Tag: nevin manimala

J Am Coll Clin Pharm. 2026 Sep;9(9):e70269. doi: 10.1002/jac5.70269.

ABSTRACT

BACKGROUND: Large language models (LLMs) are increasingly explored for drug information support, yet their reliability and clinical applicability remain uncertain. This study evaluated multiple LLMs in responding to real-world drug information questions retrieved from a university hospital in Thailand, focusing on clarity in Thai, concordance with pharmacist responses, relevance, context awareness, and citation credibility.

METHODS: A total of 102 drug information questions were submitted to seven LLMs, generating 714 responses. In the inter-rater reliability phase, 10 pilot questions were submitted to all seven LLMs, and the resulting 70 responses were evaluated by three assessors, yielding 210 rating instances. Agreement was measured using intra-class correlation coefficient and Fleiss’ kappa. Following satisfactory agreement, the 102 questions were divided into three subsets, each assessed by one assessor using a predefined rubric. Binary outcomes were coded to calculate sensitivity and domain fulfillment rates, with pharmacist-provided answers serving as the reference standard for concordance. Model performance was compared using Cochran’s Q test, and citation-related issues were identified from qualitative comments.

RESULTS: Inter-rater reliability demonstrated substantial to almost perfect agreement, with coefficients ranging from 0.79-0.86. Overall, most LLMs performed well in clarity, relevance, and context awareness. Clarity scores ranged from 85.25%-92.75%, while fulfillment rates ranged from 0.97-1.00 for relevance and 0.90-0.99 for context awareness. Concordance was more variable, ranging from 0.70-0.86, whereas citation credibility was consistently weak, ranging from 0.03-0.36. A significant difference between LLMs was observed only in the concordance, with post hoc analyses identifying a significant difference between ChatGPT-5.2 Thinking (OpenAI, San Francisco, CA, USA) and Copilot Think Deeper (Microsoft, Redmond, WA, USA). (McNemar test, adjusted p = 0.0178).

CONCLUSIONS: LLMs show potential as tools for preliminary drug information retrieval and rapid responses generation in drug information services. However, variable concordance and persistent limitations in citation credibility indicate the need for continued pharmacist oversight.

PMID:42591004 | DOI:10.1002/jac5.70269

J Educ Eval Health Prof. 2026;23:26. doi: 10.3352/jeehp.2026.23.26. Epub 2026 Aug 13.

ABSTRACT

PURPOSE: When instructors address students by name, this may be associated with students’ engagement and sense of inclusion in higher education. However, name-based instructor-student interaction has rarely been conceptualized as a multidimensional construct, and no psychometrically evaluated instrument is available for medical education. This study developed and psychometrically evaluated a pilot questionnaire assessing students’ perceived experiences of being addressed by name in medical teaching contexts.

METHODS: Questionnaire development followed a multistep exploratory approach that included qualitative input, iterative item refinement, and expert content review. An initial pool of 59 items was administered to medical students (n=270) from semesters 2-10 at a German medical faculty. Factor structure was examined using exploratory factor analysis based on Pearson correlations, oblique rotation, and predefined item-reduction criteria. Internal consistency was assessed using McDonald’s ω and Cronbach’s α, discriminant validity using the heterotrait-monotrait ratio, and generalized partial credit models were estimated separately for each factor.

RESULTS: Exploratory factor analysis yielded a parsimonious 3-factor solution comprising 15 items: cognitive activation, appreciation & social belonging, and social evaluative anxiety. The final model showed good fit, and all factors demonstrated strong internal consistency (ω=0.84-0.88), good measurement precision (expected a posteriori reliability=0.83-0.88), adequate discriminant validity (heterotrait-monotrait ratio <0.85), and acceptable item fit.

CONCLUSION: The pilot questionnaire captures 3 distinct dimensions of name-based instructor-student interaction and provides promising initial psychometric evidence for medical education research. It may support confirmatory validation and further study of relational teaching practices.

PMID:42590989 | DOI:10.3352/jeehp.2026.23.26

ANZ J Surg. 2026 Aug 13. doi: 10.1111/ans.70906. Online ahead of print.

