Tag: nevin manimala

JMIR Form Res. 2026 Jul 15;10:e89719. doi: 10.2196/89719.

ABSTRACT

BACKGROUND: The postpartum period represents a critical window for maternal health, yet many individuals lack sustained support and timely identification of physical and mental health risks. Digital health interventions offer a scalable approach to extend care beyond clinical settings. Yet, key elements, including real-world challenges, usability, and effectiveness of such platforms, are insufficiently characterized in this literature.

OBJECTIVE: This study aimed to conduct a formative randomized evaluation to assess the feasibility, engagement, and preliminary signals of impact of the Joyuus platform and to examine the potential for early identification of postpartum health risks.

METHODS: We conducted a 12-week randomized evaluation with postpartum participants recruited through community-based organizations. Participants were randomized to either the Joyuus intervention or standard postpartum care. Primary and secondary outcomes included the Barkin Index of Maternal Functioning, the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory, and the Connor-Davidson Resilience Scale. Analyses were conducted using an intention-to-treat approach with linear regression models adjusting for baseline values. Engagement metrics (ie, sessions, time on site, and feature use) were captured through in-app analytics. An exploratory predictive model was developed using baseline clinical, behavioral, and demographic variables to identify individuals at risk for postpartum depression.

RESULTS: Baseline characteristics were generally balanced across arms, and no statistically significant differences were observed in education, income, or marital status. No statistically significant differences were found between treatment and control groups in the 12-week changes for the primary or secondary outcomes. Mean EPDS scores were 9.7 in the intervention group and 9.3 in the control group. In the sample, 60 (45.5%) of the 132 participants met the criteria for elevated depression (EPDS score ≥11 or a positive response to question 10 on self-harm), indicating a high burden of symptoms within the study population. Engagement with the platform was highest during the first 4 weeks. Among intervention participants, 80% created an account. Participants reported high levels of perceived usefulness, ease of use, and relevance of content. Qualitative analysis of open-ended survey responses highlighted limited awareness of postpartum-specific resources and a preference for simple, accessible information. An exploratory predictive model demonstrated a recall of 0.89 and a precision of 0.73 in identifying individuals at risk for postpartum depression, suggesting the feasibility of early risk identification using integrated data inputs.

CONCLUSIONS: Joyuus demonstrated feasibility and acceptability but did not produce statistically significant improvements in maternal functioning or maternal health outcomes over 12 weeks. Joyuus identified high rates of depressive symptoms and early engagement patterns, which suggest an opportunity for earlier identification of risk and intervention during the postpartum period. Exploratory modeling results indicate the potential for data-driven approaches to support earlier detection. Future work includes optimizing engagement strategies and expanding validation of predictive detection to improve postpartum surveillance and outcomes.

PMID:42456164 | DOI:10.2196/89719

JMIR Med Educ. 2026 Jul 15;12:e77034. doi: 10.2196/77034.

ABSTRACT

BACKGROUND: The use of remote teaching in medical education has increased since the COVID-19 pandemic. However, the effectiveness of synchronous remote teaching for specific psychomotor components of the neurological examination, such as tendon reflex assessment, remains underexplored.

OBJECTIVE: This study aimed to evaluate the short-term effectiveness of synchronous remote teaching compared with traditional in-person teaching for training medical students in tendon reflex examination skills and related neurological examination knowledge.

METHODS: This quasi-experimental study enrolled 110 fifth-year medical students between August 2022 and April 2024, who were assigned to either synchronous remote teaching (n=46) or in-person teaching (n=64). The participants completed pre- and postcourse knowledge tests and an objective structured clinical examination (OSCE) assessing tendon reflex examination skills. Motivational beliefs related to self-regulated learning and technology acceptance were measured at baseline. Group differences were analyzed using t tests, Mann-Whitney U tests, and correlational analyses.

