Nevin Manimala

Healthc Inform Res. 2024 Oct;30(4):333-343. doi: 10.4258/hir.2024.30.4.333. Epub 2024 Oct 31.

ABSTRACT

OBJECTIVES: This study aimed to assess the feasibility of implementing OpenNotes in Korea. It involved developing and evaluating the Open-CHA service, which provides clinical summary information to patients diagnosed with craniofacial deformities and their caregivers following outpatient visits.

METHODS: The study included 109 patients diagnosed with craniofacial deformities, along with their caregivers. The Open-CHA service was developed by referencing OpenNotes and involved a user needs assessment, a pilot test, and an evaluation of its effectiveness. Data were analyzed using descriptive statistics and the paired t-test.

RESULTS: Short message service templates for the Open-CHA service based on a user needs assessment conducted with patients, caregivers, and healthcare professionals. These templates were refined and improved following a pilot test. After the implementation of the Open-CHA service, most participants evaluated OpenNotes positively. Additionally, there were observed increases in health knowledge and efficacy in patient-physician interactions. A statistically significant improvement in mobile health literacy was also confirmed.

CONCLUSIONS: The implementation of the Open-CHA service significantly enhanced mobile health literacy among patients with craniofacial deformities and their caregivers, indicating positive outcomes for the potential adoption of OpenNotes in Korea. This suggests that introducing OpenNotes into the Korean healthcare system is appropriate.

PMID:39551920 | DOI:10.4258/hir.2024.30.4.333

Healthc Inform Res. 2024 Oct;30(4):312-323. doi: 10.4258/hir.2024.30.4.312. Epub 2024 Oct 31.

ABSTRACT

OBJECTIVES: The spread of misinformation through the internet can lead to dangerous behavioral changes and erode trust in reliable sources, especially during public health crises like coronavirus disease 2019 (COVID-19). To combat this issue, innovative strategies that leverage information technology are essential. This study focused on developing and evaluating a mobile application (app), COVID-Iran, aimed at countering COVID-19 misinformation by delivering accurate, reliable, and credible information.

METHODS: The development of the app involved a multi-step, user-centered approach that integrated qualitative expert consultations with quantitative survey research to pinpoint and validate key features. The app was initially prototyped using Enterprise Architect software and subsequently developed using Android Studio and MySQL. We conducted a usability evaluation using the System Usability Scale (SUS), where participants engaged in various tasks related to information seeking, self-assessment, and health management. Data were analyzed using descriptive statistics in SPSS version 19.

RESULTS: The findings revealed a high usability level (SUS score of 81.35), with participants reporting ease of use and learnability. The app effectively countered misinformation by providing access to trusted sources and evidence-based counterarguments. User feedback emphasized the app’s strengths in clarity, accuracy, trustworthiness, and its comprehensive approach. Plans for future improvements include the integration of artificial intelligence to deliver personalized content.

CONCLUSIONS: Despite limitations such as the small sample size and potential self-selection bias, this study highlights the significant potential of mHealth apps to provide reliable health information and combat misinformation.

PMID:39551918 | DOI:10.4258/hir.2024.30.4.312

Support Care Cancer. 2024 Nov 18;32(12):798. doi: 10.1007/s00520-024-08986-2.

ABSTRACT

PURPOSE: The impact of the components of survivorship care plans on adherence to cancer screening guidelines among cancer survivors is limited. We examined the association of receipt of treatment summaries, follow-up instructions, and type of doctor providing survivorship care with adherence to breast cancer screening (BCS) and cervical cancer screening (CCS) guidelines in female cancer survivors.

METHODS: A cross-sectional analysis using Behavioral Risk Factor Surveillance System (BRFSS) data from 2014, 2016 and 2018 was conducted. BCS and CCS-eligible women were aged 40-74 and 30-64, respectively. BCS adherence was defined as a mammogram within 2 years and CCS adherence as a pap smear within 3 years or HPV test within 5 years. Univariate analysis with chi-square and multivariable logistic regression are reported.

