Tag: nevin manimala

JMIR Form Res. 2025 Sep 8;9:e76782. doi: 10.2196/76782.

ABSTRACT

BACKGROUND: Delayed discharge among older patients presents a major challenge for the efficiency of health service delivery. Prolonged hospitalizations limit bed turnover, increase costs, and reduce the availability of hospital resources. In Japan, older adults must undergo a formal care needs certification process to access public long-term care (LTC) services. Initiating this process during hospitalization is considered ideal for ensuring continuity of care. However, the relationship between the timing of LTC certification applications and hospital length of stay (LOS) remains unclear.

OBJECTIVE: This study examined the association between the timing of LTC certification applications-specifically those submitted during hospitalization-and average LOS among older inpatients across Japanese prefectures.

METHODS: We conducted an ecological cross-sectional analysis using data from all 47 prefectures in Japan for fiscal year 2020. The exposure variable was the proportion of LTC certification applications submitted during hospitalization among all new LTC applications in each prefecture. Exposure data were sourced from the Long-Term Care Database Open Data (Kaigo DB Open Data). The outcome was average LOS among individuals aged ≥65 years at the prefectural level from the 2020 Patient Survey. Linear regression models were used to evaluate the association between the exposure and outcome variables adjusting for relevant covariates. Prefecture-level covariates included proportion of residents living alone, with cognitive decline, or with higher dependency; the proportion requiring dialysis or a respirator before application; the number of health care providers per 100 beds; and the number of nursing and care home beds per 1000 LTC recipients. Sensitivity analyses were conducted using alternative LOS data sources (eg, 2018 and 2020 Hospital Report and 2017 Patient Survey).

RESULTS: The median proportion of in-hospital LTC certification applications was 30.5% (IQR 24.5%-36.1%). The median LOS for older adults was 40 (IQR 37-45.5; range 30-82) days. Prefectures with a higher proportion of in-hospital applications had substantially longer average LOSs. In univariate analysis, the association was statistically significant (β=0.04; P=.003), indicating that a 1% increase in in-hospital applications was associated with an approximately 2-day increase in average LOS. This association remained statistically significant after adjustment for all covariates in multivariate models (β=0.06; P=.04). Findings were consistent across sensitivity analyses.

CONCLUSIONS: Although initiating LTC certification during hospitalization is essential for supporting timely discharge, our findings indicate a positive association with extended hospital stays. This may reflect systemic delays in the certification process. Even with ideal discharge planning, such delays could extend hospitalization and lead to suboptimal allocation of health care resources. As this study was ecological in design, the findings should be interpreted cautiously. Further individual-level data research is warranted to clarify the mechanisms and inform strategies for improving transitional care efficiency in aging populations.

PMID:40921066 | DOI:10.2196/76782

JMIR Hum Factors. 2025 Sep 8;12:e67476. doi: 10.2196/67476.

ABSTRACT

BACKGROUND: The rapid advancement of next-generation sequencing has significantly expanded the landscape of precision medicine. However, health care professionals face increasing challenges in keeping pace with the growing body of oncological knowledge and integrating it effectively into clinical workflows. Precision oncology decision support (PODS) tools aim to assist clinicians in navigating this complexity, yet their current functionalities only partially address clinical needs. A lack of comprehensive needs assessment may result in unaddressed requirements, limiting the effectiveness of these tools in real-world practice.

OBJECTIVE: This study aimed to explore clinicians’ needs and expectations regarding the functionalities of integrated PODS tools, providing insights into essential features that could enhance their usability and impact.

METHODS: We conducted a qualitative investigation at Peking University Cancer Hospital to explore clinicians’ needs and expectations for the functions of integrated PODS tools. Data were collected through 143 structured participant observations during multidisciplinary team meetings and 17 in-depth semistructured interviews with a diverse group of oncology specialists, including physicians, surgeons, molecular biologists, radiotherapists, radiologists, and pathologists. Thematic analysis was applied to identify key functional requirements, and a requirements framework was formed.

RESULTS: Three overarching functional needs emerged: (1) better access to oncological knowledge, including support for therapy selection (guidelines, conferences, and consensuses), clinical trials, drug and treatment information, and complex case knowledge, as well as improved diagnostic and prognostic insights; (2) clinical contextualization and resource navigation, referring to the process of contextualizing scientific knowledge within real-world clinical settings, including access to clinical trials and drugs, along with predictive models for treatment response; and (3) support abilities in the decision-making process, highlighting the need for integration of flexible biological knowledge and phenotypic data; automated patient information synthesis; improved data visualization; and optimized retrieval, recommendation, and question-answering functionalities. A functional framework for integrated PODS tools was proposed based on these findings.

