Nevin Manimala

Adv Neonatal Care. 2026 Jul 28. doi: 10.1097/ANC.0000000000001415. Online ahead of print.

ABSTRACT

BACKGROUND: Maternal voice exposure provides significant neurodevelopmental benefits for preterm infants, yet its integration into routine clinical care remains inconsistent. Understanding the “knowledge-to-action” gap is critical for establishing effective developmental care practices in the neonatal intensive care unit (NICU).

PURPOSE: To determine the knowledge levels of NICU nurses regarding maternal voice exposure, evaluate their clinical practices, and identify perceived systemic barriers to implementation.

METHODS: A descriptive, cross-sectional design was used. Data were collected from 166 NICU nurses across Türkiye using a structured knowledge questionnaire (content validity index = 0.99) and a clinical practice assessment tool. Statistical analyses included descriptive statistics and group comparisons (t-tests and analysis of variance).

RESULTS: The mean knowledge score was high (82.70 ± 9.29). Despite this, 75.9% of nurses did not implement maternal voice exposure in their units. A significant majority (94.0%) reported a total absence of written protocols. Key barriers identified were lack of guidelines, time constraints, and equipment shortages. Knowledge scores positively correlated with age and professional experience (P < .05).

IMPLICATIONS FOR PRACTICE AND RESEARCH: Although NICU nurses possess high theoretical knowledge, a profound “knowledge-to-action” gap exists. The primary systemic barrier is the lack of standardized, evidence-based written protocols. Neonatal intensive care unit leadership should prioritize developing clinical guidelines and nursing education programs that address perceived barriers, such as infection control and equipment use, to transition theoretical knowledge into routine bedside practice.

PMID:42520284 | DOI:10.1097/ANC.0000000000001415

Health Informatics J. 2026 Jul-Sep;32(3):14604582261470637. doi: 10.1177/14604582261470637. Epub 2026 Jul 28.

ABSTRACT

ObjectiveThis study evaluates the performance of large language models (LLMs)-ChatGPT-4.0, Gemini 2.0 Pro, o3-mini, Doctor GPT and DeepSeek-V3-in a national orthopaedic proficiency examination and explores their implications for health informatics and medical education. The responses of these models were analysed to assess accuracy rates and differences between models.MethodA total of 100 multiple-choice questions from the 2024 TOTEK examination were administered to each AI model under identical conditions. Correct and incorrect responses were recorded, and differences in performance were evaluated using chi-square testing and frequency analysis. Question categories were also compared to identify domain-specific variations.Resultso3-mini achieved the highest accuracy rate (79%), while Gemini 2.0 showed the lowest (68%); all models exceeded the 60% pass threshold. A statistically significant difference between models was identified in the Surgical Procedures category, in which Gemini 2.0 answered fewer questions correctly (23/36) than the other models (30-32/36) (χ² = 9.87, df = 4, p = 0.043). No significant differences were observed in the remaining categories (all p > 0.05), and the overall difference in accuracy between models did not reach statistical significance (χ² = 4.01, df = 4, p = 0.405). Clinical decision-making and visual content-based questions were the most challenging for all models.ConclusionAI models demonstrate generally high accuracy in medical examinations; however, they struggle with interpreting clinical context, recognising atypical medical scenarios and answering questions involving visual content.

PMID:42520276 | DOI:10.1177/14604582261470637

JMIR Mhealth Uhealth. 2026 Jul 28;14:e74121. doi: 10.2196/74121.

ABSTRACT

BACKGROUND: Heart failure (HF) is a major health care challenge in the United States, with approximately 900,000 older adults hospitalized annually. Gaps in self-management, including unrecognized worsening symptoms and failure to adhere to dietary sodium restriction, can reduce quality of life and precipitate hospital admissions. Existing mobile health approaches to HF self-management have produced mixed results, highlighting the need for innovative strategies to improve postdischarge outcomes in at-risk patients.

OBJECTIVE: The ManageHF trial aimed to evaluate the effectiveness of 2 just-in-time adaptive interventions delivered via a mobile app to enhance HF self-management. The interventions focused on symptom recognition and lower dietary sodium restriction, with the goal of reducing readmissions and improving health-related quality of life (HRQOL) over a 12-week period.

METHODS: The trial was a 2×2 factorial, double-blind, randomized controlled study conducted across several US institutions. Participants recently hospitalized for acute HF were randomized into 4 groups: both interventions, either intervention alone, or an active control. The primary outcome was a composite measure assessing time to all-cause death, time to first HF readmission, and HRQOL changes, using the Minnesota Living with HF Questionnaire.

