Tag: pubmed

JMIR Med Educ. 2026 Jun 23;12:e81570. doi: 10.2196/81570.

ABSTRACT

BACKGROUND: The number of 1-year Accreditation Council for Graduate Medical Education (ACGME) fellowships continues to grow. The ACGME recommends a holistic curriculum with nonclinical areas, inclusive of educational sessions. Given the competing demands between clinical skill development, educational pursuits, and work-hour restrictions, we propose an andragogic curriculum using pediatric anesthesiology as the model fellowship.

OBJECTIVE: The primary objective was to improve fellows’ perceptions of their educational experience during their fellowship year after implementing an andragogic holistic curriculum. Secondary objectives assessed improvements in diversity, equity, and inclusion (DEI) training and resources.

METHODS: This was a single-center educational improvement project completed at Lucile Packard Children’s Hospital Stanford. Data were collected between 2014 and 2024. The new curriculum was introduced in 2021-2022 and involved 12 different teaching modalities rooted in andragogic principles. A statistical process control p-chart was used to analyze the primary outcome based on the ACGME annual program evaluation. Outcomes were analyzed using censored regression modeling or a t test, depending on the presence of ceiling effects.

RESULTS: From 2014 to 2024, 58 of 60 pediatric anesthesiology fellows completed the ACGME survey. A break in the statistical process control p-chart for educational content scores occurred during 2021-2022, when the new curriculum was introduced. The mean difference was 0.89 (P<.001). Scores in DEI improved (mean difference 0.52; P=.03), and no difference was noted in resources (mean difference -0.13; P=.98).

CONCLUSIONS: Introduction of an andragogic curriculum into a pediatric anesthesiology fellowship program was associated with more favorable perceptions of educational content and DEI training.

PMID:42335453 | DOI:10.2196/81570

JCO Oncol Pract. 2026 Jun 23:OP2501413. doi: 10.1200/OP-25-01413. Online ahead of print.

ABSTRACT

PURPOSE: Multiple reports have suggested that receiving immunotherapy infusions earlier in the day is associated with improved outcomes, including longer overall survival (OS) and lower toxicity rates. However, the definition of early varies between publications. Reports also fail to account for confounding factors (including distance to infusion center), are subject to survivor bias (analyzing postbaseline factors at baseline), and do not adjust P values for multiple comparisons when evaluating multiple potential thresholds for early versus late time of day of infusion.

METHODS: We analyzed a previously reported multicenter clinical trial evaluating pembrolizumab as adjuvant therapy for participants with resectable high-risk melanoma. Standard statistical methodologies that account for potential biasses were used to evaluate the association between time of day of infusion and clinical outcomes.

RESULTS: A total of 628 participants received pembrolizumab and had time of first infusion recorded. The median age was 55 years, range, 20-82. Odds of infusion before 11:00 hours increased by 32% over 12 months of therapy (P = .013). Participants living further from their treating institution had later infusion times on average: odds of infusion before 11:00 decreased by 9% for each additional 50 miles (P = .017). The optimal cut point for first infusion time for OS was 15:48 with hazard ratio (HR) = 1.40; changing the cut point by 30 minutes earlier to 15:18 decreased HR to 0.98, indicating lack of robustness of the threshold. No significant association was identified between proportion of early infusions and outcomes in multivariable time-dependent Cox regression models.

CONCLUSION: In this multicenter trial of adjuvant pembrolizumab for participants with high-risk melanoma, analyses that account for common sources of bias found no significant association between recurrence-free or OS and time of day of infusion.

PMID:42335437 | DOI:10.1200/OP-25-01413

Eur J Gastroenterol Hepatol. 2026 Aug 1;38(8):971-976. doi: 10.1097/MEG.0000000000003223. Epub 2026 Jun 25.

ABSTRACT

BACKGROUND: Alcohol consumption is associated with increased risk for development of atrial fibrillation. Outcomes of patients with atrial fibrillation in the context of acute alcohol-associated hepatitis have yet to be investigated.

METHODS: We performed a retrospective study of patients with alcohol-associated hepatitis from the National Inpatient Sample (2016-2019), comparing those with and without concurrent atrial fibrillation. Subgroup analysis with and without cirrhosis was alone performed. Statistical analysis performed using STATA 16.1 and multivariate logistic and linear regression.