CONCLUSIONS: The study conducted a qualitative descriptive observation and interview in the use, needs of integrated PODS tools. PODS tools serve as complex, multilevel decision support systems. A clear understanding of clinicians’ actual needs is crucial for their refinement and practical adoption. By capturing perspectives directly from oncology professionals, this study provides actionable insights into the functional enhancements required for PODS tools, ultimately aiming to bridge the gap between genomic advancements and clinical decision-making in precision oncology.

PMID:40921061 | DOI:10.2196/67476

JMIR Pediatr Parent. 2025 Sep 8;8:e71433. doi: 10.2196/71433.

ABSTRACT

BACKGROUND: Alone time with health care providers is critical for adolescents, and several professional organizations recommend it. Alone time with providers promotes better utilization of health services, empowers adolescents to manage their health, and facilitates discussions on sensitive issues. However, only 40% of adolescents have private conversations with clinicians during visits. The advancement of mobile health technology provides an excellent opportunity to deliver effective interventions to promote adolescent-provider alone time with adolescents, parents, and providers.

OBJECTIVE: This pilot study aims to explore the preliminary efficacy of a technology-based intervention designed to increase alone time with providers during well-adolescent visits and its impact on trustworthiness, parent-adolescent communication, sexual risk communication, parental monitoring, and parental support before and after the intervention.

METHODS: A pre- and postintervention design was used. Participants were recruited through local clinics. After obtaining consent, participants accessed a study website to complete a baseline survey, independently interact with 4 educational modules on a website or cellphone, and complete a post-test survey 1 month after their well-adolescent visits. The surveys assessed alone time with providers, trustworthiness, parent-adolescent communication, sexual risk communication, parental monitoring, and parental support. Mixed model analysis and effect sizes were used to evaluate changes in these outcomes from pre- to postintervention.

RESULTS: Thirty-two dyads (38 adolescents and 32 mothers) participated in this pilot study. About 86% (n=33) of adolescents and 87% (n=28) of mothers completed the pre- and post-test assessments and the intervention. This study found a trend toward an increase in alone time from 81.6% to 84.4%, albeit not statistically significant. Adolescents initiating alone time with providers rose from 6.45% (n=2) to 18.5% (n=5). Over 90% (n=26) of adolescents reported feeling comfortable in one-on-one interactions with providers postintervention. Mixed model analysis revealed significant improvements among adolescents in parental monitoring (z=2.93, P<.001), sexual risk communication (z=3.11, P<.001), parent-adolescent communication (z=3.11, P<.001), open family communication (z=2.00, P=.04), and parental support (z=2.87, P<.001). For mothers, significant improvements were found in parental monitoring (z=2.45, P<.001) and problem family communication (z=2.24, P=.03).

CONCLUSIONS: This pilot study demonstrates promising results regarding the preliminary efficacy of a technology-based intervention to increase alone time with providers during well-adolescent visits and to enhance communication and parenting practices. Improving access to alone time and strengthening communication between parents and adolescents facilitates discussions about sensitive topics, including parental monitoring, sexual and reproductive health, and may strengthen overall satisfaction with health care.

TRIAL REGISTRATION: ClinicalTrials.gov NCT07064070; https://clinicaltrials.gov/study/NCT07064070.

PMID:40921058 | DOI:10.2196/71433

Dis Esophagus. 2025 Oct 1;38(5):doaf071. doi: 10.1093/dote/doaf071.

ABSTRACT

Clinical practice guidelines for esophagogastric junction cancer (EGJ GLs) were published in 2023. In order to evaluate how EGJ GLs have been adopted into clinical practice worldwide and to identify any outstanding clinical questions to be addressed in the next edition, this survey was conducted. An electronic questionnaire was developed. The questionnaire comprised 16 questions designed to assess the adoption of the guideline. Responses were collected online. The survey was conducted by the EGJ working group of International Gastric Cancer Association (IGCA) following approval from the guideline committee of The International Society for Diseases of the Esophagus (ISDE). As results, we received 344 valid and complete responses. 55% of respondents were from East Asia followed by Europe, Central/South America, and Central/West Asia. 80% of respondents recognized and followed the guidelines to some extent. There was still diversity in the extent of lymphadenectomy for EGJ cancers with an esophageal invasion of 2-4 cm. Although white light imaging (WLE) alone was recommended in the EGJ GLs, both WLE and image enhanced endoscopy were used in 86% of respondents. The perioperative treatment was shown to be highly diverse worldwide. While 50% of respondents provided perioperative chemotherapy, preoperative chemotherapy without adjuvant treatment and upfront surgery were still the first treatment option in 15% of respondents. In conclusion, the current survey conducted by IGCA and ISDE identified the current standard and remaining issues of EGJ cancers.