ABSTRACT

BACKGROUND: Anatomical variants of the cystic duct impair attainment of the critical view of safety during laparoscopic cholecystectomy, predisposing to bile duct injury, bile leak, and conversion to open surgery. No prior synthesis has examined their prevalence across all detection modalities.

OBJECTIVES: To determine the pooled prevalence of cystic duct anatomical variants and their association with surgical outcomes.

DATA SOURCES: MEDLINE/PubMed, Embase, and Cochrane CENTRAL were searched from January 2000 to November 2025. Reference lists were hand-searched for additional eligible studies.

REVIEW METHODS: PRISMA 2020-compliant systematic review and meta-analysis. Pooled prevalence estimates were calculated using a random-effects model with Freeman-Tukey double arcsine transformation. Heterogeneity was assessed using the I² statistic and Cochran’s Q test. Quality was assessed using the JBI Prevalence checklist. Prospectively registered: PROSPERO (CRD420251178103).

RESULTS: Fifty-three studies (n = 18 875 patients; 22 countries) were included. The pooled prevalence of any cystic duct variant was 19.1% (95% CI 13.2%-25.7%). Variant-specific estimates were: high insertion 16.6% (9.2%-25.6%; k = 16), medial insertion 7.3% (4.0%-11.5%; k = 19), low insertion 6.5% (4.2%-9.2%; k = 29), spiral/posterior course 14.6% (8.2%-22.5%; k = 17), and right hepatic duct insertion 1.3% (0.7%-2.1%; k = 15). Heterogeneity was considerable (I² = 79.6%-99.4%), attributable to variation in detection modality and classification systems. Only 11 studies (20.8%) reported surgical outcomes; pooled conversion to open surgery rate was 11.0% (95% CI 6.9%-15.2%). No significant publication bias was detected (Egger’s test p = 0.208).

CONCLUSION: Cystic duct anatomical variants affect approximately one in five patients undergoing biliary imaging or cholecystectomy. The lack of a universal system and the paucity of outcome data stratified by variant subtype represent a major gap. Prospective studies using standardised nomenclature and systematically reporting surgical outcomes are urgently needed.

PMID:42590983 | DOI:10.1111/ans.70906

Acta Orthop. 2026 Aug 13;97:538-543. doi: 10.2340/17453674.2026.46527.

ABSTRACT

BACKGROUND AND PURPOSE: Hip fracture treatment with (hemi)arthroplasty carries a risk of periprosthetic joint infection (PJI), which may be reduced by using dual antibiotic-loaded bone cement (ALBC). We aimed to compare the rate of all-cause revision, revision for infection, and mortality following single or dual ALBC use in hip fracture arthroplasty.

METHODS: From the Dutch Arthroplasty Register, we identified all cemented hemiarthroplasties (HA) and total hip arthroplasties (THA) performed in the period 2007-2024 for proximal femoral fracture. Crude cumulative incidences of all-cause and infection revision were estimated using competing risk survival analyses with death as competing event. Mortality was estimated using Kaplan-Meier analysis. Cause-specific Cox regression models adjusting for age, year of surgery, history of previous surgeries, and American Society of Anesthesiologists (ASA) classification estimated hazard ratios (HRs).

RESULTS: We analyzed 56,434 hip arthroplasties, of which 1,651 used dual ALBC. 1-year crude cumulative incidences were similar across groups for all-cause revision, infection revision, and mortality. After adjustment, dual ALBC was not associated with a reduced rate of all-cause revision (HR 1.2, 95% confidence interval [CI] 0.9-1.5]) compared with single ALBC. Dual ALBC was associated with a modestly higher revision for infection (HR 1.6, CI 1.0-2.5) and mortality in HA (HR 1.2, CI 1.1-1.2).

CONCLUSION: Dual ALBC was not associated with lower revision rates compared with single ALBC but a modestly higher revision rate was noted for infection and mortality following hip arthroplasty after hip fracture.