RESULTS: Recruitment was hindered by the COVID-19 pandemic, leading to the early discontinuation of the trial. Of the 62 participants enrolled, 43 completed the study. Participants were diverse, with a mean age of 55 (SD 14.4) years, 32% (20/62) were female, and 55% (34/62) identified as Black or African American. Most had HF with reduced ejection fraction. However, due to the early termination and small sample size, the ability to detect statistically significant differences was limited.

CONCLUSIONS: The ManageHF trial highlighted the potential of mobile health technology to support HF management, particularly in enhancing HRQOL. Future studies using more effective recruitment and retention strategies are crucial for establishing the efficacy of these interventions with greater certainty.

PMID:42520258 | DOI:10.2196/74121

Global Spine J. 2026 Jul 28:21925682261474153. doi: 10.1177/21925682261474153. Online ahead of print.

ABSTRACT

Study DesignRetrospective Study.ObjectivesTo compare long-term adjacent-segment kinematic changes and radiographic adjacent segment degeneration (rASD) after two-level cervical hybrid surgery using Bryan or Mobi-C prostheses.MethodsWe retrospectively reviewed 78 patients who underwent contiguous two-level anterior cervical hybrid surgery between 2010 and 2018, including 38 treated with Bryan and 40 with Mobi-C prostheses. All patients had more than 7 years of follow-up. Flexion-extension center of rotation (FE-COR) trajectories at the superior adjacent segment were measured on dynamic radiographs. Long-term rASD was evaluated using the Walraevens score.ResultsClinical outcomes improved significantly in both groups (P < 0.001), with no significant between-group differences. Segmental range of motion remained stable and comparable between groups (P > 0.05). However, FE-COR trajectories differed. At 1 year, the Mobi-C group showed anterior-inferior FE-COR displacement, with FE-COR_Y decreasing to 44.92% ± 12.55%, whereas the Bryan group maintained a relatively stable FE-COR_Y of 59.01% ± 10.66% (P < 0.001). At final follow-up, rASD occurred in 12.5% of Mobi-C patients and 23.7% of Bryan patients, although this difference was not statistically significant (P = 0.198).ConclusionConventional ROM measurements alone cannot fully capture segmental biomechanics. Early anterior-inferior FE-COR displacement in the Mobi-C group was observed and was associated with a numerically lower, but statistically non-significant, rASD rate. These findings suggest that FE-COR may be a sensitive radiographic parameter for describing postoperative micro-kinematic patterns, but its causal relationship with long-term adjacent segment degeneration requires further biomechanical and MRI-based validation.

PMID:42520254 | DOI:10.1177/21925682261474153

J Med Internet Res. 2026 Jul 28;28:e90458. doi: 10.2196/90458.

ABSTRACT

BACKGROUND: Multimorbidity involves heterogeneous disease combinations, treatment burden, competing priorities, and complex care pathways. Digital health interventions (DHIs) may support monitoring, self-management, and care coordination, but their effects on health-related outcomes remain uncertain.

OBJECTIVE: This systematic review and meta-analysis evaluated the effectiveness of DHIs on physiological, psychological, and functional outcomes in adults with multimorbidity, summarized implementation outcomes, and explored intervention-multimorbidity matching patterns.

METHODS: PubMed, Web of Science Core Collection, Embase, Cochrane Library, CINAHL with Full Text, Scopus, gray literature sources, trial registries, reference lists, and forward citations were searched through April 7, 2026. English-language randomized or cluster-randomized trials enrolled adults with 2 or more chronic conditions and compared a DHI with a comparator lacking the same digital component. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Random-effects meta-analyses used restricted maximum likelihood estimation, Hartung-Knapp adjustment, and Nagashima-Noma-Furukawa prediction intervals. Certainty of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.

RESULTS: In total, 36 reports (37 trials) were included. A total of 7 were rated as high risk of bias and 29 as having some concerns; none was rated as low risk overall. No statistically significant pooled effects were observed for glycated hemoglobin, blood pressure, mortality, hospitalization, or readmission, depression response, health-related quality of life, or pain-related functional impact or disability. For glycated hemoglobin, 6 studies (3992 participants) yielded a mean difference of -0.12 percentage points (95% CI -0.36 to 0.11; 95% prediction interval -0.70 to 0.43). For systolic blood pressure, 6 studies including 5596 participants yielded a mean difference of -3.40 mm Hg (95% CI -8.94 to 2.14; 95% prediction interval -19.15 to 13.03). Depression severity was the only outcome whose pooled 95% CI favored the intervention (8 studies; 1861 participants; standardized mean difference -0.49, 95% CI -0.82 to -0.16), but its prediction interval spanned benefit to harm (-1.53 to 0.51). Certainty was low or very low for all 7 GRADE-assessed outcomes. Implementation findings suggested feasibility, especially with monitoring, coaching, or clinician contact, but reporting was heterogeneous.

