Nevin Manimala

JMIR Form Res. 2025 Apr 11;9:e67275. doi: 10.2196/67275.

ABSTRACT

BACKGROUND: Evidence-based guidelines support the use of structured exercise to facilitate concussion recovery. Despite the growing number of mobile health (mHealth) apps aimed at managing concussions, few focus on delivering exercise rehabilitation protocols. Therefore, a mobile app was developed to provide personalized rehabilitation programs based on evidence-based exercise principles designed to cater to individuals recovering from concussions.

OBJECTIVE: This study aimed to evaluate the usability and user experience of a mobile app designed to deliver an evidence-based rehabilitation program to individuals recovering from concussions.

METHODS: A two-week prospective single-arm pilot study was conducted among adults with a physician-diagnosed concussion. Participants engaged in home-based rehabilitation exercises through a mobile app. Usability was assessed using a combination of the mHealth App Usability Questionnaire (MAUQ) and five custom questions evaluating confidence in recommendations, exercise flow, clarity of voice commands, and usability of the exercise report feature. Following the two-week period, participants rated each question on a 7-point Likert scale ranging from “strongly agree” to “strongly disagree”.

RESULTS: Twenty-six participants consented and were enrolled in the study, with 23 participants (82%) completing all study components at the end of two weeks. The majority of participants were women, aged 26-38 years, and on average, approximately at three months postconcussion. Responses to both the MAUQ and custom questions were overwhelmingly positive. Overall, seven MAUQ questions received 100% positive responses, with no single question scoring below 83% positive responses. In the “ease of use and satisfaction” category, 100% of users responded positively to questions on ease of learning, usability, interface likeness, and comfort in social settings, while 83%-96% (19-22) of users responded positively to the remaining four questions. In the “system information arrangement” category, 100% (N=23) of users rated screen navigation, function usability, and health care service acceptability positively, with 87%-96% of users approving action acknowledgment, error recovery, and expected functions. Under the “usefulness” category, 96% (n=22) of users found the app beneficial for health and well-being, and 91% (n=21) users felt it effectively managed their health. For the five custom questions, 100% (N=23) users responded positively to voice command clarity, exercise awareness, ease of following exercises, and report understandability, with a single unfavorable response noted for confidence in app recommendations.

CONCLUSIONS: The findings of this study indicate that the mobile app is a user-friendly platform for delivering evidence-based exercise rehabilitation to individuals recovering from concussions. Positive user feedback, particularly in the areas of recommendation confidence, ease of exercise flow, and clarity of voice commands, highlights the app’s potential to support concussion recovery. Future iterations of the app will aim to improve time efficiency and streamline error recovery processes to further enhance the user experience.

PMID:40215401 | DOI:10.2196/67275

J Clin Psychiatry. 2025 Apr 2;86(2):24m15516. doi: 10.4088/JCP.24m15516.

ABSTRACT

Objectives: To describe the characteristics, clinical trajectories, and disposition of older adults consulting in the emergency department (ED) for mental health issues. The secondary objective was to explore the impact of age, sex, and living environment on those patients’ clinical care and disposition.

Methods: This registry study included data from 5 Canadian EDs. Patients were included if they were aged ≥65 years and consulting in the ED between March 1, 2020, and March 31, 2021, for mental health issues. Relative risks (RRs) were obtained using a modified Poisson regression model, and 95% confidence intervals (CIs) were estimated with a robust variance estimator.

Results: 1,673 patients were included. The mean ±SD age was 75.2±8.1 years; 58.8% were female, and 87.4% had a prior history of mental health issues. Suicidal ideations (40.8%) and neurocognitive disorders (31.8%) were the most frequent diagnostic impressions. 52.0% were assessed by a psychiatrist, and 49.9% were discharged from the ED. Males were at higher risk of neurocognitive (RR: 1.16 [95% CI, 1.01-1.32]) and substance use disorders (RR: 1.54 [95% CI, 1.19-1.99]). Patients aged ≥85 were more likely to be physically/chemically restrained and less likely to be assessed by psychiatry and hospitalized (RR: 1.69 [95% CI, 1.14-2.50], RR: 0.62 [95% CI, 0.52-0.74], RR: 0.73 [95% CI, 0.57-0.95]).

