Tag: nevin manimala

BMC Health Serv Res. 2025 May 6;25(1):650. doi: 10.1186/s12913-025-12818-2.

ABSTRACT

BACKGROUND: Evidence-based Practice (EBP) is essential for improving the quality of care, patient outcomes, and the cost-effectiveness of healthcare services. Curricula and innovative teaching methods, such as virtual education, should be strongly emphasized to foster nursing students’ intentions to engage in the EBP process. This study investigated the effect of a virtual training program on nursing students’ intentions to engage in EBP.

METHODS: This interventional study included 79 nursing students in the sixth and eighth semesters of the School of Nursing who had completed courses in nursing research and nursing information technology and had started their clinical training. A virtual training program on the intentions to engage in EBP was delivered through a website in the form of one module during a week. Questionnaires on demographic information and the Persian version of Intentions to Engage in EBP Process, originally developed by Rubin and Parrish (2010), were used to collect data before the intervention and one month later. Data were collected from March to April 2023 and analyzed using SPSS (version 21). Descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (independent samples t-test, paired t-test, chi-square test and analysis of covariance) were used. A significance level of ≤ 0.05 was utilized.

RESULTS: Prior to the intervention, an independent t-test revealed no statistically significant difference between the two groups (p = 0.15). However, post-intervention results indicated a statistically significant difference (p = 0.03), with the intervention group reporting higher intentions to engage in EBP (44.62 ± 3.67) compared to the control group (36.56 ± 3.53), demonstrating the effectiveness of the educational program. A paired t-test confirmed that the improvement within the intervention group was statistically significant (p = 0.02), whereas the change observed in the control group was not (p = 0.06).

CONCLUSIONS: This study demonstrated a change in undergraduate nursing students’ intentions to engage in EBP following virtual training. Based on these findings, health policymakers, planners, and healthcare providers should prioritize strategies that empower and equip nursing students with EBP competencies to effectively implement EBP in their future professional practice.

PMID:40329371 | DOI:10.1186/s12913-025-12818-2

Genome Med. 2025 May 6;17(1):45. doi: 10.1186/s13073-025-01474-0.

ABSTRACT

BACKGROUND: The convergence of resistance and hypervirulence in Klebsiella pneumoniae represents a significant public health threat, driven by the horizontal transfer of plasmids. Understanding factors affecting plasmid transfer efficiency is essential to elucidate mechanisms behind emergence of these formidable pathogens.

METHODS: Hypermucoviscous K. pneumoniae strains were serially passaged in LB medium to investigate capsule-deficient phenotypes. Capsule-deficient mutants were analyzed using genetic sequencing to identify the types and insertion sites of insertion sequences (IS). Bioinformatics and statistical analyses based on the NCBI and National Microbiology Data Center (NMDC) database were used to map the origins and locations of IS elements. Conjugation assays were performed to assess plasmid transfer efficiency between encapsulated and capsule-deficient strains. A murine intestinal colonization model was employed to evaluate virulence levels and IS excision-mediated capsule restoration.

RESULTS: Our research revealed that a hypervirulent K. pneumoniae (hvKP) strain acquired a bla_NDM-1-bearing IncX3 plasmid with IS5 and ISKox3 elements. These IS elements are capable of inserting into capsular polysaccharide synthesis genes, causing a notably high frequency of capsule loss in vitro. The IS-mediated capsular phase variation, whether occurring in the donor or recipient strain, significantly increased the conjugation frequency of both the resistance plasmid and the virulence plasmid. Additionally, capsular phase variation enhanced bacterial adaptability in vitro. Experiments in mouse models demonstrated that capsule-deficient mutants exhibited reduced virulence and colonization capacity. However, during long-term intestinal colonization, IS element excision restored capsule expression, leading to the recovery of hypervirulence and enhanced colonization efficiency.

CONCLUSIONS: Our findings reveal that IS elements mediate capsular phase variation by toggling gene activity, accelerating the genomic convergence of multidrug resistance and hypervirulence in K. pneumoniae, as well as facilitating adaptive transitions in different environments.

