Tag: nevin manimala

JMIR Form Res. 2025 Feb 5;9:e64444. doi: 10.2196/64444.

ABSTRACT

BACKGROUND: Technology that detects early when a patient at risk of falling leaves the bed can support nurses in acute care hospitals.

OBJECTIVE: To develop a better understanding of nurses’ perspectives and experiences with a bed-exit information system (BES) in an acute care hospital setting.

METHODS: BES was implemented on 3 wards of a university medical center. Nurses completed 2 online surveys at each time point (P0 and P1) and participated in focus groups before (P0) and after (P1) implementation. Additional patient data were collected. Descriptive statistics summarized the survey results, while content analysis was applied to focus group data. Patient rates and adverse events in both phases were compared using negative binomial models. Reporting of this study adhered to the GRAMMS checklist.

RESULTS: A total of 30 questionnaires were completed at P0 (30/72, 42%) and 24 at P1 (24/71, 33%). Of the participants, 15 completed both questionnaires (complete cases). At P1, 64% (9/14) of participants agreed that their perceived workload and strain in caring for patients with cognitive impairment was reduced by the use of the BES. The adverse event rate per patient per day was reduced by a factor of 0.61 (95% CI 0.393-0.955; P=.03). In addition, 11 nurses participated in 4 focus groups before and after the intervention. Participants found it challenging to operationalize the use of the BES due to the heterogeneity of care settings, but certain behaviors of patients with cognitive impairment were recognized as indicating a need for intervention. Negative experiences included information overload and alarm fatigue, leading to occasional removal of the system.

CONCLUSIONS: While BES provides some support in managing patients with cognitive impairment, its impact remains limited to specific scenarios and does not significantly reduce nurses’ workload or strain. Our findings highlight the need to manage expectations of BES performance to ensure alignment between expected and actual benefits. To improve BES effectiveness and long-term implementation, future research should consider both objective measures of patient care and subjective factors such as nurse experience, structural conditions, and technical specifications. Improving information mechanisms within call systems could help reduce alarm fatigue and increase perceived usefulness. Overall, successful integration of BES in acute care settings will require close collaboration with nursing staff to drive meaningful healthcare innovation and ensure that the technology meets the needs of both patients and nurses.

TRIAL REGISTRATION: German Register for Clinical Studies DRKS00021720; https://drks.de/search/de/trial/DRKS00021720.

PMID:39908092 | DOI:10.2196/64444

J Med Internet Res. 2025 Feb 5;27:e65615. doi: 10.2196/65615.

ABSTRACT

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating adverse effect of neurotoxic chemotherapy characterized by symptoms such as numbness, tingling, and weakness. Effective monitoring and detection of CIPN are crucial for avoiding progression to irreversible symptoms. Due to the inconvenience of clinic-based objective assessment, CIPN detection relies primarily on patients’ reporting of subjective symptoms, and patient-reported outcomes are used to facilitate CIPN detection. Our previous study found evidence that objective functional assessments completed within a smartphone app may differentiate patients with and those without CIPN after treatment.

OBJECTIVE: This prospective, longitudinal observational cohort study aimed to determine the feasibility and accuracy of app-based remote monitoring of CIPN in patients with cancer undergoing neurotoxic chemotherapeutic treatment and to conduct exploratory comparisons of app-based functional CIPN monitoring versus patient-reported outcome-only monitoring.

METHODS: The NeuroDetect app (Medable Inc) includes subjective EORTC (European Organization for Research and Treatment of Cancer) Quality of Life Questionnaire (QLQ)-20-item scale (CIPN20) and 6 objective functional assessments that use smartphone sensors to mimic neurological examinations, such as walking, standing, and manual dexterity tests. The functional assessment data were collected from patients with cancer undergoing neurotoxic chemotherapy, and a neurological examination was conducted at the end of treatment to diagnose CIPN in the feet (CIPN-f) or CIPN in the hands (CIPN-h). Various classification models including NeuroDetect features only (NeuroDetect Model) CIPN20-only (CIPN20 Model) or a combination of both (Combined Model) were trained and evaluated for accuracy in predicting CIPN probability.

