Tag: pubmed

Talanta. 2026 Jun 2;310:130077. doi: 10.1016/j.talanta.2026.130077. Online ahead of print.

ABSTRACT

The limit of detection (LOD) is a key parameter for determining the lowest measurable analyte concentration. Despite the widespread use of theoretical equations to estimate LOD, significant discrepancies are often observed between calculated and empirically achievable values. This study critically examines these discrepancies by applying multiple calculation approaches – including blank signal statistics, error propagation, and graphical methods – to square-wave voltammetry (SWV) and differential pulse voltammetry (DPV) measurements of [Fe(CN)₆]^3-/4- at a gold electrode. The results reveal that commonly used equations can yield LOD values that differ from experimental observations by up to an order of magnitude, depending on the technique and calculation method. Critically, we demonstrate that numerous literature reports incorrectly equate the limit of detection with the limit of quantification (LOQ), leading to overoptimistic sensitivity claims. Furthermore, we revisit the mechanistic understanding of the [Fe(CN)₆]^3-/4-/Au system, showing that the gold electrode is not inert but participates via Au(CN)₂^– formation, which contributes to signal instability at low concentrations. Based on these findings, we propose a statistically rigorous experimental framework for empirical LOD determination that accounts for matrix effects and electrode stability, thereby improving the reliability of electroanalytical methods for real-world applications.

PMID:42258921 | DOI:10.1016/j.talanta.2026.130077

Eur J Radiol. 2026 Jun 5;203:112964. doi: 10.1016/j.ejrad.2026.112964. Online ahead of print.

ABSTRACT

PURPOSE: To determine whether QP-Prostate, a commercially available artificial intelligence (AI) decision-support system, improves Prostate Imaging Reporting and Data System (PI-RADS)-based detection of clinically significant prostate cancer (csPCa) using prostate MRI by readers with different levels of experience, without loss of specificity.

METHODS: This single-center retrospective study included 52 men with pathologically confirmed csPCa who underwent preoperative 3.0-T multiparametric magnetic resonance imaging (mpMRI) and radical prostatectomy between 2021 and 2023. To match AI inputs, four radiologists (1-25 years of experience) interpreted the PI-RADS findings using only biparametric components (T2WI and DWI) under three scenarios: reader-alone, reader + AI, and AI-alone. Per-case (evaluating sensitivity only) and per-lesion analyses were conducted, setting PI-RADS ≥ 3 as positive. The primary endpoint was the within-reader per-lesion AUC difference evaluated via DeLong’s test with Holm adjustment; secondary metrics were assessed using DeLong and McNemar tests.

RESULTS: In the per-case (index-lesion) analysis, AI assistance significantly increased sensitivity only for the least-experienced reader, from 0.73 to 0.87 (p = 0.046), whereas higher point estimates for the other readers were not statistically significant. In the per-lesion analysis, AI assistance significantly improved sensitivity for 3/4 readers and increased AUC for all readers (p-values ranging 0.002-0.027; within-reader ΔAUC, +0.013 to + 0.037; all 95% CIs excluded zero), with no statistically significant change in specificity (all p ≥ 0.061). AI-alone showed high specificity (0.94) and low sensitivity (0.34) in the per-lesion analysis, with a per-lesion AUC (0.64) closest to that of the least-experienced reader.

CONCLUSION: In this small prostatectomy-enriched cohort, AI assistance was associated with improved lesion-level discrimination and increased sensitivity, with the greatest apparent benefit observed among less-experienced readers. These findings should be interpreted as proof-of-concept/feasibility data rather than as evidence of improved reader agreement or immediate clinical generalizability.

PMID:42258918 | DOI:10.1016/j.ejrad.2026.112964

Appl Radiat Isot. 2026 Jun 4;236:112749. doi: 10.1016/j.apradiso.2026.112749. Online ahead of print.

ABSTRACT

PURPOSE: This study systematically compares the dose prediction performance of three knowledge-based RapidPlan models-Broad-Spectrum Model (Model-BS), K-means Clustering-Based Classification Model (Model-CA), and Volume Stratification Model (Model-V)-in volumetric modulated arc therapy (VMAT) planning for multiple brain metastases (multi-BM).

