Nevin Manimala

JAMA Netw Open. 2026 May 1;9(5):e2610798. doi: 10.1001/jamanetworkopen.2026.10798.

ABSTRACT

IMPORTANCE: Patients are often monitored closely during pregnancy, then face barriers to transitioning to primary care after delivery. These barriers may contribute to a reliance on acute care for primary care-treatable concerns.

OBJECTIVES: To evaluate the association of an intervention that increased postpartum primary care engagement over the first year after delivery with overall acute care (emergency department [ED] and urgent care center [UC]) use and acute care use for primary care-treatable concerns (ie, nonemergency conditions or conditions typically managed by a primary care practitioner [PCP]).

DESIGN, SETTING, AND PARTICIPANTS: This is a nonprespecified secondary analysis of a randomized clinical trial (RCT) conducted from November 3, 2022, to October 11, 2023, at 1 hospital-based clinic and 5 community-based obstetric clinics at a large academic medical center. The 353 participants included English- and Spanish-speaking pregnant or recently postpartum adults with 1 or more comorbidities and an assigned PCP.

EXPOSURE: This behavioral science-informed intervention included default scheduling of postpartum PCP appointments within 4 months post partum and tailored messages and reminders about the appointments and the importance of postpartum primary care.

MAIN OUTCOME AND MEASURES: Main outcomes included the use of any acute care and the number of acute care visits during the postpartum period, as well as the use of acute care and the number of visits specifically for primary care-treatable concerns (based on the reason for visit). Ordinary least-squares regression, adjusted for randomization strata and patient demographic and health characteristics, was used to assess the association of the intervention with the use of acute care. Outcomes were analyzed using an intent-to-treat approach.

RESULTS: A total of 353 patients (mean [SD] age, 34.1 [4.9] years) were enrolled in the RCT (control, 173 [49.0%]; intervention, 180 [51.0%]). The intervention had no statistically significant association with overall postpartum acute care use, but it was associated with decreased acute care use for primary care-treatable concerns (control, 70 of 173 [40.5%]; intervention, 53 of 180 [29.4%]); in the adjusted model, the intervention was associated with in a 10.2-percentage point reduction in these visits (95% CI, -20.4 to -0.04 percentage points). The intervention was also associated with a reduced number of visits for primary care-treatable concerns (control: mean [SD], 0.7 [1.1] visits; intervention: mean [SD], 0.4 [0.8] visits), corresponding to a reduction of 0.3 visits (95% CI, -0.5 to -0.1 visits) in the adjusted model.

CONCLUSIONS AND RELEVANCE: In this secondary analysis of an RCT, a behavioral science-informed intervention that increased postpartum primary care engagement was associated with decreased acute care use for primary care-treatable concerns. The results suggest that supporting postpartum transitions to primary care may reduce reliance on acute care, perhaps by facilitating greater care coordination and early detection and management of chronic conditions in the primary care setting.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05543265.

PMID:42090155 | DOI:10.1001/jamanetworkopen.2026.10798

JAMA Netw Open. 2026 May 1;9(5):e2610898. doi: 10.1001/jamanetworkopen.2026.10898.

ABSTRACT

IMPORTANCE: Children with acute gastroenteritis-associated vomiting discharged from emergency departments (EDs) have improved outcomes when provided with ondansetron for home use. However, only one-third of children who present with significant vomiting experience ongoing vomiting after discharge.

OBJECTIVE: To identify characteristics associated with 3 or more vomiting episodes among pediatric patients within 24 hours of ED discharge.

DESIGN, SETTING, AND PARTICIPANTS: This nonprespecified secondary analysis of a randomized clinical trial of children aged 6 months to less than 18 years presenting to EDs between September 14, 2019, and June 27, 2024, with acute gastroenteritis-associated vomiting and who were followed up for 7 days. A prognostic score was derived using generalized linear mixed models across 10 imputed datasets. Data analysis was performed between May 9, 2025, and February 13, 2026.

