Tag: nevin manimala

JCO Precis Oncol. 2026 Jul;10(7):e2600158. doi: 10.1200/PO-26-00158. Epub 2026 Jul 8.

ABSTRACT

PURPOSE: Precision medicine has revolutionized oncology; however, tumor biomarkers are not reflective of the heterogeneous cancer population. We evaluated NRG Oncology prostate cancer (PCa) clinical trials for demographic differences among patients with optional biospecimen collection (BC) consent and biospecimen submission (BSub).

METHODS: Data from 19 NRG PCa clinical trials closed before 2015 were analyzed. Patients who consented to BC and completed BSub were evaluated by race, ethnicity, median income, area deprivation index (ADI; categorized as highest v lowest three quartiles), age at enrollment, site, and year of enrollment. T/chi-square tests were used for continuous/categorical variables, respectively, followed by logistic regression.

RESULTS: Of the 15,648 randomized patients eligible for BC, 11,796 (75%) had specimens submitted. In all, 4,598 (82.2%) of 5,597 eligible patients consented for optional BC in nine clinical trials with a separate BC consent process (consent rates by race/ethnicity: 74.1% Black, 72.8% Hispanic/Latino, 83.8% White). A smaller proportion of Black and Hispanic/Latino patients consented to optional BC compared with those who did not (12.1% v 19.5% Black, P < .0001; 3.5% v 5.8% Hispanic, P = .0006). In univariable logistic regression models, high ADI (more socioeconomic disadvantage) was associated with a decreased likelihood for optional BC consent (odds ratio [OR], 0.67 [95% CI, 0.55 to 0.82]; P = .02), but not a decreased likelihood for BSub (OR, 0.74 [95% CI, 0.53 to 1.04]; P = .08). Multivariable models demonstrated that Black/Hispanic/Latino patients were less likely to consent to optional BC, and Black patients were less likely to have BSub (P < .05 for all).

CONCLUSION: White/non-Hispanic patients and those with less socioeconomic disadvantage were more likely to consent to optional BC, whereas Black patients were less likely to have BSub. Targeted solutions are needed to improve biorepository representation so that precision medicine approaches better reflect the cancer population.

PMID:42418740 | DOI:10.1200/PO-26-00158

J Med Internet Res. 2026 Jul 8;28:e89136. doi: 10.2196/89136.

ABSTRACT

BACKGROUND: Digital health literacy (DHL), the ability to seek, understand, and apply digital health information, is increasingly important in the United Kingdom, with a focus on digital transformation within the health service. While digital tools offer potential to improve access and equity, they may exacerbate existing health inequities if segments of the population are unable to engage with them effectively. Understanding the sociodemographic, economic, and social factors associated with DHL is essential to designing inclusive digital health services.

OBJECTIVE: This study aimed to measure DHL among UK adults and identify its sociodemographic, economic, and social associates.

METHODS: A cross-sectional online survey was disseminated to a nationally representative sample of UK adult internet users from November to December 2024. DHL was self-reported using the validated eHealth Literacy Scale (eHEALS), which ranges from 8 to 40. eHEALS score was dichotomized into high and low DHL based on a cutoff of 26. Multivariable logistic regression was used to identify associates of DHL, with missing data handled using multiple imputation by chained equations.

RESULTS: The median eHEALS score was 31 (IQR 27-32); 21% (320/1525) of the participants had low DHL, while 79% (1205/1525) had high DHL. Those aged 65 years and older, compared with those in the age group of 18-44 years, had higher odds of low DHL (odds ratio [OR] 1.43, 95% CI 1.02-2.01; P=.04). Those belonging to a lower social grade also had higher odds of low DHL, compared with those belonging to the higher social grade (OR 1.37, 95% CI 1.05-1.80; P=.02). Females had lower odds of low DHL (OR 0.60, 95% CI 0.46-0.77; P<.001), as did those with an undergraduate or postgraduate degree or higher, compared with those educated to below degree level (undergraduate degree OR 0.52, 95% CI 0.37-0.74, P<.001; postgraduate degree or higher OR 0.58, 95% CI 0.40-0.82, P=.002). Those who socialized daily, compared to those who did this never or rarely, had marginally lower odds of low DHL (OR 0.64, 95% CI 0.42-1.00; P=.05). In subgroup analysis among participants with chronic health conditions, age and social grade were not significant associates of DHL.

