Tag: pubmed

JMIR Form Res. 2026 Jun 17;10:e85135. doi: 10.2196/85135.

ABSTRACT

BACKGROUND: University hospital employees face role-specific stressors that can impair mental well-being and work-related vitality. While worksite health promotion programs show potential for improving mental well-being by targeting lifestyle behaviors, most target single professions or hospital subunits, and evidence for mental well-being and work-related vitality remains mixed. Mobile apps offer unique advantages for delivering such worksite health promotion programs hospital-wide. However, accessible interventions tailored to a diverse workforce are lacking.

OBJECTIVE: This study aimed to investigate the feasibility of an app-based worksite health promotion program (the Recharge360 program [The Recharge Company]) targeting multiple lifestyle behaviors, including a team-based competition element, for improving mental well-being and work-related vitality of hospital employees over a 5-month follow-up period by evaluating two objectives: (1) the implementation process of the program, and (2) the preliminary effects of the program on mental well-being and work-related vitality.

METHODS: We included 532 employees (mean age 43, SD 12 y; n=482, 91% women; n=480, 90% highly educated) from a university hospital in Amsterdam, the Netherlands. The study had a single-arm, longitudinal pretest-posttest design lasting 5 months, during which employees participated in the 5-day Recharge360 program (Recharge week) 3 times-in weeks 1, 9, and 17. At baseline (T0) and after each Recharge week (T1-T3), we assessed mental well-being, work ability, need for recovery, and task performance. The process was evaluated by assessing recruitment, attrition, and survey completion rates, and the degree of participation. Preliminary effects were evaluated by linear mixed model regression analyses to assess changes in mental well-being and work-related vitality between baseline and follow-up.

RESULTS: Recruitment appeared feasible, but attrition rates were high (up to 70% in the final Recharge week), and the degree of participation decreased over time. We showed statistically significant, albeit small, increases in well-being at T3 (unstandardized β coefficient=2.08, 95% CI 0.33-3.84), with progressively larger improvements in the analyses among those who started at least 1, 2, and all 3 Recharge weeks (unstandardized β coefficient=3.27, 95% CI 1.09-5.45). Results for work-related vitality were mixed. The need for recovery remained unchanged, task performance increased slightly at T3 (unstandardized β coefficient=0.16, 95% CI 0.07-0.24). Work ability showed a small, but statistically significant, decline across follow-up (unstandardized β coefficient=-0.46, 95% CI -0.64 to -0.29).

CONCLUSIONS: This app-based worksite health promotion program might be feasible to implement in a university hospital setting and shows potential to slightly improve mental well-being, but primarily for a selective group of highly educated, health-conscious women. While these findings support further investigation in a randomized controlled trial in similar university hospital settings, they also highlight the need for more participatory study designs to improve the tailoring of program components and engagement of underrepresented groups, as well as for a supportive culture and population-based approaches at the organizational level.

PMID:42308479 | DOI:10.2196/85135

JMIR Mhealth Uhealth. 2026 Jun 17;14:e79995. doi: 10.2196/79995.

ABSTRACT

BACKGROUND: Heart rate (HR) monitoring by wearable devices offers a physiological, personalized, and continuous method for assessing physical activity (PA) duration and intensity. However, methods to translate HR data into meaningful PA metrics are diverse and nonstandardized.

OBJECTIVE: This study aims to provide an overview of how HR data are used to quantify PA behavior and estimate physiological outcomes in adult patients with cardiovascular disease (CVD).

METHODS: A systematic search was performed in PubMed, Web of Science, and CENTRAL for studies published between 2014 and 2024. Eligible studies included adults with CVD or related risk factors wearing HR monitors to estimate PA. Data were synthesized narratively. The methodological quality of the included studies was evaluated using the Crowe Critical Appraisal Tool (CCAT; Michael Crowe).

RESULTS: Twenty studies were included, spanning four HR-based PA estimation methods: (1) HR zone analysis (n=14), which assessed time spent in moderate-to-vigorous zones to evaluate guideline or training adherence; (2) physiological modeling (n=4), estimating outcomes such as energy expenditure (physical activity level) or cardiorespiratory fitness (maximal oxygen uptake); (3) change detection (n=1), using time-series and machine learning algorithms to quantify shifts in PA behavior; and (4) a derived personalized scoring system (n=1). While each approach demonstrated clinical promise of using HR data, external validation, and methodological transparency is often lacking.

