Tag: nevin manimala

J Am Med Inform Assoc. 2025 Oct 16:ocaf180. doi: 10.1093/jamia/ocaf180. Online ahead of print.

ABSTRACT

BACKGROUND AND SIGNIFICANCE: Ambient listening tools powered by generative artificial intelligence (GenAI) offer real-time, scribe-like support that reduce documentation burden and may help alleviate burnout. This study assesses physician-perceived benefits and challenges of ambient AI implementation through surveys and evaluates its effectiveness in clinical workflows using automatically recorded electronic health record (EHR) time-efficiency metrics.

METHOD AND MATERIALS: A quality improvement pilot has been underway at UCI Health since December 2023. Epic EHR Signal metrics were analyzed to assess changes in note length, documentation time, and same-day encounter closure rates. Matched pre- and post-implementation surveys evaluated physician-perceived changes in documentation burden, clinical efficiency, and care quality. We also examined open-ended survey responses using thematic analysis to supplement quantitative findings.

RESULTS: Analysis on EHR usage data from 167 physicians showed significant reductions in note-writing time, despite an increase in note length. Survey responses (n = 65) also indicated statistically significant improvements across multiple domains. Physicians reported reduced cognitive demand (P = .031) and documentation effort (P = .014), alongside perceptions of enhanced clinical efficiency, patient-centered care, and EHR system usability. Thematic analysis confirmed these quantitative findings and identified opportunities for improvement, including specialty-specific customization and expanded AI functionality.

DISCUSSION: Ambient AI tools demonstrated improved documentation efficiency, perceived care quality, and reduced cognitive workload. These benefits suggest potential to alleviate key burdens in clinical documentation.

CONCLUSION: Future development should prioritize customization for specialty-specific and individual physician needs, ensure the reliability and accuracy of AI-generated content, and integrate ethical and legal considerations to facilitate safe and scalable implementation in patient-centered care contexts.

PMID:41100159 | DOI:10.1093/jamia/ocaf180

Adv Neonatal Care. 2025 Oct 10. doi: 10.1097/ANC.0000000000001303. Online ahead of print.

ABSTRACT

BACKGROUND: High levels of nurse stress and burnout, including among Neonatal Intensive Care Unit (NICU) nurses, were documented prior to the pandemic. The pandemic increased stressors for NICU nurses although not all NICUs were affected in the same way.

PURPOSE: To examine the relationship between NICU nurses’ perceived stress and burnout during a period of workforce strain.

METHODS: A secondary analysis of cross-sectional survey data collected from 259 nurses in 10 NICUs enrolled in a parent study between 2021 and 2023. A researcher-developed questionnaire captured nurses’ demographic and work characteristics at the time of parent study enrollment. Perceived stress was measured using the Perceived Stress Scale (PSS) and burnout was assessed using the Emotional Exhaustion (EE) subscale of the Maslach Burnout Inventory. Descriptive statistics and multivariable linear regression were used for the analysis.

RESULTS: The mean EE score was 19.7, and more than half of all participants reported a moderate or high degree of burnout. Higher PSS scores, more years of NICU experience, and more weekly hours in direct patient care were associated with higher EE scores. Variation in EE score distribution was observed between NICUs, and the relationship between perceived stress and burnout varied by NICU.

IMPLICATIONS FOR PRACTICE AND RESEARCH: We observed high levels of stress and burnout with experienced nurses and those providing direct care most at risk. Strategies to reduce burnout include periodic reduction of direct patient care hours and support tailored to nurses’ career stages. Future research should focus on intervention development and testing.

PMID:41100149 | DOI:10.1097/ANC.0000000000001303

JAMA Ophthalmol. 2025 Oct 16. doi: 10.1001/jamaophthalmol.2025.3622. Online ahead of print.

ABSTRACT

IMPORTANCE: Multiple choice questions (MCQs) are an important and integral component of ophthalmology residency training evaluation and board certification; however, high-quality questions are difficult and time-consuming to draft.