METHODS: A total of 138 multi-BM patients (with 2 to 16 lesions) treated between 2021 and 2024 were retrospectively included. Among these, 122 patients were randomly selected to construct Model-BS (general knowledge-based), Model-CA (unsupervised clustering based on lesion count and total volume features), and Model-V (volume stratification based on total volume thresholds). The remaining 16 patients were designated as the test group and received automated plans (BS-plans, CA-plans, and V-plans) as well as manual plans (MP-plans). All plans used single-isocenter technique, with a prescription dose of 30 Gy/5Fr. Dose metric parameters, including conformity index (CI), gradient index (GI), and organ-at-risk (OAR) doses, were compared.

RESULTS: All knowledge-based plans (RP-plans) showed comparable or slightly improved target coverage compared to MP-plans. Compared to Model-BS, both Model-CA and Model-V significantly reduced high-dose volumes (V₂₄ Gy-V₁₂ Gy) in the Brain and normal brain tissue (Brain-PTV) (p < 0.05). Model-V plans had the lowest gradient index (GI = 5.55), significantly outperforming CA-plans (GI = 5.81) and BS-plans (GI = 5.61); however, the difference compared to MP-plans (GI = 5.89) did not reach statistical significance (p = 0.134). Model-V also demonstrated the highest conformity index (CI = 0.924). However, Model-V was slightly less effective in protecting some OARs, such as the optic nerve Dmax, compared to Model-CA.

CONCLUSION: The classification knowledge-based model, built on tumor lesion count and total volume, significantly improves the dose distribution in multi-BM VMAT planning. Among the models, Model-V achieved the optimal dose gradient (GI), while Model-CA offered the best overall balance between target conformity, dose gradient fall-off, and OAR sparing.

PMID:42258912 | DOI:10.1016/j.apradiso.2026.112749

Geriatr Nurs. 2026 Jun 8;71:104124. doi: 10.1016/j.gerinurse.2026.104124. Online ahead of print.

ABSTRACT

AIM: The aim of the study was to evaluate effectiveness of nurse-led preoperative education in reducing kinesiophobia and improving mobilization indicators among older adult patients undergoing total knee arthroplasty.

METHODS: This randomized controlled study was conducted with a total of 120 participants. Patients were randomly assigned to either the control group, which received standard hospital-based health education, or the experimental group, which received nurse-led preoperative education. Baseline data were collected at the first clinical encounter. Following the intervention, kinesiophobia levels and secondary outcomes measures were assessed at four subsequent time points: (1) on the morning of surgery, (2) 24 h after surgery, (3) 24 h after mobilization, and (4) at the time of discharge. Data collection was performed using structured questionnaires, validated scales, and smart bracelet. All statistical analyses were conducted using R software.

RESULTS: The experimental group showed significantly lower kinesiophobia 24 h after mobilization than the control group (3.8 ± 0.2 vs. 4.0 ± 0.3, p < 0.001). Anxiety scores on the morning of surgery were also lower in the experimental group than in the control group (44.0 ± 4.9 vs. 50.4 ± 6.6, p < 0.001). Following surgery, patients in experimental group initiated mobilization earlier and recorded a higher number of steps compared to the control group (p = 0.001). No significant differences were observed between the groups in postoperative pain intensity and length of hospital stay.

CONCLUSION: Nurse-led preoperative education was found to be effective in reducing kinesiophobia and preoperative anxiety while promoting earlier mobilization and greater physical activity among older adult patients undergoing total knee arthroplasty.

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov; NCT05950217.

PMID:42258910 | DOI:10.1016/j.gerinurse.2026.104124

Am J Health Promot. 2026 Jun 8:8901171261458119. doi: 10.1177/08901171261458119. Online ahead of print.

