Tag: nevin manimala

JMIR Mhealth Uhealth. 2026 Feb 5;14:e67514. doi: 10.2196/67514.

ABSTRACT

BACKGROUND: Integrating electronic patient-reported outcomes (ePROs) into electronic health records (EHRs) can enhance the quality of patient care. However, collecting longitudinal ePRO data throughout treatment and posttreatment surveillance remains challenging in patients with breast cancer. To address this, we implemented an automated system that enables ePRO acquisition and seamless integration into the EHR. The system delivers questionnaire weblinks via a mobile messaging app, allowing patients to complete ePROs before clinic visits, with responses automatically transferred to the EHR.

OBJECTIVE: This study aimed to assess patient response rates to the ePRO system and identify key factors influencing the response rate among patients with breast cancer who received radiotherapy and postradiotherapy follow-up.

METHODS: We conducted a retrospective analysis of prospectively collected ePRO data by using the BREAST-Q questionnaire, a validated patient-reported outcome measure for breast surgery, from patients who received adjuvant radiotherapy at our institution between May 2023 and April 2024. At a preradiotherapy or postradiotherapy visit, each patient was asked to complete the questionnaire via a weblink sent to their mobile messaging app, KakaoTalk. The questionnaire was dispatched from minutes to several days before each visit. The response rate was calculated as the percentage of patients whose responses were successfully recorded in the EHR among those who were requested to respond. A complete response (CR) was defined as completion of all required questionnaire items. CR rates were analyzed according to clinical factors using univariate and multivariate logistic regression.

RESULTS: Data from 1488 patients were analyzed, encompassing 2431 encounters (median 1, IQR 1-2 per patient). The median age of the patients was 51 (range 23-83) years, with 65.1% (n=968) patients aged 40 to 59 years. Comorbidities were present in 15% (223/1488) of the patients. The CR rate for the first, second, and third ePRO encounters was 89.9% (1338/1488), 98.3% (735/748), and 97.3% (180/185), respectively. Among first-time respondents, younger patients had a significantly higher CR rate (patients aged <60 years: 100/1104, 90.9%; patients aged ≥60 years: 334/384, 87%; P=.03). The timing of the questionnaire dispatch also affected the CR rate (P<.001). The CR rate was the highest when questionnaires were sent more than 1 hour before the visit (547/583, 93.3%) or in the afternoon of the previous day (505/545, 92.7%) and the lowest when sent 2 or more days before (100/130, 76.9%) or within 1 hour before the appointment (92/112, 81.7%). Both age (P=.006) and timing (P<.001) remained significant in the multivariate analysis.

CONCLUSIONS: This study demonstrates the feasibility of integrating ePRO into EHR through a mobile messaging app-based system, with high patient adherence. Response rates were significantly influenced by patient age and the timing of questionnaire dispatch. These findings provide practical insight for optimizing ePRO implementation in routine oncology care.

PMID:41643191 | DOI:10.2196/67514

J Clin Exp Neuropsychol. 2026 Feb 5:1-8. doi: 10.1080/13803395.2026.2627996. Online ahead of print.

ABSTRACT

INTRODUCTION: PTSD is among the most commonly diagnosed mental health conditions in the military and veteran populations. Shura et al. (2023) and Schroeder and Bieu (2024) developed three symptom validity indices for the PTSD Checklist for the DSM-5 (PCL-5) examining overreported PTSD symptomatology in veteran populations. The current study aimed to cross-validate these SVTs in an active-duty United States military sample.

METHODS: The sample consisted of multiple criterion groups comprised active-duty service members (N = 165). Criterion for valid or invalid responses were based on Personality Assessment Inventory symptom validity scales. The three PCL-5 symptom validity indices included PCL-5 Symptom Severity (PSS), PCL-5 Extreme Symptom (PES), and PCL-5 Rare Items (PRI).

RESULTS: Areas under the curve ranged from .73 to .76 for valid full sample group versus invalid group, which met classification accuracy goals. Optimal cutoff scores were identified for each scale (PES ≥ 16, PSS ≥ 59, PRI ≥ 3) with corresponding sensitivities of PSS = 0.50, PES = 0.40, and PRI = 0.20 with specificity ≥0.90.