CONCLUSIONS: Among UK internet users, male sex, lower educational attainment, lower social grade, less frequent socializing, and older age were statistically significant associates of low DHL. The model’s modest explanatory power suggests that additional factors beyond those examined play an important role. As findings are based on internet users, the prevalence of low DHL in the general population is likely higher than reported. This study provides a partial basis for identifying groups who may benefit from additional support, but intervention design should not rely solely on factors identified here. Inclusive interventions accounting for a broader range of factors are needed to ensure that digital transformation in health care narrows rather than widens health inequities.

PMID:42418731 | DOI:10.2196/89136

Nurs Open. 2026 Jul;13(7):e70668. doi: 10.1002/nop2.70668.

ABSTRACT

AIM: To systematically evaluate the current state of research on symptom clusters in patients with chronic obstructive pulmonary disease (COPD) and the impact of identifying symptom clusters on health-related quality of life (HRQoL) outcomes.

DESIGN: A systematic review.

METHODS: Two reviewers independently screened the studies against the eligibility criteria. Studies were assessed for risk of bias using the Appraisal tool for Cross-Sectional Studies (AXIS tool). Data were extracted using a pre-developed extraction tool and thematically analysed.

DATA SOURCES: Databases searched included EMbase, PubMed, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database and China Science and Technology Journal Database. Searches were conducted from inception to June 12, 2025.

RESULTS: Eighteen studies were included. Symptom clusters were identified using two tool types, including four multi-symptom and 18 single symptom evaluation tools. Common symptom clusters are respiratory-related symptom cluster, psychological-related symptom cluster, sleep-related symptom cluster and fatigue-related symptom cluster. Seven studies found significant negative associations between symptom clusters and HRQoL. Six studies reported the negative effect of each symptom cluster on HRQoL, but only one study showed no association for the sleep-related cluster.

CONCLUSION: The study of COPD symptom clusters still lacked general evaluation tools and statistical methods. Robust studies are needed to deeply explore the differential impact of symptom clusters across various dimensions of HRQoL.

IMPLICATIONS FOR NURSING PRACTICE: Our findings may make symptom management strategies based on the perspective of symptom clusters possible. In clinical practice, nurses should prioritize identifying and intervening in the symptom clusters with the most significant impact on HRQoL, thereby promoting the transformation of the nursing model from ‘single-symptom management’ to ‘multi-symptom collaborative management.’

REPORTING METHOD: This study adheres to PRISMA and SWiM reporting guidelines.

PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Involvement because of the systematic review.

TRIAL REGISTRATION: PROSPERO: CRD42024606544.

PMID:42418728 | DOI:10.1002/nop2.70668

Nurs Open. 2026 Jul;13(7):e70511. doi: 10.1002/nop2.70511.

ABSTRACT

AIM: The purpose of this study was to investigate Palestinian nurses’ knowledge, beliefs, attitudes and practices towards complementary and alternative medicine (CAM) as well as the factors that influence these behaviours.

DESIGN: A descriptive cross-sectional design was used.

METHODS: A questionnaire was distributed to nurses at healthcare institutions throughout Palestine using social media. Information on knowledge, beliefs, attitudes and practices of CAM was collected, as well as demographic data. SPSS version 20 was used for analysis.

RESULTS: A total of 202 subjects (female, 112; male, 90) participated in the study. The mean knowledge, belief, attitude and practice of CAM scores were 61 out of 80 (75%), 25 out of 43 (58%), 33 out of 54 (61%) and 15 out of 40 (38%), respectively. Knowledge was significantly negatively associated with age and work experience (p < 0.05). Males and lower-income nurses reported stronger beliefs in CAM than other groups (p < 0.05). Attitudes towards CAM were statistically significantly affected by gender, age and chronic disease status (p < 0.05). Regression analyses showed that work experience was a predictor of CAM knowledge. Gender, place of graduation and income were found to be predictors of CAM beliefs. The presence of chronic conditions was also a predictor of the practice of CAM.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:42418723 | DOI:10.1002/nop2.70511

JMIR Form Res. 2026 Jul 8;10:e85388. doi: 10.2196/85388.

