Tag: pubmed

JCO Clin Cancer Inform. 2025 Oct;9:e2500102. doi: 10.1200/CCI-25-00102. Epub 2025 Oct 1.

ABSTRACT

PURPOSE: The increasing use of patient portal messages has enhanced patient-provider communication. However, the high volume of these messages has also contributed to physician burnout.

METHODS: Patient-generated portal messages sent to a single cancer center from 2011 to 2023 were extracted. BERTopic, a natural language processing topic modeling technique based on large language models, was optimized. For further categorization, the topic words were labeled using GPT-4, followed by review by two oncologists. Uniform Manifold Approximation and Projection was used for dimensionality reduction and visualizing topics. Message volume changes over time were assessed using a Student’s t test.

RESULTS: A total of 2,280,851 messages were analyzed. The monthly average number of messages increased from 2,071 in 2012 to 43,430 in 2022 (P < .001). There was a significant rise in message volume after the COVID-19 pandemic, with a posterior probability of a causal effect of 96.4% (P = .04). Scheduling-related messages were the most frequent across departments, whereas symptoms and health concerns were second or third most common topics. In medical oncology and surgical oncology, topics on prescriptions and medications were more common compared with radiation oncology and gynecologic oncology. Despite concurrent institutional changes in self-scheduling systems, scheduling-related messages did not decrease over time.

CONCLUSION: The substantial increase in patient portal messages, particularly scheduling-related inquiries, underscores the need for streamlined communication to reduce the burden on health care providers. These findings highlight the need for strategies to manage message volume and mitigate physician burnout, laying groundwork for artificial intelligence-driven future triage systems to improve message management and patient care.

PMID:41032743 | DOI:10.1200/CCI-25-00102

JMIR Form Res. 2025 Oct 1;9:e70158. doi: 10.2196/70158.

ABSTRACT

BACKGROUND: The dose of mobile health (mHealth) interventions can influence participant engagement, acceptability, and overall impact. However, few mHealth interventions have explored this dose-response relationship.

OBJECTIVE: This study aims to explore how dose influences the acceptability, engagement, cost, and impact on infant feeding status of a parent-targeted mHealth text messaging program which aims to enhance child health, including breastfeeding exclusivity and duration.

METHODS: This pragmatic randomized controlled trial was conducted from October 2021 to May 2024. The Healthy Beginnings for Hunter New England Kids (HB4HNEKids) program provides- text messages aimed to support parents and carers and their children by providing evidence-based preventive health information across the first 2000 days. Participants were enrolled in HB4HNEKids from 5 Child and Family Health Services in the Hunter New England region of New South Wales, Australia, and randomized into either a high-dose or low-dose text message group for the first 2 years of the pilot program. Dose refers to the quantity and frequency of text messages sent to participants. Participants in the high-dose text message group received an average of 111-121 text messages, and the low-dose text message group received 80-82 text messages across the 2 years. Outcomes of interest included acceptability, engagement, cost, and infant feeding status in relation to dose. Engagement with the messages was determined using click rates and program opt-out rates. Participant acceptability was assessed via a brief survey. Impact on infant feeding status (ie, breastfeeding, formula feeding, or mixed feeding) was determined by participants reporting their feeding status at several time points across the program. Cost was determined by assessing the per participant and total cost of sending text messages for each dose group across the 2-year period.

RESULTS: There were no statistically significant differences in click rates between high or low-dose text message groups. In the first 6 months, significantly more participants opted out of the high-dose text message group (191/2724; 7%) compared to the low-dose (108/2812; 3.8%; P<.001). In terms of program acceptability, 183 out of 214 (85.5%) participants of the high-dose and 228 out of 252 (90.5%) participants of the low-dose text message group were satisfied with the frequency of text messages. In addition, 188 out of 215 (87%) participants of high-dose and 220 out of 255 (86%) participants of low-dose text message group indicated they would recommend the program to other caregivers. The average per participant and total cost to the health service for sending messages was lower in the low-dose group (A$9.32 per participant and A$15,271.48 total; A$1 is approximately equal to US $0.68) compared to the high-dose text message group (A$12.96 per participant and A$21,241.44 total).

CONCLUSIONS: The HB4HNEKids program demonstrated positive outcomes including high acceptability across both groups and no impact on infant feeding status, irrespective of dose. Given the higher opt-out rates and message costs in the high-dose text message group, a lower dose is likely more scalable for future use.

PMID:41032735 | DOI:10.2196/70158

J Med Internet Res. 2025 Oct 1;27:e71297. doi: 10.2196/71297.