CONCLUSION: These findings provide support for the cross-validation of all three embedded symptom validity indices at the identified cutoff scores as PCL-5 over-report measures within an active-duty sample. The PSS and PES demonstrated superior classification statistics, as the PRI was hampered by lower sensitivity.

PMID:41643189 | DOI:10.1080/13803395.2026.2627996

JMIR Med Educ. 2026 Feb 5;12:e75534. doi: 10.2196/75534.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) shows promise in clinical diagnosis, treatment support, and health care efficiency. However, its adoption in real-world practice remains limited due to insufficient clinical validation and an unclear impact on practitioners’ competence. Addressing these gaps is essential for effective, confident, and ethical integration of AI into modern health care settings.

OBJECTIVE: This study aimed to evaluate the effectiveness of informed AI use, following a tailored AI training course, on the performance of general practitioners (GPs) and internists in test-based clinical competence assessments and their attitudes toward clinical AI applications.

METHODS: A pre-post intervention study was conducted with 326 physicians from 39 countries. Participants completed a baseline test of clinical decision-making skills, covering diagnosis, treatment planning, and patient counseling; attended a 1.5-hour online training on effective AI use; and then took a similar postcourse test with AI assistance permitted (GPT-4.0). Test performance and time per question were compared before and after the training. Participants also rated AI accuracy, efficiency, perceived need for structured AI training, and their willingness to use AI in clinical practice before and after the course.

RESULTS: The average test scores improved from 56.9% (SD 15.7%) to 77.6% (SD 12.7%; P<.001), and the pass rate increased from 6.4% (21/326) to 58.6% (191/326), with larger gains observed among GPs and younger physicians. All skill domains (diagnosis, treatment planning, and patient counseling) improved significantly (all P<.001), while time taken to complete the test increased slightly from before to after the course (mean 40.25, SD 16.14 min vs 42.29, SD 14.02 min; P=.03). By the end of the intervention, physicians viewed AI more favorably, reporting increased confidence in its accuracy and time efficiency, greater appreciation for the need for structured AI training, and increased confidence and willingness to integrate AI into patient care.

CONCLUSIONS: Informed use of AI, based on tailored training, was associated with higher performance in test-based clinical decision-making assessments and greater confidence in using AI among GPs and internists. Building on previous research that often lacked structured training, focused primarily on model performance, or was limited in clinical scope, this study provides empirical evidence of both competence and perceptual improvement following informed AI use in a large, multinational cohort, enhancing the generalizability. These findings support the integration of structured AI training into medical education and continuing professional development to improve clinical performance and promote competent use of AI in clinical practice.

PMID:41643188 | DOI:10.2196/75534

AIDS. 2025 Dec 2. doi: 10.1097/QAD.0000000000004421. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare dementia incidence and prevalence by HIV status, race/ethnicity, and sex.

DESIGN: Retrospective cohort, 2000-2023.

METHODS: Adults with HIV aged ≥50 years and 1:20 matched individuals without HIV from Kaiser Permanente, a U.S. healthcare system, were included. Dementia diagnoses were identified via electronic health records. We estimated rates of incident dementia diagnoses and prevalence, overall and by time period (2000-2004, 2005-2009…2020-2023) using Poisson regression, and assessed trends using Joinpoint regression. Covariate-adjusted rate ratios compared dementia by HIV status, with sub-analyses stratified by race/ethnicity and sex.

RESULTS: Among 24,762 people with HIV and 494,963 people without HIV (86.9% men, 45.5% White, 23.1% Black, 20.3% Hispanic), incident dementia diagnoses declined from 2000-2023 in both people with and without HIV (-7.68% and -2.70% per period, respectively). Overall, the incidence of dementia diagnosis was higher in people with HIV (adjusted incidence rate ratio [aIRR]=1.72, 95% CI=1.59-1.85). In the most recent period (2020-2023), this difference was not statistically significant (aIRR=1.16, 95% CI=0.99-1.35), partly due to increases in diagnoses among people without HIV during this period. Dementia prevalence remained higher in people with HIV, overall (adjusted prevalence ratio [aPR]=1.71, 95% CI=1.61-1.82) and in 2020-2023 (aPR=1.59, 95% CI=1.46-1.73), with similar patterns by race/ethnicity and sex.