PMID:42590963 | DOI:10.2340/17453674.2026.46527

J Endovasc Ther. 2026 Aug 13:15266028261477039. doi: 10.1177/15266028261477039. Online ahead of print.

ABSTRACT

PURPOSE: To compare the efficacy and safety of transradial (TR) versus transfemoral (TF) access in peripheral arterial angioplasty and stenting, providing evidence to guide clinical decision-making in endovascular interventions.

METHODS: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs) and cohort studies comparing TR and TF approaches in patients with peripheral artery disease (PAD) were included. Databases (PubMed, Embase, and Cochrane Library) were searched up to May 10, 2025. Risk of bias was assessed using the Cochrane tool, and RevMan 5.3 was used for statistical analysis. Outcomes included technical success, fluoroscopy time, hospital stay, minor/major bleeding, and access site complications.

RESULTS: Seventeen studies (13 210 patients) were analyzed. No significant difference was found in technical success (odds ratio [OR] = 1.48, P = .36, 95% CI, 0.64, 3.54). However, TR access was associated with a shorter hospital stay (mean difference = -0.09 days, P = .01, 95% CI, -0.16, -0.02) and a trend toward fewer access site complications (OR = 0.49, P = .07, 95% CI, 0.23, 1.06), with significant reduction in lower extremity interventions (P < .01). Transradial also showed lower bleeding risks, with a trend in minor bleeding (P = .09) and significant reduction in major bleeding (P = .03).

CONCLUSION: Transradial access for peripheral angioplasty and stenting offers advantages over TF, including reduced hospital stay, fewer complications, and lower bleeding risks. As TR techniques advance, TR may become the preferred approach, particularly when TF access is not feasible.Clinical ImpactThis study provides clinically relevant evidence supporting transradial (TR) access as a practical alternative to transfemoral (TF) access for peripheral arterial interventions. TR access showed fewer access-site complications, shorter hospitalization, and a trend toward reduced bleeding, suggesting benefits for both patient recovery and healthcare resource use. Although TF access remains preferable in certain femoropopliteal interventions, the growing availability of TR-specific devices and robotic technologies may further expand the role of TR access. These findings can guide access-site selection and improve procedural safety in clinical practice.

PMID:42590943 | DOI:10.1177/15266028261477039

J Nurs Manag. 2026;2026(1):e2913316. doi: 10.1155/jonm/2913316.

ABSTRACT

BACKGROUND: Nurses are increasingly required to adapt to organizational changes related to healthcare reform. Organizational members’ readiness for implementing change is a key determinant of effective change. However, a reliable tool for assessing organizational readiness for implementing change among Chinese nurses is currently lacking.

AIMS: To cross-culturally adapt the Organizational Readiness for Implementing Change (ORIC) scale and validate its psychometric properties in the context of Chinese healthcare institutions.

METHODS: In this cross-sectional study, Samples A and B were collected using convenience and stratified convenience sampling from four tertiary Grade A hospitals from July to December 2025. Data were collected using the General Information Questionnaire and the adapted Chinese ORIC scale. Sample A was used for item analysis and exploratory factor analysis, while Sample B was used for multilevel confirmatory factor analysis and multilevel reliability to examine the psychometric properties of the ORIC scale.

RESULTS: The valid response rates were 100% for Sample A and 93.33% for Sample B. Item analysis supported the retention of all 10 items (r > 0.300, p < 0.050). Exploratory factor analysis extracted two factors, accounting for 79.81% of the total variance. Multilevel confirmatory factor analysis demonstrated a good fit of the two-factor structure at the organizational level (χ²/df = 1.211, RMSEA = 0.014, CFI = 0.978, TLI = 0.988, SRMR-Within = 0.024, SRMR-Between = 0.017). Reliability analyses indicated good multilevel internal consistency (Cronbach’s ɑ = 0.771-0.988) and satisfactory test-retest reliability (p < 0.001).

CONCLUSIONS: The Chinese ORIC scale comprises two dimensions with 10 items. Following rigorous cross-cultural adaptation and validation, it demonstrates good psychometric properties and can be used to assess nurses’ organizational readiness for implementing change in Chinese healthcare institutions.