ABSTRACT

PurposeThe study aimed to evaluate the effectiveness of a school-based health promotion program in reducing key risk factors for NCDs in Nepal.DesignA repeated cross-sectional, quasi-experimental study design.SettingSchool.SampleThe sample size for each of the intervention and control arms was 209.InterventionHealth education intervention.MeasuresMeasurement of change in metabolic equivalent of task (MET), body mass index, body fat percentage, fruit and vegetable servings per day, and other risk factors of non-communicable diseases.AnalysisData for both groups were summarized as frequencies and percentages at baseline (T0), after the first intervention (T1), and after the second intervention (T2). Intervention and control groups were compared using the Chi-square test, Mann-Whitney U test, independent-samples t-test, Mood’s median test, and Cluster-level Difference-in-Difference (DiD) analysis.ResultsA total of 423, 366, and 270 adolescents (intervention: 214, 176, 135; control: 209, 190, 125) from 9 schools (5 intervention, 4 control) participated at baseline, T1, and T2. Cluster-level DiD analysis to assess the effectiveness of the intervention found improvements in BMI, body fat percentage, fruit and vegetable purchase frequency, and school canteen fruit availability, but none were statistically significant.ConclusionAlthough not statistically significant, the intervention produced directionally favorable changes in physical activity, anthropometric measures, and dietary behaviors, suggesting potential public health benefits at the school level.

PMID:42258891 | DOI:10.1177/08901171261458119

West J Emerg Med. 2026 Apr 14;27(3):644-650. doi: 10.5811/westjem.48916.

ABSTRACT

INTRODUCTION: In-situ simulation offers a realistic training environment with a higher level of fidelity compared to other simulation models. It is associated with enhanced knowledge retention and a higher level of composure during real clinical encounters. One common barrier to undertaking in-situ simulation is the concern that it contributes to a delay in providing patient care. In this study we gave patients in the waiting room seven hypothetical emergency medical scenarios, two of which were training simulation scenarios, and we asked them how long they would be willing to delay their care if the different scenarios were actually occurring in the emergency department (ED). Our objective was to investigate whether patients in the ED waiting room would be willing to delay their care if they knew that there were simulation training scenarios occurring.

METHODS: This was a prospective convenience sample of participants conducted at a Level 1 trauma centre. Participants completed a survey that presented seven hypothetical scenarios, including two in-situ simulation scenarios. They were then asked to indicate the amount of additional wait time they would deem acceptable for each scenario.

RESULTS: Responses to the two in-situ simulation scenarios indicated that 342 (40%) and 335 (40.5%) of the 827 study participants, respectively, were willing to wait > 40 minutes for these to occur. In contrast, and after controlling for age, sex, waiting time, and time of recruitment, subjects reported they would tolerate shorter wait times for simulation scenarios than for real patient-care scenarios. [Willingness to wait > 40 minutes for the five real scenarios ranged from 70.5-79.9%, P < .05).

CONCLUSION: While patients demonstrated lower tolerance for simulation-related delays than for routine clinical care, our results showed that most were still willing to wait up to an additional hour to allow in-situ simulation to proceed. These findings indicate that in-situ simulation is broadly acceptable to patients and supports its continued use in clinical settings.

PMID:42258882 | DOI:10.5811/westjem.48916

West J Emerg Med. 2026 May 18;27(3):698-708. doi: 10.5811/westjem.50598.

ABSTRACT

INTRODUCTION: Program diversity impacts rank-list creation for emergency medicine (EM)-bound applicants, but how lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and other sexual and gender minorities (LGBTQIA+) identities influence residency selection is unknown. This study investigates general patterns in EM applicant LGBTQIA+ identities, disclosure of those identities, and how LGBTQIA+ factors impact residency selection. Additionally, we present data exploring the relationship between medical school location and the location of top-ranked programs for LGBTQIA+ and non-LGBTQIA+ identifying applicants.

METHODS: We surveyed 2,287 EM-bound United States MD/DO applicants who applied to one of five author EM programs and programs affiliated with the Emergency Medicine Education Research Alliance from May 16-June 30, 2024. The survey included multiple-choice, free-text, and Likert scale questions. Data were explored with descriptive statistics, and we used chi-square and Fisher exact tests to compare differences in proportions. We also analyzed applicants’ medical school state and a graphical representation of the top three positions on their residency rank lists, using inverse-proportional weighting.