CONCLUSIONS: HR-based PA estimation holds the promise of physiologically meaningful, personalized PA monitoring in CVD care. Modeling approaches and personalized scoring systems linking PA behavior to cardiovascular outcomes may provide highly needed clinical tools for PA management in patients. Research should prioritize algorithm transparency, clinical validation, and standardization.

PMID:42308476 | DOI:10.2196/79995

JMIR Rehabil Assist Technol. 2026 Jun 17;13:e85072. doi: 10.2196/85072.

ABSTRACT

BACKGROUND: An increasing amount of digital health data are being collected across rehabilitation settings, but their integration into routine clinical practice remains limited, despite its potential to motivate patients or inform clinical decision-making. Specifically, effective visualization and communication of assessment outcomes to both patients and health care practitioners (HCPs) represent a key gap in the neurorehabilitation practice.

OBJECTIVE: This study describes the development and evaluation of RehaLink (author ND, ETH Zürich), a proof-of-concept mobile app that delivers structured, interpretable feedback from conventional and technology-based assessments to neurorehabilitation patients and HCPs.

METHODS: The app was developed through a 3-step iterative co-design process involving 17 inpatients with multiple sclerosis and 15 HCPs from a single rehabilitation center. The app integrates a full battery of conventional assessments routinely conducted at the clinic, as well as digital health metrics from the Virtual Peg Insertion Test, a validated technology-based assessment of upper limb function, as a proof of concept for integrating technology-based assessment data into clinical workflows. Three structured feedback sessions were conducted, in which participants evaluated feedback types, visualization formats, and app usability using Likert-scale ratings, preference rankings, open-ended questions, and the System Usability Scale. Data were analyzed using descriptive statistics and directed content analysis.

RESULTS: Across all 3 sessions, progress bars and color-coded indicators were consistently preferred over text-heavy or abstract formats by both patients and HCPs. A persistent set of competing demands was observed, with participants requesting both visual simplicity and access to absolute values and normative comparisons. HCPs tended to underestimate patients’ preference for informative visualizations. The perceived value of structured feedback increased over the course of the study; patients’ median ratings rose from 4.0 to 5.0 and HCPs’ from 4.0 to 4.5 on a 5-point Likert scale. The resulting mobile app prototype demonstrated high usability, with patients achieving a mean System Usability Scale score of 93.6 (mean 6.4; best imaginable) and HCPs 80.9 (SD 8.1; good), according to established benchmarks.

CONCLUSIONS: These findings demonstrate the feasibility and value of a co-designed digital feedback tool for neurorehabilitation. By combining conventional and technology-based assessment outcomes in an accessible, user-centered format, the app has the potential to enhance patient engagement, support clinical decision-making, and advance the implementation of value-based, personalized care.

PMID:42308475 | DOI:10.2196/85072

Retina. 2026 Jul 1;46(7):1251-1257. doi: 10.1097/IAE.0000000000004821.

ABSTRACT

PURPOSE: The aim of this study was to evaluate the association between prostacyclin analog (PCA) therapy and the long-term incidence of diabetic retinopathy (DR) in patients with diabetes and pulmonary arterial hypertension.

METHODS: In this retrospective, real-world cohort study, the authors used 1:1 propensity score matching within the TriNetX Global Collaborative Network to compare patients receiving dual therapy including PCAs versus matched controls treated with endothelin receptor antagonists, phosphodiesterase-5 inhibitors, or soluble guanylate cyclase stimulators without PCAs. Patients with a prior DR diagnosis were excluded. The incidence of nonproliferative DR, proliferative DR, and diabetes with ophthalmic complications was assessed over a 5-year period using Cox proportional hazards models and Kaplan-Meier survival analyses.

RESULTS: Among 2,584 matched patients in both cohorts, PCA therapy was associated with a significantly lower incidence of nonproliferative DR (24 vs. 42 events; hazard ratio [HR] = 0.59; 95% confidence interval [CI], 0.35-0.97; P = 0.0345) and diabetes with ophthalmic complications (65 vs. 99 events; HR = 0.67; 95% CI, 0.49-0.91; P = 0.0105). No statistically significant difference was observed in proliferative DR incidence (10 vs. 15 events; HR = 0.63; 95% CI, 0.27-1.43; P = 0.2617).

CONCLUSION: PCA therapy may be associated with a reduced risk of developing DR, suggesting potential systemic microvascular protective effects. Further prospective studies are warranted to explore the therapeutic role of PCAs in diabetes-related retinal disease.

PMID:42308470 | DOI:10.1097/IAE.0000000000004821

Chem Rev. 2026 Jun 17. doi: 10.1021/acs.chemrev.5c01081. Online ahead of print.