Conclusion: This study highlights that most older ED patients consulting for mental health issues had a prior history of such issues. A psychiatrist assessed most patients, but those aged ≥85 were less likely to be assessed or hospitalized, yet more likely to be restrained. These results should be considered when designing targeted investigations to meet the complex needs of this population.

PMID:40215386 | DOI:10.4088/JCP.24m15516

J Clin Psychiatry. 2025 Mar 31;86(2):24m15476. doi: 10.4088/JCP.24m15476.

ABSTRACT

Background: Major depressive disorder (MDD) has been associated with both all cause and suicide mortality in young adults. However, the effects of parental severe mental disorders (SMDs), such as schizophrenia, bipolar disorder, MDD, alcohol use disorder (AUD), and substance use disorder, on the risks of all-cause and suicide mortality in adolescents and young adults with MDD remain unclear.

Methods: We retrospectively evaluated the incidence of all-cause and suicide mortality (2001-2011) in 196,000 adolescents (age: 10-17 years) and young adults (age: 18-29 years) with MDD. We investigated associations between parental SMDs and all-cause and suicide mortality among patients with MDD using Cox regression analyses. In addition, we assessed the additive effects of paternal and maternal SMDs on the mortality risk of depressed offspring.

Results: Our findings revealed that all cause mortality in offspring was associated with paternal AUD (hazard ratio [HR]: 1.66) as well as maternal schizophrenia (HR: 2.77), bipolar disorder (HR: 1.99), and MDD (HR: 1.25). Furthermore, suicide mortality in offspring was associated with maternal schizophrenia (HR: 4.36) and bipolar disorder (HR: 4.01). Notably, the risk of suicide mortality was the highest in offspring with paternal bipolar disorder and maternal MDD (HR: 7.31).

Conclusion: Parental SMDs such as schizophrenia, bipolar disorder, MDD, and AUD are associated with all-cause and suicide mortality in adolescents and young adults with MDD. Optimizing support systems and prioritizing early interventions for parental mental health problems may help reduce the risks of suicide and premature death in young patients with MDD.

PMID:40215383 | DOI:10.4088/JCP.24m15476

JMIR Form Res. 2025 Apr 11;9:e63700. doi: 10.2196/63700.

ABSTRACT

BACKGROUND: Dependent older people or those losing their autonomy are at risk of emergency hospitalization. Digital systems that monitor health remotely could be useful in reducing these visits by detecting worsening health conditions earlier. However, few studies have assessed the medico-economic impact of these systems, particularly for older people.

OBJECTIVE: The objective of this study was to compare the clinical and economic impacts of an eHealth device in real life compared with the usual monitoring of older people living at home.

METHODS: This study was a comparative, retrospective, and controlled trial on data collected between May 31, 2021, and May 31, 2022, in one health care and home nursing center located in Brittany, France. Participants had to be aged >75 years, living at home, and receiving assistance from the home care service for at least 1 month. We implemented among the intervention group an eHealth system that produces an alert for a high risk of emergency department visits or hospitalizations. After each home visit, the home care aides completed a questionnaire on participants’ functional status using a smartphone app, and the information was processed in real time by a previously developed machine learning algorithm that identifies patients at risk of an emergency visit within 7 to 14 days. In the case of predicted risk, the eHealth system alerted a coordinating nurse who could then inform the family carer and the patient’s nurses or general practitioner.

RESULTS: A total of 120 patients were included in the study, with 60 in the control group and 60 in the intervention group. Among the 726 visits from the intervention group that were not followed by an alert, only 4 (0.6%) resulted in hospitalizations (P<.001), confirming the relevance of the system’s alerts. Over the course of the study, 37 hospitalizations were recorded for 25 (20.8%) of the 120 patients. Additionally, of the 120 patients, 9 (7.5%) were admitted to a nursing home, and 7 (5.8%) died. Patients in the intervention group (56/60, 93%) remained at home significantly more often than those in the control group (48/60, 80%; P=.03). The total cost of primary care and hospitalization during the study was €167,000 (€1=US $1.09), with €108,000 (64.81%) attributed to the intervention group (P=.20).

