Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 778 appraisals
The Journal of rheumatology
Examining the Role of Wearables in Inflammatory Arthritis Care: A Narrative Literature Review
Rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis are types of inflammatory arthritis (IA) characterized by joint pain and stiffness that, despite therapeutic advances, remain difficult to treat. Changes in physical activity (PA) and sleep patterns may provide insights into IA disease course and activity. Wearable accelerometers have been validated as reliable, objective measures of PA and have provided insight into IA disease activity and progression through both PA and sleep metrics. Further, the granular nature of accelerometry data may provide the opportunity to identify early signals of treatment response or disease flares, leading to more effective and personalized therapeutic regimens in patients with IA. In this review, we summarize the current state of wearable technology in IA and explore the potential of wearables to bridge gaps in care.
3 Aug 2026
Read appraisal →Journal of medical Internet research
Advancing Human-Centered AI in Clinical Decision Support: Sociocognitive Human-in-the-Loop Study in HIV Care
BACKGROUND: AI-powered clinical decision support systems (CDSS) have shown promise in improving prediction, monitoring, and treatment optimization across clinical domains, including HIV care. However, translating AI outputs derived from electronic health records into clinically meaningful, trustworthy, and actionable decision support remains challenging, underscoring the need for more human-centered and socioecologically grounded CDSS design. OBJECTIVE: This study aimed to explore how we can effectively translate the outputs of machine learning models based on HIV electronic health records into a real AI-powered CDSS for HIV care. Using the human-in-the-loop method, we engaged a set of stakeholders, including HIV physicians, nurse practitioners, infectious disease pharmacists, social workers, and case managers. Stakeholders interacted with an AI-powered CDSS prototype to identify barriers and challenges to adoption, as well as to inform a more holistic and context-aware AI-powered CDSS design. METHODS: We conducted a field study at Prisma Health in South Carolina that included pre- and postsurveys, interactive usability testing sessions, think-alouds, and in-depth interviews with 16 clinicians providing HIV care between March and September 2025. We analyzed survey responses using descriptive statistics, and then transcribed and analyzed think-aloud and interview data using an etic and emic approach. RESULTS: Clinicians identified multiple challenges and design considerations for AI-powered HIV CDSS, demonstrating that clinician-AI interaction is inherently sociotechnical and embedded across multiple socioecological levels. While clinicians relied on familiar clinical indicators as cognitive anchors for interpreting AI predictions, they emphasized that social determinants of health were central to their own risk assessment and clinical decision-making. Additionally, clinicians' trust in AI is conditional and develops over time, with explainability and actionability emerging as critical factors for translating predictions into meaningful clinical interventions. CONCLUSIONS: Findings highlight the need to move beyond technically accurate predictions toward AI-powered CDSS designs that align with clinicians' cognitive practices and socioecological realities of HIV care. By extending a sociocognitive framework through empirical grounding in HIV clinical practice, this study offers design insights for developing AI-powered CDSS that are trustworthy, context-aware, and capable of supporting actionable decision-making in HIV care settings and beyond.
2 Aug 2026
Read appraisal →Journal of psychiatric research
Systematic review of machine learning and deep learning models for EEG-based detection of depression.
OBJECTIVE: Depression is a leading cause of global disability, motivating the development of objective and scalable diagnostic approaches. Quantitative electroencephalography (QEEG) combined with machine learning (ML) and deep learning (DL) techniques has gained increasing attention for depression detection. This systematic review aimed to critically examine and descriptively compare the methodologies, performance metrics, and limitations of ML- and DL-based models applied to EEG data for depression detection. METHODS: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Seven electronic databases (PubMed, Scopus, IEEE Xplore, ScienceDirect, Web of Science, SAGE Journals, and MDPI) were searched for peer-reviewed studies published between 2020 and 2024. Eligible studies included human participants, used EEG signals for depression detection, and applied ML or DL algorithms. Extracted information comprised algorithm type, sample size, EEG acquisition parameters, validation strategies, and reported performance metrics, which were synthesized descriptively across studies. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. RESULTS: A total of 42 studies met the inclusion criteria, including 23 ML-based and 19 DL-based investigations. Reported classification accuracy ranged from approximately 76% to 100%. DL studies showed a higher mean reported accuracy than ML studies (93.92% vs. 90.78%); however, this difference was not statistically significant in the exploratory non-parametric comparison. Near-perfect performance values were frequently observed in studies with small sample sizes and subject-dependent or exclusively internal validation strategies, raising concerns regarding overfitting and limited generalizability. Studies relying on publicly available datasets tended to report more stable performance. QUADAS-2 assessment revealed recurrent risk-of-bias concerns, particularly in the domains of patient selection and index test conduct. CONCLUSIONS: Both ML and DL approaches demonstrate potential for EEG-based depression detection, but reported performance differences between them should be interpreted cautiously. Although DL studies tended to report higher accuracy values, this pattern was not statistically significant in exploratory analyses and was strongly influenced by sample size, validation strategy, and methodological design. Future research should prioritize larger and more diverse samples, subject-independent or external validation strategies, and standardized reporting frameworks to enhance methodological rigor and clinical applicability.
2 Aug 2026
Read appraisal →Artificial intelligence in medicine
Artificial intelligence language models for medical text analysis: A systematic review
Medical text records serve as essential repositories of patient information, providing a foundation for informed clinical decision-making, accurate diagnosis, reliable prognosis, and effective treatment planning. Recent advancements in Artificial Intelligence (AI), particularly in Natural Language Processing (NLP) and Machine Learning (ML), have positioned AI-driven language models as powerful tools for analyzing, classifying, and generating medical textual data. In this systematic literature review, an initial search retrieved 548 records published between 1 January 2000 and 1 July 2024. After rigorous screening based on predefined inclusion and exclusion criteria, 22 original research articles were included. The review highlights substantial progress in applying advanced architectures such as Bidirectional Encoder Representations from Transformers (BERT) and Generative Pre-trained Transformers (GPT) to medical text processing tasks. These models consistently outperform conventional NLP and ML approaches, achieving superior results in disease classification, automated clinical documentation, and predictive analytics. However, critical challenges persist, including the limited availability of clinically validated datasets, variability in data preprocessing protocols, insufficient external validation, and the lack of interpretable AI frameworks, all of which collectively hinder clinical trust and large-scale adoption. Future research should prioritize the development of hybrid AI systems that integrate multimodal data sources (text, imaging, and structured records), incorporate explainable AI mechanisms, and adhere to standardized reporting frameworks. Addressing these methodological gaps will be pivotal in enhancing the reliability, clinical applicability, and impact of AI language models, thereby advancing evidence-based medicine, personalized treatment strategies, and overall patient care.
2 Aug 2026
Read appraisal →Rheumatic diseases clinics of North America
Toward Artificial Intelligence-driven Clinical Decision Support Tools in Rheumatology
Clinical decision support systems (CDSS) have the potential to enhance rheumatology practice by assisting with differential diagnosis, treatment decisions, and predicting patient outcomes. Rheumatic conditions are complex diseases largely diagnosed clinically rather than with a predefined set of clinical, laboratory, or imaging findings. Newer artificial intelligence (AI)-driven CDSS, known as machine-learning-based systems, may be better suited for applications to rheumatic conditions compared to knowledge-based systems, which rely on a set of predefined rules. This report reviews existing studies on CDSS in rheumatology and highlights the potential benefits and pitfalls of incorporating AI-driven CDSS into rheumatology practice.
1 Aug 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Efficacy and safety of fecal microbiota transplantation in Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials with GRADE assessment
BACKGROUND: Parkinson's disease (PD) is a common neurodegenerative disease that is a growing public health challenge. Recent evidence showed that gut microbiota dysbiosis is involved in the pathogenesis of PD, prompting interest in fecal microbiota transplantation (FMT) as a potential disease-modifying intervention. This systematic review and meta-analysis aim to evaluate the efficacy and safety of FMT in patients with PD. METHODS: We conducted a systematic literature review using PubMed, Scopus, Web of Science, and the Cochrane Library till June 4, 2026, to identify RCTs comparing FMT with placebo or control interventions in PD. After removal of duplicates alongside title and abstract screening, followed by full-text screening, seven randomized controlled trials were included in this systematic review and meta-analysis. RESULTS: A total of seven randomized controlled trials (RCTs) with 318 subjects were analyzed. FMT was delivered via oral capsules, nasojejunal tubes, or colonoscopy, with follow-up periods ranging from 12 to 52 weeks. The meta-analysis indicated a notable short-term enhancement in daily motor activities, as assessed by MDSUPDRS Part II, after one month (mean difference - 2.19, 95% confidence interval - 4.32 to -0.06; P = 0.044). Nevertheless, no significant estimates were noted for MDS-UPDRS Part III, aggregate MDS-UPDRS scores, motor complications, non-motor symptoms, or overall life quality at any assessed time frame. Some individual studies reported gains in cognitive ability, anxious feelings, quality of life related to constipation, and certain PDQ-39 categories, although these improvements were not uniformly observed. Overall, FMT was well tolerated by participants, with adverse reactions mostly comprising mild, self-resolving gastrointestinal issues and no major safety risks. CONCLUSIONS: FMT is a safe treatment for individuals with PD and may offer modest short-term advantages in performing daily motor tasks. However, current evidence does not indicate lasting enhancements in overall motor capabilities, non-motor symptoms, or life quality. More extensive and sufficiently powered trials utilizing standardized FMT procedures and longer observation periods are necessary to elucidate the therapeutic benefits of FMT in Parkinson's disease.
1 Aug 2026
Read appraisal →PloS one
Evaluating the cultural alignment of multilingual LLMs in typical Japanese workplace scenarios
While current evaluations of LLM cultural alignment predominantly rely on static benchmarks in Western contexts, their ability to navigate generative, high-context socio-pragmatic demands in non-Western environments remains critically underexplored. This study investigates how multilingual LLMs adapt to the Japanese workplace-a stringent stress-test environment characterized by strong high-context communication norms and rigid honorific conventions-using Hofstede's six cultural dimensions as a heuristic framework. We evaluated five state-of-the-art LLMs (LLM-jp, Phi, Llama, Qwen, and GLM) through a large-scale crowdsourced human evaluation. Based on 1,718 valid evaluator sessions, native Japanese raters assessed model outputs to generate a holistic Japanese Workplace Cultural Alignment Score (JWCAS). To dissect the underlying communicative strategies, we paired this with a three-layer diagnostic sub-score analysis (Linguistic Form, Socio-Cultural Values, and Social Action). Our results reveal that leading multilingual models (Phi and GLM) achieved overall JWCAS scores comparable to, or significantly higher than, the native Japanese model (LLM-jp). Crucially, our sub-score analysis demonstrates that holistic evaluation metrics can obscure deep pragmatic deficits: while LLM-jp overfits to surface-level linguistic politeness (Layer 1), it shows critical weaknesses in socio-cultural values (Layer 2) and context-aware social strategies (Layer 3). In contrast, leading multilingual models demonstrate balanced competence across all layers. These findings suggest that true cultural competence requires moving beyond native linguistic mastery, highlighting the necessity of multi-dimensional diagnostic frameworks for cross-cultural AI alignment.
29 July 2026
Read appraisal →Lasers in medical science
Effect of photobiomodulation on trapezius myofascial pain: a randomized, sham-controlled, double-blind clinical trial.
To investigate the effect of 16 J of 808 nm low-level laser therapy (LLLT) on pain in individuals with trapezius trigger points (TPs). Randomized, double-blind, controlled trial conducted with 52 adults (≥ 18 years) with chronic trapezius pain and TPs. Participants were assigned to the LLLT group (808 nm, 16 J per TP) or the sham group (same protocol without emission). Both received eight sessions over four weeks. Outcomes included pain perception, number of TPs, cervical function, skin temperature, global perceived effect, and adverse events. Randomization was concealed from evaluators and participants. Repeated measures ANOVA (SPSS 21) was used for analysis. No significant differences were found between groups for pain [F(2,100) = 1.21; p = 0.30, η2 = 0.024], TPs [F(1.09,54.27) = 0.35; p = 0.57, η2 = 0.007], cervical skin temperature [F(1.79,89.65) = 0.79; p = 0.45, η2 = 0.042], trapezius temperature [F(2,100) = 1.09; p = 0.34, η2 = 0.021], or global perceived effect [F(1.44) = 1.91; p = 0.17, η2 = 0.029]. Cervical function improved significantly in the LLLT group [F(1.36,67.73) = 3.75; p = 0.04, η2 = 0.070]. Adverse effects were mild and infrequent, mainly warmth. Both groups reported clinically relevant pain reduction. LLLT at 16 J per TP with 808 nm was not superior to placebo for pain, TP count, or skin temperature. However, it improved cervical function, suggesting a functional benefit. Registration: july 18, 2022 on the Brazilian Clinical Trials Registry (REBEC - RBR-10m474jv).
28 July 2026
Read appraisal →Medicine
Role of antazoline in cardioversion of atrial fibrillation: A PRISMA-compliant systematic review and meta-analysis
BACKGROUND: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Antazoline, a first-generation antihistamine with antiarrhythmic properties, has shown efficacy in the rapid conversion of recent-onset AF to sinus rhythm; however, direct comparative evidence against standard antiarrhythmic agents remains limited. This study aims to systematically evaluate the efficacy and safety of antazoline for pharmacological cardioversion of AF, in comparison with standard antiarrhythmic agents such as amiodarone and propafenone. METHODS: The methodology of this systematic review and meta-analysis adhered to the preferred reporting items for systematic reviews and meta-analyses guidelines. A systematic search was conducted in ScienceDirect, Embase, PubMed, and Cochrane Library from inception to April 2025, including citation and reference screening. Statistical analyses were performed using R version 2025.05.0 + 496. RESULTS: From 172 records, 5 studies comparing antazoline with propafenone (n = 5) or amiodarone (n = 3) for AF were included. For antazoline vs propafenone, conversion to sinus rhythm favored antazoline (risk ratio [RR] 1.13 [95% confidence interval (CI): 1.04-1.23], P = .017). No significant difference was observed in time to conversion (mean difference -10.98 [95% CI: -124.93-102.98], P = .436), bradycardia (RR 0.84 [95% CI: 0.35-2.03], P = .478), hypotension (RR 0.40 [95% CI: 0.14-1.12], P = .056), or other adverse events (RR 1.24 [95% CI: 0.01-247.13], P = .694). For antazoline vs amiodarone, conversion to sinus rhythm favored antazoline (RR 1.22 [95% CI: 1.08-1.36], P = .018, I2 = 0%), with no significant differences in bradycardia (RR 1.36 [95% CI: 0-1072357.09], P = .823) or hypotension (RR 1.05 [95% CI: 0.04-26.16], P = .877). CONCLUSION: Antazoline might be more effective than propafenone and amiodarone in achieving sinus rhythm in AF, with no significant differences in safety outcomes.
26 July 2026
Read appraisal →Scientific reports
Recognition of everyday activities using experiment data from wearable sensors: a deep learning-based framework
Tracking everyday activities is vital for detecting changes in older adults' health, allowing timely support to promote well-being. Wearable sensors and deep learning provide continuous monitoring, making them a supportive tool in detecting such changes. However, a more refined method is needed to recognise precise activities with a minimal set of sensors. This study aimed to develop a method to recognise everyday activities among older adults by utilising wearable sensors and a deep learning model. This is a small-scale home lab experiment to develop a method to recognise 14 everyday activities. We compared five models that recognised everyday activities with different sensor signal counts and accuracy. Our results showed that sensor placement is important. Based on the results, we proposed a two-sensor method (pelvis and right hand) to collect and correctly recognise everyday activities among older adults. This model, which utilises two sensors, classified 12 activities with an accuracy of 89.3%. Another model recognised all 14 activities with a lower accuracy of 88.2% using five sensors. We also explored a one-sensor approach, which showed low recognition performance and struggled to distinguish activity variability. The two-sensor-based system will allow for large-scale data collection on everyday activities of older adults.
26 July 2026
Read appraisal →PloS one
Fundus image analysis of retinitis pigmentosa using artificial intelligence
Retinitis pigmentosa (RP) is a group of inherited retinal diseases that are caused by genetic defects that lead to progressive photoreceptor loss and eventual blindness. Early diagnosis would be helpful for effective management of the disease; however, many patients stay unaware of early symptoms. Meanwhile, fundus images are widely obtained during routine medical checkups but are underused for detecting RP. This study explores the effectiveness of finetuning deep learning models, pre-trained for general visual tasks, to identify RP from color fundus images. The dataset comprised 321 color fundus images from 201 Japanese subjects at Keio University Hospital, including 200 images from 107 patients with retinitis pigmentosa and 121 images from 94 non-retinitis pigmentosa subjects. Multiple images were available for some subjects. Using transfer learning, pretrained convolutional neural network models -VGG16, Resnet50, and InceptionV3- were finetuned to detect RP. As a result, Inception V3 achieved the best accuracy of 96.97%, which matches the average diagnostic accuracy of ophthalmologists. Gradient-weighted Class Activation Mapping (Grad-CAM) suggested that the model attended to clinically relevant fundus regions, including the peripheral retina and posterior pole, which may reflect features such as peripheral degenerative changes and retinal vascular attenuation. These findings support the potential interpretability of the finetuned model and suggest that deep learning may assist ophthalmologists in RP screening as a supportive tool.
25 July 2026
Read appraisal →PloS one
Systematic review and meta-analysis of the acute effects of self-selected rest intervals on exercise performance maintenance, lactate levels, and heart rate.
BACKGROUND: Rest interval duration is a key variable in exercise prescription, influencing both performance and physiological responses. Traditional training typically employs fixed rest intervals; however, this approach may not adequately reflect individual variability in recovery needs. Recently, self-selected rest intervals-based on individual perception-have gained attention as a potential strategy for more precise load regulation. Nevertheless, current evidence regarding their effects on exercise performance, heart rate, and blood lactate remains inconsistent. METHODS: This study followed PRISMA guidelines and conducted a systematic search of Web of Science, PubMed, Cochrane Library, and Embase from database inception to March 20, 2026. Acute experimental studies comparing self-selected and fixed rest intervals were included. A three-level random-effects meta-analysis was performed to account for dependency among multiple effect sizes. Subgroup analyses, meta-regression, and sensitivity analyses were conducted to explore potential moderators and assess robustness. RESULTS: Sixteen studies (k = 16) involving 281 participants were included. No significant overall difference was observed between self-selected and fixed rest intervals for exercise performance (g = 0.27, 95% CI [-0.14, 0.69], p = 0.29), with substantial between-study heterogeneity. After removing outliers, a small but significant effect favoring self-selected rest intervals was identified (g = 0.20, 95% CI [0.08, 0.33], p < 0.01). No significant differences were observed for heart rate (g = 0.002, p = 0.98) or blood lactate (g = -0.20, p = 0.36). CONCLUSION: Self-selected and fixed rest intervals produce comparable effects on exercise performance and physiological responses. However, self-selected rest intervals may confer a small advantage in maintaining performance under specific conditions. These findings should be interpreted with caution due to sensitivity to outliers and study heterogeneity.
25 July 2026
Read appraisal →Scandinavian journal of pain
Exercise prescription and monitoring of heart rate parameters in people with chronic pain: a systematic review
INTRODUCTION: Chronic pain affects over 50 million adults in the United States and is associated with autonomic nervous system dysfunction assessed through measurements of heart rate variability (HRV). While exercise has been shown to improve HRV in healthy individuals, the effects of different exercise protocols in chronic pain populations on HRV remain underexplored. CONTENT: The purpose of this systematic review investigated how exercise interventions influence HRV and pain in individuals with chronic pain. A literature search was conducted in accordance with PRISMA guidelines across four electronic databases. Six randomized controlled trials met the inclusion criteria and were critically appraised for methodological quality. Studies were included if they involved an exercise intervention and reported HRV. If pain was assessed, it was included as an outcome measure. SUMMARY AND OUTLOOK: Six randomized controlled trials were identified with 283 participants. All studies measured HRV, while four reported pain outcomes. Five studies reported significant improvements in HRV following exercise interventions (p <0.05), while findings related to pain outcomes were mixed. Methodological reporting of HRV procedures was generally insufficient. Due to heterogeneity across studies, it remains unclear whether exercise improves pain or HRV sufficiently. While pain outcomes are commonly reported, HRV is the only measure specific to \autonomic function, and its reliability as a clinical metric in individuals with chronic pain remains uncertain. Limited research across diverse chronic conditions, sexes, and methodological approaches restricts generalizability. This highlights the need for greater methodological rigor and broader inclusion to strengthen the use of HRV metrics in chronic pain populations.
25 July 2026
Read appraisal →Clinical and experimental dermatology
Pemphigus vegetans: insights from a systematic review of the literature.
BACKGROUND: Pemphigus vegetans (PVg) is a rare variant of pemphigus vulgaris with distinct clinical and histological features, with fewer than 200 cases of patients with the condition reported. OBJECTIVES: To systematically review cases of patients with PVg and summarize clinical, histopathological, immunological features, treatment and outcomes. METHODS: Following PRISMA guidelines, PubMed, Embase and Web of Science were searched (1889 to January 2025) using 'pemphigus AND vegetans'. Eligible studies included case reports, series and observational studies. Data on demographics, subtypes, histopathology, immunopathology, treatment and outcomes were extracted. RESULTS: In total, 197 patients with the condition from 148 studies were identified. The mean age was 52.2 (SD 20.2) years with near-equal sex distribution. Oral mucosa was the commonest initial site (44.7%, 73/163); flexural areas such as the groin and axilla were frequently involved. Reported triggers included drugs, infections and vaccination. In 89 patients where clinical subtypes were reported, the Hallopeau variant was found in 47 (53%). When treatment outcomes were reported by subtype, patients with the Hallopeau variant demonstrated higher sustained remission rates (68%, 28/41) and lower mortality (2%, 1/41) compared with those with the Neumann variant [52% (16/31) sustained remission; 16% (5/31) mortality]. Key histological findings included suprabasal acantholysis (84.9%, 158/186) and eosinophilic microabscesses (65.1%, 121/186). Direct immunofluorescence showed intercellular IgG (92.4%, 121/131) and C3 (53.4%, 70/131). Oral corticosteroids (89.5%, 145/162) were the most used therapy. Relapse occurred in 23.0% (35/152) of patients achieving remission. CONCLUSIONS: This review highlights the need for standardized diagnostic criteria, improved immunological profiling and collaborative data collection to guide evidence-based management.
25 July 2026
Read appraisal →Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
Quality of life with anophthalmia: a systematic review.
PURPOSE: Anophthalmia due to enucleation, evisceration, or exenteration, results in permanent vision loss that may have profound functional, psychological, and social consequences. The purpose of this study is to evaluate health-related quality of life, vision-related quality of life, and psychosocial outcomes among adults with anophthalmia. METHODS: This systematic review was conducted in accordance with PRISMA 2020 guidelines and prospectively registered on PROSPERO (ID: CRD420251274476). MEDLINE, Embase, and CENTRAL were searched from inception to September 9, 2025. Eligible studies included participants with congenital or acquired anophthalmia and reported outcomes related to quality of life or psychosocial health. Risk of bias was assessed using the Cochrane RoB-2 tool for randomized trials and Joanna Briggs Institute critical appraisal tools for observational studies and results were synthesized narratively. RESULTS: Forty-two studies (1999-2025) including 4544 patients (56.0% male; mean age 49.9 years) were included. Enucleation was the most common procedure (55.1%), and most cases were unilateral (59.6%). Health-related quality of life was commonly assessed using the SF-36 and vision-related quality of life using the NEI VFQ-25. Early postoperative reductions in health-related quality of life were frequently observed, with partial recovery over time. Vision-related quality of life remained persistently impaired, particularly for depth perception, peripheral vision, and driving. While mean anxiety and depression scores were often within normal ranges, a substantial subset of patients experienced ongoing psychological distress and appearance-related concerns. CONCLUSIONS: Acquired anophthalmia is associated with enduring vision-specific and psychosocial challenges, supporting the need for anticipatory counseling and integrated multidisciplinary rehabilitation in clinical practice.
25 July 2026
Read appraisal →Emergency medicine journal : EMJ
Are rapid diagnostic tests reliable for the detection of malaria in the emergency department?
A short systematic review assessed the diagnostic accuracy of malaria rapid diagnostic tests in febrile adults from malaria-endemic regions. A database search of MEDLINE, EMBASE, Cochrane and Google Scholar returned 138 papers. Six papers met the inclusion criteria and were included in our analysis.
23 July 2026
Read appraisal →MedEdPORTAL : the journal of teaching and learning resources
Artificial Intelligence and Large Language Models: A Case-Based, Peer-Teaching Workshop for Preclinical Medical Students
INTRODUCTION: Artificial intelligence tools have rapidly become integrated in health care settings and are quickly affecting medical student education. However, there remains limited formal teaching on such tools in student curricula. This project sought to introduce preclerkship medical students to the basics of large language models and allow them to practice ways to best use these tools to supplement their learning. METHODS: The authors designed, implemented, and evaluated a 60-minute lecture and 100-minute workshop for second-year medical students. The workshop included interactive cases covering various aspects of artificial intelligence use, and some groups were led entirely by student leaders, allowing for peer teaching. RESULTS: One hundred sixty-eight students from Harvard Medical School and Harvard School of Dental Medicine were enrolled in this session. Anonymous pre- and postsession surveys (N = 124 and N = 62, respectively) were collected and compared via unpaired t test assuming unequal variance and showed statistically significant increase in the mean ratings of six 5-point Likert scale questions assessing artificial intelligence-related knowledge/self-efficacy (P < .01) and mixed changes to 5 questions relating to attitudes/behavioral intent. DISCUSSION: Our artificial intelligence and large language model session provides a framework for teaching medical students, early in their educational journey, the basics of these tools. Our session provides interactive exercises to illustrate how best to leverage such tools while also discussing their potential risks. Such education will be important to incorporate into medical student curricula as artificial intelligence technologies grow increasingly common.
23 July 2026
Read appraisal →Journal of medical Internet research
Digital Transformation in Health Care: Are We on the Right Track?
Health care digital transformation is gaining increasing attention, despite the observed challenges in its implementation. The envisioned benefits, together with the growing need for better health care, are motivating academia, organizations, regulatory agencies, and governments to develop more effective digital health care solutions. Through extensive debates among the authors, this paper discusses how digital transformation is being conducted in the health care sector. Our discussion relies on concepts from sociotechnical systems theory, categorizing it into 3 social (people, culture, and goals) and 3 technical (processes/procedures, infrastructure, and technology) dimensions. Drawing on both the literature discussed in this paper and our combined academic and practical experience-each author contributing over a decade of work in health care digital transformation-we examined current digitalization efforts from a sociotechnical standpoint. Overall, we argue that both social and technical dimensions present elements that have either encouraged or discouraged the progress of health care digital transformation. The identification of current trends on such (on- and off-track) elements allowed the formulation of 12 propositions across each sociotechnical dimension for future testing and validation. This approach can help establish better government policies, foster private initiatives, and shift regulatory guidelines to support a successful digital transformation in health systems. Finally, from a research perspective, we outline some opportunities for further interdisciplinary investigation in the field, promoting advances in the understanding of health care digital transformation.
22 July 2026
Read appraisal →BMJ open
Endoscopic biopsy strategies for gastric ulcers: an updated systematic review
OBJECTIVE: To systematically summarise recent evidence on endoscopic biopsy for gastric ulcer. DESIGN: Systematic review of clinical studies. DATA SOURCES: PubMed, Embase, Cochrane Library, Web of Science, CNKI and CiNii Research were searched for studies published from 2015 to May 2025. ELIGIBILITY CRITERIA: Original studies involving adults with endoscopically diagnosed gastric ulcers or ulcerative gastric lesions directly informing biopsy strategy were eligible if they evaluated biopsy timing, number, site or related diagnostic outcomes. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened studies, extracted data and assessed risk of bias using the Newcastle-Ottawa Scale. Owing to substantial clinical and methodological heterogeneity, findings were synthesised narratively. RESULTS: Seven studies were included and grouped into four domains: biopsy timing, biopsy number, biopsy site and safety. Available data suggested that most malignancies may be identifiable at the initial endoscopy examination although repeat biopsy during ulcer healing or scarring might still detect some missed cancers. Evidence on the biopsy site remained limited and inconsistent, and findings from healed-phase ulcers further suggested that the anatomical site alone may be insufficient to guide biopsy strategy. Available studies also indicated that four well-targeted biopsies may be adequate for some depressed or polypoid lesions whereas more extensive sampling might be needed for infiltrative or otherwise suspicious lesions. Limited safety data did not show a clear increase in adverse events with broader biopsy strategies or the biopsy of stabilised bleeding ulcers. CONCLUSIONS: Contemporary evidence on endoscopic biopsy for gastric ulcers remains limited, heterogeneous and largely observational. Available data suggest that biopsy at initial endoscopy and adequate, lesion-targeted sampling may improve diagnostic yield, while follow-up and intensive sampling should be individualised according to endoscopic appearance, histological findings and clinical suspicion. PROSPERO REGISTRATION NUMBER: CRD420251157851.
21 July 2026
Read appraisal →Medicine
Effect of physical exercise on executive function in individuals with substance use disorder: A systematic review and meta-analysis
BACKGROUND: The increasing number of individuals with substance use disorder (SUD) has a serious impact on individuals, families, and society. As a complementary therapy, physical exercise has been used in the rehabilitation of individuals with SUD. This study systematically aimed to evaluate the effect of physical exercise interventions on enhancing executive function in individuals with SUD. METHODS: Electronic databases were searched, covering the period from their inception to December 26, 2024. The Cochrane Risk of Bias Assessment Tool was utilized to assess the methodological quality of the included literature. Data were extracted from study graphs using GetData Graph Digitizer 2.26, and Stata 17.0 was also employed to conduct analysis. Grading of recommendations assessment, development and evaluation pro was utilized to evaluate the quality of evidence of outcome indicators. RESULTS: Nine studies, encompassing 752 participants, were included in the analysis. Compared with the control group, physical exercise improved inhibition (Hedges's g = 0.47, 95% CI: 0.29 to 0.65, P < .001) and working memory (Hedges's g = 0.42, 95% CI: 0.16 to 0.69, P = .002), but did not significantly affect cognitive flexibility (Hedges's g = 0.51, 95% CI: -0.22 to 1.24, P = .170). Subgroup analysis revealed that physical exercise with single time of 46 to 60 minutes (Hedges's g = 0.39, 95% CI: 0.05 to 0.73, P = .024), 5 times per week (Hedges's g = 0.45, 95% CI: 0.07 to 0.83, P = .020), duration of 8 weeks (Hedges's g = 0.46, 95% CI: 0.14 to 0.77, P = .004) may improve working memory in individuals with SUD (these subgroup findings are exploratory and should be interpreted as hypothesis-generating). CONCLUSION: Evidence from this study suggests physical exercise may enhance inhibition and working memory in individuals with SUD. However, the improvement in cognitive flexibility requires further investigation in future studies.
19 July 2026
Read appraisal →Medicine
Exploring the role of generative artificial intelligence in enhancing clinical skills training: A bibliometric analysis
BACKGROUND: Traditional clinical skills training faces challenges such as limited standardized patient resources, high costs of simulation equipment, and restricted opportunities for repeated practice. Generative artificial intelligence (GAI), particularly large language models, has attracted increasing attention as a potential tool for simulation, feedback, and adaptive learning in medical education. However, the research landscape and thematic development of GAI in clinical skills training remain insufficiently mapped. METHODS: A bibliometric analysis was conducted using literature retrieved from the Web of Science Core Collection from January 1, 2011 to April 1, 2025. VOSviewer, the Bibliometrix R package, and CiteSpace were used to analyze publication trends, country and institutional contributions, journal distribution, collaboration networks, keyword co-occurrence, co-cited references, and citation bursts. RESULTS: A total of 322 publications were included. Research activity remained limited before 2023 but increased rapidly thereafter. The United States contributed the largest number of publications, followed by China and India. Major contributing institutions included the National University of Singapore, Gazi University, and Nova Southeastern University. Frequently publishing journals included JMIR Medical Education, Medical Teacher, and BMC Medical Education. Keyword and thematic analyses showed that current research attention is mainly concentrated on ChatGPT, large language models, natural language processing, clinical reasoning simulation, personalized learning, virtual patient interaction, and ethical governance. CONCLUSIONS: Research on GAI in clinical skills training is in an early but rapidly expanding stage, with growing scholarly attention to language-model-driven educational applications and related ethical issues. The bibliometric findings reflect research activity, knowledge structure, and thematic priorities rather than direct evidence of educational effectiveness. Future studies should adopt rigorous empirical designs and standardized evaluation frameworks to assess the effectiveness, safety, and appropriate boundaries of GAI applications in clinical skills training.
19 July 2026
Read appraisal →BMJ open
Current evidence on radiofrequency denervation for chronic low back pain: a systematic review and meta-analysis
OBJECTIVE: To assess the effects of radiofrequency (RF) denervation for chronic low back pain (LBP) from facet joint, sacroiliac joint, discogenic and non-specific pain. DESIGN: Systematic review and meta-analysis. DATA SOURCES: We searched Medline, Embase, Cochrane Library, CINAHL, PsycINFO, ClinicalTrials.gov and WHO ICTRP up to 18 February 2025 for randomised controlled trials (RCTs). STUDY SELECTION, DATA EXTRACTION AND SYNTHESIS: Pairs of reviewers independently selected studies, extracted data and assessed risk of bias (Cochrane RoB 2). Meta-analyses with clinically homogeneous studies were performed and certainty of evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation. RESULTS: 55 RCTs (n=4394) were included; many outcomes were at some risk of bias. Low to moderate certainty evidence suggested small improvements in pain and function with RF denervation versus sham for facet joint pain, sacroiliac, discogenic and non-specific chronic LBP. None exceeded predefined minimally clinically important between-group differences, suggesting limited clinical relevance. CONCLUSIONS: RF denervation showed small improvements in pain and function compared with sham, steroid injection or standard care, but the effects did not reach clinically meaningful thresholds and the certainty of evidence was very low to moderate. Additional research is needed to clarify the effects of RF denervation and guide clinical decision-making. PROSPERO REGISTRATION NUMBER: CRD42023460743.
18 July 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Creative thinking in Parkinson's disease: A systematic review and meta-analysis
INTRODUCTION: Creativity in Parkinson's disease (PD) has aroused research interest due to its neurological underpinnings, which involve brain regions crucial for creative and divergent thinking (a core-process of creative thinking), and because of some patients who displayed an increased artistic drive following dopaminergic treatment. From a cognitive point of view, creative thinking underlies several cognitive abilities, such as executive functions and memory. Therefore, a better understanding of whether it is increased (or, at least, preserved) in PD patients can provide useful insights for sustaining cognitive functioning. The aim of the present study was to investigate whether PD patients regularly assuming dopaminergic medications present higher divergent thinking skills than healthy controls. METHODS: A meta-analysis was conducted according to the PRISMA guidelines to provide a statistical synthesis of the studies. Study quality was assessed using the QUADAS -2 tool. RESULTS: Ten studies were included in the meta-analysis, which indicated the absence of significant differences between PD patients and healthy controls in tasks assessing divergent thinking (Cohen's d = -0,095 (95% CI: -0,308, 0,118)). CONCLUSIONS: Such findings support the notion that divergent thinking can be spared by the disease, maybe constituting a possible resource for patients' cognitive functioning, as it involves those cognitive abilities that can compensate impairments in PD. Clinical implications and guidance to further studies and interventions to support PD patients' cognition were discussed.
17 July 2026
Read appraisal →Journal of neurology
Effects of respiratory muscle training on respiratory function in patients with amyotrophic lateral sclerosis: a systematic review and meta-analysis
BACKGROUND: Respiratory decline is prognostically important in amyotrophic lateral sclerosis (ALS), but the efficacy of respiratory muscle training (RMT) remains uncertain. We synthesized randomized evidence on respiratory and related outcomes. METHODS: We searched databases, specialized registers, and trial registries through June 19, 2025, for randomized RMT trials in ALS. Risk of bias was assessed with the Cochrane tool. Random-effects meta-analyses reported standardized mean differences (SMDs) with 95% confidence intervals (CIs), and certainty was rated with GRADE. RESULTS: Six studies were included; five concurrently randomized trials contributed quantitative data, whereas Pinto 2013 was retained for qualitative context. RMT improved maximal expiratory pressure (MEP; SMD 0.387, 95% CI 0.192-0.581; P = 0.008) and showed small favorable effects on maximal inspiratory pressure (MIP; SMD 0.156, 95% CI 0.089-0.224; P = 0.005), sniff nasal inspiratory pressure (SNIP; SMD 0.216, 95% CI 0.039-0.392; P = 0.034), peak expiratory flow (PEF; SMD 0.205, 95% CI 0.088-0.323; P = 0.017), and ALSFRS-R (SMD 0.214, 95% CI 0.039-0.388; P = 0.030). Forced vital capacity showed a borderline favorable trend (SMD 0.129, 95% CI - 0.003 to 0.262; P = 0.053). Low heterogeneity estimates were imprecise because most endpoints included only three to four small studies. Certainty was moderate for MIP, low for MEP, FVC, and PEF, and very low for SNIP and ALSFRS-R. Exploratory analyses identified no reliable effect modifiers. CONCLUSIONS: RMT was associated with small, directionally consistent improvements mainly in pressure- and flow-based outcomes, whereas effects on FVC and longer-term clinical outcomes remain uncertain. RMT may be considered an individualized adjunct to ALS respiratory care, not a disease-modifying therapy. Larger, longer, standardized trials with patient-important endpoints are needed.
16 July 2026
Read appraisal →Sleep
Consensus roadmap on periodic leg movements during sleep: outcomes of the international PLMS taskforce
Periodic leg movements during sleep (PLMS) are a frequently observed motor phenomenon in polysomnography, yet their biological meaning and clinical relevance are debated. Further, how these should be assessed and tabulated for optimal evaluation is uncertain. To address these gaps, an international, multidisciplinary taskforce convened a series of online meetings followed by an in person taskforce workshop held in Troina, Italy, on November 14-15, 2025, where agreement was reached through iterative discussion (qualitative; no Delphi or predefined voting thresholds). This taskforce roadmap summarizes the taskforce conclusions across five priority domains: (1) clinical significance and impact, (2) measurement and characterization, (3) treatment, (4) basic and translational research, and (5) PLMS across the life span and epidemiology. For each domain, we delineate where the field currently stands, identify critical gaps in knowledge, and propose concrete strategies, including key milestones, study designs, and infrastructure needs, to advance the field in a coordinated and standardized manner. A central unifying theme is that PLMS should no longer be viewed solely as a countable polysomnographic index, but rather as a spectrum of sleep-related motor activity with heterogeneous neurophysiological substrates and variable clinical impact. Achieving progress will require harmonized scoring standards, validated automated and wearable technologies, large longitudinal and outcome-oriented studies, and sustained international collaboration. This roadmap provides a framework to guide research, clinical innovation, and future guideline development, but it is not a clinical practice guideline or standards statement.
