Tag: nevin manimala

Int J Pharm Pract. 2026 May 22:riag067. doi: 10.1093/ijpp/riag067. Online ahead of print.

ABSTRACT

BACKGROUND: Faced with local and global shortages of academic pharmacists, this study aimed to determine Nigerian pharmacy students’ interest in academia to inform policies for strengthening the academic pharmacist workforce.

METHODS: A cross-sectional survey was conducted among Nigerian pharmacy students between May and August 2024. Data were collected via online and paper-based validated questionnaires covering sociodemographic, academic characteristics, writing self-efficacy, writing apprehension, and research publication needs assessment. Statistical analyses were performed using SPSS version 27, with P < .05 indicating significance.

KEY FINDINGS: Of 607 responses, 56% were women and 95% were under 30 years old. Community pharmacy was the most favoured practice area (35%), while academia was the least (7%). Over 80% desired to publish research and enrol in a research mentorship program. Gender {AOR = 0.573 (0.358-0.916)}, previous peer-reviewed publication {AOR = 1.877 (1.067-3.303)}, preferred pharmacy practice if remuneration was equal across the different pharmacy practice areas {AOR 5.442 (2.285-12.965)}, and research publication needs assessment score {AOR 1.014 (1.001-1.027)} significantly predicted interest in academic pharmacy. The logistic model (X2 (18) = 150.1, P < .001) explained 38% of variance and classified 74.3% of cases correctly.

CONCLUSIONS: A relatively low percentage of students initially prefer academic pharmacy, and less than half show high intrinsic interest. Gender, previous publication, pharmacy practice preferences under equal remuneration, and research needs assessment predict academic pharmacy interest. These findings highlight motivations and structural barriers, such as remuneration and writing-related concerns, suggesting avenues for interventions to enhance Nigeria’s academic pharmacist workforce.

PMID:42172052 | DOI:10.1093/ijpp/riag067

JAMA Netw Open. 2026 May 1;9(5):e2614030. doi: 10.1001/jamanetworkopen.2026.14030.

ABSTRACT

IMPORTANCE: Guideline-adherent management of pediatric in-hospital cardiac arrest (IHCA) remains challenging, and deviations from best practices are common. Augmented-reality (AR)-enabled, role-specific decision support may improve adherence to American Heart Association (AHA) Pediatric Advanced Life Support (PALS) guidance and key performance metrics.

OBJECTIVE: To determine whether an AR-enhanced, role-specific decision support system improves resuscitation performance and adherence to AHA PALS guidelines during simulated pediatric IHCA.

DESIGN, SETTING, AND PARTICIPANTS: This open-label, multicenter, simulation-based randomized clinical trial was conducted from April to May 2025 at 2 tertiary pediatric emergency centers (Geneva, Switzerland and Alberta, Canada). Participants included teams of pediatric nurses and physicians.

INTERVENTION: Teams managed a standardized scenario of a 12-minute IHCA due to hyperkalemia (progressing from nonshockable to shockable rhythms) using the AR-enhanced, role-specific decision support system (intervention) or AHA PALS pocket cards (control).

MAIN OUTCOMES AND MEASURES: The primary outcome was time from recognition of loss of pulse to first epinephrine. Secondary outcomes included adherence to 3- to 5-minute epinephrine dosing intervals, time to first defibrillation, adherence to 2-minute shock and rhythm-check cycles, chest compression fraction, peri-shock pause, medication-dosing accuracy, and user experience and technology acceptance.