RESULTS: 5,001 BCS and 3,014 CCS-eligible survivors were identified. In the BCS group, recipients of treatment summaries and follow-up instructions were significantly more adherent with BCS (84.1% vs. 77.4%; 83.4% vs. 74%, respectively, p < 0.001). In the CCS group, recipients of follow-up instructions were significantly more adherent with CCS (78.1% vs. 67.7%, p < 0.001). In both groups, there was no significant difference in BCS or CCS based on type of physician providing care (p = 0.087). On multivariate analysis, receipt of follow-up instructions was the only factor significantly associated with BCS (OR:2.81; 95%CI:1.76-4.49) and CCS (OR:3.14; 95%CI:1.88-5.23).

CONCLUSIONS: Follow-up instructions, as part of survivorship care plans, have the strongest association with BCS and CCS among female cancer survivors. Additional research should focus on improving the distribution of survivorship care plans, particularly follow-up instructions, as a method to increase BCS and CCS among cancer survivors.

PMID:39551914 | DOI:10.1007/s00520-024-08986-2

Eur Arch Psychiatry Clin Neurosci. 2024 Nov 18. doi: 10.1007/s00406-024-01935-4. Online ahead of print.

ABSTRACT

The modulation of gut microbiota through probiotics holds promise as a novel avenue for schizophrenia treatment. This study aims to analyze probiotic complementary therapy on individuals with schizophrenia systematically, to investigate probiotic efficacy, potential mechanisms, and implications for clinical practice. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched in Medline, Web of Science, Embase, ClinicalTrials.gov, CNKI, VIP, and WanFang databases using keywords (“probiotics” OR “prebiotics” OR “synbiotics” OR “Lactobacillus” OR “Bifidobacterium”) AND (“schizophrenia”), focused on randomized controlled trials published before July 1, 2023. Among the identified studies, 8 randomized controlled trials met the inclusion criteria, encompassing a total of 342 participants in the intervention group and 306 participants in the control group. Our analysis revealed a statistically significant reduction (p = 0.03) in the total Positive and Negative Syndrome Scale (PANSS) scores following probiotic treatment in individuals with schizophrenia. While no statistical significance was observed in individual subscales (P > 0.05), significant improvements were noted in insulin levels, Insulin Resistance Index (IRI), and glucose levels. Additionally, the Quantitative Insulin Sensitivity Check Index (QUICKI) demonstrated a significant increase (all P < 0.05). The probiotic intervention significantly reduced gastrointestinal discomfort among schizophrenia patients (P = 0.003). This study suggests that probiotics could hold therapeutic potential for addressing clinical symptoms, abnormal glucose metabolism, and gastrointestinal discomfort in individuals with schizophrenia. Future research should encompass comparative trials employing robust experimental designs to explore the differential effects of various probiotic strains on schizophrenia treatment to provide evidence-based therapeutic approaches. TRIAL REGISTRATION: This review protocol was pre-registered on PROSPERO (No. CRD42023455273).

PMID:39551901 | DOI:10.1007/s00406-024-01935-4

Eur Arch Psychiatry Clin Neurosci. 2024 Nov 17. doi: 10.1007/s00406-024-01928-3. Online ahead of print.

ABSTRACT

In this article we aimed synthesize all available evidence regarding the effects of non-invasive brain stimulation (NIBS) techniques combined with mindfulness-based interventions (MBIs) on mental health indicators. We performed a systematic review of randomized controlled trials evaluating NIBS/MBIs combinations in clinical populations and a random effects pairwise meta-analysis of studies evaluating anxiety and depression symptoms. After independent trial selection by two authors based on titles/abstracts, and then on full texts, twelve trials were retrieved. There was a large effect size favoring the NIBS/MBIs over the control intervention for anxiety symptoms (Cohen’s d = – 0.82 (- 1.35, – 0.30), I² = 55%, moderate certainty of evidence). As for depression symptoms, there was a small-to-medium effect size that did not reach statistical significance (Cohen’s d = – 0.24 (- 0.61, 0.13), I² = 30%, low certainty of evidence). MBIs/NIBS combination is feasible and well tolerated. There is preliminary evidence for its therapeutic promise. Future studies should inform combination choices by neural correlates of respective interventions and offer patients mindfulness familiarization before implementation of the NIBS/MBIs treatment.Trial registration CRD42022353971.