RESULTS: Of the 45 patients who completed functional assessments and neurological examinations, 24 had CIPN-f, and 29 had CIPN-h. The NeuroDetect Model could discriminate between patients with and those without CIPN-f (area under the curve=83.8%, comparison with no information rate P=.02) but not CIPN-h (area under the curve=67.9%, P=.18). The rolling rotation features from the eyes-closed phase of the Romberg Stance assessment showed the greatest contribution to CIPN-f (40% of total variable importance) and the Finger Tapping assessment showed the greatest contribution to CIPN-h (85% of total variable importance). The NeuroDetect Model had numerically, and at some time points statistically, superior performance to the CIPN20 Model in both CIPN-f and CIPN-h, particularly before and early in treatment. The Combined Model numerically, though not statistically, outperformed either assessment strategy individually, indicating that the combination of functional and patient-reported assessment within a smartphone may be optimal to CIPN detection.

CONCLUSIONS: Our findings demonstrate the feasibility of integrating subjective and objective CIPN assessment into a smartphone app for remote, longitudinal CIPN monitoring. Studies of larger patient cohorts are needed to refine the app-based CIPN detection models and determine whether their use in practice improves CIPN detection.

PMID:39908091 | DOI:10.2196/65615

JMIR Public Health Surveill. 2025 Feb 5;11:e63428. doi: 10.2196/63428.

ABSTRACT

BACKGROUND: Young sexual minority men have among the highest rates of HIV in the United States; yet, the use of evidence-based prevention strategies, including routine HIV testing and pre-exposure prophylaxis (PrEP), remains low. Mobile apps have enormous potential to increase HIV testing and PrEP use among young sexual minority men.

OBJECTIVE: This study aims to assess the efficacy of 2 theory- and community-informed mobile apps-LYNX (APT Mobility) and MyChoices (Keymind)-to improve HIV testing and PrEP initiation among young sexual minority men.

METHODS: Between October 2019 and May 2022, we implemented a 3-arm, parallel randomized controlled trial in 9 US cities to test the efficacy of the LYNX and MyChoices apps against standard of care (SOC) among young sexual minority men (aged 15-29 years) reporting anal sex with cisgender male or transgender female in the last 12 months. Randomization was 1:1:1 and was stratified by site and participant age; there was no masking. The co-primary outcomes were self-reported HIV testing and PrEP initiation over 6 months of follow-up.

RESULTS: A total of 381 young sexual minority men were randomized. The mean age was 22 (SD 3.2) years. Nearly one-fifth were Black, non-Hispanic (n=67, 18%), Hispanic or Latino men (n=67, 18%), and 60% identified as gay (n=228). In total, 200 (53%) participants resided in the Southern United States. At baseline, participants self-reported the following: 29% (n=110) had never had an HIV test and 85% (n=324) had never used PrEP. Sociodemographic and behavioral characteristics did not differ by study arm. Compared to SOC (n=72, 59%), participants randomized to MyChoices (n=87, 74%; P=.01) were more likely to have received at least 1 HIV test over 6 months of follow-up; those randomized to LYNX also had a higher proportion of testing (n=80, 70%) but it did not reach the a priori threshold for statistical significance (P=.08). Participants in both MyChoices (n=23, 21%) and LYNX (n=21, 20%) arms had higher rates of starting PrEP compared to SOC (n=19, 16%), yet these differences were not statistically significant (P=.52).

CONCLUSIONS: In addition to facilitating earlier treatment among those who become aware of their HIV status, given the ubiquity of mobile apps and modest resources required to scale this intervention, a 25% relative increase in HIV testing among young sexual minority men, as seen in this study, could meaningfully reduce HIV incidence in the United States.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03965221; https://clinicaltrials.gov/study/NCT03965221.