14 July 2026
Read appraisal →Scientific reports
Satisfaction with telepsychiatry and mental health stigma among health sciences students in Egyptian universities
Health sciences students have a higher incidence of mental health disorders; however, stigma and barriers have complicated help-seeking. Telepsychiatry may be a solution, but acceptance, satisfaction, and stigma in this population, especially in Egypt, remain unclear. This study aimed to evaluate the levels of satisfaction regarding telepsychiatry, stigma perceived with respect to mental illness, among health sciences students towards mental health services. It also aims to assess sociodemographic factors associated with these outcomes. This was a questionnaire-based cross-sectional study conducted among 799 students from various universities in Egypt. It was conducted between August and November 2025, and the questionnaire involved sociodemographic data, the telepsychiatry satisfaction scale (21 items), and the STIG-9 stigma scale. Data were analyzed using descriptive statistics, chi-square and t-tests, and linear regression, with significance set at p < 0.05. Overall, participants had a mean age of 21.4 years, while 66.8% of participants were female. In total, 24.0% agreed, and 18.4% strongly agreed to being satisfied with telepsychiatry, with a mean total satisfaction score of 67.84/105. The mean STIG‑9 stigma score was 14.44/27. Linear regression identified sociodemographic variables independently associated with satisfaction and stigma; higher stigma was also positively associated with higher satisfaction. In this cohort of Egyptian health sciences students with prior telepsychiatry experience, satisfaction with telepsychiatry was positively associated with perceived stigma. These findings suggest that addressing socio-cultural stigma may support the acceptability of telepsychiatry and improve engagement with digital mental health services in similar student populations.
13 July 2026
Read appraisal →Medicine
Risk factors for episiotomy during vaginal birth: A systematic review and meta-analysis
BACKGROUND: Despite the numerous harms associated with episiotomy during vaginal birth, the risk factors for this procedure remain a topic of controversy. This study aimed to identify the potential risk factors for episiotomy during vaginal birth. METHODS: A systematic search was conducted across 7 databases, including PubMed/MedLine, Embase, Cochrane, Web of Science, Chinese Knowledge Infrastructure (CNKI), and Wanfang, up to January 2025. Statistical analyses, including heterogeneity tests, sensitivity analysis, and publication bias assessment, were conducted using Stata 18.0 and Review Manager 5.4. RESULTS: A total of 16 articles were included in this meta-analysis, comprising a sample size of 17,502 individuals. Newborn weight (odds ratio [OR] = 2.393; 95% confidence interval [CI] = 1.627-3.520; P < .001) and oxytocin use (OR = 2.341; 95% CI = 1.652-3.318; P < .001) were identified as significant risk factors for episiotomy. In contrast, maternal age (OR = 0.978; 95% CI = 0.922-1.038; P = .466), the type of childbirth attendant (OR = 0.920; 95% CI = 0.569-1.488; P = .733), and the duration of the second stage of labor (OR = 1.299; 95% CI = 0.781-2.162; P = .314) were not statistically significant risk factors for episiotomy. CONCLUSION: High newborn weight and oxytocin use are associated with higher rates of episiotomy. However, other potential risk factors are still controversial due to a lack of sufficient evidence, highlighting the need for more rigorous studies to strengthen the evidence base.
13 July 2026
Read appraisal →PLoS medicine
How to benchmark medical AI agents
Medical artificial intelligence research is shifting from single-task models toward multimodal large language model-based agents for complex clinical workflows, requiring benchmarks that assess clinical reasoning, process safety, and resource stewardship rather than final outputs alone.
12 July 2026
Read appraisal →Current treatment options in oncology
Telemedicine and Virtual Reality Technologies in Pain Management for Cancer Patients: A Structured Narrative Review
Cancer-related pain remains a complex and persistent clinical challenge due to its multidimensional nature and the limitations of pharmacological treatments alone. In our view, telemedicine and virtual reality (VR) technologies represent complementary and increasingly relevant approaches that address different yet interconnected dimensions of pain management in oncology care. Telemedicine should be considered a key component of contemporary cancer care, particularly for continuous symptom monitoring, early detection of pain exacerbation, and timely clinical intervention. Its ability to enhance communication between patients and healthcare providers and to support continuity of care makes it especially valuable in the long-term management of cancer-related symptoms. In contrast, VR interventions offer a targeted, non-pharmacological strategy for modulating pain perception through attentional distraction, emotional regulation, and immersive engagement. Based on current evidence, VR appears particularly useful in the management of procedure-related pain and in patients experiencing persistent pain that is insufficiently controlled with standard approaches. We propose that the integration of telemedicine and VR should be considered within a coordinated, patient-centered care model, where telemedicine facilitates ongoing assessment and identification of patient needs, and VR is applied as an adjunctive intervention tailored to individual symptom profiles. Such an approach has the potential to enhance both symptom control and psychological well-being while supporting treatment adherence. However, despite their promise, the implementation of these technologies requires careful consideration of clinical context, patient characteristics, and system-level factors, including digital literacy and technological infrastructure. Future research should prioritize the development of standardized protocols and the evaluation of long-term outcomes to support the sustainable integration of these digital health strategies into routine oncology practice.
11 July 2026
Read appraisal →Cell host & microbe
Adjunctive fecal microbiota transplantation for major depressive disorder: A randomized, double-blind, placebo-controlled trial
Gut microbiota may influence antidepressant treatment outcomes, yet whether targeted modulation can enhance efficacy remains unclear. We conducted a randomized, double-blind, placebo-controlled trial in patients with major depressive disorder, administering a 2-week course of fecal microbiota transplantation (FMT) capsules or placebo as an adjunct to escitalopram (ChiCTR2300071421). Remission rates at week 8 did not differ significantly between groups, but FMT produced greater reductions in Hamilton Depression Rating Scale, 17-item version (HAMD-17) scores at weeks 2 and 8. FMT was well-tolerated with a safety profile comparable to placebo. Multi-omics analyses show durable donor microbial engraftment and enrichment of beneficial Lachnospiraceae and Oscillospiraceae taxa. Microbial remodeling is accompanied by an increase in serum bile acids that correlate with the alleviation of depressive symptoms. Mediation analysis supports a bile-acid-mediated suppression of inflammatory pathways linking microbial changes to antidepressant effects. Overall, FMT may provide a safe avenue to enhance escitalopram efficacy through microbiota-directed regulation of bile-acid metabolism and inflammation.
10 July 2026
Read appraisal →JMIR infodemiology
Self-Reported Tianeptine Experiences on Reddit: Natural Language Processing-Assisted Qualitative Study
This study, using natural language processing and manual thematic analysis of Reddit posts, revealed a rapid rise in discussions about tianeptine, with posts frequently reporting dependence, withdrawal, and coingestion with other unregulated substances, highlighting tianeptine as an emerging public health concern.
8 July 2026
Read appraisal →Psychological medicine
Extreme heat and mental health: systematic review and qualitative investigation of risk and protective factors
BACKGROUND: Extreme hot weather poses increasing risks to mental health. Yet, factors affecting vulnerability are under-researched. This mixed-method study integrates a systematic review and qualitative investigation to identify risk and protective factors for heat-related mental health issues, leading to the co-development of a screening tool. This could inform future research and, pending validation in clinical settings, support mental health professionals in assessing vulnerability among service users. METHODS: We searched PubMed and Web of Science for publications on extreme heat, mental health, and risk/protective factors. In addition, we conducted six focus groups with 21 people with lived experience of heat and/or mental illness and 12 healthcare professionals. Transcripts were analyzed using thematic content analysis and informed the co-development of the screening tool. RESULTS: Out of 764 articles identified by the systematic review, 47 were included. Evidence emerged for age, sex, existing mental illness, ethnicity, and socioeconomic status as risk factors. However, findings were inconsistent between studies, likely due to differences in study population and methodology. Protective effects included good physical health, social support, and exposure to green spaces. Our qualitative investigation identified additional risk and protective factors related to: (1) behavioral adaptability, (2) personal heat sensitivity, and (3) disparities in heat exposure. The resulting screening tool, HEAT-MH (Heat Exposure Assessment Tool for Mental Health), contains 15 questions on previous experiences of heat, general health, and lifestyle. CONCLUSIONS: The mental health impacts of extreme heat depend on a range of risk and protective factors, including demographic, socioeconomic, health, and lifestyle characteristics.
8 July 2026
Read appraisal →JMIR formative research
Knowledge, Attitudes, and Practices Related to AI in Learning and Research Among Medical Students in Vietnam: Cross-Sectional Study
BACKGROUND: In recent years, artificial intelligence (AI) has ushered in a promising era in medicine, particularly in medical education. However, studies assessing the knowledge, attitudes, and practices related to AI among medical students in Vietnam remain limited. OBJECTIVE: This study aimed to evaluate AI knowledge, attitudes, and practices among Vietnamese medical students in learning and research, and to identify factors associated with their AI practices. METHODS: A cross-sectional study was conducted among medical students at Thai Binh University of Medicine and Pharmacy from November to December 2025. Data were collected using an online structured questionnaire covering demographic characteristics and AI knowledge, attitudes, and practices. The main outcome of interest was AI practices in learning and research. Descriptive statistics and multivariable linear regression were used to examine associated factors. Regression coefficients (β), 95% CIs, and P values are reported. RESULTS: A total of 1002 medical students (mean age 21.00, IQR 19.00-23.00 years; n=596, 59.5% female) were included. The median percentage of maximum possible (POMP) score of AI knowledge was 66.67 (IQR 33.33-83.33), with a high level of familiarity with common tools (n=798, 79.6%). AI attitudes were generally positive (median POMP score 70.00, IQR 53.33-76.67). AI-related practices were lower (median POMP score 50.00, IQR 46.88-71.88), with AI being used primarily for information retrieval and literature research support. In the multivariable analysis, knowledge POMP score (β=0.12, 95% CI 0.08-0.16) and attitudes POMP score (β=0.42, 95% CI 0.34-0.51) were significantly associated with AI practices POMP score (P<.001). Age, gender, major, grade point average classification, and having participated in an AI seminar or training were not associated with AI practices. CONCLUSIONS: Medical students showed favorable knowledge and positive attitudes, but their AI practices remained limited. Integrating AI into medical curricula, including fundamentals, applications, and ethical aspects, is essential to prepare future physicians for AI-driven health care.
5 July 2026
Read appraisal →JMIR mental health
From Alliance to Nexus: Rethinking Digital Therapeutic Relationships
In traditional human psychotherapy, the therapeutic alliance (TA) is regarded as a fundamental factor that describes the client-therapist relationship, mainly due to strong evidence demonstrating its impact on treatment outcomes regardless of theoretical orientation. More recently, advances in artificial intelligence (AI) and other technologies have led to the emergence of the concept of digital TA, used to characterize the relationship between clients and AI-based therapeutic systems. This approach replicates human dynamics but overlooks key differences between human therapists and digital agents. Prematurely translating the concept of TA into the digital context fails to address issues such as the sycophantic tendencies of current systems and the inherent limitations of algorithmic interaction. We propose the digital therapeutic nexus, a framework that recognizes these differences and provides a set of structured criteria for categorizing digital interactions into 3 progressive levels. This Viewpoint argues that only at the highest level can parallels be drawn to the human TA and stratifies the main risks associated with each nexus level. Transitioning from the concept of alliance to that of a nexus offers a more precise conceptual basis for describing and evaluating digital therapeutic relationships, with implications for research, design, and the ethical development of AI-based mental health interventions.
3 July 2026
Read appraisal →Telemedicine journal and e-health : the official journal of the American Telemedicine Association
Utilization of Telemedicine Among Offshore Health Care Workers and Its Influencing Factors
INTRODUCTION: Telemedicine has become an essential tool for providing health care to offshore workers. Despite its advancements, there is still a lack of understanding about its optimal use and the factors affecting it among health care providers in offshore settings. The objective of this work was to study and determine the level of telemedicine utilization among offshore health care workers and its associated factors in Malaysia. METHODS: In this cross-sectional study, online questionnaires were distributed to health care workers involved in offshore medical services. The questionnaire includes sociodemographic information and the validated Malay version of the Telemedicine Acceptance Model (TAM) Questionnaire. A total of 73 offshore health care workers were recruited from a local company using universal sampling. Data analysis involved descriptive statistics as well as simple and multiple logistic regression. RESULTS: A total of 65.8% of offshore health care workers reported using telemedicine in their practice. Multiple logistic regression analysis indicated that Chinese and Indian workers were significantly more likely to use telemedicine compared with Malay workers, with adjusted odds ratios of 32.11 (p = 0.045) and 33.51 (p = 0.037), respectively. Workers with a good attitude toward telemedicine had 11.84 times higher odds of utilization (p = 0.004), while those with high behavioral intention were 25.80 times more likely to use telemedicine compared with their counterparts with low behavioral intention (p < 0.001). CONCLUSIONS: A majority of offshore health care workers utilize telemedicine, with Chinese and Indian ethnicity, good attitude, and high behavioral intention significantly predicting its utilization.
3 July 2026
Read appraisal →Journal of the American Medical Informatics Association : JAMIA
Clinicians' rationale for editing ambient AI-drafted clinical notes: persistent challenges and implications for improvement
OBJECTIVE: The use of ambient AI documentation tools is rapidly growing in US hospitals and clinics. Such tools generate the first draft of clinical notes from scribed patient-provider conversations, which clinicians can then review and edit before signing into electronic health records (EHR). Understanding how and why clinicians make modifications to AI-generated drafts is critical to improving AI design and clinical efficiency, yet it has been under-studied. This study aims to address this gap. MATERIALS AND METHODS: We conducted semistructured interviews with 30 clinicians from the University of California, Irvine Health who used a commercial ambient AI tool in routine outpatient care. We invited them to describe how and why they edited AI drafts based on both their personal experience and review of some real-world examples identified from our previous studies. RESULTS: Modifications to AI drafts were primarily made to improve clinical accuracy and specialty-specific precision, reduce medico-legal and liability risk, and meet billing, coding, and documentation standards. Such editing was necessary due to reasons such as transcription errors, speaker attribution mistakes, overconfident statements without evidence, missing key clinical details, and AI's lack of information about the patient context. CONCLUSION AND DISCUSSION: Improving ambient AI documentation will require coordinated effort from vendors, institutions, and clinicians. Key targets include core model reliability (eg, transcription accuracy), specialty- and encounter-level customization, clinician-level personalization, more effective EHR integration, and institutional support (eg, training, governance, and standardized review guidance), complemented by clinicians' adaptive communication strategies that strengthen human-AI collaboration.
2 July 2026
Read appraisal →Psychiatric services (Washington, D.C.)
Psychiatric Risk Associated With Large Language Model Chatbots: An Emerging Concern
Large language model chatbots such as ChatGPT have been adopted by millions of users, yet their psychiatric implications are poorly understood. Recent media reports describe 26 apparent instances of psychosis and two instances of depression and suicide in the context of heavy chatbot use, often marked by delusions seemingly reinforced by the model. Because chatbots simulate conversation but are statistical systems optimized for agreement, they may amplify distorted beliefs. Research is needed to determine whether these reports represent a genuine pattern of risk and to identify vulnerable populations. Clinicians should screen for chatbot use and discuss these systems with patients.
2 July 2026
Read appraisal →Current opinion in psychiatry
Opportunities and risks of large language models in digital interventions for substance use disorders
PURPOSE OF REVIEW: Large language models (LLMs) are increasingly integrated into digital mental health tools, yet their role in substance use disorder (SUD) interventions remains poorly understood. This review synthesizes emerging evidence on the opportunities and risks of applying LLMs across the digital SUD care continuum. RECENT FINDINGS: Studies report promising applications in early detection, personalized support, continuous monitoring, and relapse prevention. LLMs demonstrate capacity to extract substance-use signals from natural language, generate supportive and motivational responses, and interpret narrative data for patient-reported outcomes. However, risks are substantial. LLMs can produce inaccurate or hallucinated content, may reinforce stigma or demographic bias, and can generate misleading or potentially unsafe advice. Privacy concerns are amplified in SUD contexts, where sensitive data are often managed outside regulated healthcare systems. Existing regulatory frameworks such as the EU AI Act or U.S. device regulations, do not yet provide clear governance for anonymous, AI-supported SUD interventions. SUMMARY: LLMs have potential to expand scalable, low-threshold support for SUDs, but their safe deployment requires validation, bias mitigation, transparent data governance, and robust human oversight. Evidence remains preliminary, and clinical integration should proceed cautiously.
2 July 2026
Read appraisal →Langmuir : the ACS journal of surfaces and colloids
Wearable Sleep Detection System Based on Piezoelectric Signals and Convolutional Neural Network Analysis
Long-term and comfortable sleep monitoring is a core requirement for daily health management. However, existing sleep monitoring technologies fail to simultaneously achieve accurate sleep stage classification, wearing comfort, and direct monitoring of characteristic physiological signals. Here, we report a wearable sleep monitoring system (SMS) based on piezoelectric sensing and convolutional neural network (CNN) analysis. The system assesses sleep structure and quality by capturing characteristic eye movement signals and provides actionable recommendations for long-term sleep health management. The sensor employs a highly stereoregular polyacrylonitrile (PAN) composite fiber film modified with PDA@ZnO as the sensing unit, providing high sensitivity, excellent wearing comfort, and long-term durability. It conforms closely to the upper eyelid, enabling effective acquisition of direct physiological signals associated with sleep. Furthermore, we developed a CNN model for five-state sleep classification and validated it using original-recording-level 5-fold validation and a 1000-sample processed held-out test set, achieving an accuracy of 95.90% with a Cohen's Kappa coefficient of 0.949. The system efficiently presents sleep quality information through a simple and user-friendly human-computer interaction interface. The proposed system introduces a novel approach to convenient health monitoring and provides a feasible technical solution for accurate and long-term sleep health assessment in daily life.
1 July 2026
Read appraisal →Medical education online
Exploring medical Artificial Intelligence Readiness among Korean medical students: a cross-sectional study
INTRODUCTION: Artificial intelligence (AI) is rapidly transforming healthcare systems and clinical practice, increasing the need to prepare future physicians to work effectively with AI technologies in clinical contexts. Despite growing interest in integrating AI into medical education, empirical evidence regarding medical students' readiness to use AI remains limited. This study aimed to assess medical AI readiness among Korean medical students and explore factors associated with their readiness. METHODS: A cross-sectional survey was conducted among medical students enrolled in a six-year medical program at a university in Korea. A total of 204 students participated in the study. Medical AI readiness was measured using the Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS), which assesses four domains: cognition, ability, vision, and ethics. Descriptive statistics, independent t-tests, and Pearson's correlation analyses were performed using SPSS version 27. RESULTS: The overall mean score of medical AI readiness was 4.19 on a 7-point Likert scale, indicating a moderate level of medical AI readiness. Among the subscales, ethics showed the highest mean score (4.69), followed by vision (4.44), ability (4.18), and cognition (3.92). The frequency of AI use was significantly associated with medical AI readiness, whereas the daily duration of AI use was not. No significant gender differences were observed. When students were divided into the low (pre-medical years 1-2) and high (medical years 1-4) groups, the high group showed significantly higher scores only in the ability subscale. CONCLUSIONS: The findings suggest that medical students are not yet sufficiently prepared to utilize AI technologies in clinical practice, particularly in terms of knowledge and practical competencies related to AI. These results highlight the need for structured and longitudinal AI education in medical curricula to better prepare future physicians for AI-integrated healthcare environments.
1 July 2026
Read appraisal →BMJ supportive & palliative care
Efficacy and safety of acupuncture for breast cancer-related insomnia: a systematic review and meta-analysis
Breast cancer-related insomnia (BCRI) is a common and burdensome sequela. Acupuncture is frequently used, but robust evidence is limited, and previous systematic reviews included few trials yielding imprecise estimates. This updated systematic review and meta-analysis evaluated the efficacy and safety of acupuncture for BCRI. We systematically searched eight databases for randomized controlled trials (RCTs) up to July 1, 2025. RCTs comparing acupuncture with any control for BCRI were eligible. Methodological quality was assessed using the Cochrane Risk of Bias tool (RoB 2.0) and the modified Jadad scale. Meta-analyses employed a random-effects model. Subgroup analyses explored heterogeneity sources, and the GRADE framework rated evidence certainty. Twenty-seven RCTs (n=2,025) were included. Acupuncture significantly reduced Pittsburgh Sleep Quality Index (PSQI) scores (MD= -2.74, 95% CI [-3.92, -1.55], P<0.00001) and increased the overall efficacy rate (RR=1.51, 95% CI [1.27, 1.81], P<0.00001) compared to control, but did not significantly improve Insomnia Severity Index (ISI) scores. Subgroup analyses identified control intervention type and treatment frequency as significant sources of heterogeneity. Adverse events were infrequent and typically mild. GRADE assessments rated the certainty of evidence as low or very low, primarily due to risk of bias and substantial heterogeneity. Current evidence suggests acupuncture may improve sleep in patients with BCRI, with effects moderated by comparator type and treatment frequency. However, conclusions are limited by methodological weaknesses and heterogeneity. Future rigorous RCTs using validated sham controls, standardized protocols, and objective outcomes are needed to confirm efficacy and guide practice. PROSPERO Registration number (ID: CRD42024559828).
1 July 2026
Read appraisal →BMJ supportive & palliative care
Ethical dilemmas for palliative care nurses: systematic review
BACKGROUND: Nurses play a unique and critical role in palliative care, and it is noteworthy that nurses often encounter ethical dilemmas in this field. OBJECTIVE: This review aims to conduct a summarised synthesis of the latest research on the ethical considerations nurses faced in palliative care. METHODS: We conducted a rigorous systematic review of relevant existing studies published in high-quality English peer-reviewed journals from January 2017 to July 2023. We identified a total of 4492 articles (1029 in Web of Science, 1570 in PubMed and 1893 in Science Direct). Out of these, only 13 studies met the inclusion criteria. RESULTS: Following the thematic analysis, the ethical considerations reported in these 13 studies were grouped into three main themes and four subthemes: ethical issues in communication (ethical issues in communication with patients, ethical issues in communication with families), ethical issues in decision-making (autonomy, dignity) and moral distress in palliative care. CONCLUSION: This study elaborated on the ethical challenges faced by nurses in their communication with patients and families as well as decision-making and analysed the causes and effects of ethical distress, hoping to give a hand to ethical issues for nurses' work in palliative care.
1 July 2026
Read appraisal →The Journal of dermatological treatment
Intralesional human papillomavirus vaccination for cutaneous verrucae: a systematic review and meta-analysis of therapeutic efficacy
OBJECTIVES: To evaluate the efficacy of intralesional human papillomavirus (HPV) vaccination in the management of cutaneous warts. METHODS: A comprehensive search of PubMed, MEDLINE, Embase, Scopus, and ClinicalTrials.gov was conducted in accordance with a registered PROSPERO protocol (CRD420251170324). Chronic or persistent warts were defined as lesions lasting more than six months or showing inadequate response to conventional therapies. The primary outcome was complete wart clearance, and pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS: Six studies were included. Intralesional HPV vaccination was associated with a significantly higher rate of complete clearance compared with intralesional normal saline (RR 18.54; 95% CI 6.59-52.18). Subgroup analyses demonstrated comparable efficacy between bivalent and quadrivalent vaccines. Reported adverse events were mild and localized. CONCLUSION: Intralesional HPV vaccination demonstrated significant therapeutic efficacy in the treatment of cutaneous warts and represents a promising immunotherapeutic option for patients with persistent or treatment-refractory disease.
30 June 2026
Read appraisal →Journal of gastrointestinal and liver diseases : JGLD
Colon Cleaning after Inadequate Bowel Preparation: A Pooled-data Analysis
BACKGROUND AND AIMS: An adequate bowel preparation is essential for performing high-quality ccolonoscopy; however, it remains ineffective for a certain percentage of patients. We conducted a literature search to identify evidence on salvage strategies following inadequate bowel preparation. METHODS: The search of medical literature was conducted using Medline and Google Scholar, restricted to studies published in English as a full paper. From retrieved studies, the success rate was calculated according to the rescue approaches used, including different oral- or device-assisted procedures, and pooling data of similar approaches. RESULTS: By considering data of 17 studies with 2,167 patients, an adequate colon cleaning was overall achieved in 79.3% (95%CI: 77.5-80.1). By grouping data of similar approaches, the success rate was 78.1% with oral high-volume polyethylene glycol (PEG), 75.3% with low-volume PEG, 82.5% with oral sennosides, and 84.6% following colonoscope or device-assisted preparation. CONCLUSIONS: Effective bowel cleansing is not achieved in nearly 20% of patients due to inadequate bowel preparation and although multiple approaches have been investigated, none has consistently provided adequate bowel preparation for all patients.
29 June 2026
Read appraisal →Medicine
Efficacy and safety of traditional Chinese medicine decoctions as an adjuvant treatment for rheumatoid arthritis: A systematic review and meta-analysis
BACKGROUND: To assess the effectiveness and safety of traditional Chinese medicine (TCM) decoctions as an additional therapy for rheumatoid arthritis (RA) via a systematic review and meta-analysis. METHODS: Databases including PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wanfang were searched up to June 2024. Randomized controlled trials (RCTs) on TCM decoctions as adjunctive RA treatment were included. Primary outcomes were efficacy and safety. Effect sizes were measured using standardized mean difference, risk ratio, and 95% confidence intervals. Sensitivity and subgroup analyses were conducted to test result robustness and identify heterogeneity sources. Data were analyzed using RevMan 5.4 and Stata 15. In addition, the quality of evidence was assessed using grading of recommendations assessment, development and evaluation grading. RESULTS: Thirty-six RCTs with 6934 participants showed that TCM decoctions significantly improved overall efficacy versus control (risk ratio = 1.25, 95% confidence interval [1.21-1.29], P < .00001). They also reduced erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, swollen joint count, Disease Activity Score, and morning stiffness duration compared to placebo. Subgroup analysis suggested treatment duration, disease duration, and age may affect efficacy. Among them, the quality of evidence was high for Visual Analog Scale, and moderate for overall efficacy, C-reactive protein, Disease Activity Score, Traditional Chinese Medicine Symptom Score, and interleukin-1. CONCLUSION: TCM decoctions as adjunctive RA treatment significantly enhance efficacy. However, due to study limitations, further large-scale, multicenter RCTs are needed to confirm these findings.
28 June 2026
Read appraisal →Medicine
Artificial intelligence-guided clavicle fracture detection on plain radiographs: A retrospective diagnostic accuracy study.
Extensive research exists on artificial intelligence (AI)-assisted fracture detection in various anatomical regions, but clavicle fractures remain comparatively understudied. This study aimed to compare the diagnostic performance of AI-guided clavicle fracture detection on plain radiographs with that of an experienced orthopedic surgeon. We retrospectively analyzed all clavicle radiographs obtained at our institution between September 11,2023 and October 31,2024 following the clinical implementation of AI-guided fracture detection. Radiological findings confirmed by a senior radiologist served as the reference standard. AI performance was additionally compared with the assessments of an experienced, blinded orthopedic surgeon. Diagnostic performance metrics included accuracy, sensitivity, specificity, Cohen kappa, F1 score, and Youden index. A total of 367 clavicle radiographs were included, comprising 186 anteroposterior (AP) and 181 second-plane views. The mean patient age was 44.6 ± 26.2 years, and 59.4% were male. According to the reference standard, clavicle fractures were present in 96 AP radiographs (51.6%) and 95 second-plane radiographs (52.5%). On AP radiographs, the AI system achieved an accuracy of 97.31%, sensitivity of 95.83%, specificity of 98.89%, Cohen kappa of 0.95, and F1 score of 0.97. Diagnostic performance on second-plane radiographs was similarly high and overall comparable to that of the experienced orthopedic surgeon. This retrospective diagnostic accuracy study shows that AI-guided clavicle fracture detection is highly accurate and reliable, with performance approaching that of an experienced orthopedic surgeon. These findings support the potential role of AI as a diagnostic support tool in clavicle fracture detection, while prospective and multicenter validation remains warranted.
28 June 2026
Read appraisal →The Behavioral and brain sciences
Fair contracts for artificial intelligence?
This comment explores resource-rational contractualism (RRC) as a framework for artificial intelligence (AI) alignment and reasoning. It assesses RRC's capacity to capture the insights of philosophical contractualism and canvasses its extension to AI alignment. It suggests that a modified version of RRC, centered on impartial deliberation, can be used to identify principles for alignment and to guide efficient AI moral cognition.
27 June 2026
Read appraisal →JMIR medical education
Exploring the Role of Early Career Medical Professionals From a Digital-Oriented University in Germany in Promoting Digital Health in Professional Settings: Qualitative Interview Study
BACKGROUND: To address care delivery gaps, the health care system must embrace innovative digital solutions. Additionally, the rising integration of digitalization as a topic into medical education is providing students with broader opportunities to engage with digitalization overall. As digital health becomes an increasingly integral component of medical education and health care practice, digitally affine early career medical professionals constitute a vital resource for advancing digitalization within the health care sector. OBJECTIVE: This study examines how early career medical professionals from Witten/Herdecke University in Germany, with various courses focusing on digitalization, acquire digital knowledge, apply it across diverse practical contexts-ranging from start-ups and corporate environments to traditional clinical settings-and how they contribute to the advancement of digitalization within the entire health care sector. METHODS: Using a qualitative approach, 19 interviews were conducted with early career medical professionals who graduated in the last 15 years at Witten/Herdecke University. Subsequently, the interviews were transcribed and analyzed using a deductive-inductive approach. RESULTS: The findings reveal that medical graduates often acquire digital skills through intensive self-study and learning on the job, integrating them in various ways into their professional lives. Moreover, while graduates recognize their high potential to make their own contribution to the advancement of digitalization, they also face significant barriers such as knowledge gaps, limited resources, and complex regulations, which hinder their ability to contribute to digitalization in a variety of professional settings. Medical graduates report that they face a pressing need for enhanced knowledge access, improved institutional frameworks, and supportive policy measures to maximize their potential in advancing digitalization initiatives. CONCLUSIONS: Recent medical graduates represent an underused resource for health care digitalization. Unlocking this potential requires coordinated action across medical education, health care institutions, and policymaking to create appropriate conditions for graduates to actively drive digitalization.
26 June 2026
Read appraisal →La Medicina del lavoro
Cadmium Exposure and Risk of Pancreatic Cancer: A Systematic Review and Meta-Analysis
INTRODUCTION: Pancreatic cancer is a highly lethal malignancy with poor prognosis and limited treatment options. Environmental exposures, particularly to heavy metals such as cadmium, may contribute to its etiology. This systematic review and meta-analysis evaluated the association between cadmium exposure from different sources and pancreatic cancer incidence or mortality. METHODS: Following PRISMA guidelines, we searched PubMed, EMBASE, and Scopus. Eighteen studies comprising 20 risk estimates were included. Random-effects meta-analyses were conducted overall and stratified by exposure source, gender, region, study design, and outcome. Dose-response relationships were assessed using meta-regression of cadmium exposure measures. Publication bias was evaluated using funnel plots and Egger's test. RESULTS: Overall, cadmium exposure was associated with an increased risk of pancreatic cancer [relative risk (RR) = 1.69, 95% confidence interval (CI): 1.28-2.22]. Occupational exposure showed the most consistent association (RR = 1.38, 95% CI: 1.19-1.61), followed by urinary and blood/serum biomarkers. Risk was higher in men than in women, and in case-control than in cohort studies. Dose-response analysis did not reveal a linear trend. There was limited evidence of publication bias overall, though some asymmetry was observed for urinary cadmium studies (P = 0.045). CONCLUSION: Cadmium exposure was associated with pancreatic cancer risk, particularly in occupational and biomarker-based studies. While findings support a potential causal link, heterogeneity, residual confounding, and limited dose-response data necessitate cautious interpretation.
26 June 2026
Read appraisal →Oral health & preventive dentistry
Association Between Ankylosing Spondylitis and Periodontitis: A Systematic Review
PURPOSE: This systematic review aimed to investigate a potential association between ankylosing spondylitis (AS) and periodontitis (PD), two chronic inflammatory diseases. METHODS AND MATERIALS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, searches were conducted in PubMed, The Cochrane Library, Scopus, and Web of Science. Keywords included 'spondyloarthritis', 'ankylosing spondylitis', 'periodontal diseases', and 'periodontitis'. Study selection was performed by independent authors, and quality was assessed using Scottish Intercollegiate Guidelines Network (SIGN) methodology and the STROBE-MR statement. RESULTS: Out of 255 initial studies, 18 eligible studies (3 cohort, 14 case-control, 1 Mendelian randomisation) were selected, all of acceptable to high quality. The prevalence of PD in AS patients showed conflicting results. Periodontal parameters like bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment loss (CAL) didn't consistently show statistically significant differences but were frequently correlated with AS parameters (eg, MASES, BASDAI, BASFI, CRP, AS duration). AS treatment with anti-TNF-α agents was associated with a decrease in PPD and CAL. Other findings included an increase in Gingival Index in AS patients treated with anti-TNF-α and mixed results for the Decayed, Missing, and Filled Teeth Index. Microbiological studies showed inconsistent results for Porphyromonas gingivalis (Pg), but anti-Pg IgG levels correlated with AS parameters. PD appeared to significantly increase inflammatory markers (IL-6, TNF-α, CRP, ESR) in AS patients. Only one study investigated a genetic association, finding none. CONCLUSION: A definitive conclusion regarding an increased prevalence of PD in AS patients cannot be drawn with certainty from this review, possibly due to heterogeneous classification criteria. However, the correlation between PD and AS parameters, alongside the impact of AS therapy on periodontal health, is noteworthy. Screening and treating periodontal disease in AS patients might delay symptom progression and reduce drug dosage, though targeted clinical trials are necessary to confirm these findings.
26 June 2026
Read appraisal →BMJ open
Understanding self-management and digital health needs in musicians with playing-related musculoskeletal disorders: an explanatory sequential mixed-methods study
OBJECTIVES: To explore the characteristics of musicians with current or previous troubling musculoskeletal symptoms associated with musician self-limitation of activity (often referred to as playing-related musculoskeletal disorders (PRMSDs)), barriers and facilitators to PRMSD self-management, health needs and perspectives on digital health interventions (DHIs). The purpose of the study was to understand the unique needs of this population to effectively inform future DHIs to support this community. DESIGN: A mixed-methods study comprising an online survey and four online focus groups (2-3 participants per group). Survey data were analysed statistically, and focus group discussions were analysed thematically. SETTING: Online survey and focus groups conducted via Zoom. PARTICIPANTS: UK-based musicians with current or previous PRMSDs. RESULTS: A total of 100 musicians participated in the survey study, and 10 musicians participated in the focus group study. Over a third (38%, n=38) of participants had experienced musculoskeletal symptoms that interfered with their ability to play at their usual level 0-2 times in the last 5 years, 24% (n=24) reported 3-5 episodes, and 38% (n=38) had experienced them more than five times. The majority of participants (67%, n=67) continued playing music while experiencing these symptoms. Several barriers to self-management were identified, including limited music-specific health education during training, financial and time constraints and insufficient accessible resources. Key facilitators and health needs included healthcare professionals who understood musicians' professional demands and performance pressures, personalised instrument-specific health support, peer support from fellow musicians and accessible digital resources including self-assessment tools, automated reminders, health tracking, motivational features, peer support forums and multimedia resources organised by condition or symptom stage. Addressing these needs could enable musicians to better manage their symptoms, maintain playing activity and make informed decisions about when and how to seek help. CONCLUSION: This study reveals unmet health needs in musicians and offers recommendations for designing DHIs that promote musicians' health and well-being. Key design recommendations include personalisation by instrument type, health tracking, peer support and consolidated multimedia resources. These findings can inform both intervention design and policy development to better support this population.
26 June 2026
Read appraisal →European respiratory review : an official journal of the European Respiratory Society
Mucoactive agents in bronchiectasis: a systematic review and meta-analysis
BACKGROUND: Mucoactive agents aim to improve mucociliary clearance in bronchiectasis, disrupting the cycle of impaired clearance, infection and inflammation. Registry data show 28% of patients use these agents, but prescribing varies due to limited evidence. We aimed to update evidence on mucoactive agents' effects in adults with bronchiectasis. METHODS: We conducted a systematic review and meta-analysis, searching Medline, Embase, CENTRAL and trial registries to 1 October 2025. Eligible studies included adults with bronchiectasis, evaluating any mucoactive agent versus placebo or control. Cystic fibrosis and paediatric studies were excluded. The primary outcome was exacerbation frequency; secondary outcomes included lung function, quality of life and adverse events. FINDINGS: From 1512 records, 24 studies (20 randomised, four observational: n=7051) evaluated eight mucoactive agents (ambroxol, bromhexine, carbocisteine, erdosteine, hypertonic saline, mannitol, N-acetylcysteine, rhDNase). Most trials had high or some risk of bias. Seven randomised studies (n=1259) reported exacerbations; pooled analysis did not demonstrate a statistically significant difference in annualised exacerbation incidence (mean difference -0.40 per patient per year, 95% CI -1.04-0.24; p=0.22; I2=91%; very low certainty). Nine studies (n=767) reported percent predicted forced expiratory volume in 1 s (FEV1 % pred), showing a small mean increase of 3.23% (95% CI 0.31-6.15; p=0.03; I2=69.9%; very low certainty). Pooled analyses did not demonstrate significant differences for other spirometry measures, quality of life or adverse events. INTERPRETATION: Pooled evidence did not show a reduction in exacerbations and FEV1 % pred improvements were small. Evidence certainty was low/very low, meaning overall clinical benefit remains uncertain, highlighting the need for targeted trials of specific agents and subgroups.
