Tag: pubmed

JMIR Form Res. 2025 Oct 1;9:e68052. doi: 10.2196/68052.

ABSTRACT

BACKGROUND: Depression in women results in elevated morbidity rates, functional impairment, diminished quality of life, and an increased risk of suicide. Numerous obstacles impede access to mental health treatment for women in India. Digital mental health solutions can bridge the treatment gap, but it is important to tailor these solutions to the context and to end-users.

OBJECTIVE: We conducted a pilot randomized controlled trial to test the feasibility, acceptability, and preliminary effectiveness of a mental health app deployed in community-based organizations in improving depression outcomes.

METHODS: The Multiuser Interactive Health Response Application (MITHRA) is a multiple-user mobile app used in community-based organizations for screening, tracking, and supporting stepped-care treatment for depression. MITHRA is based on the healthy activity program, a brief psychological intervention based on behavioral activation. It includes audio, video, and enhanced touchscreen capabilities to overcome the barrier of illiteracy and lack of access. It was developed in collaboration with a participatory design group consisting of primary and secondary end-users and is available on tablets installed in self-help groups (SHGs), which are community-based organizations in India. The SHGs were randomized to MITHRA (n=3) or enhanced usual care (EUC; n=3). During SHG meetings, women completed the Patient Health Questionnaire-9 (PHQ-9). Based on their PHQ-9 scores, they were assigned different modules. In the EUC SHGs, women viewed one module of education on symptoms of depression. Primary outcomes include feasibility and acceptability, and secondary outcomes include depressive symptoms and functioning. Repeated-measures ANOVA was performed to compare the change in the outcome scores over time between study groups. A P value of<.05 was considered statistically significant.

RESULTS: MITHRA was found to be feasible and acceptable. A total of 96% of intervention arm participants completed at least half of their assigned modules. Although not powered for effectiveness outcomes, in this trial, we found that the change at 6 months from baseline in depressive symptoms (PHQ-9) were significantly different between MITHRA and EUC (P=.037), with greater improvement in the intervention group. Similarly, significant improvement in the World Health Organization Disability Assessment Scale score was noted in the MITHRA group (P=.005).

CONCLUSIONS: MITHRA is feasible and acceptable for use in women’s SHGs. Larger studies should examine the effectiveness of this approach in identifying and treating depression.

PMID:41032879 | DOI:10.2196/68052

JMIR Nurs. 2025 Oct 1;8:e72846. doi: 10.2196/72846.

ABSTRACT

BACKGROUND: “Internet Plus Nursing Service” (IPNS) offers innovative solutions for China’s growing home health care demands. Understanding primary care nurses’ participation intentions is crucial for service optimization.

OBJECTIVE: This study evaluates primary health nurses’ intention to participate in IPNS-a technology-mediated home care model combining mobile health platforms with in-person visits-and examines how digital readiness, safety perceptions, and organizational factors influence participation decisions, to guide policy optimization for scalable digital home health care delivery.

METHODS: A cross-sectional survey was conducted in Jiangsu Province, China (December 2023-December 2024) using the validated Participation Intention of Nurses on IPNS Scale. Convenience sampling enrolled 3952 nurses from 13 prefecture-level cities in Jiangsu-the second-tier administrative divisions in China that typically encompass both urban and rural areas, each with independent health care systems governed by municipal health authorities. Statistical analyses included t tests and ANOVA with SPSS 22.

