, including hybrid research-clinical opportunities (67%), work-life balance (52%), and financial security (26%).

CONCLUSION: This national survey provides an overview of the current state of early-career physician-scientists. It examines the factors contributing to the inclination to leave the scientific track and identifies the primary career challenges faced by this vulnerable community. Furthermore, it highlights key priorities of physician-scientists and gaps that require attention, offering valuable insights into strategies for retaining and supporting this critical workforce.

PMID:40247298 | DOI:10.1186/s12909-025-07144-4

BMC Med Educ. 2025 Apr 17;25(1):562. doi: 10.1186/s12909-025-07116-8.

ABSTRACT

CONTEXT: Jining Medical University has adopted the traditional large-class teaching mode in its Histology and Embryology course. In this mode, students’ participation and learning outcomes are not satisfactory.

OBJECTIVE: To solve this problem, we integrated design thinking into the large-class flipped teaching.

METHOD: A mixed methodology (qualitative and quantitative) was employed. Participants were from the university’s Clinical Medicine Program, randomly assigned to the experimental and control groups. The experimental group received integrated flipped classroom instructions, whereas the control group received traditional large-class teaching. Data were collected using an empathy canvas, questionnaires, and classroom assessments.

RESULTS: Analysis of 24 empathy maps identified 32 learning gains and 18 pain points, categorized into four dimensions: self-awareness, teamwork, learning efficiency, and comprehensive competencies. Survey results showed 89.3% of students found this teaching model enhanced knowledge comprehension, 85.3% reported no increased learning burden, and 80% acknowledged improved comprehensive abilities. Significant gender differences emerged in resource preferences (males favored interactive resources while females preferred structured materials) and perceived learning burden (p < 0.05). Classroom assessments revealed no statistically significant difference between the experimental group (75.87 ± 12.06) and control group (74.25 ± 12.65) (p > 0.05).

CONCLUSION: The large – class flipped classroom model integrated with design thinking has the potential to enhance learning outcomes and comprehensive literacy without imposing an additional burden. This model shows potential for application in the teaching of histology and embryology. However, further validation is needed to confirm its applicability across different content areas and learning environments.

PMID:40247295 | DOI:10.1186/s12909-025-07116-8

BMC Health Serv Res. 2025 Apr 18;25(1):567. doi: 10.1186/s12913-025-12742-5.

ABSTRACT

BACKGROUND: The shortage of general practitioners (GPs) in Germany, particularly in rural areas, is a pressing issue that requires innovative and sustainable solutions. One promising approach is the integration of trained medical assistants to support GPs by handling specific tasks, thus enhancing the efficiency of healthcare delivery. Delegated home visits can be carried out by healthcare professionals (HPs) with a well-defined range of tasks.

METHODS: This quasi-experimental, non-randomised longitudinal observational study runs from January 2023 to June 2025. The study participants are patients cared for by participating GPs, selected based on defined inclusion criteria, who receive regularly delegated home visits. Health-related quality of life (HRQoL) and satisfaction is assessed at three data collection points (t0 as baseline before starting the intervention, t1 after the first testing and data collection phase, and t2 after the second data collection phase). For assessing the HRQoL, we use the Short-Form-Health Survey (SF-12), and satisfaction is being measured using the patient satisfaction questionnaire ZUF-8. These parameters, as well as the continuously collected parameters (kilometers driven, travel and setup time), are analysed statistically (descriptive statistics, paired t test, Wilcoxon test, ANOVA). At t1 and t2, focus group interviews are conducted with the assistants on their satisfaction. They allow to identify the potential for concept improvement by qualitative content analysis.

DISCUSSION: The “VERSORGT am ORT” (VaO, engl. “PROVIDED on SITE”) project aims to optimise healthcare by using scarce resources in a more efficient way, maintaining patient-professional trust, and extending delegation. It seeks to implement care plans with minimal location changes and generate real-world evidence. Due to geographical and policy limitations, the study will have comparatively few participants and will use a repeated measures design instead of a control group to assess patient HRQoL and satisfaction over time. Changes in HRQoL cannot be directly linked to the new care model due to unclear causalities. Mergenthal et al. reported that 59% of GPs in rural areas delegate home visits to healthcare professionals, saving time. The VaO project aims to further relieve GPs, increasing efficiency without compromising care quality.

TRIAL REGISTRATION: DRKS00033915 – Registration Date 19/03/2024.

PMID:40247290 | DOI:10.1186/s12913-025-12742-5

J Orthop Surg Res. 2025 Apr 18;20(1):389. doi: 10.1186/s13018-025-05800-5.

ABSTRACT

BACKGROUND: The impact of Total Knee Arthroplasty (TKA) on the biomechanics of bilateral ankle joints with valgus knees remains unclear. This study aimed to evaluate how unilateral TKA affects bilateral ankle tilt, limb alignment, and biomechanics in knee valgus.

METHODS: Among 105 patients with end-stage knee osteoarthritis and mild-to-moderate valgus deformity who underwent TKA between January 2021 and June 2023, 86 were included in the study retrospectively. The hip-knee-ankle angle (HKA), weight-bearing line ratio (WBLR), knee joint line convergence angle (KJLCA), knee joint line obliquity (KJLO), tibial anterior surface angle (TAS), tibial plafond inclination (TPI), talar inclination (TI), and tibiotalar tilt (TT) were measured on standing full-length lower limb radiographs preoperatively and postoperatively, with postoperative follow-up averaging 10.4 months. Patients were divided into Group A (0°~5°, 25 knees), Group B (5°~10°, 40 knees), and Group C (10°~15°, 21 knees) based on the degree of lower limb alignment correction. Additionally, patients were classified into contralateral knee varus (30 knees) and valgus (56 knees) groups based on the preoperative HKA angle of the contralateral knee.

RESULTS: With changes in HKA, both TAS and TT showed concurrent change. Postoperative TAS [93.2 (86.9, 116.8)] and TT [-0.4 ( -5.9, 8.1)] showed a significant increase in absolute value compared to preoperative TAS [90.3 (83.1, 100.5)] and TT [0.2 ( -5.2, 6.4)] (P < 0.05). This suggests that TKA may alter the inclination angle of the talar articular surface by correcting the lower limb mechanical axis. Postoperative comparisons of ΔTPI and ΔTI across correction groups revealed statistically significant differences (P < 0.05). These findings indicate that greater knee deformity is associated with a larger preoperative angle between the distal tibial articular surface and the horizontal plane. Correction of severe deformities increases the postoperative TI angle, leading to a more inclined talar articular surface. No correlation was observed between preoperative and postoperative HKA and alignment of the contralateral ankle joint.

CONCLUSION: Before and after TKA, concurrent changes were observed in the ipsilateral ankle’s inclination angle. For severe knee valgus deformities, maintaining a residual valgus deformity postoperatively should be considered to avoid postoperative ankle complications.

PMID:40247287 | DOI:10.1186/s13018-025-05800-5