Tag: pubmed

J Radiol Prot. 2026 Jan 6. doi: 10.1088/1361-6498/ae33cd. Online ahead of print.

ABSTRACT

Crew members on missions beyond low-earth orbit (BLEO) receive considerable radiation doses, but the effects and relative biological effectiveness of many relevant types of irradiation, including neutrons with energies of hundreds of MeV, largely remain under-investigated. Such small animal irradiations can only be compared to respective photon irradiations if comparable doses can simultaneously be delivered to a variety of organs during both irradiations, despite the different underlying dose deposition patterns.&#xD;Method: To evaluate the dosimetric comparability of upcoming small animal neutron and photon irradiations, experimental depth-dose measurements were performed at the TRIUMF neutron facility (TNF) and the British Columbia Cancer Research Centre (BCCRC), using a neutron beam with energies of up to 450 MeV and a Cs-137 irradiator. The MOBY digital mouse phantom was used to perform Monte Carlo simulations of neutron and photon animal irradiations. Evaluated metrics included the ratio between the dose delivered to a variety of different organs (including lungs, brain, and heart) during neutron and photon irradiation. A sensitivity analysis including a variety of animal parameters (tissue elemental compositions and mass densities, animal size, and animal orientation) was performed, and the statistical significance (p < 0.05) of the dosimetric impact of uncertainties in simulation parameters was analyzed.&#xD;Results: During nominal simulations, differences in organ doses during neutron and photon irradiation were <9% in all organs except the lungs (13%), in agreement with the dosimetric measurements performed, which exhibited differences of up to ≈20% depending on depth. During sensitivity analysis, no investigated source of uncertainty had a statistically significant dosimetric impact. &#xD;Conclusion: Organ doses during simulated neutron and photon irradiations were found to be comparable for various organs. Investigated sources of uncertainties had no statistically significant impact. These findings are therefore expected to be robust to realistic variations in animal parameters during upcoming small animal irradiations.

PMID:41494205 | DOI:10.1088/1361-6498/ae33cd

JMIR Med Inform. 2026 Jan 6;14:e76424. doi: 10.2196/76424.

ABSTRACT

BACKGROUND: Minimally invasive posterior lumbar interbody fusion (MIS-PLIF) is commonly performed to treat degenerative lumbar spinal conditions. Patients of advanced age often present with multiple comorbidities and reduced physiological reserves, influencing surgical risks and recovery. The growing aging population has led to a rising demand for care for older adults, posing significant challenges for health care systems worldwide.

OBJECTIVE: This study aimed to identify the associations between different age groups and MIS-PLIF outcomes.

METHODS: This study retrospectively analyzed data from the United States Nationwide Inpatient Sample collected between 2016 and 2020. Patients aged ≥60 years who underwent MIS-PLIF were eligible for inclusion in this study. Patients were categorized into age groups (60-69, 70-79, and ≥80 y). Logistic and linear regressions were used to determine the associations between the study variables and outcomes, including in-hospital mortality, complications, nonroutine discharge, and length of stay.

RESULTS: A total of 785 patients aged ≥60 (mean age 69.4, SD 0.2) years who underwent MIS-PLIF were included in the analysis, and 18.7% (147/785) experienced at least one complication. After adjustment, compared with patients aged 60 to 69 years, the risk of nonroutine discharge was significantly increased in patients aged 70 to 79 years (adjusted odds ratio 2.33, 95% CI 1.57-3.46; P<.001) and ≥80 years (adjusted odds ratio 4.79, 95% CI 2.64-8.67; P<.001). No significant differences in the risk of complications or length of hospital stay were observed across the age groups.

CONCLUSIONS: In older patients undergoing MIS-PLIF, advanced age is an independent predictor of nonroutine discharge. Furthermore, our findings suggest that age alone is not an independent risk factor for complications or extended hospital stays among older patients. These findings underscore that MIS-PLIF is a viable option for older patients, for whom extra attention may still be needed for postoperative care. Implementing age-stratified management for older patients undergoing MIS-PLIF may have important clinical policy implications.

PMID:41494180 | DOI:10.2196/76424

JMIR Ment Health. 2026 Jan 6;13:e78659. doi: 10.2196/78659.