MAIN OUTCOMES AND MEASURES: The primary outcome was 3 or more episodes of vomiting within 24 hours of ED discharge. Secondary outcomes included unscheduled health care revisits, intravenous fluid administration, and hospitalization within 7 days after the ED visit.

RESULTS: Of 1030 children enrolled, 977 had follow-up data available and were included in this analysis (median age, 47.0 months [IQR, 22.1-80.1 months]; 493 [50.5%] girls; 925 [89.8%] with complete follow-up data). Eighty of 927 children (8.6%) had 3 or more episodes of vomiting in the 24 hours after ED discharge. In unadjusted analysis, only age 6 months to less than 2 years was associated with ongoing vomiting after discharge (odds ratio [OR], 2.17; 95% CI, 1.37-3.43). In multivariable regression analysis, variables associated with postdischarge vomiting included age 6 months to less than 2 years, symptom duration of 24 to 48 hours, or 10 or more vomiting episodes in the 24 hours preceding the ED visit. In a predictive model, a score of 4 points or more was associated with a 13.6% (95% CI, 9.9%-18.1%) probability of 3 or more vomiting episodes within 24 hours of ED discharge, with a sensitivity of 0.50 (95% CI, 0.39-0.61) and specificity of 0.70 (95% CI, 0.67-0.73). Children with 3 or more vomiting episodes within 24 hours of discharge, compared with those without, were more likely to have an unscheduled health care visit (33 of 80 [41.3%] vs 65 of 846 [7.7%]; difference, 33.6%; 95% CI, 22.6%-44.5%), receive intravenous fluids (9 of 80 [11.3%] vs 15 of 846 [1.8%]; difference, 9.5%; 95% CI, 2.5%-16.5%), and be hospitalized (5 of 80 [6.2%] vs 9 of 846 [1.1%]; difference, 5.2%; 95% CI, -0.2% to 10.5%) within 7 days of discharge.

CONCLUSIONS AND RELEVANCE: In this analysis of children presenting for ED care with vomiting, younger children and those unwell for 24 to 48 hours with 10 or more episodes of vomiting at presentation were more likely to have persistent vomiting after discharge. Based on these findings, these children are most likely to benefit from being provided ondansetron for home administration.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03851835.

PMID:42090154 | DOI:10.1001/jamanetworkopen.2026.10898

JAMA Netw Open. 2026 May 1;9(5):e2611045. doi: 10.1001/jamanetworkopen.2026.11045.

ABSTRACT

IMPORTANCE: The COVID-19 pandemic was associated with a substantial prevalence of physicians intending to reduce their clinical hours (ITR) or intending to leave their current organization (ITL). It is unclear how work intentions have changed since that time.

OBJECTIVE: To characterize how the prevalence of ITR and ITL changed among physicians since the COVID-19 pandemic, factors associated with ITR and ITL, and factors associated with physicians’ decision to remain at their current clinical workload or their current organization.

DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study was conducted from January 7, 2022, to November 3, 2024, among 160 organizations across the US with 100 or more physicians across specialties. Physicians responded to the American Medical Association’s Organizational Biopsy study in 2022, 2023, or 2024.

MAIN OUTCOMES AND MEASURES: Main outcomes were ITR within the next 12 months and ITL within the next 24 months.