RESULTS: A total of 3952 surveys were completed. The participation intention scale yielded a mean (SD) total score of 66.13 (7.89) across respondents. Subscale analysis revealed mean (SD) scores of 18.57 (2.68) for participation attitude, 18.87 (2.49) for subjective norms, and 25.67 (3.48) for perceived behavioral control. Significant demographic predictors of participation intention were identified through statistical analysis. Male nurses demonstrated stronger intention (t72.974=-23.139, P<.0001), as did those over 30 years old (F39,51=27.215, P<.0001) and bachelor’s degree holders (t2185.018=-4.994, P<.0001). Workplace characteristics also showed significant associations, with nursing management department staff (F39,51=45.877, P<.0001) and those with less organizational workloads (F39,51=9.829, P<.0001) displaying greater intention. Professional factors including higher positional rank (F39,51=37.32, P<.0001), more advanced titles (F39,51=30.176, P<.0001), and over 11 years of experience (F39,51=5.242, P=.001) predicted stronger participation intent. Finally, nurses earning 5000-10,000 RMB (a currency exchange rate of RMB 1=US $0.71 is applicable) monthly showed significantly higher intention scores (F39,51=16.141, P<.0001).

CONCLUSIONS: Policymakers should prioritize 3 interventions: (1) develop IPNS-specific safety protocols and legal safeguards, (2) optimize workload allocation through intelligent scheduling systems, and (3) establish tiered incentive mechanisms targeting middle-income nurses and experienced practitioners.

PMID:41032878 | DOI:10.2196/72846

JMIR Form Res. 2025 Sep 30. doi: 10.2196/80917. Online ahead of print.

ABSTRACT

BACKGROUND: Discharge instructions are essential for patient post-hospital care, but are time-consuming to write. With the rise of large language models (LLMs), there is strong potential to automate this process. This study explores the use of open-source LLMs for generating discharge instructions.

OBJECTIVE: We investigated whether a Mistral model can reliably generate patient-oriented discharge instructions. Two distinct instruction-tuning paradigms were compared, each using a different mechanism for embedding guidance during fine-tuning.

METHODS: In our experiment, we applied Mistral-NeMo-Instruct, a large language model, in combination with two distinct instruction strategies for fine-tuning. The first were detailed instructions tailored to the task of discharge instruction generation. The second was a basic instruction with minimal guidance and no task-specific detail. The independent variable in this study is the instruction strategy (detailed vs. generic), while the dependent variables are the evaluation scores of the generated discharge instructions. The generated discharge instructions were evaluated against 3,621 ground-truth references. We used BLEU-1 to BLEU-4, ROUGE (ROUGE-1, ROUGE-2, ROUGE-L), SentenceTransformer similarity, and BERTScore as evaluation metrics to assess the quality of the generated outputs in comparison to the corresponding ground-truth instructions for the same discharge summaries.

RESULTS: The detailed instruction model demonstrated superior performance across all automated evaluation metrics compared with the generic instruction model. BERTScore increased from 78.92% to 87.05%, while structural alignment measured by ROUGE-L improved from 8.59% to 26.52%. N-gram precision (BLEU-4) increased from 0.81% to 21.24%, and METEOR scores rose from 15.33% to 18.47%. Additional metrics showed consistent gains: ROUGE-1 improved from 16.59% to 42.72%, and ROUGE-2 increased from 1.97% to 45.84%. All improvements were statistically significant (P < .001), indicating that detailed, task-specific instruction design substantially enhances model performance.

CONCLUSIONS: The use of detailed, task-specific instruction strategies significantly enhances the effectiveness of open-source large language models in generating discharge instructions. These findings indicate that carefully designed instructions during fine-tuning substantially improve model performance.

PMID:41032874 | DOI:10.2196/80917

JMIR Form Res. 2025 Oct 1;9:e75335. doi: 10.2196/75335.

ABSTRACT

BACKGROUND: Menopause is a significant time in a woman’s life, but only recently has there been an open discussion about it in the media, workplaces, and general society. With increasing frequency, women are using the internet to research menopause, making it essential that online sources provide safe, high-quality, and relevant information.

OBJECTIVE: This study aimed to investigate the current state of the online information landscape for menopause from the perspective of information seekers, exploring (1) information-seeking behavior and (2) perceptions of online resources for menopause.

METHODS: A 10- to 15-minute online survey was conducted asking about the respondents’ use of and opinions about online resources specifically for menopause. We distributed the survey via social media, email, and word of mouth. Quantitative data were explored using means and frequencies. Group differences between menopausal groups were analyzed using chi-square, Fisher exact, or Kruskall-Wallis tests as appropriate. Qualitative data were analyzed using data-driven thematic analysis.