RESULTS: A total of 54 participants were randomized into 18 teams (18 team leaders [12 female [71%] and 36 nurses [33 female [87%]), with 9 teams (27 participants) in each group. Mean (SD) time to first epinephrine was shorter in the intervention group (97.2 [38.5] vs 113.8 [44.5] seconds; mean difference, -16.6 seconds; 95% CI, -51.3 to 17.0 seconds; P = .40), but this difference was not significant. For subsequent epinephrine, the intervention group improved consistency: mean (SD) deviation from the 4-minute target was 17.2 (32.5) vs 49.7 (40.3) seconds (mean difference, -32.4 seconds; 95% CI, -58.8 to -5.8 seconds; P = .03), with fewer guideline violations (2 of 19 participants [11%] vs 9 of 21 participants [43%]; risk difference, -0.32; 95% CI, -0.55 to -0.05; risk ratio, 0.25; 95% CI, 0.06 to 0.996; P = .03). Time to first defibrillation and adherence to 2-minute cycles were similar between groups. Estimates for chest compression fraction, peri-shock pauses, and medication-dosing accuracy did not suggest meaningful between-group difference. User experience and technology acceptance were favorable.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, AR support did not clearly improve time to first epinephrine in simulated pediatric cardiac arrest, with estimates compatible with both benefit and little or no effect. It improved adherence to epinephrine dosing intervals without impairing other performance domains.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06376643.

PMID:42172032 | DOI:10.1001/jamanetworkopen.2026.14030

JAMA Netw Open. 2026 May 1;9(5):e2614046. doi: 10.1001/jamanetworkopen.2026.14046.

ABSTRACT

IMPORTANCE: Optimizing participant recruitment is critical to the success and generalizability of clinical research, yet there is limited randomized clinical trial evidence comparing the effects of digital recruitment strategies and message framing on participant engagement.

OBJECTIVE: To determine the impact of various recruitment strategies on engagement with potential research participants.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was embedded within the Research for Personalized Cardiovascular Disease Prevention (RESILIENCE) study and had a 2 × 2 factorial design. This component of the RESILIENCE study was exclusively virtual and completed online within a single large academic health system in the United States. Potential research participants were identified through electronic health records. The study recruited participants between September 2019 and March 2022, with the analysis undertaken in July to December 2025. No follow-up was undertaken for this study.

INTERVENTIONS: Participants were randomized to a recruitment modality (email vs patient portal) and to a type of message content (altruistic vs individualistic).

MAIN OUTCOMES AND MEASURES: The primary outcome was participant interest, defined as logging onto the study website by clicking the link in the message within 6 months. A robust log-linear Poisson model was used to estimate the relative risk (RR) of the primary outcome based on modality and message content.

RESULTS: Of 15 376 potential research participants (9309 [60.5%] female) identified through the electronic health records, 7737 (50.3%) were randomized to the email recruitment modality and 7639 (49.7%) were randomized to the patient portal modality; 7682 (50.0%) received an altruistic recruitment message and 7694 (50.0%) received an individualistic recruitment message. The primary outcome occurred in 1220 participants (7.9%). The email recruitment modality led to a higher likelihood of the primary outcome than patient portal messages (768 [9.9%] vs 452 [5.9%]; RR, 1.68; 99% CI, 1.45-1.95), while no difference was observed by message content type (634 [8.3%] altruistic vs 586 [7.6%] individualistic; RR, 1.08; 99% CI, 0.94-1.25). There was no significant interaction between message modality and content. Exploratory interactions by age and risk phenotype were observed, with altruistic messaging more effective than individualistic messaging in those aged 60 years and younger and email more effective than patient portal in those older than 60 years and in individuals with obesity.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of recruitment strategies, email messaging led to higher participant interest than patient portal messaging, particularly in older individuals. Message content did not significantly impact engagement overall, but altruistic messaging was more effective in younger participants. These results can inform recruitment strategies for future trials.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04551872.

PMID:42172031 | DOI:10.1001/jamanetworkopen.2026.14046

JAMA Netw Open. 2026 May 1;9(5):e2614265. doi: 10.1001/jamanetworkopen.2026.14265.

ABSTRACT

IMPORTANCE: Chimeric antigen receptor T-cell (CAR-T) therapy is a paradigm-changing therapy in treating non-Hodgkin lymphoma (NHL). Although NHL is a leading cause of cancer-attributable deaths for persons living with HIV (PWH) in high-income countries, PWH are frequently excluded from CAR-T clinical trials.