RESULTS: Among 475 600 patients with alcohol-associated hepatitis, 27 675 (5.8%) had atrial fibrillation. Patients with atrial fibrillation had a nearly two-fold increased in-hospital mortality (6.9%) compared with those without atrial fibrillation (3.9%) [adjusted odds ratio (OR) = 1.35, 95% confidence interval (CI) = 1.20-1.53] and higher odds of developing acute kidney injury (OR = 1.23, 95% CI = 1.15-1.32). They also had longer hospital stays and higher total hospital charges (7.5 vs. 6.0 days and $20 005 vs. $14 714, respectively). Among patients with alcohol-associated hepatitis and atrial fibrillation, 33% also had cirrhosis (n = 9190), and these patients had an even higher mortality rate (11.3%) than those with alcohol-associated hepatitis and atrial fibrillation alone (4.7%). Acute coronary syndrome, chronic kidney disease, and obesity were independently associated with increased mortality.

CONCLUSION: Patients with alcohol-associated hepatitis who have atrial fibrillation have an increased risk of in-hospital mortality and underlying cirrhosis compounds this risk. Early recognition of the effect of concomitant atrial fibrillation and alcohol-associated hepatitis could provide an opportunity for intervention.

PMID:42335427 | DOI:10.1097/MEG.0000000000003223

J Trauma Nurs. 2026 Jun 24. doi: 10.1097/JTN.0000000000000929. Online ahead of print.

ABSTRACT

BACKGROUND: Timely transition from the emergency department (ED) to definitive care is critical in severely injured patients. Deploying surgical trauma intensive care nurses (ICU) as trauma response nurses (TRNs) during highest (alpha-level) trauma activations may improve care coordination and expedite transitions; however, evidence supporting this practice remains limited.

OBJECTIVE: To evaluate the effect of the TRN on ED length of stay (LOS) and time to definitive care for alpha trauma activation patients.

METHODS: This single-center, retrospective cohort study analyzed all alpha trauma activations involving patients aged 16 years and older admitted to a Level I trauma center in the southeastern US between July 1, 2022, and June 30, 2024. Clinical outcomes were compared between patients managed with and without a TRN during trauma bay resuscitation.

RESULTS: Among 353 patients, 193 (55%) were in the TRN group and 160 (45%) in the non-TRN group. The median ED LOS was 77 minutes (IQR, 59-105.5) for the TRN group versus 81.5 minutes (IQR, 61.5-127.3) for the non-TRN group (p = .20, r = 0.07). The median time to the operating room (OR) was 63 (IQR, 32-94.5) minutes versus 80 (IQR, 24.8-120.5) minutes (p = .88, r = 0.03). The median time to ICU was 77 (IQR, 62.5-105) minutes with a TRN, compared to 81 (IQR, 65-129.3) minutes (p = .21, r = 0.07). We did not observe statistically significant differences between groups.

CONCLUSION: ED LOS, time to OR, and time to ICU were similar between groups, with slightly lower values in patients with TRN involvement. Further evaluation is needed to determine clinical relevance and impact on trauma protocol adherence.

PMID:42335398 | DOI:10.1097/JTN.0000000000000929

Adv Clin Exp Med. 2026 Jun 23. doi: 10.17219/acem/210555. Online ahead of print.

ABSTRACT

The specific conditions prevailing in prisons increase the risk of disease transmission among inmates. Several factors influence the risk of infectious disease transmission in prisons, including overcrowding, limited access to water, delayed diagnosis, and poor ventilation. The aim of this study was to assess the burden of selected infectious diseases among Polish prisoners between 2002 and 2023 and to analyze the literature addressing these diseases published between 2015 and 2025. In the 1st part, a systematic review was conducted. In the 2nd part, the results of the authors’ own research were presented. The source material was obtained from Statistics Poland. An increase in tuberculosis (TB) cases was observed from the early to mid-2010s, peaking in 2012. Subsequently, a decrease in TB cases was noted after 2012, reaching a nadir in 2021, followed by a resurgence in 2023. A decrease in scabies cases was also observed. However, from 2009 onward, this trend reversed, with cases increasing and peaking in 2014. Subsequently, the number of cases reached a new low in 2022, before increasing again in 2023. For Salmonella/Shigella, the number of tests remained around 5,000 in the early years, reaching a peak of 8,876 in 2020. This was followed by a decline, with 5,204 tests recorded in 2023. To minimize the risk of infectious disease transmission in prisons, several preventive measures should be implemented, including screening of newly admitted prisoners, introduction of prophylactic programs, and development of standardized procedures to follow in cases of infection.