RESULTS: Data from 627 participants were analyzed (early perimenopause: n=171, 27.3%, late perimenopause: n=125, 19.9%, postmenopause: n=262, 41.8%, and surgical menopause: n=69, 11%). The majority of respondents had used the internet as a source of information (581/627, 92.7%), with the internet being the first choice of information source (489/581, 84.2%). The most searched-for information online was about menopause symptoms (479/581, 82.4%), menopause treatment options (442/581, 76.1%), and self-help tips or strategies (318/581, 54.7%). The majority of participants trusted online information to some extent (615/627, 98.1%), with many also considering online information accurate to some extent (555/627, 88.5%). Many participants reported finding some but not all of the information they were looking for online (379/581, 65.2%). Thematic analysis revealed 10 themes related to information quality and accessibility and sought-after information (eg, symptom specifics, treatment, and nonformal management strategies). Analysis also indicated that information is lacking for several groups, including those in medically induced or surgical menopause.

CONCLUSIONS: The study showed that online informational resources are widely accessed and widely perceived as useful and trustworthy. However, it is crucial that the quality of online information is evaluated, especially considering the large number of users who rely on it as their first or only informational source. Online searches were usually performed to find information related to symptoms, treatment, and self-help recommendations, with differences in search behaviors observed across menopausal stages and groups, highlighting the need for tailored informational resources. Thematic analysis revealed gaps in the provision of online information both in terms of content and quality. Participants noted a lack of comprehensive symptom information, inadequate information for groups such as those experiencing medical or surgical menopause, and concerns about outdated content and a lack of source transparency. Future research with more diverse samples is needed to better understand variations in online health information-seeking behaviors across groups.

PMID:41032866 | DOI:10.2196/75335

JMIR Mhealth Uhealth. 2025 Oct 1;13:e68464. doi: 10.2196/68464.

ABSTRACT

BACKGROUND: Management of noncommunicable diseases (NCDs) is an increasing challenge for health care systems. Although remote patient monitoring presents a promising solution by utilizing technology to monitor patients outside clinical settings, there is a lack of knowledge about the effect on resource utilization.

OBJECTIVE: This systematic review aimed to review the effects of remote patient monitoring on health care resource utilization by patients with NCDs.

METHODS: Eligible randomized controlled trials (RCTs) involved digital transmission of health data from patients to health care personnel. Outcomes included hospitalizations, length of stay, outpatient visits, and emergency visits. A systematic literature search was performed in Medline, Embase, and Cochrane Central Register of Controlled Trials in June 2024. Titles, abstracts, and full texts were screened individually by 2 authors. Risk of bias was assessed, and data were extracted, analyzed, and pooled in meta-analysis when possible. Confidence in the estimates was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS: We included 40 RCTs published between 2017 and 2024. The largest group of NCDs was cardiovascular disease (16 studies). Remote patient monitoring may slightly decrease the proportion of hospitalizations compared with usual care (risk ratio [RR] 0.86, 95% CI 0.77 to 0.95; low certainty). Compared with usual care, remote patient monitoring had fewer or an equal number of hospitalizations (mean difference -0.13, 95% CI -0.29 to 0.03; low certainty). Hospital length of stay may be slightly reduced with remote patient monitoring compared with usual care (mean difference -0.84, 95% CI -1.61 to -0.06 days; low certainty). The proportion of outpatient visits showed probably little to no difference between remote patient monitoring and usual care (RR 0.94, 95% CI 0.87 to 1.02; moderate certainty). Compared with usual care, remote patient monitoring had slightly more outpatient visits, but the CI was wide (mean difference 0.41, 95% CI -0.22 to 1.03; low certainty). The results indicate a small or no difference between remote patient monitoring and usual care regarding proportion of emergency visits (RR 0.91, 95% CI 0.79 to 1.05; low certainty). We are uncertain whether remote patient monitoring increases or decreases the number of emergency visits, as the evidence was of very low certainty.

