Nevin Manimala

Can Fam Physician. 2025 Nov-Dec;71(11-12):e280-e289. doi: 10.46747/cfp.711112e280.

ABSTRACT

OBJECTIVE: To determine the uptake and feasibility of human papillomavirus self-sampling (HPV SS) offered to patients in a family medicine clinic.

DESIGN: Implementation study.

SETTING: Community family medicine clinic in Edmonton, Alta, with a cervical cancer screening rate of 80%.

PARTICIPANTS: Patients 25 to 69 years old with a cervix who had not received a Papanicolaou (Pap) test in 2.5 years or more. Exclusion criteria included being pregnant; experiencing colposcopy care or having been discharged from care within 11 months; having history of invasive cancer; experiencing abnormal vaginal bleeding or current menstruation; identifying as transgender; and having abnormal results on the last Pap test.

INTERVENTIONS: Eligible patients were opportunistically offered HPV SS in the clinic (September 2024 to November 2024) as the first phase of the Alberta Cervical Cancer Screening HPV SS pilot program.

MAIN OUTCOME MEASURES: The primary outcome was the proportion of patients who completed HPV SS. Secondary outcomes were factors associated with completing HPV SS, HPV SS results, patient preferences, physician perspectives, and environmental impact.

RESULTS: Overall, 226 patients were offered HPV SS. Characteristics of patients included the following: the median age was 43 years (interquartile range [IQR]=32 to 56); 89% lived in urban areas; 14% were immigrants; 4% were Indigenous; 58% were panelled (ie, attached to a family physician); and the median number of months since a last Pap test was 37 (IQR=32 to 45). Overall, 81% completed HPV SS: 165 had negative results, 17 were positive, and 2 were indeterminate, resulting in 7 Pap tests and 10 direct colposcopy referrals. Among patients who completed HPV SS, 98% preferred to have HPV SS as an option for future screening. Family physicians supported its use and HPV SS has the potential to decrease carbon impact by up to 20%.

CONCLUSION: The study suggests that HPV SS may be the preferred cervical cancer screening approach for patients attending a family medicine clinic. Screening programs should consider improving access to HPV SS for this population.

PMID:41285635 | DOI:10.46747/cfp.711112e280

Can Fam Physician. 2025 Nov-Dec;71(11-12):730-739. doi: 10.46747/cfp.711112730.

ABSTRACT

OBJECTIVE: To understand the health care-seeking behaviour and preferences of people in Canada who report not having a primary care clinician (PCC; family doctor or nurse practitioner).

DESIGN: An anonymous, online, national cross-sectional survey was conducted. It was available from September 2022 to October 2022 in English and French. Responses were weighted based on sociodemographic factors to approximate the population of Canada.

SETTING: Canada.

PARTICIPANTS: People aged 18 years or older.

MAIN OUTCOME MEASURES: Characteristics, health care-seeking behaviour, and preferences of people without a primary care clinician compared to people with one.

RESULTS: A total of 9279 completed surveys were analyzed. About 21.8% of respondents said they did not have a primary care clinician. Among these, 83.1% said they were trying to find one and 66.2% of those looking reported doing so for over 1 year. Fewer men (vs women) (78.0% vs 89.3%; P<.001) and people without supplementary health benefits (vs with) (72.1% vs 85.8%; P<.001) reported looking. More people without a primary care clinician (vs with) indicated they tried getting care from a walk-in clinic (71.8% vs 41.2%; P<.001), but fewer reported their needs being met (40.6% vs 55.3%; P<.001). More people without a primary care clinician responded favourably to potential team- and neighbourhood-based care reforms.

CONCLUSION: People without a regular family doctor or nurse practitioner face several challenges. Many are trying to find one, but cannot. They value relationship-based care yet are more likely to use walk-in clinics and less likely to be satisfied with that care compared to people with a primary care clinician. Reforms should align with the values and preferences of those without primary care.

PMID:41285627 | DOI:10.46747/cfp.711112730

Ann Fam Med. 2025 Nov 24;23(6):539-541. doi: 10.1370/afm.250090.

