Nevin Manimala

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

JMIR Hum Factors. 2025 Apr 17;12:e56860. doi: 10.2196/56860.

ABSTRACT

BACKGROUND: The growing demand for hospital-based care, driven by aging populations and constrained resources, has accelerated the adoption of telehealth tools such as teleconsultations and remote monitoring in hospital-at-home (HaH) programs. Despite their increasing use in delivering acute care at home, studies exploring health care providers’ experiences and perceptions of these tools within HaH settings remain limited.

OBJECTIVE: This study aimed to understand the experiences and perspectives of health care providers toward teleconsultations and vital signs monitoring systems within a HaH program in Singapore to optimize effectiveness and address challenges in future implementation.

METHODS: A convergent mixed methods approach that combines qualitative in-depth interviews with an electronic survey designed based on the 5 domains (usefulness, ease of use, effectiveness, reliability, and satisfaction) of the Telehealth Usability Questionnaire was used.

RESULTS: In total, 37 surveys and 20 interviews were completed. Participants responded positively to the use of both teleconsultation and vital signs monitoring with a mean total score of each method being 4.55 (SD 0.44) and 4.52 (SD 0.42), respectively. Significantly higher mean ratings were observed among doctors compared with other health care providers for usefulness (P=.03) and ease of use (P=.047) in teleconsultations. Health care providers with fewer years of clinical experience also perceived the use of vital signs monitoring to be more effective (P=.02) and more usable (P=.04) than those with more years of experience. Qualitative analysis identified four themes: (1) benefits of telehealth for health care providers such as improved work convenience, efficiency, and satisfaction; (2) challenges of telehealth implementation relating to communication and technology; (3) perspectives on telehealth impact; and (4) enablers for successful implementation. Comparing both datasets, qualitative findings were aligned with and confirmed quantitative results.

CONCLUSIONS: This study highlighted the benefits and usability of telehealth among health care providers. However, challenges relating to patient communication, technological issues, and delivery of care were also discussed along with enablers for successful implementation. These insights can inform strategies to optimize future implementation of telehealth in HaH.

PMID:40245429 | DOI:10.2196/56860

JMIR Mhealth Uhealth. 2025 Apr 17;13:e59884. doi: 10.2196/59884.

ABSTRACT

BACKGROUND: Web-based pharmacy apps facilitate the electronic exchange of health-related supplies. They are digital platforms that run on websites and smartphones. Pakistan is experiencing significant progress in smartphone integration and digital services, leading to the expansion of the online pharmacy business. However, concerns remain over the legitimacy and precision of these apps.

OBJECTIVE: The aim of this study was to undertake a thorough assessment of digital pharmacy apps accessible in Pakistan. Specifically, our focus was on apps accessible via the Google Play Store and the iOS App Store. To fulfill this objective, an evaluation of these apps was performed using the Mobile App Rating Scale (MARS).

METHODS: A research investigation was conducted to analyze the online pharmacy apps in Pakistan. Initially, 50 apps were identified, but 10 were excluded for not meeting pre-established criteria, 10 were excluded for being in languages other than English, and 7 could not be downloaded. All paid and non-English apps were also excluded. A total of 23 apps were selected for the study, acquired via the Google Play Store and iOS App Store. The evaluation was conducted by 2 researchers who maintained independence from one another by using the MARS.

RESULTS: Initially, 50 apps were identified, of which 27 were excluded for not meeting the predetermined criteria. A total of 23 apps were selected for the study, acquired via the Google Play Store and iOS App Store. Strong positive correlations between higher user engagement and better app functionality and information quality were observed. The average rating of the 23 apps ranged between 2.64 and 4.00 on a scale up to 5. The aesthetics dimension had the highest mean score of 3.6, while the information dimension had the lowest mean score of 3.2. For credibility and reliability, different tests (intraclass correlation, Cohen κ, Krippendorff α, and Cronbach α) on each dimension of the MARS were performed by using SPSS Statistics 27. The intraclass correlation of all MARS dimensions ranged from 0.702-0.913 (95% CI 0.521-0.943), the Cohen κ of all MARS dimensions ranged from 0.388-0.907 (95% CI 0.151-0.994), the Krippendorff α of all MARS dimensions ranged from 0.705-0.979 (95% CI 0.657-0.923), and Cronbach α had a lower score of 0.821 in the information dimension and a higher score of .911 in the subjective quality dimension of the MARS.

CONCLUSIONS: This study evaluated online pharmacy apps in Pakistan by using the MARS. It is the first study on online pharmacy apps in Pakistan. The findings of the evaluation have provided insights into the reliability and efficacy of these apps.

PMID:40245428 | DOI:10.2196/59884

Obstet Gynecol. 2025 May 17;145(5):542-552. doi: 10.1097/AOG.0000000000005888.

