Tag: nevin manimala

Breast Cancer Res. 2025 May 12;27(1):76. doi: 10.1186/s13058-025-02036-3.

ABSTRACT

BACKGROUND: Cancer-related fatigue (CRF) is a common symptom in breast cancer patients and survivors, which can substantially impair quality of life. Previous studies suggested that CRF may be associated with poorer survival outcomes, but had limited follow-up duration or insufficient adjustment for established prognostic factors. The aim of this analysis was to assess the prognostic value of CRF at the end of radiotherapy for overall survival in a cohort of women with breast cancer with a median follow-up time of 19 years.

METHODS: Data from the prospective ISE study, which enrolled women with non-metastatic breast cancer between 1998 and 2001, were analysed. Patients did not receive chemotherapy. A vital status follow-up was conducted in 2019. CRF was collected at the end of radiotherapy using the EORTC QLQ-C30 and classified using the threshold of clinical importance. Cox regression models adjusted for CRF, age, body mass index (BMI), tumour size, nodal involvement, grading and receptor status were calculated.

RESULTS: Of 437 patients with fatigue assessments, 164 (38%) reported CRF. During 10 years of follow-up, 25 patients without and 27 patients with CRF died. Tumour size, nodal involvement and age were statistically significantly associated with 10-year overall survival. For CRF, a statistically significant effect was observed for ≥ 5 years of follow-up (HR: 2.44), but not within the first 5 years of follow-up (HR: 1.26).

CONCLUSIONS: CRF assessments at the end of radiotherapy showed prognostic value for long-term survival beyond established factors and could potentially be used to identify patients that require monitoring in risk-adapted aftercare programmes in order to improve survival.

PMID:40355939 | DOI:10.1186/s13058-025-02036-3

J Transl Med. 2025 May 12;23(1):532. doi: 10.1186/s12967-025-06507-1.

ABSTRACT

BACKGROUND: Accurate assessment of expected survival in melanoma patients is crucial for treatment decisions. This study explores deep learning-based body composition analysis to predict overall survival (OS) using baseline Computed Tomography (CT) scans and identify fully volumetric, prognostic body composition features.

METHODS: A deep learning network segmented baseline abdomen and thorax CTs from a cohort of 495 patients. The Sarcopenia Index (SI), Myosteatosis Fat Index (MFI), and Visceral Fat Index (VFI) were derived and statistically assessed for prognosticating OS. External validation was performed with 428 patients.

RESULTS: SI was significantly associated with OS on both CT regions: abdomen (P ≤ 0.0001, HR: 0.36) and thorax (P ≤ 0.0001, HR: 0.27), with lower SI associated with prolonged survival. MFI was also associated with OS on abdomen (P ≤ 0.0001, HR: 1.16) and thorax CTs (P ≤ 0.0001, HR: 1.08), where higher MFI was linked to worse outcomes. Lastly, VFI was associated with OS on abdomen CTs (P ≤ 0.001, HR: 1.90), with higher VFI linked to poor outcomes. External validation replicated these results.

CONCLUSIONS: SI, MFI, and VFI showed substantial potential as prognostic factors for OS in malignant melanoma patients. This approach leveraged existing CT scans without additional procedural or financial burdens, highlighting the seamless integration of DL-based body composition analysis into standard oncologic staging routines.

PMID:40355935 | DOI:10.1186/s12967-025-06507-1

Cardiovasc Diabetol. 2025 May 12;24(1):201. doi: 10.1186/s12933-025-02738-0.

ABSTRACT

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent clinical syndrome with high morbidity and mortality. Although HFpEF frequently coexists with cardiometabolic diseases, the causal mechanisms and potential mediators remain poorly understood.

OBJECTIVES: This study aimed to identify cardiometabolic risk factors specifically driving HFpEF and to determine their underlying circulating mediators.

METHODS: We used two-sample Mendelian Randomization (MR) to analyze the effects of obesity, Type 2 diabetes, hypertension, chronic kidney disease (CKD), and dyslipidemia on HFpEF and heart failure with reduced ejection fraction (HFrEF) in large European-ancestry GWAS datasets. We then performed mediation MR to identify plasma proteins and metabolites that mediate the transition from each cardiometabolic disease to HFpEF, respectively. We applied multivariable MR to assess the impact of risk confounding on the results. Bioinformatic analyses were conducted to delineate mechanisms.

RESULTS: Cardiometabolic diseases had heterogeneous effects on HFpEF and HFrEF. Obesity and type 2 diabetes showed adjusted causal effects with HFpEF, hypertension showed potential relevance to HFpEF, whereas dyslipidemia and CKD did not. MR analysis identified 5 proteins that mediate obesity to HFpEF; 5 proteins that mediate type 2 diabetes to HFpEF. Further mediation MR analysis of obesity and T2D on HFrEF revealed heterogeneity in circulating mediators between metabolic HFpEF and HFrEF. Comprehensive bioinformatics analyses showed that IL1R1, together with other proteins such as TP53 and FGF19, orchestrates the inflammatory and fibrotic processes underlying HFpEF.

CONCLUSIONS: These findings suggest that metabolic HFpEF has distinct etiological features compared with HFrEF and is driven by complex, condition-specific mediators. IL1R1 mediates HFpEF in multiple metabolic risk states, suggesting a potential therapeutic target. Further translational studies are warranted to evaluate anti-inflammatory strategies targeting IL1R1 in HFpEF.

PMID:40355922 | DOI:10.1186/s12933-025-02738-0

BMC Oral Health. 2025 May 12;25(1):712. doi: 10.1186/s12903-025-06083-2.

ABSTRACT

BACKGROUND: Maintaining good oral and dental hygiene is one of the most crucial components of a healthy lifestyle. Health education is implemented through various techniques, such as lectures, movie screenings, printed materials, etc. This study aimed to develop a multimedia teaching instrument for oral and dental health education and assess its effectiveness in raising teenagers’ knowledge and satisfaction.

METHODS: the research’s sample size included 70 teenagers, who were chosen randomly. The users were given access to the program before and after using the software, and its efficacy was assessed from their perspective using questionnaires. The data analysis was performed using descriptive statistics indices and analytical tests, SPSS version 26. A significance level of 0.05 was considered.

RESULTS: The average age and educational grade of software users were 14.49 years and 8.49 years, respectively. Before using the software, 67.76 ± 19.8% of the questions were answered correctly, while after using the software, 86.85 ± 10.21% of the questions had an accurate response. Before and after utilizing the program, there was an increase of 22.9 ± 17.8% in the mean correct response.

CONCLUSION: Useful training in the mentioned software, along with multimedia content and easy access of teenagers to the training, will facilitate and increase the speed of health education and reduce the time and cost of subsequent oral and dental health disorders.

PMID:40355920 | DOI:10.1186/s12903-025-06083-2

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