CONCLUSIONS: Current evidence does not support consistent, transferable benefits of DHIs across most outcomes in adults with multimorbidity. Their real-world value may depend less on technology type than on alignment among intervention mechanisms, patient complexity, outcomes, and delivery context. Future DHIs should be adaptive, burden-sensitive, and workflow-integrated, linking digital data to patient priorities, clinician responses, and care coordination.

PMID:42520248 | DOI:10.2196/90458

R I Med J (2013). 2026 Aug 1;109(8):49-53.

ABSTRACT

BACKGROUND/PURPOSE: Dietary factors greatly influence kidney stone disease (KSD). We aimed to examine the dietary pattern changes of adult stone formers (SF) in the United States from 1988 to 2018.

METHODS: We used weighted, multiple linear regression analyses to examine dietary data from prevalent SF in the National Health and Nutrition Examination Survey (NHANES) III and 2007-2018.

RESULTS: The study was divided into four periods: 1988-1994, 2007-2010, 2011-2014, and 2015-2018. The KSD prevalence rate increased from 5.5% in 1988-1994 to 10.8% in 2015-2018. No significant changes occurred in the intake of total calories, total protein, saturated fat, or sodium. Total daily fat intake increased significantly (78.9 g in 1988-1994 to 88.7 g in 2015-2018, p=0.03). Daily potassium intake decreased significantly (2,947 mg in 1988-1994 to 2,628 mg in 2015-2018, p<0.001). Daily calcium intake (795 mg in 1988-1994 to 950 mg in 2015-2018, p<0.001) and daily fluid intake (2,120 ml in 1988-1994 to 3,124 ml in 2015-2018, p<0.001) increased significantly. No effect modification by gender or age group was detected.

CONCLUSION: There were significant increases in polyunsaturated fat, calcium, and fluid intakes. However, dietary potassium intake was reduced. Overall, there were no statistically significant changes in dietary intakes of calories, protein, carbohydrates, fiber, saturated fat, and sodium.

PMID:42520235

R I Med J (2013). 2026 Aug 1;109(8):43-48.

ABSTRACT

PURPOSE: We evaluate the Clínica Esperanza Ophthalmology Service, a free service for uninsured patients in southern New England.

METHODS: The service operates monthly under a novel clinic-within-a-clinic model, existing as a subsidiary of a local free clinic. A mixed-methods program evaluation and a retrospective chart review from December 2021 to January 2025 were analyzed using descriptive statistics.

RESULTS: One hundred and forty-three (143) patients were scheduled during the study period, of whom 106 (74%) were seen. Median age was 51 years and 52/106 (49%) were female. Most patients (97%) identified Spanish as their primary language. There were no significant demographic differences between those seen and no-shows. Diabetic retinopathy was the most common diagnosis (37/106, 35%), followed by dry eye (35/106, 33%), and cataracts (29/106, 27%). Half of the patients (51/106, 48%) received a referral, most commonly for refraction (23/51, 45%). Ophthalmic medication was prescribed for 53/106 (50%) patients, most commonly for artificial tears (43/53, 81%). Qualitative strengths included education and low operational overhead. Qualitative challenges included long length of encounters and consequently, low patient volumes.

CONCLUSIONS: Our novel ophthalmology service supplements existing operations and helps meet an unmet public health need among its region’s most vulnerable patients. Opportunities for improvement include improving clinic volumes and mitigating no-show rates.

PMID:42520234

JMIR Res Protoc. 2026 Jul 28;15:e91675. doi: 10.2196/91675.

ABSTRACT

BACKGROUND: Continuing medical education (CME) is a legal and ethical obligation for physicians in Germany. The rapid rise of large language models (LLMs) such as ChatGPT, Gemini, Claude, and Grok raises concerns about the integrity of CME assessments, as LLMs can already pass German CME tests.

OBJECTIVE: This study aims to determine whether the choice of document format (searchable PDF, protected PDF, raster PDF, or vector PDF) and LLM influences the ability of LLMs to solve CME test questions at rates exceeding the passing threshold specified for each CME module (typically 70%).

METHODS: In a fully crossed within-subjects repeated-measures design, 18 expired CME articles from 3 major German publishers across 6 specialties will be converted into 3 cheating-impeding PDF formats and processed alongside the original PDF files by 4 current LLMs (GPT-5, Claude Sonnet 4, Grok-4, and Gemini 3). This results in 16 model-format combinations. Each model will answer every article 3 times per file-format condition, with outcomes derived from aggregated run-level results. The primary outcome is the proportion of correctly answered questions; the secondary outcome is the pass/fail rate.

