Tag: nevin manimala

J Med Internet Res. 2025 Jul 31;27:e64616. doi: 10.2196/64616.

ABSTRACT

BACKGROUND: Digital nursing technologies (DNTs) are a promising solution to address challenges in health care systems, such as demographic shifts, nursing shortages, or difficulties in retaining nurses. Despite their potential benefits, the integration of DNTs into care settings remains complex due to multiple factors influencing their implementation and adoption.

OBJECTIVE: We aimed to examine factors that influence the implementation and adoption of DNTs used in nursing care settings from the perspective of nurses.

METHODS: We used an umbrella review methodology to synthesize the evidence on DNTs and the complexities of their implementation. We searched for systematic reviews that focused on DNTs in formal care settings across 4 databases (PubMed, CINAHL, Cochrane Library, and Business Source Premier) and examined reference lists of the included reviews published in English until January 2025. Two researchers independently performed data extraction and quality assessment. Data analysis was structured by embedding the results in the NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework, a model for explaining the adoption and abandonment of health and care technologies, as well as challenges to their scaling, diffusion, and sustainability. Reporting of this study adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist.

RESULTS: A total of 4803 reviews were identified, of which 65 (1.36%) met the inclusion criteria. We identified 52 influencing factors across 6 NASSS domains, with particular emphasis on adopter-related barriers and facilitators. Key barriers included insufficient training, increased workload, and low technological confidence, which impacted efficiency and the quality of care. In addition, concerns regarding professional role, autonomy, and privacy influenced nurses’ acceptance of DNTs. Facilitators included leadership support, a positive corporate culture, and targeted training initiatives.

CONCLUSIONS: We synthesized key facilitators and barriers to implementation and adoption of DNTs in nursing care. Leadership support, adequate training, and alignment with care needs drive successful implementation, while resource constraints and workflow disruptions pose challenges. Addressing both technological requirements and nursing needs is critical. Future research should focus on long-term studies and practical tools to support stakeholders in effectively integrating DNTs into nursing practice.

TRIAL REGISTRATION: OSF Registries 10.17605/OSF.IO/BG8CY; https://osf.io/bg8cy.

PMID:40743516 | DOI:10.2196/64616

JMIR Form Res. 2025 Jul 31;9:e70146. doi: 10.2196/70146.

ABSTRACT

BACKGROUND: Despite evidence that use of patient portals and telehealth is associated with many health benefits, disparities exist in awareness, adoption, and use. Understanding factors and strategies specific to underserved populations is key to achieving digital equity and better health.

OBJECTIVE: This study assesses portal and telehealth experiences among residents of a minoritized and lower-resource area of Dallas, Texas.

METHODS: Using an explanatory sequential design, we conducted surveys and semistructured interviews with English- and Spanish-speaking adults in 15 ZIP Codes surrounding a community-based clinic. We recruited participants via a patient portal, flyers, emails distributed by clinic and community partners, and in person. Surveys were offered online and on paper. We used Fisher exact tests to identify factors associated with telehealth and/or portal use. We also recruited a subsample of survey participants to expound on survey findings in semistructured interviews. Our thematic analysis assessed convergence in survey and interview findings.

RESULTS: Among 182 survey respondents, most were older (n=109, 66%; age ≥60 years), African American or Black (n=120, 65%), and female (n=142, 79%); a little more than half (n=97, 54%) had completed ≥1 telehealth appointment, and a majority (n=131, 72%) had used a patient portal at least once. Compared with those who used the portal and/or telehealth, those reporting no use of portal or telehealth were more likely to have a high school education or less (P<.001) or be Spanish speakers (P<.011). A majority, regardless of portal or telehealth use, agreed with health promotion activity survey statements like “Using the Internet for health-related activities makes me feel actively involved with my health care” (n=103, 59%) and “I find the Internet useful for monitoring my health” (n=100, 58%). In interviews with 20 individuals, most of whom were older, Black, female, and had digital technology experience, seven factors were key to increased engagement in portals and telehealth: (1) improving patient autonomy, (2) integrating digital health technology into daily life, (3) receiving recommendations from trusted individuals, (4) appreciating the value of digital health technologies, (5) enlisting the support of care partners or peers, (6) managing severe or chronic illness, and (7) accessing test results rapidly.

CONCLUSIONS: This study builds on previous work by confirming and contributing insights about factors key to technology uptake and use among underserved populations. Interventions using digital health technologies should focus on these factors to promote digital and health equity and achieve better health outcomes. Future research should explore which clinical settings and contexts are most conducive to increasing digital technology uptake and use, and implementation should leverage partnerships with community groups.