RESULTS: Posttest knowledge scores were higher in the synchronous remote teaching group than in the in-person group (mean difference 0.86, 95% CI 0.21-1.51; Cohen d=0.50; P=.01), indicating a modest effect size. Both groups demonstrated substantial improvements in tendon reflex OSCE performance; however, the between-group difference in OSCE score improvement was not statistically significant (mean difference -3.64; 95% CI -9.36 to 2.08; Cohen d=-0.26; P=.21). Within the synchronous remote teaching group, higher motivational beliefs were positively correlated with OSCE score gains (Pearson r=0.34; P=.04; n=46), suggesting a potential role of self-regulated learning-related motivational processes. These exploratory findings should be interpreted with caution.

CONCLUSIONS: Under the conditions of this study, synchronous remote teaching was associated with modest improvements in knowledge outcomes and with OSCE-assessed tendon reflex examination skill gains that were comparable to those of traditional in-person teaching, without statistically significant between-group differences in psychomotor performance. These findings do not establish durable skill acquisition and should not be interpreted as evidence of equivalence or superiority of synchronous remote teaching over in-person instruction. Unlike many prior remote medical education studies that primarily focused on asynchronous learning or self-reported outcomes, this study incorporated synchronous interactive instruction with objective OSCE-based psychomotor assessment. These findings contribute to the emerging literature on synchronous remote clinical skills education, although future randomized and longitudinal studies are needed to evaluate long-term skill retention and broader applicability.

PMID:42456133 | DOI:10.2196/77034

J Med Internet Res. 2026 Jul 15;28:e86045. doi: 10.2196/86045.

ABSTRACT

BACKGROUND: of findings (SoF) tables are widely used in systematic reviews and clinical practice guidelines to present evidence about health care interventions in a concise and transparent format. Although developed to improve accessibility and interpretation of evidence, previous studies have shown that users often experience difficulties understanding statistical information, certainty ratings, and the relationships between outcomes and treatment effects. Limited research has explored how different groups of users cognitively interact with SoF tables while solving evidence interpretation tasks, particularly when table complexity increases.

OBJECTIVE: This study aimed to investigate how different types of users-Grading of Recommendations Assessment, Development, and Evaluation (GRADE) or Cochrane experts, practicing clinicians, and health care users-interact with SoF tables of varying complexity while answering intervention-related questions, and to examine differences in search behavior, navigation patterns, and task performance.

METHODS: We used the Read&Learn tool (ERI-Lectura and LAIA-UV) in an online, single-session study to evaluate participants’ interactions with SoF tables. Participants (n=120; 40 per group) accessed preselected SoF tables via a secure link and unique login. Participants completed tasks involving 4 SoF tables with increasing complexity. Specific table cells were blurred and had to be clicked to reveal information. Outcomes included the number of correct answers, total time spent on tasks, number of table cells visited, number of target and nontarget cells, and question-reading behavior.

RESULTS: Simpler SoF tables with a small number of outcomes and single target cells were correctly interpreted by most participants, regardless of their expertise. As table complexity and task demand increased, all participant groups demonstrated reduced performance and less efficient navigation patterns. Experts generally performed better than clinicians and health care users, particularly by spending less time reading nontarget cells and visiting fewer irrelevant table elements. Nevertheless, even experts experienced difficulties with tasks requiring synthesis and interpretation across multiple table cells. Questions requiring comparison and integration of information across outcomes resulted in the highest rates of incorrect responses in all groups. Heatmaps of the number of clicks and time spent on tables demonstrated that experts used more targeted search strategies, whereas clinicians and health care users explored a larger number of nontarget cells and spent more time navigating the tables. The most complex SoF tables produced the highest cognitive demands for all groups, suggesting that increasing element interactivity and information density substantially affect usability.