RESULTS: Of 445 respondents (19.4%), 59 (13.3%) identified as LGBTQIA+. Gender identities included 173 cisgender men (38.9%), 254 cisgender women (57.1%), one transgender man (0.2%), one transgender woman (0.2%), four non-binary (0.9%), one genderqueer (0.2%), and seven “preferred not to answer” (1.6%). Among LGBTQIA+ respondents, seven (11.9%) disclosed their status within the application, nine (15.3%) during the interview, 18 (30.5%) in both, and 25 (42.4%) did not disclose. Among 56 respondents, 36 (64.3%) supported adding LGBTQIA+ status to the residency application; 20 (35.7%) did not. Of the program factors considered, program diversity (91.1%) and commitment to underserved communities (96.4%) were significantly more important for LGBTQIA+ respondents (P < .01), while proximity to partner(s) (64.3%; P < .01) and program length (66.1%; P = .02) were significantly less important compared with non-LGBTQIA+ respondents. Additional factors that influenced LGBTQIA+ applicants’ rank list included political environment, friendliness of the learning environment, and presence/absence of anti-LGBTQIA+ laws.

CONCLUSION: Many LGBTQIA+ applicants do not disclose their identities when applying for residency. LGBTQIA+ respondents value program diversity and commitment to underserved communities, and they consider LGBTQIA+-specific factors such as the presence of anti-LGBTQIA+ legislation. These insights can inform residency programs and recruitment practices.

PMID:42258874 | DOI:10.5811/westjem.50598

West J Emerg Med. 2026 May 15;27(3):669-675. doi: 10.5811/westjem.53133.

ABSTRACT

INTRODUCTION: Intravenous (IV) fluids are routinely administered empirically in the emergency department (ED) for patients presenting with stimulant intoxication (eg, cocaine, methamphetamine, synthetic marijuana), although the literature is sparse regarding the benefits and risks of this practice. Our primary objective in this study was to assess whether empiric administration of IV fluids in the ED is associated with increased discharge length of stay (LOS) among ED patients presenting for stimulant intoxication who were subsequently discharged.

METHODS: This single-center, retrospective cohort study included 100 patients 18-69 years of age who were discharged from the ED with a non-incidental diagnosis related to stimulant intoxication between May 29, 2020-December 31, 2023, based on International Classification of Diseases code and chart review, in addition to a triage heart rate ≥ 90 beats per minute. We excluded patients if the medical decision-making reflected a clear indication for IV fluids or the presence of pre-defined confounding diagnoses or an uncontrolled factor that would have inherently impacted discharge LOS. Our primary outcome measure was discharge LOS. A multiple linear regression model controlled for the potentially confounding secondary outcome measures of age, sex, alcohol involvement, advanced imaging, sedation, and discharge escort.

RESULTS: A total of 100 patients were included, including 50 (50%) patients who did not receive IV fluids and 50 (50%) patients who did. Median patient age was 35 (interquartile range [IQR] 29-41) and 73% of patients were male. Patients who received IV fluids had a median LOS of 345 minutes (IQR 260-470) vs 305 minutes (IQR 205-413), with multivariable linear regression showing no statistically significant difference (β = 40.3, 95% CI, -13.6 to 94.2, R² = 0.162).

CONCLUSION: This study suggests that empiric IV fluid administration in stimulant-intoxicated ED patients was not significantly associated with discharge length of stay. Although the observed difference and confidence interval suggest the possibility of a clinically meaningful increase in discharge LOS with empiric IV fluid, these findings should be interpreted cautiously. Time is an important resource in high-volume ED settings, and this study suggest the need for judicious use of IV fluids in the absence of a clear indication.

PMID:42258873 | DOI:10.5811/westjem.53133

West J Emerg Med. 2026 Apr 8;27(3):651-658. doi: 10.5811/westjem.48825.

ABSTRACT

INTRODUCTION: Emergency departments (ED) in the United States serve as a safety net for millions, including those with limited English proficiency (LEP). Eight percent of individuals living in the United States have LEP, placing them at risk for language barriers that can adversely affect the quality and safety of their care. Many hospitals lack language-concordant care, especially at the time of discharge. Miscommunication at discharge can lead to adverse health outcomes, including medication errors, poor compliance, and unnecessary return visits to the ED. Our objectives in this study were to evaluate the quality and safety of artificial intelligence (AI)-generated translations of physician-written, patient-specific ED discharge instructions and to assess performance across varying levels of instruction complexity.