25 June 2026
Read appraisal →Reviews in the neurosciences
Probiotics and seizure susceptibility in preclinical epilepsy models: mechanistic insights from a systematic review and meta-analysis
The gut microbiota can affect neuronal excitability, inflammation, and oxidative balance via the gut-brain axis, shaping seizure susceptibility. To translate these findings into clinical approaches, a synthesis of preclinical microbiome-based evidence is needed. This systematic review and meta-analysis examined the putative anticonvulsant, anti-inflammatory, antioxidant, and neuroprotective effects of probiotics in rodent models. An extensive systematic search up to July 2025 identified eligible animal studies in which probiotics were administered in seizure models. Reported outcomes included seizure latency, duration, severity, and frequency, as well as inflammation, oxidative stress, and behavioral measures. Of the 24 studies that met the inclusion criteria, 19 provided sufficient data to be included in the meta-analysis. The most frequently used strains belonged to the Lactobacillus (e.g., acidophilus, casei, fermentum) and Bifidobacterium genera (e.g., bifidum, longum), with occasional synbiotic combinations. Probiotics significantly increased seizure latency (MD = 22.09; 95 % CI: 10.52 to 33.67) and reduced seizure severity (MD = -1.08; 95 % CI: -1.39 to -0.76) and duration (MD = -23.19; 95 % CI: -35.56 to -10.82). Probiotics significantly reduced IL-1β, IL-6, and TNF-α levels while MDA showed a nonsignificant trend toward reduction (p = 0.076). Behaviorally, improvements in spatial learning (p < 0.05) and reduced anxiety-like behavior (p < 0.001) were observed. Probiotic supplementation appears to exert anticonvulsant, anti-inflammatory, antioxidant, and behavioral benefits in preclinical epilepsy models, although the evidence is heterogeneous and limited to animal studies. Mechanistic evidence indicates modulation of the gut-brain axis, enhanced GABAergic signaling, and improved mitochondrial function. These findings support further investigation of specific probiotic formulations as promising adjunct candidates in well-designed, mechanism-driven clinical trials.
25 June 2026
Read appraisal →Journal of medical Internet research
Digital Health Intervention to Promote Lifelong Specialized Care in Adults With Congenital Heart Disease: Theory-Driven Community Co-Designed Study
BACKGROUND: Adults with congenital heart disease frequently experience gaps in lifelong adult congenital heart disease (ACHD) specialty care, leading to preventable complications, hospitalizations, and premature mortality. However, effective, scalable, accessible, and sustainable strategies to reduce these gaps are lacking. Digital health offers potential solutions but requires a rigorous scientific approach in its design to address the needs of the target population. OBJECTIVE: This study aims to describe the development of a theory-based, community co-designed digital health intervention to improve lifelong ACHD care. METHODS: We integrated theory-based behavioral frameworks, semistructured qualitative interviews with patients and clinicians, and a community-engaged approach to develop a digital health intervention for ACHD. The primary behavioral target was completing an ACHD specialist appointment. We conducted Capability, Opportunity, Motivation, and Behavior (COM-B)-guided semistructured interviews with patients with ACHD and clinicians to identify barriers to specialized care amenable to a digital intervention, and patient-centered goals for the digital tool. The community partners helped develop key intervention objectives, create a theory-driven framework, and specify how each intervention component targets specific COM-B barriers. RESULTS: We interviewed 54 participants (n=37 patients with ACHD, and n=17 clinicians) and engaged 21 community partners representing 4 advocacy organizations. Design objectives emphasized addressing patient loneliness, ensuring accessibility and credibility, and enabling scalability while centering patient perspectives. Participants identified 4 priorities: providing credible resources, uplifting patient voices, customizing to patient needs, and centering positivity and joy. The digital tool, named by community partners as Empower My Congenital Heart (EMCH), was designed within the web- and mobile-based, Apple- and Android-compatible, Eureka Digital Research platform (University of California, San Francisco). Key intervention components included educational modules, peer support, appointment planning nudges, and a digital medical passport. The EMCH's theory-driven framework specifies how each intervention component targets specific COM-B barriers to specialized ACHD care. CONCLUSIONS: The theory-driven, community co-designed EMCH digital tool provides a scalable approach to promote lifelong ACHD specialist care. Ongoing process evaluation and a planned randomized controlled trial will assess acceptability, engagement, and effectiveness in reducing care gaps. If proven effective, EMCH has the potential to prevent complications, emergency hospitalizations, and mortality affecting the majority of adults with congenital heart disease.
25 June 2026
Read appraisal →Lasers in medical science
Effect of photobiomodulation on pain and quality of life in fibromyalgia syndrome: a systematic review
Fibromyalgia Syndrome (FMS) is a chronic pain disorder characterized by widespread pain and central sensitization that significantly impacts the quality of life (QoL). For management to be effective, a multidisciplinary approach to care is typically required. Photobiomodulation therapy (PBMT), a non-pharmacological treatment, has garnered attention lately, though its clinical relevance and applications are not well defined. The objective of this review was to assess the effectiveness of PBMT in reducing FMS symptoms. This systematic review was registered at PROSPERO (CRD420251084730) and conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. A total of seven randomized controlled trials were identified following an extensive literature search across various databases, including PubMed, Scopus, Web of Science, the Cochrane Library, Embase, Ovid and ProQuest. To evaluate the methodological quality of these studies, the Cochrane Risk of Bias (RoB 2.0) tool was applied. PBMT demonstrated consistent short-term reductions in pain intensity and improvements in QoL. Additional positive effects on sleep quality and psychological well-being were observed, indicating that PBMT may provide additional therapeutic benefits beyond pain reduction, including improvements in sleep quality and psychological well-being. PBMT has shown promise as a safe, non-pharmacological adjunct therapy that may provide short-term improvements in pain levels and QoL, but substantial heterogeneity limits generalizability. Clinical trials with large samples and standardized methodologies should be conducted to better clarify the role of PBMT in multidisciplinary therapy for FMS.
24 June 2026
Read appraisal →Journal of medical Internet research
Trusting Generative AI for Health Advice: Preregistered Survey Experiment
BACKGROUND: Generative artificial intelligence (AI) systems are increasingly used for health information seeking, yet it remains unclear how the public evaluates AI-generated health advice relative to guidance from credentialed clinicians in digital environments. Understanding the conditions under which AI is perceived as credible is critical as these systems become integrated into digital health ecosystems. OBJECTIVE: This study examined how source type (a human nurse in an online portal, a health care-specialized generative artificial intelligence system framed as an "AI nurse," or ChatGPT [OpenAI], a general-purpose chatbot), message characteristics, contextual risk, values framing, and individual differences in medical skepticism and experience with AI shape credibility evaluations of the provided advice and its purported source. METHODS: In a preregistered online experiment, a national sample of US adult participants (N=1502) was randomly assigned to 1 of 3 source conditions and evaluated health advice across 3 scenarios: low risk (dietary advice for cholesterol), high risk (chest pain triage), and a morally sensitive scenario (egg freezing). Advice type (intuitive vs counterintuitive) was manipulated in the risk scenarios, and ideological framing (neutral, conservative-leaning, and liberal-leaning) was manipulated in the morally sensitive scenario. Primary outcomes included participants' perceived credibility of the advice and beliefs about whether the patient should follow it. Source-level perceptions of competence and benevolence were also assessed. Medical skepticism and prior AI experience were examined as moderators. RESULTS: Advice attributed to a human nurse was rated as more credible than advice attributed to either AI source. Message intuitiveness showed effects comparable to, and sometimes larger than, the effects of source: intuitive advice was perceived as more credible than counterintuitive advice, with this difference amplified in high-risk contexts. In the morally sensitive scenario, ideological framing influenced perceived bias but did not interact significantly with source. Medical skepticism moderated source evaluations: higher skepticism was associated with greater perceived competence of the AI nurse and lower perceived competence of the human nurse. CONCLUSIONS: Generative AI is evaluated within existing credibility frameworks rather than dismissed outright as inferior to human expertise. While licensed clinicians retain a credibility advantage, AI-generated advice is generally perceived as competent and legitimate. Importantly, individuals skeptical of traditional medical authority may evaluate AI-based guidance more favorably, suggesting that AI systems may redistribute-rather than uniformly erode-trust in health advice. As AI tools become embedded in patient-facing health platforms, message design and audience characteristics may shape acceptance more strongly than source labeling alone.
24 June 2026
Read appraisal →Archives of disease in childhood
AI-simulated clinical consultations: Assessing the potential of ChatGPT to support medical training
BACKGROUND: Simulated medical scenarios are useful for evaluating and developing clinical competencies but scheduling them is expensive and time-consuming. Large language models show promise in role-playing tasks. We investigated the fidelity with which ChatGPT can mimic patients, clinicians and examiners in educational settings. OBJECTIVE: To determine the realism with which ChatGPT can portray patient, doctor and examiner roles, and the utility of these agents in clinical education. METHOD: We selected four paediatric scenarios from mock objective structured clinical examinations (OSCEs) and set up separate patient, doctor and examiner ChatGPT agents for each. The patient and doctor agents conversed with each other in written format. The examiner agent marked the doctor agent based on this conversation. Patients and clinicians familiar with the OSCE assessed the dialogues. RESULTS: The patient agent was judged to be true to character most of the time and good at expressing emotion. The doctor agent was reported to be an effective communicator but occasionally used jargon. Both agents tended to produce repetitive responses which undermined realism. The examiner agent had good correlation with human clinicians. There was moderate support for using the simulated interactions for educational purposes. CONCLUSION: Although the realism of the agents can be improved, ChatGPT can generate plausible proxies of participants in medical scenarios and could be useful for complementing standardised patient-based training.
24 June 2026
Read appraisal →BMJ open
Workplace interventions for chronic musculoskeletal disorders: a systematic review
OBJECTIVES: To provide an updated systematic review of the effectiveness of workplace interventions for chronic musculoskeletal disorders, identify key intervention components and assess their impact on health and work-related outcomes. DESIGN: Systematic review of randomised controlled trials. DATA SOURCES: MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus and Web of Science were searched for studies published between 2018 and 2024. Grey literature sources were also consulted. ELIGIBILITY CRITERIA: Randomised controlled trials and cluster-randomised trials evaluating workplace interventions targeting adults with chronic musculoskeletal disorders were included. Outcomes of interest included pain, functional outcomes, quality of life and work-related outcomes (eg, work ability, productivity, presenteeism and absenteeism). DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened studies, extracted data and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Due to heterogeneity, only a narrative synthesis was conducted. RESULTS: 23 studies involving 2456 participants were included and classified into physical exercise, ergonomic and multicomponent interventions. Physical exercise interventions consistently improved pain and functional outcomes. Digital delivery of exercise interventions demonstrated comparable effectiveness to face-to-face or workplace-based approaches. Multicomponent interventions, combining exercise with ergonomic strategies, demonstrated the most consistent benefits across outcomes. Evidence for work-related outcomes was limited and inconsistent, and quality of life was assessed in only a small number of studies. CONCLUSIONS: Workplace interventions, particularly multicomponent approaches combining exercise, ergonomics and education, can be effective in improving health outcomes in chronic musculoskeletal disorders. However, evidence on work-related outcomes remains limited and inconsistent. PROSPERO REGISTRATION NUMBER: CRD420261289218.
24 June 2026
Read appraisal →Acta orthopaedica
Registration and reporting characteristics of trials investigating exercise therapy following total knee arthroplasty: a systematic review.
BACKGROUND AND PURPOSE: Prospectively registering the primary trial outcome is important to reduce selective outcome reporting and increase the trustworthiness of findings, which guide clinical practice. The objectives of our systematic review were to explore and compare the reporting characteristics of prospectively and non-prospectively registered trials investigating exercise therapy following total knee arthroplasty. METHODS: Randomized trials comparing effects of exercise therapy after total knee arthroplasty for osteoarthritis were identified in 4 databases from 2000 to August 12, 2024. One primary outcome per trial was extracted, using a pre-specified hierarchical algorithm, irrespective of outcome domain. Pooled standardized mean differences (SMDs) were calculated on pre-specified outcome domains, and risk-of-bias assessed using the Cochrane Risk-of-Bias tool v2. RESULTS: 94 trials, comprising 9,396 participants, were included, of which 13 were prospectively registered, 33 retrospectively registered, and 48 unregistered. A single primary outcome was defined in 44% of the 94 trials, and 4 trials reported a primary outcome consistent with a prospective registration. The pooled SMD of primary outcomes was 0.06 (95% confidence interval [CI] -0.03 to 0.16) for prospectively registered trials, 0.67 (CI 0.22-1.11) for retrospectively registered trials, and 0.59 (CI 0.32-0.86) for unregistered trials. Lower risk-of-bias ratings and higher proportions of intention-to-treat adherence, dropout reporting, and adverse event reporting were observed among prospectively registered trials. CONCLUSION: Among prospectively registered trials we showed smaller effect size estimates between interventions with lower risk-of-bias ratings, and higher proportions of intention-to-treat adherence, dropout reporting, and adverse event reporting in contrast to trials without prospective registration; furthermore, clear specification of a single primary outcome was uncommon among trials evaluating exercise therapy after total knee arthroplasty.
23 June 2026
Read appraisal →PloS one
Applications of electromyography in Amyotrophic Lateral Sclerosis: A systematic review
This systematic review examined the use of surface electromyography (sEMG) for the neuromuscular assessment of individuals with Amyotrophic Lateral Sclerosis (ALS), focusing on clinical parameters, the muscle groups evaluated, acquisition protocols, technical properties of the recording systems, integration with other technologies, and signal processing strategies. We included observational studies that applied sEMG to individuals diagnosed with ALS, with or without comparison to healthy controls, and without restrictions on publication year. The analyses included signals recorded at rest and during voluntary contractions, with or without the use of biofeedback. Most studies employed conventional or high-density surface electrodes, with sampling frequencies ranging from 500 Hz to 3000 Hz. The results showed that the primary parameters assessed were muscle fatigue, fasciculation patterns, the number of motor units (MUNE/MUNIX), motor unit firing rates, and signal complexity. These parameters demonstrated sensitivity to disease progression and may contribute to early diagnosis, phenotypic stratification, and functional monitoring of ALS. Additionally, the studies highlighted the increasing use of advanced computational approaches, such as machine learning, for feature extraction and automated classification. In conclusion, sEMG is a promising tool for functional assessment in ALS, with the potential to improve diagnostic accuracy and support new therapeutic strategies based on electrophysiological biomarkers. However, despite technological advances, the included studies displayed substantial methodological heterogeneity and limited protocol standardization. Integration with other neurophysiological modalities also remains underexplored, despite its significant clinical potential.
23 June 2026
Read appraisal →Rheumatology international
Mortality and survival in patients with systemic lupus erythematosus in the Middle East and North Africa: a systematic review and meta-analysis
Systemic lupus erythematosus (SLE) is associated with increased mortality compared with the general population, with outcomes influenced by ethnicity and organ involvement. Data from the Middle East and North Africa (MENA) remain limited, particularly regarding long-term survival and mortality predictors. To estimate and compare all-cause mortality and survival rates among adult patients with SLE in the MENA region and identify predictors of mortality. A systematic review and meta-analysis of cohort studies reporting survival and mortality in patients with SLE in the MENA region was conducted. Eligible studies were identified through a comprehensive database search and screened according to PRISMA guidelines. Data on treatment exposures and clinical predictors of mortality were extracted. Twelve cohort studies, including 3,478 adults with SLE from five MENA countries (Türkiye, Iran, Egypt, Israel, and Tunisia), were analyzed. The pooled all-cause mortality rate was 9.9% (95% CI: 7.2%-14.0%; I² = 89.7%). Survival remained high at 5 years (93.9%) and 10 years (90.0%), but declined at 15 years (85.5%) and 20 years (71.7%), with long-term estimates highly sensitive to single-study exclusion. Leave-one-out analysis slightly increased survival estimates and reduced heterogeneity. Major mortality predictors included renal involvement, cardiovascular disease, infections, hypertension, diabetes, hematologic abnormalities, and male sex. Higher cumulative corticosteroid and cyclophosphamide exposure was linked to increased mortality, whereas hydroxychloroquine and azathioprine appeared protective. Infection was the leading cause of death, followed by active disease, renal failure, and cardiovascular complications. Patients with SLE in the MENA region show high short-term survival, but long-term outcomes remain variable. Mortality is mainly driven by renal, cardiovascular, and infectious complications, with treatment exposure contributing to risk. These findings highlight the need for multicenter registries, standardized reporting, and strategies to reduce infection burden and optimize nephritis care.
23 June 2026
Read appraisal →Spine
Differentiating Spinal Deformity Versus Leg Length Discrepancy in Patients With Pelvic Obliquity : Systematic Review of Diagnostic Methods, Imaging, and Clinical Management
STUDY DESIGN: Systematic review, PROSPERO ID: (CRD42023112392). OBJECTIVE: We aim to provide physicians with an evidence-based stepwise approach to distinguishing the primary cause of plane pelvic obliquity (PO) to guide treatment. SUMMARY OF BACKGROUND DATA: PO is a frequent clinical finding in both spinal deformity (SD) and leg length discrepancy (LLD) but distinguishing between these etiologies remains challenging due to overlapping clinical and radiographic features and potential multifactorial origins. Misdiagnosis may delay care and worsen patient outcomes. MATERIALS AND METHODS: PubMed, Embase, Scopus, and Web of Science were searched from inception to July 2025 for English-language studies evaluating coronal PO in the context of LLD and/or SD that explicitly compared or differentiated limb-origin from spine-origin obliquity using radiographic, advanced imaging, or validated clinical assessments and reported diagnostic accuracy, discriminative features, or management impact. Two reviewers independently screened studies, extracted data, and performed ROBINS-I risk assessment and Newcastle-Ottawa Scale quality assessment. Owing to marked heterogeneity in populations, measurement protocols, and thresholds, findings were synthesized qualitatively with stratification by age group where possible. RESULTS: Of 436 records, 24 cohort studies met the inclusion criteria. Standing anteroposterior (AP) radiographs reliably quantified both LLD and PO, while advanced imaging provided high reproducibility for subtle or ambiguous cases. Radiographic block or shoe lift correction tests distinguished limb-origin and spine-origin PO through immediate postural correction. Key discriminators included a lumbar curve or PO resolving with block/lift correction suggesting LLD, versus persistent deformity despite correction suggesting spinal etiology. Difficulty remains in diagnosing and treating mixed etiology patients. CONCLUSION: Accurate differentiation of spinal versus limb-driven PO begins with a structured diagnostic approach. AP radiographs, followed by functional block tests, and advanced imaging, may increase diagnostic confidence and decrease unnecessary interventions. Particularly in patients with both LLD and coronal plane SD, prospective studies are required to standardize measurement protocols and improve long-term outcomes. LEVEL OF EVIDENCE: Level IV.
16 June 2026
Read appraisal →Journal of affective disorders
The role of treatment expectancy in lifestyle interventions for depression.
BACKGROUND: Treatment expectancy is a key mechanism underlying placebo. While well-documented in psychopharmacology and psychotherapy, its role in lifestyle-based interventions for mental disorders is uncertain. Given the emerging role of lifestyle-based mental health care, a comprehensive evaluation of the role of treatment expectancy has not yet been explored, especially when compared to other more established therapies. The potential for genuine treatment efficacy to be masked by placebo response may bring into question the magnitude of effects of this treatment. METHODS: We sought to: 1) investigate the role of treatment expectancy as a moderator of depression treatment outcomes in a completed randomised controlled trial of psychotherapy versus lifestyle therapy (the CALM trial); and 2) provide guidance on measuring and reporting expectancy effects in future trials. CALM was a two-arm, parallel-group, non-inferiority randomised controlled trial, comparing lifestyle therapy (delivered by accredited dietitians and exercise physiologists) and psychotherapy (facilitated by psychologists). A total of 182 participants (91 per arm) experiencing psychological distress (equivalent to 'indicative depression') during the COVID-19 pandemic were randomised. We assessed associations of expectancy (measured prior to randomisation using the Credibility-Expectancy Questionnaire) with reductions in depressive symptoms (as measured by the PHQ-9). RESULTS: Expectancy scores did not differ between treatment groups at baseline (β = 1.14; 95%CI = -1.93, 4.22). Both arms reduced PHQ-9 between baseline and 8-weeks (lifestyle mean difference = -30.25%, SD = 58.23%; psychotherapy mean difference = -22.46%, SD = 66.87%). However, higher expectancy was associated with a greater reduction in depression only in the psychotherapy arm: for every 1-unit increase in expectancy score depressive symptoms reduced by an additional 3.21% for psychotherapy compared to lifestyle therapy (95%CI = -5.77, -0.65). CONCLUSIONS: In this study we showed that participants' expectations about treatment at enrolment were only associated with treatment response in psychotherapy. These findings highlight the need to account for modality-specific drivers of expectancy when evaluating all treatments for depression, and support the inclusion of expectancy in reporting guidelines for future trials. REGISTRATION: The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621000387820; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380897).
16 June 2026
Read appraisal →European journal of pharmacology
Inhibition of the serotonin transporter and risk of heart valve disease: A systematic review and meta-analysis
BACKGROUND: The serotonin transporter (SERT) plays an essential role in regulating a wide range of physiological and psychological processes, including neurotransmitter homeostasis, circadian rhythm, sleep regulation, platelet function, immune modulation, mood and emotions. Although SERT was initially studied in the context of neurological and psychiatric disorders, growing evidence highlights how its off-target exogenous inhibition, and the resulting dysregulation of serotonin signaling, can promote valvular interstitial cell proliferation, extracellular matrix remodeling, and fibrosis, thereby contributing to the pathophysiology of heart valve disease (HVD). Despite the increasing interest in the role of SERT in valve biology, mechanistic studies remain limited, and a deeper understanding of the implications of commonly used SERT-targeting drugs in the progression of HVD is still needed. METHODS: In this review, we examine the impact of drug-induced SERT inhibition on HVD, integrating findings from cellular studies, animal models, and clinical data to better understand the risks associated with chronic use of SERT inhibitors. To strengthen the clinical relevance of our review, we also performed a meta-analysis of published clinical studies on SERT-modulating drugs, which revealed a significant association between the use of these medications and increased HVD risk (OR = 2.76). CONCLUSIONS: Our analysis supports the implementation of clinical screening for high-risk patients, such as those with diabetes, hypertension, or pre-existing valvular abnormalities, prior to serotonergic drug recommendations. Ultimately, a deeper understanding of the role of serotonin and SERT in valvular pathophysiology may guide safer prescribing practices and facilitate the development of novel therapeutics for managing or preventing the progression of HVD.
16 June 2026
Read appraisal →Journal of affective disorders
Assessing symptom severity in patients with markedly treatment-resistant depression: Insights from the RECOVER trial
BACKGROUND: The performances of the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptomatology-Clinician (QIDS-C) and Self-Report (QIDS-SR) ratings have never been evaluated in markedly treatment-resistant depression (TRD). RECOVER, a 12-month randomized, controlled trial, compared adjunctive active to adjunctive sham vagus nerve stimulation, provided data to address this knowledge gap, and to examine the basis for the differential sensitivities of these scales in detecting overall and between-treatment-group symptom changes. METHODS: We employed classical test and item response theory methods to characterize each scale. Effect sizes identified items that were most sensitive to change over time across treatments, best discriminated between the two treatments, and best detected at least a partial symptom response in clinician global ratings. RESULTS: All three inventories were unidimensional, with high retest reliability and strong internal consistency. MADRS total scores were less sensitive in detecting overall and between-treatment-group symptom differences. On each scale, five symptom domains-mood, energy/lassitude, interest/inability to feel, negative self-view/pessimism, and concentration-covaried most strongly with overall depression severity and had the largest effect sizes in detecting overall therapeutic change and between-group difference in efficacy. LIMITATIONS: These findings may not generalize to less treatment-resistant populations or to different treatments. The relative insensitivity of suicidal ideation, sleep, and appetite items may be due to study design or concomitant medications. CONCLUSION: The MADRS, QIDS-C, and QIDS-SR are suitable for use in markedly TRD. Whether sadness, energy, interest, guilt, and concentration are "core" symptoms that are especially sensitive to change deserves further study.
16 June 2026
Read appraisal →Sexual health
Digital versus clinic-based sexual health services: patterns of use and equity implications from a UK-based evaluation
BACKGROUND: Digital sexual health services have expanded rapidly in England; yet, concerns remain regarding equitable access among different population groups. We compared demographic characteristics and outcomes between online and clinic-based sexual health service users in Leicester, Leicestershire, and Rutland. METHODS: A retrospective analysis of data (April 2019-June 2023) compared online contacts, via SH:24, a UK online sexual health service providing postal sexually transmitted infection (STI) testing and remote contraception, with in-clinic attendances. Demographic variables included age, gender, ethnicity and Index of Multiple Deprivation (IMD 2019) decile, where Deciles 1-2 represent the most deprived areas. Ethnicity was recoded into Office for National Statistics categories. Reasons for attendance, contraception methods, and STI test outcomes were analysed. Risk ratios with 95% confidence intervals compared proportions between modalities. RESULTS: Online users were younger than clinic attendees (mean age, 25.1 vs 31.4 years). A slightly higher proportion of women accessed online services although gender was unrecorded in 59.1% of online attendances. White and mixed ethnicity groups were more likely to use online services than Black, Asian and 'Other' ethnic groups. Individuals living in the most deprived areas were less likely to access online services. STI testing was more frequent online (56.8% vs 43.3%), while positivity rates for infections were lower. CONCLUSIONS: Complementary to clinic-based sexual health services, online pathways provide accessible STI testing and contraception. Differences in uptake by age, ethnicity and deprivation highlight the importance of monitoring equitable access as digital provision expands. Maintaining both online and face-to-face provision is likely to remain important for equitable sexual health care.
16 June 2026
Read appraisal →Journal of affective disorders
Heart rate variability as a predictor of future depressive symptoms: A systematic review and meta-analysis
Depression has limited early detection strategies. Heart rate variability (HRV), an indicator of autonomic regulation, has been linked to depression cross-sectionally, but its prospective value remains uncertain. We performed a meta-analysis and systematic review examining whether HRV is prospectively associated with later depressive symptom levels. PubMed, Embase, Cochrane, and PsycINFO (inception November 3, 2024) were searched for longitudinal studies of initially non-depressed baseline HRV and at least one-month follow-up assessing depressive or internalizing symptoms. Meta-analyses used multilevel random-effects models; prediction models were synthesized by HRV's statistical role. From 12,023 records, 56 studies entered the meta-analysis, and 62 the qualitative synthesis. HRV showed small but significant negative correlations with later depressive symptoms for frequency-domain indices (HF-HRV (r = -0.16, 95% CI -0.22 to -0.11), LF-HRV (r = -0.19, 95% CI -0.27 to -0.10), and VLF-HRV (r = -0.19, 95% CI -0.28 to -0.11)), and time-domain indices (RMSSD (r = -0.17, 95% CI -0.28 to -0.05) and SDNN (r = -0.15, 95% CI -0.26 to -0.03)). Across prediction-models, HRV showed direct effects in 43% and conditional effects in 57%, involving RSA and nonlinear patterns. HRV reflects psychophysiological mechanisms of depression vulnerability, but its prospective effects are small and context-dependent. Clinically, HRV may function as an adjunctive tool for identifying individuals who are more vulnerable to adversity and for informing preventive strategies, including the personalization of biofeedback and other regulation-focused interventions.
16 June 2026
Read appraisal →International journal of medical informatics
Accuracy and completeness of large language models in Epidemic keratoconjunctivitis Queries: A Comparative study
BACKGROUND: Large language models (LLMs) are increasingly applied in clinical contexts, yet their reliability in disease-specific ophthalmic domains remains insufficiently characterized. Epidemic keratoconjunctivitis (EKC), a highly contagious adenoviral ocular infection, represents a critical area where accurate diagnostic and therapeutic information is essential. This study aimed to assess and compare the accuracy and completeness of responses generated by two widely used LLMs, namely ChatGPT and Meta AI, to standardized ophthalmology questions related to EKC. METHODS: This cross-sectional expert evaluation study was conducted between January and March 2025. Thirty-four structured questions covering five EKC domains (etiology, clinical features, diagnosis, treatment, and prognosis) were developed using authoritative ophthalmology sources. Responses generated by ChatGPT (Plus subscription, web interface) and Meta AI (web interface) were independently scored by two fellowship-trained cornea specialists using a five-point Likert scale for accuracy and completeness. Inter-rater agreement was assessed using Cohen's κ and mean absolute error (MAE). RESULTS: Both models demonstrated strong overall performance, with mean accuracy and completeness scores of 4.87 and 4.90 for ChatGPT and 4.87 and 4.93 for Meta AI, respectively. Agreement between expert raters was substantial (κ range 0.78-0.88). Domain-specific analysis revealed consistently high scores across all categories, with Meta AI showing slightly higher completeness, particularly in diagnostic and symptom-related responses. CONCLUSION: LLMs exhibit consistently strong performance and domain consistency when addressing ophthalmic queries related to EKC. Their performance supports their potential use as adjunct informational and educational tools for ophthalmic conditions such as EKC, particularly for structured knowledge retrieval, treatment explanation, and patient counseling, provided that use remains under appropriate professional oversight.
15 June 2026
Read appraisal →Cancer
Alcohol consumers' receptivity to artificial intelligence-generated alcohol-cancer risk messages: An experimental study.
BACKGROUND: Alcohol is a group 1 carcinogen linked to seven cancers, yet awareness of this risk remains low in the United State. Identifying effective alcohol-cancer communication strategies is a public health priority. The objective of this study was to test the effects of message specificity (general vs. cancer-specific) and visual intensity (text-only, neutral pictorial, graphic pictorial) on message receptivity (attention, emotional reactions) and precursors of behavior (harm perception; intentions to reduce, limit, or stop drinking) among moderate and heavy alcohol consumers. METHODS: Eight evidence-based text messages were created across two topics: general and cancer-specific harm. Artificial intelligence was used to generate pictorial versions at two intensities: neutral (symbolic, no visible disease) and graphic (explicit health consequences). In a 2025 online within-subject/between-subject crossover experiment, 639 US adult consumers (aged 21 years and older; 49.3% female) each viewed two randomly selected messages (one general, one cancer-specific) presented in three formats (text-only, neutral, and graphic; for six total formats), with counterbalanced order. Linear mixed-effects models were used to estimate differences by intensity, specificity, and drinking levels, reporting regression coefficients (β, 95% confidence intervals). RESULTS: Cancer-specific messages produced greater attention, emotional reactions, and intentions to reduce drinking than general messages (β = 0.10-0.19; p < .05). Graphic pictorials outperformed neutral images on emotional and behavioral outcomes (β = 0.19-0.22; p < .05). Moderate consumers showed stronger perceived harm and message responsiveness than heavy consumers (β = 0.29-0.77; p < .05). CONCLUSIONS: Artificial intelligence-generated alcohol-cancer messages are feasible and effective in strengthening precursors to behavior change. Cancer-specific content and higher visual intensity enhance impact, particularly among moderate consumers, highlighting the importance of tailoring alcohol-cancer communication strategies to different audience characteristics. Many people in the United States are unaware that drinking alcohol increases the risk of several cancers. This study tested different ways of communicating the alcohol–cancer link, including text‐only messages, messages with artificial intelligence–generated images (neutral or graphic), and general versus cancer‐specific content; in addition, the authors examined whether responses differed between moderate drinkers and heavy drinkers. The authors observed that messages with images were more effective than those with text alone, especially when the images clearly showed health harm. Messages that named specific cancers (such as breast or colon cancer) were also more effective than general statements about cancer; however, heavy drinkers, who face the highest cancer risk, were less responsive overall. The findings suggest that effective alcohol–cancer communication should carefully consider what the message says, how it is presented, and who the audience is. Nonstigmatizing, harm‐reduction messages that encourage small, realistic changes and are delivered in supportive settings, such as conversations with health care providers, may work better for heavy drinkers. The study also highlights the promise of artificial intelligence as a tool for developing and tailoring health messages. Future research should explore how different messages influence behavior over time.
15 June 2026
Read appraisal →Journal of affective disorders
Brain aging in bipolar disorder using a neuroimaging and machine learning-derived metric: Findings from the ENIGMA BD Working Group.
BACKGROUND: Bipolar disorder (BD) is associated with clinical and biological markers of premature aging. In this largest study of brain age in BD to date, with 2919 participants, we compared brain-predicted age difference (brain-PAD) in individuals with BD and healthy comparison (HC) participants. Brain-PAD is a machine learning-estimated metric that quantifies the difference between an individual's predicted brain age and their chronological age, a potential clinical bio-signature of premature brain aging. Within individuals with BD, we also examined how medication and clinical characteristics were related to brain-PAD. METHODS: Age was predicted from 77 MRI measures of regional subcortical and lateral ventricle volumes, cortical thickness, and surface area for 1342 BD and 1577 HC adult participants, aged 18-75 yrs. old (μ = 37.2; SD = 12.3), from the curated ENIGMA Bipolar Disorder working group (ENIGMA-BD) and leveraging an ENIGMA machine learning model previously trained and validated using independent samples. Chronological age was subtracted from predicted age to produce an individual-level estimate known as brain-PAD. Linear mixed models (adjusting for sex and age as fixed effects and site as a random effect) were used to examine group differences and clinical associations. RESULTS: BD was associated with higher brain-PAD, compared to HC, primarily among older patients, as demonstrated by a significant age by diagnosis interaction (+0.05 [SE: 0.02] years). Individuals with BD on antiepileptic (AED) medications only (+3.20 [SE: 0.78] years) or on both AED and second-generation antipsychotics (SGA) (+3.74 [SE: 0.89] years) demonstrated greater brain-PAD compared to individuals who were not on any of the examined medications. Those taking lithium, whether alone or with AED and SGA independently, showed no difference in brain-PAD compared to individuals not taking any of the examined medications. However, individuals who were taking lithium showed lower brain-PAD compared to those on AED (-4.48 [SE: 0.84] years) or AED and SGA (-5.01 [SE:0.92] years). Individuals with a BD I subtype diagnosis had a higher brain-PAD (+1.50 [SE:0.55] years) compared to those with BDII or subtypes that are not otherwise specified (NOS). CONCLUSIONS: Results from this study suggest compounding effects of BD diagnosis and older age on brain-PAD, an ML-derived summary metric of structural alterations. Within BD, brain-PAD was differentially related to medication use, consistent with prior findings from ENIGMA-BD. Notably, AED use was generally related to more advanced brain age. Lithium use, alone or in combination with other medications, was not associated with advanced brain age, suggesting a possible neuroprotective effect of lithium. Brain-PAD as an ML-derived summary metric of structural alterations of the brain may provide clinical utility in assessing long-term holistic brain health to monitor the effectiveness of lifestyle modifications or treatments over time. LIMITATIONS: The cross-sectional nature of the study design and the limited granularity of the clinical data limit interpretation. Longitudinal studies with detailed chronicity data, medications and clinical measures overtime will improve brain-PAD modeling in BD.
15 June 2026
Read appraisal →Journal of affective disorders
Implementing artificial intelligence (AI) to facilitate health outcomes in mood disorders: Application versus aspiration.
The burden of depressive and bipolar disorders at the individual and societal level are extraordinary and increasing. For decades, evidence-based treatments for these conditions have been established but outcomes amongst individuals with lived experience remains suboptimal. Notwithstanding calls to close gaps between current practice and best practice, there is an absence of evidence that overall health outcomes are significantly improving. Artificial Intelligence (AI) is the cornerstone of the digital revolution. Currently, AI sources (e.g., Open Source) are widely accessed by healthcare providers and persons with lived experience for search queries and decision support. The aspiration for AI-informed medical practice is to improve health outcomes by assisting in timely diagnostic detection, illness monitoring, informing treatment selection, integrating multimodality care, decreasing barriers to access and facilitating scalability to psychosocial interventions. Against this background, rigorous evidence is still needed to empirically demonstrate transformative improvement in each of the aforementioned areas. In addition, multiple ethical, technical, scientific and economic questions are not adequately answered including aspects of confidentiality and patient engagement. This short commentary endeavors to succinctly summarize the evidentiary base as it relates to the capabilities that AI offers currently, in the near and more intermediate term. The overarching aim is to provide readers with an up-to-date understanding of what aspects of AI are currently applicable versus those that are aspirational.
15 June 2026
Read appraisal →Journal of global health
Plasma proteomic signatures predict incident benign prostatic hyperplasia: a prospective cohort study of 20 996 men
BACKGROUND: Benign prostatic hyperplasia (BPH) is a prevalent disease in elderly men. However, the plasma proteomic signatures for incident BPH are absent, hindering early prediction and risk stratification. We aimed to identify plasma proteins associated with incident BPH and the implicated biological pathways. METHODS: This prospective cohort was constructed based on the UK Biobank, enrolling 20 996 BPH-free males at baseline. We used the Olink Explore platform to determine the abundances of 2920 plasma proteins. We used Cox regression models to evaluate associations and the Extreme Gradient Boosting model to perform feature selection and predictive modelling. We performed pathway enrichment and Mendelian randomisation analyses to elucidate the molecular pathways involved and assess causality. RESULTS: During the median follow-up period of 13.38 years, 2405 incident BPH cases were recorded. Cox regression identified 92 plasma proteins significantly associated with BPH risk (false discovery rate <0.05). Extreme Gradient Boosting model prioritised a three-protein signature: TSPAN1 (hazard ratio (HR) = 1.24) and KLK3 (HR = 1.34) as risk factors, and EDA2R (HR = 0.83) as a protective factor. This three-protein panel achieved an AUC of 0.71 (95% confidence interval = 0.69-0.73) for predicting BPH onset. Enrichment analysis revealed the associated proteins were mainly involved in immune-inflammatory pathways and stromal remodelling. As revealed by Mendelian randomisation, TSPAN1 and KLK3 were causally associated with incident BPH. CONCLUSIONS: We identified a three-protein panel (TSPAN1, KLK3, EDA2R) which can predict incident BPH. The findings highlight potential targets for non-invasive risk assessment and therapy.