CONCLUSIONS: SoF tables remain cognitively demanding even for experienced users of evidence synthesis. Increasing table complexity appears to reduce users’ ability to identify, interpret, and synthesize relevant information. These findings suggest that current SoF formats may impose substantial intrinsic and extraneous cognitive load, particularly for nonexpert audiences. Future development of SoF tables should prioritize clearer presentation of clearer outcomes, inclusion of absolute alongside relative effects, and interactive or user-centered formats that support evidence navigation and interpretation.

PMID:42456099 | DOI:10.2196/86045

Crit Care Med. 2026 Jul 15. doi: 10.1097/CCM.0000000000007265. Online ahead of print.

ABSTRACT

OBJECTIVES: Amiodarone or lidocaine are recommended for the treatment of shockable out-of-hospital cardiac arrest (OHCA). Previous comparisons between the two antiarrhythmic drugs were inconclusive.

DESIGN: This analysis included data from the Resuscitation Outcomes Consortium Cardiac Epidemiologic Registry 3 (2011-2015). A target trial framework was used to overcome confounding inherent in observational comparisons.

SETTING: Data from patients with OHCA were prospectively collected by emergency medical services (EMS) at multiple North American sites.

PATIENTS: Adults with nontraumatic OHCA and an initial shockable rhythm who received at least three defibrillation attempts were included. Time zero was defined as first antiarrhythmic drug administration, at which eligibility criteria had to be met.

INTERVENTIONS: Two antiarrhythmic treatment strategies were compared: lidocaine vs. amiodarone.

MEASUREMENTS AND MAIN RESULTS: The primary outcome was survival to hospital discharge. The key secondary outcome was favorable neurologic outcome at discharge (modified Rankin scale score of 3 or less). Group differences were adjusted using inverse probability weighting (key covariates: age, sex, location of OHCA, witness status, bystander resuscitation, automated external defibrillator shock, elapsed time from call to advanced life support arrival/first EMS shock/advanced airway, intraosseous access) and a multiple logistic regression model. Of 2451 patients included, 987 received lidocaine and 1464 received amiodarone. The adjusted percentage point difference in survival to hospital discharge was 2.8% favoring lidocaine (95% CI, -0.6 to 6.2); the estimated survival probabilities were 26.2% (275/987) with lidocaine and 23.5% (329/1464) with amiodarone. No difference was observed in the estimated probability of favorable neurologic outcome at discharge between the lidocaine group (17.7%) and the amiodarone group (16.2%) (adjusted difference, 1.5%; 95% CI, -1.5 to 4.5).

CONCLUSIONS: No statistically significant difference in survival or favorable neurologic outcome was observed between lidocaine and amiodarone; however, the wide CIs cannot exclude a clinically meaningful benefit for lidocaine. These findings are consistent with randomized controlled trials, but residual confounding cannot be excluded.

PMID:42456091 | DOI:10.1097/CCM.0000000000007265

J Clin Oncol. 2026 Jun 9:JCO2502520. doi: 10.1200/JCO-25-02520. Online ahead of print.

ABSTRACT

PURPOSE: To assess whether adding fluoropyrimidine sensitized radiotherapy (CXRT) to adjuvant chemotherapy improves overall survival (OS) after curative intent resection of the pancreatic head.

METHODS: This was a multicenter, randomized phase III, two step trial. Step 1: gemcitabine versus gemcitabine + erlotinib (previously reported). Step 2: random assignment to sixth chemotherapy cycle ± CXRT after five cycles of step 1 chemotherapy without progression. Outcomes of step 2 random assignment are reported here. Assuming 17 months median OS (chemotherapy alone), the sample size was 354 patients (hazard ratio [HR], 0.76, 80% power, one-sided α = .05, 316 OS events). OS/disease-free survival (DFS) were estimated by Kaplan-Meier and arms compared using the log-rank test.