RESULTS: The sample consisted of 37 112 physicians (7176 physicians in 2022, 12 248 in 2023, and 17 688 in 2024; median organizational response rate of 41.5% [IQR, 29%-60%]; 18 626 of 35 202 male physicians [52.9%]) from 160 organizations, including 81.4% physicians (25 381 of 31 182) who identified as practicing clinically full-time. The overall point prevalence of ITR decreased from 25.6% (1489 of 5815) in 2022 to 22.5% (3266 of 14 540) in 2024 (P = .002), while the prevalence of ITL decreased from 19.9% (1345 of 6760) in 2022 to 15.1% (2414 of 15 935) in 2024 (P = .002). Decreases in ITR and ITL were seen across multiple physician groups. In multivariable-adjusted models, female physicians had higher odds of ITR than male physicians (odds ratio [OR], 1.11; 95% CI, 1.04-1.20), but lower odds of ITL (OR, 0.93; 95% CI, 0.87-0.99). Part-time physicians had 1.18 (95% CI, 1.09-1.29) times the odds of ITR and 1.35 (95% CI, 1.25-1.45) times the odds of ITL compared with full-time physicians. The most prevalent factors that would make respondents reconsider ITR or ITL-including a desire for increased workflow efficiency, improved staffing, and enhanced compensation-were common across the 2 outcomes.

CONCLUSIONS AND RELEVANCE: This serial, cross-sectional, multisite study of US physicians suggests that while the prevalence of ITR and ITL have decreased since the COVID-19 pandemic, more than one-fifth of physicians continued to report ITR and nearly 1 in 6 reported ITL. In aggregate, compared with historical data, current rates represent mixed progress with favorable overall trends in ITL but unfavorable trends in ITR. Common factors, including greater workflow efficiency and consistent staffing, were reported as potentially mitigating both ITR and ITL. These findings can help leaders prioritize and target interventions to sustain the effort of the physician workforce.

PMID:42090152 | DOI:10.1001/jamanetworkopen.2026.11045

JAMA Netw Open. 2026 May 1;9(5):e2611402. doi: 10.1001/jamanetworkopen.2026.11402.

ABSTRACT

IMPORTANCE: Scalable interventions are urgently needed to mitigate the adverse effects of heat on pregnancy and newborn health.

OBJECTIVE: To evaluate whether low-dose aspirin modifies the association between heat exposure and preterm birth.

DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of the Global Network for Women’s and Children’s Health Research Aspirin Supplementation for Pregnancy Indicated Risk Reduction in Nulliparas (ASPIRIN) randomized, double-blinded, placebo-controlled clinical trial was conducted from March 2016 to June 2018. Statistical analyses were performed from June 2024 to June 2025. The study settings included the Democratic Republic of Congo, Zambia, Kenya, Guatemala, Pakistan, and Belagavi and Nagpur, India. Participants included nulliparous individuals between 6 and 13 weeks’ gestation recruited through local clinics and communities, with delivery at 20 or more weeks’ gestation.

EXPOSURES: Prenatal care site-specific daily maximum humid heat averaged across gestation and by gestational week, and randomization to aspirin or placebo.

MAIN OUTCOME AND MEASURE: The main outcome was preterm birth (delivery between 20 and <37 weeks’ gestation) with gestational age confirmed by enrollment ultrasonography.

RESULTS: Of 11 558 participants (mean [SD] age, 20.9 [3.3] years), 5787 were randomized to receive aspirin and 5771 to receive placebo. Preterm birth occurred among 754 placebo recipients (13.1%) and 668 aspirin recipients (11.6%). In mixed-effects pooled logistic regression, each 1 °C increase in mean daily maximum shaded wet-bulb globe temperature across gestation was associated with a 5% increased odds of preterm birth (adjusted odds ratio, 1.05; 95% CI, 1.01-1.10). In stratified analyses, this increased risk was observed only among placebo recipients (adjusted odds ratio [AOR], 1.07; 95% CI, 1.02-1.13), not among aspirin recipients (AOR, 1.03; 95% CI, 0.97-1.10). In pooled mixed-effects logistic distributed lag models, increased odds of preterm birth were observed 17 to 19 weeks before delivery among individuals whose daily maximum shaded wet-bulb globe temperature exceeded the site-specific 75th percentile compared with the lowest 3 quartiles. This vulnerability was not observed among aspirin recipients. In contrast, the association of heat with perinatal mortality was observed only among those receiving aspirin (AOR, 1.15; 95% CI, 1.05-1.26) and not among those receiving placebo (AOR, 1.03; 95% CI, 0.96-1.11).

