Tag: statistics

JMIR Res Protoc. 2025 Jul 16;14:e63549. doi: 10.2196/63549.

ABSTRACT

BACKGROUND: Nursing in palliative medicine combines primary patient care with the special challenges of this medical field (eg, handling the processes of dying, grief, and death). These cause high stress levels and burden on the nursing staff, resulting in an early exit from working life because of physical or psychological disorders like burnout.

OBJECTIVE: DiPa (digitally identifying and minimizing stressors in palliative care) is a prospective study investigating the feasibility of measuring burden and its causes in palliative care using methods of subjective and objective stress detection. Based on these results, stress-reducing interventions are to be deduced and evaluated. In this paper, we present our study protocol.

METHODS: The nursing staff of an inpatient university palliative hospital ward gathered data over 6 weeks. Each was equipped with a smart wristband and a smartphone that continuously measure physiological and ambient parameters throughout their working day. These objective data were enriched by subjective measurements: a questionnaire at the beginning of the study that assessed multiple potential stressful situations and constellations in the private and working environment as well as ecological momentary assessments (EMAs) during the workday. The EMAs were prompted by scanning near-field communication (NFC) tags placed at different locations on the ward. The ongoing data analyses will be processed using computer algorithms partly programmed specifically for this study and partly drawn from existing libraries, such as toolboxes for neurophysiological signal processing for Python. Comparisons between subjective and objective measures and group comparisons between variables of interest will be made using inferential statistics, including regression analyses and analyses of variance. Data analysis using machine learning algorithms will be implemented once sufficient data are gathered.

RESULTS: The study was funded in October 2019. As of July 2025, 12 of 18 nurses in the palliative care unit consented to participate in our study. We expect to start detailed data analysis in in the third quarter of 2025 and to finish and publish our results in 2026.

CONCLUSIONS: The DiPa study aims at testing the feasibility of measuring and merging subjective and objective stress parameters for palliative care nurses.

TRIAL REGISTRATION: German Register for Clinical Studies DRKS00024425; https://drks.de/search/en/trial/DRKS00024425/details.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63549.

PMID:40669075 | DOI:10.2196/63549

JMIR Form Res. 2025 Jul 16;9:e65157. doi: 10.2196/65157.

ABSTRACT

BACKGROUND: Nigeria has one of the highest child mortality rates globally, with 111 deaths per 1000 live births. Exclusive breastfeeding (EBF) improves infant survival by providing essential nutrients and antibodies that protect against infections and diseases. Despite its benefits, EBF rates in Nigeria remain low at 29%, largely due to limited health care support and breastfeeding guidance. With the proliferation of mobile phones in Nigeria, mobile health (mHealth) interventions are being explored as scalable solutions. SMS text messaging interventions have demonstrated success in delivering behavioral interventions; yet, few use artificial intelligence (AI) for personalized breastfeeding support.

OBJECTIVE: This study evaluates the effectiveness of Mwana, an AI-powered SMS-based app, in improving breastfeeding outcomes for postpartum mothers in Lagos, Nigeria.

METHODS: Mwana was developed using TextIt for SMS integration and Meta’s Wit.ai for natural language processing (NLP). The chatbot provides breastfeeding support via SMS, offering personalized tips, addressing common challenges, and connecting users to human agents when necessary. The intervention was piloted with 216 postpartum mothers recruited through local health care networks, focusing on usability, usefulness, and engagement. The study used a mixed methods approach, using structured surveys and observation to assess participant experiences at multiple intervals over a 6-month period. Primary outcomes measured were app usability, usefulness, and breastfeeding adherence.

RESULTS: The intervention was well-received, with high scores for both usefulness (mean 4.01, SD 1.41) and usability (mean 3.92, SD 1.35) on a 5-point scale. The majority of respondents, 57% (118/206), rated the chatbot’s usefulness at the highest score of 5. Qualitative feedback statements identified areas for improvement, including enhancing AI comprehension, response times, and human-like interaction.

CONCLUSIONS: The study highlights the potential of Mwana to improve breastfeeding outcomes in resource-limited settings, contributing to the growing body of evidence supporting mHealth interventions in maternal and child health. By leveraging personalized messaging, SMS-based delivery, and language localization, Mwana offers a scalable, accessible solution. However, challenges remain regarding AI comprehension, and further research is necessary to evaluate Mwana’s effectiveness among populations not actively engaged with health care services. Future iterations will expand AI training datasets, refine NLP capabilities, and scale to broader populations.

