Tag: nevin manimala

BMC Health Serv Res. 2025 Jan 6;25(1):32. doi: 10.1186/s12913-024-11782-7.

ABSTRACT

BACKGROUND: Voice barriers among frontline healthcare workers hinder safety related to work and patients. Understanding these barriers and practices is crucial to improve voice behavior in healthcare settings. Therefore, this study aims to identify the voice barriers and practices among healthcare workers in Pakistan.

RESEARCH METHOD: The study has adopted a mixed-method research design. Data was collected from 15 frontline healthcare workers through semi-structured interviews to achieve study objectives. Descriptives and content analysis were conducted to explore voice barriers and alternative practices to solve their concerns. After that, a quantitative study was conducted to determine the statistical significance of the identified voice barriers and the magnitude of their effect. For this purpose, data was collected from 480 frontline healthcare workers in the primary, secondary, and territory healthcare units. A questionnaire survey was used for data collection. Then, multistage hierarchical regression analysis was employed for data analysis.

RESULTS: Study findings highlight the determinants of two key factors: withholding patient safety concerns and withholding worker safety concerns. First, the study identifies several factors that increase the likelihood of healthcare workers withholding concerns about patient safety. These factors include professional designation, work experience, blackmailing, overconfidence, longer work tenure, feelings of insult, early career stage, fear of patient reactions, bad past experiences, job insecurity, and uncooperative management. Fear of increased workload also plays a significant role. Second, when it comes to work-related safety concerns, factors such as gender, shyness, lack of confidence, fear of duty changes, management issues, interpersonal conflicts, and resource shortages contribute to the withholding of concerns. To navigate these challenges, healthcare workers often resort to strategies such as seeking political connections, personal settlements, transfers, union protests, quitting, using social media, engaging in private practice, or referring patients to other hospitals.

CONCLUSION: Findings demonstrates that healthcare workers in Pakistan often withhold safety concerns due to hierarchical pressures, personal insecurities, and fear of repercussions. Their reliance on external mechanisms, such as political influence or social media, underscores the need for significant reforms to improve safety culture and management support. Addressing these issues is crucial for ensuring both patient and worker safety.

PMID:39762886 | DOI:10.1186/s12913-024-11782-7

Health Res Policy Syst. 2025 Jan 6;23(1):5. doi: 10.1186/s12961-024-01260-1.

ABSTRACT

BACKGROUND: An increasing number of people live with chronic disease or multi-morbidity. Current consensus is that their care requires an integrated model bringing different professionals together to provide person-centred care. Although primary care has a central role in managing chronic disease, and integration may be important in strengthening this role, previous research has shown insufficient attention to the relationships between primary care and integration. This review summarizes primary care involvement in integrated care interventions and assesses the effect of those interventions on a range of measures of primary care functions and wider outcomes.

METHODS: We searched Medline and Embase using terms for “integrated care”, “chronic disease” and “multimorbidity”. We included integrated care interventions involving different levels of care organizations or different care sectors. Risk of bias was appraised, and the contents of integrated care interventions assessed using the Sustainable intEgrated care modeLs for multi-morbidity: delivery, FInancing and performancE (SELFIE) conceptual framework. Effectiveness of integrated care interventions was assessed using meta-analysis of primary care functions (access, continuity, comprehensiveness and coordination) and wider outcomes (patient health and mortality, hospital admissions and costs). Sub-group analyses were conducted for different types of primary care involvement.

RESULTS: From 17,752 studies screened, 119 studies on integrated care were identified, of which 69 interventions (58%) involved primary care. Meta-analyses showed significant beneficial effects on two measures of primary care function: access (effect size: 0.17, 95% CI 0.05-0.29) and continuity (effect size: 0.32, 95% CI 0.14-0.50). For wider outcomes, the only statistically significant effect was found on costs (effect size: 0.02, 95% CI 0.02-0.03).

CONCLUSIONS: Integrated care interventions involving primary care can have positive effects on strengthening primary care functions, but these benefits do not necessarily translate consistently to wider outcomes.

PMID:39762867 | DOI:10.1186/s12961-024-01260-1

BMC Nurs. 2025 Jan 6;24(1):12. doi: 10.1186/s12912-024-02605-5.

ABSTRACT

BACKGROUND: Compassion Competence and the ability to strive to understand the suffering of patients in psychiatric ward is essential for nurses to establish effective therapeutic communication in the process of their recovery. Patient Safety Competency is of great importance for nurses to prevent adverse events and minimize errors. This study aimed to investigate the relationship between Compassion Competence and Patient Safety Competency in nurses working in psychiatric wards of Shiraz University of Medical Sciences affiliated hospitals in 2024.

