Nevin Manimala

J Med Internet Res. 2025 Feb 19;27:e69109. doi: 10.2196/69109.

ABSTRACT

BACKGROUND: Cognitive impairment is an important public health challenge among older adults, particularly in long-term care facilities (LTCFs), where prevalence is higher due to staffing shortages, limited resources, and difficulty maintaining structured exercise programs. Furthermore, older adults often lose interest in repetitive interventions. The exergame “WarioWare: Move It!” (Nintendo) offers a novel solution by combining aerobic exercise, motor coordination, balance training, and cognitive engagement into an immersive experience.

OBJECTIVE: This study aimed to assess the clinical efficacy of an exergame-based training program delivered via “WarioWare: Move It!” in improving physical flexibility, joint range of motion, motor coordination, hand dexterity, and cognitive function in older adults living in LTCFs.

METHODS: The training program was conducted across multiple rural LTCFs in Shanxi Province, China. Participants were randomly assigned to the intervention or control group. The intervention protocol encompassed two 60-minute sessions per week over 12 weeks, using motion-sensing exercises such as waving, jumping, arm swinging, rotational movements, and object-mimicking postures with Joy-Con controllers. Primary outcome measures were derived through clinical tests, including the sit and reach test, shoulder flexibility test, trunk rotation flexibility test, shoulder and elbow range of motion, figure-of-8 walk test, standing balance test, hand dexterity test, and cognitive function tests. Statistical analysis was performed using mixed ANOVA, with time as the within-participant factor and intervention group as the between-participant factor, to assess the training effects on the various outcome measures.

RESULTS: A total of 232 participants were recruited, including 32 (13.8%) patients with mild dementia, 18 (7.8%) with moderate dementia, and 182 (78.4%) with mild cognitive impairment, all of whom completed the study. The mixed ANOVA revealed significant group × time interactions across multiple physical flexibility assessments, including the remaining distance between the hands and toes during the forward bend (F_2,156=8.484; P<.001; η²=0.098), the distance between the hands clasped behind the back (F_2,156=3.666; P=.04; η²=0.045), and the angle formed by trunk rotation to the left and right (F_2,156=17.353; P<.001; η²=0.182). Significant group × time interactions also emerged for shoulder joint forward flexion (F_2,156=17.655; P<.001; η²=0.185), abduction (F_2,156=6.281; P=.004; η²=0.075), and elbow flexion (F_2,156=3.298; P=.049; η²=0.041). In addition, the time to complete the figure-of-8 walk test (F_2,156=11.846; P<.001; η²=0.132) and the number of blocks moved within 1 minute (F_2,156=4.016; P=.02; η²=0.049) showed significant interactions. Finally, all scale-based measures exhibited statistically significant group × time interactions (all P values <.001).

CONCLUSIONS: The “WarioWare: Move It!” intervention significantly improved physical flexibility, joint range of motion, motor coordination, hand dexterity, and cognitive function among older adults with mild cognitive impairment or dementia residing in rural LTCFs. The intervention offers an innovative and feasible approach for promoting the health of older adults in resource-limited settings, demonstrating its potential for widespread application in diverse low-resource environments.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06717971; https://clinicaltrials.gov/study/NCT06717971.

PMID:39969990 | DOI:10.2196/69109

Eur J Cardiothorac Surg. 2025 Feb 19:ezaf049. doi: 10.1093/ejcts/ezaf049. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of the study was to evaluate the outcomes of aortic valve repair techniques using cusp patch-plasty with CardioCel.

METHODS: Between September 2014 and June 2021, a total of 167 patients underwent aortic valve reconstruction using cusp repair. In all patients CardioCel patch was used exclusively. An isolated cusp repair was performed in 117 patients (70%), while 50 patients with concomitant aortopathy needed a combined valve and root repair. Seventy-two patients (43%) presented with tricuspid valve. The mean age of the entire cohort was 54.3 ± 12.3 years , 143 patients being males.

RESULTS: Early (30-day/in-hospital) mortality was 0.6%. The survival at 2, 4, and 6 years was 98.8%, 96.8%, and 95.7%, respectively. During the mean follow-up of 4.2 ± 1.7 years (resulting in 697 patient-years), a relevant aortic insufficiency occurred in 10 patients (8 of them presenting with bicuspid valve). All the patients underwent a valve replacement, resulting in a 7.8 ± 2.5% cumulative risk of aortic valve reoperation and/or insufficiency ≥3+ at 6 years. The causes of reoperation were cusp tear at the suture line, progressive valve pathology, endocarditis, and unknown in 4, 4, 1, and 1, respectively. Degeneration and/or calcification of the CardioCel has not been observed.