ABSTRACT

Artificial intelligence and organic chemistry are redefining each other in a fundamentally bidirectional relationship. This Review highlights how the intrinsic challenges of organic chemistry have acted as a catalyst for conceptual and methodological innovation in AI itself. Sparse and heterogeneous reaction data sets spurred the development of self-supervised and few-shot learning paradigms; the combinatorial complexity of multireactant chemistry motivated the transition from graph neural networks to hypergraph architectures; the need to bridge symbolic chemical reasoning with statistical prediction inspired chemical language models grounded in large language model frameworks; and the iterative, decision-intensive nature of synthesis planning catalyzed the rise of autonomous agentic systems. We survey the multimodal landscape of chemical data, tracing the evolution of molecular representations from classical fingerprints to geometric encodings and examining how each representation class shapes downstream model capabilities. We analyze how data scarcity and uneven property distributions have driven advances in transfer learning, self-supervised pretraining, and meta-learning frameworks tailored to molecules and reactions. Reaction prediction, mechanistic inference, and retrosynthesis planning are examined as core areas where chemistry has shaped modern AI techniques. We further explore chemical reasoning through multimodal fusion, generative molecular design, and self-driving laboratories. We conclude by identifying persistent challenges, including data sparsity, selection bias, benchmark-to-lab gaps, and reproducibility.

PMID:42308460 | DOI:10.1021/acs.chemrev.5c01081

Neurology. 2026 Jul 28;107(2):e218214. doi: 10.1212/WNL.0000000000218214. Epub 2026 Jun 17.

ABSTRACT

BACKGROUND AND OBJECTIVES: Traumatic brain injury (TBI) during mid-to-late life is associated with increased risk of stroke, Parkinson disease (PD), epilepsy, and dementia. These conditions may also predispose to TBI. Thus, we investigated the incidence of dementia, stroke, epilepsy, and PD in older Veterans before and after acute TBI to determine whether there is a bidirectional association.

METHODS: In this retrospective cohort study, we identified Veterans aged ≥55 years who received care at US Veterans Health Affairs (VHA) facilities between October 1, 1999, and September 30, 2021, and who had acute TBI (concurrent International Classification of Diseases (ICD) code + emergency department visit + brain imaging) using VHA databases. We matched participants 3:1 to a non-TBI cohort based on age, sex, race/ethnicity, and visit date. Incident stroke, PD, epilepsy, and dementia were determined from ICD codes one year before and after TBI in the TBI cohort and over a two-year period in the non-TBI cohort. We excluded those with prevalent conditions at least 1 year before the study period. Incidence rate ratios (IRRs) and 95% CIs were calculated by comparing the pre-TBI period with the post-TBI period and with the non-TBI cohort.

RESULTS: We included 13,801 Veterans with acute TBI and a balanced cohort of 41,403 Veterans without TBI (average age 77.8 years, 96.5% male). Veterans with TBI had higher incidence rates of the 4 conditions before TBI compared with the non-TBI cohort: incidence of stroke (IRR = 3.2 [95% CI 2.9-3.5]), dementia (IRR = 3.1, [95% CI 2.9-3.4]), and PD (IRR = 3.0 [95% CI 2.4-3.7]) was 3 times higher, and that of epilepsy was over 4 times higher (IRR = 4.4 [95% CI 3.6-5.4]). Results were slightly attenuated but remained significant after adjusting for comorbidities and health care utilization. Veterans with TBI also had higher incidence rates 1 year after TBI compared with the pre-TBI period. Incident stroke (IRR = 1.83 [95% CI 1.65-2.04]) and epilepsy (IRR = 2.29 [95% CI 1.88-2.78]) rates were twofold higher; dementia incidence was also higher (IRR = 1.24 [95% CI 1.12-1.38]), but PD rates did not differ (IRR = 1.06 [95% CI 0.82-1.36]).

DISCUSSION: We found a bidirectional association between TBI and several neurologic conditions, with higher incidence rates preceding TBI and higher rates after TBI. Generalizability to non-Veteran populations is uncertain. Future studies may determine whether TBI prevention measures for adults with stroke, dementia, PD, and epilepsy are warranted.

PMID:42308449 | DOI:10.1212/WNL.0000000000218214

Neurology. 2026 Jul 14;107(1):e218165. doi: 10.1212/WNL.0000000000218165. Epub 2026 Jun 17.