PMID:40743511 | DOI:10.2196/70146

Ocul Immunol Inflamm. 2025 Jul 31:1-9. doi: 10.1080/09273948.2025.2536049. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the epidemiology, clinical features, laterality, and long-term visual prognosis of uveitis.

METHODS: This is a retrospective observational study.

RESULTS: We included 1362 patients diagnosed with uveitis at Miyata Eye Hospital, Japan, from 2015 to 2020. The main outcome measures were anatomical and etiological diagnoses, laterality, best-corrected visual acuity (BCVA) at onset and 1, 3, 5, and 10 years thereafter, and ocular complications.Human T-cell leukemia virus type 1 (HTLV-1) uveitis was the most common etiology (10.5%), followed by sarcoidosis (10.4%) and Vogt-Koyanagi-Harada disease (8.7%). Anatomically, panuveitis was most frequent (47.1%), followed by anterior uveitis (42.1%). Anterior uveitis was predominantly unilateral (75.1%), while panuveitis was mostly bilateral (76.9%). Infectious uveitis was largely unilateral (71.0%), whereas non-infectious uveitis was primarily bilateral (76.8%). BCVA at onset was worse in posterior uveitis and panuveitis than in anterior and intermediate uveitis. Posterior uveitis and panuveitis showed significant BCVA improvement at 1 year, while anterior and intermediate uveitis improved at 3 years. Among major etiologies, Behçet’s disease had the worst visual prognosis at 10 years. Glaucoma that required treatment was observed in 33.5% of the eyes, with higher prevalence in anterior uveitis (32.5%) and panuveitis (37.9%). Cataract surgery was performed in 38.4% of the eyes during the study period.

CONCLUSIONS: This study revealed unique epidemiology in an HTLV-1 endemic area. The laterality patterns and visual prognosis varied by anatomical and etiological diagnoses. Long-term visual outcomes were influenced by anatomical location, etiology, and ocular complications, emphasizing the importance of tailored management strategies for different uveitis types.

PMID:40743510 | DOI:10.1080/09273948.2025.2536049

J Am Nutr Assoc. 2025 Jul 31:1-8. doi: 10.1080/27697061.2025.2531086. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to assess the effect of probiotic supplementation on multiple dimensions of tuberculosis (TB) care, including clinical, humanistic, and safety outcomes.

METHOD: This study is a prospective cohort study. Data were collected for TB treatment outcome, hematologic inflammatory indices, anti-tuberculosis treatment (ATT)-induced adverse drug reactions (ADRs), and health-related quality of life (HRQoL) using EuroQol 5-Dimension 5-level questionnaire to evaluate the effect of probiotics supplementation.

RESULTS: In all, 177 patients with drug-sensitive pulmonary TB were enrolled. TB treatment success rates in the study group (SG) and the reference group (RG) were 85.1% and 84.6%, respectively (p = 1.000). Among hematologic inflammatory indices, only the systemic inflammation response index (SIRI) showed a statistically significant reduction after probiotic supplementation (p = 0.048). No significant changes were observed in HRQoL scores at various time points. ATT-induced ADRs were significantly lower in the SG than the RG (14.8% vs 61.3%; p < 0.001).

CONCLUSION: Probiotic supplementation did not significantly influence TB treatment success or HRQoL outcomes. However, it showed a favorable impact on systemic inflammation and a significant reduction in the incidence of ATT-induced ADRs, especially gastrointestinal side effects. These findings suggest a potential role for probiotics as a supportive adjunct to ameliorate ATT-induced ADRs. Future studies should focus on assessing long-term supplementation effects to investigate humanistic outcomes.

PMID:40743501 | DOI:10.1080/27697061.2025.2531086

Arch Orthop Trauma Surg. 2025 Jul 31;145(1):394. doi: 10.1007/s00402-025-06011-7.

ABSTRACT

OBJECTIVES: This study aimed to introduce a novel mathematical model for preoperative precalculated pelvic tilt (PT) in patients with thoracolumbar kyphosis due to ankylosing spondylitis (AS) after three-column osteotomy.

METHODS: A total of 20 patients with AS, including 19 men and one woman, who underwent three-column osteotomy from April 2017 to April 2021, in the study hospital were retrospectively reviewed. Spinopelvic parameters, including global kyphosis, pelvic incidence, sacral slope, PT, sagittal vertical axis, horizontal distance between hip axis and hilus pulmonis (HDHH), measured on preoperative, postoperative, and final follow-up radiographs were analyzed. A coordinate diagram was created on the lateral spine radiographs with the hip axis as the origin. The distances and angles between the osteotomy apex, hilus pulmonis, and hip axis were measured, and a mathematical model was established using basic vector functions. The planned osteotomy angle was substituted into the mathematical model to obtain precalculated postoperative PT. Paired sample t-test was performed to determine the differences between planned osteotomy angle and actual osteotomy angle and between predictive postoperative PT and actual postoperative PT.