ABSTRACT

BACKGROUND: Health care workers continue to experience heightened levels of distress and burnout, which contribute to higher levels of job dissatisfaction, turnover intentions, presenteeism, and staffing shortages.

OBJECTIVE: The aim of this study was to examine how participation in the StressPal Frontline: Essential Resilience Self-Care and Burnout Prevention program influenced health care workers’ stress and resilience. The study also sought to identify specific measures of perceived stress and resilience that were most affected by participation in the program and to explore whether pre-and-post differences varied based on participant characteristics. The StressPal Frontline program is a digital resilience intervention specifically developed for health care workers to enhance psychological flexibility and stress resilience. The self-paced training program, designed for approximately a 6-week period, consists of brief modules, follow-up resources, and a peer engagement community.

METHODS: A pretest-posttest quasi-experimental design was used to assess the effectiveness of the StressPal Frontline program in reducing stress and building resilience among 76 health care workers who voluntarily joined and completed the program. Outcome measures included the Perceived Stress Scale and the Brief Resilience Scale to assess participants’ perceptions of stressful situations and their ability to bounce back from stress. Descriptive statistics, correlation analysis, paired-samples 2-tailed t test, and multiple regression analysis were conducted. The paired-samples t test was calculated at the scale level and item level to evaluate the statistical significance of pretest and posttest mean differences, and the Cohen d statistic was used as a measure of effect size. Statistical analysis for this study was conducted in Excel (Microsoft), SPSS (IBM Corp), and Jamovi (jamovi project).

RESULTS: The results indicated a 1.53-point reduction in the Perceived Stress Scale score after participating in the StressPal Frontline program, suggesting a statistically significant decline in average perceived stress due to participation in the program (P=.004). The corresponding value of Cohen d was 0.34, suggesting a small-to-medium effect of the intervention, StressPal Frontline program, in reducing perceived stress. For the Brief Resilience Scale, pre-and-post difference was not significant at the scale level (P=.07); however, item-level analysis found significant increases in participants’ perception of their ability to bounce back quickly after hard times and handle difficult situations. No significant differences were found in outcome measures based on age, race, ethnicity, professional role, or practice setting.

CONCLUSIONS: The StressPal Frontline program was associated with positive outcomes in reducing perceived stress. Our study also found no statistical differences in outcomes among participants of different age groups, races, ethnicities, occupations, genders, and practice settings. This is an important finding, as it indicates that the StressPal Frontline program may provide positive benefits for reducing stress across professions, settings, and individual characteristics. This program, along with other resources, could be implemented by health care organizations to support workers’ professional development, behavioral health, and well-being.

PMID:42418697 | DOI:10.2196/85388

JMIR Res Protoc. 2026 Jul 8;15:e95287. doi: 10.2196/95287.

ABSTRACT

BACKGROUND: Medical adherence is traditionally defined as the extent to which a person’s behavior corresponds with agreed-upon recommendations from a health care provider. The rapid diffusion of patient-facing digital health applications (DHAs) challenges the direct applicability of this framework to software-mediated interventions. Unlike pharmacological treatments, DHAs automatically generate detailed usage data but lack a broadly accepted standard for determining which specific data points and usage patterns actually constitute “adequate” use across a broad variety of medical indications and population groups. In parallel, DHAs are becoming increasingly embedded in formal regulatory and reimbursement pathways. A notable example is Germany, where recent reforms plan to link at least 20% of reimbursement for Digitale Gesundheitsanwendungen-formally regulated and reimbursed DHAs-to performance-related indicators that implicitly operationalize adherence as a determinant of reimbursable performance. Despite this growing policy relevance, adherence in patient-facing DHAs remains conceptually fragmented and methodologically heterogeneous.