METHOD: This descriptive-analytical study was conducted on 184 nurses working in the psychiatric wards of Shiraz University of Medical Sciences affiliated hospitals from January 2024 to April 2024 as a census. Data were collected using the Compassion Competence, Patient Safety Competency and Demographic Survey questionnaires and were then analyzed using descriptive and analytical statistics. The analyses were performed using SPSS 22 statistical software.

RESULTS: The results showed that the compassion competence score of psychiatric nurses was 3.98 ± 0.46, with subscales of sensitivity (4.05 ± 0.56), insight (3.79 ± 0.62), and communication (4.04 ± 0.48). Additionally, the patient safety competency score of psychiatric nurses was 3.56 ± 0.44, with subscales of attitude (3.67 ± 0.34), knowledge (3.06 ± 0.77), and skill (3.63 ± 0.58). A statistically significant correlation was also found between Compassion Competence and Patient Safety Competency (r = 0.458, p < 0.001). Regression results showed that the sensitivity (p = 0.012) and insight (p = 0.026) dimensions predict Patient Safety Competency. Among the demographic variables, only the completion of a communication skills course was significantly associated with both Compassion Competence (p = 0.04) and Patient Safety Competency (p = 0.02).

CONCLUSION: The findings of this study revealed a statistically significant correlation between Compassion Competence and Patient Safety Competency among psychiatric nurses. It is recommended that educational programs be designed to consider these two components and their dimensions to help enhance the competencies of nurses.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:39762865 | DOI:10.1186/s12912-024-02605-5

BMC Ophthalmol. 2025 Jan 6;25(1):5. doi: 10.1186/s12886-024-03818-7.

ABSTRACT

BACKGROUND: Primary acquired nasolacrimal duct obstruction (PANDO) is a condition in which tear ducts are blocked, leading to epiphora and dacryocystitis. This systematic review and meta-analysis aimed to measure the ability of transcanalicular dacryocystorhinostomy (TC-DCR) as an alternative approach to PANDO compared to traditional external dacryocystorhinostomy (EX-DCR).

METHODS: Our search included Embase, Medline, and the Cochrane Central Register of Controlled Trials (CENTRAL). We included only observational studies, randomized controlled trials (RCTs), and quasi-experimental studies that compared TC-DCR and EX-DCR. The outcomes measured were anatomical and functional success rates, intraoperative complications, postoperative complications, and surgical time. Statistically significant results were determined as a p value of less than 0.05; thus, a confidence interval of 95% was used. Dichotomous outcomes were reported via risk ratios (RR), whereas continuous outcomes were reported using standardized mean differences (SMD).

RESULTS: There was a statistically significant difference in anatomical success (RR = 0.84, 95% CI 0.72-0.97; P = 0.02), favoring EX-DCR; functional success (RR = 0.87, 95% CI 0.78-0.97; P = 0.01), favoring EX-DCR; operative (OR) time (SMD = -2.42, 95% CI -2.92 – -1.91; P < 0.00001) favoring TC-DCR; and intraoperative complications (RR = 0.16, 95% CI 0.06-0.43; P = 0.0003), favoring TC-DCR. Moreover, the subgroup analysis comparing single-diode TC-DCR to EX-DCR revealed a statistically significant difference in terms of anatomical success and functional success; however, the comparison of multidiode TC-DCR to EX-DCR revealed no statistically significant difference.

CONCLUSIONS: More research should be conducted to compare the anatomical and functional success of muli-diode TC-DCR with EX-DCR because the analysis performed comparing them revealed no statistical significance.

PMID:39762863 | DOI:10.1186/s12886-024-03818-7

BMC Med Educ. 2025 Jan 6;25(1):23. doi: 10.1186/s12909-024-06362-6.

ABSTRACT

BACKGROUND: Health literacy (HL) is crucial for making informed health decisions. Over one-third of US adults have limited HL, leading to adverse health outcomes. Despite its importance, HL education lacks standardization in medical training. This study evaluates medical learners’ confidence and experiences with HL at the University of South Carolina School of Medicine Greenville’s (USCSOMG) and the Family Medicine Residency Program Greenville (FMRGVL) to propose recommendations for HL instruction.

METHODS: A convergent parallel mixed methods design was used to assess the learners’ experiences with HL training through a student survey and faculty interviews. The study utilized thematic analysis for qualitative data and statistical analysis for quantitative data, focusing on prior and current HL training, confidence in HL application, and perceptions of HL education.

RESULTS: The curriculum at USCSOMG and FMRGVL incorporate active learning strategies, emphasizing HL and patient communication. Most participants reported high confidence in their HL knowledge and skills. The preferred teaching methods were hands-on clinical interactions, observing clinical interactions, and interactive lessons. Barriers to using HL interventions included time constraints and lack of real-world experience. Faculty recommended time prioritization and collaborative strategies to overcome these barriers.