CONCLUSIONS: Incident dementia diagnoses have declined in people with HIV and are approaching those of people without HIV, with consistent trends across demographic subgroups. However, prevalence remains elevated, likely reflecting excess risk from earlier years. These findings highlight the need for sustained attention to cognitive health and the integration of dementia-related services in HIV care.

PMID:41643176 | DOI:10.1097/QAD.0000000000004421

Chem Biodivers. 2026 Feb;23(2):e02986. doi: 10.1002/cbdv.202502986.

ABSTRACT

This study investigated the chemical profile and allelopathic potential of Ambrosia artemisiifolia root exudates. Metabolomic profiling was performed on hydroponic culture exudates using XAD-4 resin and UHPLC-QTOF/MS. The analysis identified a total of 1408 metabolites, with stearidonic acid (SA) being the most abundant, accounting for 28.02% of the total root exudate constituents. The allelopathic bioassays conducted on dicot and monocot weed species revealed no statistically significant increase in growth at concentrations of 10-50 µg/mL, whereas inhibition occurred at 250 µg/mL or higher. Monocots exhibited greater sensitivity to the allelopathic effects. At a concentration 500 µg/mL, the application of exudates resulted in a reduction of root and shoot lengths in Setaria viridis by 24.18% and 51.85%, respectively, and in Poa annua by 28.34% and 27.89%, respectively. SA exhibited a stronger inhibitory effect, suppressing root elongation by 43.37% and 71.66% and shoot growth by 33.51% and 64.42% in S. viridis and P. annua, respectively. Moreover, both SA and root exudates modulated superoxide dismutase (SOD) and peroxidase (POD) activities in Amaranthus retroflexus and S. viridis. At higher concentrations, growth was inhibited despite the upregulation of these antioxidant enzymes, suggesting that the accumulation of reactive oxygen species (ROS) exceeded the plants’ antioxidant capacity. Results demonstrate root exudates drive invasion by disrupting antioxidant defenses, offering potential for concentration-dependent bioherbicides in sustainable weed management.

PMID:41643171 | DOI:10.1002/cbdv.202502986

JMIR Mhealth Uhealth. 2026 Feb 5;14:e76862. doi: 10.2196/76862.

ABSTRACT

BACKGROUND: The use of mobile health (mHealth) apps can assist with the management of gestational diabetes (GDM). Although a number of studies have demonstrated their efficacy in improving maternal-fetal outcomes, opinions differ regarding their usability and overall quality. Poorly designed apps, with ill-conceived features or inappropriate content, may pose a threat to patient safety. Nevertheless, very few studies provide in-depth evaluations of app design quality, and the diversity of features and techniques used remains insufficiently explored.

OBJECTIVE: We aimed to evaluate the quality and multifunctionality of commercially available mHealth apps for GDM.

METHODS: This is a systematic app review guided by the TECH (target user, evaluation focus, connectedness, and health domain) framework and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist. Searches were conducted on the Apple App Store and Google Play. Apps were screened by name, description, and full navigation to identify inclusions. The quality of the apps was evaluated using the Mobile App Rating Scale and IMS Institute for Healthcare Informatics Functionality Score. Multifunctionality of the apps was evaluated using the GDM-adapted features and techniques list developed from the App Behavior Change Scale, NICE (National Institute for Health and Care Excellence) 2015 guidelines, and previous studies. The general features list, which contains instruction, data security, customization, and technical issues, was derived from previous studies.

RESULTS: The search (June 2024) identified 23 commercially available apps from UK app stores. The overall app quality was evaluated to be satisfactory (Mobile App Rating Scale: mean 4.0, SD 0.36; IMS Institute for Healthcare Informatics Functionality Score: mean 5.83, SD 3.03). The multifunctionality evaluation found that the apps had a mean of 17.95 and SD of 7.31 across all 45 items. Overall, our findings suggested that mHealth apps for GDM achieved a certain level of multifunctionality. However, their feature types and supporting digital techniques are relatively basic. The apps focused on education and managing blood glucose control rather than integrating other self-monitoring data and pregnancy-relevant management into their design. The digital techniques used to achieve these features included text and manual operation, rather than other automated features.