PMID:39551900 | DOI:10.1007/s00406-024-01928-3

Ann Hematol. 2024 Nov 18. doi: 10.1007/s00277-024-06088-x. Online ahead of print.

ABSTRACT

This study describes the health-related quality of life (HRQoL) and symptom-specific functional impairment of patients with paroxysmal nocturnal hemoglobinuria (PNH) in a real-world setting. US-based adults with PNH treated with a parenterally administered complement inhibitor (PACI) for ≥ 6 months completed an online, cross-sectional, observational survey; a subset of patients also participated in semi-structured qualitative interviews. The survey included the PROMIS^® 29 + 2 Profile v2.1 (PROMIS 29 + 2) to measure HRQoL. The FACIT-Fatigue, Neuro-QOL Item Bank v2.0 Cognitive Function Short Form, and PROMIS Item Bank v1.0 Dyspnea Functional Limitations 10a Short Form measured symptom-specific functional impairment. For each patient with PNH who completed the online survey, 3 age- and sex-matched adults from the general population (GP) also completed the survey. The HRQoL and functional impairment of the PNH sample were compared to that of the GP sample. The association between HRQoL/functional impairment and fatigue severity for the PNH sample was also investigated. Compared to the age- and sex-matched GP sample, patients treated with PACIs for PNH had significantly worse HRQoL and greater functional impairment for all measured domains (p < 0.05). Within the PNH sample, statistically significant associations (p < 0.05) were observed between fatigue severity and HRQoL/functional impairment for all outcomes except the PROMIS 29 + 2 Sleep Disturbance domain. Interview participants described fatigue-related impairments in their physical, social, and cognitive functioning. Despite receiving treatment for PNH, patients experienced deficits in HRQoL and functional impairment, suggesting that opportunities to improve patient-relevant outcomes through treatment should be identified.

PMID:39551895 | DOI:10.1007/s00277-024-06088-x

Hum Genet. 2024 Nov 18. doi: 10.1007/s00439-024-02717-7. Online ahead of print.

ABSTRACT

Ischemic stroke (IS), characterized by complex etiological diversity, is a significant global health challenge. Recent advancements in genome-wide association studies (GWAS) and transcriptomic profiling offer promising avenues for enhanced risk prediction and understanding of disease mechanisms. GWAS summary statistics from the GIGASTROKE Consortium and genetic and phenotypic data from the UK Biobank (UKB) were used. Transcriptome-Wide Association Studies (TWAS) were conducted using FUSION to identify genes associated with IS and its subtypes across eight tissues. Colocalization analysis identified shared genetic variants influencing both gene expression and disease risk. Sum Transcriptome-Polygenic Risk Scores (STPRS) models were constructed by combining polygenic risk scores (PRS) and polygenic transcriptome risk scores (PTRS) using logistic regression. The predictive performance of STPRS was evaluated using the area under the curve (AUC). A Phenome-wide association study (PheWAS) explored associations between STPRS and various phenotypes. TWAS identified 34 susceptibility genes associated with IS and its subtypes. Colocalization analysis revealed 18 genes with a posterior probability (PP) H4 > 75% for joint expression quantitative trait loci (eQTL) and GWAS associations, highlighting their genetic relevance. The STPRS models demonstrated superior predictive accuracy compared to conventional PRS, showing significant associations with numerous UKB phenotypes, including atrial fibrillation and blood pressure. Integrating transcriptomic data with polygenic risk scores through STPRS enhances predictive accuracy for IS and its subtypes. This approach refines our understanding of the genetic and molecular landscape of stroke and paves the way for tailored preventive and therapeutic strategies.

PMID:39551887 | DOI:10.1007/s00439-024-02717-7

J Egypt Natl Canc Inst. 2024 Nov 18;36(1):36. doi: 10.1186/s43046-024-00244-0.