CONCLUSIONS AND RELEVANCE: The findings of this secondary analysis of the Global Network ASPIRIN trial suggest that low-dose aspirin initiated early in pregnancy among nulliparous individuals may mitigate the effects of heat exposure on preterm birth. The increasing global prevalence of heat stress warrants testing its efficacy more broadly among pregnant people as well as its safety with respect to perinatal mortality.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02409680.

PMID:42090150 | DOI:10.1001/jamanetworkopen.2026.11402

J Endocrinol Invest. 2026 May 6. doi: 10.1007/s40618-026-02903-6. Online ahead of print.

ABSTRACT

INTRODUCTION: Primary aldosteronism (PA) can be managed either by unilateral adrenalectomy (ADX) or pharmacologically with mineralocorticoid receptor antagonists (MRA). Several recent meta-analyses have examined how these treatment modalities affect cardiovascular outcomes in patients with PA. However, the impact of treatment on quality of life (QoL) remains largely unexplored.

OBJECTIVE: To synthesize data from previous studies that have investigated QoL in either medically or surgically treated patients with PA.

METHODS: A literature search was conducted in May 2025 in PubMed, Embase and Web of Science. Studies containing data on QoL before and after ADX or MRA were selected.

RESULTS: Fifteen studies evaluated QoL after treatment for PA. Most comparative studies reported greater and faster QoL improvement after ADX than with MRA. QoL consistently improved after ADX, whereas results with MRA were variable and less consistent. Patients treated with MRA were older than patients treated with ADX and frequently received low MRA doses. Five studies (259 ADX-treated and 88 MRA-treated patients) were included in a meta-analysis. Baseline QoL did not differ between treatment groups. At 6 months, QoL improved in both groups, with no statistically significant difference between ADX and MRA.

CONCLUSION: Treatment of PA is associated with improved QoL following both ADX and MRA therapy. Although several studies suggest superior outcomes after adrenalectomy, the meta-analysis did not show a significant difference at 6 months of follow-up. The limited number of patients, short follow-up duration, and potential undertreatment with MRA represent important limitations.

PMID:42090114 | DOI:10.1007/s40618-026-02903-6

J Endocrinol Invest. 2026 May 6. doi: 10.1007/s40618-026-02878-4. Online ahead of print.

ABSTRACT

BACKGROUND: Anti-Müllerian hormone (AMH) is widely used as a marker of ovarian reserve. However, its reliability in functional hypothalamic amenorrhea (FHA) remains debated. FHA is characterized by reduced gonadotropin secretion and impaired folliculogenesis, which may influence AMH expression and lead to an underestimation of reproductive potential.

METHODS: We conducted a case-control study including women diagnosed with FHA and age-matched healthy controls. FHA patients were stratified according to the presence or absence of polycystic ovarian morphology (PCOM). Serum gonadotropins, estradiol, androgens, and AMH were measured and compared between groups. Correlation analyses were performed to explore associations among hormonal parameters.

RESULTS: Overall, AMH concentrations in FHA patients were comparable to those of controls. However, stratification revealed that FHA without PCOM was associated with significantly reduced AMH, whereas FHA with PCOM displayed increased values. FHA patients also showed reduced gonadotropins, estradiol, and androgens compared with controls. In the non-PCOM FHA subgroup, AMH correlated positively with androgens and negatively with estradiol. These findings suggest that suppression of gonadotropins and consequent androgen deficiency may contribute to reduced AMH levels in FHA.

CONCLUSIONS: This pilot study indicates that low AMH in FHA may reflect hypothalamic suppression of gonadotropins rather than true ovarian reserve potentially leading to misinterpretation in fertility counseling. These observations should be interpreted with caution given the small sample size, but they support the hypothesis that AMH levels might recover with restoration of hypothalamic-pituitary activity and menstrual cycles. Larger, longitudinal studies are warranted to confirm the reversibility of AMH and clarify its prognostic value in FHA.

