Tag: pubmed

Neurology. 2026 Mar 24;106(6):e214689. doi: 10.1212/WNL.0000000000214689. Epub 2026 Feb 19.

ABSTRACT

BACKGROUND AND OBJECTIVES: Patients with spinal cord injury (SCI) frequently experience dysphonia, leading to communication difficulties, social participation restrictions, and reduced quality of life. In the absence of consensus guidelines, we conducted a systematic review to synthesize evidence on diagnostic tools and rehabilitation protocols for dysphonia after SCI, with the aim of informing clinical practice and future research.

METHODS: Six biomedical, rehabilitation, and speech pathology databases were searched, along with reference lists of relevant studies. Inclusion criteria were as follows: adults with acquired SCI of any etiology, studies reporting dysphonia assessments or rehabilitation protocols, and designs ranging from randomized controlled trials (RCTs) to case reports (English only). Two reviewers independently screened studies, extracted data, and assessed risk of bias (RoB) and level of evidence (LoE) using design-specific tools and Oxford Centre for Evidence-Based Medicine criteria. Dysphonia assessments-including instrumental, acoustic, perceptual, and self-reported measures-were summarized as frequencies and percentages; rehabilitation protocols were described narratively. The review was registered in the International Prospective Register of Systematic Reviews (CRD42024561809).

RESULTS: From 626 unique records, 18 studies were included (total n = 303; mean age 39 years; 79.3% male), comprising 4 RCTs (LoE 2) and 14 observational or case studies (LoE 3-4). Most studies focused on cervical SCI with varied etiologies and American Spinal Injury Association Impairment Scale grades (A-D). RoB was generally low to moderate. Dysphonia assessments included instrumental evaluations (83%, mainly spirometry or plethysmography of lung volumes, pressures, and flows), acoustic analyses (83%, most commonly maximum phonation time and sound pressure level), perceptual measures (78%, using heterogeneous tools), and patient questionnaires (67%, mainly the Voice Handicap Index extended and short forms [VHI/VHI-10]). Reported rehabilitation protocols included the use of speech valves for ventilated patients, glossopharyngeal breathing, abdominal binding, and neurologic music therapy.

DISCUSSION: Current research on dysphonia after SCI remains limited and methodologically heterogeneous. Evidence supports combining spirometry, indirect laryngoscopy, acoustic and perceptual analyses, and VHI-10 for comprehensive assessment. Among rehabilitation approaches, abdominal binding and neurologic music therapy show the most consistent benefits. High-quality, large-scale studies with longer follow-up are needed to standardize diagnostic and rehabilitation protocols and improve voice outcomes in this underexplored field.

PMID:41712883 | DOI:10.1212/WNL.0000000000214689

JMIR Infodemiology. 2026 Feb 19;6:e77578. doi: 10.2196/77578.

ABSTRACT

BACKGROUND: Social media has transformed the landscape of health communication. Video content can optimally activate our cognitive systems, enhance learning, and deliver accessible information. Evidence has suggested the positive impact of videos on health knowledge and health-related behaviors, yet the impact of social media videos on quantitative health outcomes is underresearched. Evaluating such outcomes poses unique challenges in measuring exposure and outcomes within internet-based populations.

OBJECTIVE: We aimed to evaluate the impact of social media videos on quantitative health outcomes, examine methodologies used to measure these effects, and describe the characteristics of video interventions and their delivery.

METHODS: In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, MEDLINE, Embase, Web of Science, CINAHL, and Google Scholar were searched. Studies were eligible if they were original research evaluating long-form social media video interventions addressing any health-related condition, delivered via social media platforms, and reported quantitative health outcomes. The primary outcome was the effect of social media videos on quantitative health outcomes. Additional outcomes included participant characteristics, video features, delivery methods, and the use of theoretical frameworks. A narrative synthesis was conducted. A subgroup meta-analysis was performed to synthesize health outcomes mentioned in 2 or more studies with sufficient homogeneity. Risk of bias assessment was conducted using Cochrane Risk of Bias 2, ROBINS-I, or National Institutes of Health Quality Assessment Tool, depending on the study design. One reviewer screened titles and abstracts. Two reviewers independently conducted full-text screening, data extraction, and risk of bias assessment.