ABSTRACT

BACKGROUND AND OBJECTIVES: The association between breast cancer diagnosis and treatment and the risk of incident ischemic stroke remains unclear. We investigated ischemic stroke risk among breast cancer survivors and evaluated associations by age, follow-up duration, and type of cancer treatment.

METHODS: We conducted a nationwide, retrospective, matched cohort study using the Korean National Health Insurance Service database. Women aged 18 years and older with newly diagnosed breast cancer who underwent breast cancer surgery between January 2010 and December 2016 and had no prior stroke were identified. Each was matched 1:3 by birth year to cancer-free women. The primary outcome was first ischemic stroke, defined as hospitalization with International Classification of Disease, Tenth Revision codes I63/I64 plus inpatient brain CT or MRI. Subdistribution hazard ratios (sHRs) and 95% CIs were estimated using Fine-Gray models that accounted for death as a competing risk and adjusted for sociodemographic factors and cardiovascular and non-CV comorbidities.

RESULTS: We analyzed 107,606 breast cancer surgery survivors (mean age, 50.0 years) and 322,818 matched cancer-free women. Over a mean 7.2-year follow-up, ischemic stroke occurred in 1,155 survivors (1.07%). Stroke risk was elevated shortly after breast cancer diagnosis (1-year sHR 1.59; 95% CI 1.34-1.89; 3-year sHR 1.17; 95% CI 1.05-1.30) compared with cancer-free women, with stronger associations at 3 and 6 months after diagnosis across all age groups. Over the long term, survivors had a slightly lower risk of stroke (sHR 0.94; 95% CI 0.88-1.00), and in a 1-year landmark analysis including only event-free individuals, the risk was lower (sHR 0.87, 95% CI 0.81-0.93). Among survivors, anthracycline use (sHR 1.25) and combined tamoxifen-aromatase inhibitor therapy (sHR 1.49) were associated with increased risk of stroke, whereas radiation therapy was associated with decreased risk (sHR 0.84). These associations attenuated and became nonsignificant beyond 1 year. Stroke risk was also higher among survivors with low income, hypertension, diabetes, or current smoking.

DISCUSSION: The association between breast cancer and ischemic stroke risk is time dependent, with a short-term increase after diagnosis and treatment followed by a gradual decline over time. These findings highlight the need for proactive stroke risk management, including early CV assessment and ongoing monitoring for thromboembolic events during survivorship.

PMID:42308440 | DOI:10.1212/WNL.0000000000218165

JMIR Med Educ. 2026 Jun 17;12:e83657. doi: 10.2196/83657.

ABSTRACT

BACKGROUND: Despite the importance of quality improvement in advancing patient care and safety, there is limited literature describing structured, practical, and co-designed quality improvement education.

OBJECTIVE: This study aimed to (1) describe how learner co-design was operationalized within Kern’s 6-step curriculum development framework to develop a quality improvement workshop for medical students and resident physicians, (2) evaluate preworkshop and postworkshop changes in learners’ self-reported understanding of and confidence in quality improvement, and (3) explore participants’ attitudes toward quality improvement and their perceptions of the workshop’s relevance to future practice.

METHODS: Using Kern’s 6-step curriculum development model, informed by Kolb’s Experiential Learning Theory, we co-designed a 1-day quality improvement workshop with medical students and resident physicians. To address objective 1, the workshop development process was guided by a literature review and a targeted needs assessment. To address objective 2, we used a mixed methods pre-post educational evaluation design. The workshop incorporated expert-led lectures, small-group project design exercises, and peer presentations addressing audit methodology, ethical considerations, and practical implementation. Preworkshop and postworkshop surveys assessed changes in participants’ self-reported understanding of quality improvement concepts, confidence, and attitudes using 10-point Likert scales. Quantitative data were analyzed using the Wilcoxon matched-pairs signed-rank and Fisher exact tests. Semistructured interviews explored participants’ experiences and helped to explain their quantitative responses. Interview transcripts were analyzed using thematic analysis.

RESULTS: Findings from the literature review and targeted needs assessment identified gaps in practical quality improvement education related to project design, implementation, and ethical considerations, which informed workshop co-design. In total, 31 learners attended the workshop, and 77.4% (24/31) completed preworkshop and postworkshop surveys. There was a significant improvement in participants’ understanding of the Plan-Do-Study-Act cycle (preworkshop median score 2.0, IQR 1.0-2.8 vs postworkshop median score 4.0, IQR 4.0-5.0; P<.001). Confidence in engaging in quality improvement projects improved significantly (preworkshop median score 4.5, IQR 2.3-7.0 vs postworkshop median score 7.5, IQR 6.3-8.0; P=.004). Self-reported knowledge of additional methodologies, including Six Sigma, Lean, and root cause analysis, also improved significantly. Participants rated the workshop highly (median score 9.5 out of 10). Qualitative findings indicated that participants perceived improved capability in project planning, greater ethical awareness, and stronger motivation to apply learning in clinical practice. These findings reflect self-reported learning experiences rather than objectively verified skill development.