PMID:42090112 | DOI:10.1007/s40618-026-02878-4

Int Urol Nephrol. 2026 May 6. doi: 10.1007/s11255-026-05178-1. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the concordance between treatment recommendations generated by LLMs and decisions made by a multidisciplinary uro-oncology tumor board.

METHODS: Forty-eight consecutive prostate cancer cases previously discussed at a multidisciplinary tumor board were retrospectively analyzed. For each case, treatment recommendations were generated using five LLM platforms (ChatGPT-4o, ChatGPT, Perplexity, Copilot, and DeepSeek) based on standardized clinical summaries. Four independent urology specialists evaluated the concordance between LLM recommendations and tumor board decisions using a 5-point Likert scale. Differences among models were assessed using the Friedman test followed by Bonferroni-corrected Wilcoxon signed-rank tests. Inter-rater agreement was calculated using the intraclass correlation coefficient.

RESULTS: Significant differences in concordance were observed among the evaluated AI platforms (χ² = 32.16, p < 0.001). Perplexity and ChatGPT-4o demonstrated the highest alignment with tumor board decisions, each achieving a median Likert score of 4.75, whereas Copilot showed the lowest concordance (median 3.00). DeepSeek and ChatGPT demonstrated intermediate performance. Post hoc analyses revealed that Perplexity significantly outperformed several lower-performing platforms; however, no statistically significant difference was observed between Perplexity and ChatGPT-4o (p = 0.149). Expert evaluations showed strong inter-rater agreement (ICC = 0.82).

CONCLUSION: Large language models can demonstrate substantial concordance with multidisciplinary tumor board decisions in prostate cancer management. However, variability among models and the risk of hallucinated information indicate that LLMs should function as clinical decision-support tools under expert supervision rather than as autonomous decision-makers.

PMID:42090098 | DOI:10.1007/s11255-026-05178-1

Int Urol Nephrol. 2026 May 6. doi: 10.1007/s11255-026-05183-4. Online ahead of print.

ABSTRACT

BACKGROUND: Laparoendoscopic single-site donor nephrectomy (LESS-DN) has been proposed as a minimally invasive alternative to conventional laparoscopic donor nephrectomy (CLDN), but its perioperative advantages remain controversial. This meta-analysis aimed to compare the outcomes of LESS-DN and CLDN based on randomized controlled trials (RCTs).

METHODS: PubMed, Embase, and the Cochrane Library were searched up to August 20, 2025, for English-language RCTs comparing LESS-DN and CLDN. The risk of bias was assessed using the original Cochrane Risk of Bias tool (RoB 1.0), and pooled analyses were performed using Review Manager 5.4.1 software.

RESULTS: Four randomized controlled trials involving 274 donors (LESS-DN, n = 136; CLDN, n = 138) were included. There were no significant differences between groups in operative time, warm ischemia time, estimated blood loss, length of hospital stay, time to extraction, or overall complication rates.

CONCLUSIONS: Based on the currently available randomized evidence, no statistically significant differences were detected between LESS-DN and CLDN in the perioperative outcomes analyzed in living kidney donors. Further adequately powered, multicenter randomized trials-particularly evaluating postoperative pain, patient-reported recovery, and cosmetic satisfaction-are warranted.

PMID:42090097 | DOI:10.1007/s11255-026-05183-4

Ophthalmic Physiol Opt. 2026 May 6. doi: 10.1007/s44402-026-00102-7. Online ahead of print.

ABSTRACT

PURPOSE: To develop a Scheimpflug-based image analysis technique to quantify tear exchange during scleral lens wear and investigate fluid reservoir tear dynamics during fenestrated lens wear.

