Tag: nevin manimala

J Am Acad Orthop Surg. 2025 Apr 10. doi: 10.5435/JAAOS-D-24-01049. Online ahead of print.

ABSTRACT

INTRODUCTION: The steep rise in utilization of large language model chatbots, such as ChatGPT, has spilled into medicine in recent years. The newest version of ChatGPT, ChatGPT-4, has passed medical licensure examinations and, specifically in orthopaedics, has performed at the level of a postgraduate level three orthopaedic surgery resident on the Orthopaedic In-Service Training Examination question bank sets. The purpose of this study was to evaluate ChatGPT-4’s diagnostic and decision-making capacity in the clinical management of bone-related injuries of the foot and ankle.

METHODS: Eight bone-related foot and ankle orthopaedic cases were presented to ChatGPT-4 and subsequently evaluated by three fellowship-trained foot and ankle orthopaedic surgeons. Cases were scored using criteria on a Likert scale, graded from a total score of 5 (lowest) to 25 (highest) across five criteria. ChatGPT-4 was referred to as “Dr. GPT,” establishing a peer dynamic so that the role of an orthopaedic surgeon was emulated by the chatbot.

RESULTS: The average score across all criteria for each case was 4.53 of 5, noting an overall average sum score of 22.7 of 25 for all cases. The pathology with the highest score was the second metatarsal stress fracture (24.3), whereas the case with the lowest score was hallux rigidus (21.3). Kendall correlation analysis of interrater reliability showed variable correlation among surgeons, without statistical significance.

CONCLUSION: ChatGPT-4 effectively diagnosed and provided appropriate treatment options for simple bone-related foot and ankle cases. Importantly, ChatGPT did not fabricate treatment options (ie, hallucination phenomenon), which has been previously well-documented in the literature, notably receiving its second-highest overall average score in this criterion. ChatGPT struggled to provide comprehensive information beyond standard treatment options. Overall, ChatGPT has the potential to serve as a widely accessible resource for patients and nonorthopaedic clinicians, although limitations may exist in the delivery of comprehensive information.

PMID:40233367 | DOI:10.5435/JAAOS-D-24-01049

JMIR Res Protoc. 2025 Apr 15;14:e63269. doi: 10.2196/63269.

ABSTRACT

BACKGROUND: Cognitive impairments are a key aspect of schizophrenia spectrum disorders (SSDs), significantly affecting clinical and functional outcomes. The COVID-19 pandemic has heightened concerns about mental health services and cognitive stimulation opportunities. Despite evidence-based interventions like action-based cognitive remediation (ABCR) and metacognitive training (MCT), a research-to-practice gap exists in their application across mental health settings.

OBJECTIVE: The iCogCA study aims to address this gap by implementing digital ABCR and MCT through a national Canadian collaborative effort using digital psychological interventions to enhance cognitive health in SSDs.

METHODS: The study involves 5 Canadian sites, with mental health care practitioners trained digitally through the E-Cog platform, which was developed by our research group. Over 2.5 years, participants with SSDs will undergo pre- and postintervention assessments for clinical symptoms, cognition, and functioning. Each site will run groups annually for both ABCR and MCT, totaling ~390 participants. A nonrandomized concurrent controlled design will assess effectiveness design, in which one intervention (eg, ABCR) acts as the active control for the other (eg, MCT) and vice versa, comparing cognitive and clinical outcomes between the interventions using generalized linear mixed effect modeling. Implementation strategy evaluation will consider the digital platform’s efficacy for mental health care practitioners’ training, contextual factors influencing implementation, and sustainability, using descriptive statistics for quantitative data and thematic analysis for qualitative data.

RESULTS: A pilot pragmatic trial has been conducted previously at the Montreal site, evaluating 3 early implementation outcomes: acceptability, feasibility, and engagement. Patient and therapist acceptability was deemed as high and feasible (21/28, 75% of recruited service users completed therapy, rated feasible by therapists). Technology did not appear to significantly impede program participation. Therapist-rated levels of engagement were also satisfactory. In the ongoing study, recruitment is underway (114 participants recruited as of winter 2024), and intervention groups have been conducted at all sites, with therapists receiving training via the E-Cog learning platform (32 enrolled as of winter 2024).