OBJECTIVE: To explore access to CAR-T trials for the general population and PWH.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study queried ClinicalTrials.gov for all interventional CAR-T clinical trials for the treatment of NHL. Zip codes for each trial site were extracted, and travel time to the nearest location was calculated. Trials included had at least 1 trial site in the contiguous US, and were actively recruiting trials for adult patients (aged ≥18 years) as of May 20, 2025.

EXPOSURE: All trials were reviewed for relevance and eligibility of PWH.

MAIN OUTCOMES AND MEASURES: The primary outcomes were median population-weighted travel time to the nearest trial and 1-hour and 3-hour access for the general population, HIV-inclusive trials, and HIV-exclusive trials. Proportions were compared using a χ2 test, and continuous median travel times were compared using unpaired t tests.

RESULTS: In total, 254 trials were eligible for review, and 80 met criteria for inclusion with 11 (13.8%) trials including PWH, 58 (72.5%) excluding PWH, and 11 (13.8%) not mentioning HIV. The median (IQR) population-weighted travel time was 0.73 (0.36-1.64) hours for the general population, 1.15 (0.49-2.38) hours for trials including PWH, and 0.84 (0.40-1.91) hours for trials excluding PWH. Compared with trials that excluded PWH, trials that included PWH had significantly lower 1-hour (46.07% [95% CI, 46.06%-46.07%] vs 55.27% [95% CI, 55.27%-55.28%]; P < .001) and 3-hour (82.22% [95% CI, 82.22%-82.23%] vs 87.76% [95% CI, 87.75%-87.76%]; P < .001) access. Travel time in the South was significantly longer for trials that included PWH compared with trials that excluded PWH (median [IQR], 1.70 [0.69-2.99] hours vs 0.92 [0.46-2.00] hours; P < .001).

CONCLUSIONS AND RELEVANCE: This cross-sectional study of travel time to CAR-T trials found that PWH had to travel significantly longer than the general population to reach the nearest trial. Despite efforts to reduce clinical trial exclusion based solely on HIV status, access for PWH remains disproportionately lower compared with the general population, and particularly poor in the South, where there is the highest prevalence of HIV. Further efforts to increase access to trials for underserved and underrepresented populations, particularly for PWH, are needed.

PMID:42172029 | DOI:10.1001/jamanetworkopen.2026.14265

JAMA Netw Open. 2026 May 1;9(5):e2614337. doi: 10.1001/jamanetworkopen.2026.14337.

ABSTRACT

IMPORTANCE: Urologic cancers have been linked to nonessential chemical elements with no known beneficial role in the body, though associations between low-level environmental exposure and urologic cancer risk are poorly understood.

OBJECTIVE: To systematically synthesize epidemiologic evidence on the association between environmental exposure to nonessential elements and risk of urologic cancers.

DATA SOURCES: English- and Chinese-language databases, including PubMed, Embase, Web of Science, Scopus, Cumulated Index in Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, China National Knowledge Infrastructure, and Wanfang, were searched from inception to January 27, 2026, without language restrictions.

STUDY SELECTION: Cohort and case-control studies reporting associations between exposure to at least 1 nonessential element (eg, arsenic, cadmium, lead, vanadium, or nickel) and risk of urologic cancers (prostate, bladder, kidney, urinary tract, or testicular) were included.

DATA EXTRACTION AND SYNTHESIS: Data were extracted independently by 4 author reviewers. Random-effects meta-analyses were conducted to estimate pooled relative risks (RRs) comparing the top vs bottom tertiles of exposure levels and to evaluate dose-response associations. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.

MAIN OUTCOMES AND MEASURES: RRs for urologic cancers associated with exposure to nonessential elements.

