Nevin Manimala

JMIR AI. 2026 Aug 25;5:e95964. doi: 10.2196/95964.

ABSTRACT

BACKGROUND: Motivational interviewing (MI) is widely used in preventive interventions, yet coding MI techniques and monitoring intervention adherence remain resource-intensive due to the reliance on manual transcription and expert review. Large language models (LLMs) offer a promising approach to automate these tasks, but their agreement with human coders in the context of prevention interventions has not been established.

OBJECTIVE: This study evaluated the agreement between an AI-based coder (OpenAI’s GPT 4.1) and trained human coders on two tasks: (1) identification of MI techniques (eg, open questions, affirmations, giving information) at the facilitator-message level and (2) completing a 21-item checklist of implementation adherence for a brief MI-based preventive intervention for adolescent substance use.

METHODS: Two certified MI facilitators independently coded 72 facilitator messages from 2 standardized Spanish-language Brief Intervention Based on Motivational Interviewing program (Intervención Breve Basada en Entrevista Motivacional [IBEM]) practice sessions with chatbot-simulated adolescent responses. The facilitators classified MI techniques using the OARS (open questions, affirmations, reflections, and summaries) framework and completed a 21-item implementation-adherence checklist. An AI-based coder (OpenAI’s GPT-4.1, accessed through the API) classified the same facilitator messages and checklist items using a structured prompt derived from the MI coding manual. MI techniques were compared at the facilitator-message level and implementation adherence at the session level. Intercoder agreement in use of MI techniques and implementation adherence was assessed using Cohen κ, Fleiss κ, and Cochran Q tests.

RESULTS: For use of MI techniques, the AI coder demonstrated moderate-to-substantial agreement with human coders across most techniques, including open questions (κ=0.66-0.69), affirmations (κ=0.66-0.77), and giving information (κ=0.91). No statistically significant differences in percentages of MI technique use were observed among the 3 coders, although agreement was the weakest for higher-inference categories such as complex reflections (κ=0.00). For MI implementation adherence, overall agreement was moderate (Fleiss κ=0.487), and pairwise agreement between the AI coder and 1 human coder was substantial (κ=0.67), exceeding the agreement observed between the 2 human coders (κ=0.53).

CONCLUSIONS: These findings provide support for the feasibility of using LLMs to recognize MI techniques and assess implementation adherence. The results support a human-AI collaborative model in which the AI coder “precodes” facilitator messages and flags sessions for expert review, while human coders retain responsibility for higher-inference judgments and shift their effort from routine coding toward contextual review and coaching feedback. Because the analyses are based on only 2 sessions, these results should be interpreted as early-stage, proof-of-concept evidence rather than a basis for large-scale deployment. Future research should compare different LLMs and evaluate whether AI-assisted coding improves the scalability of routine implementation monitoring.

PMID:42640265 | DOI:10.2196/95964

Am J Manag Care. 2026 Jul 1;32(7):e242-e248. doi: 10.37765/ajmc.2026.89989.

ABSTRACT

OBJECTIVES: Objective: To examine geographic access to preferred pharmacies in Medicare Part D prescription drug plans (PDPs) and Medicare Advantage PDPs (MAPDs).

STUDY DESIGN: We conducted a nationwide, retrospective analysis using Part D preferred pharmacies’ data, Zip Code Tabulation Areas (ZCTAs) from the US census, and socioeconomic characteristics from the American Community Survey and the Area Health Resources Files from 2010 to 2024.

METHODS: We computed mean distance from the centroid of each ZCTA to the nearest preferred pharmacy in stand-alone PDPs and in MAPDs. We compared mean distance as well as additional distance to a preferred vs a nonpreferred pharmacy, across rural and urban ZCTAs, and across geographic areas with relatively high densities of different racial/ethnic groups. We employed regression models to evaluate the association between ZCTA-level characteristics and additional distance to a preferred pharmacy.

RESULTS: Rural areas in the West North Central, Mountain, and East South Central divisions of the US tended to lack preferred pharmacies in PDPs and MAPDs, as did some urban areas. Among ZCTAs with preferred pharmacies, a rural ZCTA was associated with a 0.734-mile longer additional distance ( P < .01) among PDPs, which was more than double the mean additional distance. For MAPD plans, the additional distance for rural ZCTAs was 0.320 miles longer ( P < .01), an 80% increase relative to the mean.

CONCLUSIONS: Many rural and urban areas in the US lack preferred pharmacies. In areas with preferred pharmacies, distances were generally minimal relative to the cost savings, but rural-urban disparities persist.