CONCLUSIONS: At least 3 significant innovations will stem from this project. First, this national effort represents a catalyst for the use of digital technologies to increase the adoption of evidence-based interventions and will provide important results on the effectiveness of digitally delivered ABCR and MCT. Second, the results of the implementation component of this study will generate the expertise needed to inform the implementation of similar initiatives. Third, the proposed study will introduce and validate our platform to train and supervise mental health care practitioners to deliver these interventions, which will then be made accessible to the broader mental health community.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05661448; https://clinicaltrials.gov/study/NCT05661448.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63269.

PMID:40233365 | DOI:10.2196/63269

JMIR Form Res. 2025 Apr 15;9:e68093. doi: 10.2196/68093.

ABSTRACT

BACKGROUND: Emerging digital health research poses roadblocks to the inclusion of historically marginalized populations in research. Exclusion of underresourced communities in digital health research is a result of multiple factors (eg, limited technology access, decreased digital literacy, language barriers, and historical mistrust of research and research institutions). Alternative methods of access and engagement may aid in achieving long-term sustainability of diversified participation in digital health research, ensuring that developed technologies and research outcomes are effective and equitable.

OBJECTIVE: This study aims to (1) characterize socioeconomic and demographic differences in individuals who enrolled and engaged with different remote, digital, and traditional recruitment methods in a digital health pregnancy study and (2) determine whether social media outreach is an efficient way of recruiting and retaining specific underrepresented populations (URPs) in digital health research.

METHODS: The Better Understanding the Metamorphosis of Pregnancy (BUMP) study was used as a case example. This is a prospective, observational, cohort study using digital health technology to increase understanding of pregnancy among 524 women, aged 18-40 years, in the United States. The study used different recruitment strategies: patient portal for genetic testing results, paid/unpaid social media ads, and a community health organization providing care to pregnant women (Moses/Weitzman Health System).

RESULTS: Social media as a recruitment tool to engage URPs in a digital health study was overall effective, with a 23.6% (140/594) enrollment rate of those completing study interest forms across 25 weeks. Community-based partnerships were less successful, however, resulting in 53.3% (57/107) engagement with recruitment material and only 8.8% (5/57) ultimately enrolling in the study. Paid social media ads provided access to and enrollment of a diverse potential participant pool of race- or ethnicity-based URPs in comparison to other digital recruitment channels. Of those that engaged with study materials, paid recruitment had the highest percentage of non-White (non-Hispanic) respondents (85/321, 26.5%), in comparison to unpaid ads (Facebook and Reddit; 37/167, 22.2%). Of the enrolled participants, paid ads also had the highest percentage of non-White (non-Hispanic) participants (14/70, 20%), compared to unpaid ads (8/52, 15.4%) and genetic testing service subscribers (72/384, 18.8%). Recruitment completed via paid ads (Instagram) had the highest study retention rate (52/70, 74.3%) across outreach methods, whereas recruitment via community-based partnerships had the lowest (2/5, 40%). Retention of non-White (non-Hispanic) participants was low across recruitment methods: paid (8/52, 15.4%), unpaid (3/35, 14.3%), and genetic testing service subscribers (50/281, 17.8%).

CONCLUSIONS: Social media recruitment (paid/unpaid) provides access to URPs and facilitates sustained retention similar to other methods, but with varying strengths and weaknesses. URPs showed lower retention rates than their White counterparts across outreach methods. Community-based recruitment showed lower engagement, enrollment, and retention. These findings highlight social media’s potential for URP engagement and enrollment, illuminate potential roadblocks of traditional methods, and underscore the need for tailored research to improve URP enrollment and retention.

PMID:40233355 | DOI:10.2196/68093

J Am Acad Orthop Surg. 2025 Apr 10. doi: 10.5435/JAAOS-D-23-00543. Online ahead of print.

ABSTRACT

INTRODUCTION: Spondylolysis, a defect in the pars interarticularis, can be symptomatic or asymptomatic with an estimated prevalence of 4% by age 6 years and 6% by adulthood. This study’s goal was to determine the prevalence of lumbar spondylolysis found on CT scans in children and to characterize patient-specific risk factors.

