Nevin Manimala

JMIR Form Res. 2026 Aug 26;10:e95883. doi: 10.2196/95883.

ABSTRACT

BACKGROUND: Large language models (LLMs) are increasingly used to support digital health communication, yet their reliability in patient-facing cardiovascular imaging education remains uncertain. Cardiovascular imaging involves complex terminology and procedural details that many patients struggle to understand, creating a need for accurate, clear, and reassuring explanations. While prior evaluations of conversational AI have focused primarily on diagnostic reasoning or clinician-oriented tasks, few studies have systematically compared contemporary LLMs in their ability to communicate effectively with patients.

OBJECTIVE: This study aimed to compare the accuracy, clarity, completeness, and patient-centered communication quality of responses generated by 3 state-of-the-art conversational agents (DeepSeek, GPT-o1, and GPT-4o) when addressing real-world patient questions about cardiovascular imaging.

METHODS: A prospective methodological evaluation was conducted using 84 unique patient-centered questions curated from authoritative cardiovascular information sources and online patient forums. Each question was independently submitted to DeepSeek, GPT-o1, and GPT-4o in isolated sessions to avoid contextual contamination. Two cardiovascular radiologists scored each response across 4 domains (accuracy, clarity and appropriateness, completeness, and user engagement and reassurance) using a standardized 3-point rubric (total score range 4-12). Discrepancies were resolved through predefined adjudication procedures. Because the scores were ordinal, median domain and composite scores with IQRs were summarized and compared across the 3 models using the Kruskal-Wallis test, with ε² as an effect size. Statistical significance was defined as an α value of .05.

RESULTS: Across the 84 patient questions, all 3 models produced largely accurate, clear, and complete responses, with comparably high scores across the accuracy, clarity, and completeness domains (median 3 of 3, IQR 3-3 in each). The only meaningful difference appeared in user engagement and reassurance. A “good” engagement rating was assigned to 96.4% (81/84) of DeepSeek responses and 98.8% (83/84) of GPT-o1 responses but only 53.6% (45/84) of GPT-4o responses (Kruskal-Wallis P<.001). Composite scores were correspondingly lower for GPT-4o (median 11, IQR 10-12) than for DeepSeek and GPT-o1 (both median 12, IQR 11-12; P<.001). No significant differences were observed across models for accuracy (P=.91), clarity (P=.06), or completeness (P=.65), and no unsafe statements were identified in any model.

CONCLUSIONS: DeepSeek and GPT-o1 consistently delivered accurate, clear, and patient-centered explanations of cardiovascular imaging questions, whereas GPT-4o, despite comparable technical accuracy, provided less engaging and reassuring communication. These findings suggest that affective qualities rather than factual correctness represent the main differentiator among current LLMs in patient education tasks. As conversational agents become integrated into cardiovascular imaging workflows, attention to communication tone, emotional support, and health literacy alignment will be essential to ensure safe and effective patient use.

PMID:42647860 | DOI:10.2196/95883

JMIR Serious Games. 2026 Aug 26;14:e98694. doi: 10.2196/98694.

ABSTRACT

BACKGROUND: Hemiplegic cerebral palsy (CP) commonly affects upper-limb function in children and may limit functional use of the affected arm and hand. Virtual reality (VR)-based rehabilitation can provide interactive, feedback-based, and task-oriented practice, but whether adding VR-based intervention to conventional therapy provides additional benefits remains uncertain. Previous reviews have often included broader CP populations, mixed comparators, or broad upper-limb outcome labels, limiting domain-specific interpretation.

OBJECTIVE: This systematic review and meta-analysis evaluated VR-based intervention combined with conventional therapy versus conventional therapy alone for upper-limb-related outcomes in children with hemiplegic CP.