PMID:39908084 | DOI:10.2196/63428

JMIR Med Inform. 2025 Feb 5;13:e64479. doi: 10.2196/64479.

ABSTRACT

BACKGROUND: Modern lifestyle risk factors, like physical inactivity and poor nutrition, contribute to rising rates of obesity and chronic diseases like type 2 diabetes and heart disease. Particularly personalized interventions have been shown to be effective for long-term behavior change. Machine learning can be used to uncover insights without predefined hypotheses, revealing complex relationships and distinct population clusters. New data-driven approaches, such as the factor probabilistic distance clustering algorithm, provide opportunities to identify potentially meaningful clusters within large and complex datasets.

OBJECTIVE: This study aimed to identify potential clusters and relevant variables among individuals with obesity using a data-driven and hypothesis-free machine learning approach.

METHODS: We used cross-sectional data from individuals with abdominal obesity from The Maastricht Study. Data (2971 variables) included demographics, lifestyle, biomedical aspects, advanced phenotyping, and social factors (cohort 2010). The factor probabilistic distance clustering algorithm was applied in order to detect clusters within this high-dimensional data. To identify a subset of distinct, minimally redundant, predictive variables, we used the statistically equivalent signature algorithm. To describe the clusters, we applied measures of central tendency and variability, and we assessed the distinctiveness of the clusters through the emerged variables using the F test for continuous variables and the chi-square test for categorical variables at a confidence level of α=.001.

RESULTS: We identified 3 distinct clusters (including 4128/9188, 44.93% of all data points) among individuals with obesity (n=4128). The most significant continuous variable for distinguishing cluster 1 (n=1458) from clusters 2 and 3 combined (n=2670) was the lower energy intake (mean 1684, SD 393 kcal/day vs mean 2358, SD 635 kcal/day; P<.001). The most significant categorical variable was occupation (P<.001). A significantly higher proportion (1236/1458, 84.77%) in cluster 1 did not work compared to clusters 2 and 3 combined (1486/2670, 55.66%; P<.001). For cluster 2 (n=1521), the most significant continuous variable was a higher energy intake (mean 2755, SD 506.2 kcal/day vs mean 1749, SD 375 kcal/day; P<.001). The most significant categorical variable was sex (P<.001). A significantly higher proportion (997/1521, 65.55%) in cluster 2 were male compared to the other 2 clusters (885/2607, 33.95%; P<.001). For cluster 3 (n=1149), the most significant continuous variable was overall higher cognitive functioning (mean 0.2349, SD 0.5702 vs mean -0.3088, SD 0.7212; P<.001), and educational level was the most significant categorical variable (P<.001). A significantly higher proportion (475/1149, 41.34%) in cluster 3 received higher vocational or university education in comparison to clusters 1 and 2 combined (729/2979, 24.47%; P<.001).

CONCLUSIONS: This study demonstrates that a hypothesis-free and fully data-driven approach can be used to identify distinguishable participant clusters in large and complex datasets and find relevant variables that differ within populations with obesity.

PMID:39908080 | DOI:10.2196/64479

JAMA. 2025 Feb 5. doi: 10.1001/jama.2024.26389. Online ahead of print.

NO ABSTRACT

PMID:39908043 | DOI:10.1001/jama.2024.26389

JAMA Psychiatry. 2025 Feb 5. doi: 10.1001/jamapsychiatry.2024.4694. Online ahead of print.

ABSTRACT

IMPORTANCE: Although psychological traumas have been associated with endometriosis, limited information is available regarding the role of trauma type and genetic predisposition.

OBJECTIVE: To examine the relationship between traumatic experiences and endometriosis using observational and genetically informed analyses.

DESIGN, SETTING, AND PARTICIPANTS: For this case-control study, the analyses were performed between May 13, 2023, and September 30, 2024. Genotypic and phenotypic information was combined from UK Biobank individual-level data (up to 8276 patients with endometriosis and 240 117 female controls) with genome-wide information available from a large meta-analysis (European ancestry: 21 779 patients and 449 087 female controls; East Asian ancestry: 1713 patients and 1581 female controls) and the FinnGen cohort (16 588 patients and 111 583 female controls of European descent).