PMID:40669071 | DOI:10.2196/65157

JMIR Serious Games. 2025 Jul 16;13:e73044. doi: 10.2196/73044.

ABSTRACT

BACKGROUND: Virtual reality (VR) interventions are emerging as promising nonpharmacological strategies for people with dementia, aiming to prevent cognitive decline, reduce behavioral and psychological symptoms of dementia (BPSD), and alleviate caregiver burden. Although some studies have reported beneficial effects, findings remain inconsistent, and little is known about the duration and sustainability of these effects, particularly in real-world care settings.

OBJECTIVE: This study aimed to examine both the immediate and long-term effects of an immersive VR reminiscence intervention on BPSD and caregiver burden in people with dementia attending day care centers.

METHODS: This longitudinal observational study was conducted in 10 dementia day care centers in Kaohsiung, Taiwan. A total of 82 participants with dementia were enrolled. The VR intervention consisted of twice-weekly sessions over one month, featuring culturally familiar live-action 360° scenes filmed in well-known Taiwanese locations. Each session lasted approximately 10-12 minutes and included interactive elements. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory Questionnaire, and caregiver burden was assessed using the Zarit Caregiver Burden Interview. Measurements were taken at 3 time points: preintervention, immediately postintervention, and 2 months after the intervention ended. The Wilcoxon signed-rank test was used for statistical comparisons, and rank-biserial correlation was calculated as the effect size.

RESULTS: Significant improvements were observed after 1 month of VR intervention in both caregiver burden (Z=-3.095, P=.002, r=0.34) and neuropsychiatric symptoms (Z=-2.929, P=.003, r=0.32). At the two-month follow-up, neuropsychiatric symptoms remained significantly improved (Z=-4.327, P<.001, r=0.48), although caregiver burden returned to preintervention levels. Regarding specific neuropsychiatric symptoms, significant improvements were observed immediately after the intervention in dysphoria or depression, anxiety, and sleep or nighttime behaviors. These effects were sustained over time, with additional long-term improvements noted in euphoria or elation, apathy or indifference, irritability or lability, aberrant motor behavior, and appetite or eating behaviors.

CONCLUSIONS: A 1-month immersive VR reminiscence intervention appears to improve neuropsychiatric symptoms and temporarily reduce caregiver burden in people with dementia, with some symptom improvements lasting up to 2 months. These findings suggest that VR may offer a meaningful therapeutic option in day care settings. Future studies with control groups, including nonimmersive 2D conditions, and comparisons to traditional reminiscence therapy are needed to validate and expand upon these findings.

PMID:40669069 | DOI:10.2196/73044

JMIR Hum Factors. 2025 Jul 16;12:e57314. doi: 10.2196/57314.

ABSTRACT

BACKGROUND: A guideline-based clinical decision support system (CDSS) is a knowledge-based system designed to collect crucial data from electronic medical records to generate decision-making based on system data requirements and inputs from standard guidelines. Despite the potential to enhance health care delivery, the adoption rate of CDSSs in clinical practice remains suboptimal.

OBJECTIVE: This study aimed to evaluate the determinants influencing the intention to use a new CDSS in preventive care within clinical practice.

METHODS: A single-center, questionnaire-based, cross-sectional study was conducted among physicians and medical students responsible for providing comprehensive preventive services at the Continuity of Care Clinic, Siriraj Hospital, Thailand.

RESULTS: In total, 89 participants were enrolled. Relationships between factors impacting the adoption of CDSSs were analyzed using correlation and regression analysis. We found that physicians’ intentions to adopt the CDSS for preventive care were high, with 79% (70/89) of participants expressing their intention to use the system. According to the study’s conceptual framework, modified from the original unified theory of acceptance and use of technology model, physicians’ positive attitudes toward CDSS use in preventive services and a high level of effort expectancy emerged as crucial factors influencing the intention to use the new CDSS. The odds ratios for these factors were 5.44 (95% CI 1.62-18.34, P=.006) and 7.60 (95% CI 1.55-31.37, P=.01), respectively. Similar results were observed for medical students and for physicians who had graduated. The most prevalent barriers to CDSS implementation were related to physicians’ attitudes, followed by issues such as the accuracy and burden of data input, time constraints for clinicians, and the risk of workflow disruption.

CONCLUSIONS: There was a high intention to adopt the CDSS in preventive care. Positive physician attitudes toward CDSS use in preventive services and effort expectancy were found to be critical factors influencing the intention to use the new CDSS.