METHODS: This review was prospectively registered with PROSPERO (CRD420261486172). PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception to April 15, 2026. Eligible randomized controlled trials included children aged ≤12 years with hemiplegic CP and compared VR-based or interactive game-based intervention plus conventional therapy with conventional therapy alone. Outcomes were grouped into upper-limb activity, dexterity, motor control and movement quality, activities of daily living (ADLs), and grip strength. Risk of bias was assessed using the revised Cochrane risk-of-bias 2 tool. Random-effects meta-analyses with Hartung-Knapp-Sidik-Jonkman adjustment were performed; Nagashima-corrected prediction intervals (PIs) were calculated where applicable; and certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

RESULTS: Thirteen randomized controlled trials involving 458 children were included. Pooled estimates generally favored VR combined with conventional therapy, but no outcome reached statistical significance; effect estimates were as follows: upper-limb activity (standardized mean difference [SMD] 0.28, 95% CI -0.07 to 0.64), dexterity (SMD 0.26, 95% CI -0.34 to 0.86), motor control and movement quality (SMD 0.29, 95% CI -0.22 to 0.80), ADLs (SMD 0.17, 95% CI -0.22 to 0.55), and grip strength (mean difference 0.89, 95% CI -1.93 to 3.72). PIs also crossed the null value for all outcomes, ranging from -0.51 to 1.04 for upper-limb activity and from -4.89 to 6.45 for grip strength, suggesting variable effects across settings. Heterogeneity was low to moderate for most outcomes but substantial for grip strength. Most trials had some risk-of-bias concerns. Certainty of evidence was low for all outcomes except grip strength, which was very low.

CONCLUSIONS: VR-based intervention combined with conventional therapy did not provide clear evidence of additional benefits over conventional therapy alone. Although effects generally favored the combined intervention, CIs, PIs, risk-of-bias concerns, and low to very low certainty of evidence support cautious interpretation. VR may be considered a potentially engaging adjunct, but current evidence does not support its use as a replacement for therapist-led rehabilitation or as a definitively effective intervention. Larger, adequately powered trials with clearer reporting of VR characteristics, intervention dose, task specificity, and longer follow-up are needed.

TRIAL REGISTRATION: PROSPERO CRD420261486172; https://www.crd.york.ac.uk/PROSPERO/view/CRD420261486172.

PMID:42647858 | DOI:10.2196/98694

J Med Internet Res. 2026 Aug 26;28:e96002. doi: 10.2196/96002.

ABSTRACT

BACKGROUND: Rehabilitation clinical practice guidelines (CPGs) have increased rapidly, but inconsistent methodological quality limits their implementation. Although Appraisal of Guidelines for Research and Evaluation II (AGREE II) and Reporting Items for Practice Guidelines in Health Care (RIGHT) provide standardized appraisal frameworks, their application is time-consuming. Large language model (LLM)-based AI agents may offer a scalable alternative with uncertain reliability.

OBJECTIVE: We evaluated rehabilitation CPGs’ methodological and reporting quality and determined whether structured guidance improves human expert-AI agent agreement.

METHODS: We systematically reviewed English- and Chinese-language rehabilitation CPGs from Embase, Scopus, PubMed, China National Knowledge Infrastructure, Wanfang Data, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, and Guidelines International Network up to June 2026. Methodological and reporting quality were assessed using AGREE II and the RIGHT checklist. Factors associated with guideline quality were examined using regression and subgroup analyses. Two AI agents were compared with human consensus with and without a structured guideline appraisal workbook, followed by external validation using 6 anterior cruciate ligament reconstruction CPGs.

RESULTS: We included 227 CPGs (163 English-language, 64 Chinese-language). After introducing a structured guideline appraisal workbook, agreement among human experts improved markedly-mean intraclass correlation coefficients (ICCs) increased from -0.09 to 0.66 to 0.84-0.92 across AGREE II domains. Overall guideline quality remained low, with 35.9% (SD 18,8%) applicability and 52% (SD 17.2%) stakeholder involvement. English-language guidelines outperformed Chinese-language guidelines in scope and purpose (mean 74.64, SD 15.4 vs mean 68.88, SD 13.9; P=.004) and applicability (mean 39.14, SD 18.6 vs mean 27.54, SD 16.7; P<.001). Backward-elimination logistic regression revealed external review as an associated process characteristic (odds ratio 20.39, 95% CI 4.66-89.27; P<.001). RIGHT assessments showed consistent reliability (ICC=0.80-0.88). Reporting was highest for basic information (70.5%) and lowest for funding, declaration, and management of interests (44.1%). Meta-analysis of RIGHT reporting rates showed lower reporting among Chinese-language than English-language guidelines (risk difference [RD] -0.07, 95% CI -0.13 to -0.02, 95% prediction interval [PI] -0.39 to 0.24) and among guidelines published before vs after RIGHT release (RD -0.19, 95% CI -0.26 to -0.13, 95% PI -0.56 to 0.17). Without additional guidance, agent-human agreement was moderate (ICC=0.608-0.629). The workbook improved agreement for both models, with DeepSeek-R1’s increasing from 0.613 to 0.709 and o1-mini’s from 0.629 to 0.687. In validation beyond rehabilitation, DeepSeek-R1 maintained stable agreement (ICC=0.711) and completed appraisals in 5.44 minutes compared to 11.18 minutes for humans.