ABSTRACT

BACKGROUND: Sharing information derived from individual patient data is restricted by regulatory frameworks due to privacy concerns. Generative artificial intelligence can generate shareable virtual patient populations as proxies for sensitive reference datasets. Explicit demonstration of privacy is demanded.

OBJECTIVE: This study evaluated whether a privacy-by-design technique called “avatars” can generate synthetic datasets replicating all reported information from randomized clinical trials (RCTs).

METHODS: We generated 2160 synthetic datasets from two phase 3 RCTs for patients with multiple sclerosis (NCT00213135 and NCT00906399; n=865 and 1516 patients) with different configurations to select one synthetic dataset with optimal privacy and utility for each. Several privacy metrics were computed, including protection against distance-based membership inference attacks. We assessed fidelity by comparing variable distributions and assessed utility by checking that all end points reported in the publications had the same effect directions, were within the reported 95% CIs, and had the same statistical significance.

RESULTS: Protection against membership inference attacks was the hardest privacy metric to optimize, but the technique yielded robust privacy and replication of the primary end points (in 72.5% and 80.8% of the 1080 generated datasets). Utility was uneven across the variables and end points, such that information about some end points could not be captured. With optimized generation configurations, we selected one dataset from each RCT replicating all efficacy end points of the placebo and approved treatment arms while maintaining satisfactory privacy (hidden rate: 85.0% and 93.2%).

CONCLUSIONS: Generating synthetic RCT datasets replicating primary and secondary efficacy end points is possible while achieving a satisfactory and explicit level of privacy. To show the potential of this method to unlock health data sharing, we released both placebo arms as open datasets.

PMID:41032725 | DOI:10.2196/71297

JMIR Med Educ. 2025 Oct 1;11:e78320. doi: 10.2196/78320.

ABSTRACT

BACKGROUND: Large language models such as ChatGPT (OpenAI) have shown promise in medical education assessments, but the comparative effects of prompt engineering across optimized variants and relative performance against medical students remain unclear.

OBJECTIVE: This study aims to systematically evaluate the impact of prompt engineering on five ChatGPT variants (GPT-3.5, GPT-4.0, GPT-4o, GPT-4o1-mini, and GPT-4o1) and benchmark their performance against fourth-year medical students in midterm and final examinations.

METHODS: A 100-item examination dataset covering multiple choice questions, short answer questions, clinical case analysis, and image-based questions was administered to each model under no-prompt and prompt-engineering conditions over 5 independent runs. Student cohort scores (N=143) were collected for comparison. Responses were scored using standardized rubrics, converted to percentages, and analyzed in SPSS Statistics (v29.0) with paired t tests and Cohen d (P<.05).

RESULTS: Baseline midterm scores ranged from 59.2% (GPT-3.5) to 94.1% (GPT-4o1), and final scores ranged from 55% to 92.4%. Fourth-year students averaged 89.4% (midterm) and 80.2% (final). Prompt engineering significantly improved GPT-3.5 (10.6%, P<.001) and GPT-4.0 (3.2%, P=.002) but yielded negligible gains for optimized variants (P=.07-.94). Optimized models matched or exceeded student performance on both exams.

CONCLUSIONS: Prompt engineering enhances early-generation model performance, whereas advanced variants inherently achieve near-ceiling accuracy, surpassing medical students. As large language models mature, emphasis should shift from prompt design to model selection, multimodal integration, and critical use of artificial intelligence as a learning companion.

PMID:41032724 | DOI:10.2196/78320

Elife. 2025 Oct 1;14:RP106614. doi: 10.7554/eLife.106614.

ABSTRACT

Past sensory experiences influence perception of the present. Multiple research subfields have emerged to study this phenomenon at different temporal scales. These phenomena fall into three categories: the influence of immediately preceding sensory events (micro), expectations established by short sequences of events (meso), and regularities over long sequences of events (macro). In a single paradigm, we examined the influence of temporal context on human perception at each scale. By integrating behavioral and pupillometry recordings with electroencephalographical recordings from a previous study, we identify two distinct mechanisms that operate across all scales. The first is moderated by attention and supports rapid motor responses to expected events. The second operates independently of task demands and dampens the feedforward neural responses produced by expected events, leading to unexpected events eliciting earlier and more precise neural representations.

PMID:41032362 | DOI:10.7554/eLife.106614

J Med Internet Res. 2025 Oct 1;27:e79289. doi: 10.2196/79289.

ABSTRACT

BACKGROUND: Peer online forums offer people experiencing mental health challenges easily accessible and anonymous support. However, little is known about the impacts of using forums, how these impacts are generated, or who might benefit from which type of forum.

OBJECTIVE: We aimed to develop a program theory to understand how peer online mental health forums work to help potential users, health professionals, service providers, and commissioners to decide whether to use forums and which to choose.