RESULTS: A systematic search was conducted on October 25, 2023, and was updated on June 12, 2025, yielding a total of 41,172 records after duplicate removal. Sixteen studies were included, involving 4158 participants. Mental health-related conditions were the most studied (10 studies). Most video interventions were delivered via YouTube (12 studies). Studies have reported that video interventions were associated with significant improvements in peri-procedural anxiety, mood, and physical activity levels, although most findings were limited to individual studies with variable methodological quality. Three studies that developed videos with user input and theoretical frameworks significantly impacted study-specific primary outcomes. A subgroup meta-analysis demonstrated a significant moderate impact of online video interventions in improving peri-procedural anxiety (standard mean difference=0.57, 95% CI 0.09-1.05). All but one study showed some concern or high risk of bias.

CONCLUSIONS: We demonstrated a potential positive impact of social media videos on quantitative health outcomes, notably in improving peri-procedural anxiety. Videos developed with user input and theoretical frameworks significantly impacted study-specific primary outcomes. Nevertheless, there is the need to shift focus toward measuring physical health-related outcomes and to develop better designed, innovative methodologies to measure the impact that can better simulate the social media environment.

PMID:41712867 | DOI:10.2196/77578

JMIR Perioper Med. 2026 Feb 19;9:e86666. doi: 10.2196/86666.

ABSTRACT

BACKGROUND: Traditional statistical models often fail to capture the complex dynamics influencing survival outcomes in patients with bladder cancer after radical cystectomy, a procedure where approximately 50% of patients develop metastases within 2 years. The integration of artificial intelligence (AI) offers a promising avenue for enhancing prognostic accuracy and personalizing treatment strategies.

OBJECTIVE: This study aimed to develop and evaluate a machine learning algorithm for predicting disease-free survival (DFS), overall survival (OS), and the cause of death in patients with bladder cancer undergoing cystectomy, using a comprehensive dataset of clinical and pathological variables.

METHODS: Retrospective data of 370 patients with bladder cancer who underwent radical cystectomy at Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, were collected. The dataset comprised 20 input variables, encompassing demographics, tumor characteristics, treatment variables, and inflammatory markers. For specific analyses and models, we used patient subcohorts. The CatBoost algorithm was used for regression tasks (DFS in 346 patients, OS in 347 patients) and a binary classification task (tumor-related death in 312 patients). Model performance was assessed using mean absolute error (MAE) for regression and F1-score for classification, prioritizing a minimum recall of 75% for tumor-related deaths. Five-fold cross-validation and Shapley additive explanations (SHAP) values were used to ensure robustness and interpretability.

RESULTS: For DFS prediction, the CatBoost model achieved an MAE of 18.68 months, with clinical tumor stage and pathological tumor classification identified as the most influential predictors. OS prediction yielded an MAE of 17.2 months, which improved to 14.6 months after feature filtering, where tumor classification and the systemic immune-inflammation index (SII) were most impactful. For tumor-related death classification, the model achieved a recall of 78.6% and an F1-score of 0.44 for the positive class (tumor-related deaths), correctly identifying 11 of 14 cases. Bladder tumor position was the most influential feature for cause-of-death prediction.

CONCLUSIONS: The developed machine learning algorithm demonstrates promising accuracy in predicting survival and the cause of death in patients with bladder cancer after cystectomy. The key predictors include clinical and pathological tumor staging, systemic inflammation (SII), and bladder tumor position. These findings highlight the potential of AI in providing clinicians with an objective, data-driven tool to improve personalized prognostic assessment and guide clinical decision-making.

PMID:41712865 | DOI:10.2196/86666

JMIR Hum Factors. 2026 Feb 19;13:e85454. doi: 10.2196/85454.