RESULTS: Of 23 160 records screened, 68 studies met inclusion criteria and 62 were included in the meta-analysis. Comparing the top vs bottom tertile of exposure levels, pooled RRs for arsenic were 1.72 (95% CI, 1.33-2.22) for all urologic cancers, 1.60 (95% CI, 1.13-2.27) for bladder cancer, 1.19 (95% CI, 1.01-1.40) for prostate cancer, and 3.37 (95% CI, 1.71-6.66) for urothelial carcinoma (renal pelvis, ureter, urethra, and/or bladder). Arsenic exposure was not associated with kidney cancer (RR, 1.38; 95% CI, 0.76-2.52). A nonlinear dose-response association was observed between urologic cancer risk and drinking-water arsenic levels above 10 µg/L but not at or below this level; the RR steadily increased from concentrations of 10 to 429 µg/L. Estimated using the population attributable fraction, reducing arsenic concentrations in drinking water to 10 µg/L could potentially lower age-standardized annual rates of some urologic cancers by 0.1 to 31.8 cases per 100 000 population in high-exposure areas. Pooled RRs for overall urologic cancer risk were 1.38 (95% CI, 1.04-1.82) for top vs bottom tertile of cadmium exposure and 1.15 (95% CI, 1.05-1.26) for vanadium, whereas evidence for other elements was limited.

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis of epidemiologic studies, environmental exposure to arsenic, cadmium, and vanadium was associated with increased risk of urologic cancers, although high heterogeneity across studies limited interpretability. These findings highlight the need for high-quality prospective studies to assess causality and quantify the public health burden from environmental exposure to nonessential elements.

PMID:42172026 | DOI:10.1001/jamanetworkopen.2026.14337

JAMA Netw Open. 2026 May 1;9(5):e2614345. doi: 10.1001/jamanetworkopen.2026.14345.

ABSTRACT

IMPORTANCE: Pandemic-related disruptions in cirrhosis care resulted in major gaps and delays in surveillance for hepatocellular carcinoma (HCC). Whether these initial declines improved and rebounded to prepandemic levels remains unclear.

OBJECTIVE: To evaluate contemporary clinical practice data on HCC surveillance utilization from before the COVID-19 pandemic to 4 years after the onset of the pandemic among safety-net populations with cirrhosis.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted at 5 safety-net health systems in the US. Adults with cirrhosis were evaluated longitudinally across 3 time periods: March 1, 2018, to February 29, 2020 (pre-COVID-19 period), March 1, 2020, to February 28, 2022 (COVID-19 era), and March 1, 2022, to February 29, 2024 (post-COVID-19 period).

MAIN OUTCOMES AND MEASURES: The primary outcome was undergoing HCC surveillance identified using Current Procedural Terminology codes for ultrasonography, computed tomography, and magnetic resonance imaging, and corresponding International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for indication. Comparisons of HCC surveillance across time periods used paired t tests, and comparisons of HCC surveillance between subgroups within the same time period used χ2 tests.

RESULTS: Among 6940 patients with cirrhosis, 4001 (57.7%) were men (median [IQR] age, 58 [52-64] years), 206 (3.0%) were Asian, 1720 (24.8%) were Hispanic, 1672 (24.1%) were non-Hispanic Black or African American, and 3081 (44.4%) were non-Hispanic White. The proportion who underwent HCC surveillance within 6 months after diagnosis was 30.8% (1940 patients) in the pre-COVID-19 era, which declined to 21.1% (1468 patients) in the COVID-19 era, and remained at 22.3% (1405 patients) in the post-COVID-19 era. Consistent trends were observed among men and women and among all age and race groups, except for Asian individuals, for whom there was an observed increase in the post-COVID-19 era. Similar trends of low HCC surveillance post-COVID-19 were observed across insurance types but was particularly concerning among uninsured or indigent care covered patients, among whom only 116 of 997 (11.9%) underwent surveillance in the most recent period.

CONCLUSIONS AND RELEVANCE: In this observational study of US safety-net populations with cirrhosis, rates of HCC surveillance following pandemic-related declines remained persistently low even up to 4 years after the onset of the COVID-19 pandemic, with fewer than 1 in 4 patients having undergone guideline-concordant HCC surveillance.

PMID:42172025 | DOI:10.1001/jamanetworkopen.2026.14345

Nutr Health. 2026 May 22:2601060261454264. doi: 10.1177/02601060261454264. Online ahead of print.