OBJECTIVE: This scoping review aims to map how adherence is conceptualized, operationalized, and measured in the context of patient-facing DHAs, and to explore whether these approaches differ between applications embedded within formal regulatory and/or reimbursement frameworks and those operating outside such settings.

METHODS: This scoping review follows the Joanna Briggs Institute methodology and will be reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. PubMed (MEDLINE), Scopus, and Web of Science will be searched for scientific literature published between 2020 and 2025, inclusive. Machine learning-assisted title and abstract screening will be performed using ASReview, following a sampling-based stopping criterion. Three independent reviewers will conduct screening and data extraction. Relevant gray literature will be identified through targeted searches.

RESULTS: Database searches identified 15,403 records (5469 from PubMed/MEDLINE, 6198 from Scopus, and 3736 from Web of Science), which were reduced to 7052 unique records after automated deduplication using Zotero (Corporation for Digital Scholarship). The full results are intended to be submitted to a peer-reviewed journal by the end of 2026.

CONCLUSIONS: Conducted as part of the DEKODE (Digital Health Adhärenz: Konzept und datenbasierte Evidenz) project funded by the German Federal Joint Committee’s Innovation Fund, this review contributes to the development of a conceptual and empirical adherence framework for patient-facing DHAs. Although DEKODE is primarily oriented toward the German Digitale Gesundheitsanwendungen context, this review applies no geographical restrictions, reflecting the value of establishing a broad evidence base before narrowing the focus to country-specific settings and rendering findings relevant for understanding DHA adherence in all geographies. By clarifying how adherence is currently conceptualized, operationalized, and measured, the review will promote more consistent and context-specific generation and interpretation of adherence-related evidence and support evidence-based policy discussions, international harmonization of evidence standards for DHAs, and health economic evaluations in digital health.

PMID:42418694 | DOI:10.2196/95287

JMIR Diabetes. 2026 Jul 8;11:e86651. doi: 10.2196/86651.

ABSTRACT

BACKGROUND: Digital therapeutics integrating continuous glucose monitoring (CGM) with personalized lifestyle coaching can enhance glycemic control in individuals with type 2 diabetes mellitus (T2DM). However, real-world evidence evaluating such multicomponent interventions-combining CGM with nutrition coaching, physiotherapy, and cognitive behavioral therapy within a unified digital platform-remains limited in South Asian populations.

OBJECTIVE: This study aimed to evaluate the effectiveness of an app-based lifestyle-integrated intervention program (Glycemic Lifestyle Intervention in Diabetes Empowerment-CGM; GLIDE-C) on glycemic, anthropometric, lipid profile, quality of life (QoL), and behavioral outcomes, as well as outcomes related to HEOR (health economics and outcomes research), in adults with mildly uncontrolled T2DM.

METHODS: A prospective observational cohort study was conducted among adults aged ≥18 years with confirmed T2DM and baseline hemoglobin A1c (HbA1c) between 7.5% and 9.5%. The intervention was delivered via the Goodflip mobile app, including a 15-day CGM period and a structured analysis of glucose variations, among other clinical assessments, with follow-up on days 15, 30, and 60. The digital intervention combined CGM-guided personalized diet, exercise, and cognitive behavioral therapy plans delivered through the mobile app, supported by multidisciplinary coaching. Primary outcomes were changes in HbA1c, fasting plasma glucose, postprandial glucose, and CGM metrics; secondary outcomes included lipid profile, anthropometric indices, QoL, and behavioral determinants of glycemic improvement.

RESULTS: Eighteen participants (mean age 49.45, SD 10.91 years; n=11, 61.1% male) completed the program. Mean HbA1c decreased by 0.59% (P=.05), with postprandial glucose decreasing by 25.42 mg/dL (P=.06) and time in range increasing by 9.98%. Modest reductions, consistent with the short intervention duration, occurred in low-density lipoprotein cholesterol (-8.38 mg/dL), body fat (-1.13 kg), and waist circumference (-1.56 cm). QoL improved significantly for sleep quality (P=.04). Improvements were also observed for motivation (P=.06), stress management (P=.08), and mood (P=.12), although these changes were not statistically significant. Behavioral analysis demonstrated strong associations with glycemic outcomes; all participants who reduced their consumption of energy-dense, nutrient-poor foods experienced improvements in HbA1c, whereas those who did not reduce energy-dense, nutrient-poor intake showed less favorable outcomes.