ABSTRACT

BACKGROUND: Digital health technologies offer new opportunities for cognitive screening and monitoring among older adults. In Thailand, where dementia prevalence is rising, accessible web-based cognitive tools remain limited despite their potential to facilitate early detection and community-based assessment. Understanding usability and validity is critical to ensure successful implementation in real-world contexts.

OBJECTIVE: This study aimed to develop and validate a web-based application, Healthy Brain Test, for cognitive and functional assessments in dementia screening among older Thai adults. Specific objectives were to (1) design user-centered cognitive modules covering key cognitive domains and (2) evaluate correlations between the web-based assessments and conventional clinical tools to determine diagnostic cutoffs for cognitive impairment.

METHODS: We designed Healthy Brain Test as a self-administered web application suitable for older users and their caregivers. The platform includes digital versions of the Thai Mental State Examination (e-TMSE), a clock drawing test, and a category verbal fluency test, along with electronic versions of the short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-16) and cognitive instrumental activities of daily living (IADLs). Participants completed both web-based and paper-based assessments. Correlations between modalities were analyzed, and receiver operating characteristic (ROC) curves were generated to determine sensitivity and specificity. Data were analyzed using SPSS for Windows, version 30.0 (IBM Corp) and MedCalc Statistical Software (MedCalc Software Ltd).

RESULTS: A total of 198 older adults participated (women: 137/198, 69.2%; median age 69.4 years), with 57.1% (113/198) having more than 6 years of education. Of the 198 participants, 44 were diagnosed with major neurocognitive disorder, 58 were diagnosed with mild neurocognitive disorder, and 96 were cognitively normal. The e-TMSE showed strong agreement with the traditional TMSE (r=0.837; P<.001). Category verbal fluency, IQCODE-16, and IADL modules also demonstrated significant correlations (P<.001). The e-TMSE achieved an area under the ROC curve of 0.84 (bootstrapped 95% CI 0.78-0.89); a cutoff ≤23 provided 88.6% sensitivity and 70.1% specificity for identifying major neurocognitive disorder. Participants reported high ease of use and engagement during pilot testing.

CONCLUSIONS: Healthy Brain Test demonstrated strong validity and usability as a web-based cognitive and functional assessment platform for dementia screening. Its integration of established cognitive measures into a digital interface enables remote, accessible, and user-friendly evaluation for older adults and caregivers. Future research should assess long-term feasibility, user adherence, and integration with clinical workflows to support large-scale screening initiatives.

PMID:41712850 | DOI:10.2196/85454

Tunis Med. 2025 Mar 5;103(3):369-373. doi: 10.62438/tunismed.v103i3.5255.

ABSTRACT

INTRODUCTION: Posttraumatic stress disorder PTSD in the pediatric population has clinical features. The Clinician-Administered PTSD Scale for DSM-5,child and adolescent version (CAPS-CA-5) is the gold standard in positive diagnosis. Our study had two primary objectives, first, to translate the CAPS-CA-5 into Tunisian dialectal Arabic, and second, to validate the translated version within the Tunisian sociocultural context.

METHODS: This is a descriptive cross-sectional study conducted in two hospital departments. We recruited children older than seven years who were exposed to a potentially traumatic event at least one month before. We validated the tool through translation, content, construct validity and reliability.

RESULTS: The validation was made on 146 records after the exclusion of 4 incompleted assessments. We initially translated the CAPS-CA-5 into Tunisian dialect. We validated the content through pre-test and scientific committee evaluation. Afterwards we validated the construction. We calculated the Bartlett’s sphericity test (p<0.001) and the KMO index that was 0.766. Concerning the reliability study, we found a Cronbach’s alpha coefficient equal to 0.92. We studied the inter-rater reliability via the intra-class coefficient which was between 0.8 and 1. Conclusion: We validated the CAPS CA5 in our cultural context with satisfactory psychometric qualities. This tool will facilitate the early detection and diagnosis of PTSD in pediatric population.

PMID:41712847 | DOI:10.62438/tunismed.v103i3.5255

Tunis Med. 2025 Mar 5;103(3):332-340. doi: 10.62438/tunismed.v103i3.5377.