CONCLUSIONS: This systematic review showed that remote patient monitoring possibly led to lower proportions of patients being hospitalized, fewer hospitalizations, and shorter hospital length of stay compared with usual care. Patients undergoing remote monitoring had possibly more outpatient visits compared with usual care. The proportions of patients with outpatient visits or emergency visits were probably similar. Finally, we had very low certainty in the number of emergency visits. The results should be considered with caution as the certainty of evidence was moderate to very low. We did not find results regarding institutional stay.

PMID:41032865 | DOI:10.2196/68464

Medwave. 2025 Oct 1;25(9):e3106. doi: 10.5867/medwave.2025.09.3106.

ABSTRACT

INTRODUCTION: Surgical waiting lists for conditions not covered by the Explicit Health Guarantees represent unmet needs and structural gaps within the Chilean public health system. The field of orthopedics and traumatology accounts for a high volume of pending procedures, with total knee arthroplasty being the most frequently delayed. The coexistence of deferrable pathologies not formally recorded, combined with the low efficiency in the use of operating rooms, aggravates this problem. This study aims to characterize the surgical waiting list for conditions not covered by the Explicit Health Guarantees in Chile between 2022 and 2024, with a focus on orthopedics and traumatology. Additionally, we identify the most delayed procedures, the most affected health services, and the current capacity for resolution.

METHODS: A descriptive observational study based on official data requested from the Ministry of Health through transparency and public records, including the Department of Health Statistics and Information and the National Health Fund. Surgical procedures awaiting treatment were analyzed by specialty, region, establishment, sex, and age for the period from 2022 to 2024.

RESULTS: Orthopedics and traumatology were the specialties with the highest number of pending procedures (22 to 24% of the total). Knee arthroplasty consistently ranked first, with over 20 000 cases annually. The O’Higgins Health Service had the highest burden. In 2022, the rate of arthroplasties performed on patients covered by the National Health Fund was four times lower than on patients covered by Social Security Health Institutions. No region achieved a surgical volume sufficient to reduce the waiting list significantly.

CONCLUSIONS: The problem of waiting lists in orthopedics is mainly due to organizational shortcomings. Creating the role of trauma emergency ward, optimizing the use of wards, and creating outpatient surgical units are short- and medium-term measures to reverse this trend.

PMID:41032845 | DOI:10.5867/medwave.2025.09.3106

Opt Lett. 2025 Oct 1;50(19):6145-6148. doi: 10.1364/OL.571324.

ABSTRACT

Harmonically mode-locked soliton fiber laser can host an ensemble of identical solitons in parallel, providing a unique many-body system for exploring the intrinsic stochasticity of soliton dynamics in nonlinear optical systems. We report in this work the experimental observation of parallel soliton dynamics under homogeneous perturbation in a harmonically mode-locked fiber laser. Given an abrupt and transient decrease in the pump power, the parallel solitons exhibit evolution trajectories of probabilistic nature, featuring prominent re-distribution of soliton energies followed by random collapse and recovery after the perturbation. We investigate statistical dependences of the soliton collapse upon the perturbation parameters, while revealing threshold behaviors of the recovery dynamics. This work provides unique insight into the stochasticity of the nonlinear soliton evolution in mode-locked fiber lasers and may help to improve laser stability.

PMID:41032814 | DOI:10.1364/OL.571324

Opt Lett. 2025 Oct 1;50(19):6133-6136. doi: 10.1364/OL.574551.