CONCLUSIONS: The novel GLIDE-C program demonstrated clinically meaningful improvements in glycemic control, behavioral outcomes, and QoL in adults with T2DM, without pharmacological modification. These findings strengthen the role of integrated, CGM-guided digital therapeutic platforms as an effective adjunct to the conventional standard of care.

PMID:42418692 | DOI:10.2196/86651

JMIR Form Res. 2026 Jul 8;10:e88916. doi: 10.2196/88916.

ABSTRACT

BACKGROUND: Crown preparation is a technically demanding psychomotor skill in undergraduate dental education. While traditional typodont training is the gold standard, it is resource-intensive and difficult to individualize. Screen-based haptic virtual reality simulators (HVRSs) may provide a pedagogical adjunct to conventional training, but their effectiveness in supporting transfer of skills to physical tooth preparation remains unclear.

OBJECTIVE: This study evaluated whether 3 hours of self-directed HVRS training improved undergraduate dental students’ performance in physical typodont crown preparation compared with no HVRS training. Secondary aims were to examine self-confidence and students’ perceptions of HVRS-based training. Manual dexterity was assessed exploratorily using the Grooved Pegboard Test (GPT).

METHODS: A mixed methods study was conducted with 44 fifth-semester dental students at Karolinska Institutet. Participants were allocated to an HVRS training group (n=22) or a control group (n=22). The HVRS group completed 3 hours of self-directed HVRS training over 1 week, whereas the control group received no simulator-based training. Both groups then prepared a maxillary right first molar for a monolithic zirconia crown on a phantom head. Crown preparation quality was assessed using PrepCheck, and a blinded examiner scored 8 areas of interest on a 0-3 grading scale. Manual dexterity was assessed using the GPT. Self-confidence was evaluated in both groups using survey items, while perceptions of the HVRS were evaluated only among HVRS group participants. Free-text responses from the HVRS group were analyzed using inductive thematic analysis.

RESULTS: The HVRS group achieved a higher mean total preparation score than the control group, but the difference was not statistically significant (11.9 vs 10.9; P=.24). In unadjusted analyses, the HVRS group scored higher for total occlusal convergence (P=.04), but this difference did not remain statistically significant after Bonferroni correction for 8 area-of-interest comparisons. Manual dexterity measured by the GPT improved in both groups, but the control group was significantly faster at baseline (P=.04) and postintervention (P=.001). Self-confidence ratings were broadly similar between groups; very low confidence was reported by 5% (1/20) of respondents in the HVRS group and 18% (4/22) in the control group. Most HVRS group respondents rated the HVRS drilling sensation as having limited comparability with typodont teeth and natural teeth. Qualitative responses suggested that students valued the HVRS for understanding procedural steps, applying theoretical knowledge, and allowing repeated practice, while reported challenges included limited realism, visual-tactile disconnect, and occasional technical issues.

CONCLUSIONS: Three hours of self-directed HVRS training did not significantly enhance overall crown preparation quality on typodont teeth or improve students’ general self-confidence. There is preliminary indication that HVRS could assist in mastering specific geometric parameters like total occlusal convergence. Future randomized controlled trials with stratified baseline dexterity and larger sample sizes are required to determine the optimal role of HVRS in dental education.

PMID:42418261 | DOI:10.2196/88916

J Biochem Mol Toxicol. 2026 Jul;40(7):e71018. doi: 10.1002/jbt.71018.