ABSTRACT

BACKGROUND: The high number of mental disorders poses challenges for health care systems. In 2020, digital health applications (DHAs) were introduced in Germany as a new form of health care financed by the statutory health insurance. They aim to detect, monitor, treat, or alleviate disease, injury, or disability. DHAs for mental disorders (DHA-MD) intend to improve outpatient care for patients with mental disorders. However, evidence on general practitioners’ (GPs’) perspectives on DHA-MD and their prescribing behavior is limited.

OBJECTIVE: This study aimed to analyze GPs’ perspectives on DHA-MD and their prescribing behavior in the care of patients with mental disorders.

METHODS: A mixed methods study was conducted (January-October 2024), including a Germany-wide online survey and qualitative interviews with GPs and medical assistants (MAs). Sampling was conducted in collaboration with German research practice networks, which distributed the study invitation to their affiliated GPs. The questionnaire as well as the interview guides for GPs and MAs was developed by the study team according to the Consolidated Framework for Implementation Research. Descriptive analyses of prescribing behavior and perceived need (measured on an 11-point scale) for DHA-MD were conducted, followed by multivariate regression analyses to identify predictors of prescribing behavior and perceived need for DHA-MD. The interviews with GPs and MAs were analyzed using qualitative content analysis according to Mayring.

RESULTS: A sample of 149 GPs participated, and 12 GPs as well as 5 MAs were interviewed. The median prescription frequency of DHA-MD per quarter was 1, whereas the median estimated need was 3. Working in a half digitized and half paper-based practice (odds ratio 5.133, 95% CI 1.695-15.542) as well as working in a completely digitized practice (odds ratio 3.006, 95% CI 1.296-6.969) positively predicted the prescribing behavior. The duration of GPs’ medical practice (b=-0.057; P=.01) negatively predicted the perceived need, while working in a group practice (b=0.980; P=.02) positively predicted the perceived need for DHA-MD. In the interviews, GPs and MAs reported that they valued DHA-MD as a temporary or supplementary option for bridging waiting times for psychotherapy and considered their effectiveness to be highly dependent on indication and patient adherence. Reported barriers of GPs according to DHA-MD included lacking knowledge about DHA-MD, missing effectiveness studies, and difficulties integrating them into existing care processes.

CONCLUSIONS: GPs are reluctant to prescribe DHA-MD, as the need is considered to be low and their use is primarily seen as a temporary or supplementary treatment option rather than a stand-alone intervention. There are significant reasons for rejection and barriers that hinder prescription in primary care. Addressing these barriers and involving GPs as well as patients in future research are essential for the development of DHA-MD.

PMID:41494179 | DOI:10.2196/78659

J Infus Nurs. 2026 Jan-Feb 01;49(1):52-68. doi: 10.1097/NAN.0000000000000624. Epub 2025 Dec 23.

ABSTRACT

OBJECTIVE: The aim of this study is to assess catheter-related bloodstream infections (CRBSIs) in Chinese intensive care units (ICUs), covering prevalence, risk factors, pathogen distribution, and impacts of outcome.

METHODS: A cross-sectional study was conducted in ICUs across 22 tertiary hospitals (2023-2024), with CRBSI diagnoses following Chinese national guidelines. Data were analyzed using R software (version 4.4.2), employing chi-square tests, robust Poisson regression, and Bayesian logistic regression (P < .05).

RESULTS: The prevalence of CRBSI was 1.19% (1.53/1000 catheter days, 32 patients, and 36 episodes). Risk factors included no formal education/illiteracy (OR: 1.995-9.604), circulatory diseases (OR: 1.142-5.787), complex/rare diseases (OR: 2.417-13.048), and multiple catheterizations (OR: 4.502-15.093). The subclavian vein was safest (femoral/axillary OR: 4.01-6.86). Gram-negatives predominated (47.22%). Each additional day of catheter dwell days increased CRBSI risk by 4.33% (95% CI: 3.04%-5.20%), and each additional ICU stay raised risk by 4.2% (95% CI: 2.9%-5.1%). CRBSI increased mortality (OR: 8.65), prolonged ICU stay (mean increase of 9.09 days), and additional costs (¥122 539.56 per case, approximately $17 505.65).

CONCLUSION: CRBSI significantly worsens outcomes and costs in Chinese ICUs. Prioritizing subclavian catheterization, infection prevention bundles, and gram-negative antimicrobial stewardship is essential. Further research is needed to validate these interventions across diverse settings.

PMID:41494177 | DOI:10.1097/NAN.0000000000000624

J Infus Nurs. 2026 Jan-Feb 01;49(1):22-28. doi: 10.1097/NAN.0000000000000629. Epub 2025 Dec 23.