RESULTS: Seven patients underwent single-level osteotomy, and 13 patients underwent two-level osteotomy. No significant difference was observed between the planned osteotomy angle and the actual osteotomy angle. No statistically significant difference was found between the precalculated postoperative PT and the actual postoperative PT.

CONCLUSIONS: The novel mathematical model was reliable in predicting postoperative PT in patients with AS undergoing three-column osteotomy.

PMID:40742613 | DOI:10.1007/s00402-025-06011-7

J Robot Surg. 2025 Jul 31;19(1):439. doi: 10.1007/s11701-025-02619-4.

ABSTRACT

The use of robotic assistance in colorectal surgery has mainly shown benefit in low rectal resections. The comparisons between robotic and laparoscopic high anterior resections have largely reported similar clinical outcomes at the expense of higher cost and longer operative time in the former. Most of these involve unmatched retrospective studies based on earlier robotic systems. The current study aims to provide contemporary data from a center with an established robotic surgery practice. Patients who underwent elective robotic anterior resections between January 2021 and December 2023 were propensity-score matched with a laparoscopic group. Perioperative management was in accordance with an Enhanced Recovery protocol. Outcomes and histopathological data were compared. One hundred and thirty patients were available for analysis after matching. The use of robotic assistance was associated with significantly less intra-operative blood loss, shorter operative duration, faster recovery of gastrointestinal function, earlier discharge, and lower complication rate. There was no significant difference in tumor characteristics or short-term oncological outcomes. Robotic assistance provides benefits that are clinically significant to both the patient and the healthcare system.

PMID:40742611 | DOI:10.1007/s11701-025-02619-4

JAMA Netw Open. 2025 Jul 1;8(7):e2522732. doi: 10.1001/jamanetworkopen.2025.22732.

ABSTRACT

IMPORTANCE: The Parent-Focused Redesign for Encounters, Newborns to Toddlers (PARENT) trial demonstrated increased anticipatory guidance and well child care visit (WCV) attendance but no effect on emergency department (ED) utilization.

OBJECTIVE: To assess whether the PARENT intervention was associated with lower non-WCV costs, and whether the increasing WCV attendance might offset recurring intervention costs.

DESIGN, SETTING, AND PARTICIPANTS: The PARENT cluster-randomized clinical trial was conducted from March 5, 2019, to July 14, 2022. This secondary cost analysis was conducted throughout the trial and continued to November 15, 2024. Participants included 937 enrolled parents with a child younger than 2 years presenting for a WCV at 10 clinics from 2 federally qualified health centers (FQHCs). Data on utilization and estimated cost of care using a unit cost approach were collected. Parents were interviewed at baseline and 6 and 12 months and asked about the number of encounters and the child’s diagnosis for subspecialty referrals, urgent care visits, ED visits, and hospitalizations.

INTERVENTION: PARENT is a team-based approach to health care that uses a trained community health worker as part of the well child care team to provide preventive care services to children aged 0 to 2 years.

MAIN OUTCOMES AND MEASURES: The main outcome of this analysis was 2016 unit cost estimates for subspecialty referrals, urgent care visits, ED visits, and hospitalizations by health condition and child’s age using data from the US Disease Expenditure Study.

RESULTS: Among 937 enrolled PARENT participants, 785 (83.8%) completed the 12-month interview and were included in analyses. Mean (SD) child age at enrollment was 4.4 (4.0) months, and most participants were mothers (868 of 914 with available data [95.4%]) and were Medicaid insured (855 of 914 with available data [93.5%]). The intervention group had statistically significant lower costs than the control group for both subspecialty referrals (-$213; 95% uncertainty interval [UI], -$540 to -$106) and total cost of urgent care visits, ED visits, and hospitalizations (-$70; 95% UI, -$150 to -$13). Based on the mean (SD) volume of newborns across all participating clinics (5.8 [4.1] newborns per week), marginal revenue from increased WCV attendance was greater than annual community health worker salary and benefits costs under select current reimbursements.

CONCLUSIONS AND RELEVANCE: This secondary analysis of a cluster-randomized clinical trial suggests that the cost of the PARENT intervention was offset by savings in non-WCV health care utilization, and revenue for federally qualified health centers from increased WCV attendance could fund ongoing intervention costs.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03797898.