ABSTRACT

Home Health Focus is a new publicly available data set representing home health utilization by Medicare beneficiaries, aggregated annually at the home health agency, county, and state levels from 2016 to 2019. This data can be used by anyone interested in trends of Medicare home health users, both locally and nationally. We describe the creation of the cohorts of home health users, including over 6 million home health stays from 5 million Medicare beneficiaries. We also provide examples of potential research questions using these data sets.

PMID:41285612 | DOI:10.1370/afm.250090

Ann Fam Med. 2025 Nov 24;23(6):515-523. doi: 10.1370/afm.240569.

ABSTRACT

PURPOSE: Reducing potentially preventable hospitalization (PPH), also known as ambulatory care-senstive conditions, is a global concern. This study linked data from Sax Institute’s 45 and Up Study on individuals aged 45 years and older from New South Wales, Australia, with Australian Medicare claims data to establish a causal relationship between continuity of care and acute PPH using a double machine learning model.

METHODS: We utilized 11 years of linked data (2007-2017) to analyze the impact of continuity of care on acute PPH, controlling for key patient characteristics (ie, age, multimorbidity status, cultural diversity, sex, education level, psychological status, physical limitation, smoking status, socioeconomic deciles). Estimation was done using a double machine learning technique with 4 algorithms (ie, least absolute shrinkage and selection operator, random forest, extreme gradient boosting, artificial neural network) to ensure robustness.

RESULTS: Among 54,376 participants, 27,634 individuals (50.8%) experienced at least 1 acute PPH episode during the 11-year study period. Our findings indicate that even a slight improvement in continuity of care can reduce the incidence of acute PPH compared with non-acute PPH. For example, the reduction in the probability of acute PPH compared with non-acute PPH ranges from 9.8% (95% CI, 1.1%-17.8%) to 23.5% (95% CI, 14.1%-32.4%) across 4 models when continuity of care increases from the 45th percentile (0.274) to the 50th percentile (0.301).

CONCLUSION: Continuity of care at the primary level plays a key role in reducing acute PPH. Policies focused on person-centered or integrated care should include initiatives to promote continuity of care and support general practitioners in improving continuity of care.The authors of this article have provided Hindi and Vietnamese translations of the abstract.

PMID:41285609 | DOI:10.1370/afm.240569

Ann Fam Med. 2025 Nov 24;23(6):546-551. doi: 10.1370/afm.250066.

ABSTRACT

Latinos face significant health disparities, particularly concerning chronic conditions such as cardiovascular disease, diabetes, asthma, and cancer. Primary care plays a critical role in managing and preventing chronic diseases, yet Latinos face multiple barriers to accessing quality care, including uninsurance, employment environments without health care benefits, systemic discrimination, and increased social risks. To address the intersection of these complex topics, the Primary Care Latino Equity Research (PRIMER) Center convened the second annual Latino Primary Care Summit, focused on this theme, “Chronic Conditions in Latinos: Trends, Innovations and Care for the Future” in April 2024. The Summit consisted of 7 expert presentations with breakout discussion groups and discussant commentary to the entire Summit group. Nine key themes were identified from presentation content, and from notes taken at each small group discussion. Themes included: (1) social factors such as economics, political power, and advocacy, (2) Latino narratives, (3) characteristics and unique experiences of Latinos, (4) Latino subgroups, (5) family/aging/generational differences, (6) health care workforce limitations and transformation, (7) primary care approaches, systems, and quality for Latinos, (8) technology, artificial intelligence (AI), and telemedicine, and (9) trauma across the life course. From these discussions, we offer the following recommendations to the US health services and primary care research community, in order to generate knowledge that will positively impact the outcomes of chronic conditions in Latinos in the United States. By addressing these multifaceted issues with comprehensive and culturally aware strategies, primary care can significantly improve chronic care delivery for Latino patients.

PMID:41285608 | DOI:10.1370/afm.250066

Ann Fam Med. 2025 Nov 24;23(6):535-538. doi: 10.1370/afm.240549.