CONCLUSIONS: This study highlights the impact of curricular approaches at USCSOMG and FMLGVL on learners’ confidence in engaging with patients facing low health literacy (LHL). To overcome barriers like time constraints and real-world challenges, medical educators should consider implementing competency-based exams, increasing practical opportunities for health literacy skills, and incorporating continuous curriculum evaluation based on faculty and student feedback. HL training and evaluation are essential to ensure that medical learners are adequately prepared to meet diverse patient literacy needs.

CLINICAL TRIAL NUMBER: Not Appliable.

PMID:39762861 | DOI:10.1186/s12909-024-06362-6

Int J Med Inform. 2024 Dec 31;195:105782. doi: 10.1016/j.ijmedinf.2024.105782. Online ahead of print.

ABSTRACT

BACKGROUND: Solid organ transplantation (SOT) is vital for end-stage organ failure but faces challenges like organ shortage and rejection. Artificial intelligence (AI) offers potential to improve outcomes through better matching, success prediction, and automation. However, the evolution of AI in SOT research remains underexplored. This study uses bibliometric analysis to identify trends, hotspots, and key contributors in the field.

METHODS: 821 articles from the Web of Science Core Collection were exported for analysis. Microsoft Excel 2021 was used for descriptive statistics. VOSviewer, CiteSpace, Scimago Graphica, and Biblioshiny were used for bibliometric analysis. The ggalluvial package in R was utilized to create Sankey diagrams, and top articles were selected based on citation count.

RESULTS: This analysis reveals the rapid expansion of AI in SOT. Key areas include robotic surgery, organ allocation, outcome prediction, immunosuppression management, and precision medicine. Robotic surgery has improved transplant outcomes. AI algorithms optimize organ matching and enhance fairness. Machine learning models predict outcomes and guide treatment, while AI-based systems advance personalized immunosuppression. AI in precision medicine, including diagnostics and imaging, is crucial for transplant success.

CONCLUSION: This study highlights AI’s transformative potential in SOT, with significant contributions from countries like the USA, Canada, and the UK. Key institutions such as the University of Toronto and the University of Pittsburgh have played vital roles. However, practical challenges like ethical issues, bias, and data integration remain. Fostering international and interdisciplinary collaborations is crucial for overcoming these challenges and accelerating AI’s integration into clinical practice, ultimately improving patient outcomes.

PMID:39761617 | DOI:10.1016/j.ijmedinf.2024.105782

Int J Pediatr Otorhinolaryngol. 2025 Jan 2;189:112214. doi: 10.1016/j.ijporl.2025.112214. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aims to evaluate musical pitch and timbre perception in children who stutter and compare the results with typically developing children.

METHODS: A total of 50 participants were included in the study, consisting of 25 children with stuttering (mean age = 10.06 years; range 6-17 years) and 25 typically developing children (mean age = 10.38 years; range 7-16 years). Participants were administered Pitch Direction Discrimination (PDD) and Timbre Recognition (TR) tests in the original form of The Clinical Assessment of Music Perception. Both subtests were administered in a quiet room, and the children used headphones to receive auditory stimuli.

RESULTS: The mean PDD score of the stuttering group was 3.60 semitones (SD = 2.71), while the mean score of the typically developing children was 2.26 semitones (SD = 1.43). In the TR test, the mean accuracy of the stuttering group was 53.17 % (SD = 21.69), while the mean accuracy of the non-stuttering group was 65.33 % (SD = 19.64). The difference between the two groups was statistically significant in the PDD (t(48) = 2.17, p = 0.03) and TR (t(48) = -2.08, p = 0.04) tests.

CONCLUSIONS: The study found that children who stuttered had poorer pitch and timbre musical perception skills than age-matched peers who were typically developing children. The lower success rates of the stuttering group on both tests may indicate general deficits in auditory processing, which could be related to attention and short-term memory processing.

PMID:39761608 | DOI:10.1016/j.ijporl.2025.112214

Pediatr Emerg Care. 2025 Jan 7. doi: 10.1097/PEC.0000000000003315. Online ahead of print.

ABSTRACT

OBJECTIVE: Evaluate the accuracy and reliability of various generative artificial intelligence (AI) models (ChatGPT-3.5, ChatGPT-4.0, T5, Llama-2, Mistral-Large, and Claude-3 Opus) in predicting Emergency Severity Index (ESI) levels for pediatric emergency department patients and assess the impact of medically oriented fine-tuning.

METHODS: Seventy pediatric clinical vignettes from the ESI Handbook version 4 were used as the gold standard. Each AI model predicted the ESI level for each vignette. Performance metrics, including sensitivity, specificity, and F1 score, were calculated. Reliability was assessed by repeating the tests and measuring the interrater reliability using Fleiss kappa. Paired t tests were used to compare the models before and after fine-tuning.