MAIN OUTCOMES AND MEASURES: Phenotypic associations via multiple regression; latent-class analysis (LCA) to investigate the co-occurrence patterns of different traumatic experiences in endometriosis cases and controls; genetic correlation and polygenic risk scoring (PRS) analyses to assess pleiotropy linking traumatic events to endometriosis.

RESULTS: Up to 8276 women with endometriosis (mean [SD] age, 53.2 [13.0] years) and 240 117 female controls (mean [SD] age, 56.5 [9.6] years) were investigated in the study. Women with endometriosis were more likely to report childhood and adulthood traumatic experiences and stressful events (eg, contact trauma odds ratio [OR], 1.28; 95% CI, 1.02-1.26). Our LCA highlighted the association of endometriosis with emotional and physical trauma (225 [8%] vs 3948 [5%]; P < 2.2 × 10-16) and sexual trauma (414 [5%] vs 3158 [4%]; P = 2.9 × 10-3). Unaffected women (controls) were more likely assigned to the “no trauma” latent class (563 [20%] vs 18 949 [24%]; P = 7.4 × 10-14). Our genetic correlation (rg) analyses linked endometriosis to multiple trauma-related outcomes, including posttraumatic stress disorder (meta-analysis rg = 0.31, P = 7.1 × 10-16; FinnGen rg = 0.26, P = 4.7 × 10-15) and childhood maltreatment (meta-analysis rg = 0.23, P = 1.3 × 10-6; FinnGen rg = 0.16, P = 1 × 10-4). Endometriosis PRS was associated with increased odds of the disease (β = 0.31, P < 2.2 × 10-16), but no interaction was observed with different types of trauma events.

CONCLUSIONS AND RELEVANCE: The present study comprehensively investigated the impact of childhood and adulthood traumatic experiences and stressful events on endometriosis. In particular, our findings highlight the potential association between contact traumas and endometriosis, which appears to be independent of the disease genetic predisposition.

PMID:39908042 | DOI:10.1001/jamapsychiatry.2024.4694

JAMA Netw Open. 2025 Feb 3;8(2):e2457834. doi: 10.1001/jamanetworkopen.2024.57834.

ABSTRACT

IMPORTANCE: Employer-sponsored benefit programs aim to increase access to behavioral health care, which may help contain health care costs. However, research has either focused solely on clinical outcomes or demonstrated reductions in medical claims without accounting for the costs of behavioral health services, leaving the financial return on investment unknown.

OBJECTIVE: To determine whether a clinically effective employer-sponsored behavioral health benefit is associated with net medical cost savings.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included participants eligible for an employer-sponsored behavioral health benefit between November 1, 2019, and May 31, 2023. Eligibility criteria included having a behavioral health diagnosis and, in the program group, attending at least 1 behavioral health appointment. Program users were matched to nonusers on medical risk scores, behavioral health diagnoses, date of diagnosis, age, sex, and employer. Participants were followed up for 1 year before and after the benefit launch.

EXPOSURE: A digital platform screened individuals for common behavioral health conditions and provided access to video and in-person psychotherapy, medication management, care navigation, and self-guided digital content.

MAIN OUTCOMES AND MEASURES: Primary outcomes were per member per month (PMPM) medical spending, inclusive of all medical claims and program costs. A difference-in-differences analysis was used to compare changes in net medical spending between groups from the year before and up to 1 year after an index mental health diagnosis.

RESULTS: This study included 13 990 participants: 4907 of 4949 (99.1%) eligible program group members were matched to 9083 control participants. Their mean (SD) age was 37 (13.2) years, and most participants (65.5%) were female. Costs decreased in the program group relative to the control group, with a net difference-in-differences of -$164 PMPM (95% CI, -$228 to -$100 PMPM), corresponding to savings of $1070 per participant in the first program year and a return on investment of 1.9 times the costs (ie, every $100 invested reduced medical claims costs by $190). Behavioral health costs in the program group increased relative to the control group but were more than offset by decreases in physical health care costs. Savings were larger for participants with higher medical risk.