CONCLUSIONS: Rehabilitation CPGs, particularly Chinese-language CPGs, continue showing deficiencies in applicability and stakeholder involvement. LLM-based appraisal without structured guidance provides insufficient agreement. Structured guidance improved agent-human agreement, supporting AI-assisted guideline appraisal under human oversight. Although further validation across additional clinical specialties is needed, AI agents can serve as efficient assistants in guideline appraisal instead of replacing humans. Future synthesis requires human-AI integration guided by structured, expert-defined principles.

TRIAL REGISTRATION: PROSPERO CRD420251270676; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251270676.

PMID:42647856 | DOI:10.2196/96002

R I Med J (2013). 2026 Sep 1;109(9):72-77.

ABSTRACT

INTRODUCTION: Case-based learning strategies have been shown to enhance student engagement, promote active learning, and improve problem-solving ability by simulating clinical scenarios. However, few interventions focus specifically on integration within basic science domains, and even fewer have been student-led and implemented longitudinally throughout a pre-clerkship curriculum. This study evaluates the impact of a student-led initiative that incorporated interdisciplinary clinical vignettes into first-year medical coursework at a large allopathic medical school in the United States.

METHODS: Vignettes were designed to align with curricular themes across anatomy, histology, and pathology for each of the 13 curricular blocks. First-year medical students completed post-intervention surveys measuring confidence in applying course material, integration between concepts, and perceived relevance of the vignettes.

RESULTS: Across all blocks of vignettes, the majority of respondents agreed that the vignettes allowed them to think about lecture material in a new way (98%; 57% strongly agree, 41% somewhat agree), felt relevant to current material (95%; 73% strongly agree, 22% somewhat agree), and related the concepts from their anatomy, pathology, and histology courses (94%; 69% strongly agree, 25% somewhat agree). The analysis of our survey data confirms that students’ confidence in exam material increased after the use of the clinical vignettes. This was statistically significant for every discipline and across the vast majority of blocks.

CONCLUSIONS: Integrated vignettes fostered interdisciplinary learning and improved confidence in applying pre-clerkship knowledge across disciplines. This low- resource, peer-led model may serve as an adaptable tool to support early clinical reasoning and integrative learning across foundational science curricula.

PMID:42647842

R I Med J (2013). 2026 Sep 1;109(9):63-71.

ABSTRACT

BACKGROUND: In the United States, significant disparities exist in preventative health among underserved communities, including African American/Black (AA/B), Hispanic/Latino (H/L) and lesbian/gay/bisexual/transgender/ queer (LGBTQ+) individuals. We explored the influence of social determinants of health (SDOH) on preventative health outcomes in these groups.

METHODS: We conducted a comprehensive cross-sectional needs assessment at safety-net health clinics in Providence, Rhode Island, from June to September 2022.

RESULTS: Of N=1,017 individuals, 67% identified as H/L, 16% identified as AA/B, and 19% identified as LGBTQ+. The most common diagnosed health conditions were anxiety (26%), depression (23%), hypertension (20%), and diabetes (15%). People reported most commonly needing help with food (31%), housing (25%), and utilities (22%). More social needs were associated with reductions in COVID-19 booster vaccination (p<.01) and higher mental health diagnoses (p<.01). AA/B individuals with higher health literacy were also less likely to be diagnosed with a mental health condition (p=.02). LGBTQ+ individuals were more likely to report a history of mental health illness, tobacco use, hazardous alcohol use, other substance use, and more sexual partners (p<.05).