ABSTRACT

The nulliparous, term, singleton, vertex (NTSV) cesarean birth rate is a metric that may be used to evaluate obstetric care and compare performance across similar hospitals and regions. Safe reduction of primary cesarean birth prevents the need for future cesarean births and associated maternal morbidity risk. Quality-improvement methodologies such as optimizing culture of care; practice environment; data collection and monitoring, including monitoring of data by race and ethnicity; and proactive management and planning for known and unanticipated drivers of cesarean birth may safely reduce NTSV cesarean birth rates. Obstetrician-gynecologists should engage with patients in informed decision making, informed consent, and birth preference conversations, particularly related to induction of labor and cesarean birth, to support equitable and respectful obstetric care and outcomes related to NTSV cesarean birth.

PMID:40245424 | DOI:10.1097/AOG.0000000000005888

JMIR Aging. 2025 Apr 17;8:e64254. doi: 10.2196/64254.

ABSTRACT

BACKGROUND: Frailty syndrome increases the vulnerability of older adults. The growing proportion of older adults highlights the need to better understand the factors contributing to the prevalence of frailty. Current evidence suggests that geomatic tools integrating geolocation can provide valuable information for implementing preventive measures by enhancing the urban physical environment.

OBJECTIVE: The aim of this study was to analyze the relationship between various elements of the urban physical environment and the level of frailty syndrome in older Chilean people.

METHODS: A cohort of 251 adults aged 65 years or older from Talca City, Chile, underwent comprehensive medical assessments and were geographically mapped within a Geographic Information Systems database. Frailty was determined using the Fried frailty criteria. The spatial analysis of the frailty was conducted in conjunction with layers depicting urban physical facilities within the city, including vegetables and fruit shops, senior centers or communities, pharmacies, emergency health centers, main squares and parks, family or community health centers, and sports facilities such as stadiums.

RESULTS: The studied cohort was composed of 187 women and 64 men, with no significant differences in age and BMI between genders. Frailty prevalence varied significantly across clusters, with Cluster 3 showing the highest prevalence (14/47, P=.01). Frail individuals resided significantly closer to emergency health centers (960 [SE 904] m vs 1352 [SE 936] m, P=.04), main squares/parks (1550 [SE 130] m vs. 2048 [SE 105] m, P=.03), and sports fields (3040 [SE 236] m vs 4457 [SE 322]m, P=.04) compared with nonfrail individuals. There were no significant differences in urban quality index across frailty groups, but frail individuals lived in areas with higher population density (0.013 [SE 0.001] vs 0.01 [SE 0.0007], P=.03).

CONCLUSIONS: Frail individuals exhibit geospatial patterns suggesting intentional proximity to health facilities, sports venues, and urban facilities, revealing associations with adaptive responses to frailty and socioeconomic factors. This highlights the crucial intersection of urban environments and frailty, which is important for geriatric medicine and public health initiatives.

PMID:40245404 | DOI:10.2196/64254

J Med Internet Res. 2025 Apr 17;27:e67646. doi: 10.2196/67646.

ABSTRACT

BACKGROUND: The global COVID-19 pandemic’s mental health impact was primarily studied in the initial year of lockdowns but remained underexplored in subsequent years despite evolving conditions. This study aimed to address this gap by investigating how COVID-19-related factors, including nationwide COVID-19 deaths and incidence rates, influenced mental health indicators over time.

OBJECTIVE: This study aimed to examine the interplay among national COVID-19 pandemic deaths, incidence rates, stay-at-home behaviors, and mental health indicators across different income-level countries. Specifically, we assessed the mediating role of stay-at-home behaviors in the relationship between the COVID-19 pandemic deaths and mental health indicators.

METHODS: We analyzed data from 45 countries spanning March 2020 to October 2022. COVID-19-related factors included national COVID-19 pandemic deaths and incidence rates, obtained from publicly available datasets. Stay-at-home behaviors were assessed using Google Location History data, which captured residence-based cell phone activity as a proxy for mobility patterns. Mental health indicators were evaluated through Google Trends data, measuring changes in search volumes for “insomnia” and “suicide.” The interplay among these variables was assessed using mediation analysis to quantify the proportion mediated by stay-at-home behaviors in the association between COVID-19 deaths and mental health indicators.

RESULTS: In high-income countries, during the first pandemic year (March 2020 to February 2021), a higher monthly COVID-19 death count was associated with increased searches for “insomnia,” with a total effect estimate of 2.1×10^-4 (95% CI 4.3×10^-5 to 3.9×10^-4; P=.01). Stay-at-home behaviors mediated 31.9% of this effect (95% CI 9.8% to 127.5%, P=.02). This association weakened and became nonsignificant in the second and third years (P=.25 and P=.54, respectively). For middle-income countries, a different pattern emerged regarding “suicide” searches. Higher COVID-19 death counts were linked to a decline in “suicide” searches in the first (estimate: -3.5×10^-4, 95% CI -6.1×10^-4 to -9.8×10^-5; P=.006) and second years (P=.01). Mediation analysis indicated that this effect was not significantly explained by stay-at-home behaviors, suggesting the influence of other societal factors. In high-income countries, no significant association between COVID-19 deaths and “suicide” searches was observed in the first year (P=.86). However, a positive association emerged in the second year, approaching statistical significance (estimate: 2.2×10^-4, 95% CI -9.5×10^-7 to 4.2×10^-4; P=.05), and became significant in the third year (estimate: 5.0×10^-4, 95% CI 5.0×10^-5 to 1.0×10^-3; P=.03,), independent of stay-at-home behaviors.