RESULTS: A total of 354 patients (median age 63, 55% male, 56% performance status, 1) were randomly assigned to chemotherapy (174) or chemotherapy + CXRT (180). Univariable median and 5-year OS (90% CIs) were 2.6 years (2.1-3.1) and 23.1% (17.7-28.6) for chemotherapy alone, and 2.3 years (2.0-2.6) and 27.9% (22.2-33.6) for chemotherapy + CXRT. The OS primary end point was not met (HR, 0.96 [90% CI, 0.79 to 1.18]; one-sided P = .38, two-sided P = .77). Chemotherapy + CXRT was associated with a trend for improved DFS (univariably; HR, 0.82 [95% CI, 0.65 to 1.03]; P = .089), without increase in grade 4/5 toxicities. However, grade 3 toxicity increased (38% v 19%, P < .001). Significantly, treatment by nodal status interactions showed that CXRT improved OS (P = .0063) and DFS (P = .014) in node-negative patients.

CONCLUSION: Overall, the addition of adjuvant CXRT to adjuvant gemcitabine did not statistically significantly improve OS, DFS, or increase grade 4/5 toxicity. For node-negative patients, CXRT improved OS and DFS. These results, if confirmed in studies with current or future systemic therapies, would support the use of adjuvant/neoadjuvant CXRT for node-negative patients.

PMID:42456089 | DOI:10.1200/JCO-25-02520

Otol Neurotol. 2026 Jul 15. doi: 10.1097/MAO.0000000000005003. Online ahead of print.

ABSTRACT

OBJECTIVES: The advancement of high-resolution magnetic resonance imaging (MRI) has enabled clinicians to detect endolymphatic hydrops, thereby prompting interest in distinguishing between Ménière disease (MD) and vestibular migraine (VM) in patients presenting with vertigo, headache, hearing loss, ear fullness, and tinnitus. The aim of this study is to compare cochlear and vestibular endolymphatic hydrops in diagnosing VM, MD, and vestibular migraine with Ménière disease (VMMD).

METHOD: A prospective clinical study evaluating patients with episodic vertigo meeting criteria for either MD, VM, or both was conducted between July 2019 and December 2021. All patients underwent an MRI to assess hydrops in both ears. Treatment response was evaluated and considered the gold standard for diagnosis.

RESULTS: A total of 231 patients were included. The gold standard diagnosis was determined based on treatment response over at least 2 years. For MD, regardless of definite or probable diagnosis, grade I hydrops was most common for the cochlea (59.6%) and grade II for the vestibule (50.6%). No cochlear or vestibular hydrops were identified in 58.0% and 50.7% of VM cases, respectively. Grade I hydrops predominated in VM (cochlear: 39.1%; vestibular: 39.1%). Our study revealed statistically significant differences between the final diagnoses of MD, VM, and VMMD and the severity grading of vestibular and cochlear hydrops.

CONCLUSION: Endolymphatic hydrops and its severity grading are associated with MD. More than 50% of VM patients demonstrated no evidence of hydrops. However, it is important to recognize that when hydrops is present in VM patients, it is most often mild.

PMID:42456062 | DOI:10.1097/MAO.0000000000005003

Otol Neurotol. 2026 Jul 15. doi: 10.1097/MAO.0000000000005006. Online ahead of print.

ABSTRACT

OBJECTIVE: Middle ear surgery is frequently associated with significant postoperative pain, nausea, and vomiting. Such issues have prompted clinicians to adopt regional nerve blocks, such as the superficial cervical plexus block (SCPB) and the great auricular nerve block (GANB). Our aim was to evaluate the efficacy of regional nerve blocks in adult patients undergoing different middle ear surgeries.

DATABASES REVIEWED: PubMed, the Cochrane Central Database of Controlled Trials and Systematic Reviews (CDSR), Scopus, Web of Science, and Google Scholar.

METHODS: Eligible randomized controlled trials (RCTs) used targeted nerve blocks (SCPB or GANB) against a sham block (saline) or standard care in adults undergoing middle ear surgery. Outcomes evaluated included pain scores, opioid consumption, rescue analgesics, postoperative nausea and vomiting (PONV), and adverse events (vertigo, dizziness, and tinnitus). Non-RCTs, pediatric/animal studies, and trials comparing 2 active blocks were excluded.