CONCLUSIONS: This study presents encouraging results on the impact of a remote medical monitoring system for older adults, demonstrating a reduction in both emergency department visits and hospitalization costs.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05221697; https://clinicaltrials.gov/study/NCT05221697.

PMID:40215100 | DOI:10.2196/63700

Anal Chem. 2025 Apr 11. doi: 10.1021/acs.analchem.4c06815. Online ahead of print.

ABSTRACT

The target neutrophil-activating peptide-2, NAP2, is a potential biomarker for early lung cancer diagnosis, whereas there are currently no precise techniques for differentiating NAP2 from its precursors. To overcome this difficulty, we created an electrochemical aptamer-based sensor (E-AB) consisting of the 33-mer aptamer domain, a 2-bp three-junction region, and two conductive signal reporter stems. Whereas E-AB-AT and E-AB-RAN sensors with two (AT)₆ or N₁₂ stems, respectively, were unable to distinguish between platelet basic protein (PBP) (94 aa) and NAP2 (70 aa). However, in contrast, the E-AB-GC sensor with two (GC)₆ stems could selectively detect NAP2 but hardly recorded PBP. Here, we developed an E-AB-GC point-of-care test (POCT) technique to detect NAP2 away from its precursors in 10 μL of human serum and provide concentration data in 5 min. Interestingly, serum NAP2 levels in human samples, as determined by the E-AB-GC sensor, were roughly 30-50% lower than those obtained by ELISA. Results also showed that E-AB-GC analysis of serum NAP2 in patients in stages I through IV revealed statistical significance and an excellent guiding function in the early diagnosis of lung cancer, particularly for patients in stage I cancer (p = 0.0054, area under the curve, 0.95). Importantly, this E-AB-GC POCT platform has shown potential as an on-site quick diagnostic tool, which can also be used to detect other lung cancer markers. Our research on the impacts of stem sequencing on sensing capabilities might assist in the future development of E-AB biomarker sensors.

PMID:40215095 | DOI:10.1021/acs.analchem.4c06815

Musculoskeletal Care. 2025 Jun;23(2):e70099. doi: 10.1002/msc.70099.

ABSTRACT

BACKGROUND: General practitioners (GPs) use of imaging for acute low back pain (LBP) is above guideline recommendations, and the reasons for this remain under-researched. We examined the perspectives, expectations and information needs of Australian GPs requesting lumbar spine diagnostic imaging for patients presenting with acute LBP.

METHODS: We completed semi-structured interviews with 12 GPs practising in Victoria, Australia. Transcripts were thematically analysed, and themes compared according to whether or not GPs reported they regularly requested imaging for LBP.

RESULTS: We identified four themes. (1) Besides responding to ‘red flags’, GPs’ experiences of uncovering unexpected but serious findings on imaging for LBP as well as perceived external pressures motivated their defensive imaging practices. (2) While most were reluctant to request imaging for LBP, once requested, GPs escalated through imaging modalities and focused on the diagnostic benefit of their findings. (3) GPs supported the inclusion of epidemiological data on imaging reports, but (4) largely opposed imaging reports being written in plain language, believing reports to be clinician-to-clinician communications that patients would misunderstand. All GPs were aware of the limited utility of imaging for diagnosing LBP, and themes were similar between GPs who regularly requested imaging and those who did not. Factors other than knowledge of imaging efficacy for LBP seemed to play an important role in imaging requests.

CONCLUSIONS: Our study identified key drivers of imaging use for LBP in primary care. The findings underscore that interventions targeting GPs addressing the overuse of imaging for LBP should transcend knowledge deficit models.

PMID:40215089 | DOI:10.1002/msc.70099

Psychooncology. 2025 Apr;34(4):e70149. doi: 10.1002/pon.70149.