PMID:40329368 | DOI:10.1186/s13073-025-01474-0

AIDS Res Ther. 2025 May 6;22(1):51. doi: 10.1186/s12981-025-00745-5.

ABSTRACT

BACKGROUND: HIV/AIDS persists as a global health challenge despite significant advancements in antiretroviral therapy (ART). The transformation of HIV into a chronic condition, coupled with regional disparities and evolving epidemiological trends, necessitates an updated analysis of the disease burden.

METHODS: We conducted a comprehensive analysis of HIV/AIDS burden among individuals aged 15-79 years from 1990 to 2021 using the latest data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 database. Multiple statistical approaches were employed to investigate temporal trends, geographic variations, and health inequalities.

RESULTS: From 1990 to 2021, global HIV/AIDS age-standardized incidence rates (ASIR) decreased by 41%, while age-standardized prevalence rates (ASPR), mortality rates (ASMR), and disability-adjusted life year rates increased by 222%, 57%, and 59%, respectively. Sub-Saharan Africa demonstrated the highest HIV/AIDS ASPR in 2021, with High-middle and Middle SDI regions, particularly Oceania, South Asia, and Eastern Europe, experiencing the most significant ASPR growth over three decades. Joinpoint analysis identified 1997 and 2015 as critical years for ASIR declines, and 2004 for ASMR reductions. Decomposition analysis revealed population growth as the primary driver of increasing incidence in lower SDI regions, while epidemiological changes were more influential in higher SDI areas. The age-period-cohort model showed peak HIV/AIDS incidence among individuals aged 25-34, with diminishing incidence risk across successive birth cohorts and periods. Health inequality analysis from 1990 to 2021 revealed a substantial widening of disparities across countries, with the slope index of inequality rising from 265 to 1006.

CONCLUSION: While global efforts have reduced HIV/AIDS incidence, increasing prevalence due to extended survival with antiretroviral therapy presents ongoing challenges. Regional disparities and rising incidence among specific demographics underscore the need for sustained, targeted interventions.

PMID:40329367 | DOI:10.1186/s12981-025-00745-5

BMC Med Educ. 2025 May 6;25(1):657. doi: 10.1186/s12909-025-07271-y.

ABSTRACT

INTRODUCTION: Sharp object injuries (SOI) pose significant risks to dental healthcare workers. This study evaluated the impact of an educational intervention on dental students’ knowledge, attitudes, and practice habits regarding SOI management.

METHODS: A quasi-experimental before-after study was conducted among 87 dental students (59.8% female, 40.2% male; mean age: 23.45 years) in clinical years (DDS 2022-2025) at Qazvin University of Medical Sciences, Iran. Participants completed a validated 34-item questionnaire (10 knowledge, 7 attitude, 17 practice questions) before and after watching a 3-minute 36-second animated video on SOI management and post-exposure prophylaxis (PEP). Data were analyzed using SPSS 26 with chi-square, ANOVA, and Bonferroni correction (p < 0.0031).

RESULTS: This study revealed significant differences in immediate post-injury performance knowledge (P = 0.001), PEP awareness (P = 0.025), and needle-capping (P = 0.001). However, there was no statistically significant difference in the extent of injury with sharp objects based on sex or age. There was a significant relationship between students’ year of university entry and the extent of injury with a sharp object (P = 0.025). Most students (67.8%) did not know how to function correctly after a sharp object injury, and the highest number of sharp object injuries occurred in the 7th semester. Over 60% of injuries went unreported, primarily due to perceived insignificance (44.1%).

CONCLUSIONS: Structured educational interventions, particularly visual aids, enhance SOI management knowledge. However, long-term behavioral changes and reporting compliance require further investigation. Integrating SOI training into dental curricula and fostering a culture of incident reporting are critical to mitigating risks.

PMID:40329360 | DOI:10.1186/s12909-025-07271-y

Perioper Med (Lond). 2025 May 6;14(1):52. doi: 10.1186/s13741-025-00521-z.