CONCLUSIONS: Addressing health literacy and other social determinants of health is important to address disparities and achieve health equity among marginalized communities.

PMID:42647841

R I Med J (2013). 2026 Sep 1;109(9):42-46.

ABSTRACT

OBJECTIVE: Partial hospitalization programs (PHP) are acute psychiatric settings that commonly treat patients with active suicidal ideation (SI), anxiety, and alcohol use. Alcohol use is common among patients with SI and anxiety, and this triple vulnerability may negatively impact treatment engagement and outcomes in PHP. This study examined whether patients presenting with SI, elevated anxiety, and alcohol use (“triple vulnerability”) demonstrated differences in PHP treatment outcomes (completing treatment, number of days attended, number of absences) compared to patients without the vulnerability.

METHODS: Participants were 493 patients admitted to an Acceptance and Commitment Therapy-based PHP program in the United States between 2014-2020. Triple vulnerability was defined as reporting (1) active SI, (2) clinically elevated anxiety (CUXOS-D ≥ 20), and (3) consuming ≥ 1 alcoholic drink on a typical drinking day within the past year. Binary and linear regressions were used to assess differences in treatment completion status, number of days attended, and number of absences.

RESULTS: The triple vulnerability was not significantly associated with treatment completion status or with the number of absences; it was, however, positively associated with the number of days attended at PHP.

CONCLUSION: People who experience SI, clinically elevated anxiety, and who consume at least one alcoholic beverage on a typical drinking day are more likely to attend PHP for a longer duration of time, but are not any more susceptible to not finishing treatment, relative to people who do not have the triple vulnerability. Future work can benefit from exploring additional treatment outcomes that may be impacted by patients with the triple vulnerability.

PMID:42647836

R I Med J (2013). 2026 Sep 1;109(9):37-41.

ABSTRACT

Rates of adolescent suicide have risen over the last 10 years, creating a public health crisis. Disclosure of suicidal thoughts and behaviors (STBs) is one help-seeking strategy available to adolescents. Estimates from prior studies on the frequency of youth STB disclosure vary considerably. It is crucial to understand patterns and rates of STB disclosure for youth at elevated risk for suicide, including those who have been psychiatrically hospitalized or who hold sexual and gender minority (SGM) status. To examine STB disclosure in this high-risk population, the current study examined self-report of STB disclosure behaviors, including to whom, how, and when disclosure occurred, as well as the outcome of the disclosure in a sample of psychiatrically hospitalized youth with prior STBs (N=163). Data showed that the most common recipients of disclosures were caregivers, health professionals, and in-person friends. The most frequently endorsed method of disclosure was doing so in person, and there were no significant differences in when adolescents disclosed STBs (before, during, or after the experience). SGM adolescents were half as likely as non-SGM adolescents to disclose to parents or caregivers, and SGM adolescents disclosed more often during the STB than non-SGM youth. These findings can inform future interventions targeted at reducing STBs in youth or increasing help-seeking behaviors for psychiatrically hospitalized adolescents.

PMID:42647835

R I Med J (2013). 2026 Sep 1;109(9):31-36.

ABSTRACT

BACKGROUND: Co-occurrence of Bipolar Disorder (BD) and Substance Use Disorder (SUD) increases the risk of negative mental health outcomes, including both intentional (i.e., suicide self-poisoning) and unintentional overdose (i.e., accidental). While it is clear that both forms of overdose are a relevant concern, less is understood about the differences in phenomenology between intentional and unintentional overdose among this high-risk group.

METHODS: Demographic and clinical characteristics were drawn from a sample of patients at a Rhode Island hospital during their baseline session of a larger psychosocial intervention clinical trial.

RESULTS: Among 171 participants with co-occurring BD-SUD, 77% reported a history of any type of overdose, 48% reported a history of unintentional overdose, 56% reported a lifetime suicide attempt via intentional overdose, and 28% reported experiencing both intentional and unintentional overdose. Collectively, antidepressant/antipsychotic/mood-stabilizing medications were the most frequently reported substances for intentional overdose, followed by sedating medications and alcohol. Opioids were the most frequently reported substance for accidental overdose, followed by alcohol and stimulants. Polysubstance use was indicated for 62% of intentional overdose events and 43% of accidental overdose events. Compared to participants with a history of intentional overdose only, those who have experienced both types of overdose were significantly younger and more likely to have co-occurring alcohol use disorder and drug use disorder.

