Tag: pubmed

J Nutr Educ Behav. 2026 Aug 24:S1499-4046(26)00415-X. doi: 10.1016/j.jneb.2026.07.005. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify and compare pedagogical approaches to weight-related topics among US higher education instructors who teach health-related courses.

DESIGN: Survey, including an open-ended question, Universal Measure of Bias-FAT (UMB-FAT) and Beliefs About Obese People (BAOP) scores, collected responses from April to August 2023.

SETTING: Online, 53-item virtual platform survey.

PARTICIPANTS: One hundred and twelve health profession instructors (aged ≥ 18 years; including nursing, dietetics, medicine, allied health, exercise science) participated and were selected by cluster sampling from 3 randomly selected colleges and universities per state.

PHENOMENON OF INTEREST: Instructors’ pedagogical strategies and biases toward weight.

ANALYSIS: Sentiment and content analysis conducted by 2 researchers. Sentiments were weight-centric, mixed/hybrid (MH), or weight-inclusive (WI) with categories (weight metrics, topics and concepts, teaching strategies, and theories and constructs) and mapped for comparison. Scale scores (UMBFAT; BAOP) were analyzed for descriptive statistics.

RESULTS: Weight-centric approaches emphasized body mass index and dieting, WI emphasized behavior, social determinants, and Health at Every Size. Discussion-based teaching and bias-awareness content appeared more in MH and WI. Weight-inclusive instructors had lower UMB-FAT (1.58 ± 0.52) and BAOP (3.20 ± 0.97) scores.

CONCLUSIONS: Teaching sentiment can determine how weight is framed. Findings highlight opportunities to investigate how WI curricula affect student weight attitudes and behaviors.

PMID:42640230 | DOI:10.1016/j.jneb.2026.07.005

JMIR Res Protoc. 2026 Aug 25;15:e92804. doi: 10.2196/92804.

ABSTRACT

BACKGROUND: Breast cancer screening through mammography is essential for early detection and improved survival; however, pain and discomfort during the procedure remain major barriers to women’s participation. Pain perception during mammography is influenced not only by technical factors but also by psychological variables such as anxiety, depression, pain catastrophizing, and personality traits. Despite growing evidence, findings on the role of psychological factors remain inconsistent, and the contribution of personality traits remains largely unexplored, highlighting the need for further investigation.

OBJECTIVE: This study aims to investigate associations among psychological factors (anxiety, depression, and pain catastrophizing), Ten-Item Personality Inventory personality traits, and pain perception and experience in women undergoing routine mammography at public and private radiology centers in Cyprus. The study hypothesizes that higher anxiety levels and first-time mammography experience are associated with greater perceived pain during mammography.

METHODS: This cross-sectional study will include approximately 380 women aged 35 to 75 years undergoing routine screening mammography at public and private radiology centers in Cyprus. Participants will complete the Patient Health Questionnaire-4, the Pain Catastrophizing Scale, the Ten-Item Personality Inventory, and a demographic and clinical questionnaire before the examination. The primary outcome will be perceived pain intensity during mammography, assessed immediately after the examination using a Visual Analog Scale. Psychological factors, including anxiety, depression, pain catastrophizing, and personality traits, will be evaluated as the main independent variables. Secondary analyses will examine the role of demographic and clinical characteristics, as well as previous mammography experience, in pain perception. Descriptive statistics will summarize participant characteristics, and associations between study variables and pain intensity will be examined using Pearson or Spearman correlation analyses and hierarchical multiple linear regression models adjusted for relevant confounders. The study will be conducted and reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for observational studies.

RESULTS: Participant recruitment and data collection began in March 2026. By June 2026, 50 women had been enrolled in the study. Recruitment and data collection are expected to continue through September 2026. Data analysis is anticipated to be completed by December 2026, with dissemination of findings and manuscript submission planned for 2027. Following study initiation, the study setting was expanded to include a public radiology center to facilitate recruitment and enhance sample representativeness.

CONCLUSIONS: If the study findings support the proposed associations, early identification and management of psychological factors related to pain perception during mammography may improve women’s overall experience, enhance comfort during the procedure, and potentially increase adherence to breast cancer screening programs.

PMID:42640226 | DOI:10.2196/92804

Am J Manag Care. 2026 Jul;32(7):414-416. doi: 10.37765/ajmc.2026.89916.

ABSTRACT

Given the fixed supply of residency training slots, pathways to increasing physician supply are limited. We assess use of the novel assistant physician (AP) status and the early impact of regulatory changes in Missouri. We find limited impacts of APs on supply, with a substantial majority (80.2%) of licensed APs not reporting a practice address and declining numbers of new licenses in recent years. We discuss implications and potential changes to increase health care supply through an AP pathway.