METHODS: Abdominopelvic CT scans done (2017 to 2020) in patients up to age 18 years were reviewed. The radiology report was retrospectively reviewed for a spondylolysis, and a radiologist rereviewed the CT scan. Patient demographics and indications for CT scan were included. Firth bias-reduced logistic regression was used to model spondylolysis with each demographic variable as a predictor.

RESULTS: One thousand nine hundred thirty-one CT reports and imaging were reviewed; abdominal pain (41.91%) and trauma (29.46%) were the most common reasons for CT scan. Spondylolysis was found in 42 patients (2.18%) per the radiology report and in 71 patients (3.68%) on radiologist overread. Median age was 13 years (interquartile range, 10 to 16 years). Age groups had the following prevalence: 0 to 6 years (0.41%); 7 to 10 years (1.58%); 11 to 13 years (3.59%); 14 to 18 years (5.1%). Increased prevalence was found in ages 14 to 18 years that was statistically significant (odds ratio 1; P = 0.0004). L5 was the most common level; most defects were bilateral. White patients had a higher rate of spondylolysis (5.06%) than Black patients (2.05%). Black patients were less likely to have a spondylolysis with an OR of 0.4 (0.22 to 0.69; P = 0.0007).

DISCUSSION: This study demonstrated a lower prevalence of lumbar spondylolysis (3.68%) in children compared with the previous literature. Increasing prevalence with age suggests that spondylolysis develops over time, likely because of repetitive stress. Future studies should characterize these age-related and race-related differences for better understanding.

LEVEL OF EVIDENCE: Level IV, retrospective.

PMID:40233349 | DOI:10.5435/JAAOS-D-23-00543

Vopr Virusol. 2025 Mar 12;70(1):57-65. doi: 10.36233/0507-4088-286.

ABSTRACT

INTRODUCTION: The main quality indicator for inactivated influenza vaccines is their potency (the amount of hemagglutinin). The potency test for the influenza vaccine with the SOVIDON adjuvant is carried out in a trivalent bulk vaccine before the addition of the adjuvant. This approach has its fair share of drawbacks. The analysis of the statistical process control and stability by control charts plays an important role in the release of influenza vaccines. The aim of the study is to compare the results of hemagglutinin quanitation in the trivalent bulk vaccine and in the final lots of influenza vaccine with SOVIDON adjuvant; as well as the analysis of the potency test results to evaluate the statistical process control.

MATERIALS AND METHODS: This study covered the inactivated influenza vaccine with the SOVIDON adjuvant. Both the trivalent bulks vaccine before the addition of the adjuvant and the final lots were investigated by single radial immunodiffusion assay. The software SIAMS Photolab was used to calculate the amount of hemagglutinin. Microsoft Excel was used to create the control charts using the data of the manufacturer.

RESULTS: The data of the study confirm the absence of statistically significant differences (p < 0.05) of the content of hemagglutinin in the trivalent bulks and the final lots of the influenza vaccine. The analysis of control charts showed the presence of out-of-control signals.

CONCLUSION: The study has shown the possibility and feasibility of the potency testing of the influenza vaccine with the SOVIDON adjuvant. The presence of out-of-control signals on the control charts is the basis for the identification of the reasons behind the changes and for the analysis of risks of the release of a defective influenza vaccine.

PMID:40233337 | DOI:10.36233/0507-4088-286

Vopr Virusol. 2025 Mar 12;70(1):25-34. doi: 10.36233/0507-4088-271.

ABSTRACT

INTRODUCTION: Predisposition to different courses of the infectious process is largely associated with the polymorphisms in human genome, especially in genes encoding proteins of the immune system. In the early stages of influenza infection such components of innate immunity as interferons I (α/β) and III (λ) type play a significant role in limiting virus replication. The aim of the work was to investigate associations of single nucleotide polymorphism in IFNL3 (rs8099917 T/G) and IFNL4 (rs12979860 C/T) genes with different course of influenza, and identify genetic markers of influenza complicated by community-acquired pneumonia. The genes noted above affect the production of interferon-λ3, which is involved in restriction of the viral replication.