CONCLUSIONS AND RELEVANCE: In this cohort study, every $100 invested in an employer-sponsored behavioral health program with fast access to psychotherapy and medication management was associated with a reduction in medical claims costs by $190. These findings suggest that expanding access to behavioral health care may be a financially viable cost-reduction strategy for health care buyers.

PMID:39908020 | DOI:10.1001/jamanetworkopen.2024.57834

JAMA Netw Open. 2025 Feb 3;8(2):e2458059. doi: 10.1001/jamanetworkopen.2024.58059.

ABSTRACT

IMPORTANCE: Cognitive processing therapy (CPT) is an evidence-based treatment for posttraumatic stress disorder (PTSD). However, there is little evidence on the efficacy of CPT in East Asia.

OBJECTIVE: To evaluate whether CPT is effective in treating PTSD among outpatients in a Japanese medical setting.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial used a 16-week, single-center, assessor-blinded, parallel-group superiority design to examine the efficacy of CPT in conjunction with treatment as usual (CPT-TAU) vs waiting list with TAU (WL-TAU) from April 2016 through December 2022. The trial included adult patients with PTSD at a national psychiatric referral hospital in Tokyo, Japan. Analysis was based on intention to treat and per protocol and was performed from February 1 to April 30, 2024.

INTERVENTIONS: Participants were randomized 1:1 to CPT-TAU (n = 29), which consisted of 12 weekly individual CPT sessions, or WL-TAU (n = 31), which consisted of clinical monitoring and/or pharmacotherapy.

MAIN OUTCOMES AND MEASURES: The primary outcome was the Clinician-Administered PTSD Scale (CAPS-5) score for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) at 17 weeks. Secondary outcomes included self-reported PTSD symptoms assessed by the PTSD Checklist-5 and responder status at 17 weeks. Adverse events were evaluated using the Japanese version of the Common Terminology Criteria for Adverse Events, version 4.0.

RESULTS: Among 60 eligible participants (all included in the intention-to-treat analysis), mean (SD) age was 36.9 (9.9) years; 54 (90.0%) were women. The CPT-TAU group showed a mean (SE) reduction in CAPS-5 scores of 14.00 (1.92) points, with a low dropout rate (2 of 29 [6.9%]). Patients in the CPT-TAU group showed superiority in all secondary and other outcomes. The mean change difference was observed in depression (8.83; 95% CI, 6.00-11.66), suicidal ideation (6.73; 95% CI, 1.25-12.22), disability (8.16; 95% CI, 3.90-12.43), clinical global impression (0.84; 95% CI, 0.41-1.26), and loss of principal PTSD diagnosis (59.09; 95% CI, 37.19-81.00). There were no serious adverse events in the CPT-TAU group and 3 serious adverse events in the WL-TAU group during the intervention period.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of CPT-TAU vs WL-TAU, CPT was superior in reducing PTSD symptoms. These results strengthen the evidence for use of CPT in East Asian populations.

TRIAL REGISTRATION: Umin.Uc.Jp/Ctr Identifier: UMIN000021670.

PMID:39908018 | DOI:10.1001/jamanetworkopen.2024.58059

JAMA Netw Open. 2025 Feb 3;8(2):e2458141. doi: 10.1001/jamanetworkopen.2024.58141.

ABSTRACT

IMPORTANCE: In 2024, the US Preventive Services Task Force (USPSTF) reversed a 2009 policy recommending only females aged 50 to 74 years complete a biennial mammogram. Understanding whether females facing heterogeneous breast cancer risks responded to the 2009 guidance may illuminate how they may respond to the latest policy update.

