Tag: nevin manimala

JMIR Form Res. 2025 Jul 24;9:e73453. doi: 10.2196/73453.

ABSTRACT

BACKGROUND: Urinary issues pose a significant burden on health care systems, necessitating innovative solutions to enhance patient care and alleviate the provider burden.

OBJECTIVE: The objective of this study was to explore health care professionals’ perceptions of urinary issues and assess their acceptance and readiness to adopt wearable and remote technologies for managing these conditions. The study aimed to identify the attributes and barriers influencing technology integration in clinical practice, using established theoretical frameworks, such as the Health Belief Model (HBM) and the Technology Acceptance Model (TAM).

METHODS: A cross-sectional survey-based study was conducted. A structured survey questionnaire was administered online to a sample of 256 health care professionals recruited through social media and personal networks. The survey included both closed- and open-ended questions to gather data. Quantitative data were analyzed using descriptive statistics, Pearson correlation, and multiple regression.

RESULTS: Quantitative analysis revealed strong correlations between belief agreement and factors such as health literacy (r=0.591, P<.001), the perceived burden (r=0.628, P<.001), device attributes (r=0.650, P<.001), and support services (r=0.622, P<.001). Multiple regression analysis identified that the perceived burden (β=.284, P=.01), device attributes (β=.371, P<.001), and integrating technology (β=.312, P<.001) are positively associated. The survey demonstrated strong internal consistency, with Cronbach α=.85, indicating high reliability in measuring health care professionals’ perceptions of technology adoption.

CONCLUSIONS: Health care professionals’ acceptance of technology in managing urinary issues is influenced by factors such as the perceived burden, device attributes, and the ease of integrating technology into existing workflows. Addressing barriers to technology adoption, providing comprehensive training and support, and prioritizing user-centered design are crucial for successful technology integration. Future research should focus on longitudinal studies and explore the perspectives of patients and other stakeholders to gain a more holistic understanding of technology integration in urological care.

PMID:40705415 | DOI:10.2196/73453

J Med Internet Res. 2025 Jul 24;27:e73687. doi: 10.2196/73687.

ABSTRACT

BACKGROUND: In recent years, digital technologies have shown possibilities for improving cognitive function after stroke, but their effectiveness and treatment options vary, the optimal treatment remains unclear, and the current evidence is somewhat contradictory.

OBJECTIVE: This study aimed to evaluate the efficacy of various digital interventions in improving poststroke cognitive function and provide evidence-based support for clinical decision-making.

METHODS: A systematic search was conducted across PubMed, Web of Science, Cochrane Library, Scopus, Embase, and CNKI databases from their inception to January 2025, with no restrictions on language or publication year. Randomized controlled trials evaluating digital interventions (eg, virtual reality [VR], computer-assisted cognitive therapy [CACT], and robot-assisted therapy [RAT]) for poststroke cognitive impairment in adults (aged≥18 y) were included. Eligible studies reported outcomes measured by the Montreal Cognitive Assessment (MoCA) or the Mini-Mental State Examination (MMSE), with cognitive improvement quantified through pre- to postintervention scores. Multiple researchers independently extracted data. Network meta-analysis was performed using R software, incorporating consistency or inconsistency models (based on Deviance Information Criterion differences), random-effects models, and I² statistics to assess heterogeneity. Sources of heterogeneity were analyzed through sensitivity analyses, subgroup analyses, and meta-regression. Intervention efficacy was ranked using Surface Under the Cumulative Ranking Curve (SUCRA) values. Robustness and consistency were validated via Egger test, sensitivity analyses, and node-splitting methods. Evidence quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.

RESULTS: A total of 2128 articles were retrieved, with 27 meeting the inclusion criteria. Compared to conventional rehabilitation or care (C), CACT demonstrated significant superiority in MoCA scores (mean difference [MD]=3.03, 95% CI 1.69 to 4.38; SUCRA=91.53%); while cognitive training (CCT) demonstrated no statistical difference (MD=0.70, 95% CI -0.88 to 2.28). The ordering is CACT>VR>RAT>CCT. For MMSE scores, RAT ranked highest in efficacy (MD=5.99, 95% CI 3.20 to 8.79; SUCRA=99.44%); whereas both VR (MD=1.34, 95% CI -0.94 to 3.62) and CCT (MD=1.12, 95% CI -1.46 to 3.69) showed no significant improvement. The ordering is RAT>CACT>CCT>VR.