15 June 2026
Read appraisal →Pulmonology
Hypnodensity sleep metrics from fingertip photoplethysmography are better associated with daytime sleepiness and fatigue than traditional metrics from polysomnography
BACKGROUND: Traditional sleep metrics from polysomnography are often limited by the hypnogram, in which each 30-s epoch is classified into one of the five sleep stages. This oversimplifies sleep stage continuity and fragmented sleep, typical in sleep-disordered breathing (SDB). Deep learning offers more dynamic sleep modelling with a higher temporal resolution by providing probabilities for each sleep stage, known as hypnodensities. RESEARCH QUESTION AND METHODS: We investigated whether high-frequency (1/s) hypnodensities captured from nocturnal fingertip photoplethysmography (PPG) recordings better correlate with patient-reported outcomes in SDB than traditional metrics. RESULTS: Among 2,280 patients (65% male, mean age 62 years, mean apnoea-hypopnoea index (AHI) 23.5/h), we found that several PPG-derived hypnodensity metrics correlate with self-reported daytime fatigue and sleepiness. The level of correlation was better or similar compared to traditional hypnogram-based sleep metrics derived from manually scored polysomnography. Specifically, PPG-based hypnodensities for N1 and N3 sleep showed a stronger association (p < 0.005) with fatigue and sleepiness than manually scored N1 and N3 sleep. Multivariable logistic regression (adjusted for age, sex, body mass index, AHI, and total sleep time below 90% blood oxygen saturation) revealed significant associations (p < 0.01) between multiple PPG-based hypnodensity metrics and daytime sleepiness. CONCLUSION: These findings suggest that PPG-based hypnodensities improve the characterisation of sleep quality and better predict patient-reported outcomes in SDB patients. Future uses may include tracking sleep quality with fingertip pulse oximeters outside of sleep centres, potentially over multiple nights due to their simplicity.
14 June 2026
Read appraisal →Journal of global health
mHealth for chronic disease management: effects on adherence in Ghanaian patients with diabetes and hypertension
BACKGROUND: Medication non-adherence remains a major barrier to effective chronic disease management, particularly in low- and middle-income countries. In Ghana, limited access to continuous care and patient engagement tools contributes to poor adherence among individuals living with type 2 diabetes and hypertension. Mobile health interventions, including smartphone applications, may offer scalable solutions to support long-term medication use and self-management. Here, we assess the effect of a smartphone-based intervention on medication adherence among adults with these conditions. METHODS: We conducted a quasi-experimental study among 874 adults with type 2 diabetes or hypertension in Ghana. Participants were assigned to either a smartphone-based intervention, which included medication reminders, educational content, and self-monitoring tools, or standard care involving routine outpatient management and follow-up without access to the smartphone-based intervention. We measured medication adherence at baseline and six months using the Medication Adherence Rating Scale and assessed it through generalised estimating equations and difference-in-differences analyses, adjusting for baseline adherence, age, sex, and treatment setting. RESULTS: Use of the smartphone application was associated with a greater improvement in medication adherence over six months in the overall study population (adjusted beta coefficient (aβ) = 0.062; 95% confidence interval (CI) = 0.010-0.123). Similar improvements were observed among participants with type 2 diabetes (aβ = 0.067; 95% CI = 0.012-0.135) and hypertension (aβ = 0.068; 95% CI = 0.005-0.134). However, there was no statistically significant difference in adherence between the intervention and control groups at six months. CONCLUSIONS: Smartphone-based interventions were associated with modest improvements in medication adherence over time, although between-group differences at follow-up were not statistically significant. As access to mobile technology expands across Africa, such interventions may provide scalable strategies to support chronic disease management.
14 June 2026
Read appraisal →Journal of neurology, neurosurgery, and psychiatry
Clinically reported covert cerebrovascular disease and risk of neurological disease: a whole-population cohort of 367 988 people using natural language processing
BACKGROUND: The relevance of covert cerebrovascular disease (CCD) in practice is uncertain, partly because estimation of risk in whole clinical populations is difficult. Studies have had success extracting CCD from clinical text using natural language processing (NLP), though they have been limited to specific CCD phenotypes. Here, we used NLP to measure multiple clinically-reported CCD phenotypes in a large clinical cohort and estimated subsequent disease risk in health record data. METHODS: From all people with brain imaging in Scotland (2010-2018), we selected people with no prior hospitalisation for neurological disease (n=367 988). NLP of imaging reports identified: white matter hypoattenuation or hyperintensities (WMH), lacunes, cortical infarcts and cerebral atrophy. Adjusted HRs (aHRs) were estimated between each phenotype and stroke, dementia and Parkinson's disease (conditions previously associated with CCD), epilepsy and colorectal cancer (control conditions). RESULTS: For each phenotype, the aHR of stroke was WMH 1.4 (95% CI 1.3-1.4), lacunes 1.6 (1.5-1.6), cortical infarct 1.8 (1.7-1.9) and cerebral atrophy 1.1 (1.0-1.1). The aHR of dementia was WMH 1.3 (1.3-1.3), lacunes 1.0 (0.9-1.0), cortical infarct 1.1 (1.1-1.2) and cerebral atrophy 1.7 (1.7-1.8). The aHR of Parkinson's disease was WMH 1.1 (1.0-1.2), lacunes 1.1 (0.9-1.2), cortical infarct 0.7 (0.6-0.9) and cerebral atrophy 1.4 (1.3-1.5). The aHRs between CCD phenotypes and epilepsy and colorectal cancer were around the null. CONCLUSION: CCD and atrophy have implications for future disease risk and can be identified at scale using NLP of clinical reports. Prevention of neurological disease in people with CCD should be a priority for healthcare policy makers.
14 June 2026
Read appraisal →JMIR medical education
Training Empathetic Communication Skills in Medical Students With a Role-Prompted GPT-4o Chatbot: Quasi-Experimental Intervention Study
BACKGROUND: There is growing concern that artificial intelligence (AI) may diminish the quality of human relationships. However, in a context of widespread social importance (empathetic conversations between doctors and patients), AI can actually improve human conversational skills, potentially enhancing professional relationships. Recent advances in AI allow for realistically role-prompted counterparts for practicing professional conversations, enabling relational learning without the need for human counterparts. OBJECTIVE: This study aimed to show the effectiveness of AI chatbots for learning professional communicative skills in medical education. Specifically, we hypothesized that a single conversation with an AI chatbot improves communication skills in medical students across 4 different conversational competencies. METHODS: We conducted a quasi-experimental intervention study involving 4 distinct role-prompted scenarios (ie, shared decision-making, motivational interviewing, sexually transmitted diseases, and breaking bad news)-each designed to elicit in-depth empathic conversational skills aligned with key learning objectives in medical curricula. Students rated their competence for the 4 scenarios before and after a conversation with GPT-4o (OpenAI) using default settings, without fine-tuning. We expected higher perceived communication competence (PCC) in their conversation topic after the interaction compared with before the interaction in a 2-sided paired t test. Participants received AI-generated feedback, which they rated regarding adequacy. Post hoc analyses addressed gender and case effects, feedback adequacy, and prevalues in PCC. RESULTS: This study shows that a role-prompted GPT chatbot improves PCC in 162 medical students after a single conversation with mean of 13 (SD 4.8; 95% CI 12-14) prompt-response pairs. We found an increase in PCC with a mean difference of 0.94 (SD 1.64; 95% CI 0.69-1.20; Cohen d=0.58) from 5.89 (95% CI 5.55-6.23; scale 0-10) before the conversation to 6.83 (95% CI 6.55-7.12) after the conversation across 4 different patient role prompts. Furthermore, we found participants rating AI feedback of their conversation to be useful (mean 7.92, SD 1.61; 95% CI 7.67-8.17; scale 0-10), but feedback adequacy did not correspond to PCC increase (r=0.08; P=.32). CONCLUSIONS: Our results demonstrate how role-prompted GPT increases self-assessed communication competencies, introducing a novel tool for teaching relational learning. Our results present a starting point for using AI in education, particularly teaching communication in professional roles. On the basis of our findings in medical education, we anticipate further studies to investigate conversational training between lawyers and clients, marketers and customers, or managers and employees. Our research thus has implications for any field with a need for conversational training and relational learning.
14 June 2026
Read appraisal →PloS one
Internet-based vestibular rehabilitation versus written instructions after acute vertigo: A randomised controlled trial
BACKGROUND: Acute vestibular syndrome (AVS) causes sudden and continuous vertigo, dizziness, and postural instability and is a common reason for emergency department visits, most commonly due to vestibular neuritis and, in rare cases, stroke. Vestibular rehabilitation (VR) is an evidence-based exercise therapy that facilitates vestibular compensation and is effective in chronic vestibular disorders. However, evidence for VR in acute vertigo remains limited and, despite guideline support, it remains underused in practice. Internet-based VR has demonstrated benefit in chronic dizziness but has not been evaluated in acute vertigo. This study aimed to evaluate the efficacy of an internet-based VR tool compared with standard care (written instructions) in reducing vestibular symptoms after acute onset vertigo. METHODS AND FINDINGS: A multicentre, randomised, evaluator-blinded superiority trial was conducted across nine hospitals in Sweden. Adults with ongoing AVS were recruited within 1-7 days after symptom onset and randomised (1:1) to six weeks of internet-based VR with personalised, progressively adjusted home exercises or to written instructions for home-based VR exercises. The primary outcome was the between-group difference in vestibular symptoms at six weeks measured using the Vertigo Symptom Scale Short Form (VSS-SF; range 0-60), with a difference of ≥3 points prespecified as clinically significant. Secondary outcomes included dizziness-related disability, walking speed, and balance. Of 184 randomised participants, 183 were included in the analyses (94 online VR; 89 written instructions; median age 56 years). In the intention-to-treat analysis, both groups improved at six weeks, with no significant between-group difference (adjusted mean difference -2.0 points, 95% CI -4.9 to 0.9; p = 0.18). Per-protocol analyses were consistent (-1.7 points, 95% CI -4.7 to 1.3; p = 0.27). Over 12 weeks, both groups showed reduced vestibular symptoms and improved disability, balance, and walking speed, without significant between-group differences. No serious adverse events were attributed to the interventions, and compliance was high in both groups. CONCLUSIONS: Internet-based VR was not superior to written instructions in reducing vestibular symptoms six weeks after acute onset vertigo. Both groups demonstrated improvement from baseline, with no statistically significant between-group differences. These findings suggest that ensuring access to vestibular rehabilitation exercises may be more important than the specific mode of delivery after acute onset vertigo, and internet-based tools represent viable alternatives for patients who prefer or may benefit from a digital format. TRIAL REGISTRATION: Clinicaltrials.gov NCT05056324. https://clinicaltrials.gov/study/NCT05056324. Registered on September 24, 2021.
14 June 2026
Read appraisal →JMIR mental health
Prevalence and Predictors of Self-Reported Adverse Experiences in Digital Meditation Training: 2 Randomized Controlled Trials
BACKGROUND: Digital meditation-based interventions (MBIs) reach vast global audiences with millions of active users, yet concerns persist about the frequency and nature of adverse experiences (ie, AExs) occurring during meditation training. Some researchers have argued that AExs are substantially underdetected and reflect iatrogenic harm caused by meditation (ie, adverse effects [AEfs]). Others contend that these experiences largely reflect common stressors that would be experienced without meditation. These competing perspectives underscore the need for further research, particularly in the context of digital MBIs, the most widely used form of meditation training. OBJECTIVE: This study examined the prevalence, predictors, and subjective evaluations of AExs during a digital MBI and tested whether reported experiences may be caused by meditation practice via comparisons between meditation-exposed and nonexposed participants. METHODS: Data were drawn from 2 trials of the Healthy Minds Program. Exploratory study 1 (n=315) consisted of a sample of distressed US undergraduate students to estimate the prevalence of AExs and identify baseline predictors. Preregistered confirmatory study 2 (n=594) sampled distressed US adults from all 50 states to replicate findings from study 1 and to examine participants' subjective evaluations of AExs. Study 2 additionally compared AEx rates between participants who did and did not complete guided meditations to assess whether AExs could be caused by meditation exposure. Study 3 (n=87) used qualitative methods to analyze study 1 participants' responses to an open-ended question regarding their strategies for coping with AExs. RESULTS: In studies 1 and 2, 27.9% (88/315) and 10.1% (40/396) of participants, respectively, reported at least one AEx during the study period, with 6.7% (21/315) and 3% (12/396) reporting functional impairment, largely aligning with previous research. Critically, in study 2, rates of AExs did not significantly differ between participants who did and did not complete guided meditations, suggesting that these experiences were not caused by meditation practice. Higher baseline depression, anxiety, loneliness, experiential avoidance, and perceived barriers to meditation predicted more frequent AExs. In studies 1 and 2, 89.8% (79/88) and 90% (36/40) of participants who reported AExs, respectively, indicated that they were glad to have learned to meditate. Qualitative analyses showed that participants used diverse coping strategies, often using skills learned through the Healthy Minds Program. CONCLUSIONS: AExs were relatively common but occurred at comparable rates among participants who did and did not meditate, challenging claims that such experiences were caused by meditation practice in distressed individuals. Although a small subset of participants reported some degree of functional impairment, most evaluated their AExs as tolerable and described their overall MBI experience as positive. Together, these findings highlight the importance of distinguishing AExs that likely reflect epiphenomena of preexisting distress or symptoms from iatrogenic harm attributable to MBIs.
14 June 2026
Read appraisal →Journal of medical Internet research
Telehealth Usability, Engagement Patterns, and Technical Infrastructure in Managing Noncommunicable Diseases Among Health Care Professionals in Brazil, Ghana, Honduras, and the United Kingdom: Multinational Cross-Sectional Study
BACKGROUND: Noncommunicable diseases (NCDs) account for over 70% of global deaths, with hypertension and diabetes serving as major contributors. The COVID-19 pandemic disrupted traditional health care services for NCDs and highlighted telehealth as a crucial alternative. Telehealth-encompassing synchronous and asynchronous electronic communication to deliver clinical services remotely-can overcome geographical barriers and enhance patient engagement. However, telehealth usability among health care professionals (HCPs) remains under-studied across low-, middle-, and high-income countries. OBJECTIVE: This study aimed to examine which telehealth engagement patterns, technical infrastructure factors, and user profiles were most strongly associated with usability among HCPs and to descriptively compare these across 4 diverse countries: Brazil (high- to middle-income country), Ghana (low- to middle-income country), Honduras (low- to middle-income country), and the United Kingdom (high-income country). METHODS: A multinational cross-sectional survey was conducted with 290 HCPs across 4 countries. Participants completed the System Usability Scale and provided data on telehealth engagement (eg, frequency, duration, and number of systems used), technical infrastructure (connection stability and support satisfaction), and their user profile (demographics, job role, and training received). Descriptive statistics summarized these patterns and usability scores. Multiple linear regression with bootstrap-based sensitivity analyses identified factors associated with telehealth usability. Given the nonprobability design, no formal inferential comparisons were made between countries. Instead, observed patterns were reported descriptively. RESULTS: Higher telehealth usability scores were associated with greater connection stability (b=5.06, 95% CI 3.06-7.05), higher satisfaction with online support information (b=5.02, 95% CI 3.27-6.75), more frequent use (b=3.05, 95% CI 1.36-4.73), longer duration of use (b=1.59, 95% CI 0.49-2.68), and being a physician by profession (b=3.82, 95% CI 0.23-7.40). Average usability scores were highest among users in Ghana (mean 79.75, SD 14.19) and the United Kingdom (mean 79.00, SD 14.71), followed by Brazil (mean 72.01, SD 14.62) and Honduras (mean 63.09, SD 15.57). According to System Usability Scale guidelines, scores corresponded to "good" usability for users in Ghana, the United Kingdom, and Brazil and were below the "good" threshold for users in Honduras. While most users in Ghana (97/111, 87.4%), Honduras (31/38, 81.6%), and Brazil (57/80, 70.4%) reported using only 1 telehealth system, two-thirds of UK users (40/60, 66.7%) reported using 2 or more systems. User profiles also varied; prepandemic use was highest in Ghana (84/111, 75.7%) and lowest in Honduras (7/38, 18.4%). Other engagement patterns across countries were reported. CONCLUSIONS: Telehealth usability is driven by technical infrastructure reliability, a robust online support infrastructure, and an "experience effect" from frequent and long-term engagement. Descriptive differences in engagement patterns and infrastructure highlight the need for tailored strategies to address setting-specific challenges. These are essential to optimize telehealth integration and improve health care outcomes for patients with NCDs worldwide.
14 June 2026
Read appraisal →Current atherosclerosis reports
Comparative Efficacy of Nutraceuticals on Endothelial Function: A Systematic Review and Network Meta-Analysis
PURPOSE OF REVIEW: This network meta-analysis (NMA) compares the efficacy of dietary interventions in improving flow mediated dilation (FMD) as a measure of endothelial function among individuals with cardiovascular diseases (CVDs) and hypertension. This work can be a basis for the design of future clinical trials and for the development of evidence-based nutritional guidelines to improve cardiovascular outcomes. RECENT FINDINGS: The most substantial improvements in FMD were observed with magnesium (MD: 8.17; CoE: High), vitamin D3 (MD: 7.84; CoE: High), flaxseed (MD: 7.39; CoE: Low), barberry (MD: 6.64; CoE: Moderate), folic acid (MD: 3.36; CoE: Low), and omega-3 (MD: 1.83; CoE: Very low). Sensitivity analyses confirmed the robustness of these findings. Several dietary interventions, particularly magnesium and vitamin D₃, have been shown to improve endothelial function in individuals with CVDs and hypertension. These findings highlight the potential role of nutritional strategies as adjunct therapies for preserving vascular health. TRIAL REGISTRATION: Systematic review registered with PROSPERO, registration number CRD420251041093.
14 June 2026
Read appraisal →Human vaccines & immunotherapeutics
Immunogenicity and safety of AS03-adjuvanted A/Astrakhan/3212/2020 (H5N8)-like influenza vaccine in adults: Phase 1/2, observer-blinded, randomized trial
Influenza pandemics arise from novel influenza A viruses. Recent emergence of a new clade (2.3.4.4.b) of the highly pathogenic H5N1 in animals and humans highlighted its pandemic potential. We evaluated the immunogenicity and safety of GSK's AS03-adjuvanted H5N8 vaccine in adults. In this phase 1/2, observer-blinded, age-stratified, randomized trial, healthy US adults (age, ≥18 y) received two intramuscular doses of hemagglutinin antigen (3.75 or 7.50 μg) with AS03A or AS03B, administered 21 d apart. Immunogenicity - seroprotection rates (SPRs), seropositivity, geometric mean titers (GMTs), geometric mean fold rise (GMFR), and seroconversion rates (SCRs) - was evaluated on day 43 using hemagglutination inhibition (HI) and microneutralization (MN) assays. Safety was monitored throughout the study. Of 520 enrolled participants, 518 were vaccinated. On day 43, the US Food and Drug Administration's (FDA) Center for Biologics Evaluation and Research criteria for influenza vaccines were met. HI SPRs, seropositivity rates, SCRs, GMTs, and GMFR appeared to be higher in the AS03A vs AS03B group. Immune responses were generally higher in younger (aged 18-64 y) vs older (aged ≥65 y) adults. Immune responses were also detected in MN assays, with a correlation between HI and MN responses on day 43 across age groups and vaccine formulations. Safety was acceptable, with no increase in adverse events post-dose 2. Reactogenicity appeared more common in younger adults. The antigen-sparing potential of AS03 was demonstrated, with an acceptable safety profile. The benefit/risk profile was favorable for all formulations tested, including 3.75 µg AS03A (licensed in the US).ClinicalTrials.gov registration: NCT05975840. Influenza pandemics occur when new influenza viruses emerge, causing widespread illness. A recent study investigated a new vaccine, GSK’s AS03-adjuvanted H5N8 influenza vaccine, for its ability to trigger an immune response and its safety in adults aged 18–64 y and older adults aged ≥65 y. Overall, 518 participants received at least one dose of the vaccine, with different amounts of hemagglutinin antigen (3.75 or 7.50 µg) combined with different concentrations of AS03 adjuvant. Immune responses were assessed at multiple time points, with the primary endpoint measured on day 43 post-vaccination. The vaccine produced a strong immune response in both age groups, with younger adults showing slightly better responses than older adults. The vaccine met the required standards for an immune response set by the US Food and Drug Administration (FDA). AS03A typically induced greater immune response than AS03B. Safety monitoring showed that the vaccine was generally well tolerated, with the most common side effects being mild, such as injection-site pain and muscle ache. This study confirmed that the AS03-adjuvanted H5N8 vaccine has the potential to provide protection against influenza with an acceptable safety profile, making it a valuable candidate for pandemic preparedness.
14 June 2026
Read appraisal →JMIR mHealth and uHealth
WeChat-Delivered Mobile Medical Nutrition Therapy Intervention in Gestational Diabetes Mellitus: Randomized Controlled Trial
BACKGROUND: Medical nutrition therapy (MNT) serves as the foundational intervention in the clinical management of gestational diabetes mellitus (GDM) management. However, inadequate supportive care often hinders patients' ability to sustain dietary modifications and self-management behaviors, particularly for complex regimens. Flexible online interventions are thus gaining interest as adjuncts to clinical care, with the potential to improve the outcomes of GDM self-management. OBJECTIVE: This study sought to evaluate the benefits of WeChat-delivered medical nutrition therapy (WeMNT), a WeChat-delivered MNT intervention, for patients with GDM. METHODS: A parallel-group, single-blind randomized controlled trial (with outcome assessor blinding) was implemented at a university hospital's obstetric clinic. Eligible participants were those with a 24- to 28-week singleton pregnancy, a GDM diagnosis confirmed by the 75 g oral glucose tolerance test, no requirement for insulin therapy, and the ability to use a smartphone and WeChat, as well as to communicate in Chinese. Participants were randomized 1:1 to the intervention (n=47, 50%) or control group (n=47, 50%) using a random number table. The WeMNT intervention was designed per the behavior change wheel framework: (1) analyze capability-, opportunity-, and motivation-based barriers related to MNT adherence; (2) formulate targeted intervention functions; and (3) select evidence-based behavior change techniques. Three WeChat mini-programs served as the core delivery platform to implement the multifaceted intervention functions. The primary outcomes measured in this study included fasting blood glucose, 2-hour postprandial glucose (2hPG), hemoglobin A1c (HbA1c), and gestational weight gain (GWG). The secondary outcomes assessed included obstetric complications and neonatal parameters. Intention-to-treat analysis using adjusted generalized linear mixed models was conducted to evaluate the effects of the intervention. RESULTS: From March 2023 to October 2023, a total of 94 participants were enrolled in this study. Among the participants, 88 (93.62%) individuals (mean age 32.18, SD 5.04 years) successfully completed the study, 44 (46.81%) in the intervention group and 44 (46.81%) in the control group. Approximately 68.18% (30/44) of the participants in the intervention group demonstrated sustained adherence, as expected, adhered to the diet plan ≥60% of the days. Compared with the control group, the intervention group showed a significantly greater decrease in GWG over time (group×time interaction: β=-1.96, 95% CI -3.58 to -0.34; P=.02), with no significant effects on fasting blood glucose. Conversely, significant decreases in 2hPG (β=-0.12, 95% CI -0.19 to -0.04; P<.001) and HbA1c (β=-0.49, 95% CI -0.74 to -0.23; P<.001) were noted in the intervention group. No unexpected maternal adverse events occurred, and no significant effects on other health outcomes were detected. CONCLUSIONS: As a WeChat-delivered, behavior change wheel-informed intervention, WeMNT successfully reduced 2hPG, HbA1c, and GWG in GDM management. Its integrated self-management model yields robust evidence, validating this patient-centered tool as a viable option for clinical adoption.
14 June 2026
Read appraisal →BMJ open
Barriers and facilitators to digital health tool adoption for hypertension management: systematic review of qualitative studies
OBJECTIVES: Digital health interventions (DHIs) show considerable promise in supporting hypertension self-management by promoting preventative care and self-monitoring. While their efficacy is increasingly evident, the long-term uptake, acceptance and sustained engagement with these tools are frequently challenged by issues such as usability, trust and varying user experiences. This review aims to synthesise qualitative evidence to identify barriers and facilitators and the key factors that impact the adoption, acceptance and engagement with DHIs for hypertension self-management. DESIGN: Systematic review of qualitative literature using thematic analysis following Cochrane's qualitative and implementation methods guidance. DATA SOURCES: PubMed, PsycInfo, Web of Science and the Cochrane Library were searched in February 2025. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: The searches included relevant qualitative and mixed-methods studies on the use of digital devices for hypertension management, which described the barriers and facilitators associated with these tools. We included studies published from 2015 to 2025 to capture relevant evidence. Only studies published in English with a qualitative approach were included. RESULTS: From an initial 10 943 identified publications, 15 met our inclusion criteria, primarily originating from Europe and the USA, exploring diverse racial and ethnic group experiences. Our thematic synthesis revealed 7 analytical and 22 descriptive themes detailing barriers and facilitators encountered by patients with hypertension, healthcare providers (HCPs) and caregivers. These themes covered technology utilisation, design components, linguistic and cultural relevance, healthcare factors, trust and credibility and interpersonal interactions. CONCLUSION: Our analysis underscores that factors such as the usability, design and relevance of social support profoundly influence the uptake and acceptance of DHIs in hypertension self-management among patients, caregivers and HCPs. PROSPERO REGISTRATION NUMBER: CRD42023480389.
14 June 2026
Read appraisal →Family practice
Current state of electronic problems lists in primary care: a rapid scoping review
BACKGROUND: Electronic problem lists (PLs) are central to the problem-oriented medical record and increasingly underpin clinical decision support (CDS), interoperability, and emerging artificial intelligence applications in primary care. However, persistent concerns regarding PL accuracy, completeness, and governance limit their clinical value. OBJECTIVE: To update the foundational framework proposed by Hodge and Narus by synthesizing contemporary evidence on electronic PLs in primary care and primary care-relevant settings. METHODS: We conducted a rapid scoping review following Joanna Briggs Institute guidance and PRISMA-ScR reporting standards. MEDLINE (Ovid) was searched for peer-reviewed studies published between March 2016 and May 2026. Eligible studies examined digital PLs or extractable PL-related practices relevant to primary care. Findings were synthesized using a hybrid inductive-deductive approach and mapped to the seven Hodge and Narus themes. RESULTS: A total of 103 studies were included. Across settings, PLs were widely recognized as foundational for longitudinal care, safety, and coordination. However, incomplete, outdated, or inconsistently maintained PLs remained common. Persistent challenges included unclear ownership, workflow misalignment, and variability in what constitutes a "problem." Emerging technologies-including CDS, natural language processing, and machine learning-were increasingly used to support PL generation, curation, reconciliation, and organization, with greatest benefit when embedded within clinician-led workflows. CONCLUSION: Despite technological advances, the clinical value of electronic PLs in primary care continues to depend on governance, workflow integration, and shared accountability. Updating the Hodge and Narus framework highlights the need for sociotechnical approaches to PL improvement as PLs become integral to CDS and artificial intelligence-enabled care. Problem lists (PL) are a key part of electronic health records. They provide clinicians with a quick overview of a patient's important health issues—such as long-term conditions, past diagnoses, and current concerns—and help support safe and informed care. When PLs are accurate and up to date, they can improve communication and decision-making. However, in everyday clinical practice, many PLs are incomplete, outdated, or difficult to maintain. As electronic health records are increasingly used to support clinical decision support tools and new digital technologies, the quality of PLs has become more important than ever. Poor-quality PLs can lead to missed information, duplicated work, or unsafe care decisions. To better understand how PLs are working in modern healthcare, we conducted a rapid scoping review of research published between 2016 and 2026. We examined studies that looked at how PLs are used, how accurate they are, what challenges clinicians face in keeping them updated, and what solutions have been proposed. In total, 103 studies were included. Across these studies, several common problems were identified. Important health conditions were often missing or out of date, and clinicians were frequently unsure who was responsible for updating the PL. Time pressures and busy clinical workflows made regular maintenance difficult. Some studies explored new digital tools, such as automated text analysis, to help identify or update problems, but these approaches are still developing and require careful evaluation. Improving PLs will require clearer standards, shared responsibility among healthcare teams, and EHRs that make updating information easier. Thoughtful use of new technologies may also help reduce clinician workload while improving patient safety. This review highlights where PLs are working well and where improvements are still needed, offering guidance for future research, technology design, and improvements in primary care practice.
14 June 2026
Read appraisal →Journal of medical Internet research
Patient Cognitive Bias in Large Language Model-Supported Health Consultations: Simulation-Based Comparative Study
BACKGROUND: Large language models (LLMs) are increasingly used by patients for health information and preliminary medical advice. In patient-facing consultations, users may present explicitly stated diagnostic preferences or symptom narratives emphasizing a preferred explanation. Such cognitively biased input constrains the diagnostic context available to the model and may systematically steer its reasoning during interactive LLM-supported health consultations. OBJECTIVE: This study aimed to quantify the impact of patient cognitive bias on LLM diagnostic performance in multiturn consultations, assess the effectiveness of prompt-based mitigation strategies and decoding temperature adjustment, and evaluate a dual-system framework for improving robustness under biased interaction. METHODS: We developed a simulated patient agent to generate both unbiased and cognitively biased consultations using 1273 medical question answering dataset United States Medical Licensing Examination cases. Six widely used LLMs of varying capacities were evaluated through 3-round, multiturn dialogues, after which each model produced a final diagnostic judgment based on the complete consultation record. Diagnostic accuracy was the primary outcome. Secondary outcomes included bias-induced accuracy decline (absolute reduction in accuracy under biased vs standard consultations) and bias-influenced error proportion (proportion of incorrect responses aligned with the patient's preferred but incorrect diagnosis). Three prompt-based mitigation strategies and 4 decoding temperature settings were tested. In addition, a dual-system framework was evaluated, in which a conversational foundation LLM conducted patient interaction and history taking (System 1), while a reasoning-oriented LLM (o1-mini) generated the final diagnostic judgment (System 2). In the foundation-only condition, the same LLM performed both interaction and diagnosis. RESULTS: Across all 6 evaluated models, cognitively biased consultations led to marked diagnostic accuracy declines of approximately 7 to 39 percentage points compared with standard multiturn consultations, whereas static single-response tests and standard consultations showed comparable accuracy. Larger deteriorations were observed in lower-capacity models, with some approaching random-guess performance under bias. Errors were frequently aligned with patient bias, with bias-influenced error proportion exceeding one-third across models, indicating systematic conformity rather than random error. Prompt-based mitigation strategies and decoding temperature reduction yielded limited and inconsistent improvements and did not reliably prevent bias-induced performance loss. By contrast, the dual-system framework substantially improved diagnostic accuracy under biased conditions, producing gains of approximately 10 to 39 percentage points across most models and recovering a large proportion of the performance lost due to bias, particularly in lower-capacity systems. CONCLUSIONS: Patient-driven cognitive bias represents an underrecognized behavioral risk in LLM-supported health consultations. Common mitigation approaches, such as prompt engineering or decoding parameter adjustment, provide limited resilience. Explicitly separating conversational interaction from deliberative diagnostic reasoning through a dual-system framework enables more robust diagnostic performance under biased input while potentially preserving patient-facing dialogue fluency by retaining the foundation LLM as the conversational component, offering a scalable design strategy for safer medical AI systems.
14 June 2026
Read appraisal →Journal of neurology, neurosurgery, and psychiatry
On the relationships between apathy, depression and anhedonia
BACKGROUND: Apathy, depression and anhedonia are clinically overlapping constructs, which hinders diagnostic clarity and treatment development. This study aimed to comprehensively characterise these syndromes to identify a core set of non-redundant symptoms that maximally dissociate them and to investigate the psychological nature of key distinguishing features. METHODS: Data from seven datasets (N=4578) of healthy individuals and patients with major depressive disorder were analysed using the Apathy Motivation Index, Beck Depression Inventory and Snaith-Hamilton Pleasure Scale. A machine-learning algorithm identified the most informative, non-redundant items for dissociating 'pure' apathy, depression and anhedonia. The nature of emotional apathy was further investigated with follow-up studies. RESULTS: Although substantial symptom overlap existed, 'pure' syndromes were present. Factor analysis revealed a robust five-factor structure, separating depression, anhedonia and three distinct apathy domains (behavioural, social and emotional). Machine learning identified 10 core symptoms that differentiated the pure syndromes with high accuracy (area under the curve >0.90) and could also identify well the presence of each syndrome in individuals suffering from two or more syndromes. Emotional apathy negatively correlated with depression and was specifically associated with reduced affective empathy and a diminished sensitivity to the intensity of negative facial emotions, rather than with alexithymia or antidepressant-induced emotional blunting. CONCLUSIONS: Apathy, depression and anhedonia are dissociable constructs with distinct symptom signatures. Emotional apathy is a unique dimension which provides a novel target for research. A 10-item Apathy-Depression-Anhedonia Measure developed here provides a pragmatic tool for rapid, precise phenotyping to guide more personalised therapeutic strategies.
14 June 2026
Read appraisal →Journal of medical Internet research
Uptake of Clinical Decision Support Systems Among Health Care Professionals in Six European Countries and the United States: Cross-Sectional Survey Within the I-CARE4OLD Project
BACKGROUND: The use of Clinical Decision Support Systems (CDSS), such as clinical decision rules, algorithms, or machine learning-based applications, has gained attention in recent years. However, their adoption and effectiveness may vary across different health care systems and settings. For a CDSS to be adopted, it must effectively address the practical issues encountered by professionals; however, little research has been done to identify these needs and requirements. OBJECTIVE: This study aims to describe and compare the current use of various decision-support and prediction tools in long-term care for older people across health professionals from 6 European countries and the United States. METHODS: This study analyzed survey data from a CDSS pilot study in a purposive sample of health professionals working with older adults with complex chronic conditions from six European countries and the United States. The survey included participants' general background information, their current use of decision support tools, and their attitudes on the potential benefits of CDSS. About 20 participants were sampled per country. Closed responses were analyzed using correlation coefficients and regression models, while open-ended responses were clustered in a qualitative manner, categorizing each response. RESULTS: A total of 151 professionals (mean age 45.5, SD 11.6 years, 71.5%, 108/151 female) participated in the pilot study. Most participants were physicians (85/151, 56.3%) or nurses (57/151, 37.7%). About 51% (78/151) of the participants reported using CDSS, while 22.4% (34/151) used predictive CDSS, showing important variation across samples from the seven countries. The regression model for comfort with technology showed a positive association for openness to new technologies (β=0.622; P<.001), although an inverse significant association was found for age (β=-0.022; P<.001). No significant associations were found for the actual use of CDSS. Participants reported using CDSS mainly for diagnostic purposes or for guideline implementation, not aimed at prognostic information. In contrast, examples of prognostic tools were most frequently mentioned by respondents as being valuable improvements to clinical practice. CONCLUSIONS: While some countries' samples reported well-integrated digital health infrastructures and higher CDSS adoption rates, others still face challenges in implementing these. However, we found multiple examples of emerging tools, and at the same time, an important demand for predictive CDSS. Our findings highlight the need for improvement of current CDSS implementation and both development and implementation of particularly predictive CDSS.
14 June 2026
Read appraisal →Lancet (London, England)
Atrasentan in patients with IgA nephropathy (ALIGN): final 2·5-year results from a randomised, double-blind, placebo-controlled, phase 3 trial
BACKGROUND: Atrasentan, a selective endothelin A receptor antagonist, reduced proteinuria in the prespecified interim analysis (week 36) of the ALIGN trial in adults with IgA nephropathy. We assessed whether atrasentan slowed estimated glomerular filtration rate (eGFR) decline after 2·5 years' treatment. METHODS: We performed a randomised, double-blind, placebo-controlled, phase 3 trial (133 sites, 20 countries). Adults with biopsy-proven IgA nephropathy, eGFR of at least 30 mL/min per 1·73 m2, and urinary protein excretion of at least 1·0 g/day while receiving renin-angiotensin system inhibition were enrolled (main stratum). An exploratory stratum enrolled participants also receiving an SGLT2 inhibitor. Participants were randomly assigned (1:1) to oral atrasentan 0·75 mg once daily or placebo for 132 weeks, followed by a 4-week off-treatment follow-up. The key secondary endpoint was change from baseline to week 136 in eGFR in the main stratum, assessed in all randomised patients (excluding data after intercurrent events, defined as initiation of restricted or alternative IgA nephropathy medications or kidney replacement therapy). Safety was assessed in all randomised patients who received at least one dose of study treatment. ALIGN is registered with ClinicalTrials.gov, NCT04573478; the double-blind section is complete, and the open-label extension is ongoing. FINDINGS: Between March 15, 2021, and April 28, 2023, 404 participants were randomly assigned (main stratum: 340; SGLT2 inhibitor stratum: 64). In the main stratum, change from baseline in eGFR at week 136 was -7·5 mL/min per 1·73 m2 (95% CI -9·2 to -5·8) with atrasentan and -9·9 mL/min per 1·73 m2 (-11·7 to -8·1) with placebo (between-group difference 2·4 mL/min per 1·73 m2; 95% CI -0·1 to 4·8; p=0·057). The between-group difference in eGFR change from baseline at end of treatment (week 132) was 2·6 mL/min per 1·73 m2 (95% CI 0·1-5·0), and the difference in total eGFR slope (baseline to week 136) was 1·4 mL/min per 1·73 m2 per year (95% CI 0·5-2·3). In the SGLT2 inhibitor stratum, the difference in eGFR change from baseline at week 136 between atrasentan and placebo was 9·1 mL/min per 1·73 m2 (95% CI 3·0-15·2). Treatment-emergent adverse events were well balanced between atrasentan and placebo, with no new safety signals. In the main stratum, fluid retention adverse events occurred in 24 (14%) of 169 patients receiving atrasentan and 20 (12%) of 170 receiving placebo. INTERPRETATION: Atrasentan reduced proteinuria and preserved kidney function after 2·5 years. This effect was present with or without concomitant SGLT2 inhibitor use. Atrasentan was well tolerated. FUNDING: Novartis.
