Tag: nevin manimala

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

BMC Musculoskelet Disord. 2025 Apr 17;26(1):380. doi: 10.1186/s12891-025-08648-2.

ABSTRACT

BACKGROUND: Managing heel spurs presents challenges due to multiple treatment options and varying patient satisfaction. This study was conducted to compare the results of heel spur treatment with corticosteroid injections and conservative treatments in patients with heel spurs.

METHODS: This retrospective cohort study was conducted using convenience sampling on seventy patients with heel spurs in 2022. Among them, forty-four patients were in the treatment group, receiving local corticosteroid injections, and twenty-six patients were in the conservative treatment group. Data were collected using a checklist and analyzed using SPSS-26 statistical software. Both descriptive and inferential statistics were applied, with a significance level set at less than 0.05.

RESULTS: The average age of patients with heel spurs was 43 ± 11.2 years. 88.6% of patients were female. Among forty-four individuals receiving corticosteroid injections, 18 (40.9%) experienced favorable outcomes. out of the twenty-six individuals undergoing conservative treatment, 8 (30.8%) also had favorable outcomes. No statistically significant difference was found between the two treatment approaches (P > 0.05). Among the sixty-two women studied, twenty-six experienced positive outcomes; 18 (69.2%) underwent corticosteroid injections, while 8 (30.8%) received conservative treatment. None of the men examined showed any impact from the treatment and expressed dissatisfaction with it. Statistically, a significant association exists between the treatment results of the two groups studied and the gender of patients with heel spurs (P < 0.05).

CONCLUSION: The results highlight the importance of considering demographic factors, particularly gender, when selecting treatment strategies for heel spurs. Both corticosteroid injections and conservative treatments were effective in treating heel spurs; however, corticosteroid injections are recommended as the preferred option due to higher patient satisfaction. Longer follow-up periods are needed to confirm these findings and explore additional variables that may influence treatment efficacy.

TRIAL REGISTRATION: Not applicable.

PMID:40247281 | DOI:10.1186/s12891-025-08648-2

BMC Pulm Med. 2025 Apr 17;25(1):184. doi: 10.1186/s12890-025-03660-7.

ABSTRACT

BACKGROUND: The awareness and attention toward lower respiratory tract infections caused by respiratory syncytial virus (RSV) are lower in adults than in children. Moreover, the clinical data on severe RSV infections in adults are lacking. This study aimed to augment the clinical understanding of RSV infections.

METHOD: This study was performed on 191 adult patients with severe lower respiratory tract infections admitted to the intensive care unit (ICU) of Zunyi Medical University Affiliated Hospital (Zhuhai). The sputum specimens were collected for RSV testing, and the clinical data were collected and analyzed statistically.

RESULTS: The findings revealed that patients in the RSV-positive group were older, had a higher prevalence of underlying diseases, were more likely to require noninvasive mechanical ventilation, and had prolonged hospital stays compared with those in the RSV-negative group. Furthermore, Kaplan-Meier survival analysis conducted within 90 days revealed comparable mortality rates between the RSV-positive and RSV-negative groups. In the RSV-positive group, elderly patients and patients with congestive heart failure or chronic obstructive pulmonary disease had lower survival rates.

CONCLUSION: Patients in the RSV-positive group, particularly elderly patients and patients with congestive heart failure or, experience reduced survival durations compared with those in the RSV-negative group.

PMID:40247280 | DOI:10.1186/s12890-025-03660-7

BMC Med Educ. 2025 Apr 17;25(1):566. doi: 10.1186/s12909-025-06968-4.

ABSTRACT

INTRODUCTION: The accuracy of ultrasound diagnosis of nurses in intensive care unit is helpful to improve the quality of nursing care. The traditional ultrasound teaching model has been unable to meet the needs of intensive care. Ultrasound simulation training as a new teaching model can improve the quality and efficiency of teaching. Therefore, the application of ultrasonic simulation training in intensive care ultrasound teaching hopes to improve the technical expertise, proficiency and accuracy of ultrasound use in intensive care nurses.

METHODS: A total of 40 nurses were divided equally into two groups. Twenty nurses in the control group were taught with the classic teaching method, and 20 nurses in the experimental group were taught with the ultrasound simulation training method. Each nurse practiced for about 15 min each time, three times a week, for a total of 30 days. After training, the theoretical and practical scores of the two groups were compared.

RESULT: The experimental group were significantly higher than those of the control group, and the difference was statistically significant (p < 0.05) including the aspect of the theoretical scores (p < 0.001), practical scores (p < 0.001), and nursing satisfaction rates (p < 0.05).

CONCLUSIONS: Compared with traditional teaching mode, ultrasonic simulation training is helpful to improve the teaching quality of intensive care nursing, and it can be tried to be applied to ultrasonic training in the future.

PMID:40247261 | DOI:10.1186/s12909-025-06968-4

J Surg Res. 2025 Apr 16;309:88-102. doi: 10.1016/j.jss.2025.03.002. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to analyze the systemic immune-inflammation index (SII)’s diagnostic performance in diagnosing acute appendicitis (AA) and discriminating between complicated acute appendicitis (CAA) and noncomplicated acute appendicitis (NCAA).