PMID:42640262 | DOI:10.37765/ajmc.2026.89989

Am J Manag Care. 2026 Jul 1;32(7):e234-e241. doi: 10.37765/ajmc.2026.89988.

ABSTRACT

OBJECTIVES: The burden of a new cancer diagnosis on state Medicaid programs is not well understood. Our study aimed to (1) quantify Medicaid program spending, use of health care services, and enrollment patterns among Medicaid beneficiaries newly diagnosed with cancer; and (2) assess how spending and health care use differ between a new metastatic and a new nonmetastatic cancer diagnosis.

STUDY DESIGN: Cross-sectional study.

METHODS: This study used Transformed Medicaid Statistical Information System Analytic Files (2016-2019) to identify Medicaid beneficiaries 50 years and older who were newly diagnosed with cancer in 2017 and 2018. We provide descriptive evidence about their use of health care resources and used linked Medicare-Medicaid claims to follow enrollment patterns among dual-eligible beneficiaries. We also used generalized estimating equations to compare Medicaid program spending among those diagnosed with a new metastatic vs nonmetastatic cancer. Study measures were differences in total Medicaid spending, hospitalizations and emergency department visits per year, and Medicaid enrollment status at the end of the study (ie, continuously enrolled, disenrolled, or died) by metastatic status.

RESULTS: We identified 291,014 new cancer diagnoses among Medicaid beneficiaries 50 years and older (18.8% metastatic vs 81.2% nonmetastatic). A metastatic cancer diagnosis was associated with higher hospitalizations, emergency department use, and spending compared with a nonmetastatic cancer diagnosis.

CONCLUSIONS: Our results quantify the cost and health care resource utilization burden borne by state Medicaid programs following a new cancer diagnosis. These findings can inform policy makers about the budgetary considerations associated with investing in reducing late-stage cancer diagnoses, such as through early detection and increased access to care.

PMID:42640261 | DOI:10.37765/ajmc.2026.89988

Am J Manag Care. 2026 Jul 1;32(7):e228-e233. doi: 10.37765/ajmc.2026.89987.

ABSTRACT

OBJECTIVES: Medication adherence measures for hypertension drive financial incentives and patient care strategies for many value-based health care programs. The association between medication adherence and hypertension control as a value-based quality measure is not well described. The objectives of this study were to compare blood pressure (BP) control among Medicare and Medicare Advantage patients who meet vs do not meet the medication adherence for hypertension (MAH) measure and compare patient and prescription factors associated with adherence vs disease control.

STUDY DESIGN: Retrospective cohort study using linked payer and electronic health record data from a single health system.

METHODS: Medicare patients eligible for MAH in 2023 were categorized as adherent or nonadherent according to measure specifications, and hypertension control was defined as a primary care office BP less than 140/90 mm Hg or less than 130/80 mm Hg. Multivariable logistic regression was used to identify factors independently associated with adherence and disease control.

RESULTS: Of the 5206 patients evaluated, 77.9% were classified as adherent to the MAH measure. Of adherent patients, 77.2% achieved a BP less than 140/90 mm Hg vs 73.5% of nonadherent patients ( P = .01), and 45.9% and 43.4%, respectively, achieved a BP of less than 130/80 mm Hg ( P = .14). White race and younger age were positively associated with hypertension control, whereas extended days’ supply and non-White race were associated with meeting the MAH measure.

CONCLUSIONS: Patients classified as adherent were more likely to achieve a BP less than 140/90 mm Hg, but achievement of BP less than 130/80 mm Hg did not differ between groups. A sizeable proportion of patients who did not meet the adherence measure (73.5%) achieved a BP less than 140/90 mm Hg. Factors associated with adherence vs disease control differed. Emphasis on disease control over medication adherence measures may more meaningfully reflect high-value clinical care.

PMID:42640260 | DOI:10.37765/ajmc.2026.89987

Ir Med J. 2026 Aug 20;119(7):131.

ABSTRACT

AIM: Management of non-ST-elevation myocardial infarction (NSTEMI) in older patients remains challenging, particularly following the SENIOR-RITA trial, which did not demonstrate a mortality benefit with invasive management. This audit aims to compare outcomes between invasive and non-invasive management strategies in patients aged ≥75 years presenting with NSTEMI at Connolly Hospital, Blanchardstown, and to relate these findings to European Society of Cardiology (ESC) guidelines and SENIOR-RITA.