PMID:40669060 | DOI:10.2196/57314

JMIR Public Health Surveill. 2025 Jul 16;11:e68854. doi: 10.2196/68854.

ABSTRACT

BACKGROUND: People with opioid use disorder (OUD) have the highest rates of hepatitis C virus (HCV) infection. Despite the availability of curative HCV medication, people with OUD have limited health care access largely due to stigma. In a recent, pragmatic, randomized controlled trial (RCT), we compared a facilitated telemedicine intervention for HCV treatment integrated into opioid treatment programs (OTPs) with off-site referral. Facilitated telemedicine is bidirectional videoconferencing between a remote provider and a patient, supported by a case manager who facilitates the telemedicine encounter. The case manager schedules telemedicine visits, provides appointment reminders, and operates the digital equipment. Among 602 participants in the RCT, 90% (n=262) were cured through facilitated telemedicine and 39% (n=123) were cured through off-site referral. In this work, a multidisciplinary group of investigators, who directed the RCT, conducted a workshop, “Advancing Viral Hepatitis Screening and Treatment in Opioid Treatment Settings – Models & Resources,” at the American Association for Treatment of Opioid Dependence Conference in May 2024 to disseminate knowledge of facilitated telemedicine, including implementation considerations. We highlighted facilitated telemedicine as a patient-centered, sociotechnical, pragmatic health care delivery model for underserved populations.

OBJECTIVE: This study aimed to identify lessons learned to successfully overcome challenges of facilitated telemedicine implementation for HCV treatment integrated into OTPs.

METHODS: We partnered with the National Alliance of State and Territorial AIDS Directors in planning the workshop. The workshop consisted of 7 presentations on topics related to facilitated telemedicine implementation. The workshop was recorded and transcribed by Zoom (Zoom Communications). The transcripts served as data for the thematic analysis. The transcripts were interpreted to elucidate patterns of meanings and nuances derived from each presentation. In an iterative process, preliminary findings were compared and coalesced into themes. Verbatim quotes from the workshop were highlighted to support the themes.

RESULTS: We developed 3 themes. First, patient-centered care promotes HCV treatment for underserved populations through facilitated telemedicine. Case managers leveraged the destigmatizing environment of the OTP to build trust with patients, promoting an HCV cure through facilitated telemedicine. Second, sociotechnical approaches expand health care access for people with OUD. To be effective, facilitated telemedicine integrates 2 necessary components, a social aspect and a technical aspect. Third, facilitated telemedicine supports pragmatic research emphasizing people with OUD. Pragmatic research of facilitated telemedicine is needed to assess sustainability and scaling considerations beyond OTPs. Overall, we found that facilitated telemedicine overcame the digital divide, promoting access to digital technology, internet provision, and digital literacy.

CONCLUSIONS: Facilitated telemedicine incorporates both a technical and a social component. The technical component largely addresses geographical challenges, while the social component addresses temporal (ie, care coordination) issues, promotes trust, and largely assuages patients’ concerns related to HCV treatment. The patient-centered, sociotechnical intervention can address the digital divide, thereby increasing health care access.

PMID:40669057 | DOI:10.2196/68854

JMIR Med Inform. 2025 Jul 16;13:e69328. doi: 10.2196/69328.

ABSTRACT

BACKGROUND: Wearable devices are increasingly used for monitoring health and detecting digital biomarkers related to chronic diseases such as metabolic syndrome (MetS). Although circadian rhythm disturbances are known to contribute to MetS, few studies have explored wearable-derived circadian biomarkers for MetS identification.

OBJECTIVE: This study aimed to detect and analyze sleep and circadian rhythm biomarkers associated with MetS using step count and heart rate data from wearable devices and to identify the key biomarkers using explainable artificial intelligence (XAI).

METHODS: Data were analyzed from 272 participants in the Korean Medicine Daejeon Citizen Cohort, collected between 2020 and 2023, including 88 participants with MetS and 184 without any MetS diagnostic criteria. Participants wore Fitbit Versa or Inspire 2 devices for at least 5 weekdays, providing minute-level heart rate, step count, and sleep data. A total of 26 indicators were derived, including sleep markers (midsleep time and total sleep time) and circadian rhythm markers (midline estimating statistic of rhythm, amplitude, interdaily stability, and relative amplitude). In addition, a novel circadian rhythm marker, continuous wavelet circadian rhythm energy (CCE), was proposed using continuous wavelet transform of heart rate signals. Statistical tests (t test and the Wilcoxon rank sum test) and machine learning models-Shapley Additive Explanations, explainable boosting machine, and tabular neural network-were applied to evaluate marker significance and importance.