RESULTS: The study has been approved by the Witten/Herdecke University Ethics Committee (S-260/2025; dated August 10, 2025) and is preregistered at the Open Science Framework. The study is supported by internal departmental resources only, and no external funding was received. Because this protocol evaluates LLMs using expired CME materials, no human participants are being recruited. Data collection is planned to begin in June 2026 and is expected to last approximately 4 weeks. At the time of manuscript submission, no data have been collected or analyzed. Results are expected to be available after the completion of data collection and statistical analysis in 2026. The analyses will quantify performance differences across document formats; these findings may inform the feasibility of nonsearchable document formats as a temporary measure to reduce LLM-enabled cheating risks in CME contexts.

CONCLUSIONS: By quantifying how document format constrains LLM performance, this study aims to evaluate simple technical safeguards that may reduce artificial intelligence-assisted manipulation of CME tests and inform regulators and CME providers about how to balance assessment validity, accessibility, and responsible LLM integration into postgraduate medical education.

PMID:42520225 | DOI:10.2196/91675

J Bone Miner Res. 2026 Jul 28:zjag117. doi: 10.1093/jbmr/zjag117. Online ahead of print.

ABSTRACT

Time in moderate-to-vigorous intensity activity (MVPA), light intensity activity (LPA), and sleep are critical for bone health in older adults but are often considered separately despite being inherently co-dependent. We examined cross-sectional associations between compositions of accelerometry-derived MVPA, LPA, inactivity, and sleep with bone microarchitecture and strength (High-Resolution Peripheral Quantitative Computed Tomography; HR-pQCT) in community-dwelling older men (n=119) and women (n=177), mean age 76.3±4.6 yrs. Participants wore an ActiGraph GT9X on their non-dominant wrist for 7 consecutive 24hr periods during the Study of Muscle, Mobility and Aging (SOMMA) baseline visit. The primary outcomes were distal radius (DR) and tibia (DT) estimated failure load, and secondarily, total volumetric bone mineral density (vBMD), and cortical (Ct) and trabecular (Tb) vBMD, area (Ar), and thickness (Th) from HR-pQCT. Compositional data analysis methods evaluated proportions of time in one behavior relative to the remaining behaviors. Sex-stratified multiple linear regression estimated associations between 24hr composition with sex-specific standardized HR-pQCT parameters. Compositional isotemporal substitution methods estimated hypothetical changes in continuous HR-pQCT measures if 10-60 min in one behavior was displaced by another. On average, women spent 90.2 min/day (6.3%) in MVPA, 346.1 min/day (24.0%) in LPA, 556.4 min/day (38.6%) in inactivity, and 447.4 min/day (31.1%) in sleep; men spent 93.6 min/day (6.5%) in MVPA, 309.5 min/day (21.5%) in LPA, 596.7 min/day (41.4%) in inactivity, and 440.2 min/day (30.6%) in sleep. Compared to the average sex-specific 24hr composition, higher proportions of MVPA were associated with higher DR and DT failure load in women; higher DR Tb.vBMD and Tb.Th in men; and higher DR Tt.vBMD, Ct.Ar, and Ct.Th, and DT Ct.vBMD, Ct.Ar, and Ct.Th in women. Hypothetically displacing 10-60 min in inactivity for MVPA resulted in more favorable HR-pQCT parameters. These data support the importance of MVPA for a healthy skeleton in older men and women.

PMID:42520223 | DOI:10.1093/jbmr/zjag117

Int J Clin Exp Hypn. 2026 Jul 28:1-31. doi: 10.1080/00207144.2026.2700719. Online ahead of print.

ABSTRACT

Hypnosis has a long history of use in anesthesia, but it has not yet achieved the level of widespread clinical usage, despite favorable results in some individual studies. This systematic review aimed to quantify hypnosis in the different anesthetic domains. A comprehensive search of the literature was undertaken using Medline, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials. In addition, the studies needed to be randomized controlled trials studying hypnosis and anesthesia. The search yielded 19 studies with a total of 3,699 patients over obstetrics, pediatrics, and dentistry. The results are encouraging, especially in the pediatric and dental areas where hypnosis was correlated with a statistically significant decline in both preoperative and intraoperative anxiety and a partial reduction in postoperative pain. In obstetrics, there was no beneficial impact from hypnosis on the pain. In conclusion, even though the number of high-quality studies is small, the studies indicate that hypnosis could serve as a helpful adjunct in defined anesthetic domains.

PMID:42520209 | DOI:10.1080/00207144.2026.2700719