METHODS: A retrospective audit of 50 NSTEMI patients aged ≥75 admitted from 2020 to 2024 examined mortality, length of stay, complications, and readmission rates. Survival was analysed with Kaplan-Meier.

RESULTS: Of 50 patients, 29 (58%) underwent invasive management. Baseline features were similar between the invasive and conservative groups, though frailty was infrequently documented with formal assessment tools. Invasive patients had shorter stays (p=0.041) and lower 6-month mortality (14.3% vs 85.7%, p=0.03254). Kaplan-Meier analysis showed higher survival in the invasive group. Complication and readmission rates were similar.

DISCUSSION: Invasive management was associated with a shorter hospital stay and lower mortality. However, the findings should be interpreted cautiously, given the retrospective design and possible selection bias. These findings do not contradict the SENIOR-RITA trial, and local practice aligned with ESC guidelines.

PMID:42640250

J Perianesth Nurs. 2026 Aug 25:S1089-9472(26)00453-3. doi: 10.1016/j.jopan.2026.08.006. Online ahead of print.

ABSTRACT

PURPOSE: To systematically analyze the current safety status of intrahospital transport for patients recovering from general anesthesia, identify primary risk factors, and propose data-driven, systematic improvement strategies.

DESIGN: A retrospective analysis was conducted on transport monitoring records of 255 patients who underwent general anesthesia in a tertiary hospital.

METHODS: Transport duration, data integrity rate, and changes in oxygen saturation (SpO₂) and pulse rate (PR) were statistically analyzed.

FINDINGS: The mean transport duration was (9.68 ± 4.25) minutes, with a median time of 9.40 minutes. The overall monitoring data integrity rate was 75.35%. The incidence of hypoxemia (SpO₂ less than 90%) reached 50.59% (129/255). The mean minimum SpO₂ was (88.96 ± 4.40)%, and the mean maximum PR was (89.22 ± 16.46) bpm, indicating significant physiological fluctuations.

CONCLUSION: Even after meeting discharge criteria, patients undergoing general anesthesia exhibit physiological instability during intrahospital transport, characterized by a high incidence of hypoxemia and significant gaps in monitoring data, which may precipitate anesthesia-related safety incidents. Therefore, constructing a safety system encompassing standardized procedures, enhanced team safety awareness, and technological empowerment is a crucial measure to mitigate transport risks and ensure patient safety following general anesthesia.

PMID:42640243 | DOI:10.1016/j.jopan.2026.08.006

J Hand Surg Am. 2026 Aug 25:S0363-5023(26)00513-7. doi: 10.1016/j.jhsa.2026.06.005. Online ahead of print.

ABSTRACT

PURPOSE: Although fourth generation total wrist arthroplasties (TWAs) have improved implant longevity compared to earlier generations, high failure rates persist. This study aimed to assess how a shift in the center of rotation will affect kinematic outcomes of the joint. This has been accomplished through a TWA redesign, known as the reverse total wrist arthroplasty (RTWA).

METHODS: Eight cadaveric specimens (75.1 ± 10.9 years, 8 men) were implanted with both a custom load sensing TWA and a novel redesigned RTWA. For both reconstructed states, the specimens were mounted and actuated through flexion-extension (FE) and radial-ulnar deviation (RUD) using an active motion simulator. Muscle forces and articular loading patterns were recorded in both states for comparison of the implant designs. Statistical analysis completed showed RUD motion was underpowered and are therefore presented as exploratory and descriptive because of limited power.

RESULTS: In general, during both FE and RUD the RTWA required a lower magnitude of force from the muscles compared to the TWA state. Throughout FE, four of the five muscles examined required less force after RTWA implantation. Through RUD, three of five required less force. In addition, through both ranges of motion the carpal component joint loading was decreased in all wrist positions (41.6 ± 8.6% and 38.1 ± 7.1% for extension and flexion motion, respectively) after implantation of the RTWA compared to the TWA.

CONCLUSIONS: The redesigned RTWA performed well compared to a standard TWA implant and there was a noted decrease in both the muscle forces and joint loading following RTWA implantation.

CLINICAL RELEVANCE: The new RTWA design may have the potential to reduce the magnitude of force required by muscles to actuate the joint and reduce the high loading patterns within the distal carpal component that are noted after implantation of TWA implants.

PMID:42640233 | DOI:10.1016/j.jhsa.2026.06.005

J Nutr Educ Behav. 2026 Aug 24:S1499-4046(26)00415-X. doi: 10.1016/j.jneb.2026.07.005. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify and compare pedagogical approaches to weight-related topics among US higher education instructors who teach health-related courses.