ABSTRACT

AIMS: In Tunisia, during the Coronavirus Disease 19 pandemic, the transition to e-learning was brutal. The aim of this study was to assess undergraduate medical students (UMSs)’ perception of the e-learning experience at the Faculty of Medicine of Sousse, and to derive some determinants of its implementation.

METHODS: Eligible participants were all UMSs (n=1397). The data was collected from an email questionnaire distributed in January/March 2021. The questionnaire consisted of 89 items exploring three main parameters: institution role, students’ personal experience, and environment impact.

RESULTS: A total of 419 UMSs responded (30% response rate). Half of the UMSs described this transition as difficult, and three-quarters felt concerned about the credibility of their degrees. Logistical issues negatively affected the transition to e-learning, particularly those related to Internet speed. Understanding difficulty via the screen interface was reported by 40% of UMSs. ”Face-to-face” sessions were described as more conducive to assimilation by 64% of UMSs. As far as “information retrieval” is concerned, 83% of UMSs turned to social networks and adopted Wikipedia as a reference.

CONCLUSIONS: In Tunisia, as an example of North African country, the transition to exclusive e-learning has been largely impacted by the drawbacks of limited logistics. This study highlights the multiple facets to be considered in the future for the successful implementation of e-learning in medical education.

PMID:41712844 | DOI:10.62438/tunismed.v103i3.5377

Tunis Med. 2025 Mar 5;103(3):363-368. doi: 10.62438/tunismed.v103i3.5381.

ABSTRACT

PURPOSE: To investigate factors associated with Pediatric Intensive Care Unit (PICU) admission in children with severe MIS-C.

METHODS: We conducted an observational cohort study between July 1, 2020, and May 31, 2021, in the only pediatric hospital in Tunisia.

RESULTS: A total of 45 children (33 males) with no recent history of COVID-19 infection were included. Mean age was 7±3.2 years. Sixteen patients (35%) required PICU admission. There was no significant difference in mean age of patients with and without PICU admission (7.5±2.7 vs. 6.76±3.46 years; p=0.4). The frequency of respiratory distress (p=0.001), shock (p=0.001), cardiac dysfunction (p=0.003), mean CRP (p=0.001), and median troponin (p=0.003) were significantly higher in patients with PICU admission than in those without. The independent predictive factor for PICU admission was cardiac dysfunction; adjusted Odds Ratio (aOR) = 12.8, 95% CI = (2.1-76.4), p=0.002.

CONCLUSION: The only independent risk factor for PICU admission in patients with MIS-C was cardiac dysfunction.

PMID:41712843 | DOI:10.62438/tunismed.v103i3.5381

Tunis Med. 2025 Mar 5;103(3):356-362. doi: 10.62438/tunismed.v103i3.5417.

ABSTRACT

BACKGROUND: Management of syncope in the emergency department (ED) is not yet well codified. Several scores have been developed to facilitate diagnosis and management. According to the European Society of Cardiology, an EGSYS (Evaluation of Guidelines in Syncope Study) score ≥3 predicts cardiac origin.

OBJECTIVE: Evaluate the performance of the EGSYS score in the diagnosis of cardiac syncope in ED.

METHODS: We conducted a prospective study (2011-2021). Inclusion of patients who consult for syncope with calculation of the EGSYS score. Diagnosis of cardiac syncope was based on the results of the cardiological investigation. Patients were divided into two groups: SC+ group with cardiac syncope and SC- group with another etiology.