CONCLUSIONS: Digital therapies are effective in improving cognitive functioning in patients post stroke. CACT showed superior efficacy on the MoCA (emphasizing executive functioning), while RAT had the highest efficacy in the MMSE (focusing on basic cognition), suggesting different domain-specific effects. However, caution is warranted due to the heterogeneity of the included studies, risk of bias, and limited sample sizes in some studies. Future research should focus on optimizing intervention protocols, integrating neuromodulation or traditional rehabilitation techniques, and exploring cost-effective clinical implementation strategies.

PMID:40705404 | DOI:10.2196/73687

JMIR Form Res. 2025 Jul 24;9:e69556. doi: 10.2196/69556.

ABSTRACT

BACKGROUND: Just-in-time adaptive interventions (JITAIs) are a promising approach in mental health care given the potential scalability (ie, interventions are offered automatically and remotely) and preciseness (ie, the right interventions are offered at the right moments). Typically, a smartphone app is programmed to assess users’ psychological states in daily life; when a particular state is detected, the app prompts users to engage in specific behaviors. Conceptually, JITAIs hold significant potential for precision health, although there is currently limited evidence in the literature.

OBJECTIVE: We implemented this scheme as a smartphone intervention for daily stress management, based on cognitive behavioral therapy (CBT), and evaluated its feasibility and efficacy using a single-case experimental design.

METHODS: A total of 8 Japanese adults (community sample: 4 women; mean 37.6, SD 13.1 y) were recruited. An AB phase design with multiple random baselines was used, where “A” represents the baseline phase and “B” represents the intervention phase. Throughout the study period (28 d), participants were prompted to indicate their momentary levels of stress (range 0-100) using a smartphone thrice a day. The baseline phase duration was randomly varied among participants, lasting between 7 and 14 days. The remaining period was used as the intervention phase (14-21 d), where 6 CBT-based exercises (ie, breath control, mindfulness, relaxation, self-talk, cognitive defusion, and cognitive restructuring) were offered depending on the reported levels of stress.

RESULTS: Approximately 70% (6/8) of the participants perceived the intervention to be useful and helpful. A randomization test detected a statistically significant decrease in reported stress levels after the intervention began (P=.005), though this effect was less pronounced when analyzed individually for each participant. Multilevel model analysis detected a significant acute reduction in the momentary level of stress right after completing a CBT-based exercise (pre-exercise: mean 47.98, SD 21.65; post exercise: mean 42.13, SD 19.88; P=.03; Cohen dz=0.58). Also, a significant reduction in depressive rumination was observed in the postintervention assessment (preintervention: mean 13.00, SD 3.21; post intervention: mean 9.25, SD 2.60; P=.01, Cohen dz=1.17).

CONCLUSIONS: The intervention was feasible and effective in reducing subjective stress (and rumination) in the study sample. The small sample size and the nonclinical nature of the sample may limit the generalizability and implications of the study findings for clinical practice. More evidence should be collected to draw solid conclusions for technical and technological as well as clinical aspects of mobile interventions. Accumulating exemplars with different implementations will clarify how a JITAI can be designed and developed on a mobile platform and how the program can be delivered in the prevention and treatment of mental ill health.

PMID:40705402 | DOI:10.2196/69556

Clin Cancer Res. 2025 Jul 24. doi: 10.1158/1078-0432.CCR-25-0201. Online ahead of print.

ABSTRACT

PURPOSE: The optimal treatment of recurrent ovarian clear cell carcinoma (rOCCC) remains unknown. This is the first randomized trial to compare durvalumab with chemotherapy in rOCCC.