ABSTRACT

PURPOSE: Death preparedness plays a crucial role in improving the quality of death for advanced cancer patients. However, existing tools only assess certain aspects of death preparedness in advanced cancer patients, and there is limited evidence regarding their reliability and validity. To develop and validate a specific and comprehensive measurement tool for death preparedness in advanced cancer patients.

METHODS: The scale was developed using an exploratory mixed-methods approach, which included both qualitative and quantitative stages. Grounded theory and existing literature were used to construct a death preparedness scale for advanced cancer patients. Content validity was assessed using the Delphi method. A convenience sampling approach was employed to recruit 753 advanced cancer patients from the oncology wards of six tertiary grade-A general hospitals in Hubei and Anhui provinces, China, for psychometric testing of the scale. Item selection was based on item analysis, exploratory factor analysis was conducted to extract factors, and confirmatory factor analysis was used to assess structural validity.

RESULTS: The final scale consists of 4 dimensions and 22 items. These four dimensions are named “Death awareness,” “Emotional response,” “Hospice program,” and “Reflexive care.” They explain 64.010% of the total variance. The confirmatory factor analysis (CFA) model showed that the 4-factor model fit the data well. The overall Cronbach’s alpha coefficient for the scale was 0.991.

CONCLUSION: The death preparedness scale for advanced cancer patients that we developed demonstrates good reliability and validity, and can be used to comprehensively assess the death preparedness level of advanced cancer patients. Additionally, with the subscale scoring system, healthcare professionals can provide targeted interventions in specific areas of death preparedness for patients, thereby improving both the quality of life and quality of death for advanced cancer patients.

PMID:40215084 | DOI:10.1002/pon.70149

Ann Indian Acad Neurol. 2025 Apr 11. doi: 10.4103/aian.aian_773_24. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Persons with epilepsy (PWE) have poor dental hygiene, contributed by the severity of epilepsy, ignoring oral health, and the medications used. A continuing need exists for a better understanding of the effects of antiseizure medications (ASMs) on oral health. Several studies have shown the effects of older ASMs on oral health, but there is a lack of those exploring oral side effects of newer ASMs.

METHODS: A cross-sectional study was conducted in which 69 PWE on ASMs were compared with 33 controls. A structured questionnaire was used to collect data on demographics, oral hygiene practices, and medication history including use of older and newer ASMs. Dental examination along with plaque, gingival, Decayed, Missing, and Filled Teeth (DMFT), and Decayed, Missing, and Filled teeth Surface (DMFS) indices were assessed. PWE were divided into three groups based on whether they were on older ASMs, newer ASMs, or a combination of both. Data was statistically analyzed.

RESULTS: PWE have poor dental health with significantly higher gingival index, plaque index, calculus, DMFS, and DMFT scores compared to controls (P < 0.001). Concerning ASMs, patients on older ASMs had poor dental health with higher gingival index, gingivitis, and periodontitis compared to those on newer ASMs (P < 0.005). Patients on polytherapy tended to have worse periodontal parameters. Gingival hyperplasia was common in patients taking phenytoin alone compared to those taking folic acid along with phenytoin (P < 0.05).

CONCLUSION: Older ASMs, especially phenytoin, can be associated with significant oral side effects. Newer ASMs are relatively safe, but further research is needed to fully understand their long-term effects.

PMID:40215081 | DOI:10.4103/aian.aian_773_24

JAMA Health Forum. 2025 Apr 4;6(4):e250423. doi: 10.1001/jamahealthforum.2025.0423.

ABSTRACT

IMPORTANCE: Patients may initiate dialysis at their predialysis nephrologists’ primary facilities (ie, where the nephrologist saw the most patients) to preserve continuity of care, even if the facilities are of low quality. Patients from minoritized racial and ethnic groups may be the most negatively impacted.

OBJECTIVE: To examine starts at nephrologists’ primary facilities, downstream outcomes, and racial disparities in dialysis start quality.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used Medicare administrative data of patients initiating dialysis at freestanding US dialysis facilities from January 1, 2015, to October 31, 2020, with 1 year of follow-up (ending October 31, 2021). Analyses concluded January 26, 2025. Participants were adults with fee-for-service Medicare initiating dialysis.