ABSTRACT

OBJECTIVES: The United States opioid crisis has led to significant health care challenges. Patients who inject drugs (PWID) may self-inject illicit substances into vascular access devices (SIVAD). This behavior can lead to complications, including overdose and death. Given lack of data on SIVAD, this study aims to survey hospital staff on experiences with PWID and SIVAD, assess effectiveness of current protocols, and highlight the underreporting of incidents and their impact on care.

METHODS: A cross-sectional survey study was conducted among hospital staff. The survey assessed experiences with SIVAD, perceptions, and suggestions for improvement. Analyses with descriptive statistics for quantitative data and thematic analysis for qualitative responses were performed.

RESULTS: Overall, 254 surveys were obtained. Of these, 31.7% (72/227) reported confirmed SIVAD during their care, and 48.6% (110/226) believed their patient did not complete care due to the stigma of SIVAD. Furthermore, 72.3% (68/94) reported altering care plans due to concern of SIVAD. Finally, 93.8% (212/226) of respondents stated that they would use a device to mitigate SIVAD, if available.

CONCLUSION: By surveying hospital staff about their experience with SIVAD, this study highlights the impact and underreporting of this issue. This study also underscores the need for enhanced patient safety in cases of SIVAD and desire for new protocols and devices to improve care quality.

PMID:41494173 | DOI:10.1097/NAN.0000000000000629

J Infus Nurs. 2026 Jan-Feb 01;49(1):13-21. doi: 10.1097/NAN.0000000000000626. Epub 2025 Dec 23.

ABSTRACT

BACKGROUND: Peripheral intravenous catheter (PIVC) vasopressor administration is increasingly used to expedite the treatment of septic shock when central venous access is not immediately available. This shift in practice reflects growing support from national guidelines, which permit short-term peripheral administration of vasopressors in adults. On March 9, 2023, hospitals within 1 health care system implemented guidelines for PIVC vasopressor administration in adult critical care settings, specifically emergency departments and intensive care units.

OBJECTIVE: This study examined adherence to these guidelines for PIVC vasopressor use and to identify associated complications.

METHODS: This retrospective descriptive study included 106 adult patients (68 emergency department and 38 intensive care unit patients) diagnosed with sepsis and receiving peripheral vasopressors.

RESULTS: The majority of patients received norepinephrine through a short PIVC. Overall, 5 patients (4.7%) experienced complications, 4 with thrombophlebitis and 1 with an extravasation. All 5 patients received norepinephrine at the organization’s policy-specified concentration via short PIVCs. However, only 1 of these patients met the system’s guidelines for minimum PIVC size, quantity, and maximum infusion duration. Overall, only 58% of patients were managed in full compliance with the system’s guidelines.

CONCLUSION: These results support the use of standardized protocols to reduce complications associated with short-term peripheral vasopressor administration.

PMID:41494172 | DOI:10.1097/NAN.0000000000000626

J Med Internet Res. 2026 Jan 6;28:e73757. doi: 10.2196/73757.

ABSTRACT

BACKGROUND: Although video consultations (VCs) are permitted in German outpatient care and have seen a notable rise during the COVID-19 pandemic, their use still does not seem to have become established in Germany.

OBJECTIVE: This survey aims to evaluate the attitudes of physicians and psychotherapists with regard to the use of VC after the COVID-19 pandemic, in particular in the context of types of treatment and suitable medical fields.

METHODS: A standardized questionnaire was sent out to all 34,095 physicians and psychotherapists in 4 German regions. The analysis consisted of both descriptive and inferential statistics. Subgroup analysis included gender, age groups, community size of practice location, VC experience, type and ownership of practice, and area of medical care. Binary logistic regression was conducted to determine whether physicians’ and psychotherapists’ individual factors, organizational factors, or area of medical care were associated with at least monthly VC provision or interest in VC provision.