PMID:42335388 | DOI:10.17219/acem/210555

Adv Clin Exp Med. 2026 Jun 23. doi: 10.17219/acem/209761. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative urinary tract infection (UTI) following pyeloplasty remains a significant complication and continues to pose challenges in pediatric urological care.

OBJECTIVES: This study aimed to develop a simplified predictive model to identify risk factors for postoperative UTI after unilateral pyeloplasty and to support clinicians in implementing preventive strategies targeting modifiable risk factors.

MATERIAL AND METHODS: Clinical data from children who underwent unilateral pyeloplasty at the Children’s Hospital of Capital Institute of Pediatrics (Beijing, China) between January 2012 and January 2022 were retrospectively analyzed. Variables including sex, age, body mass index (BMI), surgical modality, drainage tube type, and parameters from blood and urine tests were evaluated. Statistical analyses, including least absolute shrinkage and selection operator (LASSO) regression, logistic regression, and random forest modeling, were performed to identify significant predictive factors. Variables with the greatest predictive importance were used to develop a nomogram, and its clinical utility was evaluated using decision curve analysis (DCA).

RESULTS: Among 764 patients, 265 (35%) developed postoperative UTI. Key risk factors included surgical modality, laterality of ureteropelvic junction obstruction (UPJO), drainage tube type, blood urea nitrogen (BUN) level, and patient height. LASSO regression identified 14 predictive variables, while logistic regression determined independent risk and protective factors. Ultimately, 8 variables (e.g., sex, operative time, drainage tube type, history of infection, history of fistula, age, BUN level, and renal cortical thickness) were selected for development of the nomogram predicting postoperative UTI risk after unilateral pyeloplasty.

CONCLUSIONS: This study identified 8 factors associated with postoperative UTI following unilateral pyeloplasty in children. The developed predictive model may assist clinicians in identifying high-risk patients, thereby supporting improved perioperative planning and postoperative management.

PMID:42335386 | DOI:10.17219/acem/209761

JMIR Form Res. 2026 Jun 22. doi: 10.2196/86999. Online ahead of print.

ABSTRACT

BACKGROUND: Large language models (LLMs) have demonstrated expert-level performance on medical licensing examinations, but most benchmarks focus on final accuracy, obscuring model-specific behaviors. Critical gaps remain in understanding model efficiency (latency), the efficacy of tiered “rescue” protocols for error correction, and the systematic correlation between performance and human-rated question difficulty. The German M2 exam, paired with the AMBOSS platform’s user-data-driven difficulty ratings, provides a unique opportunity to map AI performance directly against human cognitive load.

OBJECTIVE: This study aimed to move beyond singular accuracy scores by (1) evaluating and comparing the baseline (Tier 1) accuracy and response latency of next-generation rapid-response LLMs; (2) analyzing the efficacy of a two-tiered rescue (Tier 2) protocol in correcting initial errors; and (3) correlating model performance with the user-data-driven Amboss difficulty rating.

METHODS: We evaluated four LLMs (Gemini 2.5 Flash/Pro and ChatGPT 5 Instant/Thinking) on the complete 316-item German M2 (Fall 2024) medical exam, including all multimodal (image-based) questions. A zero-shot copy-paste prompting strategy was utilized, and outputs were evaluated against ground-truth answers using a strict exact-match criterion. A two-tiered protocol was used: Tier 1 (Flash/Instant) provided baseline responses. If incorrect, a Tier 2 (Pro/Thinking) model was deployed as a “rescue.” Performance was analyzed using McNemar’s test, Wilcoxon signed-rank test, Fisher’s exact test, and logistic regression.

RESULTS: Baseline (Tier 1) accuracy was identical at 91.46% (95% CI 87.85-94.06; n = 289/316) for both Gemini 2.5 Flash and ChatGPT 5 Instant, with 27 errors each. However, Gemini Flash (Mean=1.57s) was significantly faster than ChatGPT Instant (Mean = 2.07s; P < .001). Additionally, ChatGPT Instant expended significantly more time on incorrect answers compared to correct ones (P = .002), whereas Gemini Flash showed no such hesitation (P = .814). The Tier 2 rescue rate for ChatGPT 5 Thinking (48.15%, 13/27; 95% CI 30.74-66.01) was higher, though not statistically significant (P = .406), than for Gemini 2.5 Pro (33.33%, 9/27; 95% CI 18.64-52.18). This rescue protocol elevated final accuracy to 94.30% (95% CI 91.18-96.37) for the Gemini system and 95.57% (95% CI 92.70-97.34) for the ChatGPT system (P = .481). A strong, inverse relationship with difficulty was found: for every one-point difficulty increase, the odds of a correct Tier 1 response decreased by 42.1% (OR 0.579, 95% CI 0.425-0.788; P < .001) for Gemini Flash and 47.7% (OR 0.523, 95% CI 0.379-0.720; P < .001) for ChatGPT Instant. This negative correlation persisted even after the rescue (P = .013 and P = .006, respectively).