EXPOSURES: Quality of nephrologists’ primary facilities (using publicly available 5-star ratings) and primary facilities’ proximity to patients.

MAIN OUTCOMES AND MEASURES: The primary outcomes were starting dialysis at the nephrologist’s primary facility (ie, primary facility starts), whether the starting facility was high quality (ie, 4-star or 5-star ratings), mortality and hospitalization rates, and racial and ethnic disparities in high-quality primary facilities and in starting dialysis at high-quality facilities. Analyses used multivariable linear and Poisson regression with hospital service area fixed effects (unique intercepts for each area).

RESULTS: Of 143 776 adults (median [IQR] age, 73 [67-79] years; 64 447 female [45%]; 4989 Asian [3%]; 28 515 Black [20%]; 11 296 Hispanic [8%]; 96 639 non-Hispanic White [67%]), 64 186 (45%) had managing nephrologists with high-quality primary facilities. Primary facility starts were lower as the primary facility’s quality increased (0.5 percentage points [pp] lower for every 1-star increase in rating; 95% CI, 0.1-0.8 pp; P = .03). In contrast, primary facility starts were 33.9 pp (95% CI, 33.0-34.9 pp; P < .001) more likely when primary facilities were close to patients than when distant. Each additional quality star in nephrologists’ primary facility was associated with more 4-star or 5-star facility starts (7.4 pp; 95% CI, 6.9-7.9 pp) and 4.5 fewer hospitalizations per 100 person-years (95% CI, 2.8-6.1 hospitalizations per 100 person-years). Compared with White patients, Black patients were 2.8 pp (95% CI, 1.7-3.9 pp) less likely to start at 4-star or 5-star facilities and 2.0 pp (95% CI, 1.0-3.0 pp) less likely to be treated by nephrologists with 4-star or 5-star primary facilities.

CONCLUSIONS AND RELEVANCE: Primary facility starts were common even when they were low quality, and outcomes were worse when nephrologists had low-quality primary facilities. Black patients disproportionately start dialysis at low-quality facilities and are less likely to have nephrologists with high-quality primary facilities. Policies that promote improved access to high-quality dialysis facilities may be necessary to alleviate these disparities.

PMID:40215072 | DOI:10.1001/jamahealthforum.2025.0423

JAMA Health Forum. 2025 Apr 4;6(4):e250433. doi: 10.1001/jamahealthforum.2025.0433.

ABSTRACT

IMPORTANCE: Under certain circumstances, advance practice clinicians (APCs), such as physician assistants and nurse practitioners, can bill Medicare directly or indirectly (ie, incident to the services of a physician). With indirect billing, the submitted claim states the care was provided by the physician, and the reimbursement is higher.

OBJECTIVE: To quantify volume and spending on office-based encounters billed indirectly in the Medicare program.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used Medicare fee-for-service and Medicare Advantage claims data to identify indirectly billed APC services. To do so, office-based Medicare Part B claims (ie, clinician services) were linked to Part D claims for prescription drug fills. Because the latter contains the prescribing clinician’s unique identifier, this linkage distinguished between directly and indirectly billed services provided by APCs. In this way, the fraction of encounters and component services billed indirectly by APCs and physicians were quantified.

MAIN OUTCOMES AND MEASURES: Share of fee-for-service and Medicare Advantage office encounters provided by APCs and billed indirectly. Share of a physician’s billed claims actually provided by an APC and billed indirectly.

RESULTS: In 2022, of all office encounters provided by an APC, 38.9% were billed indirectly. Conversely, for the median physician in 2022, indirect billing on behalf of APCs represented 11.1% of all billed encounters. Billing for care delivered by APCs was most common among surgical specialists (29.7% of encounters) and least common for primary care physicians (3.9%). If all indirectly billed APC-provided care was billed directly by the APC, Medicare would have saved $270 million in 2022.

CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that APCs provide a substantial fraction of office-based care received by Medicare beneficiaries. Identifying indirectly billed APC-provided care is integral to understanding who serves Medicare beneficiaries.

PMID:40215071 | DOI:10.1001/jamahealthforum.2025.0433