CONCLUSIONS: Our findings suggest that psychotropic medications traditionally used to treat BD and other psy- chiatric disorders are often implicated in intentional over- dose. Additionally, our results highlight the need for a focus on prevention of polysubstance overdose across the intentionality spectrum.

PMID:42647834

R I Med J (2013). 2026 Sep 1;109(9):23-30.

ABSTRACT

PURPOSE: Sexual and gender minority (SGM) individuals experience heightened mental health problems and substance misuse. Improved approaches to screening for behavioral health in this population are needed. We evaluated the implementation of a digital intake platform incorporating behavioral health screenings at a sexual health clinic serving SGM individuals.

METHODS: Patients presenting to a sexual health clinic March 2021 through April 2023 were screened for depression, hazardous drinking, and illicit substance use using a digital intake platform. To identify SGM subpopulations most in need of services, we evaluated relationships between demographic and sexual health factors and depression, hazardous drinking, and illicit substance use.

RESULTS: In total, N=1,277 people presented for care; 28% identified as gay/lesbian, 30% as bisexual+ (attracted to more than one gender), and 12% as transgender/gender diverse. Thirteen percent reported a sexually transmitted infection in the past 12 months, 11% screened positive for a depressive disorder, 50% for hazardous drinking, and 26% for illicit substance use. Individuals 18-39 years were more likely to be depressed than adults 40+, and transgender/gender diverse individuals had 1.93-fold greater odds of depression than cisgender men. Regarding substance use, cisgender men had 2.42-fold greater odds of use compared to cisgender women, and lesbian/gay individuals had 5.08-fold increased odds compared to heterosexual individuals.

CONCLUSION: A digital intake platform for behavioral health screening identified SGM at risk for depression and substance use challenges within a sexual health clinic. This protocol was able to identify subpopulations at higher risk for these disorders, increasing opportunities for recognition and response.

PMID:42647833

BJS Open. 2026 Jul 3;10(4):zrag126. doi: 10.1093/bjsopen/zrag126.

ABSTRACT

BACKGROUND: Since 2015, multidisciplinary team (MDT) discussion is recommended for all Swedish patients diagnosed with gastric cancer. However, few studies have explored the association of MDT discussion with survival.

METHODS: This study included all Swedish patients diagnosed with gastric adenocarcinoma between 2006 and 2021. Multivariable logistic regression was used to investigate the probability of receiving treatment recommendation at an MDT meeting, whereas the association between receiving an MDT treatment recommendation and overall survival was examined using Cox regression and Kaplan-Meier methods.

RESULTS: Of 7813 patients, 5279 (68%) were discussed at an MDT meeting. Advanced age (80-89 years; odds ratio (OR) 0.30; 95% confidence interval (c.i.) 0.21 to 0.43) and lower performance status (Eastern Cooperative Oncology Group performance status 1; OR 0.68; 95% c.i. 0.56 to 0.81) were associated with a lower probability of receiving an MDT treatment recommendation. Clinical disease stages II and III, compared with stage I, were associated with a higher probability of an MDT discussion (OR 1.38 (95% c.i. 1.10 to 1.75) and 1.42; (95% c.i. 1.09 to 1.85), respectively), as was a later year of diagnosis (OR 1.37; 95% c.i. 1.35 to 1.40). In adjusted survival analysis with multivariable Cox regression, MDT discussion was associated with better survival (hazard ratio 0.89; 95% c.i. 0.83 to 0.95). In addition, median survival was longer in the group with than without MDT treatment recommendations (12.0 versus 5.9 months).

CONCLUSION: Receiving a treatment recommendation at an MDT meeting was associated with better survival in patients with gastric adenocarcinoma. Patients with advanced disease and older age were less likely to receive an MDT treatment recommendation but, if they did, it was associated with better survival.

PMID:42647827 | DOI:10.1093/bjsopen/zrag126