METHODS: Nine healthy participants wore a scleral lens (KATT™, Capricornia Contact Lenses) with a single 0.3 mm diameter limbal fenestration in one eye for 90 min. Central (0-2.5 mm from the corneal apex) and peripheral (-1.0 to 0 mm from the scleral spur) stromal cornea oedema was measured using optical coherence tomography. Scheimpflug images were obtained during lens wear at multiple time points following the application of sodium fluorescein to the bulbar conjunctiva. These images were exported and annotated manually to select the region of interest (the fluid reservoir) from which the intensity of each pixel was extracted to provide a measure of fluorescent intensity (in arbitrary units [AU] on a scale of 0-255) throughout lens wear across the central 10 mm.

RESULTS: The coefficient of repeatability for central fluid reservoir intensity measurements was 7 AU (on a scale of 0-255 AU). Fluid reservoir fluorescent intensity varied with measurement location (p < 0.001), being greater towards the periphery (4 and 5 mm from the centre). On average, intensity differences between the peripheral and central fluid reservoir diminished within 10 min of sodium fluorescein application. Two patterns of tear dynamics were observed and were classified as low and high flow. Low flow participants (n = 6) exhibited greater central (3.72× more) and peripheral (2.25× more) corneal oedema, but the difference was not statistically significant.

CONCLUSIONS: The ingress and mixing of sodium fluorescein within the fluid reservoir stabilised between central and peripheral locations after 10 min of fenestrated scleral lens wear. Two patterns of tear dynamics were observed (low and high flow), with low flow participants exhibiting greater corneal oedema. Future research utilising the developed technique may provide further insights into tear exchange during scleral lens wear with different fenestration sizes and configurations.

PMID:42090093 | DOI:10.1007/s44402-026-00102-7

Insights Imaging. 2026 May 6;17(1):124. doi: 10.1186/s13244-026-02281-w.

ABSTRACT

OBJECTIVES: Gender equity in medicine remains a topic of increasing attention. The aim was to investigate if gender influences the radiology profession, with a focus on career progression, leadership roles, work-life balance, research activity and perceived barriers.

MATERIALS AND METHODS: An anonymous online survey consisting of 22 questions was distributed by the European Society of Radiology (ESR) to its members between October and December 2024. The survey covered demographics, work schedules, family responsibilities, career development, leadership roles, research involvement, and perceived personal experiences. Quantitative data were analyzed using descriptive statistics, chi-square test, and rate differences with confidence intervals. Open-ended responses were explored qualitatively using thematic analysis.

RESULTS: Among 830 respondents, 657 completed the questionnaire (63.3% female, 35.3% male, 1.3% others). Women more frequently reported caregiving responsibilities beyond childcare (4.1% vs 3%), longer parental leave (46.2% vs 21.5%), and experiences of harassing behaviors at work. Men held a higher proportion of leadership roles (33.2% vs 25.2%). Respondents involved in research were more likely to work > 30% extra hours (47.2% vs 29.0%). Although research activity rates were similar across genders, women more often reported barriers to attending conferences and a lack of protected research time. Career fulfillment increased with age among men but decreased among women. Gender was considered a career disadvantage by 44.5% of women versus 9.5% of men.

CONCLUSION: The survey reveals perceived gender disparities in radiology, particularly in leadership access, work conditions, and career satisfaction. Addressing structural barriers and promoting supportive workplace policies are essential to achieving true gender equity in the field.

CRITICAL RELEVANCE STATEMENT: Despite improvements in the last few decades, gender inequity remains present in radiology. Variability between geographical regions suggests that key critical areas can be addressed to promote improvement and support a more equitable professional environment.

KEY POINTS: Perceived gender disparities in radiology are present across career progression, leadership roles, and work-life balance. Women were significantly more likely than men to perceive gender as a career disadvantage (44.5% vs 9.5%; p < 0.0001 35.0% [95% CI: 28.9 to 41.1]). They reported slightly higher caregiving responsibilities and longer parental leave. Structural inequalities impact gender equity in radiology, requiring targeted institutional and cultural changes.

PMID:42090088 | DOI:10.1186/s13244-026-02281-w