PATIENTS AND METHODS: MOCCA is a randomized, phase 2 trial conducted in Singapore, Korea and Australia. Eligible patients had rOCCC with recurrence after platinum-based chemotherapy, ECOG performance status ≤2 and no prior immune checkpoint blockade. Patients were randomly assigned (2:1) to durvalumab (1500mg every 4 weeks) or chemotherapy. Patients progressing on chemotherapy were allowed to crossover to durvalumab. The primary outcome was progression-free survival (PFS). Secondary outcomes included overall survival (OS), objective response rates (ORR), and safety.

RESULTS: 48 eligible women were assigned to durvalumab (N= 31) or chemotherapy (N= 17). Median PFS was 7.6 (95% CI 7.0-16.0) and 14.0 (95% CI 7.0-32.9) weeks with durvalumab or chemotherapy, (HR 1.6, 95% CI 0.8-3.0; P= 0.92). Median OS was 37.9 (95% CI 21.7-143.0) and 40.6 (95% CI 25.0-not reached) weeks, respectively (HR 1.5, 95% CI 0.7-3.3; P= 0.85). The difference in ORR between groups was not statistically significant (durvalumab 9.7% vs PCC 18.8%; difference -9.1%, 95% CI -31.3%-12.9%; P= 0.83). Fewer all-grade (35.5% vs 68.8%) and high-grade (9.7% vs 31.3%) treatment-related adverse events were observed for durvalumab. PD-L1 CPS+ was observed in 28.9% (CPS≥1%) and 10.5% (CPS≥10%) of patients. PIK3CA mutations were associated with time to progression on durvalumab ³12 weeks (RR(-mutated vs -wildtype) 2.83, 95% CI 1.16 to 14.17).

CONCLUSIONS: Durvalumab was well-tolerated, but did not improve efficacy outcomes compared with chemotherapy in rOCCC.

PMID:40705396 | DOI:10.1158/1078-0432.CCR-25-0201

Shock. 2025 Jul 23. doi: 10.1097/SHK.0000000000002652. Online ahead of print.

ABSTRACT

BACKGROUND: Sepsis, a life-threatening syndrome triggered by a dysregulated host response to infection, continues to impose a substantial global health burden. Advances in genomics and transcriptomics now enable systematic exploration of sepsis pathogenesis at the genetic level. The integration of genome-wide association studies (GWAS) and transcriptome-wide association studies (TWAS) offers a powerful framework to identify causal genetic variants and delineate molecular mechanisms underlying sepsis susceptibility and clinical outcomes.

METHODS: A cross-tissue TWAS was implemented using UTMOST to integrate sepsis GWAS summary statistics with transcriptomic data from the Genotype-Tissue Expression version 8 (GTEx v8) project. Candidate genes were validated through complementary approaches: FUSION, FOCUS, and MAGMA. Tissue-specific and pathway enrichment analyses were applied to prioritize sepsis-associated genes and characterize their functional roles in disease-relevant biological processes. Bayesian colocalization and two-sample Mendelian randomization (MR) analyses were employed to infer putative causal relationships between prioritized genes and sepsis risk.

RESULTS: Four genes-ZCCHC4, PDGFB, C18orf54, and ATG4B-demonstrated significant associations with sepsis susceptibility in cross-tissue analyses. Two-sample MR provided evidence for causal effects of genetically regulated expression of these genes on sepsis risk. Bayesian colocalization identified shared causal variants between sepsis-associated loci and expression quantitative trait loci (eQTLs), implicating dysregulation of inflammatory and autophagy pathways in sepsis pathogenesis.

CONCLUSION: Our results highlight the efficacy of cross-tissue TWAS in mapping sepsis-associated loci and elucidating the genetic architecture underlying sepsis susceptibility. These prioritized loci constitute compelling targets for functional validation and represent actionable candidates for therapeutic intervention in sepsis.

PMID:40705358 | DOI:10.1097/SHK.0000000000002652

Shock. 2025 Jun 30. doi: 10.1097/SHK.0000000000002661. Online ahead of print.

ABSTRACT

BACKGROUND: Sepsis heterogeneity affects the identification of high-risk patients. Outcomes in low- and middle-income countries are worse than those in developed nations. This study aimed to assess the prognostic potential of the previously described molecular endotypes, Mars1, Mars2, Mars3, and Mars4, in a Brazilian cohort with sepsis.