PMID:40921057 | DOI:10.1093/dote/doaf071

J Chem Inf Model. 2025 Sep 8. doi: 10.1021/acs.jcim.5c01101. Online ahead of print.

ABSTRACT

To assess environmental fate, transport, and exposure for PFAS (per- and polyfluoroalkyl substances), predictive models are needed to fill experimental data gaps for physicochemical properties. In this work, quantitative structure-property relationship (QSPR) models for octanol-water partition coefficient, water solubility, vapor pressure, boiling point, melting point, and Henry’s law constant are presented. Over 200,000 experimental property value records were extracted from publicly available data sources. Global models generated from data for diverse chemical classes resulted in more accurate property value predictions for PFAS than local models generated from a PFAS-only data set, with an average 11% reduction in mean absolute error (MAE). The global models across all property endpoints achieved strong performance on test data (R² = 0.76-0.89 for all chemical classes). The test set mean absolute error for PFAS was about 33% higher than the value for all chemicals in the test set (when averaged over the six data sets). The new global models yielded superior PFAS prediction statistics relative to those for existing Toxicity Estimation Software Tool (T.E.S.T) models, with an average 13% reduction in MAE. A nearest neighbor-based measure of model applicability domain (AD) was shown to exclude poor predictions while maintaining a relatively high fraction (∼95%) of chemicals inside the AD. In addition, most test set PFAS are outside the AD when the model was generated without PFAS in the training set.

PMID:40921046 | DOI:10.1021/acs.jcim.5c01101

Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2025 Sep 8:1-10. doi: 10.1080/19440049.2025.2553701. Online ahead of print.

ABSTRACT

Global demand for chickpeas has increased due to their high plant protein content, gluten-free nature, and overall nutritional benefits. However, chickpeas are susceptible to colonisation by Aspergillus spp. – fungi, which are capable of producing harmful mycotoxins. The natural occurrence of A. flavus contamination has been confirmed in a chickpea crop in Argentina. Fainá is a type of flat bread made from chickpea flour, which is widely consumed in Argentina. This study aimed to investigate whether the production process of fainá affects the initial contamination of aflatoxins (AFs). Aflatoxin levels were determined in chickpea flour inoculated with A. flavus, in commercial flour, as well as in fainá produced under laboratory-scale conditions. The potential exposure to aflatoxins through the consumption of fainá was evaluated using statistical estimates derived from the literature. Commercial flour intended for direct human consumption revealed AFB1 levels exceeding the EU regulatory limits for cereals. AFB1 in the flour persisted in the final product, indicating that the preparation and cooking process did not eliminate the toxic risk. The AFB1 contributed by the consumption of fainá made with naturally contaminated commercial flour represented between 2.4 to 0.4% of the provisional tolerable daily intake, according to age.

PMID:40921004 | DOI:10.1080/19440049.2025.2553701

JCO Oncol Pract. 2025 Sep 8:OP2500414. doi: 10.1200/OP-25-00414. Online ahead of print.

ABSTRACT

PURPOSE: To examine associations between special education, chronic health conditions (CHCs), and college graduation in survivors of childhood cancer and their siblings.

METHODS: Childhood Cancer Survivor Study participants included 23,082 5-year survivors (53.7% male; median [IQR] age at diagnosis, 6 [3-13] years; age at evaluation, 31.0 [24-39] years; treated between 1970 and 1999) and 5,037 siblings (47.7% male; 36.0 [28-44] years at evaluation). Special education use, reasons for special education, CHCs, and college graduation were self-reported. Primary cancer diagnosis and treatment exposures were abstracted from medical records. Comparisons between survivors and siblings were made using chi-square statistics; demographic and treatment factors associated with outcomes were examined using modified Poisson regression models.

RESULTS: More survivors reported special education use than siblings (26.5% v 8.6%; relative risk [RR], 2.55 [95% CI, 2.32 to 2.80]). Of those survivors and siblings who had special education services, use was highest between kindergarten and fifth grade (64.4% of survivors and 71.9% of siblings in kindergarten-fifth grade, 14.4% of survivors and 12.5% of siblings in sixth-eighth grade, and 9.2% of survivors and 9.0% of siblings in ninth-12th grade), and primarily attributable to learning and concentration problems. Despite receiving special education, survivors were less likely to graduate college compared with siblings requiring special education (RR, 0.76 [95% CI, 0.66 to 0.88]). Risk for not graduating college included history of CNS tumor (RR, 1.47 [95% CI, 1.40 to 1.55]), cranial irradiation (20-29 Gy, RR, 1.16 [95% CI, 1.09 to 1.25]; 30-49 Gy, RR, 1.37 [95% CI, 1.26 to 1.49]; ≥50 Gy, RR, 1.35 [95% CI, 1.28 to 1.42]), or the presence of a severe, disabling or life-threatening CHC (Common Terminology Criteria for Adverse Events grade 3-4, RR, 1.15 [95% CI, 1.07 to 1.24]).