CONCLUSIONS: Our findings highlight how the mental health impact of the pandemic varied across income groups and evolved over time. The mediating effect of stay-at-home behaviors was significant in the early phases but diminished in later stages, particularly in high-income countries. Meanwhile, middle-income countries exhibited unique patterns that suggest alternative protective factors. These insights can inform tailored mental health interventions and policy strategies in future public health crises.

PMID:40245400 | DOI:10.2196/67646

JMIR Form Res. 2025 Apr 17;9:e62754. doi: 10.2196/62754.

ABSTRACT

BACKGROUND: Nowadays, the internet has become the primary source of information for physicians seeking answers to medical questions about their patients before consulting colleagues. However, many websites provide low-quality, unreliable information that lacks scientific validation. Therefore, physicians must develop strong information search skills to locate relevant, accurate, and evidence-based content. However, previous studies have shown that physicians often have poor search skills and struggle to find information on the web, which may have detrimental consequences for patient care.

OBJECTIVE: This study aims to determine how medical students and residents searched for medical information on the internet, the quality of the web resources they used (including their nature and credibility), and how they evaluated the reliability of these resources and the answers they provided. Given the importance of domain knowledge (in this case, medicine) and information search skills in the search process, we compared the search behaviors of medical students and residents with those of computer science students. While medical students and residents possess greater medical-related knowledge, computer science students have stronger information search skills.

METHODS: A total of 20 students participated in this study: 10 medical students and residents, and 10 computer science students. Data were extracted from a freely accessible data set in accordance with FAIR (Findable, Accessible, Interoperable, and Reusable) principles. All participants searched for medical information online to make a diagnosis, select a treatment, and enhance their knowledge of a medical condition-3 primary activities they commonly perform. We analyzed search performance metrics, including search time, the use of medical-related keywords, and the accuracy of the information found, as well as the nature and credibility of web resources used by medical students and residents compared with computer science students.

RESULTS: Medical students and residents provided more accurate answers than computer science students without requiring additional time. Their medical expertise also enabled them to better assess the reliability of resources and select high-quality web sources, primarily from hospital websites. However, it is noteworthy that they made limited use of evidence-based tools such as PubMed.

CONCLUSIONS: Although medical students and residents generally outperformed computer science students, they did not frequently use evidence-based tools. As previously observed, they may avoid databases due to the risk of encountering too many irrelevant articles and difficulties in applying appropriate filters to locate relevant information. Nevertheless, clinical and practical evidence-based medicine plays a crucial role in updating physicians’ knowledge, improving patient care, and enhancing physician-patient relationships. Therefore, information search skills should be an integral part of medical education and continuing professional development for physicians.

PMID:40245399 | DOI:10.2196/62754

J Med Internet Res. 2025 Apr 17;27:e63786. doi: 10.2196/63786.

ABSTRACT

BACKGROUND: Effective physician-patient communication is essential in clinical practice, especially in oncology, where radiology reports play a crucial role. These reports are often filled with technical jargon, making them challenging for patients to understand and affecting their engagement and decision-making. Large language models, such as GPT-4, offer a novel approach to simplifying these reports and potentially enhancing communication and patient outcomes.

OBJECTIVE: We aimed to assess the feasibility and effectiveness of using GPT-4 to simplify oncological radiology reports to improve physician-patient communication.

METHODS: In a retrospective study approved by the ethics review committees of multiple hospitals, 698 radiology reports for malignant tumors produced between October 2023 and December 2023 were analyzed. In total, 70 (10%) reports were selected to develop templates and scoring scales for GPT-4 to create simplified interpretative radiology reports (IRRs). Radiologists checked the consistency between the original radiology reports and the IRRs, while volunteer family members of patients, all of whom had at least a junior high school education and no medical background, assessed readability. Doctors evaluated communication efficiency through simulated consultations.

RESULTS: Transforming original radiology reports into IRRs resulted in clearer reports, with word count increasing from 818.74 to 1025.82 (P<.001), volunteers’ reading time decreasing from 674.86 seconds to 589.92 seconds (P<.001), and reading rate increasing from 72.15 words per minute to 104.70 words per minute (P<.001). Physician-patient communication time significantly decreased, from 1116.11 seconds to 745.30 seconds (P<.001), and patient comprehension scores improved from 5.51 to 7.83 (P<.001).

CONCLUSIONS: This study demonstrates the significant potential of large language models, specifically GPT-4, to facilitate medical communication by simplifying oncological radiology reports. Simplified reports enhance patient understanding and the efficiency of doctor-patient interactions, suggesting a valuable application of artificial intelligence in clinical practice to improve patient outcomes and health care communication.

PMID:40245397 | DOI:10.2196/63786