ABSTRACT

BACKGROUND: Podocytopenia refers to a decrease in the number of podocytes. When podocytes are injured, they may detach leading to podocytopenia, which represents a critical step in the development of podocytopathy and subsequently deterioration of renal functions. Pathological assessment of podocytopenia plays a crucial role in diagnosing underlying kidney diseases.

AIM: To assess detached podocytes and evaluate their diagnostic role in the development of focal segmental glomerulosclerosis.

MATERIALS AND METHODS: This is a retrospective study, conducted on 67 archival renal biopsies with the clinical diagnosis of steroid-resistant or steroid-dependent nephrotic syndrome (SRNS) and diagnosed as focal segmental glomerulosclerosis (FSGS) and podocytopathy with detached podocytes by electron microscopy (EM). Colloidal iron stain and Desmin immunohistochemical stain were performed. Assessment of the mean percent of stained pixels in relation to the surface tuft area of the glomerulus, i.e., mean percent of stained area (PSA) was done using image analysis system (ImageJ 1.52a) software.

RESULTS: Podocytopathy with detached podocytes was diagnosed in 35 (52.24%) cases, while FSGS was diagnosed in 32 (47.76%) cases. Regarding detached podocytes, 27 (49.3%) cases showed no detached podocytes by light microscopy (LM), while only 4 (6%) showed severe podocyte detachment. There was a statistically significant difference between control cases and both podocytopathy with detached podocytes and FSGS regarding mean PSA (p ≤ 0.001).

CONCLUSION: Standardized reporting of detached podocyte cells is becoming mandatory as they have a high positive predictive value for the expected EM picture.

PMID:39551885 | DOI:10.1186/s43046-024-00244-0

Commun Med (Lond). 2024 Nov 17;4(1):234. doi: 10.1038/s43856-024-00671-z.

ABSTRACT

BACKGROUND: Cancer screening tests are considered pivotal for early diagnosis and survival. However, the efficacy of these tests for improving survival has recently been questioned. This study aims to test if cancer screening could be improved by biomarkers in peripheral blood based on multi-omics data.

METHODS: We utilize multi-omics data from 500,000 participants in the UK Biobank. Machine learning is applied to search for proteins, metabolites, genetic variants, or clinical variables to diagnose cancers collectively and individually.

RESULTS: Here we show that the overall performance of the potential blood biomarkers do not outperform clinical variables for collective diagnosis. However, we observe promising results for individual cancers in close proximity to peripheral blood, with an Area Under the Curve (AUC) greater than 0.8.

CONCLUSIONS: Our findings suggest that the identification of blood biomarkers for cancer might be complicated by variable overlap between molecular changes in tumor tissues and peripheral blood. This explanation is supported by local proteomics analyses of different tumors, which all show high AUCs, greater than 0.9. Thus, multi-omics biomarkers for the diagnosis of individual cancers may potentially be effective, but not for groups of cancers.

PMID:39551871 | DOI:10.1038/s43856-024-00671-z

Nat Commun. 2024 Nov 17;15(1):9957. doi: 10.1038/s41467-024-54281-3.

ABSTRACT

We study generative diffusion models in the regime where both the data dimension and the sample size are large, and the score function is trained optimally. Using statistical physics methods, we identify three distinct dynamical regimes during the generative diffusion process. The generative dynamics, starting from pure noise, first encounters a speciation transition, where the broad structure of the data emerges, akin to symmetry breaking in phase transitions. This is followed by a collapse phase, where the dynamics is attracted to a specific training point through a mechanism similar to condensation in a glass phase. The speciation time can be obtained from a spectral analysis of the data’s correlation matrix, while the collapse time relates to an excess entropy measure, and reveals the existence of a curse of dimensionality for diffusion models. These theoretical findings are supported by analytical solutions for Gaussian mixtures and confirmed by numerical experiments on real datasets.

PMID:39551866 | DOI:10.1038/s41467-024-54281-3