OBJECTIVE: To evaluate whether general-domain large language models (LLMs), particularly OpenAI’s Generative Pre-trained Transformer 4 (GPT-4), can reliably generate high-quality, novel, and readable MCQs comparable to those of a committee of experienced examination writers.

DESIGN, SETTING, AND PARTICIPANTS: This survey study, conducted from September 2024 to April 2025, assesses LLM performance in generating MCQs based on the American Academy of Ophthalmology (AAO) Basic and Clinical Science Course (BCSC) compared with a committee of human experts. Ten expert ophthalmologists, who were masked to the generation source, independently evaluated MCQs using a 10-point Likert scale (1 = extremely poor; 10 = criterion standard quality) across 5 criteria: appropriateness, clarity and specificity, relevance, discriminative power, and suitability for trainees.

INTERVENTION: Relevant BCSC content and AAO question-writing guidelines were input into GPT-4o via Microsoft’s Azure OpenAI Service, and structured prompts were used to generate MCQs.

MAIN OUTCOMES AND MEASURES: The primary outcomes were median scores and statistical comparisons using the bootstrapping method; string similarity scores based on Levenshtein distance (0-100, with 100 indicating identical content) between LLM-MCQs and the entire BCSC question bank; Flesch Reading Ease metric for readability; and intraclass correlation coefficient (ICC) for inter-rater agreement are reported.

RESULTS: The 10 graders had between 1 and 28 years of clinical experience in ophthalmology (median [IQR] experience, 6 years [3-15 years]). Questions generated by GPT-4 and a committee of experts received median scores of 9 and 9 in combined scores, appropriateness, clarity and specificity, and relevance (difference, 0; 95% CI, 0-0; P > .99); 8 and 9 in discriminative power (difference, 1; 95% CI, -1 to 1; P = .52); and 8 and 8 in suitability for trainees (difference, 0; 95% CI, -1 to 0; P > .99), respectively. Nearly 95% of LLM-MCQs had similarity scores less than 60, indicating most LLM-MCQs had limited or no resemblance to existing content. Interrater reliability was moderate (ICC, 0.63; P < .001), and mean (SD) readability scores were similar across sources (37.14 [22.54] vs 42.60 [22.84]; P > .99).

CONCLUSIONS AND RELEVANCE: In this survey study, results indicate that an LLM could be used to develop ophthalmology board-style MCQs and expand examination banks to further support ophthalmology residency training. Despite most questions having a low similarity score, the quality, novelty, and readability of the LLM-generated questions need to be further assessed.

PMID:41100119 | DOI:10.1001/jamaophthalmol.2025.3622

Death Stud. 2025 Oct 16:1-10. doi: 10.1080/07481187.2025.2572746. Online ahead of print.

ABSTRACT

The Aarhus Prolonged Grief Disorder Scale (A-PGDs) is a self-report measure of prolonged grief disorder (PGD) as defined in the International Classification of Diseases, 11th revision (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text revision (DSM-5-TR). To enhance its clinical utility, we developed a brief version in a bereaved community sample (n = 590) and tested its psychometric properties in a subclinical sample (n = 124). Using target exploratory factor analysis, we identified five items unique to PGD in the community sample. Confirmatory factor analysis supported their latent structure in the subclinical sample, and internal reliability was high. In the subclinical sample, 35.5% and 33.1% met criteria for probable ICD-11 and DSM-5-TR PGD, respectively, and convergent validity was supported by strong associations with a structured clinical interview. The A-PGDs-brief is a short, easy-to-use measure of ICD-11 and DSM-5-TR PGD validated against a structured clinical interview.

PMID:41100118 | DOI:10.1080/07481187.2025.2572746

JAMA Netw Open. 2025 Oct 1;8(10):e2534221. doi: 10.1001/jamanetworkopen.2025.34221.

ABSTRACT

IMPORTANCE: The emergency department (ED) is a critical point of contact within the health care system and an opportunity to initiate nonpharmacologic migraine treatment.

OBJECTIVE: To examine whether progressive muscle relaxation (PMR) smartphone-based migraine self-management improved patient-reported outcomes for migraine compared with enhanced usual care.

DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial of the smartphone application RELAXaHEAD with and without PMR. Patients aged 18 to 65 years visiting New York University Langone Health EDs for headache who met migraine criteria and self reported 4 or more migraine days per month were recruited from June 2019 to October 2021 with follow-up at 3 months. Data were analyzed from June 2022 to June 2025.

INTERVENTION: Participants in the intervention group were asked to listen to the app-based PMR for 60 days. Participants in the control group were asked to use the app as a symptom diary.

MAIN OUTCOMES AND MEASURES: Primary outcome was change in migraine-related disability (MIDAS). Secondary outcomes were change in migraine-specific quality of life (MSQv2) and monthly headache days (MHDs). Adherence (number of days of diary use, PMR use and total minutes of PMR use over 90-day period) was measured using back-end analytics.

RESULTS: Of the 94 patients (median [IQR] age, 33 [26-45] years; 57 [82.6%] female) randomized (48 control patients and 46 PMR patients), 69 of 94 (73%) had 1 or more follow-up MIDAS scores and constituted the modified intent-to-treat population (35 control patients and 34 PMR patients). The mean (SD) change in MIDAS scores from baseline to 3 months (last observation carried forward [LOCF] used if missing 3-month follow-up data) differed between groups (PMR, 25.09 [29.64] vs control, 6.86 [59.61]; P = .01). PMR had nearly double the number of respondents improving by 5 or more MIDAS points (28 of 34 [82.4%] vs 16 of 35 [45.7%] respondents; P = .002). There was no difference in MSQv2 domains from baseline to LOCF between PMR and control (mean [SD] role function preventive domain for PMR, 16.9 [24.5] vs control, 11.3 [25.9]); emotional function domain (mean [SD] for PMR, 26.5 [26.9] vs control, 19.8 [38.5]); and role function restrictive domain (mean [SD] for PMR, 18.1 [22.7] vs control, 18.7 [26.8]). Mean (SD) change in MHDs (baseline to 3 months) did not differ between groups (PMR, 2.9 [8.0]; 23 days vs control, -1.6 [6.5]; 25 days).

CONCLUSION AND RELEVANCE: A PMR-based self-management program offered to patients with migraine after ED discharge yielded clinically significant reductions in migraine-related disability.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04281030.

PMID:41100087 | DOI:10.1001/jamanetworkopen.2025.34221

Oncologist. 2025 Oct 16:oyaf320. doi: 10.1093/oncolo/oyaf320. Online ahead of print.

ABSTRACT

BACKGROUND: Trophoblast cell-surface antigen 2 (Trop2), a transmembrane glycoprotein overexpressed in multiple cancers, plays crucial roles in tumor progression and therapy resistance, yet its expression patterns and clinical significance in digestive cancers remain incompletely characterized.

METHODS: This retrospective study analyzed a consecutive cohort of 2,370 patients with histologically confirmed digestive cancers (804 gastric [GC], 1,384 colorectal [CRC], and 182 pancreatic cancers [PC]). Comprehensive clinicopathological data were systematically collected. Trop2 expression was quantitatively evaluated by immunohistochemistry (IHC) and classified into Trop2-negative, Trop2-low, and Trop2-high based on the product of staining intensity and the proportion of positive tumor cells. Statistical analyses included univariate and multivariate logistic regression were used to identify significant clinicopathological and molecular predictors of Trop2 expression patterns. Univariate and multivariate logistic regression analyses were used to explore the relationship between Trop2 expression status (positive [Trop2 intensity ≥ 2] vs. negative) and various clinicopathological features of different tumor types.

RESULTS: Trop2 was widely expressed in digestive cancers, with highest prevalence in PC and GC. Multivariate analysis revealed distinct Trop2 expression patterns in gastrointestinal malignancies. At the pan-cancer level, Trop2 expression significantly correlated with tumor type, SRCC, VI and PNI. Notably, GC showed independent associations with SRCC and intestinal-type Lauren classification; CRC showed VI as the predominant factor associated with Trop2 expression; while PC demonstrated unique correlations with female sex and T1 stage. These findings highlight tumor-type specific regulation of Trop2, providing critical insights for prognostic assessment and targeted therapy.