CONCLUSIONS: Expert-level LLM performance on the German M2 exam masks a critical, systematic vulnerability: a significant decrease in accuracy directly correlated with increased question difficulty. A two-tiered “rescue” system is an effective strategy to mitigate these difficulty-based failures and achieve >95% accuracy, rivaling the best-performing, full-capacity models. We conclude that a simple reliance on a single model is insufficient; hierarchical systems that manage query difficulty are essential for safe and effective integration into medical education.

PMID:42334858 | DOI:10.2196/86999

JAMA Netw Open. 2026 Jun 1;9(6):e2619807. doi: 10.1001/jamanetworkopen.2026.19807.

ABSTRACT

IMPORTANCE: African American and rural-dwelling family caregivers of persons with newly diagnosed advanced cancer perform critical, time-intensive tasks and historically have had limited resources to support their role.

OBJECTIVE: To determine the effect of a lay coach-led, early palliative care telehealth intervention (Educate, Nurture, Advise, Before Life Ends [ENABLE] Cornerstone) for African American and rural-dwelling family caregivers of patients with advanced cancer on caregiver and patient outcomes at 24 weeks.

DESIGN, SETTING, AND PARTICIPANTS: This single-blind randomized clinical trial was conducted from January 2020 to May 2025 at outpatient oncology clinics at 2 large cancer centers in the Southeastern US. Participants were African American and rural-dwelling family caregivers aged 21 years or older self-identifying as an unpaid close friend or family member who is involved with the day-to-day medical care of a patient with advanced cancer.

INTERVENTION: The intervention included 6 weekly, 20- to 60-minute psychosocial telephonic sessions facilitated by a trained lay coach plus monthly follow-up. Usual care consisted of mailed pamphlets outlining resources for families at each of the cancer centers.

MAIN OUTCOMES AND MEASURES: The primary outcome was caregiver distress (anxiety and depressive symptoms as measured by the Hospital Anxiety and Depression Scale [HADS]) at 24 weeks. Secondary outcomes were caregiver and patient quality of life (QOL; measured with the Patient-Reported Outcomes Measurement Information System Global Health Short Form), caregiver burden (Montgomery-Borgatta Caregiver Burden Scale), and patient distress (HADS). Outcomes were assessed using baseline-constrained linear mixed-effects models.

RESULTS: A total of 222 family caregivers (mean [SD] age, 55.5 [14.7] years; 169 [76.1%] female; 114 [51.4%] African American; 101 White [45.5%]; 7 other race [3.2%]) and 165 patients (mean [SD] age, 60.7 [12.2] years; 98 [59.4%] female; 79 African American [47.9%]; 84 White [50.9%]; 2 other race [1.2%]) were randomized. At week 24, no relevant between-group differences were observed in caregiver HADS anxiety (mean [SE] baseline-adjusted difference, 0.23 [0.44]; Cohen d = 0.05; 95% CI, -0.14 to 0.24; P = .60) or HADS depressive symptom scores (mean [SE] baseline-adjusted difference, 0.04 [0.41]; Cohen d = 0.01; 95% CI, -0.19 to 0.21; P = .91). For all other outcomes, 24-week differences were of small magnitude and not statistically significant. Exploratory sensitivity analyses of caregivers distressed at baseline indicated improvements in caregiver anxiety (mean [SE] baseline-adjusted difference, -1.21 [0.53]; Cohen d = -0.38; 95% CI, -0.70 to -0.05) and patient mental health QOL (mean [SE] baseline-adjusted difference, 3.00 [1.37]; Cohen d = 0.45; 95% CI, 0.04 to 0.86), but no statistically significant differences in caregiver burden (mean [SE] baseline-adjusted difference, -1.15 [0.69]; Cohen d = -0.32; 95% CI, -0.71 to 0.06) and patient depression (mean [SE] baseline-adjusted difference, -1.30 [0.71]; Cohen d = -0.37; 95% CI, -0.77 to 0.03).