METHODS: A realist evaluation using a mixed methods, case series design in collaboration with 7 peer online mental health forums was conducted. We triangulated analysis of a large web-based survey (n=791) with in-depth realist interviews (n=52) to test and refine previously developed program theories about the impacts of using online forums. We then analyzed forum posts to identify in situ evidence for our revised theories. We only used forum posts from individuals who had freely consented to posts being shared for research. Data collection and analysis involved extensive input from our patient and public involvement group, including forum users, moderators, and senior forum staff (n=22), which met monthly for 22 two-hour-long workshops throughout the study.

RESULTS: Impacts of using peer online mental health forums were largely positive. Forums that are easy to navigate, make users feel safe to post, and are supported by well-trained moderators offering timely and sensitive responses can help people find new ways to make sense of their mental health challenges, feel understood, and accepted in the forum. This can lead to an increase in self-efficacy, a reduction in self-stigma, and increased mental well-being. Writing about experiences in a forum can itself be cathartic, but when posts have evidently been helpful to other members, posters also benefit from a sense of greater purpose and value. Negative impacts can occur if forums are difficult to navigate or if moderation is unresponsive, insensitive, or inadequate, as users can be left feeling unheard, misunderstood, or overly responsible for the welfare of others.

CONCLUSIONS: Forums offer accessible and inclusive ways to effectively support mental health for many people, some of whom may have limited access to other forms of help. The impacts on users are largely positive, but care is needed to ensure forums are well designed and moderators are well trained and supported. These findings are being used to inform the co-design of a web-based moderator toolkit and design guidelines, which will be made freely available.

TRIAL REGISTRATION: ISRCTN 62469166; https://www.isrctn.com/ISRCTN62469166.

PMID:41032361 | DOI:10.2196/79289

Minerva Obstet Gynecol. 2025 Oct 1. doi: 10.23736/S2724-606X.25.05702-1. Online ahead of print.

ABSTRACT

BACKGROUND: Congenital anomalies of the kidney and urinary tract (CAKUT) represent 15-20% of prenatally diagnosed congenital anomalies, often presenting unilaterally. This study aimed to describe sonographic features of fetuses with unilateral renal anomalies and evaluate their postnatal outcomes. Additionally, we assessed whether specific prenatal ultrasound findings predicted postnatal complications.

METHODS: This was a retrospective, observational study including singleton pregnancies referred to our center from 2008 to 2023 for unilateral renal anomalies identified in second or third trimester ultrasounds. Sequential prenatal ultrasound evaluations were conducted to monitor disease progression and associated anomalies. Postnatal outcomes were retrieved from delivery records and pediatric follow-ups. Statistical analyses included Chi-square tests, t-tests, and ROC curve analysis to assess the predictive value of the antero-posterior diameter (DAP) of the renal pelvis for postnatal complications.

RESULTS: A total of 226 cases were included: 116 (51.3%) pyelectases, 51 (22.6%) hydroureteronephroses, 48 (21.2%) multicystic kidneys, and 11 (4.9%) renal dysplasias. Diagnosis occurred at an average gestational age of 25 weeks, with 19.3% showing progression during pregnancy and 23% having associated anomalies detected during ultrasound examinations. Of 135 children with follow-up data, 47.4% required surgery, 1.5% developed hypertension, and 1.5% developed chronic kidney disease (CKD). Associated anomalies significantly correlated with unfavorable outcomes, such as need for intervention (P=0.001), risk of developing postnatal recurrent urinary infections (P=0.025), vesicoureteral reflux (P=0.001) and CKD (P=0.010). Progression during pregnancy correlated with vesicoureteral reflux (P=0.002) and development of anomalies in the contralateral kidney (P=0.012). DAP measurement did not reliably predict postnatal complications (AUC=0.590, P=0.191).

CONCLUSIONS: Unilateral renal anomalies are often associated with other congenital anomalies, influencing postnatal outcomes. DAP measurement was not a significant predictor of postnatal complications. Comprehensive prenatal ultrasound assessments are critical for guiding parental counseling, pregnancy management, and postnatal care.

PMID:41032351 | DOI:10.23736/S2724-606X.25.05702-1

JAMA Psychiatry. 2025 Oct 1. doi: 10.1001/jamapsychiatry.2025.2689. Online ahead of print.

ABSTRACT

IMPORTANCE: Associations among general intelligence (IQ), educational attainment (EA), and alcohol use disorder (AUD) are not well understood.

OBJECTIVE: To examine the relationship between IQ, EA, and AUD risk.