ABSTRACT

BACKGROUND: Epidural morphine is considered one of the most potent drugs used for postoperative analgesia; however, its side effects are dose-related and exaggerated in elderly people. In this study, we aimed to determine which of three doses within that range (1.5 mg, 3 mg, or 4.5 mg) can provide adequate pain relief.

METHODS: A total of 102 patients were assessed for allocation into one of four groups to receive either placebo (group Morphine 0, N = 22), 1.5 mg of epidural morphine (Morphine 1.5, N = 22), 3 mg of epidural morphine (Morphine 3, N = 22), or 4.5 mg of epidural morphine (Morphine 4.5, N = 22) before skin incision, 24 h after surgery and 48 h after surgery. Cumulative intravenous IV-PCA morphine consumption, VAS pain scores, modified Ramsay Sedation Scores, nausea, vomiting, and pruritus were evaluated.

RESULTS: The VAS pain scores at activity of patients who received epidural morphine at doses of 3 mg and 4.5 mg were significantly lower than the placebo and 1.5 mg groups, VAS Score at 72 h was (2 ± 0.8) and (1.7 ± 1) vs (4.3 ± 1.1) and (4 ± 1) respectively, p value = 0.000. The mean total IV-PCA morphine consumption (mg) was significantly higher in patients who received received epidural 0.9% sodium chloride alone compared to 1.5 mg, 3 mg and 4.5 mg epidural morphine groups (38.1 ± 4.8 mg vs 27.2 ± 5.6 mg, 9.2 ± 3.5 mg, and 6.3 ± 3.3 mg respectively), p value = 0.000). However, the difference between the 3 mg and the 4.5 mg groups was not statistically significant in both of VAS scores and IV-PCA morphine consumption (P value > 0.05 for 3 mg vs. 4.5 mg). Patients who received 4.5 mg of epidural morphine experienced a significant increase in the level of sedation, measured by the Ramsay sedation scale, in comparison with 1.5 mg, 3 mg and placebo epidural morphine groups in the first 24 h, the Scale for this group was (2.5 ± 0.5) vs (2.1 ± 0.2, 2.1 ± 0.2, and 2.2 ± 0.5 respectively); p value = 0.000. No relationship between postoperative nausea and the dosage of epidural morphine was found.

CONCLUSION: Epidural morphine 3 mg as a bolus every 24 h with add on IV patient control analgesia (PCA) morphine, set to deliver 1.5 mg boluses on demand without background infusion with a lockout period of 45 min, could achieve effective and adequate analgesia lasting up to 72 h postoperatively without increasing in the level of sedation or other side effects in older adults after a lower abdominal cancer surgery.

PMID:40329346 | DOI:10.1186/s13741-025-00521-z

BMC Rheumatol. 2025 May 6;9(1):50. doi: 10.1186/s41927-025-00504-z.

ABSTRACT

BACKGROUND: Dermatomyositis (DM) is an immune-mediated myopathy characterized by proximal muscle weakness, inflammation, and cutaneous manifestations. Up to 25% of DM patients have an associated malignancy. Those with cancer-associated DM often face worse prognoses, poorer treatment responses, and reduced survival rates. Interestingly, anti TIF1γ-positive DM patients are notably at increased risk for malignancy, yet the underlying mechanisms and clinical correlation remain poorly understood. Nailfold video capillaroscopy (NVC) is a safe, non-invasive method for assessing vascular abnormalities, previously explored in various DM subsets but not specifically in anti TIF1γ-positive DM patients with malignancy. This study aims to characterize NVC findings in anti-TIF1γ-positive DM and assess their clinical relevance, particularly in malignancy-associated cases.

METHODS: A retrospective review at Mayo Clinic, Jacksonville from January 1st, 2010 to May 16th, 2024 was conducted. 19 cases with anti TIF1γ-positive DM and 18 idiopathic inflammatory myopathy controls were included.

RESULTS: We observed anti TIF1γ-positive DM cases to have significantly increased capillary density loss and higher microhemorrhages (p = 0.057). Cases also had higher frequencies of dilated capillaries, capillary ramifications, and capillary disorganization. Although no statistically significant differences in NVC pattern were identified in cancer vs. non-cancer anti TIF1γ-positive DM, there were greater hemorrhages and ramifications noted in the cancer anti TIF1γ-positive subset.