CONCLUSION: Trop2 is a promising biomarker for tumor aggressiveness and a potential target for antibody-drug conjugates (ADCs) in digestive cancers, particularly in SRCC-rich, metastatic, and invasive subtypes. These findings provide strong rationale for stratifying patient populations in future clinical investigations of Trop2-directed ADC therapies.

PMID:41100061 | DOI:10.1093/oncolo/oyaf320

Int J Environ Health Res. 2025 Oct 16:1-13. doi: 10.1080/09603123.2025.2571143. Online ahead of print.

ABSTRACT

Via allostasis, various physiological systems work together to protect the body amid various stressors. However, the wear and tear of allostatic load (AL) can ultimately predispose an organism to disease. The role of allostatic load in cardiovascular disease has been well-established, but studies have been inconclusive as to the relationship between allostatic load and sleep quality. This study explored the interplay between allostatic load and sleep disturbances. Using the National Health and Nutrition Examination Survey (NHANES) 2017-2020 Pre-Pandemic data, statistical analyses were conducted to assess associations between AL and sleep disturbances, including differences across sociodemographic and lifestyle factors. Increased AL was associated with increased prevalence of sleep disturbances such as sleep apnea symptoms. Correlations were found between increased AL and certain sociodemographic and lifestyle factors as well. Finally, increased pulse pressure was found to be associated with higher AL and older age. Results supported the idea that sleep quality and duration could be linked to AL physiological regulation and cardiovascular health. It also reinforced the idea that pulse pressure could be an indicator of cardiovascular risk, particularly for older adults. Therefore, sleep disturbances may represent a measurable indicator of AL and associated cardiovascular risk.

PMID:41100056 | DOI:10.1080/09603123.2025.2571143

Rheumatology (Oxford). 2025 Oct 16:keaf542. doi: 10.1093/rheumatology/keaf542. Online ahead of print.

ABSTRACT

OBJECTIVES: To perform the cross-cultural adaptation of the Psoriasis Epidemiology Screening Tool (PEST) questionnaire into Spanish (PEST-S) and conduct a preliminary exploratory assessment of its discriminative ability to identify psoriatic arthritis (PsA) among patients with psoriasis (Ps), osteoarthritis (OA), or both.

METHODS: The PEST questionnaire was translated and culturally adapted into Spanish following international guidelines. A cross-sectional study was conducted including adult patients with PsA, Ps, OA, and Ps+OA. The PEST-S was administered to all participants. PsA diagnosis was confirmed using CASPAR criteria. Diagnostic performance was evaluated using sensitivity, specificity, likelihood ratios, area under the ROC curve (AUC), and Cohen’s kappa coefficient. Comparisons of individual PEST-S items were performed across diagnostic groups.

RESULTS: A total of 124 patients were included: 32 with PsA, 31 with Ps, 33 with Ps+OA, and 28 with OA. The questionnaire required less than one min to complete. PEST-S scores ≥3 yielded a sensitivity of 100%, specificity of 94.2%, LR+ of 17.2, and LR- of 0. The AUC was 0.97 (95% CI: 0.95-0.99). Agreement between PEST-S and CASPAR classification was 93.2% (κ = 0.838). A statistically significant difference was found in the responses to all five PEST-S items between patients with PsA and those in the other diagnostic groups (p< 0.05).

CONCLUSION: The Spanish version of the PEST questionnaire (PEST-S) demonstrated excellent diagnostic performance in distinguishing PsA from Ps and OA in a Spanish-speaking population. These findings support its clinical utility and justify further validation in a screening context among patients with psoriasis without prior rheumatologic evaluation.

PMID:41100051 | DOI:10.1093/rheumatology/keaf542

Sports Med Open. 2025 Oct 16;11(1):120. doi: 10.1186/s40798-025-00889-8.