ABSTRACT

Family physicians are key members of the rural health care workforce, which is inadequate for current needs. From the American Medical Association Physician Masterfile, we identified actively practicing US family physicians during 2017-2023 and their region of practice. We found a year-over-year decrease in family physicians practicing in rural areas, with a net loss of 11% nationwide over the 7 years studied. We observed the greatest percentage loss of rural family physicians in the Northeast and the least percentage loss in the West. Ensuring an adequate rural family physician workforce likely requires a tailored regional approach such as medical school pathway programs from rural communities.

PMID:41285597 | DOI:10.1370/afm.240549

BMJ Qual Saf. 2025 Nov 24:bmjqs-2025-019299. doi: 10.1136/bmjqs-2025-019299. Online ahead of print.

ABSTRACT

BACKGROUND: Artificial intelligence large language models (LLMs) are increasingly used to inform clinical decisions but sometimes exhibit human-like cognitive biases when facing nuanced medical choices.

METHODS: We tested whether new chain-of-thought reasoning LLMs might mitigate cognitive biases observed in physicians. We presented medical scenarios (n=10) to models released by DeepSeek, OpenAI and Google. Each scenario was presented in two versions that differed according to a specific bias (eg, surgery framed in survival vs mortality statistics). Responses were categorised and the extent of bias was measured by the absolute discrepancy between responses to different versions of the same scenario. The extent of intransigence (also termed dogma or inflexibility) was measured by Shannon entropy. The extent of deviance in each scenario was measured by comparing the average model response to the average practicing physician response (n=2507).

RESULTS: DeepSeek-R1 mitigated 6 out of 10 cognitive biases observed in practicing physicians by generating intransigent all-or-none responses. The four biases that persisted were post hoc fallacy (34% vs 0%, p<0.001), decoy effects (44% vs 5%, p<0.001), Occam’s razor fallacy (100% vs 0%, p<0.001) and hindsight bias (56% vs 0%, p<0.001). In every scenario, the average model response deviated substantially from the average response of practicing physicians (p<0.001 for all). Similar patterns of persistent specific biases, intransigent responses and substantial deviance from practicing physicians were also apparent in OpenAI and Google.

CONCLUSION: Some biases persist in chain-of-thought reasoning LLMs, and models tend to produce intransigent recommendations. These findings highlight the role of clinicians to think broadly, respect diversity and remain vigilant when interpreting chain-of-thought reasoning artificial intelligence LLMs in nuanced medical decisions for patients.

PMID:41285583 | DOI:10.1136/bmjqs-2025-019299

Psychogeriatrics. 2026 Jan;26(1):e70113. doi: 10.1111/psyg.70113.

ABSTRACT

BACKGROUND: This study aimed to develop and validate a Japanese version of the Essentialist Beliefs about Ageing (EBA-J) scale, examining its factor structure, reliability for internal consistency, and criterion validity.

METHODS: In total, 544 Japanese older adults (M_age = 73.81, SD = 6.47; 206 men, 338 women) completed the EBA-J scale along with assessments of subjective health and subjective age bias. This scale was developed through rigorous translation and cultural adaptation. Subjective health and subjective age bias (calculated as subjective age minus chronological age) were selected as criterion variables owing to their association with ageing beliefs and broad applicability across cultures. Using confirmatory factor analysis, we compared single- and two-factor models. Internal consistency was assessed using Cronbach’s alpha; criterion validity was evaluated via correlations between the EBA-J score, subjective health, and subjective age bias.

RESULTS: Confirmatory factor analysis supported a two-factor structure-perceived malleability and biological determinism-over a single-factor model. Both factors showed acceptable internal consistency (α = 0.83 and 0.76, respectively). Perceived malleability correlated positively with subjective health (r = 0.17) and negatively with subjective age bias (r = -0.15); biological determinism correlated negatively with subjective health (r = -0.13).

CONCLUSIONS: The EBA-J scale demonstrated a reliable two-factor structure with acceptable internal consistency. Its associations with subjective health and subjective age bias, which were small yet meaningful, provided initial evidence of criterion validity. Overall, the scale is useful for measuring beliefs regarding ageing in Japan, supporting cross-cultural studies of ageing perceptions.