RESULTS: Inclusion of 526 patients. Mean age =49± 20 years. Gender ratio=1.48. Two hundred and thirty-six patients (45%) had a cardiac syncope. Comparison between the two groups SC+ versus (vs. SC-) showed the following results: mean age (58 ±19 vs. 42 ±18 years), history of heart disease: 34 (14.5%) vs. 13 (4.5%), rhythm disorders 22(9.4%) vs. 4(1.4%), bradycardia: 40 (17%) vs. 17 (5.8%), atrioventricular block: 26 (11.1%) vs. 8 (2.7%), bundle branch block: 45 (19.1%) vs. 17 (5.8%), High risk criteria: 138 (58.7%) vs. 75 (25.8%). Diagnostic performance of the EGSYS score was satisfactory with AUC=0.769, CI95% [0.73 – 0.81], p 0.001. The threshold value was 3. Sensitivity, specificity, positive predictive value and negative predictive value were 79, 80, 76 and 83% respectively. Likelihood Ratio: Positive LR=4.04, negative LR=0.26.

CONCLUSION: The EGSYS score showed good performance in predicting the cardiac syncope.

PMID:41712842 | DOI:10.62438/tunismed.v103i3.5417

Tunis Med. 2025 Mar 5;103(3):379-382. doi: 10.62438/tunismed.v103i3.5452.

ABSTRACT

INTRODUCTION: Transfusion is the medical act of transferring blood or its constituents from one individual to another. The pre-transfusion bedside test is mandatory before any transfusion well codified in circular 32/15.

AIMS: To evaluate the theoretical and practical knowledge concerning the ultimate bedside test of medical and paramedical staff of the Adult clinical hematology department of the Aziza Othmana hospital (HAO).

METHODS: It’s a single-center descriptive study, in the form of theoretical and practical test, during June 2024 among paramedical and medical staff working during this period at the adult clinical hematology department of (HAO).

RESULTS: We included 62 respondents, of whom 3,2% thought that the ultimate bed test replaced the compatibility test in the laboratory, 4,8% that it was obligatory before transfusion, 19,4% that it did not allow the detection of ABO incompatibility, 41,9% that it did not require the determination of the patient’s blood group and only one questioned that it did not require the identity of the patient against 61 questioned (98,4%) who checked it. Among those questioned, 69,4% knew that this test is the last key to transfusion safety, 80,6% knew that it is the responsibility of the doctor compared to 19,4% who were unaware of this. All those interviewed checked the concordance between the identity of the recipient and that mentioned on the grouping documents.

CONCLUSIONS: This study made it possible to show an average theoretical and good practical level of the staff of the adult clinical hematology department of the (HAO) and to target theoretical gaps during training.

PMID:41712839 | DOI:10.62438/tunismed.v103i3.5452

Tunis Med. 2025 Apr 5;103(4):499-505. doi: 10.62438/tunismed.v103i4.4993.

ABSTRACT

BACKGROUND: Therapeutic inertia is a major cause of uncontrolled hypertension. The aim of our work study is to describe the knowledge, attitudes, and practices of primary care physicians in the management of hypertension and to describe the factors of therapeutic inertia.

METHODS: This was a descriptive study among primary care physicians conducted through an online questionnaire created using Google Forms during the period from March 15 to May 15, 2022.

RESULTS: Our population included 232 physicians with an average age of 39 years. They mainly worked in the public sector (83%). Only 24% of the physicians knew the diagnostic thresholds for hypertension using all methods. Fifty percent knew the therapeutic objectives. Initiation with monotherapy was chosen by 49% of physicians. Angiotensin converting enzyme inhibitors and calcium channel blockers were chosen by 79.3% and 60.8% of physicians, respectively. The main reasons for therapeutic inertia were cost (78.4%), drug shortage (72.8%), non-adherence to therapy (61.2%), follow-up by another specialist (46.5%), fear of side effects of antihypertensive drugs (48.7%), patient’s age (40.5%), lack of organization of patient follow-up (36.6%), and the presence of other comorbidities (35%). Renal failure was the main comorbidity involved (78.4%).

CONCLUSIONS: Our study concludes that there was a lack of knowledge and application of the new recommendations for hypertension. It would be necessary to promote continuous training of primary care physicians, to insist on therapeutic education of patients, to reform the public health system in Tunisia to cover the provisions of hypertensive patients, and to introduce combination therapy.

PMID:41712830 | DOI:10.62438/tunismed.v103i4.4993