ABSTRACT

This study aimed to investigate the biological effects of Picroside II on colorectal cancer (CRC) cells, including its impacts on proliferation, migration, invasion, and epithelial-mesenchymal transition (EMT), and to explore whether its mechanism of action involves modulation of the Notch1 signaling pathway. Human CRC cell lines SW480 and SW620 were treated with various concentrations of Picroside II (10-100 μM). Cell proliferation was assessed using the CCK-8 assay, colony formation assay, and EdU incorporation assay. Migration and invasion capacities were evaluated by wound healing and Transwell assays. The expression levels of EMT-related markers (E-cadherin, N-cadherin, Vimentin, ZEB2) and key proteins in the Notch1 pathway (Notch1, Cleaved Notch1, RBP, HES1) were analyzed by Western blotting. Statistical analysis was performed using one-way ANOVA and Student’s t-test. Picroside II inhibited the proliferation of SW480 and SW620 cells in a dose- and time-dependent manner, reduced colony formation ability, and decreased DNA synthesis activity. Treatment with Picroside II suppressed the migratory and invasive abilities of CRC cells, accompanied by upregulation of E-cadherin and downregulation of N-cadherin, Vimentin, and ZEB2. Furthermore, Picroside II exposure led to a decrease in the expression of Notch1, Cleaved Notch1, RBP, and HES1 proteins in a concentration-dependent manner. Picroside II suppresses CRC cell progression in vitro by inhibiting the Notch1 signaling pathway, providing a preliminary molecular basis for further in vivo investigation.

PMID:42418248 | DOI:10.1002/jbt.71018

JMIR Med Educ. 2026 Jul 8;12:e82812. doi: 10.2196/82812.

ABSTRACT

BACKGROUND: Taiwan is projected to become a “super-aged” society by 2025, leading to an increasing demand for community psychiatric long-term care (LTC). This demographic shift necessitates frontline professionals equipped with specialized communication skills and deep empathy. However, traditional didactic teaching often fails to adequately prepare students for the complex emotional and practical challenges of real-world psychiatric caregiving.

OBJECTIVE: This study aimed to evaluate the effectiveness of the innovative youth-elder co-learning instructional model, which uniquely integrates micro-movie discussions and an intergenerational empathy board game, on adult learners’ professional knowledge, communication competence, empathic development, and overall learning satisfaction.

METHODS: A mixed methods, single-group, pre-post design was used. The educational intervention was implemented within an 18-week elective community psychiatric LTC course. Participants included 38 adult learners and continuing education students (aged 19-64 years). Notably, the majority of the cohort (n=29, 76.3%) had no prior practical experience in LTC. Quantitative data were collected using self-assessed and peer-evaluated scales for professional knowledge, communication competence, and empathy at pre-, mid-, and post-course time points, alongside an end-of-semester course student feedback survey. Qualitative data were systematically gathered through structured reflective journals and analyzed using a rigorous 6-phase thematic analysis framework.

RESULTS: Students reported high course satisfaction rates, ranging from 92.4% to 95.3%. Quantitative analysis revealed a notable divergence: there were significant improvements in peer-evaluated outcomes (P<.001) and self-assessed communication competence (P=.004), but there was more conservative, statistically nonsignificant growth in self-assessed scores for professional knowledge (P=.14) and empathy (P=.09). This discrepancy likely reflects adult learners’ heightened awareness of professional complexity and self-reflective humility. Furthermore, the qualitative thematic analysis uncovered the following three narrative shifts: (1) the dismantling of generational stereotypes through authentic, face-to-face interaction with real older adults; (2) an empathic awakening regarding the often-invisible burden of family caregivers, catalyzed by the micro-movies; and (3) the successful translation of theoretical nonviolent communication concepts into real-time clinical problem-solving during board game role-plays.

CONCLUSIONS: The youth-elder co-learning model shows promise as an innovative, experiential pedagogical approach. By bridging theoretical frameworks with authentic intergenerational contact, the intervention supported students in translating general empathic concepts into actionable communication competencies. However, given the exploratory nature of this study and the absence of a control group, the quantitative findings must be interpreted cautiously. Future research using randomized controlled trial designs across multiple institutions is warranted to establish definitive causal impacts.

PMID:42418241 | DOI:10.2196/82812