RESULTS: Claude-3 Opus achieved the highest performance amongst the untrained models with a sensitivity of 80.6% (95% confidence interval [CI]: 63.6-90.7), specificity of 91.3% (95% CI: 83.8-99), and an F1 score of 73.9% (95% CI: 58.9-90.7). After fine-tuning, the GPT-4.0 model showed statistically significant improvement with a sensitivity of 77.1% (95% CI: 60.1-86.5), specificity of 92.5% (95% CI: 89.5-97.4), and an F1 score of 74.6% (95% CI: 63.9-83.8, P < 0.04). Reliability analysis revealed high agreement for Claude-3 Opus (Fleiss κ: 0.85), followed by Mistral-Large (Fleiss κ: 0.79) and trained GPT-4.0 (Fleiss κ: 0.67). Training improved the reliability of GPT models (P < 0.001).

CONCLUSIONS: Generative AI models demonstrate promising accuracy in predicting pediatric ESI levels, with fine-tuning significantly enhancing their performance and reliability. These findings suggest that AI could serve as a valuable tool in pediatric triage.

PMID:39761573 | DOI:10.1097/PEC.0000000000003315

Chaos. 2025 Jan 1;35(1):013114. doi: 10.1063/5.0227075.

ABSTRACT

The impact of resource allocation on the dynamics of epidemic spreading is an important topic. In real-life scenarios, individuals usually prioritize their own safety, and this self-protection consciousness will lead to delays in resource allocation. However, there is a lack of systematic research on the impact of resource allocation delay on epidemic spreading. To this end, a coupled model for resource allocation and epidemic spreading is proposed, which considers both the allocation decisions and delay behavior of individuals with limited resources. Through theoretical analysis, the influence mechanism of resource allocation delay on epidemic spreading is deduced, and the relationship among epidemic threshold, delay time, and the fraction of cautious individuals is obtained, and finally, the stability of the solution under different conditions is proven. Furthermore, the dynamic characteristics of epidemic spreading under the influence of the two factors are systematically studied by combining numerical simulation and theoretical analysis. The results show that the impact of delay behavior exhibits nonlinear characteristics, namely, appropriate delay can enhance control effectiveness, while excessive delay results in insufficient resource allocation and consequently increases infection risk. Particularly, an optimal delay that maximizes the epidemic threshold is identified. In addition, an increase in the proportion of cautious individuals can significantly increase the epidemic threshold, but an excessively high proportion can severely constrain resource allocation, which reduces the control effectiveness. The results of this study provide scientific evidence for developing more effective epidemic control strategies, particularly in optimizing resource allocation and improving control outcomes.

PMID:39761558 | DOI:10.1063/5.0227075

J Med Internet Res. 2025 Jan 6;27:e66220. doi: 10.2196/66220.

ABSTRACT

BACKGROUND: The increasing use of social media to share lived and living experiences of substance use presents a unique opportunity to obtain information on side effects, use patterns, and opinions on novel psychoactive substances. However, due to the large volume of data, obtaining useful insights through natural language processing technologies such as large language models is challenging.

OBJECTIVE: This paper aims to develop a retrieval-augmented generation (RAG) architecture for medical question answering pertaining to clinicians’ queries on emerging issues associated with health-related topics, using user-generated medical information on social media.

METHODS: We proposed a two-layer RAG framework for query-focused answer generation and evaluated a proof of concept for the framework in the context of query-focused summary generation from social media forums, focusing on emerging drug-related information. Our modular framework generates individual summaries followed by an aggregated summary to answer medical queries from large amounts of user-generated social media data in an efficient manner. We compared the performance of a quantized large language model (Nous-Hermes-2-7B-DPO), deployable in low-resource settings, with GPT-4. For this proof-of-concept study, we used user-generated data from Reddit to answer clinicians’ questions on the use of xylazine and ketamine.

RESULTS: Our framework achieves comparable median scores in terms of relevance, length, hallucination, coverage, and coherence when evaluated using GPT-4 and Nous-Hermes-2-7B-DPO, evaluated for 20 queries with 76 samples. There was no statistically significant difference between GPT-4 and Nous-Hermes-2-7B-DPO for coverage (Mann-Whitney U=733.0; n₁=37; n₂=39; P=.89 two-tailed), coherence (U=670.0; n₁=37; n₂=39; P=.49 two-tailed), relevance (U=662.0; n₁=37; n₂=39; P=.15 two-tailed), length (U=672.0; n₁=37; n₂=39; P=.55 two-tailed), and hallucination (U=859.0; n₁=37; n₂=39; P=.01 two-tailed). A statistically significant difference was noted for the Coleman-Liau Index (U=307.5; n₁=20; n₂=16; P<.001 two-tailed).

CONCLUSIONS: Our RAG framework can effectively answer medical questions about targeted topics and can be deployed in resource-constrained settings.

PMID:39761554 | DOI:10.2196/66220