PMID:42640210 | DOI:10.37765/ajmc.2026.89916

Am J Manag Care. 2026 Jul;32(7):406-412. doi: 10.37765/ajmc.2026.89915.

ABSTRACT

OBJECTIVE: To evaluate the impact of an intensive outpatient clinic (IOC) model on health care utilization and costs among medically and behaviorally complex adults enrolled in a Medicaid managed care organization.

STUDY DESIGN: A retrospective cohort study using interrupted time series (ITS) and Bayesian structural time series (BSTS) analysis was conducted to examine changes in health care use and costs before and after IOC enrollment.

METHODS: Observational claims data from 2015 to 2023 were analyzed for 150 adults who enrolled in an IOC between 2017 and 2023. Outcomes included total, medical, and pharmacy costs; hospital admissions; and emergency department (ED) visits, tracked 24 months before and after enrollment.

RESULTS: Mean annual health care spending decreased by 43% 2 years after IOC enrollment. ITS analysis showed significant monthly reductions in total spending (-$142; 95% CI, -$242 to -$42; P < .01) and medical costs (-$129; 95% CI, -$229 to -$29; P = .01). Hospital admissions and ED visits declined by 36 (95% CI, -58 to -13; P < .01) and 25 (95% CI, -35 to -16; P < .01) per 1000 patients per month, respectively. BSTS estimates showed a 6% decrease in total spending, a 10% decrease in medical costs, and a 28% decrease in ED visits.

CONCLUSIONS: The IOC was associated with significant reductions in health care costs and utilization among medically and behaviorally complex adults. Scalable interventions such as an IOC may help improve care coordination and reduce costs for high-risk Medicaid populations.

PMID:42640209 | DOI:10.37765/ajmc.2026.89915

Am J Manag Care. 2026 Jul;32(7):392-395. doi: 10.37765/ajmc.2026.89983.

ABSTRACT

OBJECTIVES: The glucagon-like peptide-1 receptor agonist (GLP-1 RA) semaglutide has several branded versions, including Wegovy, which was initially approved for chronic weight management. In March 2024, the FDA expanded Wegovy’s indications to include reducing cardiovascular events in patients with overweight or obesity and cardiovascular disease. That same month, Medicare Part D expanded coverage for this indication. Evidence is lacking on how these policy changes have affected the utilization of Wegovy and other semaglutide products.

STUDY DESIGN: Retrospective analysis of monthly semaglutide fills in the US before and after expanded FDA indications and Medicare coverage.

METHODS: IQVIA National Prescription Audit PayerTrak data were used to assess temporal trends in semaglutide utilization by brand and payer between September 2023 and September 2024. Additionally, linear segmented regression was used to identify the number of additional fills associated with the FDA and Medicare policy changes.

RESULTS: Total semaglutide utilization increased during the study period, with Wegovy showing the largest relative increase compared with the prepolicy period (136.4%) among all semaglutide products. The greatest increase in relative utilization by payer was for Wegovy purchased through Medicare Part D (598.1%). Policy implementation was associated with an estimated 592,624 additional Wegovy fills by September 2024.

CONCLUSIONS: Expanded FDA indications and Medicare coverage of semaglutide for cardiovascular risk prevention were associated with increased Wegovy utilization, most notably through Medicare Part D. These policies may serve as a template for improving access to semaglutide and other GLP-1 RAs as the clinical indications for these drugs continue to expand.

PMID:42640207 | DOI:10.37765/ajmc.2026.89983

Am J Manag Care. 2026 Jul;32(7):380-382. doi: 10.37765/ajmc.2026.89982.

ABSTRACT

OBJECTIVES: We investigated the timing of supplemental indications and characteristics of those approved after 9 years (small molecules) or 13 years (biologics) post initial approval across all therapeutic areas.

STUDY DESIGN: Using FDA databases, we identified small molecule drugs (n = 97) initially approved between 2004 and 2015 and biologics between 2004 and 2011 (n = 21), allowing for at least 9 and 13 years of follow-up, respectively.

METHODS: We reviewed drug labels as of 2024 to identify supplemental indications. We characterized supplemental indications approved at least 9 or 13 years post approval in several ways: by FDA expedited review pathway, whether they had orphan designation, whether they were approved for pediatric or geriatric populations, and their therapeutic class. We calculated the mean time between consecutive indications for small molecules and biologics.