RESULTS: Circadian rhythm markers, especially heart rate-based indicators, showed stronger associations with MetS than sleep markers. The newly proposed CCE demonstrated the highest importance for MetS identification across all XAI models, with significantly lower values observed in the MetS group (P<.001). Other heart rate-based markers, including relative amplitude and low activity period, were also identified as important contributors. Although sleep markers did not reach statistical significance, some were recognized as secondary predictors in XAI-based analyses. The CCE marker maintained a high predictive value even when adjusting for age, sex, and BMI.

CONCLUSIONS: This study identified CCE and relative amplitude of heart rate as key circadian rhythm biomarkers for MetS monitoring, demonstrating their high importance across multiple XAI models. In contrast, traditional sleep markers showed limited significance, suggesting that circadian rhythm analysis may offer additional insights into MetS beyond sleep-related indicators. These findings highlight the potential of wearable-based circadian biomarkers for improving MetS assessment and management.

PMID:40669055 | DOI:10.2196/69328

JMIR Serious Games. 2025 Jul 16;13:e71385. doi: 10.2196/71385.

ABSTRACT

BACKGROUND: Heart failure (HF) is a growing global health concern, and adherence to early cardiac rehabilitation (CR) remains suboptimal. Exergaming is a promising alternative to conventional exercise programs for patients with HF. However, existing research has limitations, and the integration of exergaming into clinical practice remains challenging. Most notably, current studies often rely on commercially available systems that are not tailored to needs specific to patients with HF, lack long-term adherence strategies, and have limited evaluation in the initial phases of cardiac rehabilitation.

OBJECTIVE: This study aimed to design, develop, and assess the usability of a novel exergaming prototype (ie, HEFMOB), integrating immersive virtual reality (VR), real-time biometric monitoring, and autonomous session management to support early-phase, exercise-based CR in patients with HF.

METHODS: A multidisciplinary team developed HEFMOB through iterative prototyping. The final system included a pedal-based VR cycling game and an upper-limb mobilization minigame, with real-time monitoring of heart rate, blood pressure, and peripheral capillary oxygen saturation. Usability was assessed in two phases: (1) an expert evaluation and refinement phase and (2) a single-session usability phase involving 10 patients with HF (4 female). The sessions were recorded and individually evaluated by 2 researchers using the Serious Game Usability Evaluator tool. After each session, the participants completed the System Usability Scale (SUS) and a subscale of Intrinsic Motivation Inventory (IMI) to rate the usability of the exergaming prototype and enjoyment, respectively. Descriptive statistics were reported.

RESULTS: The participants had a mean age of 64.8 (SD 8.4) years, BMI of 26.7 (SD 4.6) kg/m2, and left ventricular ejection fraction of 40.5% (SD 7.4%). All participants completed the session without adverse events. The SUS score averaged 71.5, SD 17.8 (indicating good usability) and IMI scores indicated very high enjoyment (mean 25.1, SD 3.5). A total of 136 gameplay-related events were recorded: negative (n=76, mostly confusion), neutral (n=49), and positive (n=11). Interface-related issues (n=61) were most common, followed by design (n=52) and hardware (n=23).

CONCLUSIONS: HEFMOB appears to be a promising, engaging, and well-tolerated tool for delivering tailored exergaming interventions in patients with HF. High usability and enjoyment ratings support its acceptability, while structured user experience analysis provided valuable insights for system refinement. This study marks a critical step toward integrating personalized, gamified exercise in inpatient settings, especially where early mobilization is lacking. Building on these findings, future research will assess long-term usability and clinical impact through a multicenter randomized controlled trial.

PMID:40669044 | DOI:10.2196/71385

J Nurs Adm. 2025 Jul 15. doi: 10.1097/NNA.0000000000001599. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to describe the 6-month outcomes of a pilot study testing a web-based decision-making tool for nurse managers (NMs) to use in determining RN hiring needs, and to evaluate the effect on workforce stability and NM satisfaction at a large academic hospital.

BACKGROUND: To ensure that day-to-day staffing in inpatient units is adequate, NMs must be proactive in determining hiring needs. However, adequate tools to guide this skill are lacking, leading to administrative burden. Simultaneously, reducing the administrative burden of NMs is a priority to develop healthy work environments, foster staff development, and facilitate patient care.

METHODS: Researchers used a matched cohort comparison (24 clinical units; 1177.57 full-time equivalents) to evaluate the impact of HealthForceRx, a Web-based workforce management tool, on workforce stability and NM satisfaction. Researchers measured workforce stability as the gap between functional RNs and budgeted RNs. Primary and secondary analyses were performed using mixed model analysis of variance.