ABSTRACT

Background: Orthorexic tendencies involve rigid, rule-governed “healthy eating” and are associated with perfectionism, yet their developmental correlates are less understood. Aim: This study examined whether retrospectively reported childhood picky eating is associated with orthorexic tendencies in adulthood, whether maladaptive perfectionism dimensions mediate these associations, and whether associations vary by gender. Methods: Adults (N = 209) completed validated self-report measures of childhood picky eating, orthorexic tendencies (Eating Habits Questionnaire), and multidimensional perfectionism. Correlations, bootstrapped mediation models (2000 resamples), and gender-moderation analyses were conducted, controlling for age and gender. Results: Childhood picky eating was modestly associated with orthorexic tendencies (r = .18, p = .009). Indirect effects were statistically significant via doubts about actions (β = .06, 95% CI [.02, .10]) and parental expectations/criticism (β = .05, 95% CI [.01, .10]). The association was significant among men but not women. Conclusion: Retrospectively reported childhood picky eating may function as a developmental correlate, rather than a deterministic risk factor, for orthorexic tendencies.

PMID:42172017 | DOI:10.1177/02601060261454264

JAMA Health Forum. 2026 May 1;7(5):e261187. doi: 10.1001/jamahealthforum.2026.1187.

ABSTRACT

IMPORTANCE: State Medicaid prescription cap policies (ie, limiting the monthly number of covered prescriptions) may impede access to medications for opioid use disorder (OUD) and other chronic conditions. Yet, these policies remain understudied among those who become subject to caps at age 21 years.

OBJECTIVE: To evaluate the association of prescription cap policies with medication and acute care use among young adults with OUD.

DESIGN, SETTING, AND PARTICIPANTS: This study identified a cohort of young adults diagnosed with OUD using T-MSIS Analytic Files from January 1, 2016, to December 31, 2021. Data analysis was conducted from July 2025 to December 2025. The study compared outcomes between prescription cap and noncap states using a difference-in-differences analysis where a 2-month policy phase-in window was applied before and after age 21 years and effects estimated across the full follow-up period and the early (months 3-6), mid (months 7-9), and late (months 10-12) periods since the 21st birthday.

EXPOSURES: Becoming exposed to prescription caps at age 21 years.

MAIN OUTCOMES AND MEASURES: Monthly use (any and count) of buprenorphine, overall prescriptions, inpatient hospitalizations, and emergency department (ED) visits 12 months before vs after participant reached the age of 21.

RESULTS: This study analyzed 15 526 individuals from 26 non-prescription cap states and 1769 from 8 states with prescription cap policies. Most individuals were female (noncap states, 8156 [52.5%]; cap states, 1033 [58.4%]) and White (noncap states, 9512 [61.3%]; cap states, 705 [39.9%]). The baseline monthly prevalence for noncap and cap states was 39.3% vs 40.2% for any prescription receipt, 7.5% vs 3.1% for buprenorphine receipt, 3.2% vs 4.8% for hospitalizations, and 14.1% vs 18.7% for ED visits. After adjustment, cap policies were associated with a 4.7% (95% confidence limit [CL], -9.9% to -0.2%) lower prevalence of any prescription receipt and 12.7% (95% CL, -18.7%, -6.7%) fewer total monthly prescriptions 10 to 12 months after participants reached the age of 21. Cap states had more hospitalizations during postperiod months 10 to 12 (6.0%; 95% CL, 0.3%-10.0%) and more ED visits in postperiod months 3 to 6 (4.7%; 95% CL, 1.0%-10.0%) and months 7 to 9 (8.3%; 95% CL, 3.3%-13.3%). Buprenorphine use did not significantly change after cap implementation.

CONCLUSIONS AND RELEVANCE: In this cohort study, Medicaid prescription caps were associated with lower overall use of prescription medications and greater frequency of acute care use among young adults with OUD.

PMID:42172006 | DOI:10.1001/jamahealthforum.2026.1187

JAMA Health Forum. 2026 May 1;7(5):e261212. doi: 10.1001/jamahealthforum.2026.1212.