CONCLUSIONS: This is the first app review to consider the relationship between app features and usability for women with GDM. Future app development should integrate a wide range of pregnancy-relevant information and more automated features and use advanced digital techniques to enable a holistic digital solution for women with GDM.

PMID:41643159 | DOI:10.2196/76862

Chem Biodivers. 2026 Feb;23(2):e03761. doi: 10.1002/cbdv.202503761.

ABSTRACT

The study investigated Dactylonectria torresensis as a sustainable source of podophyllotoxin (PTOX), a key precursor for anticancer drugs such as etoposide and teniposide. The fungus was identified through morphological analysis and ITS rDNA sequencing. PTOX from the fungal extract was isolated and characterized using high-performance liquid chromatography, high-resolution mass spectrometry, and nuclear magnetic resonance spectroscopy. Antioxidant activity was evaluated via 2,2-diphenyl-1-picrylhydrazyl (DPPH) and reducing power assays, showing comparable 50% inhibition (IC₅₀) values for standard and fungal PTOX – 297.4 versus 309.8 µg/mL (DPPH) and 306.6 versus 316.3 µg/mL (reducing power). Cytotoxicity against MCF-7 breast cancer cells also revealed similar IC₅₀ values: 3.083 µM for standard and 3.188 µM for fungal PTOX. PTOX production was optimized through a two-phase statistical approach: Plackett-Burman Design followed by Face-Centered Central Composite Design. Initially, D. torresensis produced 78.46 µg/g dry weight (DW) of PTOX, which increased 6.35-fold to 498.76 µg/g DW after optimization.

PMID:41643155 | DOI:10.1002/cbdv.202503761

J Craniofac Surg. 2026 Feb 6. doi: 10.1097/SCS.0000000000012503. Online ahead of print.

ABSTRACT

OBJECTIVE: This study evaluated the optimal depth of anesthesia guided by closed-loop target-controlled infusion (TCI) in preschool-aged children undergoing dental surgery. Dental procedures in this population are frequently associated with heightened anxiety and procedural distress, often necessitating general anesthesia; however, the appropriate depth of anesthesia remains insufficiently defined.

METHODS: A randomized, double-blind, controlled trial was conducted involving 60 children aged 3 to 6 years scheduled for dental surgery. Participants were allocated to 3 groups (A, B, and C), with bispectral index (BIS) values maintained at 50, 55, and 60, respectively, using a closed-loop TCI system. The primary outcomes were heart rate (HR) and mean arterial pressure (MAP), recorded at 7 intraoperative time points. Secondary outcomes included surgical duration, time to first eye opening (defined as eyelid movement in response to verbal command without implying full orientation), extubation time, discharge time, and total propofol dose.

RESULTS: No statistically significant differences were observed among groups in HR or MAP at any intraoperative time point (between-subject effect: HR, F=2.73, P=0.074; MAP, F=1.54, P=0.222). Surgical duration (F=0.521, P=0.596) and total propofol dosage (P=0.165) also did not differ significantly. Recovery parameters demonstrated significant group differences. Time to first eye opening was 37.75±8.81 minutes in group A, 28.35±2.45 minutes in group B, and 20.70±5.21 minutes in group C (P<0.001). Extubation time was 39.40±8.08 minutes, 29.60±2.58 minutes, and 22.70±5.63 minutes in groups A, B, and C, respectively (P<0.001). Discharge time was shortest in group C (135.6±30.9 min), followed by group B (160.5±25.3 min), and longest in group A (202.5±26.5 min) (F=29.77, P<0.001). The incidence of adverse events was comparable across groups, and no serious adverse events occurred.

CONCLUSIONS: Maintaining a BIS value of 60 (±5) with a closed-loop infusion system provided adequate anesthetic depth for dental procedures in preschool-aged children, while significantly reducing recovery and discharge times. This anesthetic strategy may support enhanced recovery and improve perioperative efficiency in pediatric populations.

PMID:41643152 | DOI:10.1097/SCS.0000000000012503

JMIR Form Res. 2026 Feb 5;10:e74418. doi: 10.2196/74418.