CONCLUSIONS: The intermediate results of aortic cusp repair using CardioCel are good. Anatomo-pathology of the aortic valve and quality of the cusps seem to be main reason of repair failure. Further investigations are needed to assess the long-term durability of CardioCel patch-plasty as an alternative to biological valve replacement in specific aortic valve pathologies.

PMID:39969987 | DOI:10.1093/ejcts/ezaf049

JMIR Form Res. 2025 Feb 19;9:e57512. doi: 10.2196/57512.

ABSTRACT

BACKGROUND: Smartphones have become an indispensable part of people’s lives, and the fear of being without them, what has been termed “no mobile phone phobia” (nomophobia), is a growing phenomenon. The rise of problematic smartphone use highlights the urgent need to explore the intricate relationship between smartphones and human behavior. However, the connections between nomophobia, mental health indicators, smartphone use patterns, and daily activities remain largely underexplored.

OBJECTIVE: This study aimed to explore the relationship between young adults with depression and smartphones and investigate nomophobia by analyzing data obtained from a pilot study of depression in a youth cohort. Exploring nomophobia can enhance our understanding of the dynamics between young adults and smartphone use, potentially empowering them to manage and regulate their smartphone use more effectively.

METHODS: During an 8-week period, data collected via smartphone sensors, such as locations and screen status, were gathered from a cohort of 41 individuals diagnosed with major depressive disorder. In addition to passive-sensing smartphone data, the study collected ecological momentary assessments and psychometric measures, including the Nomophobia Questionnaire, which formed the basis of our investigation. We explored statistical associations among smartphone-derived behavioral features, psychometric indicators, and nomophobia. In addition, we used behavioral and psychometric data to develop regression models demonstrating the prediction of nomophobia levels.

RESULTS: Our findings revealed that the level of nomophobia was positively associated with depression and negative affect, lower geolocation movements, and higher comfort with smartphone sensing. The exploratory predictive linear regression models demonstrated the feasibility of predicting an individual’s Nomophobia Questionnaire score based on their smartphone sensing data. These models effectively used input features derived from both a combination of smartphone sensing data and psychometric measures and from smartphone sensing data alone.

CONCLUSIONS: Our work is the first to explore the relationship between nomophobia and smartphone sensor data. It provides valuable insights into the predictors of nomophobia level, contributing to the understanding of the relationship between smartphones and human behavior and paving the way for future studies.

PMID:39969982 | DOI:10.2196/57512

J Med Internet Res. 2025 Feb 19;27:e66802. doi: 10.2196/66802.

ABSTRACT

BACKGROUND: Recovery of upper limb function after stroke secondary to ischemia or hemorrhage is crucial for patients’ independence in daily living and quality of life. Virtual reality (VR) is a promising computer-based technology designed to enhance the effects of rehabilitation; however, the results of VR-based interventions remain equivocal.

OBJECTIVE: This study aims to review the plausible factors that may have influenced VR’s therapeutic effects on improving upper limb function in patients with stroke, with the goal of synthesizing an optimal VR intervention protocol.

METHODS: The databases PubMed, EMBASE, Web of Science, and Cochrane Library were queried for English-language papers published from May 2022 onward. Two reviewers independently extracted data from the included papers, and discrepancies in their findings were resolved through consensus during joint meetings. The risk of bias was assessed using the Physiotherapy Evidence Database Scale and the Methodological Index for Non-Randomized Studies. Outcome variables included the Action Research Arm Test, Box-Block Test, Functional Independence Measure, Upper Extremity Fugl-Meyer Assessment, and Wolf Motor Function Test. The plausible factors examined were age, total dosage (hours), trial length (weeks), session duration (hours/session), frequency (sessions/week), and VR content design. The Bonferroni adjustment was applied to P values to prevent data from being incorrectly deemed statistically significant.