PMID:40742591 | DOI:10.1001/jamanetworkopen.2025.22732

JAMA Netw Open. 2025 Jul 1;8(7):e2524154. doi: 10.1001/jamanetworkopen.2025.24154.

ABSTRACT

IMPORTANCE: Injury is a leading cause of morbidity and mortality among children worldwide. Prevention strategies rely on timely and accurate injury surveillance. Many national programs, including the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), depend on manual review of emergency department (ED) medical records to track injury trends. Rising ED volumes have strained manual processes, delaying data analysis and compromising early detection of public health risks.

OBJECTIVE: To evaluate whether natural language processing (NLP) transformer models can automate injury case detection in ED medical records, improving CHIRPP workflow efficiency while maintaining high sensitivity.

DESIGN, SETTING, AND PARTICIPANTS: Prognostic study of ED visits from January 1, 2017, to December 31, 2023, at The Hospital for Sick Children, a high-volume tertiary pediatric referral center in Toronto, Canada, and a core CHIRPP site. The dataset included pediatric ED visits across all age groups. All medical records were labeled as requiring or not requiring CHIRPP reporting, with no exclusions. Two transformer-based NLP models, DistilBERT-base-uncased (model 1) and BERT-large-uncased (model 2), were fine tuned using supervised learning to classify medical records as CHIRPP-reportable or not.

EXPOSURE: Application of fine-tuned NLP transformer models to routine ED visit data to automate classification of injury-related cases for surveillance reporting.

MAIN OUTCOMES AND MEASURES: Outcomes included true positive rate (TPR), true negative rate (TNR), false positive rate (FPR), false negative rate (FNR), area under the receiver operating characteristic curve (AUROC), and area under the precision-recall curve (AUPRC). Additional outcomes included the proportion of medical records requiring manual review to achieve 90% sensitivity.

RESULTS: Among 217 173 pediatric ED visits across all age groups, model 1 achieved an AUROC of 0.983, AUPRC of 0.932, TPR of 0.90, TNR of 0.99, FPR of 0.014, and FNR of 0.10. Model 2 showed similar performance with an AUROC of 0.983, AUPRC of 0.931, TPR of 0.90, TNR of 0.99, FPR of 0.012, and FNR of 0.09. Both models identified 90% of injury cases while reducing manual medical record review from 100% to 17% of ED visits.

CONCLUSIONS AND RELEVANCE: NLP transformer models accurately automated detecting injury cases in ED patient medical records, with the potential of enabling real-time injury surveillance monitoring.

PMID:40742588 | DOI:10.1001/jamanetworkopen.2025.24154

JAMA Netw Open. 2025 Jul 1;8(7):e2524165. doi: 10.1001/jamanetworkopen.2025.24165.

ABSTRACT

IMPORTANCE: Identification of factors associated with variation in outpatient surgery may further quality improvement efforts to safely reduce postoperative hospital length of stay nationally.

OBJECTIVES: To explore variation in the use of outpatient surgery, incorporating patient, geographic, and hospital factors.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used deidentified administrative claims data from OptumLabs Data Warehouse. Participants included adults who underwent 1 of 10 general, urological, or gynecological operations between January 1, 2015, and June 30, 2021, in the US. Patients who underwent combined procedures or reoperations or had at least 15 Elixhauser comorbidities were excluded. Data were analyzed from July 26 to December 16, 2023.

EXPOSURE: Inpatient or outpatient surgical procedures.

MAIN OUTCOMES AND MEASURES: Multilevel logistic regression assessed variation in the use of outpatient surgery rates by hospital characteristics (bed size, presence of trainees, and rural referral center status) and hospital census division, adjusting for patient factors (age, sex, number of Elixhauser comorbidities, year, and rural-urban commuting area). This multilevel model allowed for the sources of variability to be quantitatively attributed to patient characteristics, geography, and hospital characteristics.