14 June 2026
Read appraisal →Lancet (London, England)
Efficacy and safety of retatrutide, a GIP, GLP-1, and glucagon receptor agonist, in people with type 2 diabetes and inadequate glycaemic control with diet and exercise (TRANSCEND-T2D-1): a double-blind, randomised, phase 3 trial
BACKGROUND: Retatrutide is a GIP, GLP-1, and glucagon triple hormone receptor agonist, under clinical development for type 2 diabetes, obesity, and related complications. We aimed to assess the efficacy and safety of retatrutide as a monotherapy in people with type 2 diabetes that is inadequately controlled by diet and exercise alone. METHODS: In this 40-week, phase 3, randomised, double-blind, placebo-controlled trial at 48 sites in the USA, Mexico, and India, we recruited adults (aged ≥18 years) with type 2 diabetes that is inadequately controlled by diet and exercise alone, glycated haemoglobin (HbA1c) between 7·0% and 9·5% (53-80 mmol/mol), and BMI of at least 23 kg/m2. Participants were randomly assigned (1:1:1:1) to receive retatrutide (4 mg, 9 mg, or 12 mg) or placebo by once-weekly subcutaneous injection. The primary endpoint was the change in HbA1c concentration from baseline to week 40. A key secondary endpoint was the percentage change in bodyweight from baseline to week 40. This trial is registered with ClinicalTrials.gov, NCT06354660, and is completed. FINDINGS: Between April 10, 2024, and April 21, 2025, 930 participants were screened and 537 (296 [55%] female and 241 [45%] male) were randomly assigned: 134 to retatrutide 4 mg, 133 to retatrutide 9 mg, 136 to retatrutide 12 mg, and 134 to placebo. Baseline mean age was 48·8 years (SD 12·1), mean HbA1c concentration was 7·9% (SD 1·1), mean duration of diabetes was 2·5 years (SD 4·4), and mean BMI was 35·8 kg/m2 (SD 7·0). 490 (91%) participants completed the treatment period on study drug and 504 (94%) completed the study. For the treatment regimen estimand, the mean change from baseline in HbA1c concentration was -1·69% (SE 0·11) with retatrutide 4 mg, -1·86% (0·10) with 9 mg, and -1·94% (0·08) with 12 mg, versus -0·81% (0·12) with placebo, resulting in estimated treatment differences versus placebo of -0·88% (95% CI -1·18 to -0·59) with retatrutide 4 mg, -1·04% (-1·32 to -0·76) with 9 mg, and -1·12% (-1·39 to -0·85) with 12 mg (all p<0·0001). The mean percentage change from baseline in bodyweight was -11·5% (SE 0·7) with retatrutide 4 mg, -13·9% (0·8) with 9 mg, and -15·3% (0·8) with 12 mg, versus -2·6% (0·5) with placebo. The most frequent adverse events with retatrutide were generally mild to moderate gastrointestinal events, which subsided over time. Study intervention discontinuations due to adverse events were 2-5% with retatrutide and 0% with placebo. No severe hypoglycaemia was reported. Two deaths occurred during the study, both in the retatrutide 4 mg group and unrelated to the study drug. INTERPRETATION: Retatrutide showed significant improvements in glycaemic control and bodyweight reduction as a monotherapy in adults with type 2 diabetes that is inadequately controlled with diet and exercise alone, with an adverse event profile consistent with molecules with GLP-1 agonist activity, supporting its potential as an effective treatment for type 2 diabetes. FUNDING: Eli Lilly and Company.
13 June 2026
Read appraisal →Blood
Fixed-duration VenO vs FCR/BR in fit patients with untreated CLL: primary analysis of the phase 3 CRISTALLO trial
The phase 3 CRISTALLO trial compared first-line fixed-duration venetoclax-obinutuzumab (VenO) vs fludarabine, cyclophosphamide, and rituximab (FCR)/bendamustine-rituximab (BR) in patients with chronic lymphocytic leukemia (CLL), using undetectable minimal residual disease (uMRD) as the sole primary end point. Previously untreated patients with a cumulative illness rating scale score ≤6 and creatinine clearance ≥70 mL/min without del(17p)/TP53 mutations were randomized 1:1 to VenO or FCR/BR. The primary end point was uMRD (<10-4) in peripheral blood (PB) using next-generation sequencing at month 15. Key secondary end points included uMRD (<10-4) in PB and bone marrow (BM) at end of treatment (EOT) and progression-free survival (PFS). uMRD at deeper cutoffs were explored. At data cutoff (19 March 2024), 80 patients received VenO, and 86 received FCR/BR. Baseline characteristics were generally balanced across arms. The primary end point was met: 81.3% (VenO) and 54.7% (FCR/BR) achieved uMRD (<10-4) in PB at month 15 (P = .0004). uMRD (<10-4) in PB and BM at EOT was also higher with VenO vs FCR/BR. Short follow-up precluded evaluation of PFS at the first planned interim analysis; however, fewer patients progressed/died with VenO vs FCR/BR (7 vs 13). At month 15, 65.0% (VenO) and 25.6% (FCR/BR) achieved uMRD (<10-6) in PB. The overall safety profile was consistent with the known safety profile of each drug. No patient in the VenO arm was deemed high risk for tumor lysis syndrome (TLS) after obinutuzumab debulking; no clinical TLS occurred. These results confirm and extend the findings from the GAIA-CLL13 trial, validating increased depth of response with VenO vs chemoimmunotherapies. This trial was registered at www.clinicaltrials.gov as NCT04285567.
13 June 2026
Read appraisal →Journal of epidemiology and community health
Role of socioeconomic status in modifying the relationship between alcohol use and injury events: evidence from the UK Biobank
BACKGROUND: Alcohol consumption is a well-established risk factor for injuries, yet the role of socioeconomic status (SES) in modifying this relationship remains underexplored. This study examines how SES influences the association between alcohol use and injury events, including both fatal and non-fatal injuries as well as the risk of repeated injuries requiring hospitalisation. METHODS: Using data from the UK Biobank, we applied Cox proportional hazards models to assess whether SES modifies the relationship between different dimensions of alcohol use, average level and heavy episodic drinking (HED), and injury events. For injuries requiring hospitalisation, we fitted negative binomial regression models to estimate incidence rate ratios (IRRs) for the total number of unique injury admissions per individual. RESULTS: Among 482 078 participants, 48 045 injuries were recorded during follow-up. A statistically significant interaction was observed between alcohol use and low education, with individuals in lower education groups showing elevated injury risk compared with the high education group, particularly among those consuming 20-40 g/day with HED (HR: 1.17, 95% CI 1.06 to 1.28) and those consuming over 40 g/day (HR: 1.13, 95% CI 1.04 to 1.23). For non-fatal injuries, similar statistically significant interactions were found (IRR 1.17, 95% CI 1.06 to 1.28; and 1.18, 95% CI 1.08 to 1.29, respectively). CONCLUSION: Our findings highlight that individuals with lower SES face higher risks of alcohol-related injuries. Future research should investigate specific mechanisms underlying these disparities to inform more targeted policies. Population-based pricing policies could be combined with community-based programmes and tailored health messaging to address SES-related vulnerabilities.
13 June 2026
Read appraisal →BMJ open
Diabetic retinopathy treatment cascade and care continuum in the USA: a systematic review
OBJECTIVES: To characterise engagement across the diabetic retinopathy (DR) care continuum in the USA using a cascade-of-care framework and identify gaps contributing to preventable vision loss. DESIGN: Systematic review. DATA SOURCES: From September to November 2025, with an updated search in March to April 2026 using the same eligibility criteria, we systematically searched Ovid MEDLINE and Ovid Embase supplemented by reviewing reference lists of relevant articles and opportunistic searches of the Centers for Disease Control and Prevention publications. ELIGIBILITY CRITERIA: We included English-language US-based cross-sectional, cohort and case-control studies and systematic reviews containing US-based data published between 1 January 2018 and 31 December 2025 relevant to one of the defined DR cascade stages: (1) diagnosis of diabetes, (2) adherence to DR screening, (3) diagnosis of DR, (4) adherence to DR care and (5) DR-related blindness. We included systematic reviews only to inform DR-related blindness, where primary data were limited and excluded them from other stages to avoid double-counting. Exclusion criteria included studies not relevant to one of the defined DR cascade stages and editorial, perspective or commentary pieces. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened studies, extracted data and assessed risk-of-bias using the Newcastle-Ottawa Scale and Risk of Bias in Systematic Reviews tool. We synthesised data narratively and organised via the DR treatment cascade framework. RESULTS: Of 14 893 studies screened, 46 met the inclusion criteria. Cascade analysis revealed substantial losses in patient engagement at three stages: (1) only 15.5%-78.7% (median 59.4%, IQR 33.9%-74.0%) of individuals with diabetes obtain biennial DR screening; (2) a substantial 54.9%-88.5% (median 70.1%, IQR 62.5%-79.3%) of individuals with DR are unaware of their diagnosis; (3) only 30.9%-62.7% (median 52.0%, IQR 40.9%-59.1%) of individuals diagnosed with DR are initially linked to care and 55.3%-77.8% (median 70.3%, IQR 59.2%-77.7%) have a lapse in DR follow-up. CONCLUSIONS: This review identifies major gaps in the DR care continuum, particularly in diagnosis awareness, linkage to care and follow-up adherence. The cascade framework highlights key points of disengagement and provides a basis for prioritising future research.
13 June 2026
Read appraisal →The Journal of clinical psychiatry
Placebo Effects in Alcohol, Cocaine, and Methamphetamine Use Disorder: A Systematic Review and Meta-Analysis
Objective: The placebo effect is established in psychiatry, yet its role in substance use disorders (SUDs) treatment remains unclear. The aim of this study was to evaluate changes in craving scores in placebo groups in randomized controlled trials (RCTs) across different SUDs in adults. Data sources: Eight different databases (PubMed, Embase, Web of Science, Cochrane Library, Emcare, MEDLINE, PsycINFO, and Academic Search) were systematically searched up to October 28, 2024, by 2 independent researchers. Study selection: Placebo-controlled, double-blind RCTs assessing craving in patients with SUDs were included based on predefined eligibility criteria, published in English, Dutch, Spanish, or German language. Search terms were a combination and synonyms of "craving," "addiction," and "placebo." From a total of 1945 unique records identified, 9 articles met our eligibility criteria. Data extraction: Data on demographic characteristics, study design, and outcome results were extracted. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for pre-post craving scores within each placebo group; a positive difference point towards improvement in the postplacebo period. Results: A total of n=495 placebo-treated participants were included from nine RCTs in three different SUDs (n=300 in alcohol, n=88 in cocaine, and n=107 in methamphetamine use disorder). Craving scores significantly decreased over time (meaning symptom improvement) in the placebo treatment group in alcohol use disorder (5 studies, SMD=0.93 [95% CI=0.33 to 1.54]) but did not reach statistical significance in cocaine use disorder (2 studies, SMD=0.61 [95% CI=-1.41 to 2.62]) or in (meth)amphetamine use disorder (2 studies, SMD=0.44 [95% CI=-3.43 to 4.32]). Conclusions: Placebo treatment led to reductions in craving scores across all three SUDs, although statistical significance was achieved only in alcohol use disorder. Given the low number of studies for cocaine and (meth)amphetamine use disorder, these estimates were captured with much uncertainty. These findings may inform the design of future RCTs and support the development of more individualized treatment approaches in clinical settings.
13 June 2026
Read appraisal →Journal of epidemiology and community health
Incidence of physical non-communicable disease in people who have experienced imprisonment compared with the general population in high-income countries: a systematic review and meta-analysis
BACKGROUND: Non-communicable diseases (NCDs) represent a significant cause of morbidity and mortality globally. Despite a strong evidence base outlining increased risk of communicable diseases and poor mental health in people who have experienced imprisonment, the risk of NCDs has not been quantified in previous reviews. This study aimed to describe the incidence of morbidity and mortality of physical NCDs in people who have experienced imprisonment compared with the general population in high-income countries. METHODS: We searched MEDLINE, Embase, CINAHL and SocINDEX (PROSPERO CRD42024540173) for comparative studies of morbidity or mortality from NCDs. Articles were assessed against predefined criteria to select studies that included people with experience of imprisonment; measured NCD incidence; compared incidence to a general population; and were conducted in a high-income country. Two reviewers conducted independent risk of bias assessment using an adapted version of the Newcastle-Ottawa Scale. Data were synthesised using random-effects meta-analyses and vote counting based on effect direction. Meta-regression and subgroup analysis investigated heterogeneity. RESULTS: Of 3085 articles screened, 32 were included providing 341 datapoints. Meta-analysis showed a higher risk of mortality from several diseases, including respiratory disease (risk ratio (RR) 2.38 (95% CI 1.18 to 4.80), I2=97%), cardiovascular disease (RR 1.80 (95% CI 1.32 to 2.46), I2=99%), liver disease and cirrhosis (RR 2.50 (95% CI 1.08 to 5.77), I2=99%), digestive disease (RR 2.92 (95% CI 1.09 to 7.78), I2=99%), neurological disease (RR 1.94 (95% CI 1.09 to 3.44), I2=92%), head and neck cancer (RR 21.31 (95% CI 4.32 to 105.14), I2=97%), liver cancer (RR 4.07 (95% CI 2.34 to 7.08), I2=94%), cervical cancer (RR 3.95 (95% CI 3.11 to 5.01), I2=0%) and lung cancer (RR 1.95 (95% CI 1.34 to 2.85), I2=0%). Synthesis without meta-analysis also indicated imprisonment was associated with increased morbidity from multiple NCDs. CONCLUSIONS: Several NCDs, including multiple cancers, cardiovascular disease, respiratory disease and liver disease, are substantially more common in people who have experienced imprisonment compared with the general population, highlighting a need for primary prevention and NCD management.
13 June 2026
Read appraisal →Human vaccines & immunotherapeutics
Safety and immunogenicity of a booster dose of COVAC-2, a Sepivac SWE™ adjuvanted SARS-CoV-2 recombinant protein vaccine in previously vaccinated healthy adults; a randomized controlled multicentre trial.
This Phase 1 clinical trial evaluated the safety and immunogenicity of COVAC-2, a recombinant protein subunit vaccine as a heterologous booster in adults previously immunized with authorized COVID-19 vaccines (NCT05226702). COVAC-2 contains the SARS-CoV-2 S1 spike protein subunit adjuvanted with Sepivac SWE™, an open-access oil-in-water adjuvant. Sixty participants were randomized to receive a single intramuscular dose of COVAC-2 (10 µg or 25 µg) or placebo, with follow-up through Day 180. The vaccine was well tolerated, with most adverse events being mild or moderate; no serious adverse events were attributed to vaccination. Immunogenicity assessments included spike-binding antibody ELISA, pseudovirus neutralization assays (PNA), ELISpot, and flow cytometry. The 25 µg dose elicited the strongest humoral and cellular responses, with peak antibody titers observed 14 d after COVAC-2 vaccination. While titers waned, they were sustained above baseline through Day 180. ELISpot and flow cytometry revealed elevated IFN-γ and IL-2 responses indicating antigen-specific T-cell activation. Minimal IL-4 and IL-13 responses were demonstrated by flow cytometry. These findings support the safety and immunogenicity of COVAC-2 as a heterologous booster, particularly at the 25 µg dose level. The favorable safety profile, induction of immune responses, and thermal stability of the vaccine formulation suggest its potential utility in global vaccination strategies, especially in low- and middle-income countries. COVAC-2 may offer a scalable and accessible platform for enhancing protection against COVID-19.Clinicaltrials.gov: NCT05226702 - Registered 22 Jul 2022.
13 June 2026
Read appraisal →Journal of medical Internet research
Text Messaging Support for Patients Diagnosed With Impaired Glucose Tolerance During Pregnancy: Nonrandomized Pre-Post Implementation Study Assessing Impact on Postpartum Transitions of Care
BACKGROUND: Patients with impaired glucose tolerance (IGT) identified during pregnancy who do not develop gestational diabetes mellitus (GDM) often do not receive additional interventions for their long-term metabolic risks. OBJECTIVE: This nonrandomized pre-post implementation study reports the design process and initial program evaluation for Better Follow-up of Impaired Glucose Tolerance (BRIDGE), a 12-week text-based postpartum support program promoting hemoglobin A1c (HbA1c) completion and primary care provider (PCP) visit scheduling for patients diagnosed with IGT during pregnancy, assessing improvement in desired postpartum transition milestones. The 19-month program was divided into 2 arms lasting 9.5 months each, BRIDGE- (SMS text messaging support alone; October 2021-July 2022) and BRIDGE+ (SMS text messaging and IGT-focused postpartum visit; July 2022-April 2023). We aimed to assess whether BRIDGE improved desired postpartum transition milestones. METHODS: Patients were eligible for BRIDGE if they received prenatal care at the study site (a northeastern US academic tertiary care center), were diagnosed with IGT during pregnancy, never developed GDM, and could receive English text messages. We performed a program evaluation using a pre/postimplementation design, comparing outcomes for the BRIDGE population to a 19-month historical population. Primary outcomes were (1) completion of HbA1c testing by 1 year postpartum and (2) PCP visit scheduling by 12 weeks postpartum. A comparative analysis between BRIDGE- and BRIDGE+ was performed. Multivariable logistic regressions controlled for the history of IGT after stepwise backward elimination. RESULTS: In the program evaluation, 503 individuals were included (n=342 in historical population, n=82 in BRIDGE- population, and n=79 in BRIDGE+ population), with similar demographic and clinical characteristics across populations. A total of 212 individuals were screened for eligibility in BRIDGE, and 161 individuals participated in the program. BRIDGE participants had increased odds of HbA1c completion by 1 year postpartum (39.8% vs 12.5%; adjusted odds ratio [aOR] 4.28, 95% CI 2.71-6.78) and PCP visit scheduling (31.0% vs 12.0%; aOR 9.58, 95% CI 4.39-20.9) compared to the historical population. BRIDGE+ patients were more likely to complete HbA1c testing by 12 weeks postpartum than BRIDGE- participants. Most patients attended scheduled PCP visits, but rates of IGT counseling at PCP visits were low. CONCLUSIONS: Individuals with IGT rarely receive targeted interventions during pregnancy or delivery hospitalization. This innovative study demonstrates that individuals with IGT have high rates of uptake for postpartum SMS text messaging support, which tripled completion rates of HbA1c screening within 1 year postpartum and doubled the scheduling rate for PCP visits by 12 weeks postpartum. While attendance at scheduled PCP visits was very high, <60% of PCP visits included IGT counseling, highlighting key improvement areas in the quality of postpartum transitions to primary care. While a randomized trial is needed to ascertain definitive impact, SMS text messaging support may be an effective tool to improve postpartum transitions of care for this underserved population.
12 June 2026
Read appraisal →Annals of medicine
Analgesic effect of premixed nitrous oxide in postoperative rehabilitation for ankle fractures: a randomized controlled trial
INTRODUCTION: The global incidence of ankle fractures is on the rise, effective postoperative rehabilitation is a crucial aspect of surgical management. However, the occurrence of severe pain during the rehabilitation continues to pose a substantial clinical challenge. METHODS: The study utilizes a dual-arm, single-center, double-blind, randomized controlled trial design. A total of 100 participants were enrolled. Participants included patients experiencing acute pain (self-reported pain score ≥4) who underwent postoperative rehabilitation for ankle fractures. Participants undergoing rehabilitation training were randomized to receive either 65% nitrous oxide or 100% oxygen. The primary outcome measured was the pain score, while secondary outcomes encompassed anxiety scores, physiological indices, side effects, patient and therapist satisfaction, acceptance, and residual pain. RESULTS: Pain scores were found to be significantly lower in the nitrous oxide group than in the oxygen group (T1: median difference -3.0, [95% CI -3.4 to -2.6]; p < 0.001; T2: median difference -2.0, [95% CI -2.8 to -1.2]; p < 0.001). Compared with the oxygen group, both therapists (p < 0.001) and participants (p < 0.001) in the nitrous oxide group reported significantly higher satisfaction levels. Acceptance rate showed significant intergroup differences (p < 0.001). No severe adverse effects were observed in either group. Anxiety scores between the two groups did not show a significant difference (p = 0.31, η2 = 0.027). CONCLUSION: The safety and analgesic profile of nitrous oxide renders it a suitable option for pain management in postoperative ankle fractures rehabilitation, thus providing a safe and easily manageable alternative to the current available strategies. CLINICAL TRIAL REGISTRATION: We have registered at https://www.chictr.org.cn and the registration number is: ChiCTR2400089379. In comparison with oxygen gas, nitrous oxide has been demonstrated to reduce pain during rehabilitation training following ankle fracture surgery, offering a practical and effective alternative to oral analgesics.The use of nitrous oxide in postoperative rehabilitation training for ankle fractures is relatively safe, with few and mild adverse reactions.Patients and rehabilitation therapists reported high satisfaction with nitrous oxide intervention, and residual pain was significantly reduced.
12 June 2026
Read appraisal →International journal of biometeorology
Impact of balneotherapy on drug consumption: a systematic review and an economic evaluation of drug deprescribing
Some previous studies have suggested that balneotherapy could be associated with a decrease in drug consumption. No study has investigated pharmacoeconomic consequences in terms of monetary savings. The present study was performed to evaluate potential savings (according to societal perspective) associated with decreased drug consumption resulting from spa treatments using randomized clinical trials (RCT) identified after a systematic review. Among 48 RCT, 8 trials investigating rheumatological diseases (low back or shoulder pain, osteoarthritis, ankylosing spondylitis, fibromyalgia), were included in the economic evaluation of direct costs (€) using 2024 data of drug reimbursements according to French health insurance data. Savings calculated related to non-steroidal anti-inflammatory drugs (NSAIDs') decrease were between €0.05 million and €1.03 million at 6 months (mean value: €504.900) for the 441,776 patients who underwent rheumatology-oriented spa treatment in France in 2024 versus controls. For analgesics, values ranged from €0.73 million to around €2.31 million (mean value: €1,547.400). Despite several limitations that could not be overlooked (heterogeneity of studied populations, interventions, duration, outcome measures), the study showsfor the first timethat decreased drug consumption resulting from balneotherapy is associated with important savings regarding NSAIDs and, to a greater extent, analgesics. Balneotherapy is a unique opportunity for deprescribing, enabling both significant monetary savings for national health insurance, complementary health insurances and patients, while preventing adverse drug reactions or decreasing physiotherapy sessions or hospitalizations.
11 June 2026
Read appraisal →Vaccine
Immunogenicity and safety of Sabin-strain inactivated poliovirus vaccine in infants: a systematic review and meta-analysis
BACKGROUND: Poliomyelitis remains a threat to children under five despite global vaccination efforts. The Sabin-strain inactivated poliovirus vaccine (sIPV) has emerged as a safer alternative to conventional Salk-strain IPV (cIPV) due to lower biosafety requirements. This systematic review and meta-analysis evaluated the immunogenicity and safety of sIPV compared with cIPV in healthy infants completing the primary IPV series. METHODS: PubMed, Embase, Scopus, and Cochrane Library were searched for RCTs. Outcomes included seroconversion rates, seroprotection rates, geometric mean titers (GMTs), and adverse events. Data were pooled using random-effects models, and evidence certainty was assessed using RoB 2.0 and GRADE. RESULTS: Seven RCTs with 4646 infants were included. Seroconversion rates were comparable: PV1 100% (RR 1.00, 95% CI 1.00-1.01), PV2 102% (RR 1.02, 95% CI 0.98-1.07), PV3 100% (RR 1.00, 95% CI 0.99-1.01). GMTs were higher for sIPV after PV1 (MD 1.50, 95% CI 0.98-2.02) and PV2 (MD 0.52, 95% CI 0.06-0.98). Local adverse events were similar (OR 1.27, 95% CI 0.95-1.71), while systemic adverse events were higher with cIPV (OR 1.36, 95% CI 1.15-1.60). Fever (OR 1.50, 95% CI 1.20-1.87) and allergic reactions (OR 2.19, 95% CI 1.02-4.69) were slightly more frequent with sIPV. CONCLUSIONS: sIPV provides immunogenicity comparable to cIPV with an acceptable safety profile in infants. Its lower biosafety requirements support its use in global polio eradication programs.
11 June 2026
Read appraisal →Human vaccines & immunotherapeutics
Safety and immunogenicity of 4CMenB and MenACWY-CRM meningococcal vaccines when administered concomitantly in healthy adolescents: A phase 3b, randomized, observer-blind study.
Meningococcal vaccination of adolescents/young adults is recommended in various countries, including the United States (US). This phase 3b, observer-blind study (NCT04318548) evaluated the safety, reactogenicity, and immunogenicity of serogroup B vaccine, 4CMenB, and quadrivalent conjugate vaccine, MenACWY-CRM, when co-administered to healthy individuals aged 16-18 y, as per US Advisory Committee on Immunization Practices recommendations. Adolescents, who had received MenACWY vaccination ≥4 y previously, were randomized (N = 940; 1:1:1) to one of three groups to assess co-administration versus 4CMenB and MenACWY-CRM administered alone. Co-primary objectives were to demonstrate the non-inferiority of antibody responses after concomitant administration to antibody responses after 4CMenB (two doses administered 2 months apart) and MenACWY-CRM (single dose), as measured by human serum bactericidal assay (hSBA). Vaccine safety and reactogenicity were assessed as another primary objective. The co-primary endpoints were met: the lower limit of 2-sided 95% confidence intervals for all between-group ratios of hSBA geometric mean titers was >0.5 for the concomitant administration group versus 4CMenB group and MenACWY-CRM group. hSBA data after two 4CMenB doses and one MenACWY-CRM dose showed comparable between-group geometric mean ratios versus baseline, and percentages of participants with 4-fold rises in titers and titers ≥lower limit of quantitation. The safety profile of 4CMenB co-administered with MenACWY-CRM was comparable with that of 4CMenB administered alone. In conclusion, 4CMenB and MenACWY-CRM co-administration was well tolerated in adolescents aged 16-18 y and immune responses were comparable versus administration of each vaccine alone, which is consistent with a previous study of co-administration in infants. Invasive meningococcal disease, caused by the bacterium Neisseria meningitidis, poses a life-threatening risk but can be prevented through vaccination. Effective vaccines are available against the most common disease-causing meningococcal serogroups, A, B, C, W, and Y. Evidence from clinical studies and immunization programs over the last decade with the 4-component meningococcal serogroup B vaccine, 4CMenB, and serogroups A, C, W, and Y vaccine, MenACWY-CRM, confirms the effectiveness of both vaccines in population age groups at higher risk of meningococcal disease, including infants and adolescents. It was previously shown that the administration of 4CMenB and MenACWY-CRM to healthy infants at the same visit induced good immune responses and was well tolerated by young children. Adolescent vaccination with 4CMenB and MenACWY-CRM is recommended in various countries, including in the United States. We conducted a study to test the safety of concomitant administration and its ability to induce immune responses in 945 healthy adolescents aged 16–18 y; 834 from the United States and 111 from Italy. We found that most reactions to the 4CMenB and MenACWY-CRM injections were mild or moderate, and were similar whether the vaccines were given together or separately, with no unexpected side effects. Co-administration to adolescents induced robust immune responses against serogroup B and serogroups A, C, W, and Y. These results support the use of concomitant meningococcal vaccinations in adolescent immunization programs.
11 June 2026
Read appraisal →World journal of urology
The urologic impact of long-term finasteride 1-mg use for androgenic alopecia: a matched-cohort database analysis
INTRODUCTION AND OBJECTIVES: Since its approval in 1997, finasteride-1 mg (F1) can be taken daily to treat androgenic alopecia (AA) by reducing serum dihydrotestosterone (DHT). When finasteride is prescribed at the 5 mg dosage, the DHT reduction is known to affect sexual function, reduce serum prostate-specific antigen (PSA) levels and treat benign prostatic hyperplasia (BPH). However, there is no literature on the urologic function of men using long-term F1. Thus, we aimed to address this knowledge gap by analyzing a database for the impact of F1 on urologic function. METHODS: Using the Truveta database, we identified men aged 18 + diagnosed with AA per International Classification of Diseases (ICD) coding, with at least 90 days of F1 use and ≥ 5 years of follow-up. Exclusions included patients with a history of anti-depressant usage, prior diagnosis (Dx) or treatment (Tx) of erectile dysfunction (ED), BPH, or prostate cancer (PC). A control cohort with AA but no F1 use was matched based on age, race, ethnicity, and marital status. We compared Dx rates, Tx rates, and time to Dx or Tx using Chi-square and Kruskal-Wallis Rank sum tests. Survival analysis was performed with restricted mean survival time. RESULTS: We identified 3470 patients with long-term F1 use and 3470 matched patients with AA but no F1 use. The average age for the F1 group was 40.59 and 39.75 for the control. Average F1 use duration was 2011.5 days. Median follow-up was 2554.7 days for the F1 group, and 3129.5 days for the control. The F1 group had higher phosphodiesterase type 5 inhibitor (PDE5i) prescription rate (13.6% vs. 10.5%, p < 0.001) and earlier prescription by 238.6 days (95% CI -304.3, -172.9, p < 0.0001). The control group had a higher -blocker prescription rate (4.4% vs. 2.9%, p = 0.001). There were no significant differences in ED diagnosis, BPH Dx rates or time-to BPH diagnosis or α-blocker prescription. The F1 group had lower elevated PSA Dx and PC Dx rates (2.9% vs. 4.4%, p < 0.001; 0.9% vs. 1.8%, p = 0.001). CONCLUSIONS: Though ED diagnosis did not differ significantly, patients on long-term F1 for AA were more likely to be prescribed PDE5i and sooner by approximately 230 days, compared to non-F1 users. F1 did not significantly affect BPH Dx or Tx rates. F1 use was associated with decreased PC and elevated PSA Dx rates. More research on urologic effects of chronic F1 use in AA patients is needed.
9 June 2026
Read appraisal →Blood advances
Final phase 2 study results of acalabrutinib in treatment-naive and relapsed/refractory chronic lymphocytic leukemia
Acalabrutinib is a selective, covalent Bruton tyrosine kinase inhibitor approved for marketing in chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). We report final, long-term phase 1/2 study results in 99 patients with treatment-naive (TN) and 134 with relapsed/refractory (R/R) CLL/SLL. At final data cutoff, 71% and 31% of patients in the TN and R/R cohorts, respectively, remained on acalabrutinib treatment (median follow-up of 73.7 and 52.6 months). Among the events of clinical interest (any grade) in the TN and R/R cohorts, atrial fibrillation was reported in 6.1% and 9.0%, hypertension in 29.3% and 23.1%, other malignancies (excluding nonmelanoma skin cancer) in 14.1% and 17.2%, and major bleeding in 8.1% and 8.2% of patients, respectively. The incidence of the most common adverse events decreased over time. Overall response rates were 97.0% and 94.8% in the TN and R/R cohorts, respectively, with similar response findings among patients with standard and high-risk genomic features. In the TN cohort, median progression-free survival (PFS) was not reached and the 72-month PFS rate was 86.7% (95% confidence interval [CI], 77.0-92.5). For the R/R cohort, median PFS was 66.1 months (range, 0.4-87.8) and the 72-month PFS rate was 45.1% (95% CI, 35.6-54.1). This final analysis extends the duration of benefit observed with acalabrutinib, demonstrates that no new safety signals are apparent with longer follow-up, and confirms the safety and tolerability of acalabrutinib monotherapy for patients with CLL/SLL. This trial was registered at www.clinicaltrials.gov as #NCT02029443.
9 June 2026
Read appraisal →Blood advances
Ropeginterferon alfa-2b for prefibrotic myelofibrosis and lower-risk myelofibrosis requiring cytoreduction
There is currently no consensus on the optimal treatment of early myelofibrosis (MF). Ropeginterferon alfa-2b (ropeg) is a next-generation monopegylated interferon alfa-2b developed specifically to treat myeloproliferative neoplasms. We conducted a phase 2 study in patients with prefibrotic primary MF (pre-PMF) and Dynamic International Prognostic Scoring System low-/intermediate-1-risk fibrotic PMF or secondary MF (SMF) who required cytoreduction. Ongoing treatment with hydroxyurea was substituted with ropeg (week 0, 250 μg; week 2, 350 μg; week 4 onward, 500 μg every 2 weeks). The primary end points were safety and clinicohematologic complete response (CHCR). Seventy-one patients (40 men and 31 women) with a median age of 60 years (range, 31-86) were enrolled and followed up for a median of 119 weeks (range, 10-131). At weeks 24, 48, and 104, CHCR was achieved in 63.8% (pre-PMF, 74%; fibrotic PMF, 20%; fibrotic SMF, 42.9%), 63.5% (pre-PMF, 69.6%; fibrotic PMF, 25%; SMF, 53.9%), and 70% of patients (pre-PMF, 78.4%; fibrotic PMF, 33.3%; SMF, 50%), respectively. Thrombo-hemorrhagic events were not observed after stopping hydroxyurea. At weeks 24, 48, and 104, reduction in JAK2V617F variant allele frequency (VAF) was observed in 53.1%, 70%, and 67.6% of patients, and reduction in CALR mutant VAF was observed in 52.6%, 42.9%, and 40% of patients, respectively. In 50 evaluable cases at week 104, 13 patients (26%) had reduced bone marrow reticulin fibrosis. There were 3 treatment discontinuations (4.2%) due to adverse events. In conclusion, ropeg was safe and induced CHCR associated with significant molecular responses in patients with early MF. This trial was registered at www.clinicaltrials.gov as NCT04988815.
9 June 2026
Read appraisal →Annals of medicine
A body roundness index (BRI)-based predictive model for metabolic syndrome in perimenopausal and postmenopausal women-from a cross-sectional machine learning study to a longitudinal dynamic assessment
BACKGROUND AND AIMS: Metabolic syndrome (MetS) is highly prevalent among perimenopausal and postmenopausal women and poses a major public health challenge because of its association with cardiovascular disease, type 2 diabetes, and premature mortality. However, prediction tools for this population remain limited. Therefore, this study aimed to develop a Body Roundness Index (BRI)-based prediction model for MetS by integrating cross-sectional machine learning and longitudinal assessment. METHODS AND RESULTS: Cross-sectional models were trained using NHANES 2007-2020 and validated in the Affiliated Hospital of Dalian University (2023-2024). Sixteen predictors were selected via LASSO and Boruta, and eight models were evaluated using AUC, calibration, and decision curve analysis. SHAP ranked high-contribution factors. Longitudinal analysis used a 10-year cohort. Annualized change rates and cumulative exposure metrics of five key predictors were combined with baseline values to build Cox models, compared by C-index and time-dependent ROC.The artificial neural network (ANN) demonstrated optimal cross-sectional performance (internal AUC: 0.854; external AUC: 0.878) with good calibration and clinical benefit. SHAP identified BRI, WBC, ALT, MCV, and AST as top contributors, with BRI showing the strongest impact. Longitudinal analysis revealed that integrating annual change rates and annual cumulative exposure of these five predictors achieved optimal discriminative ability (C-index: 0.847), with time-dependent AUCs of 0.853, 0.859, and 0.847 at 1, 3, and 5 years, respectively. CONCLUSION: BRI is significantly associated with MetS in perimenopausal and postmenopausal women. The ANN model provides an efficient cross-sectional screening tool, while incorporating longitudinal trajectories of BRI and key laboratory indicators enhances long-term MetS risk prediction.
7 June 2026
Read appraisal →European journal of medicinal chemistry
Machine learning-based prediction of drug lactation risk: Bridging molecular features and breastfeeding safety
BACKGROUND: Breastfeeding medication safety assessment presents critical challenges due to limited clinical evidence and ethical constraints on lactation studies. While existing computational models focus on predicting pharmacokinetic surrogates such as milk-to-plasma ratios, these endpoints lack direct clinical actionability for therapeutic decision-making. METHODS: We developed LRCpredictor, a computational framework for predicting drug lactation risk based on Dr. Thomas W. Hale's evidence-based Lactation Risk Categories (LRC) system. A dataset of 391 drugs (179 high-risk L4/L5, 212 low-risk L1/L2) was characterized using three complementary molecular representations. Systematic feature engineering with four selection algorithms identified optimal feature subsets. Five ensemble machine learning algorithms were evaluated through cross-validation and independent testing. Multi-level SHAP analysis and structural alert mining were employed to elucidate molecular determinants of lactation risk. RESULTS: The optimal Gradient Boosting Decision Tree (GBDT) model using 35 selected features achieved robust cross-validated performance (AUC = 0.80, MCC = 0.52) and demonstrated notably superior discrimination for extreme risk categories (L1 vs. L5: AUC = 0.85, MCC = 0.62). Analysis revealed lactation risk is governed by the complex interplay of electronic properties, structural topology, electrotopological characteristics, polarizability and drug-likeness attributes. Matched molecular pair analysis demonstrated how specific structural modifications translate into interpretable risk changes. We further identified 18 structural alerts, including five exclusive to high-risk drugs, enabling rapid toxicophore recognition during risk assessment and drug design. CONCLUSIONS: LRCpredictor provides the first interpretable framework for clinically actionable lactation risk prediction with mechanistic molecular insights. The freely accessible web platform (https://lrcpredictor.streamlit.app/) with integrated visual explanations supports evidence-based decision-making for healthcare providers and drug design optimization.
7 June 2026
Read appraisal →BMJ paediatrics open
Impact of flash glucose monitoring versus capillary blood glucose monitoring on glycaemia in Indian youth with type 1 diabetes: a randomised crossover study
BACKGROUND: Data relating to flash glucose monitoring (FGM) use in low-resource settings are limited. Our study investigated the impact of FGM versus self-monitoring of blood glucose (SMBG) on glycaemia in Ahmedabad, India. METHODS: A randomised crossover study of FGM versus SMBG was undertaken. Participants aged 10-25 years (type 1 diabetes (T1D)>1 year) were randomised 1:1 to either Freestyle Libre 1 FGM use (intervention) for 6 months, followed by SMBG≥4 times/day (local care standard) for 6 months; or SMBG≥4 times/day, followed by FGM. After 12 months, everyone entered a 6-month observation period using the monitoring method choice. Insulin and dietary adjustments were undertaken as per local care standards. Glycated haemoglobin (HbA1c) was measured at 0, 3 and 6 months (period 1) and 9 and 12 months (period 2). Analyses included use of linear mixed-effects analysis of covariance, a paired Wilcoxon signed-rank test, and cumulative link mixed tests and model. RESULTS: Of 106 participants, 91 (86%) completed 12 months follow-up (47.3% female). At baseline, mean±SD age was 17.8±3.8 years, diabetes duration 9.9±5.0 years and HbA1c 8.6±1.9% (70±21 mmol/mol).HbA1c decreased when using FGM versus SMBG (difference -0.44% (4.8 mmol/mol); p=0.006), with greater reduction in those with higher baseline HbA1c (p=0.003). In the FGM→SMBG group, HbA1c initially decreased from 8.6±2.2% (70±24 mmol/mol) to 7.9±1.1% (62±12 mmol/mol) at 3 and 6 months (both p<0.05). After SMBG crossover, HbA1c was unchanged (7.9±1.1% (63±12 mmol/mol) at 9 months and 8.1±1.3% (65±14 mmol/mol) at 12 months). In the SMBG→FGM group, HbA1c was initially stable (8.6±1.4% (70±15 mmol/mol) at baseline; 8.8±1.7% (73±19 mmol/mol) at 6 months), but decreased after crossover to FGM (8.4±1.4% (68±15 mmol/mol) at 9 months; 8.3±0.9% (67±10 mmol/mol) at 12 months; p=0.023). CONCLUSION: This study provides evidence of improvement in glycaemic outcomes while using FGM in youth living with T1D in India. TRIAL REGISTRATION NUMBER: Clinical Trial Registry of India (CTRI/2022/02/020175).