RESULTS: A total of 7 RCTs with 459 participants were included in this review. Regional nerve block significantly reduced postoperative pain at 1, 12, and 24 hours (MDs=-0.80, -0.78, and -0.41, respectively; all P<0.0001). In addition, there was a significant reduction in intraoperative remifentanil consumption (MD=-531.18 µg) and a lower incidence of PONV (RR=0.46). Reductions in rescue analgesic requirements and differences in the incidence of adverse events were not statistically significant.

CONCLUSIONS: SCPB and GANB represent a promising adjunct in perioperative care for middle ear surgery, offering better pain management and enhanced patient recovery. Further optimization of these techniques is key to ensuring all patients receive the best perioperative care.

PMID:42456058 | DOI:10.1097/MAO.0000000000005006

Mil Med. 2026 Jul 15:usag322. doi: 10.1093/milmed/usag322. Online ahead of print.

ABSTRACT

INTRODUCTION: Cricothyrotomy is a critical intervention for airway obstruction on the battlefield. Accurate identification of the cricothyroid membrane (CTM) is essential, yet prior literature indicates that CTM localization in female patients is more challenging due to anatomical differences. This study evaluated the accuracy of CTM identification in a female model by U.S. Army medics using the Modified Laryngeal Handshake (MLH) vs the Traditional Palpation Method (TM).

MATERIALS AND METHODS: In this prospective, randomized controlled trial, 29 active-duty, U.S. Army medics (military occupational specialty 68W) without additional advanced medical training were randomly assigned to use either the MLH (n = 14) or TM (n = 15) technique to identify the CTM on a standardized live female model. Success was defined as a mark within the cephalad and caudal borders of the CTM and within 5 mm of midline. Secondary outcomes included time to task completion, distance from CTM borders, horizontal deviation from midline, and participant confidence (measured via 10-cm visual analog scale). Data were analyzed using Fisher’s exact test and Wilcoxon rank-sum tests.

RESULTS: There was no statistically significant difference in CTM identification success between the MLH (36%) and TM (33%) groups (P > .99). Secondary outcomes also showed no significant differences, including vertical and horizontal deviation, time to task completion (median MLH: 19.34 s vs TM: 12.97 s; P = .057), and confidence (median MLH: 7.0 vs TM: 8.0; P = .53).

CONCLUSION: U.S. Army medics demonstrated similarly low accuracy in CTM identification in a female model using both the MLH and TM techniques. These findings highlight the need for enhanced training protocols that consider sex-specific anatomical challenges to optimize cricothyrotomy success in prehospital battlefield settings.

PMID:42456050 | DOI:10.1093/milmed/usag322

JMIR Med Educ. 2026 Jul 15;12:e96244. doi: 10.2196/96244.

ABSTRACT

BACKGROUND: For this study, digitalization in medicine was used as an illustrative case to investigate how medical curricula respond to rapidly changing knowledge. Digitalization is transforming the way medicine and health care are provided and experienced. Experts have suggested various topics for medical curricula to keep pace with rapidly evolving knowledge. However, adapting these curricula remains a lengthy process that often lacks an interdisciplinary approach.

OBJECTIVE: The perspectives of curriculum governing bodies and the boards responsible for curriculum operations at 2 medical universities were examined regarding the need for curriculum changes to account for digitalization in medicine, as well as the difficulties in adapting the curriculum to ever-growing knowledge. We identify and suggest ways to achieve more agile curriculum development.

METHODS: This study consists of a qualitative analysis of governing policy frameworks and a qualitative study involving 14 video interviews. The interviews were performed with members of university curriculum governing bodies and the boards responsible for curriculum operations.