IMPLICATIONS FOR NURSING MANAGEMENT: The validated Chinese ORIC scale provides nursing managers with an evidence-based tool to assess organizational readiness for implementing change from the perspective of nurses as organizational members. By capturing shared perceptions of change commitment and change efficacy at the organizational level, it can inform targeted implementation strategies, strengthen organizational support, and facilitate successful healthcare change initiatives.

PMID:42590921 | DOI:10.1155/jonm/2913316

Small. 2026 Aug 12:e75018. doi: 10.1002/smll.75018. Online ahead of print.

ABSTRACT

Solving the morphological complexity of nanomaterials such as silver nanoparticles, at the one-atom level, is a prerequisite to reach a rational design of their properties. To date, structural measurements in ultra-high vacuum of silver nanoparticles remain uninterpreted. The narrow competition between octahedra and decahedra evolves in morphological statistics in the range 309-923 atoms, whereas the most stable icosahedra appear as a minority. To solve this debate, an extensive ab initio investigation of silver nanoparticles is presented in the range 18-1654 atoms (500 nanoparticles). Originally, we interpret measurements, thanks to the inclusion of defects. A very narrow competition is highlighted between defective truncated octahedra and Marks-decahedra, both dominating defective icosahedra in number but not in stability, and the experimental assumption suggesting that the presence of all symmetries is due to kinetic trapping is supported. Highly accurate computational conditions are mandatory to predict crossing sizes between structures, within one-atom precision. This exigence results from the usual stability descriptor. Imagine solving the morphological debate of silver nanoparticles without an accuracy of 10 – 5 eV. at – 1 in cohesion energy is illusory. The provided ab initio database opens promising perspectives to train machine-learning approaches aiming to examine morphological battles at larger size.

PMID:42590916 | DOI:10.1002/smll.75018

J Magn Reson Imaging. 2026 Aug 12. doi: 10.1002/jmri.70496. Online ahead of print.

ABSTRACT

BACKGROUND: Ectopic fat deposition in the liver and pancreas is closely linked to metabolic dysfunction, a key driver of the global burden of chronic disease. However, studies on intra-organ distribution of ectopic fat in the pediatric obese population remain limited.

PURPOSE: To assess MRI-based spatial distribution patterns of hepatic and pancreatic fat using a fully automated nnU-Net model and evaluate their association with biochemical risk markers.

STUDY TYPE: Prospective.

SUBJECT: Eighty-one pediatric patients (age: 12 [11, 13] years, 57 males) with overweight or obesity based on body mass index z-score.

FIELD STRENGTH/SEQUENCE: 1.5 T, gradient-echo modified-DIXON T₁W.

ASSESSMENT: The spatial distribution of fat in liver and pancreas, the correlations between hepatic and pancreatic fat fraction (FF), and the association between the fat measures and biochemical risk markers were evaluated.

STATISTICAL TESTS: Paired Wilcoxon test or t-test, repeated measure ANOVA or Friedman’s test, Kruskal-Wallis test, Spearman correlation analysis. Significance was set at p < 0.05.

RESULTS: Hepatic FF was significantly higher in the right lobe (median, 16.22%) than in the left lobe (median, 10.43%), and increased with distance from the portal vein. The degree of hepatic fat heterogeneity increased with the amount of fat deposition (whole variance: Level 0: 4.10; Level 1: 11.53; Level 2: 28.94; Level 3: 31.21). Then, the FF and its variance in the pancreatic body and tail were significantly higher than those in the head. A weak but statistically significant correlation (r range, 0.29-0.38) was observed between hepatic and pancreatic FF. Hepatic FF correlated with triglyceride and apolipoprotein B, but pancreatic fat showed no association (p range, 0.096-0.994) with lipid profiles, HOMA-IR, or HOMA-β.

DATA CONCLUSION: Intra-hepatic and intra-pancreatic fat were heterogeneously distributed in pediatric obese population. Although fat accumulation in the liver and pancreas was weakly correlated, hepatic and pancreatic fat may arise from distinct metabolic disorders.