CONCLUSION: This study investigated NVC differences among anti TIF1γ-positive DM with malignancies versus idiopathic inflammatory myopathy controls. Our findings indicate promising microvascular differences with a potential for predicting cancer development that warrant further exploration in larger studies.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40329336 | DOI:10.1186/s41927-025-00504-z

BMC Surg. 2025 May 6;25(1):197. doi: 10.1186/s12893-025-02921-w.

ABSTRACT

BACKGROUND: Achieving the global spinal alignment, especially the pelvis, in spine surgeries is considered the most important factor in the success of these surgeries, which requires an accurate evaluation of the correction angles measured during surgery. This study aimed to evaluate the accuracy of the mobile C-arm X-ray machine (C-ARM) for measuring lumbar lordosis (LL) and pelvic incidence (PI) parameters during lumbar fixation.

METHODS: In this prospective study, 59 lumbar fixation candidates who underwent surgery between 2020 and 2022 at our medical center, were examined. PI and LL parameters were measured at the fusion site with fluoroscopy, during surgery with C-ARM, and after surgery with EOS locally.

RESULTS: The mean age was 54.69 ± 17.62 years. 42 (71.2%) were female. The mean PI based on intraoperative C-ARM and post-surgery EOS findings were 54.57 ± 11.19 and 54.83 ± 11.17, respectively, which this difference was not statistically significant (P = 0.9). The mean LL estimate based on C-ARM and EOS findings was similar (P: 0.44).A significant positive linear correlation was observed for the mean PI (r: 0.97, p: 0.001) and LL (r: 0.99, p: 0.001).

CONCLUSION: The mean PI and LL angle during operation (measured with C-ARM) was similar to the mean of these parameters in EOS imaging findings after surgery. C-ARM can be used as a convenient device in the operating room with high precision to measure PI and LL values in spine surgeries.

PMID:40329329 | DOI:10.1186/s12893-025-02921-w

BMC Health Serv Res. 2025 May 6;25(1):648. doi: 10.1186/s12913-025-12808-4.

ABSTRACT

BACKGROUND: People with disabilities experience significant health inequities compared with the general population. Addressing these inequities requires the development and implementation of tailored interventions, but a gap often exists between recommended best practices and the actual care provided. Successful implementation is complex, involving multiple organizational factors. Assessing organizational readiness for change is crucial to overcome barriers and improve health outcomes for people with disabilities. This study aims to examine managers’ perceptions of their organization’s readiness for change regarding the implementation of interventions within disability healthcare in Sweden.

METHODS: This descriptive cross-sectional study employs an embedded mixed-methods approach. The primary approach for the overall study is based on quantitative data, while qualitative data is analyzed to provide supplementary deepened information. Both types of data were collected simultaneously through a web-based survey. The data analysis involves various statistical techniques for the quantitative data and inductive content analysis for the qualitative data.

RESULTS: Several key factors influence managers’ perceptions of their organization’s readiness for change, including gender, age, tenure, organizational type, managerial level, and experience. Enabling factors for implementation include trust-based leadership, staff involvement, motivation, and engagement. Barriers include complex processes, lack of support, resistance and fear, and insufficient time and resources.

CONCLUSIONS: This study highlights the complexity of organizational readiness for disability healthcare interventions, shaped by both individual and organizational factors. In particular, managerial characteristics, organizational dynamics, and resource availability play key roles. These findings suggest that a comprehensive strategy can strengthen healthcare organizations’ ability to navigate implementation challenges effectively.

PMID:40329315 | DOI:10.1186/s12913-025-12808-4

BMC Public Health. 2025 May 6;25(1):1661. doi: 10.1186/s12889-025-22925-8.

ABSTRACT

BACKGROUND: Physical activity (PA), sedentary behavior (SB), metabolic syndrome (MetS), and non-alcoholic fatty liver disease (NAFLD) have been linked in previous studies. Nevertheless, it is unclear whether MetS has a mediating influence on the relationships among physical activity, sedentary behavior, and non-alcoholic fatty liver disease. This study aims to assess the connections between physical activity, sedentary behavior, and non-alcoholic fatty liver disease and to explore the extent to which metabolic syndrome acts as a mediator in this association.