ABSTRACT

BACKGROUND: Maximal fat oxidation (MFO) and its intensity (FAT_max) are important for metabolic health, but current models explain only partially their variability. Research suggests that factors like oxygen uptake efficiency (i.e., OUES and OUEP) may better predict MFO and FAT_max than maximal oxygen uptake (VO_2max) and the first ventilatory threshold (VT1). This study investigates whether OUES and OUEP can explain more of the variation in fat oxidation during exercise.

METHODS: Fifty-five healthy male participants underwent a series of tests, including body composition measurements, resting metabolic rate, and a treadmill exercise trial to assess cardiovascular fitness (CRF) and fat oxidation. The incremental exercise test measured gas exchange and heart rate, and blood samples were collected for glucose and lactate analysis. Statistical analyses, including multivariate regression, were used to explore relationships between CRF biomarkers, OUES, OUEP, and fat oxidation, with significance set at p < 0.05.

RESULTS: Participants with excellent cardiovascular fitness (CRF) showed lower body fat, higher fat-free mass, and higher VO_2max, MFO, and FAT_max compared to those with poor or regular CRF. When oxygen uptake efficiency and VT1 were included in the models, VT1 and OUEP emerged as stronger predictors of MFO and FATmax than VO_2max. The OUES did not significantly relate to MFO or FAT_max but was a key moderator of VO_2max, explaining 71% of its variance.

CONCLUSIONS: VT1 and OUEP are stronger predictors of MFO and FAT_max than VO_2max, while OUES significantly moderates VO_2max, highlighting the importance of submaximal biomarkers in fat oxidation capacity.

PMID:41100029 | DOI:10.1186/s40798-025-00889-8

Sports Med Open. 2025 Oct 16;11(1):119. doi: 10.1186/s40798-025-00915-9.

ABSTRACT

BACKGROUND: Running is an effective exercise for personal fitness, yet many recreational runners suffer from running-related injuries. Prolonged running induces neuromuscular fatigue, interfering with an individual’s preferred running gait and increasing the injury risk. This study aimed to examine gait patterns associated with fatigue in runners during a full marathon by analyzing lower limb segment and pelvis kinematics captured via multiple inertial measurement units (IMU).

METHODS: Three IMUs were attached to measure the rearfoot, shank, and pelvis kinematics of 23 male recreational runners during an outdoor marathon. Data were extracted for nine time points: the baseline, and at the 5th, 10th, 15th, up to the 40th kilometer. Each segment’s free acceleration and angular velocity during the stance phase at these nine timelines were analyzed using statistical non-parametric mapping.

RESULTS: Male recreational runners exhibited a lower running speed (1.13 km/h, p < 0.001), lengthened stance time (0.009 s, p ≤ 0.001), and prolonged stride time (0.014 s, p < 0.05) after 35 km of running, alongside a smaller anterior and superior acceleration of rearfoot and shank during the propulsion phase (p < 0.05). With increasing running mileage, the rearfoot demonstrated a gradual increase in lateral acceleration and external rotation velocity during the propulsion phase (p < 0.01). The shank exhibited a progressive decline in anterior tilt velocity during the loading response phase (p < 0.05). Additionally, the pelvis displayed significantly greater anterior acceleration during propulsion at the 40 km mark (p < 0.01).

CONCLUSIONS: Male recreational runners exhibit a marked decline in performance only after 35 km. The progressive increase in rearfoot lateral acceleration and external rotation velocity during the propulsion phase, may be associated with a compensatory distal strategy to maintain balance stability. The gradual reduction in anterior tilt velocity of the shank during the loading response likely reflects a stiffness-enhancing mechanism in the lower limb to preserve locomotor efficiency under fatigue. The increased anterior acceleration of the pelvis at the 40 km mark suggests a proximal shift in propulsion mechanics due to fatigue. These findings underscore the necessity of long-distance protocols, continuous kinematic monitoring, and full stance-phase analysis to study running fatigue.

PMID:41100028 | DOI:10.1186/s40798-025-00915-9