MATERIALS AND METHODS: Samples from 456 patients with mild (n = 150), moderate (n = 173), and severe (n = 133) influenza were studied. The viral RNA was detected by reverse transcription and polymerase chain reaction (RT-PCR). Polymorphisms in IFNL3 (rs8099917 T/G) and IFNL4 (rs12979860 C/T) genes was detected by PCR. Statistical analysis was performed using SNPStats software.

RESULTS: Patients with the C/T or T/T genotype of IFNL4 gene (rs12979860 C/T) were more likely to have pneumonia than those with the C/C genotype (OR 2.47 (1.31-4.63); p = 0.0044; q = 0.0059). The presence of one T allele increased the risk of developing pneumonia (OR 2.02 (1.05-4.02); p = 0.006; q = 0.008). In the presence of the T/T genotype, the risk increased more than twofold: OR 2.14 (1.31-3.48). Analysis of the SNP of IFNL3 gene (rs8099917 T/G) revealed a weak association of the G allele with pneumonia (OR 1.86 (1.04-3.31); p = 0.03; q = 0.045).

CONCLUSION: Genetic markers of increased risk of community-acquired pneumonia in influenza include the presence of the T allele in IFNL4 gene (rs12979860 C/T) and, to a lesser extent, the G allele in IFNL3 gene (rs8099917 T/G). Patients carrying these alleles have an increased risk of developing pneumonia, especially in old age.

PMID:40233334 | DOI:10.36233/0507-4088-271

Pediatr Infect Dis J. 2025 Apr 11. doi: 10.1097/INF.0000000000004832. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to develop population pharmacokinetic (PK) models of cefoperazone and sulbactam through simultaneous analysis of plasma and urine data in pediatric patients and to optimize dosing regimens based on PK/pharmacodynamic (PD) simulation.

METHODS: Population PK models of cefoperazone and sulbactam were separately developed by simultaneously fitting plasma and urine data from pediatric patients described in 9 published articles. Probabilities of attaining the bactericidal target of 70% of free time above minimum inhibitory concentration (70% fT > MIC) for cefoperazone against clinical isolates of common bacteria were estimated based on the final model.

RESULTS: Seventy-eight pediatric patients were the subjects for PK modeling (0.83-14.6 years old and 6-51.6 kg of body weight). A total of 439 plasma concentrations and 138 urinary excretions up to 7 hours after administration were used for population PK modeling. The data were adequately described by 2-compartment models for cefoperazone and sulbactam. Age was not a statistically significant covariate in the PK of both drugs. For empiric therapy of community-acquired pneumonia, the PK/PD breakpoint of 0.5-hour infusion of 20 mg/kg (cefoperazone-sulbactam dose ratio of 1:1) 4 times daily was 0.13 μg/mL and could cover MIC90 of Streptococcus pneumoniae (MIC90 = 0.125 μg/mL) and Haemophilus influenzae (MIC90 = 0.125 μg/mL). However, since MIC90 values for nosocomial pathogens are high (MIC90 = 2 μg/mL for Staphylococcus aureus and MIC90 = 4 μg/mL for Morganella morganii), a 4-hour infusion of 60 mg/kg (cefoperazone-sulbactam dose ratio of 2:1) 4 times daily might be better to cover many pathogens.

CONCLUSIONS: This study described population PK models of cefoperazone and sulbactam detailing the excretion process with urine data in pediatric patients and developed optimal dosing regimens of cefoperazone-sulbactam including extended infusion in consideration with pathogens, based on PK/PD simulation.

PMID:40233330 | DOI:10.1097/INF.0000000000004832

J Craniofac Surg. 2025 Apr 15. doi: 10.1097/SCS.0000000000011389. Online ahead of print.

ABSTRACT

BACKGROUND: Financial toxicity refers to the economic burden of treatment on patients, families, and caregivers of those with chronic medical conditions. The authors sought to add to the literature regarding the financial burden on families with children undergoing cleft palate reconstruction.

METHODS: A survey assessing income, debt, and other indicators of financial impact, such as out-of-pocket (out of pocket) costs, was sent to the parents of patients who had cleft palate repair at age 18 or younger identified through CPT codes from the authors’ institution’s electronic medical record.