RESULTS: All participants agreed that digitalization will reshape the medical profession by reducing physical contact, enhancing data-driven communication, and streamlining administrative processes. They highlighted the need for graduates to acquire digital literacy, critical evaluation skills, and a basic understanding of data and statistics. Yet, despite being designed as an integrated program, most participants noted that curricula have become fragmented over time due to a lack of coordination between curriculum modules. Furthermore, current processes lead to a siloed perspective, where limited coordination between modules makes it difficult to implement new knowledge holistically. This lack of intermodule alignment emerged as a key barrier to coherent curricular change. Learning objectives were identified as a promising but underutilized tool for monitoring content, aligning modules, and ensuring that emerging topics such as digitalization are integrated consistently.

CONCLUSIONS: Most participants agreed that current processes for monitoring and updating curricula are not efficiently designed, tending to be too static and focusing primarily on the advancement of subject-specific medical knowledge. To prepare current and future students for a rapidly changing world, curriculum processes should evolve from static, fragmented structures to more agile, integrated systems. By mapping the survey results to the curriculum development frameworks of Kern and Harden, we find that the challenge lies not so much in adding new content, but rather in designing curriculum processes that achieve a holistic overview. Strengthening the use of learning objectives as a dynamic monitoring and alignment tool offers a concrete opportunity to integrate rapidly changing knowledge holistically.

PMID:42456037 | DOI:10.2196/96244

JMIR Mhealth Uhealth. 2026 Jul 15;14:e78081. doi: 10.2196/78081.

ABSTRACT

BACKGROUND: Previous studies demonstrated the effectiveness of SmartCoach, a mobile phone-based life-skills training program for addiction prevention among adolescents. However, socially stratifying factors, such as educational level or migration background, were associated with lower program engagement and participation. To address these disparities, we optimized and tailored program elements, particularly for subgroups with low engagement, using qualitative interview data.

OBJECTIVE: This study aimed to test whether the optimized program version was superior to the original one in terms of efficacy and program use. We hypothesized that optimization and advanced tailoring would result in increased program efficacy and engagement.

METHODS: A 2-arm, parallel-group, double-blind, cluster-randomized controlled trial was conducted with assessments at baseline and follow-up after 6 months. Secondary and upper secondary school classes were randomized into two groups: (1) an intervention group receiving the optimized program version and (2) a control group receiving the original version. Participants in both groups received up to 4 weekly SMS text messages over 4 months to stimulate (1) self-management skills to cope with stress, (2) self-efficacy to resist social pressure, (3) observational learning, and (4) self-regulation. The optimized program version included additional reminders, extended time for challenges, simplified language, different days for weekly messages, and additional tailoring for participants with personal or parental backgrounds from non-German-speaking countries. This subgroup received shorter video clips and information on additional stressors, including acculturation and family conflicts. The primary outcomes of this trial were the quantity of alcohol use, the number of days per month that nicotine-containing products were smoked, and cannabis use days.

RESULTS: A total of 1175 students from 67 Swiss secondary and upper secondary school classes were invited to participate in the study between September 2023 and September 2024. Of these 1175 students, 890 (75.7%; mean age 14.9, SD 1.3 y; women: n=511, 57.4%; men: n=379, 42.6%; nonbinary: n=0, 0.0%) participated in the study. Six-month follow-up assessments were completed by 552 (62.0%) of the 890 study participants. On average, program use did not differ between the study groups, with 12.6 (SD 12.8) of 38 possible activities completed in the intervention group and 12.5 (SD 12.7) activities in the control group (P=.18). The results concerning efficacy showed no significant differences between the study groups regarding the main outcomes of alcohol use quantity (P=.91), nicotine use days (P=.45), and cannabis use days (P=.67). Similarly, no significant group differences were observed for changes in perceived stress (P=.77) and social skills (P=.45).

CONCLUSIONS: The results did not show improved program use or efficacy in the optimized version of the program. Possible explanations include the relatively minor differences between the 2 program versions and the generally low prevalence rates of substance use in this age group, which limited the statistical power of the study.

PMID:42456030 | DOI:10.2196/78081