CONCLUSIONS: This randomized clinical trial of a telehealth intervention for African American and rural-dwelling caregivers of patients with advanced cancer found no differences in caregiver and patient outcomes at 24 weeks. However, an exploratory sensitivity analysis indicated potential improvements in caregiver anxiety and patient mental health QOL.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04318886.

PMID:42334850 | DOI:10.1001/jamanetworkopen.2026.19807

JAMA Netw Open. 2026 Jun 1;9(6):e2619816. doi: 10.1001/jamanetworkopen.2026.19816.

ABSTRACT

IMPORTANCE: Modern natural language processing tools have potential to improve clinical workflows, but few have been successfully deployed in practice.

OBJECTIVE: To describe the development, deployment, and evaluation of an artificial intelligence (AI) language tool for generating preliminary sign-outs to support a urine drug testing service.

DESIGN, SETTING, AND PARTICIPANTS: In this prognostic study, large language models (LLMs) were used to extract substance use patterns from clinical urine drug test interpretations at a single medical center between January 1, 2014, and February 29, 2024. An AI model using these data was trained to predict substance use from qualitative and quantitative urine testing results. Predicted substance use patterns were used to create preliminary clinical sign-out statements, which were then integrated into an existing clinical workflow.

MAIN OUTCOMES AND MEASURES: Predeployment and postdeployment user studies were performed to evaluate model performance and user experience within the workflow. Statistical differences between event rates were calculated using χ2 tests, and between means using t tests. Differences between human and LLM labelers were calculated using the McNemar test.

RESULTS: A total of 83 553 urine tests from 26 459 patients (12 413 male [46.9%]; mean [SD] age, 47.5 [16.7] years) were analyzed. LLM-based extraction of substance-use patterns was 99.9% accurate (13 509 of 13 520 tests), outperforming human labeling. Substance use prediction was similarly accurate, with area under the receiver operating curve greater than 0.99 for 23 of 26 substances. Workflow integration of the AI tool reduced clinical sign-out times by 28.5 seconds per case (23% efficiency gain), and by 65 seconds per case (51% efficiency gain) when integrated alongside a second, non-AI workflow improvement.

CONCLUSIONS AND RELEVANCE: In this prognostic study, AI-based interpretation of urine drug testing was fast and accurate, providing notable efficiency gains to the clinical service. These findings suggest that natural language processing tool integration can provide substantial clinical benefit, without compromising quality of care.

PMID:42334849 | DOI:10.1001/jamanetworkopen.2026.19816

CNS Neurosci Ther. 2026 Jun;32(6):e71001. doi: 10.1002/cns.71001.

ABSTRACT

BACKGROUND: The long-term association of central obesity with brain structural integrity remains poorly understood. This study aimed to investigate the longitudinal association between cumulative Weight-adjusted-waist Index (WWI) exposure and multi-modal neuroimaging markers of brain health.

METHODS: This prospective community-based cohort study included 935 participants from the META-KLS Study. Cumulative WWI was calculated as the time-weighted average over 12 years prior to MRI acquisition. Neuroimaging outcomes included regional gray matter volume, white matter hyperintensity (WMH), and diffusion tensor imaging (DTI) metrics. Generalized linear models, restricted cubic splines, and mediation analyzes were performed.

RESULTS: Elevated cumulative WWI was associated with adverse brain structural outcomes, particularly in females. In women, higher WWI was linked to extensive WMH burden (p_FDR = 0.002), widespread microstructural disintegration (p_FDR = 0.023), and specific atrophy in the orbital frontal cortex. A J-shaped dose-response relationship was identified for white matter injury, suggesting a tipping point for metabolic resilience. In exploratory mediation analyzes, FBG, SBP, and hs-CRP statistically accounted for 14.7%, 11.3%, and 11.3% of the association between cumulative WWI and WMH burden, respectively, while SBP accounted for 17.8% of the association with global MD.

CONCLUSION: Cumulative WWI serves as a potential predictor of adverse brain structural outcomes, particularly manifesting as white matter injury and atrophy in women. Early monitoring of WWI offers a vital window for targeted metabolic interventions to preserve brain structural integrity.

PMID:42334833 | DOI:10.1002/cns.71001