EVIDENCE LEVEL: 2.

TECHNICAL EFFICACY: Stage 1.

PMID:42590912 | DOI:10.1002/jmri.70496

Pharmacoepidemiol Drug Saf. 2026 Sep;35(9):e70446. doi: 10.1002/pds.70446.

ABSTRACT

PURPOSE: Although antidepressant use during pregnancy has been linked to adverse birth outcomes such as stillbirth and preterm delivery, existing evidence is conflicting and rarely presents absolute risk estimates. We aimed to assess the association between antidepressant use during pregnancy and birth outcomes, alongside estimates of absolute risk to aid clinical interpretation.

METHODS: We conducted a multi-country cohort study using data from the UK Clinical Practice Research Datalink (1996-2018), Norwegian Medical Birth Registry (2009-2020), and Swedish Medical Birth Register (2006-2020). Discordant sibling analyses and paternal negative controls were used to investigate associations with stillbirth, neonatal death, gestational age, size for gestational age, and Apgar score < 7 at 5-min among pregnancies delivered at ≥ 22 weeks’ gestation.

RESULTS: Among 120 209 (4.8%) pregnancies exposed to antidepressants, maternal use was associated with stillbirth (adjusted pooled odds ratio [aOR] 1.16, 95% CI 1.05-1.28), preterm delivery (aOR 1.26, 95% CI 1.23-1.30), and low Apgar score (aOR 1.83, 95% CI 1.75-1.91). Associations persisted in sibling analyses with greater uncertainty. The predicted absolute risk of stillbirth was 0.34% among unexposed pregnancies and 0.40% among exposed. When restricting to mothers with depression or anxiety, the association with stillbirth attenuated (aOR 1.07, 95% CI 0.94-1.21). Paternal antidepressant use was modestly associated with preterm delivery and low Apgar score.

CONCLUSIONS: Maternal antidepressant use during pregnancy may be associated with increased risks of preterm delivery and low Apgar score, though absolute risks remain low. Residual confounding related to parental mental health is likely to explain part of these associations.

PMID:42590906 | DOI:10.1002/pds.70446

United European Gastroenterol J. 2026 Sep;14(7):e70271. doi: 10.1002/ueg2.70271.

ABSTRACT

BACKGROUND: Endoscopy with histopathological assessment of esophageal biopsies is the cornerstone for the diagnosis and phenotypic characterization of eosinophilic esophagitis (EoE).

OBJECTIVE: To evaluate temporal trends in endoscopic assessment and biopsy sampling practices for EoE in a large European cohort and their association with temporal trends in diagnostic delay (DD).

METHODS: A cross-sectional analysis was conducted using multicenter data from the EoE CONNECT registry. Endoscopic findings and biopsy data at diagnosis were analyzed. Temporal trends in biopsy strategies, EREFS implementation, and DD were assessed. Diagnostic sensitivity of individual esophageal segments and their combinations was evaluated in patients undergoing multi-segment sampling. Associations between guideline publication and biopsy practices were analyzed using logistic regression models.

RESULTS: A total of 3298 patients were included. Biopsies were obtained from one esophageal segment in 12.6% of patients, two segments in 63.6%, and three segments in 23.8%. Adherence to guideline-recommended biopsy strategies improved over time, with reduced single-segment sampling and increased use of ≥ 2 segments. Distal esophageal biopsies provided the highest diagnostic sensitivity, and sampling that included the distal segment achieved sensitivity above 97%, particularly when combined with middle esophageal biopsies. EREFS reporting increased from 88-90% to over 98% in recent years. DD decreased significantly over time (approximately 0.7 years per calendar year), accompanied by a shift from mixed/stricturing to inflammatory phenotypes.

CONCLUSION: Increased alignment with international guidelines, reflected by standardized endoscopic reporting and multi-segment biopsy protocols, was associated with improved diagnostic sensitivity, reduced DD, and fewer fibrostricturing presentations.

PMID:42590904 | DOI:10.1002/ueg2.70271