CONCLUSIONS: Learner co-design was successfully integrated within Kern’s curriculum development framework to develop a practical quality improvement workshop informed by identified learner needs. Participation in the workshop was associated with improved self-reported understanding, confidence, and positive perceptions of relevance and usefulness. Future research should examine longer-term outcomes and evaluate adaptation across broader educational settings.

PMID:42308427 | DOI:10.2196/83657

Otolaryngol Head Neck Surg. 2026 Jun 17. doi: 10.1002/ohn.70313. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether contemporary large language models can match clinician performance in evaluating the urgency of emergency otolaryngology referrals.

STUDY DESIGN: Blinded cross-sectional diagnostic reasoning study.

SETTING: Simulated emergency referral environment modeled on tertiary care otolaryngology practice.

METHODS: Thirty emergency referral scenarios spanning the spectrum of otolaryngologic urgency were independently evaluated by 4 large language models (GPT-5, GPT-4, DeepSeek, and Grok) and 4 clinicians (otolaryngology attending and resident, emergency attending and resident). Outputs were anonymized and scored by 10 blinded otolaryngologists for appropriateness of urgency and quality of explanation using a three-point scale. Statistical analyses included nonparametric group comparisons, adjusted ordinary least squares modeling with case-level control, and correlation of each entity’s case profile with that of the otolaryngology attending.

RESULTS: Inter-rater reliability was excellent. The otolaryngology attending achieved the highest overall performance. GPT-5 demonstrated comparable mean performance, with no statistically significant difference in either domain. GPT-4 scored modestly lower but received higher mean ratings than both emergency clinicians. DeepSeek and the otolaryngology resident demonstrated intermediate performance, while Grok and the emergency clinicians performed lowest. Group-level analyses showed no significant difference between the large language model and otolaryngology cohorts; both were rated higher than emergency clinicians in this sample.

CONCLUSION: GPT-5 demonstrated triage performance comparable to the otolaryngology attending in this controlled sample. Large language models may support emergency decision-making and education when specialist consultation is limited, but require supervision, transparency, and local calibration.

PMID:42307998 | DOI:10.1002/ohn.70313

Otolaryngol Head Neck Surg. 2026 Jun 17. doi: 10.1002/ohn.70304. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether COVID-19 is a risk factor for developing airway stenosis in intubated patients.

STUDY DESIGN: Retrospective case-control study with planned chart review.

SETTING: Temple University Health Systems hospitals in Philadelphia, PA.

METHODS: Chart review of patients 18 to 90 years old diagnosed with COVID-19 who underwent endotracheal intubation and had a post-extubation CT scan at our institution between February 2020 and December 2022 was performed. Patients without COVID-19 matched for age, sex, and BMI who were intubated within one year served as a control group. Outcome variables included endoscopic and radiographic evidence of airway stenosis. Descriptive statistics were analyzed using Chi-squared and unpaired two-tailed T-test analyses for cohort comparison.

RESULTS: One hundred five COVID-positive and 101 COVID-negative met inclusion criteria. The mean age was 58.6 years. Mean endotracheal tube size was 8.05 for COVID-positive and 7.72 for COVID-negative patients (P = .0075). Twenty-six (24.76%) COVID-positive and 45 (44.55%) COVID-negative patients had COPD (P = .0016). Length of intubation was 8.8 days in COVID-positive patients and 3.5 days for COVID-negative patients (P < .0001). Thirty-five (33.98%) COVID-positive and 1 (0.99%) COVID-negative patient were ventilated while prone (P = .0002). Seventy-eight (75%) COVID-positive and 38 (41.76%) COVID-negative patients received intravenous steroids (P = .0001). Mean length of stay was 38.81 days for COVID-positive and 17.16 days for COVID-negative patients (P < .0004). Six (5.77%) COVID-positive and 2 (1.3%) COVID-negative patients developed airway stenosis (P = .202).

CONCLUSION: Patients with COVID-19 infection were not at an increased risk for intubation-related airway stenosis.

LEVEL OF EVIDENCE: IV.

PMID:42307991 | DOI:10.1002/ohn.70304