ABSTRACT

IMPORTANCE: Housing instability is associated with adverse mental health and increased health care use. Policies that reduce eviction risk may affect mental health-related health care utilization. Eviction moratoria enacted during the COVID-19 pandemic provide a natural experiment to examine these associations.

OBJECTIVE: To examine whether the lifting of eviction moratoria during the pandemic was associated with changes in mental health care utilization.

DESIGN, SETTING, AND PARTICIPANTS: A synthetic difference-in-differences approach was used, with state-week level, nationwide data of all-payer records of individuals with a mental health diagnosis or medication prescription in March to August 2020 and June to December 2021. The data were analyzed from November 2024 to November 2025. Two phases of eviction moratorium expirations were analyzed. Phase 1 included staggered expiration of state eviction moratoria from March to August 2020; phase 2 assessed the expiration of the federal eviction moratorium in August 2021, when some states maintained their own state-level eviction moratoria after the federal expiration.

EXPOSURES: State-level or federal-level eviction moratorium expirations.

MAIN OUTCOMES AND MEASURES: Weekly, state-level counts of unique patients who had (1) any outpatient mental health visit, (2) any psychotropic medication prescription, (3) outpatient visits associated with mood-related disorders, (4) outpatient visits associated with serious mental illness (SMI), and (5) suicide-related visits.

RESULTS: Of 8 963 310 individuals, 62% were female, and the mean (SD) age was 42.8 (21.5) years. Expiration of moratoria was associated with statistically significant increases in the weekly number of patients who were prescribed a psychotropic medication (0.57% in phase 1 and 1.17% in phase 2) and the number of patients who received outpatient care for SMI (3.42% in phase 1 and 3.13% in phase 2). By contrast, no measurable changes were observed in the overall patient count for mental health-related outpatient visits, outpatient visits associated with mood-related conditions, or suicide-related visits.

CONCLUSIONS AND RELEVANCE: The results of this differences-in-differences study suggest that the expiration of eviction moratoria was associated with increases in the mean number of patients with psychotropic medication prescriptions and outpatient visits for SMI. These findings underscore the importance of housing for psychiatric treatments and highlight the broader health care implications of housing policy decisions.

PMID:42172005 | DOI:10.1001/jamahealthforum.2026.1212

Med Educ Online. 2026 Dec 31;31(1):2675066. doi: 10.1080/10872981.2026.2675066. Epub 2026 May 22.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) is increasingly integrated into healthcare, making AI literacy an essential competency for medical students. Existing assessments are often generic, lack validation in medical education, and are not grounded in learning theory. This study developed and validated the AI Literacy Scale for Medical Students (ALSMS) within a self-determination theory (SDT) framework.

METHODS: We used a split-sample validation design (N = 518; exploratory factor analysis [EFA], n = 204; confirmatory factor analysis [CFA], n = 314). Candidate facets were derived from prior AI literacy instruments and a previously developed framework, then organized according to SDT. EFA refined the first-order structure, and CFA cross-validated the retained structure and compared prespecified first-order and SDT-aligned higher-order models.

RESULTS: EFA identified nine factors organized into the SDT domains of competence, relatedness, and autonomy. CFA supported the correlated nine-factor structure and demonstrated strong psychometric properties. Model comparisons identified two theory-consistent, well-fitting solutions: a correlated nine-factor model and an SDT-aligned second-order model with Ethics loading on Autonomy. Unidimensional and some hierarchical general-factor models showed poorer fit or identification problems, supporting the construct’s multidimensionality.

CONCLUSIONS: This study provides initial validity evidence for interpreting ALSMS scores as indicators of medical students’ AI literacy within an SDT-informed framework. The findings highlight the significance of integrating ethics into autonomy-supportive curricula and underscore the potential utility of ALSMS for curriculum design, advising, and the evaluation of AI literacy initiatives in medical education.

PMID:42171999 | DOI:10.1080/10872981.2026.2675066