METHODS: This review was registered in the International Prospective Register of Systematic Reviews (CRD42024587430). We included prospective and retrospective original clinical studies evaluating the diagnostic performance of SII in AA. A search was conducted in PubMed, Web of Science, Scopus, and Ovid. Search terms and keywords were the following: (appendicitis OR appendectomy) AND (systemic immune-inflammation index OR SII). Two independent reviewers selected the articles and extracted relevant data. Methodological quality was assessed using the quality assessment tool for diagnostic accuracy studies (QUADAS-2). A synthesis of the results, standardization of the metrics, four random-effect meta-analyses, and two diagnostic test accuracy (DTA) meta-analyses were performed.

RESULTS: Thirteen studies with data from 9083 participants, including 5255 patients with a confirmed diagnosis of AA and 3828 controls (CG), were included in this review. The random-effect meta-analysis of SII (AA versus CG) included 10 articles (3733 AA and 3510 controls) and resulted in a significant mean difference (95% CI) of 1072.46 (750.55, 1394.37; P < 0.001). The random-effect meta-analysis of SII (CAA versus NCAA) included nine articles (1116 CAA and 2984 NCAA) and resulted in a significant mean difference (95% CI) of 1294.2 (731.54, 1856.86; P < 0.001). Subgroup meta-analysis for studies conducted in pediatric-only populations maintained statistical significance. The DTA meta-analysis (AA versus CG) yielded a pooled sensitivity and specificity (95% CI) of 81.8% (75.2, 86.9) and 79.9% (68.2, 88.1). The DTA meta-analysis (CAA versus NCAA) resulted in a pooled sensitivity and specificity (95% CI) of 72.5% [49.6, 87.6] and 82.5% (65.1, 92.2). The pooled area under the curve (AA versus CG) was 0.88, and the pooled area under the curve (CAA versus NCAA) was 0.85.

CONCLUSIONS: SII emerges as a robust tool for diagnosing AA and differentiating between CAA and NCAA. The high meta-analytical heterogeneity, the retrospective nature of most of the included studies, and their limited geographical distribution warrant further prospective multicenter studies to validate these findings.

PMID:40245460 | DOI:10.1016/j.jss.2025.03.002

Lymphology. 2024;57(4):211-218.

ABSTRACT

Diagnosis and evaluation of genital lymphedema (GL) is a challenging yet crucial step in the treatment of GL. Single photon emission computed tomography-computed tomography (SPECT-CT) is useful for lymph flow imaging, but its characteristic findings for GL are not clarified. The purpose of this study was to uncover characteristic SPECT-CT findings in secondary GL. Medical records of patients who underwent SPECT-CT and indocyanine (ICG) lymphography for evaluation of secondary lower extremity lymphedema (LEL) and/or genital lymphedema (GL) were reviewed. Characteristic SPECT-CT findings were identified based on timing, visibility, and extension of lymphatic enhancement in the lower abdominal, inguinal, genital, and pelvic regions. Patients were divided into either GL group with genital ICG lymphography stage I-V or control group with stage 0. Prevalence of each SPECT-CT finding was compared between the groups. Ten female patients were included; 7 (70%) were classified in GL group, and 3 (30%) in control group. Characteristic SPECT-CT findings included pauci-enhancement of inguinal lymph nodes (PEIL), genital dermal back flow, external iliac lymph nodes non-enhancement, common iliac lymph nodes non-enhancement, and periaortic lymph nodes non-enhancement. There was a statistically significant difference between GL and control groups for PEIL (100% vs. 0%, P = 0.002). Characteristic SPECT-CT findings in secondary GL were identified. Further studies are warranted to clarify usefulness of the findings for management of GL.

PMID:40245438

JMIR Med Inform. 2025 Apr 17;13:e66859. doi: 10.2196/66859.

ABSTRACT

BACKGROUND: Digital communication between nurses and medicine interns plays a crucial role in patient care. However, excessive messaging may contribute to alert fatigue, potentially affecting workflow efficiency and clinical decision-making. Although prior research has examined general messaging behaviors among clinicians, few studies have specifically analyzed messaging patterns between nurses and interns, who serve as primary points of contact in inpatient care.

OBJECTIVES: This study aims to quantitatively characterize messaging patterns between the primary nurse and primary provider (ie, medicine intern) of hospitalized patients at an academic medical center in order to identify communication burdens and potential inefficiencies. By identifying trends in message volume, timing, and response rates, we seek to inform strategies to optimize communication workflows and mitigate alert fatigue.

METHODS: At a large academic hospital (Tufts Medical Center, Boston, MA), we analyzed secure messaging transactions between internal medicine interns and nurses across three medical-surgical units over 6 months. Transaction metadata, time stamps, and unique message tokens were extracted. Data processing was performed using Python, Microsoft Excel, and R. Message volume, interaction frequencies, and response times were analyzed using measures of central tendency and statistical tests of significance.

RESULTS: A total of 61,057 unique messages were exchanged between interns and nurses, with interns exchanging 2.5 times more messages per day with nurses than vice versa (P<.001). Messaging volume exhibited diurnal variation, indicating periods of increased communication burden. Interns read messages from nurses within a median of 35 (range: 0-3589) seconds, whereas nurses read messages from interns within a median of 26 (range: 0-3584) seconds (P<.001). The longest message response delays occurred at 4 AM, whereas the shortest occurred at 8 AM.

CONCLUSIONS: Interns experience a significantly higher messaging burden than nurses, with distinct peaks in message volume during morning rounds and overnight shifts. These findings suggest a need for interventions such as optimized digital communication protocols to reduce nonessential messaging and alert fatigue. Future research should explore the effectiveness of these interventions in enhancing workflow efficiency and the development of both in-person and digital interventions to optimize communication workflows and mitigate alert fatigue.

PMID:40245430 | DOI:10.2196/66859