RESULTS: The response rate was 17.9%, including a total of 5930 participants in the analysis. About 40% (2216/5863) of the physicians and psychotherapists surveyed stated that they offer VC at least once a month. In the area of medical care, the odds ratio (OR) of at least monthly VC provision in psychotherapeutic care was about 8.2 (95% CI 7.4-1.64; P<.001) compared to primary care, whereas in specialist care, the odds for monthly VC provision were approximately 50% lower than in primary care (OR 0.5, 95% CI 0.43-0.59; P<.001). Further, female participants have higher odds to provide VC at least once a month (OR 1.163, 95% CI 1.01-1.34; P=.03). The odds for monthly VC provision in older age groups are approximately 60% higher than in the <40 years old age group (OR 0.41, 95% CI 0.32-0.52; P<.001). Around 80% (4347/5442) of the participants expressed interest in VC use. The most common occasions for which treatment by VC was reported to be suitable were discussing test results (1422/1896, 75.0%), taking the patient’s medical history (1195/2147, 55.7%), issuing prescriptions for drugs and remedies (793/1204, 65.9%), and the issuing of incapacity certificates for work (677/1042, 65.0%).

CONCLUSIONS: There has been an increase in the self-reported uptake of VC among physicians and psychotherapists compared to prepandemic levels, although this remains at a relatively low level in primary and specialist care. A significant proportion of doctors and psychotherapists have expressed an interest in using VC after the pandemic period. However, this self-reported use is not yet reflected in actual usage data, suggesting the need for further investigation into the underlying factors influencing the gap and identifying potential enablers. Further, these self-assessments by service providers on suitable types of treatment and suitable medical fields can inform political decision-making.

PMID:41494170 | DOI:10.2196/73757

JMIR Res Protoc. 2026 Jan 6;15:e74186. doi: 10.2196/74186.

ABSTRACT

BACKGROUND: The prevalence of diabetes mellitus is increasing in sub-Saharan Africa. Data on the prevalence of diabetes in Zimbabwe are scarce, and the etiologic types of diabetes are not well characterized. Classification of diabetes in Zimbabwe relies on clinical criteria at the time of diagnosis, and more detailed phenotype data are lacking. Furthermore, the prevalence of complications at diagnosis of diabetes and the incidence of complications during follow-up are not well documented in Zimbabwe.

OBJECTIVE: The primary aim of this study is to characterize the etiological types of diabetes in adult and adolescent patients with newly diagnosed diabetes in Bulawayo, Zimbabwe. The secondary objectives are to determine the prevalence of chronic complications of diabetes among adult and adolescent patients with newly diagnosed diabetes and to determine the incidence and risk factors for the development of diabetes complications after a 2-year follow-up in patients with type 2 diabetes who are free of complications at baseline.

METHODS: This is a cross-sectional and prospective observational study. The cross-sectional (phase 1) study was conducted in patients presenting for the first time to the diabetes service at 2 referral hospitals and 2 diabetes clinics in Bulawayo, Zimbabwe. Data collected from consenting participants included demographic data, social and medical history, and clinical examination. Laboratory tests included serum urea, creatinine and electrolytes, liver function tests, lipids, plasma glucose, glycated hemoglobin, serum C-peptide, spot urine (dipstick, albumin, and creatinine), and β-cell antibodies (antiglutamic acid decarboxylase, anti-islet antigen, anti-insulin antibodies, anti-islet cell antibodies, and antizinc transporter 8 antibodies). All patients had retinal photography, a 12-lead electrocardiograph, and measurement of carotid intima-media thickness and arterial stiffness. Determination of the incidence of diabetes complications will be conducted through a 2-year follow-up (encompassing 6-mo review) of a subgroup of patients with type 2 diabetes and no diabetes complications at the time of enrollment. At each 6-month visit, in addition to all variables collected at baseline, data on diabetes management and drug therapy compliance will be obtained.

RESULTS: Data collection commenced in October 2021, with 323 participants recruited. Data analysis for phase 1 is ongoing. The study will be completed in October 2026. The results will describe the spectrum of diabetes and complications found at diagnosis (phase 1) and the incidence and risk factors associated with the development of complications of diabetes (phase 2).

CONCLUSIONS: The study will provide data on etiologic types of diabetes in patients presenting to health facilities in urban centers in Bulawayo, Zimbabwe. In addition, data on diabetes complications at the time of diagnosis as well as incident complications over 2 years of follow-up will be compared with data from other studies. The data will be used to inform management strategies for patients diagnosed with diabetes in Zimbabwe.

PMID:41494166 | DOI:10.2196/74186

JMIR Public Health Surveill. 2026 Jan 6;12:e71701. doi: 10.2196/71701.

ABSTRACT

BACKGROUND: Scales for measuring health literacy and numeracy have been broadly classified into performance-based (objective) and self-reported (subjective) scales. Both types of scales have been widely used in research and practice; however, they are not always consistent and may assess different latent constructs. Furthermore, an increasing number of objective measures have been developed, and it is unclear how many latent factors should be assumed.