DESIGN, SETTING, AND PARTICIPANTS: The association between IQ and AUD risk was examined in a Swedish national conscription cohort. Potential causality was explored using mendelian randomization (MR) analyses, and the association of polygenic scores (PGS) for cognitive performance with AUD diagnosis was assessed. Participant data were obtained from cross-linked Swedish national registers, genome-wide association study (GWAS) summary statistics, and the US Yale-Penn cohort.

EXPOSURES: IQ and genetic variants associated with cognitive performance.

MAIN OUTCOMES AND MEASURES: Hazard ratios (HRs; time-to-event analyses) or odds ratios (ORs) for AUD.

RESULTS: Included in this study was a national cohort of 645 488 males, born between 1950 and 1962, from the Swedish Military Conscription Register, of whom 573 855 individuals were included in this analysis. All individuals were aged 18 years at IQ assessment with no substance use disorder diagnosis at conscription, and mean (SD) follow-up time (SD) was 60.5 (7.9) years. Summary statistics from GWAS of cognitive performance (n = 257 481) and AUD (total = 753 248; cases = 113 325) in individuals of European-like genetic ancestry (EUR), with FinnGen AUD GWAS as a replication sample (total = 500 348; cases = 20 597), were used for MR analyses. PGS analyses were conducted using the data of EUR individuals from the Yale-Penn cohort (n = 5424). IQ at age 18 years was inversely associated with AUD risk in Swedish males (adjusted HR, 1.43; 95% CI, 1.40-1.47; P < .001), adjusting for parental substance use disorder, probands’ psychiatric disorders, socioeconomic factors, and birth year strata. MR analyses suggested a causal relationship between lower cognitive performance and AUD risk (β [SE], 0.11 [0.02]; P = 2.6 × 10-12). The mediating role of EA differed between national contexts. Higher cognitive performance PGS were associated with reduced odds of AUD in Yale-Penn participants (OR, 0.83; 95% CI, 0.78-0.89).

CONCLUSIONS AND RELEVANCE: IQ and cognitive performance have a significant but context-dependent association with AUD risk, highlighting the need for a better understanding of the interplay among genetic factors, cognitive traits, and sociocultural influences on AUD susceptibility.

PMID:41032335 | DOI:10.1001/jamapsychiatry.2025.2689

JAMA Surg. 2025 Oct 1. doi: 10.1001/jamasurg.2025.3611. Online ahead of print.

ABSTRACT

IMPORTANCE: Bariatric surgery is widely recognized for its health benefits; however, its association with work productivity and employment participation, though frequently reported, has not been systematically synthesized. This evidence is crucial to inform the economic evaluation of bariatric surgery.

OBJECTIVE: To systematically analyze the evidence on occupational outcomes of bariatric surgery.

EVIDENCE REVIEW: A systematic literature search was conducted in 5 online databases to identify empirical studies on bariatric surgery-related employment and productivity outcomes published up to April 2024. Two coauthors independently screened the literature, and all coauthors contributed to data extraction and validation. Differences in occupational outcomes were compared before vs after surgery and between surgery vs nonsurgery groups. Comparisons were categorized into 3 groups: improvement, no difference, and worse. Where possible, summary values of occupational outcomes (eg, the average employment rate) were synthesized for each observational time point. Reported barriers and enablers to employment return or productivity were also identified.

FINDINGS: A total of 42 studies from 15 countries were included. Studies were published between 1977 and 2023, with most conducted in high-income countries. Roux-en-Y gastric bypass was the most frequently studied procedure. The most commonly evaluated metrics were employment and unemployment rates and absenteeism and sick leave. Bariatric surgery was associated with improvements in presenteeism and work hours and ability and short-term absenteeism and employment rates. However, the long-term employment rate followed a reversed U-shape trajectory, with employment rates initially increasing postsurgery but returning to baseline levels after about 5 years. Key barriers to improved occupational outcomes included insufficient weight loss, female sex, older age, preoperative comorbidities, lower quality of life, and a lack of prior work experience.

CONCLUSIONS AND RELEVANCE: Bariatric surgery demonstrates positive short-term impact on productivity and employment, but its long-term occupational benefits remain uncertain. Certain subgroups, such as females and older adults, may require tailored postsurgery support to sustain employment and productivity gains. These findings highlight the critical need for long-term strategies to sustain the occupational benefits postsurgery and to develop targeted interventions for at-risk populations.

PMID:41032316 | DOI:10.1001/jamasurg.2025.3611

JAMA Dermatol. 2025 Oct 1. doi: 10.1001/jamadermatol.2025.3512. Online ahead of print.

NO ABSTRACT

PMID:41032310 | DOI:10.1001/jamadermatol.2025.3512