MATERIAL AND METHODS: This prospective, multicenter, observational study identified molecular expression-based endotypes in adults from four intensive care units in Brazil. Patients on their first 24-hour diagnosis of sepsis based on the Sepsis 3 criteria were included. Health care workers were included in the control group. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to quantify the transcripted levels of eight genes and determine the four endotypes. The primary endpoint was 28-day mortality with a secondary analysis of diagnostic accuracy. Statistical significance was set at P < 0.05.

RESULTS: One-hundred-sixty-eight participants and twenty-five controls were enrolled in this study. The overall mortality rate was 44%. The Mars1 group showed a higher 28-day mortality than the non-Mars1group. The log-rank test showed a worst survival probability in Mars1 subgroup (P = 0.013), and the hazard ratio was 1.78 (P = 0.017). Compared to control, area-under-the-curve (AUC) of ROC curves for diagnosing sepsis were: 0.69 for Mars1 (SD 0.62-0.77 / P = 0.0016), 0.89 for Mars2 (SD 0.85-0.94 / P < 0.0001), 0.82 for Mars3 (SD 0.75-0.88 / P < 0.0001) and 0.71 for Mars4 (SD 0.64-0.79 / P < 0.0006).

CONCLUSION: The Mars1 endotype detected by qRT-PCR was associated with worse sepsis survival in low-to middle-income countries. We also identified the Mars 2 endotype as a potential diagnostic marker for sepsis.

PMID:40705347 | DOI:10.1097/SHK.0000000000002661

JAMA Netw Open. 2025 Jul 1;8(7):e2522740. doi: 10.1001/jamanetworkopen.2025.22740.

ABSTRACT

IMPORTANCE: Intestinal multidrug-resistant organism (MDRO) colonization is highly prevalent in long-term acute care hospital (LTACH) patients and is associated with MDRO infection and transmission. However, there are no therapies approved by the US Food and Drug Administration to reduce intestinal MDRO colonization.

OBJECTIVE: To determine the safety and acceptability of fecal microbiota transplantation (FMT) in LTACH patients.

DESIGN, SETTING, AND PARTICIPANTS: This single-center, open-label nonrandomized clinical trial was conducted from April to December 2023 at an LTACH in the Southeastern US with median 50-patient census and 28-day length of stay. Patients with MDRO colonization were identified by perirectal prevalence sampling. Patients colonized with at least 1 target MDRO were approached for informed consent for FMT. FMT recipients were compared with untreated controls with MDRO colonization. Data were analyzed from August 2024 to May 2025.

INTERVENTION: Healthy donor fecal microbiota (50-100 g stool and 250 mL normal saline with 9% glycerol) instilled via gastrostomy tube or enema without antibiotic or bowel preparation conditioning.

MAIN OUTCOMES AND MEASURES: The primary outcome was frequency and severity of adverse events. Solicited adverse events were recorded for 7 days. Unsolicited adverse events were recorded for 6 months. Four weekly perirectal MDRO cultures were performed after FMT.

RESULTS: A total of 42 patients, including 10 (mean [SD] age, 63.8 (14.5) years; 7 [70%] female) who received FMT and 32 contemporaneous controls (mean [SD] age, 64.0 [13.7] years; 13 [41%] female) were assessed. In 2 prevalence surveys, 23 of 32 (72%) and 26 of 34 (77%) perirectal cultures grew at least 1 MDRO. Among the FMT group, 5 patients received FMT via gastrostomy alone, 4 via enema alone, and 1 with both routes more than 30 days apart. No serious adverse events were attributed to FMT, and post-FMT solicited adverse events were mild. At final visit, all perirectal cultures from FMT recipients grew at least 1 MDRO. Post hoc analyses found numerically fewer FMT recipients had positive blood culture results (0 individuals vs 6 individuals [19%]; P = .31), pathogen intestinal dominance (2 of 8 individuals [25%] vs 4 of 8 individuals [50%]; P = .61), and 7 fewer days of antibiotic therapy per 1000 patient days (median [IQR], 12.6 [0-25.2] days vs 19.7 [6.5-36.1] days; P = .38) compared with controls in the 6 months after prevalence survey, although these differences were not statistically significant. Accounting for higher baseline FMT recipient antibiotic use, difference-in-differences analysis estimated 26 (95% CI, -64 to 12) fewer days of antibiotic therapy per 1000 patient-days after FMT, although this difference was also not statistically significant.