ABSTRACT

BACKGROUND: Falls are a leading cause of injury among older adults, often resulting from dynamic balance disturbances. It is influenced by a complex interplay of intrinsic and extrinsic fall-risk factors. To identify individual fall risks, it is important to understand the underlying associations.

OBJECTIVE: This study aimed to build an experimental setup modeling selected factors leading to a loss of balance, measured by the margin of stability (MoS) in an ecologically valid real-world example (tripping). Additionally, these analyses aimed to assess the feasibility and safety of the protocol and to explore the use of the MoS as part of a prototypical dynamic fall-risk model to differentiate between fall-risk groups.

METHODS: Nineteen community-dwelling older adults (mean age of 71, SD 3.67 y; n=7, 37% women) completed the tripping protocol involving perturbations under various conditions. Clinical assessments were used to identify relevant fall-related intrinsic fall-risk factors. MoS was measured using an 8-camera motion capture system. Receiver operating characteristic analyses determined the ability of MoS to distinguish between low and high fall-risk groups.

RESULTS: Approximately one-quarter of participants discontinued before or at the start of the tripping scenario because of discomfort or fear of perturbations, indicating that perceived safety is an important feasibility factor. Perturbations significantly disrupted MoS, with a median MoS of -106.05 (IQR -181.40 to -41.50) mm during the perturbed step compared to 114 (IQR 81.20-155.20) mm in the preperturbation step. Recovery steps showed progressive stabilization, with the second recovery step achieving a median MoS of 88.45 (IQR 47.50-137.80) mm. The second recovery step exhibited the highest predictive accuracy for fall-risk differentiation, with area under the curve values reaching 82.3% during slow walking with a series of right-sided perturbations. In contrast, fast walking with random perturbations yielded lower area under the curve values (64.9%). Slow walking conditions generally demonstrated the clearest separation between fall-risk groups.

CONCLUSIONS: This pilot and feasibility study demonstrates the applicability of a tripping paradigm to perturb MoS in older adults and provides preliminary insights into its association with fall-risk indices. While the protocol proved safe and feasible for fit older adults, perceived safety limited full participation. The findings are exploratory and intended to guide the design of larger prospective studies rather than to establish predictive conclusions. These data suggest that MoS during controlled tripping may help differentiate fall-risk strata, but confirmation will require adequately powered studies in more diverse and frailer older populations-and across multiple real-world scenarios-before any clinical implementation can be considered.

PMID:41643136 | DOI:10.2196/74418

J Am Assoc Nurse Pract. 2026 Feb 1;38(2):108-115. doi: 10.1097/JXX.0000000000001220.

ABSTRACT

BACKGROUND: Successful use of nurse practitioner (NP) and physician assistant (PA) care models is vital to delivering optimal patient care, maintaining financial stability, and reducing staff burnout and turnover.

LOCAL PROBLEM: A large cardiovascular surgery practice experienced substantial growth, leading to an obsolete NP and PA care model. Consequently, workplace satisfaction scores were reduced, and the NP and PA turnover rate in 2018 was unacceptably high.

METHODS: A multidisciplinary redesign team was formed to address gaps in the care model through a quality-improvement initiative. The team analyzed current workflows, collected external and internal survey data, conducted patient tracers, and observed staff. Seventeen collaborative care models were proposed by frontline staff members and presented to their peers for feedback. This feedback was used to select the best aspects of the proposed models to create a new model.

INTERVENTIONS: The updated care model consisted of several key changes, which included reducing NP- and PA-to-patient ratios, eliminating redundant tasks, shifting from location-based to surgical team-based coverage, ensuring top-of-scope practice, developing specialty service lines, and separating inpatient and outpatient practices.

RESULTS: After implementation of the new care model, NP and PA turnover rates decreased from baseline by an average of approximately 74% per year. Departmental work culture scores concomitantly increased from 68% to 85% after implementation of the new care model.

CONCLUSIONS: Adapting care models in conjunction with departmental growth is crucial to enhancing staff satisfaction and reducing burnout.

PMID:41643133 | DOI:10.1097/JXX.0000000000001220