RESULTS: One hundred eighty-six began the survey; however, only 64 (9%) respondents completed the survey and were included in the statistical analysis. The average total out-of-pocket cost was $45,140 (range: $0-$400,000). Eleven respondents (17%) reported that their debt balance had increased after treatment, whereas only 3 respondents (5%) reported an improvement in their debt. However, there was no significant association between increased debt balance and increased out-of-pocket costs. Twenty-five respondents (39%) reported a reduction in their working hours. Over half (53%) reported that they and their partner missed more than 3 weeks of work cumulatively throughout their child’s treatment. Thirty respondents (47%) reported a reduction in essential household expenses and 40 respondents (63%) reported a reduction in non-essential spending.

CONCLUSIONS: Costs associated with cleft palate care results in significant financial toxicity for families of children with cleft palate. Pending legislation, including the Ensuring Lasting Smiles Act, could ameliorate out-of-pocket costs and reduce financial toxicity for cleft patients and their families.

PMID:40233308 | DOI:10.1097/SCS.0000000000011389

J Craniofac Surg. 2025 Apr 15. doi: 10.1097/SCS.0000000000011402. Online ahead of print.

ABSTRACT

The masseter and temporal muscles are primary jaw muscles vital for chewing and speaking, which work in tandem for effective mastication. On the basis of the reported studies that masseter botulinum toxin A injection causes masseter muscle atrophy without impairing chewing function in most patients, this study explores whether the temporal muscle thickens compensatively after injection of botulinum toxin A into masseter muscle. In this prospective study, the authors analyzed data from 10 patients who were treated with botulinum toxin A injection into the masseter. Ultrasonographic images of the masseter and temporal muscles were obtained to measure the muscle thickness at rest and in contraction before and 1, 2, 4, 8, and 12 weeks after the injection. Repeated measures one-way ANOVA was used to compare the statistical significance of the data and simpler linear regression to find the relationship of thickness changes between the masseter and temporal muscles. During the 3-month follow-up, there was a statistically significant decrease in masseter thickness and a corresponding increase in temporalis thickness. Masseter thickness decreased from 14.21±2.95 to 10.42±1.59 mm at rest, and from 15.08±3.11 to 11.30±1.8 mm in contraction (P<0.0001). Temporalis thickness increased from 9.27±2.18 to 13.05±1.49 mm at rest and from 10.12±2.44 to 13.74±1.59 mm in contraction (P<0.0001). There was a negative linear relationship between the thickness of masseter and temporal muscles. No serious complications occurred. Temporal muscle thickness increased after the injection of botulinum toxin A into the masseter.

PMID:40233307 | DOI:10.1097/SCS.0000000000011402

PLoS One. 2025 Apr 15;20(4):e0310578. doi: 10.1371/journal.pone.0310578. eCollection 2025.

ABSTRACT

BACKGROUND: People with Parkinson’s (PwP) can experience both physical and psychological symptoms, and understanding the perspectives of people affected is crucial for improved management, and clinical outcomes.

OBJECTIVES: This online survey aimed to gain a better understanding of the relationship between the subjectively experienced physical and psychological symptoms by PwP and their carers, while also considering the influence of personal roles and past symptom experiences.

METHODS: A UK-wide survey of 251 PwP and 62 carers was conducted. The survey focused on reported diagnosed and non-diagnosed psychological symptoms experienced, their onset, and the perceived impact of physical and psychological symptoms on one another. Responses were summarised using descriptive statistics.

RESULTS: A substantial proportion of respondents reported at least one diagnosed psychological condition (38.5%) or undiagnosed psychological symptoms (44.6%) such as anxiety and depression. Half of respondents reported perceiving a bi-directional interaction between physical and psychological symptoms, with this perception most reported in people with prior experience of psychological symptoms. Our sample shows that while PwP and carers have similar views on the impact of psychological symptoms, carers perceive the impact of physical symptoms to be greater than PwP.

CONCLUSIONS: PwP and carers appear to perceive an interaction between physical and psychological symptoms in Parkinson’s, noting that psychological symptoms frequently precede Parkinson’s diagnosis but are often under-recognised. Improved awareness of the potential link between physical and psychological symptoms in PwP may help to improve assessment, and onward referral processes to enhance care. Further research may assist in identifying potential disease subtypes and allow the prediction of changes in physical and psychological presentation.

PMID:40233306 | DOI:10.1371/journal.pone.0310578