CONCLUSIONS AND RELEVANCE: In this nonrandomized pilot clinical trial, FMT was acceptable for LTACH patients without related serious adverse events. Although not powered to test these outcomes, this study found potential reductions in bacteremia, intestinal pathogen domination, and antibiotic use associated with FMT, suggesting FMT should be evaluated in larger, randomized trials.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05780801.

PMID:40705333 | DOI:10.1001/jamanetworkopen.2025.22740

JAMA Netw Open. 2025 Jul 1;8(7):e2523044. doi: 10.1001/jamanetworkopen.2025.23044.

ABSTRACT

IMPORTANCE: The US Preventive Services Task Force (USPSTF) recommends annual computed tomographic (CT) screening for individuals aged 50 to 80 years at high risk of lung cancer. Other countries are issuing similar recommendations, with some opting for biennial screening to reduce the burden of screening. However, it is unknown whether benefits of annual screening can be preserved when adapting the interval to age, sex, and smoking history.

OBJECTIVE: To evaluate the health outcomes and costs of adaptive lung cancer screening intervals relative to annual screening.

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation used comparative modeling methods with 3 models: 2 Cancer Intervention and Surveillance Modeling Network models and the OncoSim model from the Canadian Partnership Against Cancer. Screening of the US 1965 birth cohort with adaptive intervals was evaluated according to age, sex, and smoking exposure. Simulated outcomes are recorded from 2005 to 2065 for subpopulations of 200 000 individuals with smoking history of 10 to less than 20, 20 to less than 30, and 30 or greater pack-years (PY) for each sex. This evaluation was conducted between September 19, 2023, to December 1, 2024.

EXPOSURE: Low-dose regular CT screening among those eligible per USPSTF 2021 recommendations.

MAIN OUTCOMES AND MEASURES: Strategy effectiveness was evaluated as lung cancer deaths prevented and life-years gained relative to annual screening. Screening burden is measured by the number of CT screens. To determine cost-effectiveness, quality-adjusted life-years (QALYs) gained and Surveillance, Epidemiology, and End Results- and Medicare-derived costs of treatment were calculated, as well as CT and follow-up examination costs. A willingness-to-pay (WTP) threshold of $100 000/QALY for cost-effectiveness was assumed.

RESULTS: Biennial screening at 50 to 60 years of age, followed by annual screening, reduced CT requirements while preserving most benefits. This strategy preserved 95.9% (intermodel range, 93.5%-97.5%) of lung cancer deaths prevented, compared with annual screening, with 20.6% (intermodel range, 19.3%-21.9%) fewer screens. Annual screening from 50 to 80 years of age was not cost-effective at a WTP threshold of $100 000/QALY. Cost-effective strategies varied by risk group, but all cost-effective strategies started with biennial screening and moved to annual screening at 60 years of age or a PY threshold of 30 to 40 was reached.

CONCLUSIONS AND RELEVANCE: In this economic evaluation of lung cancer screening, biennial screening for participants younger than 60 years and those with less than 30 PY of smoking exposure maintained screening benefits relative to annual screening. Resource-constricted screening programs may consider adaptive intervals.

PMID:40705331 | DOI:10.1001/jamanetworkopen.2025.23044

Med Mycol. 2025 Jul 24:myaf060. doi: 10.1093/mmy/myaf060. Online ahead of print.