RESULTS: The intervention group demonstrated a statistically significant improvement in the RN functional gap from baseline to 6 months post (P = .003), in contrast to no significant change in control units. Nurse managers also reported significant improvements in the tools available to manage staffing and determine hiring needs (P = .15), competencies (P = .28), and RN turnover (P = .007).

CONCLUSIONS: The use of this innovative software tool to proactively determine RN hiring needs may improve workforce stability and NM satisfaction.

PMID:40669016 | DOI:10.1097/NNA.0000000000001599

J Indian Prosthodont Soc. 2025 Jul 1;25(3):266-275. doi: 10.4103/jips.jips_64_25. Epub 2025 Jul 16.

ABSTRACT

AIM: Maxillectomy patients frequently have speech impairments resulting from the loss of the oral-nasal partition. Prosthodontic rehabilitation with an obturator helps restore speech intelligibility, with its success largely dependent on accurate impression recording of maxillary defects. This investigation evaluated the effectiveness of conventional versus digital impression techniques in the context of speech analysis, specifically using Hindi vowels, in maxillectomy patients rehabilitated with obturators.

STUDY SETTING AND DESIGN: This research, designed as a quasi-experimental study, was undertaken at a tertiary care hospital.

MATERIAL AND METHODS: The study included 20 patients needing obturators, assigned to two groups: one received prostheses fabricated with conventional impressions, and the other with digital techniques. Speech parameters, including fundamental frequency, formant frequencies (F1, F2, F3), intensity, jitter, shimmer, and maximum phonation duration (MPD), were analyzed using Praat software before and three months after rehabilitation. Hindi vowels aa /a:/, ii /i:/, and uu /u:/ were sustained at a controlled intensity. Swallowing efficiency was assessed via the water swallow test.

STATISTICAL ANALYSIS USED: The Wilcoxon Rank Sum test or exact test was used to compare the data, with a p-value < 0.05 considered significant.

RESULTS: The most common maxillectomy defects were Brown class 2b. After three months, significant improvement in speech parameters and swallowing efficiency was seen in both groups of participants. However, no statistically significant differences (P > 0.05) were found between the conventional and digital impression groups.

CONCLUSIONS: This novel study compared conventional and digital impressions for speech analysis using Hindi vowels in maxillectomy patients after rehabilitation with an obturator. Voice recording and acoustic analysis using Hindi vowels provide valuable insights into speech rehabilitation outcomes in maxillectomy patients. Both conventional and digital impression techniques effectively fabricate obturators, improving speech characteristics and intelligibility. Both methods can be used for maxillectomy patients, allowing flexibility in clinical practice.

PMID:40669000 | DOI:10.4103/jips.jips_64_25

J Indian Prosthodont Soc. 2025 Jul 1;25(3):258-265. doi: 10.4103/jips.jips_97_25. Epub 2025 Jul 16.

ABSTRACT

AIM: To evaluate the effects of hydroxyapatite gypsum puger-cassava starch (HAGP-CS) scaffold on the number of osteoblasts and alkaline phosphatase (ALP) and osteocalcin (OCN) expression in the alveolar bone rat model.

SETTINGS AND DESIGN: In vivo study.

MATERIALS AND METHODS: Thirty-six Wistar rats were randomly divided into three groups: rat sockets were given a 1 mm × 1 mm × 1 mm HAGP scaffold, rat sockets were given a 1 mm × 1 mm × 1 mm HAGP-CS, and a control group (rat sockets were not given scaffold material). Following lower left molar extraction, scaffold materials were applied to the sockets. Assessments were conducted on days 7th, 14th, and 28th, with osteoblast counts determined via hematoxylin-eosin staining, and ALP and OCN expressions were analyzed using immunohistochemistry (IHC) staining.

STATISTICAL ANALYSIS USED: Two-way analysis of variance and Tukey’s test.

RESULTS: A significant increase in osteoblast count was observed on day 28 (P = 0.001). In addition, significant differences were noted in ALP expression on day 7 (P = 0.030) and day 28 (P = 0.001), as well as in OCN expression on days 7 and 28 (P = 0.001) across the groups.

CONCLUSIONS: Administering a HAGP-CS scaffold significantly enhances osteoblast proliferation and increases ALP and OCN expression in the alveolar bone rat model.

PMID:40668999 | DOI:10.4103/jips.jips_97_25