RESULTS: The final sample included 15 articles with a total of 1243 participants (age range 48.6-75.59 years). Participants in the VR therapy (VRT) group (n=455) demonstrated significantly greater improvements in upper limb function and independence in activities of daily living compared with those in the conventional therapy group (n=301). Significant factors contributing to improved outcomes in upper limb function were younger age (mean difference [MD] 5.34, 95% CI 2.18-8.5, P<.001; I2=0%), interventions lasting more than 15 hours (MD 9.67, 95% CI 4.19-15.15, P<.001; I2=0%), trial lengths exceeding 4 weeks (MD 4.02, 95% CI 1.39-6.65, P=.003; I2=15%), and more than 4 sessions per week (MD 3.48, 95% CI 0.87-6.09, P=.009; I2=0%). However, the design of the VR content, including factors such as the number of features (eg, offering exercise and functional tasks; individualized goals; activity quantification; consideration of comorbidities and baseline activity level; addressing patient needs; aligning with patient background such as education level; patient-directed goals and interests; goal setting; progressive difficulty levels; and promoting self-efficacy), did not demonstrate significant effects (MD 3.89, 95% CI -6.40 to 1.09; effect Z=1.36, P=.16).

CONCLUSIONS: Greater VR effects on improving upper limb function in patients with stroke were associated with higher training doses (exceeding 15 hours) delivered over 4-6 weeks, with shorter sessions (approximately 1 hour) scheduled 4 or more times per week. Additionally, younger patients appeared to benefit more from the VR protocol compared with older patients.

PMID:39969977 | DOI:10.2196/66802

JMIR Form Res. 2025 Feb 19;9:e65302. doi: 10.2196/65302.

ABSTRACT

BACKGROUND: Medication nonadherence is a serious problem in cancer, potentially impacts patients’ health outcomes and health care costs. Although technology-based medication adherence (MA) interventions have emerged, evidence supporting their quality and effectiveness remains limited.

OBJECTIVE: This study tested the acceptability, feasibility, and potential effects of Safety and Adherence to Medications and Self-care Advice in Oncology (SAMSON), a digital solution designed to support MA and self-management in cancer.

METHODS: A 12-week, 2-arm, unblinded, pragmatic pilot randomized controlled trial was conducted. Adults with hematological malignancies who started oral cancer medicines within the last 12 months were recruited from a metropolitan specialized hospital and randomized 1:1 to SAMSON or control (usual care). The SAMSON solution included a smartphone app with tailored alerts and real-time self-care advice, a web-based dashboard for health care professionals (HCPs) to monitor patients’ adherence and symptoms, and motivational interviewing (MI) teleconsultations delivered by oncology nurses and pharmacists at baseline and weeks 1, 4, 8, and 12. Primary outcomes were the patients’ acceptance of SAMSON, measured by the Unified Theory of Acceptance and Use of Technology at 12 weeks, and study feasibility, measured by predefined rates of recruitment, randomization, retention, intervention adherence, and outcome assessment completion. Secondary outcomes were comparison of MA and clinical self-assessments through online questionnaires, including adherence, toxicity self-management, anxiety and depression symptoms, and quality of life, measured at baseline and 12 weeks between the 2 arms. Data retrieved from the SAMSON app (Swinburne University of Technology) was analysed for task completion.

RESULTS: A total of 33 patients (79% of those who were approached) consented to participate in the trial. Of those, 31/33 (94%) completed baseline surveys and were randomized to SAMSON (15/31) and control arms (16/31). Of 31 patients, 28 (90%) completed the 12-week surveys (12 SAMSON and 16 control). Overall, patients rated the SAMSON solution as highly acceptable (13/15, 87% app usage; 14/15, 93% MI teleconsultation delivery). They reported that SAMSON was easy to use (10/12, 83%) and helpful in improving their MA (6/12, 50%). All study HCPs reported the SAMSON solution was helpful in supporting patients’ MA. Patients completed an average of 99 tasks over the 12-week study period (71% of scheduled tasks). Most patients (10/12, 83%) completed all 5 scheduled consultations. All study feasibility measures were higher than the predefined upper thresholds, except the rate of patients’ responses to medication reminders.

CONCLUSIONS: The results demonstrated that the SAMSON solution is acceptable, usable, and useful for oncology HCPs and patients with cancer. The SAMSON solution is feasible in real-life oncology settings. Our next steps involve refining the SAMSON solution based on participants’ feedback, conducting a large-scale randomized controlled trial to evaluate its clinical and economic effectiveness, and exploring potential commercialization.

TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12623000472673; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385728.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2023-079122.

PMID:39969972 | DOI:10.2196/65302

Interdiscip Cardiovasc Thorac Surg. 2025 Feb 19:ivaf021. doi: 10.1093/icvts/ivaf021. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare outcomes of two different revascularization strategies in chronic kidney disease patients: coronary artery bypass grafting versus percutaneous coronary intervention.