METHODS: A total of 3351 adults from the National Health and Nutrition Examination Survey (NHANES) from 2017 to 2018 were included in our study. Physical activity and sedentary behavior were categorized as work activity (WA), recreational activity (RA), walking/bicycling (for commuting) and sedentary behavior to investigate the association with metabolic syndrome and non-alcoholic fatty liver disease. Besides, mediation analysis was utilized to determine the extent to which metabolic syndrome mediates the relationships among inadequate physical activity, prolonged sedentary behavior, and non-alcoholic fatty liver disease.

RESULTS: Regression analysis revealed that a reduced risk of developing NAFLD was associated with sufficient recreational activity (OR = 0.61, 95% CI: 0.44-0.83, P = 0.004), while an increased risk of MetS was observed in sedentary behavior group (OR = 1.28, 95% CI: 1.00-1.64, P < 0.05). In addition, strong associations were detected between MetS and NAFLD. Mediation analysis indicated that metabolic syndrome accounts for 17.9% of the influence that recreational activity has on the risk of NAFLD. Subgroup analysis indicated sex differences in these associations. Specifically, recreational activity may not significantly influence the risk of developing NAFLD in females, and the mediating role of MetS was no longer significant in both sex-specific subgroups.

CONCLUSION: In the general adult population, metabolic syndrome may account for nearly 18% of the association between insufficient recreational activity and non-alcoholic fatty liver disease.

PMID:40329313 | DOI:10.1186/s12889-025-22925-8

J Transl Med. 2025 May 6;23(1):507. doi: 10.1186/s12967-025-06400-x.

ABSTRACT

BACKGROUND: Chimeric antigen receptor T-cell (CAR T-cell) therapies have shown significant promise in treating cancers and other diseases. However, the manufacturing processes for CAR T-cell therapies exhibit considerable variability, which can affect treatment consistency and patient outcomes. While centralized manufacturing models dominate, local decentralized approaches, including point-of-care production, are being explored to address logistical and access challenges. This study aims to evaluate the current landscape of local CAR T-cell manufacturing at academic institutions.

METHODS: A comprehensive, cross-sectional survey was distributed to 130 FACT and/or JACIE accredited academic institutions globally. The survey, developed from semi-structured interviews with CAR T-cell manufacturing experts, assessed practices in cell modification methods, equipment protocols, and regulatory challenges. Data were analyzed using descriptive statistics, comparing responses across institutions and regions.

RESULTS: 45 of the 130 institutions (35 from the United States and 10 internationally, from the European Union, the United Kingdom, and Australia) responded to the survey (35% response rate). Of the 45 responding institutions, 40 were actively engaged or planning to engage in CAR T-cell production, while five had no plans to initiate manufacturing. Within the 40 institutions engaged in CAR T-cell production, 63% (25/40) reported active manufacturing, while 37% (15/40) were in the process of developing manufacturing capabilities. The most commonly reported barriers to local manufacturing were cost constraints (70%, 28/40), regulatory complexities (70%, 28/40), and facility requirements (57%, 17/40). Variability in product quality was cited by 73% (29/40) of institutions. Equipment costs and the need for specialized training emerged as major challenges, particularly for international institutions. Institutions also highlighted the need for automated platforms, with 60% (24/40) using the Miltenyi CliniMACS Prodigy and 50% (20/40) using the Lonza Cocoon.

CONCLUSIONS: This study highlights the widespread adoption of local CAR T-cell manufacturing and the significant variability in production processes across institutions. The findings emphasize the importance of establishing quality control benchmarks and data reporting frameworks to improve product consistency and access to CAR T-cell therapies. Addressing barriers such as cost, infrastructure, and regulatory challenges through standardization efforts and international collaboration could enhance the reproducibility, scalability, and accessibility of CAR T-cell therapies globally.

PMID:40329308 | DOI:10.1186/s12967-025-06400-x