OBJECTIVE: This study aimed to examine the psychometric properties and factor structure of items assessing objective health literacy across multiple scales and to clarify which aspects of objective health literacy would be correlated with subjective measures, as well as health behaviors and lifestyles.

METHODS: A total of 5 objective scales (72 items in total) were administered to Japanese-speaking adults (N=16,097; women: 7722/16,097, 48%; mean age 54.89, SD 16.46 years). The analyzed scales included items assessing the numeracy, comprehension, and application of health information, some of which were contextualized for specific diseases, such as diabetes and cancer. Participants’ responses were submitted to exploratory factor analysis, and individual factor scores were calculated to test correlations with subjective health literacy, health behavior, and lifestyle.

RESULTS: Exploratory factor analysis identified 3 factors, which were interpreted as conceptual knowledge, numeracy, and synthesis. The conceptual knowledge factor consisted of items about medical word comprehension. All numeracy items loaded onto the same factor, even when contextualized for different diseases. The synthesis factor was characterized by items assessing the ability to read and understand health-related information and make judgments on it using one’s own knowledge. The identified factors showed high interfactor correlations (r values 0.53-0.64) and small-to-moderate correlations with subjective health literacy (r values 0.14-0.45). Additionally, each factor indicated small positive correlations with healthy diet and nutrition and lower substance use (r values 0.17-0.26).

CONCLUSIONS: Our findings suggest that scales of objective health literacy have at least three latent constructs (ie, conceptual knowledge, numeracy, and synthesis) and that disease specificity is not psychometrically prominent. Each factor has some overlap with subjective health literacy, but overall, subjective and objective health literacy should be interpreted as independent constructs, given the small-to-modest correlations.

PMID:41494165 | DOI:10.2196/71701

JMIR Cancer. 2026 Jan 6;12:e68101. doi: 10.2196/68101.

ABSTRACT

BACKGROUND: Patients with cancer often face significant financial challenges, known as financial toxicity (FT), which is associated with reduced quality of life. Patients with hematologic malignancies (HMs) are especially vulnerable due to intensive and prolonged treatments, frequent hospital visits, and a high risk of complications. While FT affects many in the general population, it is particularly severe among racial and ethnic minorities, especially those below the poverty line. To our knowledge, no studies have specifically examined FT in this vulnerable group in the United States.

OBJECTIVE: This study aimed to evaluate the severity of FT in patients receiving treatment for HMs in a socioeconomically underserved population, explore sociodemographic factors that may predict the severity of FT, and evaluate the subjective experiences of these patients as they relate to FT.

METHODS: We conducted a prospective, observational, longitudinal study at the Montefiore Cancer Center’s outpatient department in the Bronx, New York, from October 1, 2022, to October 30, 2023. Participants included either adult patients newly diagnosed (ND) with HMs or those already diagnosed, undergoing cellular therapy (CT). The severity of FT was assessed using the validated Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) questionnaire. Additionally, an investigator-designed questionnaire was developed to gather sociodemographic data and evaluate the subjective effects of financial burden on patient care. Patients in both the ND and CT groups were followed for 90 days. Data collection occurred at their initial presentation, as well as on days 30 and 90.

RESULTS: Ninety patients participated in the study (ND=52 and CT=38). The median age was 59 (IQR 44-66) years, with 27% (n=24) African American and 55% (n=48) Hispanic. Overall, 75% (n=67) of participants experienced some degree of FT, most with mild FT at baseline (day 0, median COST-FACIT score=19.4). In the CT group, FT worsened significantly over time, with a decline in median COST-FACIT scores from 19.9 at day 0 to 15.5 on day 90 (P=.02). In a multivariable linear regression model, race and ethnicity were a significant predictor of FT burden: identifying as African American or Hispanic was associated with a significantly lower COST-FACIT score (ie, higher FT) compared to non-Hispanic White participants (B=-3.08, P=.04, 95% CI -6.05 to -0.12). Additionally, over half of ND and CT participants reported difficulty affording basic necessities (ND: 28/52, 54%; CT: 23/38, 61%) and concerns regarding transportation access and costs (ND: 26/50, 52%; CT: n=18/38, 47%).

CONCLUSIONS: FT is prevalent among patients with HMs receiving care in underserved populations, and the burden is significantly higher among African American and Hispanic populations.

PMID:41494164 | DOI:10.2196/68101