METHODS: we conducted this metanalysis according to PRISMA guidelines and registered with PROSPERO (CRD42021238659), evaluated studies comparing CABG and PCI in patients with CAD and CKD (defined by KDIGO guidelines). Data were extracted from PubMed, EMBASE, and Cochrane from 2000 to 2023. The primary end-point was long-term MACCE rates, with secondary end-points including 30-day mortality, stroke, MI, and repeat revascularization. Statistical analyses included Kaplan-Meier estimations, Cox regression, and meta-regression to address heterogeneity. Publication bias was assessed via funnel plots. No funding was received, and the authors report no conflicts of interest.

RESULTS: We included 33 studies with 402,300 patients (eGFR <60 mL/min/1.73m2). The cohort comprised 132,314 coronary artery bypass graft and 269,986 percutaneous coronary intervention patients.Over three years, coronary artery bypass group provided protection against major adverse cardiac and cerebrovascular events, myocardial infarction, and repeat revascularization compared to percutaneous coronary intervention. However, percutaneous coronary intervention showed better short-term outcomes, including lower 30-day mortality. Coronary artery bypass group was linked to a higher stroke risk over the 3-year follow-up.

CONCLUSIONS: Revascularization strategies for chronic kidney disease and coronary artery disease patients should balance percutaneous coronary intervention’s short-term benefits with coronary artery bypass grafting’s long-term advantages.

PMID:39969961 | DOI:10.1093/icvts/ivaf021

Respir Care. 2025 Jan 29. doi: 10.1089/respcare.12212. Online ahead of print.

ABSTRACT

Background: High-flow nasal cannula (HFNC) is an oxygen therapy delivery method used with severely ill patients. The literature regarding the effects of HFNC on overall swallowing function and aspiration risk is limited, and results from current studies are mixed. This study aimed to investigate the possible association between HFNC and swallowing impairment. Methods: This was a single-center, within-subjects, repeated-measures retrospective study of 21 hospitalized subjects. Participants underwent flexible endoscopic evaluation of swallowing (FEES) while receiving oxygen therapy via HFNC and had another instrumented swallow assessment, a FEES or a modified barium swallow study, when they no longer required HFNC oxygen. Three markers of swallowing function were extracted from reports-aspiration, silent aspiration, and overall swallowing function, and statistical analyses were conducted to assess their relationship to HFNC status. Results: There was a statistically significant difference in the proportion of subjects who aspirated while they were receiving oxygen via HFNC as compared to when they were not on HFNC (P = .033). When on HFNC, 61.9% (13/21) of subjects had an aspiration event during instrumented swallow evaluation; and when off HFNC, 23.8% (5/21) of subjects aspirated. Findings related to silent aspiration during instrumented swallowing evaluation were not significant (P = .32). When subjects were on HFNC, their overall swallowing function was significantly more impaired than when they were off HFNC (P < .001). Conclusions: The results of this study indicate that HFNC is a factor to consider when determining if a patient is appropriate for oral alimentation. Given the limited data on HFNC and swallowing function and the fragility of this population, instrumented examination of swallowing prior to initiation of oral intake may be beneficial. Future prospective studies with larger populations that stratify subjects into risk categories based on subject characteristics and pathophysiology are needed.

PMID:39969929 | DOI:10.1089/respcare.12212

Respir Care. 2025 Feb 6. doi: 10.1089/respcare.12213. Online ahead of print.

ABSTRACT

Background: Previous reports have emphasized disparities in the utilization of invasive respiratory support for bacterial pneumonia among various racial and ethnic minority groups with bacterial pneumonia. However, there is a shortage of detailed epidemiological data on this, particularly after the onset of the COVID-19 pandemic. Methods: We used the National In-patient Sample to conduct a retrospective cohort analysis from 2017 to 2021. We included patients hospitalized across the United States with a primary diagnosis of bacterial pneumonia. Statistical methods used included Pearson chi-square and multivariable regression analyses. Examining racial and ethnic differences in hospitalized subjects’ usage of invasive mechanical ventilation for bacterial pneumonia was the primary outcome of the study. Secondary outcomes included mortality, use of noninvasive ventilation, and hospital stay. Results: The study found significant differences among racial and ethnic groups in pneumonia-related outcomes and the need for advanced respiratory ventilator assistance. Black and Asian American and Pacific Islander (AAPI) subjects had the highest rates of invasive mechanical ventilation compared with other racial groups, with adjusted odds ratios (ORs) indicating a higher likelihood of requiring this intervention for Black (OR 1.15) and AAPI (OR 1.31) subjects. For secondary outcomes, Black and AAPI subjects experienced longer hospital stays than other racial and ethnic groups. Noninvasive ventilation rates were comparable across groups. Mortality rates were the highest among Black subjects, but were elevated for all racial and ethnic minority subjects compared with white subjects. The pandemic exacerbated these disparities, leading to increased rates of both invasive and noninvasive ventilation and higher mortality, with particularly pronounced effects seen in AAPI patients, thereby worsening existing health inequities. Conclusions: The study suggests potential racial-ethnic disparities in invasive mechanical ventilation use among Black and AAPI subjects, but further investigation is needed to confirm these findings and explore underlying causes.