1 June 2026
Read appraisal →Journal of medical Internet research
Daily Stress and Heart Rate Variability Among Mindfulness Meditation Practitioners: mHealth Observational Study
BACKGROUND: Mindfulness meditation has been reported to reduce stress and enhance well-being. However, its effects on heart rate variability (HRV)-a physiological marker of stress-remain underexplored. OBJECTIVE: This study aimed to examine how meditation practice is associated with subjective stress, HRV, and their interaction, using mobile health technologies. METHODS: This 3-week observational study included 90 participants-19 meditation practitioners (meditation group), 32 recreational runners as an active control group characterized by lower stress and higher HRV (running group), and 39 individuals without regular meditation or exercise habits (control group). HRV was continuously recorded using Garmin smartwatches. Subjective stress levels and activity states were assessed 3 times daily through a smartphone-based experience sampling method, yielding a total of 4557 responses (mean 50.6, SD 22.8 per participant). From the meditation group, start and end times of 632 daily meditation sessions (mean 33.3, SD 18.3 per participant) were also collected via the app. Standardized questionnaires on stress and related measures were administered at the end of the study period. RESULTS: The questionnaire survey confirmed that stress levels were significantly lower in both the meditation and running groups compared with controls (median Perceived Stress Scale scores: meditation 21, IQR 17-24; running 22, IQR 19-25; control 25, IQR 21-30; Kruskal-Wallis P=.02; adjusted Wilcoxon P=.05 and .04, respectively). Smartwatch-derived HRV (root-mean-square of successive differences [RMSSD]) was elevated in the running group relative to controls (median 47.0, IQR 44.0-54.2 and median 42.0, IQR 34.2-47.8, respectively; P<.001), whereas no significant difference was observed between the meditation and control groups (median 40.8, IQR 35.5-44.4 and median 42.0, IQR 34.2-47.8, respectively). Bayesian analysis of the experience sampling method data indicated that higher subjective stress levels were associated with a concurrent RMSSD reduction of -2.24 (95% credible interval -3.97 to -0.26) milliseconds. Although this pattern was consistent across groups, the steeper decline of -3.94 (95% CI -7.04 to -0.74) milliseconds was observed only in the running group, likely reflecting their elevated baseline HRV. Additionally, Bayesian modeling of 632 logged meditation sessions revealed an acute RMSSD increase of +4.68 (95% CI 2.96 to 6.38) milliseconds during meditation, with effects maintained for at least 30 minutes post practice. CONCLUSIONS: Although HRV among meditation practitioners did not appear elevated in overall daily life, the ability to increase HRV at arbitrary timings, along with the prolonged residual effect, may correlate with stress reduction. This hypothesis requires further exploration with adequate controls. Despite the preliminary nature of this study due to its limited sample size, our findings highlight the potential of mobile health-based methodologies to capture stress and HRV dynamics in real-world settings.
1 June 2026
Read appraisal →Clinical oral investigations
Exploring orofacial myofunctional therapy and its core components in mixed-dentition anterior open bite: the ombit study
OBJECTIVES: To explore the therapeutic effects of OMT in children with AOB in the mixed dentition phase, including a reduced form of OMT (focusing exclusively on breathing pattern and resting postures; OMTBPO) and traditional OMT (also including strength training and correction of swallowing; OMTBPSS). MATERIALS AND METHODS: In this double-baseline, longitudinal study, eight children with AOB (mean age 8.1 years old) were randomly allocated to the OMTBPO (n = 4) or OMTBPSS group (n = 4). Each participant received 7.5 h of OMT across 10 sessions. Outcomes included occlusal parameters, Photographic Open bite Severity Index (POSI) and Peer Assessment Rating (PAR) using 3D intraoral scans, orofacial function based on clinical and standardized assessment (Orofacial Myofunctional Evaluation with Scores; OMES), strength and endurance measurements, and oral health-related quality of life (child oral health impact profile - ortho; COHIP-ortho). RESULTS: Immediately post-therapy, anterior tongue strength had significantly increased in the full sample. At three-month follow-up, palatal volume, lateral lip endurance, and OMES function and deglutition scores had significantly increased, and vertical overbite had decreased. The PAR index showed a significant proportional reduction of 35% from baseline to the last follow-up moment (on average 6 months after therapy). The OMTBPO group showed significantly lower rates of atypical tongue posture and interdental articulation at six-month follow-up. CONCLUSION AND CLINICAL RELEVANCE: This study took a first step in exploring the effectiveness of OMT components in mixed-dentition AOB. Measurable short- to mid-term functional and occlusal improvements were found, and comparable outcomes between protocols suggest that posture-focused OMT may be an efficient interceptive approach. Further research including randomized controlled trials with larger sample sizes is required to provide evidence on efficacy and long-term stability.
1 June 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Developing the multidisciplinary and multispecialty workforce and the systems needed to sustain high-quality care from diagnosis through long-term survivorship
With the growing population of individuals living with and beyond cancer-who often have a variety of complex health needs across their lifetimes-coordinated multidisciplinary, multispecialty expert care is needed to ensure comprehensive survivorship cancer care beginning at diagnosis. Guided by the July 2023 US National Academies of Sciences, Engineering, and Medicine workshop, we describe the evidence and propose steps to (1) identify and promote clinician competencies through education and training; (2) improve communication and care coordination, including leveraging the electronic health record and digital health innovations; (3) examine health system interventions and financial strategies to facilitate multidisciplinary, multispecialty survivorship care; and (4) identify policy, payment, and advocacy challenges and opportunities to achieve equitable, accessible, high-quality care. Although the recommendations are centered on the United States, their applicability to other countries should also be explored.
1 June 2026
Read appraisal →BMJ open
Can digital self-screening improve identification of chronic dyspnoea in Australian general practice? A proof-of-concept protocol for the BREATHE SMART trial.
INTRODUCTION: Chronic dyspnoea is a prevalent and clinically significant symptom, often indicative of underlying cardiorespiratory disease. It is frequently under-reported by patients and under-recognised in primary care, with these challenges exacerbated in rural and remote communities where disease burden is greater and patients experience barriers to timely diagnosis and management. The BREATHE SMART trial aims to implement and evaluate an innovative, fully digital self-screening system for chronic dyspnoea, integrated into general practice workflows and information technology infrastructure. This approach seeks to enhance early detection and management of chronic cardiorespiratory conditions across diverse practice settings. METHODS AND ANALYSIS: This multisite proof-of-concept study will test a software platform delivering a preconsultation self-screening questionnaire across 40 general practices in urban, rural and remote Australia. The system identifies eligible patients (≥18 years, consenting to SMS communication with their practice), issues an automated SMS that administers a validated dyspnoea screening questionnaire, and summarises responses for integration into the electronic medical record. Process evaluation will assess acceptability and utility using deidentified audit data, software metrics and qualitative feedback from patients, staff and general practitioners (GPs) via surveys, interviews and focus groups. Approximately 12 000 patients will be screened over 12 months. Primary outcomes will include the proportion completing self-screening and prevalence of chronic dyspnoea and secondary outcomes will include the rate of newly diagnosed chronic dyspnoea-related conditions (ie, asthma, chronic obstructive pulmonary disease and heart failure) in the preceding 12 months and during the intervention period. ETHICS AND DISSEMINATION: Ethics approval was granted by the University of New South Wales Human Research Ethics Committee (HREC) (iRECS6645) and the University of Notre Dame Australia HREC (2024-155). Participating practices and each GP will provide written, informed consent. All patients being screened will provide electronic informed consent. Results of the study will be disseminated through various forums, including peer-reviewed publications and presentation at national and international conferences. Following the study, participating practices will be provided with a summary of the findings of the study, together with a full copy of any publications and a plain language statement for participants, which will be made available in the practices. TRIAL REGISTRATION NUMBER: ACTRN12624001451594.
1 June 2026
Read appraisal →Lancet (London, England)
Efficacy and safety of intravenous prasinezumab in individuals with early-stage Parkinson's disease on stable symptomatic monotherapy (PADOVA): a phase 2b, multicentre, randomised, double-blind, placebo-controlled study
BACKGROUND: Prasinezumab has previously shown potential for reducing the progression of motor signs (Movement Disorder Society-sponsored Revision of the Unified Parkinson's Disease Rating Scale [MDS-UPDRS] Part III) in patients with early-stage Parkinson's disease who were treatment-naive or receiving monoamine oxidase type B (MAO-B) inhibitors. The aim of the PADOVA trial was to evaluate the efficacy and safety of prasinezumab in a broader population of patients receiving stable symptomatic medication. METHODS: This phase 2b, multicentre, double-blind, parallel-group, placebo-controlled, randomised, superiority trial recruited participants with early-stage Parkinson's disease (age 50-85 years, 3 months to 3 years from diagnosis, Hoehn and Yahr stage 1 or 2) on stable symptomatic medication from 110 centres in nine countries in Europe and North America. Participants were individually randomly assigned (1:1) via permuted blocks (stratified by symptomatic medication [levodopa or MAO-B inhibitor]) to intravenous prasinezumab (1500 mg) or placebo every 4 weeks for at least 76 weeks and until the target number of motor progression events was reached. Participants, investigators, and clinical assessors were masked to group assignment. The primary endpoint was time to a confirmed motor progression event (≥5-point increase in MDS-UPDRS Part III off-medication score), assessed in the full analysis set (all randomly assigned participants according to the treatment to which they were assigned). Safety and tolerability were assessed in all randomly assigned participants who received at least one dose of study drug, with participants grouped according to treatment received. The trial is registered with ClinicalTrials.gov (NCT04777331) and EudraCT (2020-004997-23), and is active, not recruiting. FINDINGS: Between May 5, 2021, and March 22, 2023, 787 individuals were screened. 586 were enrolled and randomly assigned (n=293 per group; mean age 64·2 years [SD 7·3]; 214 [37%] female and 372 [63%] male); 550 completed double-blind treatment (prasinezumab, n=277; placebo, n=273). The primary endpoint was not met; the primary analysis showed a non-significant delay in motor progression with prasinezumab versus placebo (hazard ratio 0·84 [95% CI 0·69-1·01]; p=0·066); median time to confirmed motor progression in the prasinezumab group was 61·1 weeks (95% CI 52·3-71·9), compared with 49·7 weeks (40·1-58·1) in the placebo group. The incidence of one or more serious adverse events was similar between groups (prasinezumab, 34 [12%] of 292; placebo, 34 [12%] of 290) and three recorded deaths were unrelated to the study drug (prasinezumab, n=1 [<1%]; placebo, n=2 [1%]). INTERPRETATION: Although PADOVA did not meet the primary endpoint, prespecified exploratory evidence suggests clinical activity of prasinezumab in early-stage Parkinson's disease, supporting continued investigation in the ongoing phase 3 PARAISO trial (NCT07174310). FUNDING: F Hoffmann-La Roche.
1 June 2026
Read appraisal →Human vaccines & immunotherapeutics
Safety and durability of influenza and SARS-CoV-2 antibody responses through 6 months after a single dose of mRNA-1083, a multicomponent influenza and COVID-19 vaccine, in adults ≥50 years.
Seasonal influenza and SARS-CoV-2 continue to contribute substantially to global morbidity and mortality. mRNA-1083 is an investigational multicomponent mRNA vaccine targeting seasonal influenza and SARS-CoV-2. In this phase 3, observer-blind, active-controlled trial (NCT06097273), adults (aged ≥50 y) were randomly assigned (1:1) to receive mRNA-1083 (40 µg; plus placebo) or age-appropriate licensed comparator vaccines for influenza and COVID-19. Two substudies were included: Cohort A (≥65 y) and Cohort B (50-64 y). Primary objectives were to demonstrate noninferiority of mRNA-1083 versus comparators for influenza hemagglutination inhibition (HAI) responses and SARS-CoV-2 neutralizing antibody (nAb; PsVNA) responses at Day 29 after vaccination and to evaluate safety and reactogenicity of study vaccines. Here, we report safety, reactogenicity, and immunogenicity of mRNA-1083 through Day 181 in adults aged ≥50 y. mRNA-1083 induced HAI titers against all vaccine-matched influenza strains that were maintained through 6 months and were generally comparable to, or higher than, comparator responses. SARS-CoV-2 nAb responses remained higher for mRNA-1083 than comparators through 6 months. Reactogenicity was predominantly grade 1-2 in severity, and vaccination-related unsolicited adverse events were similar between groups. No serious adverse events or deaths related to vaccination were reported through 6 months. In adults aged ≥50 y, mRNA-1083 elicited durable influenza and SARS-CoV-2 humoral immune responses with an acceptable safety profile through 6 months. These findings support the use of mRNA-1083 as a multicomponent vaccine.ClinicalTrials.gov identifier: NCT06097273 (https://clinicaltrials.gov/study/NCT06097273).
1 June 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Cancer patient distress and health service use is linked with carer distress: evidence from a systematic review and meta-analysis
BACKGROUND: Family carers (caregivers) of cancer patients often have poor mental health, which may adversely affect patient wellbeing and health service use. We examined the evidence for this using a systematic review and meta-analyses. METHODS: We systematically searched online databases for studies reporting associations between carer psychological health and either: (a) psychological health of patients with cancer they cared for; or (b) health service use in carers or patients. Studies' risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool. We undertook meta-analyses to estimate pooled correlations for the most commonly reported associations between carer and patient psychological health. For associations between carer psychological health and carer and/or patient health service use, we conducted a narrative synthesis. RESULTS: Our search identified 11,911 records, 169 of which were eligible. The majority of studies were of high-to-moderate quality. Carers who were distressed, depressed, anxious, or had poor scores in the mental component of quality of life were significantly more likely to be caring for patients with these same outcomes (pooled effect sizes ranged from 0.28 to 0.42; all p < 0.001). Subgroup analyses by gender, disease stage, and study quality revealed no substantial differences. Carers with poor psychological health used general practice, mental healthcare, and hospital services more frequently than those who were psychologically healthy, and the patients they cared for used more medications and had more frequent emergency presentations. CONCLUSION: The inclusion of carers alongside patients in early psychosocial care may improve family outcomes and reduce health service use.
1 June 2026
Read appraisal →JMIR research protocols
Implementation of Mobile-Based Programs for Alcohol Cessation in the Treatment of Alcohol-associated Liver Disease: Protocol for a Type 1 Hybrid Implementation-Effectiveness Trial
BACKGROUND: The rising burden of alcohol-associated liver disease (ALD) calls for effective interventions. Alcohol cessation remains the only intervention known to reduce long-term ALD morbidity and mortality. Integrating treatment for alcohol use disorder with medical and hepatology care shows significant promise. OBJECTIVE: This study aims to conduct a randomized, controlled, type 1 hybrid implementation-effectiveness trial in patients with ALD to evaluate an evidence-based smartphone app for alcohol use disorder (Connections). The primary aim is to (1) compare the effectiveness of the Connections app plus usual care to the effectiveness of usual care alone on days of alcohol abstinence for patients with ALD and (2) assess the implementation of the Connections app in the ALD population using a multilevel model of system change to determine facilitators and barriers to the successful adoption of the app at the patient, provider, and clinic levels. METHODS: Study procedures were approved by the Institutional Review Board on March 13, 2024. Patients are recruited from General Hepatology and Multidisciplinary Clinics in Wisconsin and Michigan. Participants are randomized to an intervention (Connections + treatment as usual) or no intervention (treatment as usual). During the 6-month enrollment period, participants complete monthly e-surveys measuring alcohol consumption and quarterly e-surveys measuring patient health indicators and behaviors. Patients earn up to US $240 for participation. RESULTS: This study was funded in September 2023. Recruitment began in June 2024 and is ongoing. As of February 26, 2026, 144 participants have been enrolled in the study. Of these, 65 (45.1%) have completed all the study activities. We aim to recruit 298 participants through 2027, with analysis and results publication estimated in 2028. CONCLUSIONS: Implementation insights highlight the importance of flexibility and strong provider relationships. Challenges include reliance on technology, which limits access for patients with low digital literacy, and the risk of loss to follow-up. This trial is the first fully powered implementation-effectiveness study of a mobile health app for alcohol cessation in ALD, testing a new care model that integrates multidisciplinary expertise. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/94231.
1 June 2026
Read appraisal →BMC health services research
Does an app make patients happy? Impact of a novel medical history app on patient satisfaction in urgent care consultations in Germany: cluster-randomized interventional trial 'DASI'.
BACKGROUND: Patient satisfaction is an important indicator of healthcare quality. However, time constraints in primary care limit effective communication and history-taking. Digital medical history systems have the potential to improve the quality of medical consultations by enabling patient preparation and providing physicians with comprehensive pre-consultation information. This study aimed to evaluate the impact of a novel medical history-taking app (DASI app) on patient satisfaction in out-of-hours practices (OOHP) in Germany. METHODS: We conducted a two-center, cluster-randomized trial over 12 months. Within each practice, weeks were randomized to either an intervention or control group, resulting in a cluster-randomized trial (CRT) with clustering in weeks within the same practice. Patients either used the DASI app before consultations (intervention group) or received standard care (control group). The DASI app is a patient-facing tool that guides patients through a dynamic questionnaire adapted to the selected complaints and previous answers. Patient satisfaction was measured using 17 items from the EUROPEP instrument covering relation and communication, medical care, and information and support. Additionally, we collected sociodemographic data. Statistical analyses included Mann-Whitney U tests for individual items and t-tests for domain scores. Analyses were performed with R, version 4.5.2. RESULTS: Among 1,460 approached patients, 1,040 (71%) were enrolled and 1,034 included in analyses. Patient median age was 31 years, with 60% female participants. Patients in the intervention group (n = 496) showed significantly better ratings in 12 of 17 EUROPEP items compared to controls (n = 538) and demonstrated significantly higher satisfaction across all three EUROPEP domains. Between 78 and 96% of patients rated care as excellent or very good, with intervention group patients more likely to select top-level evaluations in 9 of 17 items. CONCLUSIONS: Digital medical history taking significantly enhanced patient satisfaction in urgent care settings. The app likely improved satisfaction through multiple pathways including increased patient empowerment, better consultation preparation, and more efficient physician-patient interactions. These findings demonstrate that user-friendly digital tools can meaningfully enhance patient experience without disrupting existing workflows, supporting healthcare digitalization efforts while maintaining high-quality patient-centered care. TRAIL REGISTRATION: German register for clinical trials (DRKS00026659; date of registration: 2021-11-03).
1 June 2026
Read appraisal →The New Zealand medical journal
Cancer risk and screening in transgender and gender-diverse individuals on gender-affirming hormone therapy: a review article for the Australasian context
AIM: We aimed to synthesise current evidence on the association between gender-affirming hormone therapy (GAHT) and cancer risk in transgender and gender-diverse (TGD) individuals and to provide evidence-based cancer screening recommendations for Australasian general practitioners. METHODS: A systematic review of epidemiological studies, case reports and clinical guidelines was conducted in accordance with PRISMA 2020 guidelines. Searches were performed across PubMed/MEDLINE, Embase, Scopus and the Cochrane Library for literature published up to December 2025. Key evidence sources were narratively synthesised to develop practical recommendations tailored to the Australasian context. RESULTS: The available evidence, although limited by short follow-up durations and small cohort sizes, does not demonstrate a consistent, statistically significant increase in common cancers among TGD individuals receiving GAHT. However, emerging case reports highlight novel clinical concerns, including malignancies in surgically constructed tissues (neophallus and neovagina). Breast cancer risk in trans women appears to increase with the duration of oestrogen therapy, though it remains lower than in cisgender women. Prostate cancer may present at a higher grade in trans women receiving oestrogen. Screening participation is consistently lower in TGD populations, often resulting in later-stage diagnoses. CONCLUSION: Cancer screening for TGD individuals should be guided by an organ-inventory approach, based on the organs a person has rather than their gender identity. Clinicians should maintain a low threshold for investigating suspicious lesions, particularly in surgically altered tissues. The development of culturally safe and inclusive primary care environments is paramount to improving screening uptake and ensuring equitable health outcomes for TGD communities in Australia and New Zealand.
31 May 2026
Read appraisal →European journal of nutrition
Microencapsulated docosahexaenoic acid increases the Omega-3 Index and attenuates the physiological impact of eccentric exercise in physically trained adults: a 12-week double-blind placebo-controlled trial
PURPOSE: This study investigated the effects of docosahexaenoic acid (DHA) supplementation on delayed onset muscle soreness (DOMS), physical function, and inflammation following eccentric exercise-induced muscle damage in physically trained male and female adults (training ≥ 5d/wk). METHODS: Thirty-eight participants (12 Control, 26 DHA) completed a 12-week double-blind, placebo-controlled matched-pair trial. The Control group received high-oleic acid tablets. The DHA group received 715 mg/d of microencapsulated DHA tablets. Participants performed eccentric cycling at weeks 0 and 12, with assessments conducted pre-exercise, 0-h, 24-h, and 48-h post-exercise. The primary outcomes were DOMS (visual analogue scale) and the Omega-3 Index (O3I) (estimated by finger-stick dry blood spot). Secondary outcomes included neuromuscular function and inflammatory cytokines. RESULTS: O3I was not different between groups at week 0 but was elevated in the DHA group (∆2.43%, [95% CI; 2.10, 2.77], P < 0.001) and between Control at week 12 (P < 0.001). DOMS was lower at 24-h and 48-h post-exercise in the DHA group and between Control at week 12 (P < 0.01). At week 12, jump height and peak vertical force improved at 48-h post-exercise in the DHA group (P < 0.05), resulting in moderate (d = 0.60) and small (d = 0.32) effect sizes for 48-h post-exercise area under the curve (AUC) between groups, respectively. There were interaction effects for 48-h post-exercise AUC of IL-6 (P = 0.049), TNF-α (P = 0.010), and IL-10 (P = 0.026). CONCLUSION: A dietary achievable dose of DHA elevated the O3I and reduced DOMS in physically trained adults. These outcomes support protracted intake of DHA to attenuate the physiological impact of eccentric exercise and promote recovery.
31 May 2026
Read appraisal →Medicine
Predicting depressive symptoms in older adults with hearing impairment development and validation of NHANES-based machine-learning models: A cross-sectional study
Depressive symptoms frequently co-occur with hearing impairment in older adults, yet available prediction tools for this high-risk subgroup remain limited in practicality and applicability. We developed and internally validated prediction models for clinically relevant depressive symptoms among older adults with hearing impairment. We analyzed cross-sectional data from 5 National Health and Nutrition Examination Survey cycles (2005-2006, 2009-2010, 2011-2012, 2015-2016, and 2017-2018). Adults aged ≥60 years with hearing impairment were identified using the 2021 World Health Organization criterion (better-ear pure-tone average at 0.5/1/2/4 kHz ≥20 dB). Depressive symptoms were defined as a Patient Health Questionnaire-9 score ≥10. Candidate predictors included sociodemographic factors, comorbidities, lifestyle behaviors, and sensory/functional limitations; missing covariates were handled using multiple imputation. Participants were randomly split into training and validation sets (7:3). Predictors were selected using the Boruta algorithm followed by least absolute shrinkage and selection operator regression, yielding 6 predictors (age, poverty-income ratio, self-rated health, sleep disorder, memory difficulty, and physical functional limitation). Logistic regression and 6 machine-learning algorithms were developed. Model performance was assessed by discrimination (area under the receiver operating characteristic curve [AUC]), calibration (calibration curves and Brier score), and clinical utility (decision-curve analysis). The analytic sample included 2123 participants, of whom 154 (7.25%) had depressive symptoms. In the validation set, AUCs across models ranged from 0.799 to 0.862. Logistic regression achieved the highest discrimination (AUC 0.862, 95% CI 0.800-0.911) with good calibration (Brier score 0.053) and favorable net benefit across clinically relevant thresholds. A nomogram, a dynamic nomogram, and an online calculator were developed to facilitate individualized risk estimation. Sensitivity analyses showed broadly consistent results, except for attenuated discrimination in the severe hearing-loss subgroup. A parsimonious 6-variable model demonstrated strong discrimination, good calibration, and potential clinical utility for risk stratification and targeted screening among older adults with hearing impairment. External validation and prospective evaluation are warranted before clinical implementation.
31 May 2026
Read appraisal →Medicine
Effect of aerobic exercise of different intensity on articular cartilage metabolism in patients with knee osteoarthritis: A randomized controlled trial
BACKGROUND: Osteoarthritis (OA) of the knee is a leading cause of disability worldwide, yet optimal exercise intensity for cartilage protection remains unclear. This randomized controlled trial investigated dose-response effects of aerobic exercise intensity on cartilage metabolism, clinical symptoms, and structural outcomes in knee OA patients. METHODS: One hundred twenty participants with knee OA (Kellgren-Lawrence grade 2-3) were randomly assigned to low-intensity (50-60% heart rate reserve [HRR]), moderate-intensity (60-70% HRR), high-intensity (70-80% HRR) treadmill walking or stationary cycling, or a control group for 12 weeks (3 sessions/week). Heart rate was continuously monitored using Polar H10 chest-strap monitors. Primary outcomes were serum C-terminal telopeptide of type II collagen and cartilage oligomeric matrix protein levels. Secondary outcomes included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, Visual Analog Scale (VAS) pain, 6-minute walk test, and magnetic resonance imaging-assessed cartilage morphology. Data were analyzed using mixed-model repeated measures analysis of variance with IBM SPSS Statistics version 26.0 (IBM Corp.). RESULTS: The high-intensity group demonstrated the greatest reductions in C-terminal telopeptide of type II collagen (-28.5%, P < .001) and cartilage oligomeric matrix protein (-22.3%, P < .001), the largest improvements in WOMAC scores (-45.3%, P < .001) and VAS pain (-52.5%, P < .001), and the greatest increases in cartilage thickness (+4.2%) and volume (+3.8%). A significant dose-response relationship was confirmed (group × time interaction: F (3108) = 4.82, P = .003). Among participants in the high-intensity group, 73% achieved the minimal clinically important differences (MCID) for WOMAC total score and 80% achieved the MCID for VAS pain. The 6-minute walk test improvement in the high-intensity group (71 m) exceeded the established MCID of 26 m. No serious adverse events were reported; minor events (transient knee pain exacerbation and delayed-onset muscle soreness) resolved spontaneously within 48 to 72 hours. CONCLUSIONS: Appropriately prescribed high-intensity aerobic exercise safely and effectively improved cartilage metabolism, alleviated symptoms, and enhanced functional capacity in knee OA patients. These findings support revising current conservative exercise recommendations upward when tolerable.
31 May 2026
Read appraisal →Medicine
Machine learning-based identification of multidimensional predictors of quality of life in individuals with multiple sclerosis
This study aimed to identify independent predictors of quality of life in patients with multiple sclerosis (MS) using machine learning approaches. One hundred and one individuals diagnosed with MS were included in this cross-sectional study. Quality of life was assessed using the MS Quality of Life-54 (MSQoL-54). Demographic variables, clinical characteristics, disability level (Expanded Disability Status Scale [EDSS]), fatigue severity, sleep quality (Pittsburgh Sleep Quality Index), depression level (Beck Depression Inventory), and functional mobility (Timed Up and Go test) were evaluated. Multiple machine learning regression models, including Linear Regression, Lasso, Elastic Net, Support Vector Machines, Random Forest, and XGBoost, were developed and compared. Five-times repeated five-fold cross-validation was applied for internal validation. Model performance was evaluated using root mean squared error (RMSE), mean absolute error (MAE), and coefficient of determination (R2). Among all models, Lasso regression demonstrated the best predictive performance (RMSE = 5.02, MAE = 4.04, R2 = 0.86). Disability level (EDSS) emerged as the strongest negative predictor of quality of life, followed by fatigue severity, sleep quality, and impaired functional mobility. Although disease duration was not significantly correlated with quality of life in univariate analyses, it showed a positive contribution in the multivariable model. Depression showed a strong bivariate association but had a relatively lower weight in the final predictive model. Quality of life in individuals with MS is strongly influenced by disability, fatigue, sleep quality, and functional mobility. Machine learning approaches provide an effective and interpretable framework for identifying key determinants of quality of life and may support personalized rehabilitation and clinical decision-making in MS.
31 May 2026
Read appraisal →JMIR medical informatics
The Regional Implementation of an Electronic Health Record-Integrated Ambient Scribe in Primary and Secondary Care in England: Real-Time Qualitative Evaluation
BACKGROUND: There is significant potential for ambient scribe technology to enhance health care productivity, with a growing range of applications being developed and implemented internationally. Strong organizational drivers to improve efficiency, coupled with the technology's potential to help address clinician burnout, are accelerating interest and adoption. However, limited attention has been paid to the integration of such systems within electronic health records and unintended consequences, as stakeholders navigate their implementation and integration into clinical practice. OBJECTIVE: This study therefore aimed to explore the processes involved in implementing and adopting ambient scribe technology across diverse health care settings. METHODS: We conducted a real-time, longitudinal qualitative evaluation of a pilot implementation of an integrated ambient scribe system across National Health Service primary care and secondary hospital settings within a care system in the Midlands region of England. Data collection involved in-depth one-to-one interviews conducted in several phases: an initial scoping study to identify key interests and stakeholders for inclusion, followed by an implementation study with participants involved in the pilot. We also conducted 16 hours of nonparticipant observations of consultations. The implementation study gathered data at 2 time points, before implementation and 3 to 4 weeks after, to capture experiences, changes, and emerging impacts over time. RESULTS: We collected data from 45 individuals. Use cases varied across settings and shaped how ambient scribe systems were deployed. Differences between general practice and secondary care in documentation purpose, format, and workflow created challenges for developing and validating templates, though the technology showed flexibility across contexts. Automated note-taking often improved patient interaction but required clinicians to adjust how they spoke to ensure the technology captured their reasoning. Outputs were sometimes generic, reinforcing defensive documentation and reducing personal tone or contextual recall. Integration pathways carried distinct trade-offs: stand-alone systems (which were used by many stakeholders in our study) were easier to adopt but offered limited long-term benefits, while integrated systems required greater effort and standardization, yet promised improved efficiency and safety. CONCLUSIONS: The ambient scribe market remains immature and volatile, creating strategic uncertainty for health systems. Careful procurement approaches are needed to balance the risks and benefits of integrated versus stand-alone systems, while aligning user demand with organizational needs for integration.
31 May 2026
Read appraisal →BMJ open
Multicentre randomised controlled trial of the Norwegian health in work service for patients with common mental disorders or musculoskeletal disorders: the Norwegian Sickness Absence Clinic (NSAC) Efficacy Study
INTRODUCTION: In many countries, a high or increasing rate of sickness absence is challenging the sustainability of present sickness absence benefit schemes. Most sickness absence is certified on the grounds of common mental disorders or musculoskeletal disorders, and substantial effort has been invested in developing interventions promoting return to work for these patients. In Norway, the Health in Work ((HelseIArbeid), HIA) clinics were established as outpatients' services within the specialised healthcare system, with the aim of improving health and supporting return to work. The HIA service admits patients with low-to-moderate anxiety/depression and/or musculoskeletal disorders. In this protocol, we describe the naturalistic multicentre randomised controlled trial Norwegian Sickness Absence Clinic Efficacy study, which aims to determine the effect of HIA on work participation and health. METHODS AND ANALYSES: The HIA outpatient service is staffed by clinical psychologists, physiotherapists, medical specialists in physical medicine and rehabilitation and employment support supervisors from the Norwegian Labour and Welfare Administration. Patients admitted to HIA have access to multidisciplinary assessment and treatment. The trial recruits' patients from five HIA outpatient clinics in Northern Norway. Patients are randomised in equal proportions to either (1) rapid HIA (assessment within 4 weeks), (2) delayed HIA (assessment within 10-14 weeks) or (3) active control, which consists of a monodisciplinary examination at HIA close to diagnosis-specific deadline for examination as suggested by guidelines (8-26 weeks). The trial commenced recruitment on 16 January 2023 and will recruit 2500 patients. The aim is to assess the effect of the HIA service, with the hypothesis that the HIA concept is superior to what resembles treatment as usual, in improving employment and preventing long-term welfare dependency. Secondary outcomes include self-reported symptoms of health problems. We also examine the effect the service has on other healthcare utilisation. To date, no research has been conducted to assess the efficacy of the HIA service. If proven efficacious, and if there is an economic case for this investment in tailored healthcare delivery, the policy implication may be implementation of the service at scale. If not, adaptations or investments into other viable paths of treatment may be considered. ETHICS AND DISSEMINATION: The study is approved by the Regional Committee for Medical Research Ethics (REC North, #122770). Results from the study will be disseminated at national and international scientific conferences, to funders and participating outpatient clinics in seminars and in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: NCT05310695.
31 May 2026
Read appraisal →JMIR infodemiology
Early Depression Detection in Social Media: Monitoring of Individual Nighttime Dynamics and Large Language Model Analysis
BACKGROUND: Depression has become a major global public health challenge, and early intervention is critical for improving patient outcomes. Current depression detection techniques based on social media data (traditional risk detection) rely heavily on users' complete historical information, which cannot meet the timeliness requirements of early intervention. This underscores the need for early risk detection (ERD) methods emphasizing early-stage, real-time warning. However, existing ERD studies have notable limitations such as (1) they overlook temporal activity patterns hidden in posting time stamps, missing vital warning signals; and (2) they depend on static templates or resource-intensive sequence models, resulting in limited interpretability and inefficient use of early data, ultimately constraining their clinical applicability for early intervention. OBJECTIVE: This study aims to develop an efficient, reliable, and interpretable ERD model. The core objectives are to extract temporal activity patterns features from posting time stamps, thereby enriching feature dimensions for risk detection; to leverage large language models (LLMs) for improved text filtering precision and depression-related factor analysis; and to achieve accurate early detection of depression to support clinical intervention. METHODS: We propose the Monitoring of Individual Nighttime Dynamics (MIND) and LLM analysis model, which integrates two key innovations: (1) circadian activity dynamics: posting time stamps are transformed into temporal activity patterns, analyzing fluctuations in posting frequency and timing to derive sleep-related features, thereby compensating for the limitations of text-only approaches, and (2) LLM depression profiler: LLMs are used for dynamic text filtering, automatically removing irrelevant noise and focusing on potential depression-related cues. Based on LLM semantic understanding, latent depression risk factors are identified, enhancing interpretability for clinical treatment and robustness to noise. RESULTS: Experiments on the eRisk2017 (data source: Reddit [Reddit Inc]) benchmark dataset demonstrated that MIND significantly outperformed existing baseline models in early detection sensitivity, specificity, and accuracy. By combining sleep-related features with text analysis, the model achieved interpretable, traceable predictions that can support clinical treatment. ALL relevant experimental code is publicly available. CONCLUSIONS: The MIND model combines temporal activity pattern features with LLM-based text analysis, addressing the challenges of poor interpretability and inefficient use of early-stage data in existing ERD methods. It significantly enhances early detection performance, offering a new paradigm for applying social media data in ERD, thereby enabling earlier intervention and reducing the public health burden of depression.
31 May 2026
Read appraisal →Human vaccines & immunotherapeutics
Strategies implemented to increase HPV vaccine uptake and confidence among men who have sex with men and transgender people: A systematic review
Men who have sex with men (MSM) and transgender persons are disproportionately affected by HPV-related disease. The HPV vaccine effectively prevents infection, but vaccine uptake remains suboptimal in this group. Thus, this systematic review aimed to synthesize the literature on interventions and strategies implemented to increase HPV vaccine confidence and uptake among MSM and transgender persons. Six databases were searched in May 2025. We assessed risk of bias and extracted and descriptively summarized key data through narrative synthesis and content analysis. Sixteen articles reporting on eight interventions were identified, all implemented in high-income settings. The interventions can be broadly categorized into two types: strategies to integrate HPV vaccination into existing health services and digital interventions aimed at generating vaccine demand. Overall, evidence remains limited on interventions to increase HPV vaccine uptake in these groups, particularly studies focusing on the needs of transgender persons.
31 May 2026
Read appraisal →Medicine
Burden of Helicobacter pylori infection in children and adults in Vietnam: A systematic review and meta-analysis of prevalence
BACKGROUND: Although Helicobacter pylori (H. pylori) prevalence has declined in many high-income countries, data from Vietnam remain limited and fragmented. This systematic review and meta-analysis aimed to estimate the pooled prevalence of H. pylori infection in Vietnamese adults and children. METHODS: A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted for observational studies published between January 2000 and September 2025. Eligible studies reported H. pylori prevalence in Vietnamese populations using validated diagnostic methods. Random-effects meta-analyses were used to calculate pooled prevalence estimates with 95% confidence intervals (CIs). Subgroup analyses were conducted by age group, geographic area, and study setting. RESULTS: Twenty-five studies met inclusion criteria, comprising 8204 adults and 4641 children. The pooled prevalence of H. pylori infection was 58.7% (95% CI: 49.9%-67.2%) in adults and 77.2% (95% CI: 67.1%-86.0%) in children, with high heterogeneity across studies (I2 > 98%, P < .001). Among adults, prevalence was 56.4% in those aged <50 years and 65.8% in those ≥50 years (P = .455). Prevalence was lower in rural areas (46.8%) compared to urban areas (60.7%) (P = .045), with no significant difference between community- and hospital-based settings (P = .723). Funnel plot assessment did not indicate evident publication bias. CONCLUSION: H. pylori infection remains common in the populations represented in this study, particularly among urban and healthcare-seeking groups in Vietnam. These findings underscore the need for expanded surveillance and monitoring to better characterize H. pylori infection patterns and inform appropriate response strategies.