RESULTS: A total of 330 424 (72.3%) of 456 954 included patients underwent outpatient surgery. The median age was 54 (IQR, 41-67) years, and of those with data available, most patients were female (268 692 of 414 193 [64.9%]). The likelihood of outpatient surgery varied significantly by hospital census division for all 10 operations (eg, MIS salpingo-oophorectomy range, 29.6%-58.8%; P < .001). Variation in hospital census division contributed most to outpatient surgery for 8 of 10 operations compared with other patient and hospital characteristics. Hospital census division contributed the greatest degree to the variation in outpatient simple mastectomy (20.6%) and the least to outpatient open ventral hernia repair (0.7%). Multivariable analysis showed that the odds of outpatient surgery for patients from metropolitan areas were higher for minimally invasive salpingo-oophorectomy (odds ratio [OR], 1.62; 95% CI, 1.34-1.95) and open ventral hernia repair (OR, 1.16; 95% CI, 1.09-1.24). Hospitals with 400 or more beds were independently associated with decreased odds of outpatient surgery compared with hospitals with 50 to 199 beds for 4 of 7 operations (MIS paraesophageal hernia repair [OR, 0.58; 95% CI, 0.47-0.71; P < .001]; MIS cholecystectomy [OR, 0.73; 95% CI, 0.68-0.78; P < .001]; open ventral hernia [OR, 0.51; 95% CI, 0.46-0.57; P < .001]; MIS ventral hernia repair [OR, 0.66; 95% CI, 0.56-0.77; P < .001]). The presence of a residency training program was independently associated with increased odds of outpatient surgery for simple mastectomy (OR, 1.35; 95% CI, 1.16-1.58; P < .001) and mastectomy with reconstruction (OR, 1.50; 95% CI, 1.27-1.77; P < .001) and decreased odds of outpatient surgery for minimally invasive cholecystectomy (OR, 0.96; 95% CI, 0.92-1.00; P = .04), open ventral hernia repair (OR, 0.93; 95% CI, 0.86-1.00; P = .04), and total thyroidectomy (OR, 0.84; 95% CI, 0.71-1.00; P = .04).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, significant variation existed in the use of outpatient surgery in the US and appeared to be driven primarily by hospital geography. Addressing these variations may improve the use of resources.

PMID:40742587 | DOI:10.1001/jamanetworkopen.2025.24165

JAMA Netw Open. 2025 Jul 1;8(7):e2524201. doi: 10.1001/jamanetworkopen.2025.24201.

ABSTRACT

IMPORTANCE: Legal barriers during cancer care contribute to longstanding disparities and lead to adverse health outcomes in vulnerable populations, yet their prevalence remains unknown.

OBJECTIVE: To identify and characterize legal barriers for patients with cancer who reached out to a legal navigation program.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the Legal & Financial Navigation (LFN) database of Triage Cancer, a nationwide nonprofit organization providing free education on legal issues faced by individuals with cancer, between March 1, 2021, and December 31, 2024. Participants included patients with cancer and caregivers and health care professionals calling on a patient’s behalf.

EXPOSURES: Sociodemographic, financial, and disease-site characteristics of patients.

MAIN OUTCOMES AND MEASURES: The main outcome was the primary legal issue prompting use of Triage Cancer’s LFN. Sociodemographic, financial, and disease-site factors of patients were characterized, and the associations of these factors with the primary legal issue were explored with logistic regression models.

RESULTS: A total of 5810 calls (3883 [66.8%] by patients, 1091 [18.8%] by caregivers, and 597 [10.3%] by health care professionals) were investigated in reference to patients from 50 US states (3710 [63.9%] female; 3293 [56.7%] aged 40 to 64 years). Patients were primarily insured (4436 [76.4%]), 2533 (43.6%) had annual household income below $50 000, and 2808 (48.3%) were in active cancer treatment. Almost half of patients (2807 [48.3%]) had 2 or more legal barriers. The most common primary barriers were health insurance (1648 [28.4%] requested help navigating claim denials, appeals, or health insurance), followed by finances (1194 [20.6%] needed help with financial assistance and housing), employment (1095 [18.8%] needed help navigating wrongful termination, working through treatment, taking time off, or unemployment benefits), and disability insurance (1082 [18.6%] needed help navigating claim denials or applying for and transitioning off disability insurance). Black or African American compared with White patients had lower odds of needing assistance with health insurance (odds ratio [OR], 0.66; 95% CI, 0.50-0.87); Black or African American compared with White patients (OR, 1.52; 95% CI, 1.12-2.05) and patients living in the South compared with the Northeast (OR, 1.32; 95% CI, 1.04-1.67) more often sought assistance for financial barriers; and patients with household income below $20 000 compared with over $100 000 (OR, 0.34; 95% CI, 0.14-0.87) and those with Medicaid (OR, 0.36; 95% CI, 0.13-0.99) or marketplace insurance (OR, 0.37; 95% CI, 0.23-0.60) vs employer-sponsored insurance less often sought assistance for employment.

CONCLUSIONS AND RELEVANCE: This cohort study examining legal barriers to cancer care access faced by patients with cancer and their caregivers found that certain populations may have greater need for legal navigation. In light of recent federal policies supporting reimbursement for complex care coordination and unmet social services needs in patients with cancer, these findings suggest a need for health care teams to better understand cancer-related legal issues and design more accessible legal navigation services.

PMID:40742586 | DOI:10.1001/jamanetworkopen.2025.24201