RESULTS: Overall, 24.0% of small molecule supplemental indications were approved at least 9 years post approval, and 10.0% of biologic supplemental indications were approved at least 13 years post approval. Of the supplemental indications approved (whether for small molecules or biologics) at least 9 or 13 years after initial approval, 56.9% received at least 1 FDA expedited review, 39.2% had orphan status, 49.0% were approved for pediatric use, and 62.7% were approved for older adults. The mean time between consecutive indications was longer for small molecules than for biologics (4.0 vs 3.3 years).

CONCLUSIONS: Additional drug indications approved after 9 years for small molecules and 13 years for large molecules are not uncommon. Many of these later-approved indications receive expedited or orphan designation and target populations with high unmet medical needs.

PMID:42640206 | DOI:10.37765/ajmc.2026.89982

Am J Manag Care. 2026 Jul;32(7):376-379. doi: 10.37765/ajmc.2026.89931.

ABSTRACT

Cancer screening in the US is at a critical juncture, facing an urgent need to shift from a focus on initial test uptake toward a mandate for complete diagnostic resolution. Historically, quality metrics have prioritized the singular event of a recommended test over the necessity of diagnostic resolution. Financial barriers, administrative blind spots in quality metrics, and the “Medicare 5-star paradox” have created a screening purgatory in which patients with abnormal findings are frequently left without a definitive diagnosis. Although the Affordable Care Act successfully increased access to initial screening tests by eliminating cost sharing for insured individuals, it historically left subsequent diagnostic pathways financially unprotected, contributing to late-stage diagnoses despite the availability of effective tools. This commentary explores the systemic failures of current Healthcare Effectiveness Data and Information Set (HEDIS) and Medicare Star Ratings metrics that continue to reward test volume while neglecting the consequences for health equity, cancer prevention, and patient survival. We review key regulatory shifts, including new 2026 federal mandates for first-dollar coverage of diagnostic follow-up for breast and cervical cancers, while noting that significant gaps remain for lung cancer screening and clinical navigation. Additionally, we highlight the potential of the 2025 HEDIS measure for breast cancer follow-up after abnormal mammogram and the proposed 2027 HEDIS measure for colorectal cancer follow-up to serve as a nascent model for aligning quality with timely resolution. Finally, we emphasize the importance of physician leadership, advocacy, and universal diagnostic closure in ensuring that screening fulfills its lifesaving potential. Aligning quality metrics with the entire screening continuum is essential to moving beyond the “easy screen” toward a system that preserves patient-centered outcomes and reduces avoidable cancer mortality.

PMID:42640205 | DOI:10.37765/ajmc.2026.89931

Ir Med J. 2026 Aug 20;119(7):128.

ABSTRACT

AIM: To design, implement, and evaluate a consultant-led Comprehensive Geriatric Assessment (CGA) service within an Irish private acute hospital, where structured geriatric models are not routinely embedded. The study examined the early operational and clinical impact of the service on care delivery for hospitalised adults aged ≥75 years.

METHODS: A retrospective service-improvement audit was conducted involving 50 consecutive inpatients aged ≥75 years admitted to acute medical wards following introduction of a consultant-led geriatric service. Data were extracted from electronic health records using a structured audit tool aligned with the Health Service Executive (HSE) Model of Care for Older People, National Clinical Programme for Older People (NCPOP) quality standards, and the British Geriatrics Society Silver Book II. Primary outcomes were (1) time to first geriatric review and (2) proportion of patients reviewed within 48 hours. Secondary outcomes included multidisciplinary team (MDT) involvement, length of stay (LOS), discharge destination, and 30‑day readmission. Post‑implementation outcomes were descriptively compared with aggregated hospital activity data from the 12 months preceding service introduction.

RESULTS: The mean age of patients was 82.6 years (SD 5.1), and 29 (58%) were female. The median time to first geriatric review was 29 hours, with 42 (84%) patients assessed within 48 hours of admission. MDT involvement was documented in 35 (70%) patients, compared with an estimated pre-implementation baseline of 22 (45%). The mean length of stay was 6.8 days, compared with a historical institutional estimate of 8.7 days derived from pre-service hospital activity data, representing an approximate 22% reduction. Discharge directly home occurred in 33 (66%) patients, while 5 (10%) were readmitted within 30 days. Staff survey responses (50) demonstrated high awareness of the service among 44 (88%) respondents and a perceived improvement in discharge coordination in 41 (82%).

CONCLUSIONS: Introduction of a dedicated geriatric service in a private acute Irish hospital was associated with earlier specialist review, high multidisciplinary engagement, and favourable discharge outcomes. These findings support further development of CGA-aligned services within the private healthcare sector.