PMID:41285568 | DOI:10.1111/psyg.70113

Epilepsy Behav. 2025 Nov 23;174:110805. doi: 10.1016/j.yebeh.2025.110805. Online ahead of print.

ABSTRACT

BACKGROUND: The efficacy of Managing Epilepsy Well Network (MEWN) self-management programs is well-established. The purpose of this study was to replicate the HOBSCOTCH program to evaluate program implementation and assess effectiveness on patient cognition, quality of life and self-management behaviors.

METHODS: Participants from clinical and community settings were recruited and randomized to intervention vs waitlist control. Program outcomes assessing quality of life, cognition, treatment adherence, depressive symptoms, and self-management behavior were measured at baseline and 3 months. Program staff provided survey data guided by the RE-AIM model regarding program delivery and acceptability, appropriateness, and feasibility. Data were analyzed using descriptive statistics, linear regression, and qualitative methods.

RESULTS: This predominantly female (69 %) and White (64 %) sample (N = 61) with active epilepsy (66 % had a seizure in the past year) also had a higher portion of Black (32 %) participants. Analyses yielded significant differences in cognition, quality of life and self-management behaviors between the two groups at follow-up. Staff indicated the packaged intervention, remote delivery, trained coaches and investment of leaders/clinical staff as intervention benefits. Implementation barriers included difficulty contacting participants and mental health concerns. Program appropriateness and feasibility ratings were high; 98 % reported that they very much or moderately enjoyed working with their coach and would recommend the program to others.

CONCLUSION: HOBSCOTCH was effective in increasing cognition and quality of life in people with epilepsy in this replication study. A novel finding highlighted changes in the frequency of participants’ self-management behaviors. These findings have implications for healthcare systems incorporating evidence-based self-management programs for their patients.

PMID:41285072 | DOI:10.1016/j.yebeh.2025.110805

Int J Med Inform. 2025 Nov 20;207:106190. doi: 10.1016/j.ijmedinf.2025.106190. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the increasing use of AI tools like ChatGPT, Claude, and Gemini in scientific writing, concerns remain about their ability to generate accurate, high-quality, and consistent abstracts for research publications. The reliability of AI-generated abstracts in dental research is questionable when compared to human-written counterparts. This study aimed to develop a framework for evaluating AI-generated abstracts and compare the performance of ChatGPT, Claude, and Gemini against human-written abstracts in dental research.

METHODS: The DAISY framework was developed to evaluate AI-generated abstracts across five domains: Data accuracy (D), Abstract quality (A), Integrity and consistency (I), Syntax and fluency (S), and Yield of human likelihood (Y). Reliability of the framework was assessed using Cohens Kappa (κ = 0.85) and Pearsons’s correlation coefficient (0.92) for inter- and intra- expert reliability and was found to be satisfactory. This study adopted a comparative observational study design. Eight research articles belonging to structured (n = 4) and unstructured (n = 4) categories were selected from reputable journals. Researchers trained in scientific writing wrote abstracts for these articles, while AI-generated abstracts were obtained using specific prompts. Ten dental experts evaluated the abstracts using this framework. Statistical analysis was performed using ANOVA and Tukey’s post-hoc test.

RESULTS: Human-written abstracts consistently outperformed AI-generated ones across all DAISY framework domains. Among AI tools, ChatGPT scored highest in all DAISY framework domains, followed by Gemini and Claude. Human-written abstracts achieved the highest human likelihood score (90.25 ± 4.68), while AI-generated abstracts scored below 50%, with Gemini scoring least (3.25 ± 1.75). The differences between the groups were statistically significant (P ≤ 0.05).

CONCLUSION: The DAISY framework proved reliable for evaluating AI-generated abstracts. While ChatGPT performed better than other AI tools, none matched the quality of human-written abstracts. This indicates that AI tools, though valuable, remain limited in producing credible scientific writing in dental research.

PMID:41285065 | DOI:10.1016/j.ijmedinf.2025.106190