31 May 2026
Read appraisal →Medicine
Prevalence and long-term outcomes of brain fog and cognitive impairment in individuals with long COVID: A systematic review
BACKGROUND: Long COVID is increasingly recognized as a complex multisystem condition, with brain fog and cognitive impairment emerging as some of its manifestations. Despite growing literature, the pooled prevalence, subgroup differences, and underlying mechanisms remain incompletely understood. METHODS: We systematically reviewed 47 studies (2000-2025) encompassing over 25,000 patients to evaluate the prevalence of brain fog and cognitive impairment among long COVID populations. Data were extracted on study design, patient demographics, follow-up duration, and subgroup variables including gender, hospitalization, vaccination, and geographic region. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS v9.0) and JBI checklists. Quantitative synthesis was performed with subgroup and temporal analyses, presented in forest plots and summary figures. RESULTS: The pooled prevalence of brain fog was 30% (95% CI: 28-32), while cognitive impairment was 25% (95% CI: 23-27). Female patients consistently showed higher rates compared to males (34% vs 23% for brain fog; 29% vs 21% for cognitive impairment). Community-managed patients demonstrated higher prevalence compared to hospitalized cohorts, and unvaccinated individuals had a greater burden than vaccinated ones. Temporal analyses indicated that prevalence increased with longer follow-up, suggesting symptom persistence or late manifestation. Pathophysiological explanations include neuroinflammation, microvascular injury, immune dysregulation, and psychosocial stressors. CONCLUSION: Brain fog and cognitive impairment are common, persistent, and clinically significant features of long COVID. Gender differences, vaccination status, and follow-up duration influence prevalence. Future studies should focus on mechanisms, preventive strategies, and targeted interventions to mitigate long-term cognitive sequelae.
31 May 2026
Read appraisal →BMC musculoskeletal disorders
The effectiveness of telerehabilitation in upper limb musculoskeletal disorders: a systematic review.
BACKGROUND: Telerehabilitative services have been increasingly used in recent years, raising questions about their effectiveness. In musculoskeletal disorders, evidence supports telerehabilitation but methodological quality of evidence is limited and focused on lower limb disorders. Hence, this systematic review aimed to assess the effectiveness of telerehabilitation in upper limb musculoskeletal disorders. METHODS: We conducted electronic searches in MEDLINE, Embase, and AMED (up until 11/27/2024), complemented by hand searches. Randomized (RCTs) and non-randomized studies of interventions (NRSIs) assessing upper limb musculoskeletal disorders reporting on pain, activities of daily living (ADL), or health-related quality of life (HrQol) were included. We focused on studies from high-income countries in English or German. Risk of bias was assessed using RoB 2 and ROBINS-I. Standardized mean differences (SMDs) and 95% confidence intervals were derived from meta-analysis, where negative values favor telerehabilitation. Certainty of evidence was rated using GRADE. We grouped studies comparing telerehabilitation to standard care (subgrouped into in-person or minimal intervention) and separately examined studies with a tele-adjunct. Compared to in-person rehabilitation we assessed whether outcomes were similarly improved with telerehabilitation. For tele-interventions as adjunct or compared to minimal care we assessed whether telerehabilitation improved outcomes. RESULTS: We included twenty RCTs representing 1,285 participants. All NRSIs were excluded due to critically high risk of bias. Compared to in-person rehabilitation, telerehabilitation showed similar improvements with very low certainty of evidence in pain (SMD: -0.33 [-1.16 to 0.5] VAS/NRS), moderate in ADL (SMD: -0.07 [-0.31 to 0.17] QuickDASH/DASH), and low in HrQol (SMD: -0.26 [-0.82 to 0.31]). Compared to brochure-based exercising, certainty of evidence was low for improved pain (SMD: -0.28 [-0.58 to 0.03]), moderate in ADL (SMD: -0.56 [-0.88 to -0.24]), and low in HrQol (SMD: -0.31 [-0.65 to 0.02]). Tele-adjunct yielded low certainty of evidence for improvements in pain (SMD: -0.38 [-0.71 to -0.05]) and moderate in ADL (SMD: -0.51 [-0.88 to -0.14). CONCLUSIONS: Our results tend to support the effectiveness of telerehabilitation across different comparisons although certainty of evidence is inconclusive. Future studies should particularly investigate the non-inferiority of telerehabilitation compared to in-person rehabilitation and the added benefit of tele-adjunct. TRIAL REGISTRATION: Prospero registration ID: CRD42024622465.
31 May 2026
Read appraisal →BMJ open
Impacts of human and digital scribes on improving physician wellness and reducing administrative burden: a scoping review protocol
INTRODUCTION: The rise in administrative burden on physicians is becoming increasingly recognised as a significant contributor to burnout and job dissatisfaction among primary care practitioners. Human scribes (HS) and digital/artificial intelligence scribes (DS) have emerged as potential tools to reduce clerical workload and improve physician well-being. There has been extensive research conducted on HS, and DS show promise but require validation across diverse healthcare settings. This scoping review aims to assess the effects of HS and DS in primary care settings to evaluate their impact on administrative work, job satisfaction, burnout and clinical operational efficiency. METHODS AND ANALYSIS: This review will follow the Arksey and O'Malley framework with enhancements from Levac et al, along with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines. A comprehensive search strategy was developed, including Ovid MEDLINE, Ovid Embase and Scopus databases in June 2025 with an academic health sciences librarian. Database searches will be conducted between March and June 2026. The inclusion criteria consist of empirical research on licensed physicians in primary care settings that implement HS or DS systems and measure physician-related outcomes. Two researchers will review and extract data independently using Covidence. The results will be analysed through thematic methods followed by descriptive summarisation. ETHICS AND DISSEMINATION: This review conducts an analysis of existing publications without needing ethical clearance. Findings will be disseminated through peer-reviewed publications and presented at academic conferences where possible. The research team will make supporting materials accessible via the Open Science Framework. TRIAL REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/T5BHY.
31 May 2026
Read appraisal →JMIR medical informatics
Advancing Alzheimer Disease Prediction With Large Language Model-Based Linguistic Feature Analysis: Development and Validation Study
BACKGROUND: Alzheimer disease (AD) is a progressive neurodegenerative disorder with rapidly growing global prevalence. Early detection is critical for timely intervention; yet, conventional diagnostic methods remain costly and invasive. Speech-based assessment has emerged as a noninvasive alternative, as AD characteristically impairs linguistic abilities including fluency, coherence, and informational content. Recent advances in large language models (LLMs) offer new opportunities to extract structured linguistic features from transcribed speech for automated AD classification. However, existing LLM-based approaches often lack transparency and clinical interpretability, limiting their adoption in clinical workflows. OBJECTIVE: This study aims to investigate the influence of linguistic features extracted from transcribed speech, as analyzed by LLMs, on the accuracy and interpretability of AD prediction. METHODS: We propose a framework that leverages LLMs to analyze linguistic features extracted from transcribed speech for AD classification. Our approach focuses on 4 key aspects, including readability, fluency, richness of detail, and keyword relevance. To enhance classification accuracy, the framework integrates transcript embeddings with feature explanation embeddings, forming a comprehensive linguistic representation. We conducted extensive ablation studies to evaluate the contributions of individual features and benchmarked our framework against existing LLM-driven methodologies through pairwise explainability evaluations. Output stability was assessed across 3 independent pipeline runs. A fully local configuration (Llama 3 8B + nomic-embed-text) was tested to evaluate privacy-preserving deployment feasibility. Explainability was assessed via LLM-based pairwise comparison (Gemini-3.1-flash-lite) against the method of Bang et al across 54 correctly classified cases and by blinded evaluation from 2 neurologists. RESULTS: The proposed framework achieved a mean precision of 91.52%, a sensitivity of 91.08%, a specificity of 96.29%, and F1-score of 91.05% across 3 independent runs on the ADReSSo 2021 dataset, outperforming existing LLM-based approaches. A fully-local configuration (Llama 3 8B+nomic-embed-text, requiring no cloud application programming interface access) achieved an F1-score of 81.58%, demonstrating framework transferability to privacy-preserving deployment environments. Keyword relevance was the most influential feature (F1-score drop of 13.22 pp when removed). Explainability evaluations showed our method was preferred in 49 out of 54 cases via Gemini-3.1-flash-lite, with human experts preferring our method in 89 of 108 blinded assessments. CONCLUSIONS: These findings highlight that a structured linguistic feature analysis using LLMs provides a robust and interpretable framework for preliminary AD detection. Our approach offers a scalable and accessible solution that bridges artificial intelligence-driven text analysis with clinical applications, supporting early detection of cognitive decline through noninvasive assessment methods.
31 May 2026
Read appraisal →BMJ open
The association of the Healthy Lifestyle Index (HLI) and HLI trajectories with risk of all-cause and cause-specific mortality: a GRADE-assessed dose-response systematic review and meta-analysis.
BACKGROUND: The Healthy Lifestyle Index (HLI) integrates key behaviours to assess their cumulative impact on health. While higher HLI adherence is linked to lower disease and mortality risk, its long-term trajectory association remains understudied. This study aims to examine the dose-response relationship and long-term association of HLI on mortality risks. DESIGN: Systematic review and dose-response meta-analysis using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. DATA SOURCES: PubMed, Scopus and Web of Science were searched until June 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included observational cohort studies that assessed the relationship of HLI or its trajectories with all-cause, cardiovascular disease (CVD)-cause or cancer-cause of mortality. RESULT: Analysis of 13.7 million participants demonstrated that higher adherence to the HLI is linked to lower risk of all-cause (HR: 0.48; 95% CI 0.46 to 0.53; GRADE: moderate), CVD-cause (HR: 0.49; 95% CI 0.44 to 0.51; GRADE: moderate) and cancer-cause mortality (HR: 0.55; 95% CI 0.49 to 0.61; GRADE: low). These associations were further confirmed in a dose-response manner. Moreover, compared with maintaining an unhealthy lifestyle, a decline in HLI adherence was associated with a 14% higher risk of all-cause and a 19% higher risk of cancer-related mortality. In contrast, an improvement in HLI adherence was linked to a 20% lower risk of all-cause and a 13% lower risk of cancer-related mortality. CONCLUSION: Adherence to HLI and its long-term patterns are associated with lower mortality risk. These findings emphasise the importance of lifestyle-based prevention and intervention strategies in reducing mortality. PROSPERO REGISTRATION NUMBER: CRD42024500538.
31 May 2026
Read appraisal →Medicine
Triple oral therapy combining metformin, SGLT-2 and DPP-4 inhibitors versus dual therapy in type 2 diabetes mellitus: A systematic review and meta-analysis
BACKGROUND: Triple oral therapy combining metformin, sodium-glucose cotransporter 2 inhibitor, and a dipeptidyl peptidase-4 inhibitor has been proposed as a synergistic approach to intensify glycemic control in patients with type 2 diabetes mellitus. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of triple therapy compared to dual therapy (metformin plus either sodium-glucose cotransporter 2 or dipeptidyl peptidase-4 inhibitor). METHODS: Following preferred reporting items for systematic review and meta-analysis guidelines, we searched PubMed, Embase, Scopus, and Web of Science through January 2026. Studies included randomized controlled trials comparing triple versus dual therapy in adults with type 2 diabetes mellitus. Outcomes included hemoglobin A1c (HbA1c), fasting plasma glucose, body weight, achievement of HbA1c < 7%, and adverse events (AEs). Pooled standardized mean differences (SMDs) and risk ratios (RRs) were calculated using random-effects models. RESULTS: Eight studies encompassing 2606 participants were included. Findings indicate triple therapy significantly reduced HbA1c levels compared to dual therapy, with a SMD of - 0.54 (95% confidence interval [CI]: -0.92 to -0.16; P = .005). Triple therapy resulted in greater reduction in fasting plasma glucose, with an SMD of -0.30 (95% CI: -0.62 to 0.01; P = .06). Patients on triple therapy were more likely to achieve HbA1c levels below 7% (RR: 2.02; 95% CI: 1.55-2.63; P < .0001). Weight reduction was modest, with an SMD: -0.14 (95% CI: -0.22 to -0.07; P = .0002). No significant differences were found in total AEs (RR = 0.97; P = .69) or hypoglycemia (RR = 1.32; P = .32), although there was higher discontinuation due to AEs (RR = 2.62; P = .03). CONCLUSION: Triple therapy offers superior glycemic control over dual therapy without major safety trade-offs, though tolerability may affect long-term adherence.
31 May 2026
Read appraisal →Lancet (London, England)
Efficacy and safety of oral semaglutide 14 mg (flexible dose) in early-stage symptomatic Alzheimer's disease (evoke and evoke+): two phase 3, randomised, placebo-controlled trials
BACKGROUND: Evidence, including animal, clinical, and real-world studies in individuals with type 2 diabetes and/or obesity, suggests reduced risk of dementia and Alzheimer's disease after GLP-1 receptor agonist exposure. The evoke and evoke+ trials aimed to investigate the efficacy and safety of oral semaglutide in individuals with early Alzheimer's disease. METHODS: evoke and evoke+ were multicentre, randomised, double-blind, placebo-controlled phase 3 trials conducted across 566 sites in 40 countries. The trials assessed the efficacy and safety of oral semaglutide up to 14 mg once daily in participants with amyloid-confirmed Alzheimer's disease, aged 55-85 years, with mild cognitive impairment or mild dementia due to Alzheimer's disease. In evoke+, participants with significant small vessel pathology were included. Participants were randomly assigned (1:1) to once-daily semaglutide 14 mg (flexible dose) or placebo for up to 156 weeks. The primary endpoint was change in Clinical Dementia Rating-Sum of Boxes (CDR-SB) score from baseline to week 104, assessed in all randomised participants. Safety was assessed in all randomised participants and reported for those receiving at least one dose of study drug. These trials were registered at ClinicalTrials.gov (NCT04777396 and NCT04777409); both trials have been discontinued due to negative clinical outcome. FINDINGS: Between May 18, 2021, and Sept 8, 2023, 9981 participants were screened, of whom 3808 were randomly assigned; 1855 in evoke (semaglutide, n=928; placebo, n=927) and 1953 in evoke+ (semaglutide, n=976; placebo, n=977). Mean age was 72·2 years (SD 7·1), and mean CDR-SB score was 3·7 (SD 1·6) at baseline. In evoke+, 54 (2·8%) participants had small vessel pathology. In evoke and evoke+, mean changes in CDR-SB score from baseline to week 104 were 2·3 (SE 0·1) and 2·2 (0·1) with semaglutide, compared with 2·3 (0·1) and 2·1 (0·1) with placebo (estimated difference -0·08 [95% CI -0·35 to 0·20], p=0·57 in evoke and 0·10 [-0·17 to 0·38], p=0·46 in evoke+). Treatment-emergent adverse events were reported in 1729 (91·2%) of 1896 participants receiving semaglutide versus 1613 (84·8%) of 1902 receiving placebo. There were five fatalities considered treatment-related by the investigators (one in the semaglutide group and four in the placebo group). INTERPRETATION: Oral semaglutide was not efficacious in slowing clinical progression in participants with early Alzheimer's disease. Safety and tolerability of semaglutide in early Alzheimer's disease is consistent with studies in other indications. FUNDING: Novo Nordisk.
31 May 2026
Read appraisal →The British journal of general practice : the journal of the Royal College of General Practitioners
General practice incentives: a review of the international literature.
BACKGROUND: In Australia, the general practice sector faces significant challenges, leading to a re-evaluation of its predominantly fee-for-service (FFS) funding models. AIM: To conduct a systematic review of reviews that evaluated the efficacy of funding models in general practice on quality outcomes in multidisciplinary primary and preventive care for people with complex chronic conditions, as well as the contextual factors that have influenced their implementation. DESIGN AND SETTING: Only systematic reviews and meta-analyses were included. Search terms covered funding mechanisms, primary care, and general practice. The review followed PRISMA guidelines for systematic reviews. METHOD: PubMed, Cochrane, Embase, CINAHL, PsycInfo, PAIS, and Web of Science databases were searched in November 2023 for publications from 2010 onwards. RESULTS: Twenty reviews were included. Blended payment models incorporating pay-for-performance (P4P) with either capitation payments or FFS were associated with small improvements in quality outcomes, particularly in multidisciplinary settings. Changes in intermediate health outcomes and process measures for people with complex chronic conditions were most evident in diabetes care but inconclusive for other health outcomes and conditions. Improvements were mainly observed in incentivised activities and in less rigorously designed studies, with ceiling effects and variation reported across healthcare systems. There was no evidence that introducing capitation payments as part of blended payments improved quality of care. CONCLUSION: Although blended payment models show promise, evidence for the effectiveness of models including P4P is highly variable. If adopted, careful evaluation of each incentive's impact on both quality and equity will be essential.
31 May 2026
Read appraisal →BMJ open
Birth outcomes for women with pre-existing mental health problems: a systematic review and meta-analysis
OBJECTIVES: To synthesise evidence on the association between any diagnosed or self-reported mental health problems prior to pregnancy (pre-existing mental health problems) and birth outcomes including preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA), neonatal unit (NNU) admission and mode of birth (instrumental birth, planned or unplanned caesarean section). METHODS: Systematic searches were conducted in MEDLINE, CINAHL, Embase and PsycINFO in December 2024 for studies examining the association between any pre-existing mental health problems and PTB, LBW, SGA, NNU admission and mode of birth. Only articles published in English were included with no restriction on year of publication. Two reviewers independently screened studies and extracted data. Study quality was assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute checklists. Random-effects meta-analyses were conducted to pool crude and adjusted ORs (aORs) and risk ratios (aRR) with 95% CIs. ORs and RRs were analysed separately. Between-study heterogeneity was quantified using the I2 statistic. RESULTS: Of 15 467 records screened, 33 studies met the inclusion criteria. Women with any pre-existing mental health problems had higher odds and risks of adverse birth outcomes, including PTB (aOR 1.41, 95% CI 1.27 to 1.56) (aRR 1.36, 95% CI 1.21 to 1.51), LBW (aOR 1.28, 95% CI 1.22 to 1.33) (aRR 1.32, 95% CI 1.04 to 1.68), SGA (aOR 1.27, 95% CI 1.07 to 1.51) (aRR 1.34, 95% CI 1.19 to 1.51) and NNU admission (aOR 1.44, 95% CI 1.19 to 1.74). Adjusted estimates were based on multivariable models that commonly controlled for maternal age, parity and socio-demographic factors. No consistent associations were observed between pre-existing mental health problems and mode of birth. CONCLUSIONS: Pre-existing mental health problems were associated with increased risks and odds of several adverse birth outcomes. These findings highlight the importance of early identification and targeted support for women with mental health problems before pregnancy to strengthen preconception and maternity care planning. PROSPERO REGISTRATION NUMBER: CRD42023485834.
31 May 2026
Read appraisal →Medicine
Associations of TyG-related indices with NAFLD-related outcomes: A systematic review and meta-analysis
BACKGROUND: The triglyceride-glucose (TyG) index and related composite indices have been increasingly studied as accessible metabolic markers for fatty liver disease. However, evidence remains difficult to interpret because different TyG-related indices have been evaluated across heterogeneous populations and nonalcoholic fatty liver disease (NAFLD)-related outcomes. We conducted a systematic review and meta-analysis to clarify the pooled associations that could be formally synthesized and to summarize the broader descriptive evidence. METHODS: We systematically searched PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, VIP Database, and China Biology Medicine Database from inception to December 2025. Observational studies evaluating the TyG index or related composite indices, including TyG-body mass index, TyG-waist circumference, and TyG-waist-to-height ratio, in relation to NAFLD-related outcomes were eligible. Random-effects meta-analyses were performed in R. Only studies with sufficient comparability in exposure operationalization, outcome definition, and effect-size reporting were quantitatively pooled; the remaining studies were retained in the descriptive synthesis. RESULTS: Nineteen studies involving 212,618 participants were included in the systematic review, including 16 cross-sectional studies and 3 cohort studies. Of these, 8 studies contributed to at least 1 quantitative synthesis. In continuous-scale analyses, higher TyG levels were associated with increased odds of NAFLD/steatosis (5 studies; pooled odds ratio [OR], 2.72; 95% confidence interval [CI], 2.08-3.55; I2 = 85.7%). In highest-versus-lowest analyses, the association remained significant (4 studies; pooled OR, 4.36; 95% CI, 3.39-5.61; I2 = 92.8%). TyG-body mass index (2 studies; pooled OR, 1.04; 95% CI, 1.03-1.05; I2 = 0.0%) and TyG-waist circumference (2 studies; pooled OR, 1.01; 95% CI, 1.01-1.01; I2 = 15.1%) were also positively associated with NAFLD/steatosis. TyG-waist-to-height ratio showed a positive association in supportive synthesis, but evidence for liver fibrosis and nonalcoholic steatohepatitis remained limited and was mainly descriptive. CONCLUSION: TyG-related indices were consistently associated with NAFLD/steatosis across the available literature. The basic TyG index had the broadest evidence base, whereas composite indices suggested possible additional value in selected settings. These markers may be useful for metabolic fatty liver risk stratification, but further studies with standardized outcome definitions and clearer exposure parameterization are needed.
31 May 2026
Read appraisal →PloS one
Probiotics, synbiotics and berberine in Type 2 diabetes mellitus: A systematic review, meta-analysis, and molecular dynamics simulation study
BACKGROUND: Type 2 diabetes mellitus is characterized by impaired regulation of blood glucose. Probiotics, synbiotics, and berberine (BBR) have been proposed as adjunctive interventions, but their overall effectiveness remains uncertain. OBJECTIVE: To evaluate the effects of these interventions on glycemic control and to explore a potential molecular interaction of BBR with a key carbohydrate-digesting enzyme. METHODS: A systematic review and meta-analysis of randomized controlled trials was conducted. Pooled effects were estimated for fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) using random-effects models. A subgroup analysis compared probiotics with placebo. An exploratory computational analysis examined the interaction of BBR with α-glucosidase. RESULTS: More than 30 trials involving over 2,000 participants were included. The pooled analysis showed significant but modest reductions in FPG (-0.71 mmol·L ⁻ ¹) and HbA1c (-0.19%), with substantial between-study variability. Probiotics alone also reduced FPG (approximately -0.80 mmol·L ⁻ ¹) and HbA1c (approximately -0.21%) compared with placebo. Computational analysis indicated weaker enzyme binding for BBR than for the reference inhibitor acarbose. CONCLUSIONS: Probiotics, synbiotics, and BBR provide statistically significant but clinically modest improvements in glycemic control. These findings support their use as adjunctive, rather than primary, therapeutic options and highlight the need for larger and longer trials with standardized interventions. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251116387, identifier CRD420251116387.
30 May 2026
Read appraisal →JMIR formative research
Wearable- and Mobile App-Based Activity Pacing and Fatigue Management in Post-COVID-19 Condition: Exploratory Observational Study
BACKGROUND: Post-COVID-19 fatigue affects millions worldwide; yet, evidence-based management strategies remain limited. Activity pacing, regulating activity to match available energy and minimize symptom exacerbation, may support symptom management, although optimal pacing approaches remain unclear. OBJECTIVE: This study aimed to explore associations between activity pacing strategies delivered through a mobile app and daily fatigue levels in individuals with post-COVID-19 fatigue. METHODS: In this exploratory observational study, 19 adults with post-COVID-19 fatigue used wearable devices (Fitbit Inspire 3) for objective activity monitoring and a mobile app (FatigueSense) to self-report daily symptoms (fatigue and energy levels) and optionally select activity pacing goals (light, balanced, or active) over a period of 3 months. We examined associations between pacing strategies and symptom outcomes by using mixed-effects linear models with random intercepts. Same-day outcomes (fatigue and energy reported on the day of goal selection) were analyzed controlling for age and sex. Next-day outcomes (fatigue and energy reported the day following goal selection) were analyzed controlling for age, sex, and prior-day symptoms. RESULTS: Across 2182 observation days, participants self-selected pacing goals on 816 (37.4%) days, demonstrating symptom-responsive behavior with higher baseline fatigue on pacing days (mean score 1.74, SD 0.59 vs 1.58, SD 0.54 on nonpacing days on a 0-3 scale where 0="none" and 3="severe"; P=.004). On pacing days (584/816, 71.6% with complete data from 18 participants), active pacing was associated with reduced same-day fatigue (β=-0.34, 95% CI -0.49 to -0.19; P<.001) and increased same-day energy (β=8.8, 95% CI 4.7-12.9; P<.001) compared to light pacing. Balanced pacing also showed significant reductions in fatigue (β=-0.15; P=.008) and increases in energy (β=5.8; P<.001) compared to light pacing. Next-day effects were attenuated and nonsignificant (fatigue: β=-0.05, P=.53; energy: β=1.1, P=.61). Individual heterogeneity was substantial, with an intraclass correlation coefficient of 0.32, indicating that 32% of the variance was attributable to between-person differences. Among participants trying multiple strategies, 58.3% (7/12) showed meaningful responses (≥0.3-point fatigue reduction) to structured pacing strategies. CONCLUSIONS: Structured activity pacing strategies (active and balanced) were associated with improved same-day symptom management in individuals with post-COVID-19 fatigue. However, substantial confounding by indication (self-selection of pacing based on symptom state) and individual heterogeneity limit causal interpretation. These exploratory findings warrant testing in randomized controlled trials to establish efficacy and identify responder characteristics.
30 May 2026
Read appraisal →Endocrine
Female sexual dysfunction in type 1 diabetes: a systematic review and meta-analysis
BACKGROUND: Female sexual dysfunction (FSD) in type 1 diabetes mellitus (T1DM) is an under-appreciated complication. Despite its profound impact on female health, including reduced quality of life and psychological distress, it remains underrepresented in major diabetes guidelines. Current data synthesis is limited, often excluding older populations or failing to compare diabetes subtypes. We aimed to collate the prevalence of FSD in T1DM, pool the risk of FSD in T1DM compared to controls, compare the risk in T1DM vs. T2DM and to investigate the impact of different variables on these effects. METHODS: PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched to identify cross-sectional/cohort studies including T1DM participants. Proportion of women with FSD in T1DM versus age-matched control/T2DM population (if reported), and population characteristics were extracted. RESULTS: The pooled analysis of 18 studies (N = 2476) indicated FSD prevalence of 37% in adults with T1DM (95% CI: 30%, 43%; I2 = 89%; random-effects model). Analysis restricted to studies (n = 12) using standard FSFI cut-off ≤ 26.5 confirmed the summary estimate as 34% (95% CI: 26%, 41%; I2 = 89%). Trim and fill analysis for publication bias found higher FSD risk in T1DM versus age-matched controls (N = 10, adjusted Risk ratio 2.10; 95% CI: 1.30, 3.39; p = 0.002; I2 = 76%). The higher incidence of FSD in T1DM versus T2DM on subgroup analysis (p-interaction < 0.01) appeared to be influenced by diabetes duration (p < 0.01, R2 = 70%). Depression and diabetes control indicators were among most consistent predictors of FSD, whereas continuous subcutaneous insulin infusion had a protective role. CONCLUSIONS: FSD is prevalent in approximately one-third of women with T1DM, with a higher risk compared to those with T2DM, likely due to earlier onset and longer diabetes duration. Comprehensive care strategies that address both the physiological and psychological aspects of T1DM are warranted to improve sexual health and overall well-being in affected women.
30 May 2026
Read appraisal →European journal of pediatrics
Effect of probiotics on allergic rhinitis in children; A systematic review and meta-analysis
BACKGROUND: Allergic rhinitis (AR) is a prevalent chronic inflammatory disorder in children, often undiagnosed and associated with reduced quality of life and risk of comorbidities such as asthma. Probiotics have been found to be potential modulators of immune responses in allergic conditions. This systematic review and meta-analysis evaluated the efficacy of probiotics compared with placebo in the management of pediatric AR. METHODS: Searches were conducted in accordance with a pre-registered protocol using MEDLINE (PubMed), the Web of Science, Scopus, and Embase through April 8, 2025. Randomized controlled trials (RCTs) of children aged < 18 years that compared probiotics, prebiotics, or synbiotics with a placebo were considered for inclusion. Outcomes of interest included clinical and laboratory parameters. Random-effects models with Hedges' g were used; heterogeneity was assessed via I2. RESULTS: Fourteen RCTs involving 1,739 children were included. Meta-analysis revealed a significant reduction in nasal symptom scores (SMD = -1.40; 95% CI: -2.26 to -0.54; I2 = 91.3%) and eye symptom scores (SMD = -3.59; 95% CI: -5.84 to -1.33; I2 = 94.3%). Quality of life (RQLQ) was also significantly improved (SMD = -2.98; 95% CI: -4.85 to -1.12; I2 = 95.7%). Among laboratory markers, a small but significant increase in serum eosinophils was observed (SMD = 0.29; 95% CI: 0.06 to 0.52; I2 = 0%). CONCLUSION: Probiotics were associated with improvements in nasal and ocular symptoms and quality of life in children with AR; however, these findings should be interpreted with caution due to substantial heterogeneity across studies. Probiotics may have a potential role as an adjunctive therapy, but further high-quality, standardized trials are needed. PROSPERO registration code: CRD420250654461 on 24 February 2025. What is Known • Probiotics have been investigated as adjunctive therapy for pediatric allergic rhinitis because of their potential immunomodulatory effects. • Previous studies and meta-analyses have reported inconsistent findings regarding the clinical and immunological effects of probiotics in allergic rhinitis. What is New •This meta-analysis demonstrated significant improvements in nasal symptoms, ocular symptoms, and quality of life in children with allergic rhinitis receiving probiotics versus placebo. • Probiotic supplementation showed no consistent beneficial effects on immunological markers, while substantial heterogeneity remained across studies.
30 May 2026
Read appraisal →PloS one
Burden and patterns of dyslipidaemia among adult Ghanaians: A systematic review
BACKGROUND: Dyslipidaemia is a major modifiable risk factor for cardiovascular disease and has become an increasing public health concern in sub-Saharan Africa. Rapid urbanisation, dietary transitions, and sedentary lifestyles have contributed to the rising incidence of cardiometabolic diseases in Ghana. However, evidence on the overall burden and patterns of dyslipidaemia in adults remains unclear. This systematic review aimed to synthesise the evidence on the prevalence and lipid profile patterns of adult Ghanaians. METHODS: A comprehensive search of PubMed, Scopus, Web of Science, African Journals Online, Africa-Wide Information and African Index Medicus databases was conducted for studies published between January 1980 and November 2025. Eligible studies reported the prevalence or distribution of dyslipidaemia in Ghanaian adults (≥ 18 years). Two reviewers independently screened, extracted, and assessed the quality of included studies. Findings were synthesised narratively and summarised in descriptive tables and figures, due to heterogeneity in study designs and data reporting. RESULTS: Twenty-four studies published between 2003 and 2023, comprising approximately 11,400 participants, met the inclusion criteria. Across the included studies, the reported prevalence of dyslipidaemia ranged from 3.0% to 72.4%, reflecting differences in study populations, diagnostic criteria and study settings. Low high-density lipoprotein cholesterol (HDL-C) was the most frequent abnormality, followed by elevated total and low-density lipoprotein cholesterol (LDL-C), whereas hypertriglyceridaemia was the least common. Studies from southern and middle regions-particularly Ashanti, Brong-Ahafo, and Greater Accra-reported a higher dyslipidaemia prevalence than those from northern Ghana. Considerable variation in diagnostic criteria, study populations and sampling strategies limited comparability and precluded meta-analysis. CONCLUSION: Dyslipidaemia is common among adult Ghanaians, with low HDL-C emerging as the predominant abnormality. Methodological differences and sampling biases limit the precise estimation of the national burden, but the available evidence indicates a growing cardiometabolic risk. Future studies should prioritise community-based sampling and context-appropriate lipid thresholds to support evidence-based cardiovascular risk-reduction strategies.
30 May 2026
Read appraisal →BMJ global health
Systematic review and meta-analysis of interventions for mental health in extreme weather events
INTRODUCTION: Climate change leading to extreme weather events (EWEs) poses critical threat to human health, including mental well-being. As the effects of climate change are becoming more pronounced, there is a need to identify effective interventions to mitigate the mental health impacts. METHODS: The aim of this review was to synthesise the existing literature on interventions to prevent and manage mental health symptoms in people affected by EWEs. We conducted a comprehensive literature search in MEDLINE, EBSCO CINAHL and Cochrane till 7 February 2024 and in Web of Science and EMBASE till 20 February 2024. Randomised controlled trials (RCTs), quasi-experimental studies and before-after study designs were included. Our search yielded 11 083 potentially relevant papers, which were screened by titles and full texts and 33 studies were finally included in the review. We recorded the study, participants, intervention, disaster and other relevant data on Excel in duplicate. We conducted a meta-analysis separately for intervention-control and before-after studies using Review Manager 5.4. The Cochrane Risk of Bias tool II was used to assess risk of bias in RCTs and the risk of bias in non-randomised studies of interventions tool for quasi-experimental and before-after designs. Main outcomes were symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, stress, general functioning and well-being. RESULTS: There was significant improvement in mental health symptoms following implementation of various interventions, leading to a decrease in PTSD symptoms (standardised mean difference (SMD) -2.92, 95% CI (-4.53 to -1.31), six intervention-control studies and SMD -0.71, 95% CI (-0.95 to -0.48), five before-after studies), depression symptoms (SMD -0.28, 95% CI (-0.53 to -0.03), three intervention-control studies and SMD -1.00, 95% CI (-1.41 to -0.59), 11 before-after studies), anxiety symptoms (SMD -0.38, 95% CI (-0.69 to -0.06), two studies and SMD -0.35, 95% CI (-0.47 to -0.23), eight before-after studies), stress symptoms (SMD -0.82, 95% CI (-1.10 to -0.53), two before-after studies), general functioning impairment (SMD -1.22, 95% CI (-1.73 to -0.70), three before-after studies) and an improvement in well-being (SMD 0.29, 95% CI (0.15 to 0.42), three intervention-control studies and SMD 0.67, 95% CI (0.25 to 1.09), two before-after studies). CONCLUSION: There are existing interventions to improve mental health after an EWE, and these should be integrated into all relevant disaster management plans.
30 May 2026
Read appraisal →The Cochrane database of systematic reviews
Botulinum toxin type A for subacute/chronic neck pain
RATIONALE: Botulinum toxin type A (BoNT-A) intramuscular injections are commonly administered for neck pain unresponsive to other therapies, but the benefit-harm profile remains uncertain. OBJECTIVES: To assess the benefits and harms of intramuscular BoNT-A injection for people with subacute to chronic neck pain. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL and trial registers, together with reference checking, citation searching and contact with study authors up to 4 March 2026. ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs), including cross-over, pragmatic, or cluster designs, were included for adults with subacute to chronic neck disorder without radicular findings, with or without cervicogenic headache, and compared BoNT-A to placebo or no-treatment. OUTCOMES: Our outcomes were pain, function-disability, health-related quality of life, participant-reported treatment success, adverse events and costs at both short-term (< 24 weeks) and long-term (≥ 24 weeks) follow-up. RISK OF BIAS: We assessed the risk of bias (RoB) using the ROB 2 tool. SYNTHESIS METHODS: We synthesised results using meta-analyses with random-effects models to calculate mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CIs), or using SWiM (Synthesis Without Meta-analysis) methods. We assessed certainty with GRADE. INCLUDED STUDIES: This update included 16 trials (855 participants) compared to six (252 participants) in the previous review: 13 parallel RCTs and three cross-over RCTs. One other trial is awaiting classification. Short-term follow-up ranged from 3 to 12 weeks post-treatment, and long-term follow-up was six months. Participants (mean age 45 years; 64% female; pain severity 56 on the Visual Analogue Scale (VAS 0 to 100)) were from ambulatory care settings in North America (five trials), Central America (one trial), Europe (six trials), the Middle East (one trial), Central Asia (one trial), and the East Asia & Pacific region (two trials), from upper (12 trials) or upper-middle (four trials) income economies. Disorder classifications included non-specific neck pain - myofascial (eight trials), whiplash-associated disorder (four trials), and cervicogenic headache (four trials). Overall, 88% of participants had chronic pain. The dose varied from 10 to 400 units over 1 to 10 trigger points. The RoB was high or raised some concern across all outcomes. SYNTHESIS OF RESULTS: Since 2011, evidence has shifted from no benefit to a potentially slight-to-small short-term benefit for BoNT-A compared with placebo. No trials compared BoNT-A with no treatment, and evidence was limited by bias (no studies with an overall low RoB), imprecision, and potential publication bias. For pain intensity measured on the VAS (scale 0 to 100), BoNT-A may result in a slight-to-small improvement in the short term (MD 5.95 points lower, 95% CI 10.89 lower to 1.02 lower; I2 = 0%; 12 studies, 393 participants; low-certainty evidence; downgraded two levels due to high overall RoB and indirectness), but not in the long term (MD 11.74 points lower, 95% CI 35.63 lower to 12.16 higher; I² = 50%; 2 studies, 43 participants; low-certainty evidence; downgraded two levels due to high RoB and imprecision). Mean pain in the placebo group was 46.66 points compared to 40.71 in the BoNT-A group, representing an absolute improvement of 6% (95% CI 11% better to 1% better). Additionally, there may be a moderate risk reduction in pain events in the short term (RR 0.68, 95% CI 0.56 to 0.83; I² = 0%; 2 studies, 292 participants; low-certainty evidence; downgraded two levels due to high overall RoB and dissemination bias, including potential conflict of interest from funding sources that may overestimate effects). Assuming a 70% risk with placebo, the corresponding risk with BoNT-A is 47%, representing a 23% absolute risk reduction. Five people (95% CI 3 to 9) would need BoNT-A treatment for one person to benefit. For physical function measured on the Neck Disability Index (scale 0 to 100), BoNT-A may have little to no effect in the short term, but the evidence is very uncertain (MD 2.49 points higher, 95% CI 9.72 lower to 14.70 higher; I² = 0%; 3 studies, 76 participants; very low-certainty evidence; downgraded three levels due to high overall RoB, indirectness, and wide confidence intervals). For health-related quality of life (change score), BoNT-A may make little to no difference in the short term (MD 2.30 points higher, 95% CI 12.57 lower to 17.17 higher; 1 study, 28 participants; low-certainty evidence; downgraded two levels due to imprecision). For participant-reported treatment success, BoNT-A may provide a small improvement in the global rating of change. Short-term results: MD 1.16 points lower on a 1 to 5 Verbal Rating Scale (95% CI 1.86 lower to 0.46 lower; 1 study, 31 participants; low-certainty evidence), corresponding to an absolute improvement of 20% (95% CI 10% to 36%). Long-term results were similar: MD 2.00 points lower on a 0 to 10 Patient Global Assessment (95% CI 3.80 lower to 0.20 lower; 1 study, 19 participants; 20% absolute risk reduction, low-certainty evidence). Evidence was downgraded by two levels for RoB and imprecision. No studies evaluated participant satisfaction or serious adverse events. For non-serious adverse events, participants treated with BoNT-A may have a small, negligible increased risk (RR 1.51, 95% CI 1.04 to 2.20; I² = 28%; number-needed-to-treat for an additional harmful outcome (NNTH) 6, 95% CI 4 to 12; 7 studies, 489 participants; low-certainty evidence; downgraded two levels due to RoB and indirectness). Participants treated with BoNT-A have a 16% increased absolute risk of experiencing non-serious adverse events lasting up to three weeks, such as injection soreness, muscle fatigue, and headache. AUTHORS' CONCLUSIONS: BoNT-A may provide slight-to-small short-term pain relief (6%) and perceived treatment success (20%) for subacute and chronic neck pain, but may offer no long-term physical function or health-related quality of life benefits. The moderate (23%) risk reduction in pain events may be overestimated due to publication bias. Non-serious adverse events are 16% more frequent. Uncertainty remains due to wide confidence intervals, short-term single-dose trials, and dose variation, highlighting the need for larger, high-quality studies with comprehensive adverse event reporting. FUNDING: This Cochrane review had no dedicated funding. REGISTRATION: Protocol and previous versions available via doi.org/10.1002/14651858.CD008626, doi.org/10.1002/14651858.CD008626.pub2 and doi.org/10.1002/14651858.CD008626.pub3 (withdrawn).