OBJECTIVE: To evaluate whether the 2009 policy was associated with changes in mammography screening in females no longer recommended to complete a biennial mammogram and whether these changes varied by factors associated with breast cancer risk.

DESIGN, SETTING, AND PARTICIPANTS: The difference-in-differences design compared biennial mammogram trends in the exposed groups (aged 40-49 and ≥75 years) with trends of the unexposed groups (aged 50-64 and 65-74 years), before and after the 2009 update. Population-based, repeated cross-sectional survey data came from the Behavioral Risk Factor Surveillance System (BRFSS) biennial cancer screening module (2000-2018). The sample was restricted to females between ages 40 and 84 years. Data were analyzed from March 1 to June 30, 2024.

MAIN OUTCOMES AND MEASURES: The outcome was a binary variable indicating whether the respondent reported a mammogram in the past 2 years (biennial). After 2009, females aged 40 to 49 and 75 or older years were exposed to the policy update, as a complete biennial mammogram was recommended. Subgroup analyses included race and ethnicity, educational level, household income, smoking history, current binge drinking status, and state of residence.

RESULTS: The sample included 1 594 834 females; 75% reported a biennial mammogram. In those aged 40 to 49 years, the USPSTF update was associated with a 1.1 percentage-point (95% CI, -1.8% to -0.3 percentage points) decrease in the probability of a biennial mammogram, with the largest decreases in the non-Hispanic Black population (-3.0 percentage points; 95% CI, -5.5% to -0.5 percentage points). In the aged 75 years or older group, the USPSTF update was associated with a 4.8 percentage-point decrease (95% CI, -6.3% to -3.5 percentage points) in the probability of a biennial mammogram, with significant heterogeneity by race and ethnicity, binge drinking status, and state residence.

CONCLUSIONS AND RELEVANCE: In this study, socioeconomic factors were associated with differences in how females responded to the 2009 USPSTF mammography recommendation. Whether the 2024 update considered such differences is unclear. These findings suggest that including risk assessment into future USPSTF policy updates may improve adoption of risk-reducing interventions and shorten the time to diagnosis and treatment for high-risk patients.

PMID:39908017 | DOI:10.1001/jamanetworkopen.2024.58141

Musculoskelet Surg. 2025 Feb 5. doi: 10.1007/s12306-025-00884-y. Online ahead of print.

ABSTRACT

PURPOSE: Magnetic resonance imaging (MRI) is often used to evaluate patients with patellar dislocations to facilitate diagnosis and management strategies. Many radiological parameters have been described in the literature. The aim of this study was to assess the significance of tibial-tubercle trochlear groove distance (TT-TG) distance and other MRI measurements in patients with and without patellar instability.

METHODS: This case-control study included 41 patients with recurrent patellar instability and 50 patients with stable knees, all of whom underwent MRI scans. A total of 19 radiological parameters were measured in both groups.

RESULTS: All measured MRI parameters had statistically significant differences between both groups (p < 0.05) apart from trochlear cartilage length. TT-TG distance. 20 mm had the strongest association with patellar instability (OR 53.3, p = 0.006, 95%CI [3.1- 927.4]) and the highest specificity (100%) but had the lowest sensitivity (34%) out of all the measured parameters. TT-TG. 13 mm had a higher sensitivity (68%) but lower specificity (72%) and weaker association with patellar instability (OR 5.5, p < 0.001, 95%CI [2.2. 13.7]). TT-TG/trochlear articular cartilage width ratio also had a strong association with patellar instability (OR 14.7, p < 0.001, 95%CI [4.5. 48.5]) with high specificity (92%) but lower sensitivity (56%).

CONCLUSION: The cut-off values for TT-TG distance at 13 mm and 20 mm both had advantages and disadvantages which supports the concept of using patient-individualised ratios. Patellar instability is associated with many radiological abnormalities demonstrated on MRI scans. Selection of the most appropriate measurement is dependent on the philosophy and preference of the treating clinician.

PMID:39907984 | DOI:10.1007/s12306-025-00884-y