CONCLUSION: Cognitive problems and CHCs increase risk for not graduating college; these problems are not alleviated by special education.

PMID:40920992 | DOI:10.1200/OP-25-00414

Cornea. 2025 Sep 8. doi: 10.1097/ICO.0000000000003983. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate visual outcomes after bacterial keratitis (BK) and identify predictive factors for poor prognosis at a tertiary referral center in Southern California.

METHODS: This is a cross-sectional retrospective review of patients’ medical records with culture-positive BK at University of California Los Angeles from January 1, 2014, to December 31, 2019. Main outcome measure was change in best-corrected visual acuity (BCVA) at 12 weeks posttreatment. Statistical analyses included ANOVA for independent populations, Pearson correlation, and binary logistic regression. P-value <0.05 was considered significant.

RESULTS: A total of 317 patients with 374 culture-positive cases were identified. Mean age was 62.1 ± 19.9 years, 52% were female, and 68.1% of isolates were Gram-positive. A total of 114 cases occurred during the summer months (June-August), and 29.8% had a history of contact lens wear, trauma, or systemic disease. Median symptom-to-presentation time was 3.5 days (range 1-60). Mean BCVA improved from 1.84 ± 0.91 at presentation to 1.40 ± 0.96 log of the minimum angle of resolution at 12 weeks (mean difference = 0.44, 95% confidence interval, 0.34-0.53; P < 0.001). Increasing age correlated negatively with change in BCVA (Pearson β = -0.167, P < 0.008). Multivariate analysis identified age >60 years, presence of systemic comorbidities, and presenting BCVA >1.00 log of the minimum angle of resolution as predictors of poor visual outcome.

CONCLUSIONS: This study provides the largest contemporary analysis of BK in Southern California and establishes a clinically applicable risk stratification model. Older age, systemic comorbidities, and poor presenting vision were independently associated with worse visual outcomes. These findings support earlier identification of high-risk patients, tailored treatment strategies to improve visual prognosis and optimize care delivery in BK.

PMID:40920988 | DOI:10.1097/ICO.0000000000003983

J Speech Lang Hear Res. 2025 Sep 8:1-20. doi: 10.1044/2025_JSLHR-24-00909. Online ahead of print.

ABSTRACT

PURPOSE: Residual speech sound disorder (RSSD) is a high-prevalence condition that can limit children’s academic and social participation, with negative consequences for overall well-being. Previous studies have described visual biofeedback as a promising option for RSSD, but results have been inconclusive due to study design limitations and small sample sizes.

METHOD: In a preregistered randomized controlled trial, 108 children aged 9-15 years with RSSD affecting American English /ɹ/ were randomly assigned to receive treatment incorporating visual biofeedback (subdivided into ultrasound and visual-acoustic types) or a comparison condition of motor-based treatment consistent with current best practices in speech therapy. An acoustic measure (the distance between the second and third formants, which is smaller in perceptually accurate /ɹ/) was used to quantify progress in the first three sessions of treatment in participants’ assigned condition. The focus on the early stages of treatment was grounded in principles of motor learning: As a type of knowledge of performance feedback, biofeedback is expected to have its greatest impact during initial acquisition of a new speech-motor plan.

RESULTS: A linear mixed-effects regression model revealed a statistically significant interaction between treatment type and session: While both groups made progress over time, the rate of progress was significantly faster in the biofeedback condition compared to motor-based treatment. No statistically significant difference was observed between the ultrasound and visual-acoustic types of biofeedback.

DISCUSSION: This large-scale randomized controlled trial supports previous small-scale research in finding that biofeedback can help children with RSSD acquire American English /ɹ/. A companion study will compare participants’ generalization learning after the end of all treatment.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.29971501.

PMID:40920957 | DOI:10.1044/2025_JSLHR-24-00909

Med Sci (Paris). 2025 Aug-Sep;41(8-9):683-689. doi: 10.1051/medsci/2025108. Epub 2025 Sep 8.

ABSTRACT

The internal condom (commonly referred to as the female condom), which can be used by both men and women, is a single-use medical device that can be inserted several hours before sexual intercourse for the prevention of sexually transmitted infections (STIs) and for contraception. This review presents an overview of its use, and a summary of the technical and regulatory aspects. We will see that this device is almost as effective as its external counterpart and offers better protection against STIs, but that it remains very underused in the general population. The potential barriers to its use will also be analyzed and discussed.

PMID:40920948 | DOI:10.1051/medsci/2025108