ABSTRACT

The progress of AlGaN-based deep ultraviolet light-emitting diodes is significantly limited by their unideal light extraction efficiency. In this work, a cost-efficient nanosphere lithography technique is utilized to fabricate wafer-scale SiO₂-based patterned dielectric nanostructures on the backside of sapphire substrates. Mapping results and statistical analyses demonstrate a uniform optical power enhancement across the entire chip, and the average power can be increased by 16.7% with almost identical peak wavelength and slightly enhanced operating voltage. The light output power of the LEDs with the patterned film exhibits a substantial enhancement of 34.0% compared to conventional LEDs at an injected current of 330 mA, accompanied by a 1.34-fold increase in light extraction efficiency. Finite-difference time-domain simulations indicate that the nanostructures on the patterned film effectively weakened total internal reflection at the sapphire/air interface. The above results validate the scalability of this method for industrial mass production of high-power DUV LEDs.

PMID:41032811 | DOI:10.1364/OL.574551

Opt Lett. 2025 Oct 1;50(19):6117-6120. doi: 10.1364/OL.570619.

ABSTRACT

Polarization optical fiber sensors are based on modifications of fiber birefringence by an external measurand (e.g., strain, pressure, acoustic waves). Yet, this means that different input states of polarization will result in very distinct behaviors, which may or may not be optimal in terms of sensitivity and signal-to-noise ratio. To tackle this challenge, this manuscript presents an optimization technique for the input polarization state using the Fisher information formalism, which allows for achieving maximal precision for a statistically unbiased metric. By first measuring the variation of the Mueller matrix of the optical fiber in response to controlled acoustic perturbations induced by piezo speakers, we compute the corresponding Fisher information operator. Using maximal information states of the Fisher information, it was possible to observe a significant improvement in the performance of the sensor, increasing the signal-to-noise ratio from 4.3 to 37.6 dB, attaining an almost flat response from 1.5 kHz up to 15 kHz. As a proof-of-concept for dynamic audio signal detection, a broadband acoustic signal was also reconstructed with significant gain, demonstrating the usefulness of the introduced formalism for high-precision sensing with polarimetric fiber sensors.

PMID:41032807 | DOI:10.1364/OL.570619

Int Braz J Urol. 2026 Jan-Feb;52(1):e20250453. doi: 10.1590/S1677-5538.IBJU.2025.0453.

ABSTRACT

PURPOSE: To evaluate the prevalence, predictors, and progression of acute kidney injury (AKI) in patients undergoing mPCNL for nephrolithiasis.

MATERIALS AND METHODS: We retrospectively analyzed data from 569 patients who underwent mPCNL at a single tertiary academic center (01/2016-10/2024). AKI was defined per KDIGO criteria as sCr increase >0.3 mg/dL or ≥1.5× baseline. Stone-free status was no residual stones on CT at 3-month follow-up. Complications were classified using the modified Clavien system. Kidney function was reassessed 30-90 days post-op. Descriptive statistics, logistic regression, and Cox regression were applied.

RESULTS: Median (IQR) age and stone volume were 57 (48-66) years and 2.1 (0.9-4.2) cm³. Median preoperative sCr and operative time were 0.9 (0.7-1.1) mg/dL and 90 (73-120) minutes. Post-mPCNL, 40 patients (7.0%) developed AKI. Complications occurred in 138 (24.2%) patients; 449 (78.9%) were stone-free. AKI patients had higher CCI (1.3 vs. 0.5, p=0.04), pre-op sCr (1.1 vs. 0.8 mg/dL, p<0.01), stone volume (5.7 vs. 2 cm³, p=0.02), and longer operative time (130 vs. 90 min, p=0.01). Complications were more frequent in AKI patients (42.5% vs. 22.8%, p=0.01). At multivariate analysis, operative time (OR 1.1, p=0.03), pre-op sCr (OR 3.8, p=0.001), and early complications (OR 2.5, p=0.02) were independently associated with AKI. AKI persisted in 9 (22.5%) patients, mainly those with complications (88.9% vs. 38.7%, p=0.01). On Cox analysis, lower BMI (HR 0.8, p=0.02) and absence of complications (HR 0.3, p=0.01) predicted faster AKI recovery.

CONCLUSION: Acute kidney injury remains a clinically significant complication following mPCNL.

PMID:41032756 | DOI:10.1590/S1677-5538.IBJU.2025.0453