PMID:39969928 | DOI:10.1089/respcare.12213

Respir Care. 2025 Jan 29. doi: 10.1089/respcare.12363. Online ahead of print.

ABSTRACT

Background: Resuscitator bags are commonly utilized in acute care settings; however, poor performance occurs irrespective of a provider’s qualifications or experience. A new flow-limiting device (Sotair by SafeBVM, Boston, Massachusetts) limits inspiratory flow during manual ventilation, thus minimizing peak inspiratory pressures. This study examined the differences in flow, pressure, and tidal volume (V_T) during ventilation with a manual resuscitator connected to the flow-limiting device versus a mechanical ventilator. Methods: Second-year respiratory therapy students were recruited from an advanced cardiovascular life support class. Participants conducted a 2-min trial of manually ventilating a test lung utilizing normal and decreased compliance settings with the flow-limiting device connected to an endotracheal tube. Demographic data on participants’ age were collected. The control group consisted of a mechanical ventilator providing ventilation with the same test lung and compliance settings. Mean differences were compared between the manual ventilation and control group. Results: A total of 41 respiratory therapy students (71% female, 76% undergraduate) participated. The mean experience level using the bag-valve-mask was 6.71, and the mean confidence level was 8.02; the scale was 0-10 with high numbers indicating greater experience or confidence. A small but statistically significant difference was found in mean peak pressures between manual ventilation with the flow-limiting device (15 cm H₂O) and the mechanical ventilator (13 cm H₂O) for the normal lung setting (P = .008) but not for the decreased compliance lung setting (23 cm H₂O vs 23 cm H₂O with the ventilator). There was a significant difference in mean V_T between manual ventilation (412 mL) and the mechanical ventilator (460 mL) in the decreased compliance lung setting (P = .003) but not the normal compliance setting (452 mL vs 474 mL with the ventilator). Conclusions: Although there were some statistically significant differences between the 2 groups, these differences were not clinically important. Participants adequately manually ventilated with V_T similar to a mechanical ventilator.

PMID:39969924 | DOI:10.1089/respcare.12363

Respir Care. 2025 Jan 29. doi: 10.4187/respcare.12378. Online ahead of print.

ABSTRACT

Background: Spinal muscular atrophy (SMA) is often complicated by respiratory problems. The disease-modifying therapies (DMTs) (nusinersen, onasemnogene abeparvovec, and risdiplam) have improved survival, motor function, and functional muscle strength in patients with SMA, but their effects on lung function and respiratory muscle strength need further clarification. Therefore, we performed a systematic review of studies that documented the effects of DMTs on lung function and respiratory muscle strength in patients with SMA types I, II, III, and IV. Methods: We searched the electronic databases PubMed/MEDLINE, CINAHL, Embase, and Web of Science up to December 2023. We included pre-post studies that determined the effect of DMTs for SMA on lung function or respiratory muscle strength in patients with SMA. Where possible, we performed a meta-analysis using a random-effects model with generic inverse variance weighing. Results: We included 19 studies of 376 identified records (16 longitudinal cohort studies and 3 case series) with 384 participants. Seventeen studies investigated the effect of nusinersen, and two studies investigated the effect of risdiplam. Seventeen studies had a moderate and two had a high risk of bias. Most of these studies did not report statistically significant improvement in lung function or respiratory muscle strength after treatment with nusinersen or risdiplam. A meta-analysis of 13 studies showed no statistically significant improvement in FVC after 2, 6, 10, and > 12 months of treatment with nusinersen. Conclusions: The findings of this review indicate that there is moderate evidence that nusinersen does not improve FVC, FEV₁, peak expiratory flow, or maximum inspiratory pressure in subjects with SMA types I, II, III, or IV. There was no statistically significant decline in lung function and respiratory muscle strength after treatment. This may suggest that nusinersen may have stabilized lung function and respiratory muscle strength.

PMID:39969920 | DOI:10.4187/respcare.12378