DESIGN: Survey, including an open-ended question, Universal Measure of Bias-FAT (UMB-FAT) and Beliefs About Obese People (BAOP) scores, collected responses from April to August 2023.

SETTING: Online, 53-item virtual platform survey.

PARTICIPANTS: One hundred and twelve health profession instructors (aged ≥ 18 years; including nursing, dietetics, medicine, allied health, exercise science) participated and were selected by cluster sampling from 3 randomly selected colleges and universities per state.

PHENOMENON OF INTEREST: Instructors’ pedagogical strategies and biases toward weight.

ANALYSIS: Sentiment and content analysis conducted by 2 researchers. Sentiments were weight-centric, mixed/hybrid (MH), or weight-inclusive (WI) with categories (weight metrics, topics and concepts, teaching strategies, and theories and constructs) and mapped for comparison. Scale scores (UMBFAT; BAOP) were analyzed for descriptive statistics.

RESULTS: Weight-centric approaches emphasized body mass index and dieting, WI emphasized behavior, social determinants, and Health at Every Size. Discussion-based teaching and bias-awareness content appeared more in MH and WI. Weight-inclusive instructors had lower UMB-FAT (1.58 ± 0.52) and BAOP (3.20 ± 0.97) scores.

CONCLUSIONS: Teaching sentiment can determine how weight is framed. Findings highlight opportunities to investigate how WI curricula affect student weight attitudes and behaviors.

PMID:42640230 | DOI:10.1016/j.jneb.2026.07.005

JMIR Res Protoc. 2026 Aug 25;15:e92804. doi: 10.2196/92804.

ABSTRACT

BACKGROUND: Breast cancer screening through mammography is essential for early detection and improved survival; however, pain and discomfort during the procedure remain major barriers to women’s participation. Pain perception during mammography is influenced not only by technical factors but also by psychological variables such as anxiety, depression, pain catastrophizing, and personality traits. Despite growing evidence, findings on the role of psychological factors remain inconsistent, and the contribution of personality traits remains largely unexplored, highlighting the need for further investigation.

OBJECTIVE: This study aims to investigate associations among psychological factors (anxiety, depression, and pain catastrophizing), Ten-Item Personality Inventory personality traits, and pain perception and experience in women undergoing routine mammography at public and private radiology centers in Cyprus. The study hypothesizes that higher anxiety levels and first-time mammography experience are associated with greater perceived pain during mammography.

METHODS: This cross-sectional study will include approximately 380 women aged 35 to 75 years undergoing routine screening mammography at public and private radiology centers in Cyprus. Participants will complete the Patient Health Questionnaire-4, the Pain Catastrophizing Scale, the Ten-Item Personality Inventory, and a demographic and clinical questionnaire before the examination. The primary outcome will be perceived pain intensity during mammography, assessed immediately after the examination using a Visual Analog Scale. Psychological factors, including anxiety, depression, pain catastrophizing, and personality traits, will be evaluated as the main independent variables. Secondary analyses will examine the role of demographic and clinical characteristics, as well as previous mammography experience, in pain perception. Descriptive statistics will summarize participant characteristics, and associations between study variables and pain intensity will be examined using Pearson or Spearman correlation analyses and hierarchical multiple linear regression models adjusted for relevant confounders. The study will be conducted and reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for observational studies.

RESULTS: Participant recruitment and data collection began in March 2026. By June 2026, 50 women had been enrolled in the study. Recruitment and data collection are expected to continue through September 2026. Data analysis is anticipated to be completed by December 2026, with dissemination of findings and manuscript submission planned for 2027. Following study initiation, the study setting was expanded to include a public radiology center to facilitate recruitment and enhance sample representativeness.

CONCLUSIONS: If the study findings support the proposed associations, early identification and management of psychological factors related to pain perception during mammography may improve women’s overall experience, enhance comfort during the procedure, and potentially increase adherence to breast cancer screening programs.

PMID:42640226 | DOI:10.2196/92804

Am J Manag Care. 2026 Jul;32(7):414-416. doi: 10.37765/ajmc.2026.89916.

ABSTRACT

Given the fixed supply of residency training slots, pathways to increasing physician supply are limited. We assess use of the novel assistant physician (AP) status and the early impact of regulatory changes in Missouri. We find limited impacts of APs on supply, with a substantial majority (80.2%) of licensed APs not reporting a practice address and declining numbers of new licenses in recent years. We discuss implications and potential changes to increase health care supply through an AP pathway.

PMID:42640210 | DOI:10.37765/ajmc.2026.89916