METHODS: Emergency physicians wrote free-form discharge instructions, representing patient-specific guidance, which are typically provided at the time of ED discharge. Four topics were selected: abdominal pain; chest pain; wrist fracture; and vaginal bleeding in pregnancy. These instructions were intentionally developed to vary in linguistic complexity and were assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level scales. Instructions were translated into Albanian, Brazilian Portuguese, and Vietnamese using the AI-based translation tools ChatGPT-4, Microsoft Copilot, and Google Translate. Translations were evaluated for semantic and syntactic accuracy. Criteria included adequacy, fluency, meaning, and severity on a 5-point scale (1 = lowest accuracy, 5 = highest accuracy). Preference and formality were rated on a 3-point scale (1 = lowest, 3 = highest). The primary outcome was the quality and safety of AI-generated translations of patient-specific discharge instructions. Secondary outcomes included the ability to handle varying instruction complexity. Professional medical translators primarily responsible for the written translation of medical text evaluated and scored the translations for accuracy and quality metrics.

RESULTS: Overall adequacy, fluency, meaning, and severity scores were similar across models. ChatGPT-4 (3.79), Microsoft Copilot (3.60), and Google Translate (3.50), showed no statistically significant differences. Albanian translation was an exception, with ChatGPT-4 scoring significantly higher (3.75) than Google Translate (3.19) (P < .001). There were no other significant differences observed for Brazilian Portuguese or Vietnamese. ChatGPT-4 was also found to be the highest rated for Albanian and Brazilian Portuguese. Both Microsoft Copilot and Google Translate produced a total of five potentially harmful translation errors, whereas none were identified for ChatGPT-4.

CONCLUSION: Miscommunication during discharge can lead to negative patient outcomes. This study evaluated ChatGPT-4, Microsoft Copilot, and Google Translate in translating ED instructions into Albanian, Brazilian Portuguese, and Vietnamese. ChatGPT-4 performed best overall and produced no harmful translations, and significantly outperformed Google Translate in Albanian. While AI-based translation tools show promise, human oversight remains necessary to mitigate risks from translation inaccuracies.

PMID:42258871 | DOI:10.5811/westjem.48825

West J Emerg Med. 2026 Apr 8;27(3):753-758. doi: 10.5811/westjem.48818.

ABSTRACT

BACKGROUND: Musculoskeletal back pain is a common presenting complaint to emergency departments (ED) worldwide. In this study we aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) as an adjunct to standard care in reducing pain for patients presenting with acute low back pain.

METHODS: This study has a dual-center, open-label, cluster-randomized controlled trial design. Participants were recruited from two tertiary-care EDs in Canada. We included patients with acute or acute-on-chronic back pain of < 3 weeks duration. Participants were randomized to receive either TENS for 30 minutes plus standard care, or standard care alone. We measured pain scores using the Visual Analogue Scale (VAS) at baseline, 30 minutes, and 60 minutes after initiation of the intervention. The primary outcome was the difference in mean VAS pain scores at 60 minutes between the two groups.

RESULTS: Of 94 patients considered, we enrolled 25 participants (15 control and 10 intervention). The group receiving TENS plus standard care showed a statistically significant reduction in pain scores compared to the standard care alone group at both the 30-minute (relative mean difference: 22.6%; absolute difference: 1.7 points on 10-point VAS (95% CI, -31.9%, -13.4%, P < .001) and 60-minute timepoints (relative mean difference 18.2%, absolute difference 1.4 points (-32.7%, -3.8%, P = .04). There were two return visits in the intervention group within two weeks from the index visit, and two patients reported slight discomfort with using TENS, although they kept the device on for the duration of the trial period.

CONCLUSION: The addition of transcutaneous electrical nerve stimulation to standard care resulted in a modest but statistically significant reduction in pain scores for patients with acute back pain in the ED setting, although it did not meet our predefined threshold of clinical significance. Further research with larger sample sizes is required to clarify the effect size and role of TENS for acute back pain in the ED waiting room.

PMID:42258870 | DOI:10.5811/westjem.48818