PMID:42640196

Radiology. 2026 Aug;320(2):e250278. doi: 10.1148/radiol.250278.

ABSTRACT

Background Differentiating benign from malignant soft tissue tumors (STTs) remains challenging, and conventional US alone is often insufficient. This study evaluated whether elastography and microvascular imaging improve diagnostic accuracy. Purpose To assess the ability of US techniques-B-mode US, shear-wave elastography (SWE), and superb microvascular imaging (SMI)-to discriminate benign from nonbenign STTs. Materials and Methods This tertiary referral center retrospective diagnostic accuracy study included consecutive patients with STTs referred for biopsy between February 2022 and July 2023. B-mode US features were recorded, including largest diameter (LD), deepest diameter (DD), DD-to-LD ratio, and SWE and SMI values. Histologic examination served as the reference standard. Receiver operating characteristic curves were used to evaluate predictions from single-variable and multivariable logistic regression models, including age and imaging-derived variables. The area under the curve (AUC) was used to summarize performance. Results A total of 167 lesions from 167 patients (mean age, 59.3 years ± 13.8 [SD]; 88 women) were included. Mean SWE and SMI values were higher in nonbenign than in benign STTs (SWE value, 4.00 m/sec vs 2.65 m/sec; SMI value, 31.5% vs 6.2%; both P < .001). DD and DD-to-LD ratio also differed between benign and nonbenign lesions (mean DD, 2.55 cm vs 4.57 cm; DD-to-LD ratio, 0.37 vs 0.51; both P < .001). Receiver operating characteristic analysis revealed AUCs of 0.82 (95% CI: 0.73, 0.92) for SMI and 0.75 (95% CI: 0.66, 0.85) for SWE. SMI sensitivity and specificity were 71% (22 of 31; 95% CI: 55, 87) and 87% (94 of 108; 95% CI: 81, 93), respectively; SWE sensitivity and specificity were 75% (24 of 32; 95% CI: 60, 90) and 71% (89 of 126; 95% CI: 63, 79). Combining LDs and DDs with SWE and SMI improved AUC to 0.87. Conclusion SWE and SMI improved diagnostic accuracy in evaluating STTs. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Lee and Stewart in this issue.

PMID:42640188 | DOI:10.1148/radiol.250278

Radiology. 2026 Aug;320(2):e253352. doi: 10.1148/radiol.253352.

ABSTRACT

Background Radiologists face substantial malpractice risk. Prior studies based on surveys or legal databases may not reflect national trends. National-scale analyses using objective data remain limited. Purpose To compare radiology malpractice claims with those from other specialties, identify predictors of higher indemnity payments, and assess temporal and regional litigation trends using the National Practitioner Data Bank. Materials and Methods This retrospective study analyzed all physician malpractice payments in the National Practitioner Data Bank from September 1990 to December 2024. Radiology malpractice cases across the United States were identified on the basis of coded allegations involving imaging errors. Comparative statistical analyses were performed across patient, malpractice case, physician, and U.S. state variables. Temporal and regional payment trends were assessed relative to radiologist employment and compensation. State-level analysis examined reform status at the time of each malpractice event, and multivariable logistic regression identified factors associated with higher payments. Results This study included 399 568 malpractice cases involving 229 276 physicians (mean age ± SD, 44 years ± 10.9, sex not reported). Diagnostic errors accounted for 71.3% of radiology claims versus 27.6% of claims in other specialties (P < .001). Radiology malpractice cases more often involved outpatient care (50.5% vs 20.6%; P < .001) and severe outcomes (64.2% vs 32.3%; P < .001). On multivariate analysis, severe patient outcome (odds ratio, 8.64; P < .001) and malpractice cases after 2010 (odds ratio, 2.23; P < .001) predicted higher indemnity payments. The presence of noneconomic damage reform laws and insurer-paid claims were associated with lower payments (both P < .05). Recent cases (2010-2025) versus earlier cases (1990-2010) had higher payments (mean ± standard error, $344 197 ± 12 802 vs $184 000 ± 9873; P < .001) and fewer filings from states with noneconomic damages reform (P < .001) and joint liability reform (P = .007). Conclusion Radiology malpractice cases, compared with other specialties, more frequently involved diagnostic errors, severe patient outcomes, outpatient settings, and higher indemnity payments, and these trends increased over time and varied by state legal environment. © RSNA, 2026.

PMID:42640185 | DOI:10.1148/radiol.253352