ABSTRACT

INTRODUCTION: Sporotrichosis is a worldwide endemic mycosis caused by thermodimorphic fungi of the genus Sporothrix. Of the around 70 Sporothrix species, four are classified within the clinical or pathogenic clade (S. schenckii, S. brasiliensis, S. globosa and S. luriei), which are usually isolated from animal and human infections. The disease shows various clinical presentations (fixed and disseminated cutaneous, lymphocutaneous, systemic or extracutaneous forms), with itraconazole being the antifungal of choice in most cases. The cat is the key player in the zoonotic scenario of sporotrichosis, but despite the high number of felines with sporotrichosis, there are few studies that explore the clinical aspects of the disease in dogs and cats. The objective of this review was to establish associations between clinical aspects and treatment outcomes in feline and canine sporotrichosis.

METHODS: through a systematic review using the PRISMA method, scientific articles from WOS and Scopus databases were collected. The presence of information about the treatment and clinical outcome of feline and canine sporotrichosis were used as inclusion criterion. We included articles in English, Portuguese or Spanish, published from 1978 to August 5, 2024. The data collected included patient species, sex, country, lifestyle, predisposing factors, diagnosis, sporotrichosis clinical form, disease evolution time, therapy type, treatment, treatment duration, clinical outcomes, and side effects. To analyze the data, we used RStudio and the Python programming language in the COLAB environment. Using violin plots we analyzed the distribution of the time of disease evolution and the duration of treatment according to 1) patient species, 2) sporotrichosis clinical form, 3) diagnosis and 4) clinical outcome. Additionally, we analyzed the independence between qualitative variables and the strength of the association between 9 different groups of variables.

RESULTS: of the total of 508 articles initially found, 54 met the inclusion criteria, of which 152 cases of animal sporotrichosis were reported (131 cat cases and 21 dog cases). Most of the reported cases came from Brazil, with S. brasiliensis being the species found in the highest proportion. 19.73% of the cases were male cats, linked to outdoor behavior. Monotherapies were the most used type of therapy, and itraconazole was the most used antifungal, with high favorable responses and low adverse effects. Analysis of relationship of the treatment duration with the clinical outcomes showed significant association of longer treatment period and favorable clinical outcome, when compared with death or diseases relapse. Furthermore, we found statistically significant associations when the clinical outcomes were correlated with clinical type of sporotrichosis, antifungal therapy type and antifungal drug side effects.

CONCLUSIONS: This work confirm previous finds that S. brasiliensis has a key role in the feline sporotrichosis epidemic ongoing in Brazil and highlights the importance of a thorough initial diagnosis to animal cases guaranteeing personalized first-line treatment for each patient, increasing cure rates, as well as decreasing S. brasiliensis transmission.

PMID:40705328 | DOI:10.1093/mmy/myaf060

Neurol India. 2025 Jul 1;73(4):740-745. doi: 10.4103/neurol-india.Neurol-India-D-24-00251. Epub 2025 Jul 24.

ABSTRACT

BACKGROUND: Ictal cognitive assessments carried out in Epilepsy Monitoring Units (EMUs) have been standardized on the Western population which is unable to capture the socioeducational differences present in the Indian population.

OBJECTIVE: This study focuses on modifying and rearranging components of the International League Against Epilepsy’s Ictal Testing Battery (ILAE-ITB) in a local setting at an Indian epilepsy center.

METHODS: The Customizable Ictal Testing Battery (C-ITB) was modified using ILAE-ITB by enabling variable order of item administration, prioritizing items testing the suspect seizure onset region. The consenting participants were assessed using both batteries. The diagnostic performance and localization ability of C-ITB were also measured.

RESULTS: 116 patients with drug-resistant epilepsy were recruited. Association between both batteries was statistically significant using the Chi-square/Fisher’s exact test (P value < 0.001). The Cohen’s kappa was 85.6 and the sensitivity and specificity indices were 100% and 80% respectively. C-ITB demonstrated an inherent validity of 94.8%. There was a significant association between the localization demonstrated by C-ITB and vEEG, MRI. The localization capabilities of C-ITB and ILAE-ITB were comparable.

SIGNIFICANCE: C-ITB is a comprehensive measure of ictal functioning adapted according to the requirements of Indian patients with epilepsy and might facilitate further research into the domain of ictal response deficits.

PMID:40705291 | DOI:10.4103/neurol-india.Neurol-India-D-24-00251