30 May 2026
Read appraisal →The Cochrane database of systematic reviews
Surgery for thumb (trapeziometacarpal joint) osteoarthritis
RATIONALE: Surgery is used to treat persistent pain and dysfunction due to osteoarthritis at the base of the thumb, when conservative management is no longer effective. This is an update of a Cochrane review first published in 2005. OBJECTIVES: To evaluate the benefits and harms of different surgeries for people with thumb (trapeziometacarpal) osteoarthritis. SEARCH METHODS: We searched CENTRAL, MEDLINE and Embase up to 19 May 2025. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs) or quasi-RCTs that compared at least two surgical techniques for trapeziometacarpal osteoarthritis. We excluded studies that used non-surgical interventions as the sole comparator (e.g. splinting). OUTCOMES: Pain, physical function, quality of life, patient global assessment, adverse events, treatment failure and trapeziometacarpal joint imaging. RISK OF BIAS: We assessed risk of bias using the Cochrane Risk of bias 1.0 tool (RoB 1). SYNTHESIS METHODS: Two authors screened studies, extracted data, assessed risk of bias, and judged the certainty of evidence using the GRADE criteria. We synthesised effect estimates for both dichotomous (risk ratio (RR) using Mantel-Haenszel method) and continuous outcomes (standardised mean difference (SMD) or MD using the inverse-variance method) using a random-effects meta-analysis model. INCLUDED STUDIES: We included 25 studies with 1591 participants. We identified 11 surgical procedures: trapeziectomy with ligament reconstruction and tendon interposition (LRTI), trapeziectomy, trapeziectomy with ligament reconstruction, trapeziectomy with interpositional arthroplasty, Artelon joint implant, arthrodesis, trapeziometacarpal joint replacement, trapeziectomy and haematoma distraction arthroplasty, trapeziectomy with interpositional arthroplasty with allograft, arthroscopic hemitrapeziectomy, and suture tape suspensionplasty. Other than arthrodesis, no studies compared surgeries that did not involve at least partial trapeziectomy (e.g. first carpometacarpal joint denervation). We found no studies with placebo or non-surgical comparators. SYNTHESIS OF RESULTS: More than 90% of the included studies were at high or unclear risk of performance, detection and selective reporting biases. Below, we summarise the evidence for trapeziectomy with LRTI, the most widely utilised technique. We did not summarise single-study comparisons for trapeziectomy with LRTI. Quality of life, patient global assessment and treatment failure were not reported. Pain was measured on a 100-point visual analogue scale (mm); physical function on a relevant scale (typically the Disabilities of the Arm, Shoulder and Hand questionnaire) presented as a mean difference; adverse events as the proportion of participants who experienced any adverse events; trapeziometacarpal joint imaging as the scapho-metacarpal distance at rest reported in mm. Trapeziectomy with LRTI versus trapeziectomy: compared to trapeziectomy, trapeziectomy with LRTI may make little to no difference to pain (MD -2.80 mm, 95% CI -9.82 to 4.21; I2 = 0%; 3 studies, 162 participants), physical function (SMD 0.01, 95% CI -0.70 to 0.72 translated to an MD of 0.03 points (95% CI -1.95 to 1.98); I2 = 19%; 3 studies, 211 participants), adverse events (RR 1.89, 95% CI 0.96 to 3.73; I2 = 0%; 4 studies, 328 participants) or scapho-metacarpal distance (MD -0.10 mm, 95% CI -0.81 to 0.61; 1 study, 42 participants); all low-certainty evidence. Trapeziectomy with LRTI versus trapeziometacarpal joint replacement: we are uncertain of the effects of trapeziectomy with LRTI compared to trapeziometacarpal joint replacement on pain (MD 1.38 cm, 95% CI 0.7 to 2.07; 2 studies, 206 participants) and physical function (MD 12.53, 95% CI 3.71 to 21.35; I2 = 78%; 2 studies, 207 participants); both very low-certainty evidence. There may be little to no difference in adverse events (RR 0.36, 95% CI 0.12 to 1.06; I2 = 0%; 3 studies, 261 participants; low-certainty evidence). Trapeziectomy with LRTI versus haematoma distraction arthroplasty: compared to haematoma distraction arthroplasty, we are uncertain of the effects of trapeziectomy with LRTI on pain (MD 0.34 cm, 95% CI -1.19 to 1.87; I2 = 97%; 2 studies, 172 participants) and physical function (MD 1.96 points, 95% CI -0.40 to 4.32; I2 = 55%; 2 studies, 172 participants); both very low-certainty evidence). LRTI may make little to no difference to adverse events (RR 16.66, 95% CI 0.99 to 279.94; 1 study, 120 participants) or scapho-metacarpal distance (MD 0.0 mm, 95% CI -2.12 to 2.12; 1 study, 120 participants); both low-certainty evidence. Trapeziectomy with LRTI versus trapeziectomy with interpositional arthroplasty: compared to trapeziectomy with interpositional arthroplasty, trapeziectomy with LRTI may slightly reduce pain (MD -0.57cm, 95% CI -1.10 to -0.04; I2 = 0%; 2 studies, 98 participants), and may make little to no difference to adverse events (RR 1.29, 95% CI 0.49 to 3.44; 2 studies, 146 participants) and scapho-metacarpal distance (MD -0.70 mm, 95% CI -1.44 to 0.04; 1 study, 46 participants); all low-certainty evidence. We are uncertain of the effects of trapeziectomy with LRTI on physical function (MD -6.75 points, 95% CI -15.88 to 2.39; I2 = 70%; 2 studies, 98 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS: There are no placebo-controlled trials or studies comparing surgery with non-operative treatment. Low-certainty evidence showed that compared to trapeziectomy, trapeziectomy with LRTI for people with thumb osteoarthritis, may result in little to no difference in pain, function or scapho-metacarpal distance. Compared to trapeziectomy with interpositional arthroplasty, trapeziectomy with LRTI may slightly reduce pain. Trapeziectomy with LRTI may make little to no difference to scapho-metacarpal distance compared to haematoma distraction arthroplasty or trapeziectomy with interpositional arthroplasty. Very low-certainty evidence showed that we are uncertain of the effects of trapeziectomy with LRTI on pain and function compared to trapeziometacarpal joint replacement or haematoma distraction arthroplasty. We are uncertain of the effects of trapeziectomy with LRTI on function compared to trapeziectomy with interpositional arthroplasty. Overall, low-certainty evidence showed that trapeziectomy with LRTI may make little to no difference to adverse events. Low- to very low-certainty evidence from small studies limits our ability to draw conclusions on the benefits and harms of surgical procedures for thumb osteoarthritis. FUNDING: None. REGISTRATION: Protocol (2004) DOI: 10.1002/14651858.CD004631 Original review (2005) DOI: 10.1002/14651858.CD004631.pub2. Review update (2009) DOI: 10.1002/14651858.CD004631.pub3 Review update (2015) DOI: 10.1002/14651858.CD004631.pub4 Review update (2017) DOI: 10.1002/14651858.CD004631.pub5.
30 May 2026
Read appraisal →Current atherosclerosis reports
Patient Engagement Strategies for Implementing Evidence-Based Care in Atherosclerosis
PURPOSE OF THE REVIEW: Despite continuing therapeutic advances in cardiovascular disease, it remains a leading cause of morbidity and mortality in the US. The current challenge is not the development of therapeutics but rather patient engagement and compliance with medical recommendations. Here in this narrative expert review we discuss strategies to improve patient engagement in cardiovascular care. RECENT FINDINGS: There is a varying level of data surrounding different patient education strategies in the care of atherosclerosis. There are three main categories of interventions reviewed with evidence of efficacy: personalized and accessible patient education, digital health interventions, and implementation of personalized medicine via genetic testing. Implementing strategies in the clinic such as personalizededucation at an accessible health literacy level, digital health interventions,and even genetic testing may improve patient engagement and outcomes.
30 May 2026
Read appraisal →BMJ open
Feasibility and acceptability of therapist-guided, asynchronous, internet-delivered trauma-focused CBT for adolescents with PTSD: a single-group feasibility trial in Sweden
OBJECTIVES: Trauma-focused cognitive behavioural therapy (TF-CBT) is the established first-line treatment for paediatric post-traumatic stress disorder (PTSD), but access to evidence-based care remains limited. This study aimed to evaluate the feasibility and acceptability of a therapist-guided, 12 week, internet-delivered TF-CBT (iTF-CBT) programme for adolescents with PTSD and to explore preliminary changes in PTSD symptoms. DESIGN: Single-group feasibility trial. SETTING: Save the Children, Sweden. PARTICIPANTS: Twenty-two adolescents (13-17 years, 82% female) with primary PTSD. INTERVENTIONS: A 12 week, therapist-guided, asynchronous, internet-delivered TF-CBT comprising eight modules and parallel caregiver modules with joint adolescent-caregiver activities. OUTCOMES: Feasibility measures included recruitment pace, participant retention, treatment adherence (module completion) and therapist time. Acceptability was evaluated through satisfaction, credibility, negative effects and reported adverse events. Within-group changes in PTSD severity using independent evaluator-rated Clinician-Administered PTSD Scale (CAPS-CA-5) and the self-reported Child and Adolescent Trauma Screen 2 (CATS-2) were used as indicators of potential clinical change. Assessments occurred at baseline, during treatment, post-treatment and at 1 month follow-up (primary endpoint). RESULTS: Recruitment was completed after 7 months of active enrolment. Retention and adherence were high, satisfaction and credibility ratings were favourable, and no intervention-related serious adverse events occurred. Within-group improvements were observed at the primary endpoint, with large reductions on CAPS-CA-5 (Cohen's d=1.27) and CATS-2 (Cohen's d=1.51). At follow-up, 47.6% of participants no longer met criteria for PTSD. CONCLUSIONS: Therapist-guided iTF-CBT for adolescents with PTSD was safe, feasible, acceptable and associated with potentially meaningful symptom improvements. These findings support further evaluation in larger, controlled trials to determine efficacy, cost-effectiveness and long-term outcomes. TRIAL REGISTRATION NUMBER: NCT06185244.
30 May 2026
Read appraisal →The Cochrane database of systematic reviews
Pharmacotherapy for post traumatic stress disorder (PTSD)
BACKGROUND: Posttraumatic stress disorder (PTSD) is a prevalent and disabling disorder. Evidence that PTSD is characterised by specific psychobiological dysfunctions has contributed to a growing interest in the use of medication in its treatment. OBJECTIVES: To assess the effects of medication for reducing PTSD symptoms in adults with PTSD. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 11, November 2020); MEDLINE (1946-), Embase (1974-), PsycINFO (1967-) and PTSDPubs (all available years) either directly or via the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR). We also searched international trial registers. The date of the latest search was 13 November 2020. SELECTION CRITERIA: All randomised controlled trials (RCTs) of pharmacotherapy for adults with PTSD. DATA COLLECTION AND ANALYSIS: Three review authors (TW, JI, and NP) independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. We contacted investigators to obtain missing data. We stratified summary statistics by medication class, and by medication agent for all medications. We calculated dichotomous and continuous measures using a random-effects model, and assessed heterogeneity. MAIN RESULTS: We include 66 RCTs in the review (range: 13 days to 28 weeks; 7442 participants; age range 18 to 85 years) and 54 in the meta-analysis. For the primary outcome of treatment response, we found evidence of beneficial effect for selective serotonin reuptake inhibitors (SSRIs) compared with placebo (risk ratio (RR) 0.66, 95% confidence interval (CI) 0.59 to 0.74; 8 studies, 1078 participants), which improved PTSD symptoms in 58% of SSRI participants compared with 35% of placebo participants, based on moderate-certainty evidence. For this outcome we also found evidence of beneficial effect for the noradrenergic and specific serotonergic antidepressant (NaSSA) mirtazapine: (RR 0.45, 95% CI 0.22 to 0.94; 1 study, 26 participants) in 65% of people on mirtazapine compared with 22% of placebo participants, and for the tricyclic antidepressant (TCA) amitriptyline (RR 0.60, 95% CI 0.38 to 0.96; 1 study, 40 participants) in 50% of amitriptyline participants compared with 17% of placebo participants, which improved PTSD symptoms. These outcomes are based on low-certainty evidence. There was however no evidence of beneficial effect for the number of participants who improved with the antipsychotics (RR 0.51, 95% CI 0.16 to 1.67; 2 studies, 43 participants) compared to placebo, based on very low-certainty evidence. For the outcome of treatment withdrawal, we found evidence of a harm for the individual SSRI agents compared with placebo (RR 1.41, 95% CI 1.07 to 1.87; 14 studies, 2399 participants). Withdrawals were also higher for the separate SSRI paroxetine group compared to the placebo group (RR 1.55, 95% CI 1.05 to 2.29; 5 studies, 1101 participants). Nonetheless, the absolute proportion of individuals dropping out from treatment due to adverse events in the SSRI groups was low (9%), based on moderate-certainty evidence. For the rest of the medications compared to placebo, we did not find evidence of harm for individuals dropping out from treatment due to adverse events. AUTHORS' CONCLUSIONS: The findings of this review support the conclusion that SSRIs improve PTSD symptoms; they are first-line agents for the pharmacotherapy of PTSD, based on moderate-certainty evidence. The NaSSA mirtazapine and the TCA amitriptyline may also improve PTSD symptoms, but this is based on low-certainty evidence. In addition, we found no evidence of benefit for the number of participants who improved following treatment with the antipsychotic group compared to placebo, based on very low-certainty evidence. There remain important gaps in the evidence base, and a continued need for more effective agents in the management of PTSD.
30 May 2026
Read appraisal →BMJ open
Self-management experiences and needs in patients with chronic obstructive pulmonary disease: a meta-synthesis of qualitative studies
OBJECTIVES: To systematically review qualitative studies on the self-management experiences and needs of patients with chronic obstructive pulmonary disease (COPD) and to provide evidence for developing needs-based self-management intervention strategies. DESIGN: A systematic review and meta-aggregation of qualitative studies conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement. DATA SOURCES: PubMed, Cochrane Library, Web of Science, Scopus, CINAHL, Embase, CNKI, Wanfang Database, VIP Database and CBM were searched from database inception to March 2025 for qualitative studies on COPD self-management experiences and needs. ELIGIBILITY CRITERIA: Qualitative studies involving adults (≥18 years) with a confirmed diagnosis of COPD that reported patients' real feelings, experiences and needs during the self-management process in any setting (hospital, community or home). Studies were excluded if the full text could not be obtained or data were incomplete, if they were duplicate publications or if they were not published in Chinese or English. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened titles, abstracts and full texts, extracted data using a standardised form and assessed methodological quality using the 2016 Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Findings (participants' quotations and authors' interpretive statements) were synthesised using a JBI meta-aggregation approach to develop categories and overarching synthesised findings. RESULTS: 15 qualitative studies were included, comprising 251 patients with COPD. A total of 52 findings were identified, grouped into 13 categories and synthesised into 4 overarching findings: (1) physical symptom burden strongly shapes psychological well-being during COPD self-management; (2) patients face multiple and interrelated barriers to effective self-management; (3) some patients develop active coping strategies and self-management resources; and (4) patients express multidimensional and continuing support needs. CONCLUSIONS: Patients with COPD experience substantial physical and psychological distress and face multiple challenges in the self-management process. Healthcare professionals should prioritise patients' lived experiences, establish comprehensive and coordinated support systems and develop diversified, needs-based intervention strategies to address patients' multidimensional needs, thereby enhancing self-management capacity and improving quality of life. PROSPERO REGISTRATION NUMBER: CRD42024607051.
29 May 2026
Read appraisal →Journal of medical Internet research
How Machine Learning Can Help Close Evidence Gaps for Drug Safety in Pregnant Women
Women, especially pregnant women, have historically been excluded from clinical research. In this News and Perspectives article, JMIR Correspondent Michelle Falci reports on how advances in data analytics may help bridge evidence gaps.
29 May 2026
Read appraisal →Human vaccines & immunotherapeutics
Comparison of safety and immunogenicity between high-dose and low-dose quadrivalent influenza vaccines in children aged 6-35 months in China: A randomized, double-blind clinical study
Influenza vaccines for children aged 6-35 months are typically low-dose (0.25 mL, 7.5 μg hemagglutinin per strain). However, studies have shown that high-dose influenza vaccines (0.5 mL, 15 μg hemagglutinin per strain) can enhance protective efficacy without increasing the risk of adverse reactions. We conducted a randomized, double-blind clinical study in children aged 6-35 months in China. A total of 3,000 participants were randomized (1:1:1) to receive two doses of either an investigational high-dose quadrivalent influenza vaccine (H-QIV), an investigational low-dose quadrivalent influenza vaccine (LQIV-01) or a commercially available low-dose quadrivalent influenza vaccine (LQIV-02). Hemagglutination inhibition (HI) antibody titers 30 d post-vaccination were measured and vaccine safety and tolerability within 6 months post-vaccination were evaluated in these participants. The primary objectives were to demonstrate the non-inferiority of investigational vaccines to the commercially available vaccine in immunogenicity and to compare the H-QIV to L-QIVs. Both investigational vaccines demonstrated non-inferiority, with their seroprotection rates (SPRs), seroconversion rates (SCRs) and geometric mean titers (GMTs) meeting immunogenicity criteria. The H-QIV exhibited >11-fold increases in GMTs against H1N1, H3N2, B/Yamagata and B/Victoria strains compared to pre-vaccination levels, with SPRs exceeding 95% and SCRs exceeding 89%. The H-QIV was superior to both L-QIVs as it induced a stronger immune response to influenza viruses. All vaccines showed comparable safety profiles. The H-QIV can provide greater protection and benefits to this high-risk population.
29 May 2026
Read appraisal →Psychological medicine
Effectiveness of 13-week dialectical behavior therapy skills training for non-suicidal self-injury: a multi-center randomized clinical trial in China
BACKGROUND: Dialectical behavior therapy skills training (DBT-ST) has received empirical evidence for treating non-suicidal self-injury (NSSI). However, its effectiveness in Chinese contexts remains understudied. This study aims to explore the effectiveness of DBT-ST for NSSI in a clinical sample of individuals with NSSI. METHODS: We conducted a multicenter, randomized clinical trial in China to evaluate the effectiveness of a 13-week DBT-ST compared with social support group therapy (SSGT). A total of 196 individuals with mental disorders and NSSI were recruited. The primary outcome was the frequency of NSSI thoughts and behaviors, assessed using the Ottawa Self-Injury Inventory. RESULTS: Participants were randomized to the DBT-ST group (n = 97) or the SSGT group (n = 99). DBT-ST was significantly more effective than SSGT in reducing the frequency of NSSI behaviors. It also showed superior effects on borderline symptoms and multiple domains of psychological functioning, including emotion dysregulation, impulsivity, alexithymia, mindfulness, psychological resilience, and emotional intelligence. Both groups exhibited significant reductions in the frequency of NSSI thoughts, suicidal ideation and attempts, and depression, with no significant between-group differences in these outcomes. CONCLUSIONS: These findings confirm that the 13-week DBT-ST intervention is an effective treatment for Chinese patients with NSSI in clinical settings.
29 May 2026
Read appraisal →Journal of medical Internet research
Digital Literacy and Interpersonal Trust as Predictors of Willingness to Share Patient-Generated Health Data Among Korean Internet Users: Cross-Sectional Study Using Privacy Calculus and Communication Privacy Management Theories
BACKGROUND: The proliferation of wearable devices and advances in data analytics are accelerating the adoption of personalized digital health care, relying heavily on patient-generated health data (PGHD). However, the sensitive nature of this data creates significant privacy boundaries. While previous research has focused on rational cost-benefit trade-offs, there is a limited understanding of how social and cognitive factors-specifically interpersonal trust and digital literacy (DL)-shape the data-sharing decisions of the general public. OBJECTIVE: This study aims to identify the factors predicting individuals' willingness to share health data (WS) by integrating privacy calculus and communication privacy management theories. It specifically examines the comparative influence of DL, interpersonal trust, and moral motivation on data-sharing decisions. METHODS: We analyzed data from the 2023 Korea Panel Survey on the Digital Society (n=4518), a nationwide representative sample of internet users. Survey-weighted structural equation modeling with weighted least squares mean and variance adjusted estimation was used to examine the relationships among perceived risk (PR), perceived benefit (PB), DL, interpersonal trust, and WS. RESULTS: PR was the strongest negative predictor of WS (standardized coefficient [std β]=-0.189, P<.001), whereas PB was the strongest positive predictor (std β=0.076, P=.009), followed by moral motivation (std β=0.062, P=.03) and interpersonal trust. DL showed a significant negative direct association with willingness to share (std β = -0.060, P<.001). However, subdimension analysis revealed heterogeneous mechanisms: the "understanding" dimension was associated with lower PR and indirectly promoted sharing, whereas use and engagement were associated with higher PR. Age-stratified analyses suggested potential heterogeneity in these relationships, although the overall interaction was not statistically significant. CONCLUSIONS: PBs and risks were the strongest determinants of PGHD sharing, with benefits increasing and risks decreasing willingness to share. Beyond this risk-benefit balance, DL (particularly understanding) and interpersonal trust also played important roles, highlighting the need for trust-based and user-centric strategies to promote PGHD sharing and support the expansion of digital health care.
29 May 2026
Read appraisal →BMJ health & care informatics
Machine learning-based prediction of a high-risk kidney function trajectory class after acute kidney injury
OBJECTIVES: Monitoring kidney function after acute kidney injury (AKI) hospitalisation is essential for identifying patients at risk of rapid progression. This study developed a machine learning (ML) model to predict membership in a high-risk longitudinal estimated glomerular filtration rate (eGFR) trajectory associated with subsequent kidney replacement therapy (KRT) initiation. METHODS: We conducted a cohort study of 88 632 adults with ≥2 post-discharge eGFR measurements between 2010 and 2017. Joint latent class mixed models were used to identify dynamic eGFR trajectories from 665 499 measurements. Patient-level data splitting (80/20) was strictly enforced. Extreme gradient boosting (XGBoost) and random forest models were trained using clinical features within 3 months after discharge to predict membership in the highest-risk eGFR trajectory class. RESULTS: Three eGFR trajectories were identified: Steady Low (high-risk phenotype), Slow Decline and Recovery. The Steady Low group showed the strongest association with KRT. The 10-variable XGBoost model demonstrated excellent discrimination (AUROC 0.974, sensitivity 0.913, specificity 0.919). The eGFR slope from discharge to 3 months was the most influential predictor of high-risk progression. DISCUSSION: Although the study was limited to a single healthcare system, this ML framework identified patients at risk of rapid kidney function decline using routinely available clinical data. The model supports early risk stratification after AKI and may enable more timely kidney-protective interventions. External validation, calibration assessment and benchmarking against simpler eGFR-based rules remain important next steps. CONCLUSION: A 10-variable XGBoost model accurately identifies patients with deteriorative eGFR trajectories (Steady Low) early after discharge, providing a practical framework for personalised post-AKI kidney care.
29 May 2026
Read appraisal →BMJ open
Multicentre prospective cohort study to develop and validate a machine learning-based model for predicting 6-month all-cause mortality in elderly patients with advanced chronic obstructive pulmonary disease in China: study protocol
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) has an unpredictable clinical course, causing difficulties in short-term mortality prediction, overtreatment and delayed palliative care. Existing prediction models are limited and lack applicability to Chinese elderly patients with advanced COPD. Given the heavy disease burden and limited palliative care in China, we designed this multicentre cohort study to develop a 6-month mortality prediction model for elderly patients with advanced COPD to aid risk stratification, timely palliative care and efficient healthcare resource allocation. METHODS AND ANALYSIS: Patient recruitment has been ongoing since May 2024 and will be completed by December 2026, with a 12-month follow-up to be completed by December 2027. Eligible patients are being enrolled, and multidimensional baseline data including demographic characteristics, clinical indicators, laboratory results, comprehensive geriatric assessment and COPD-specific prognostic factors are being systematically collected. All participants will receive 12 months of standardised follow-up (monthly for the first 6 months and quarterly thereafter) to monitor 6-month all-cause mortality (primary outcome), as well as survival duration, end-of-life healthcare utilisation and do-not-resuscitate status (secondary outcomes). After completion of data collection, we will employ multiple machine learning algorithms to develop and internally validate a 6-month mortality prediction model with pre-specified centres reserved for external validation. Model performance will be evaluated by discrimination and calibration and head-to-head comparisons with the Body Mass Index, Airflow Obstruction, Dyspnoea and Exercise Capacity (BODE) and Age, Dyspnoea and Airflow Obstruction (ADO) indices will be conducted to verify its clinical value. The findings will provide a China-specific prediction tool for elderly patients with advanced COPD to guide clinical intervention, palliative care referral and healthcare resource allocation. ETHICS AND DISSEMINATION: This study was approved by the Biomedical Ethics Review Committee of West China Hospital, Sichuan University (No. 2024-2662) and registered at ChiCTR2500100351. Informed consent is being obtained from all participants. Results will be published in peer-reviewed journals and presented at academic conferences. TRIAL REGISTRATION NUMBER: ChiCTR2500100351.
29 May 2026
Read appraisal →BMC medicine
WISE-Therapy (What's Important: Schedule and Engage) and bouldering psychotherapy for depression: A randomized clinical trial
BACKGROUND: Group therapies address the growing treatment demand-supply gap for depression. This study evaluated whether the novel WISE-Therapy (WISE-T; What's Important: Schedule and Engage) and Bouldering Psychotherapy (BPT) are more effective in reducing depressive symptoms in an outpatient group therapy setting than treatment as usual (TAU). METHODS: This randomized, controlled, assessor-blinded, longitudinal, clinical trial was conducted in a naturalistic monocentric setting in Erlangen (Germany) between April 2022 and March 2023, with follow-up until July 2024. 128 adults were randomly assigned to WISE-T (44), BPT (40), or TAU (44). In 10 weekly 2-hour group sessions, WISE-T focused on identifying what is important, scheduling meaningful activities, and engaging in them for long-term mental health, and BPT combined psychotherapy with bouldering, while the control group received TAU. Depression severity was measured with the Montgomery-Asberg Depression Rating Scale at baseline, post-intervention, and one-year follow-up, and analyzed with a hybrid marginal model. RESULTS: Both intervention groups showed significantly greater reduction in depressive symptoms than controls at post-intervention (WISE-T: -5.5 points, 95%-CI [-9.5 to -1.5], P = .007, d = 0.62; BPT: -4.2 points, 95%-CI [-8.2 to -0.3], P = .037, d = 0.48). Response rates were 35.3% for WISE-T, 29.7% for BPT, and 21.1% for controls. Remission rates were significantly higher in WISE-T (17.6%) than in controls (2.6%, P = .047). Treatment adherence was good with minimal adverse events reported. The secondary outcomes showed significant results for anxiety, sense of coherence, self-efficacy, and mindfulness during physical activity. CONCLUSIONS: Both interventions demonstrated efficacy in reducing depressive symptoms compared with controls in this single-center setting. The study supports the integration of both therapies into outpatient care settings. TRIAL REGISTRATION: Study procedures received approval from the Friedrich-Alexander-Universität Erlangen-Nürnberg Ethics Committee (Ref. 21-332-B) on December 13, 2021. The Trial was preregistered in March 2022 via ISRCTN12347878 .
29 May 2026
Read appraisal →JAMA
The Veterans Affairs' Whole Health Approach for Chronic Pain Management: The wHOPE Randomized Clinical Trial
IMPORTANCE: The US Department of Veterans Affairs (VA) Whole Health approach was congressionally mandated in 2016 for patients with chronic pain receiving care in VA hospitals, but no randomized clinical trials have tested its benefits. OBJECTIVE: To evaluate the effectiveness of a whole health team intervention in VA patients with chronic pain compared with cognitive behavioral therapy and with usual care, and to evaluate the effectiveness of cognitive behavioral therapy compared with usual care in reducing long-term pain interference. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial involving 6 VA health systems in the US enrolled participants between September 18, 2020, and January 19, 2024. Final follow-up occurred on January 27, 2025. Analyses took place between April 1, 2025, and February 3, 2026. Participants were patients with chronic pain receiving VA primary care. INTERVENTIONS: Patients with chronic pain were randomized (11:11:2) to receive a whole health team intervention (n = 343), cognitive behavioral therapy for chronic pain delivered in group sessions (n = 339), or usual care (n = 82) for 12 months. The whole health team included a primary physician or nurse practitioner, a second clinician providing nonpharmacological or integrative pain care, and a coach. The team provided interdisciplinary, individualized care consistent with the VA Whole Health model to attain personal health goals aligned with patients' personal values and life goals. MAIN OUTCOMES AND MEASURES: The primary outcome was the Brief Pain Inventory interference (BPI-I) subscale score (range, 0-10 points; higher scores indicate worse interference from pain; minimal clinically important difference, 1.0) at 12 months. RESULTS: Of 764 randomized patients (mean [SD] age, 60.5 [12.3] years; 66.5% were men), 632 (82.7%) completed 12-month follow-up. At 12 months, the whole health group had significantly improved pain interference scores (from 6.6 to 4.9) compared with the cognitive behavioral therapy (from 6.4 to 5.5) (mean difference, -0.58 [97% CI, -1.11 to -0.05]; P = .02) and usual care (from 6.4 to 5.7) (mean difference, -0.77 [99% CI, -1.40 to -0.15]; P = .002) groups. At 12 months, cognitive behavioral therapy did not improve pain interference scores significantly more than usual care (mean difference, -0.19 [99% CI, -0.89 to 0.50]; P = .46). The most common adverse event was suicidal ideation, which occurred in 15.9% of patients in the cognitive behavioral therapy group, 13.7% in the whole health team group, and 13.4% in the usual care group. CONCLUSIONS AND RELEVANCE: These results support use of the whole health team approach to attain a statistically significant but small improvement in pain interference in VA patients with chronic pain. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04330365.
29 May 2026
Read appraisal →JMIR research protocols
Digital Cognitive Behavioral Therapy for Insomnia Versus Sleep Hygiene Education for Prevention of Perinatal Depression: Protocol for a Randomized Clinical Trial
BACKGROUND: Insomnia during pregnancy is a modifiable risk factor for depression. Research in nonpregnant populations and preliminary findings in a pregnant population suggest that targeting insomnia with digital cognitive behavioral therapy for insomnia (CBT-I) may prevent depression. OBJECTIVE: This study aims to evaluate the efficacy of digital CBT-I for the prevention of depression through 12 months post partum compared to that of a credible, clinically relevant comparator intervention, sleep hygiene education (SHE). This project will also provide valuable information about how and for whom CBT-I prevents perinatal depression. METHODS: The Perinatal Research for Improving Sleep and Mental Health study is a fully remote, 2-arm parallel-group randomized controlled trial designed to test the superiority of digital CBT-I versus SHE for the prevention of perinatal depression. We aimed to randomize a target sample of at least 443 pregnant participants with insomnia disorder to digital CBT-I or SHE at a 1:1 ratio. Participants randomized to digital CBT-I received SleepioRx (Big Health, Inc), which uses sleep consolidation, stimulus control, cognitive therapy, relaxation techniques, and SHE in 6 interactive modules (5-15 min each). Participants randomized to SHE received information about sleep hygiene, the impact of sleep on performance, healthy sleep habits, lifestyle influences on sleep, and creating a sleep-friendly bedroom in 6 weekly digital handouts. Data are collected at baseline, 5 weeks after randomization, 10 weeks after randomization, 36 weeks' gestation, and 3, 6, 9, and 12 months post partum. The primary outcome is depression incidence, measured using the Structured Clinical Interview for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) Disorders, Research Version. Other outcome measures include the Edinburgh Postnatal Depression Scale, Patient Health Questionnaire-9, Columbia Suicide Severity Rating Scale, Generalized Anxiety Disorder Scale, and a birth outcomes questionnaire. Mediator measures include the Insomnia Severity Index, Consensus Sleep Diary, Structured Clinical Interview for Sleep Disorders, Perseverative Thinking Questionnaire, Dysfunctional Beliefs about Sleep Scale, Pre-sleep Arousal Scale, and Difficulties in Emotion Regulation-Short Form. RESULTS: Data collection began in November 2022 and is projected to end in December 2026. CONCLUSIONS: If study hypotheses are supported, then this project will provide a new, scalable approach for preventing perinatal depression.
29 May 2026
Read appraisal →JMIR aging
e-Counseling for Fall Prevention in Older Adults: Scoping Review
BACKGROUND: Falls are a major contributor to injury, disability, and mortality among older adults worldwide. Digital health-based e-counseling has emerged as a scalable strategy to support fall prevention by addressing physical, behavioral, and cognitive risk factors. OBJECTIVE: This scoping review aimed to map the scope, characteristics, and outcomes of e-counseling interventions for fall prevention among adults aged 60 years or older. METHODS: Guided by Arksey and O'Malley's framework and reported in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), we searched PubMed, ScienceDirect, CINAHL, and ProQuest for studies published between January 2019 and May 2025. Eligible studies evaluated digital or telehealth-based counseling interventions for fall prevention. Data were synthesized descriptively, and methodological quality was appraised using the Mixed Methods Appraisal Tool. RESULTS: A total of 13 studies were included, comprising randomized controlled trials, feasibility studies, qualitative research, and retrospective cohorts conducted across Asia, Europe, and North America. e-Counseling modalities included virtual reality, mobile health application, teleconsultations, and wearable-triggered feedback systems. Reported outcomes included reductions in fall incidence ranging from 15% to 90.9%, improvements in balance and mobility, increased fall risk awareness, and enhanced self-efficacy. Interventions incorporating cultural tailoring and digital literacy support demonstrated higher engagement and adherence. CONCLUSIONS: e-Counseling appears to be a promising and scalable approach for fall prevention in older adults, with benefits across physical and behavioral domains. Future research should focus on long-term effectiveness, equitable access in low- and middle-income settings, and integration into routine health care systems.
29 May 2026
Read appraisal →European respiratory review : an official journal of the European Respiratory Society
Implementation of long-term noninvasive positive airway pressure therapy in patients with COPD: a systematic review and meta-analysis of acceptance and adherence
BACKGROUND: Long-term noninvasive positive airway pressure (PAP) therapy is an effective, albeit complex, intervention for obstructive sleep apnoea (OSA) and/or chronic hypercapnic respiratory failure (CHRF) in patients with chronic obstructive pulmonary disease (COPD). PAP uptake and use is often reported in studies designed for other purposes. Systematic review methods were used to summarise acceptance of and adherence with PAP therapy. METHODS: A systematic search for studies that reported the proportion of patients that either declined or accepted PAP therapy and/or objective use of newly prescribed PAP therapy in patients with COPD was conducted according to a predefined protocol (PROSPERO CRD42021259262). Meta-analysis and meta-regression techniques were used to establish summary effect estimates and explore heterogeneity. RESULTS: On average, PAP therapy was declined or discontinued by 14% (95% CI 10-19) of participants, often within 6 weeks of initiation among studies reporting repeated measures. The pooled median adherence was 6.3 h·day-1 (95% CI 5.9-6.6). While meta-regression found higher acceptance (p=0.03) and shorter use per day (p<0.01) for the indication of OSA versus CHRF, this explained only some heterogeneity in the summary effect estimates. Summary of study-level variables associated with acceptance or adherence highlighted limitations in the available literature. CONCLUSIONS: An anticipated six out of seven patients with COPD newly prescribed PAP therapy will be successful using therapy; however, heterogeneity was substantial among studies, and only partly explained by indication for use. Prospective studies to explore barriers to use and detailed reporting of acceptance and adherence in studies on PAP therapy in patients with COPD are needed.
29 May 2026
Read appraisal →European respiratory review : an official journal of the European Respiratory Society
Nutrition and growth of primary ciliary dyskinesia patients: a systematic review.
BACKGROUND: Growth, nutritional status and intake can be crucial for the management and prognosis of chronic lung diseases, including primary ciliary dyskinesia (PCD); yet research in PCD is scarce. In this study, we systematically reviewed the existing literature and summarised the evidence on growth, nutritional status and intake of patients with PCD. METHODS: We conducted searches in Medline, Embase, Scopus and PubMed limited to the past 20 years, due to changes in the diagnosis of PCD. Eligible studies included cross-sectional, case-control and prospective studies, and case series with >5 people that reported on the growth, nutritional status or intake of patients with PCD. We performed additional searches through reference list checking and in medRxiv for relevant preprints. The review was registered in PROSPERO (CRD420251065699). RESULTS: 50 studies were included in the qualitative synthesis. We observed variability in growth-related outcomes, with some studies reporting reduced z-score for height, body weight or BMI, while others reported no growth differences in patients with PCD. The prevalence of undernutrition ranged from 4 to 11%; underweight ranged from 0 to 50%. Overweight and obesity estimates ranged from 3 to 25%. The prevalence of vitamin D insufficiency was 54%, while deficiency was reported in 18-26% of study participants. Only three studies reported on the nutritional intake of patients with PCD. DISCUSSION: We observed considerable variability in growth-related outcomes and a lack of nutritional intake-related data in patients with PCD. The findings we noted related to malnutrition and vitamin D insufficiency/deficiency are alarming and warrant further investigation.
29 May 2026
Read appraisal →BMJ open
Voice-assisted artificial intelligence in cardiovascular disease management: a systematic review and meta-analysis protocol
INTRODUCTION: Cardiovascular disease (CVD) remains a leading cause of global morbidity and mortality, with self-management playing a pivotal role in improving outcomes. Voice-assisted artificial intelligence (AI) technologies such as virtual assistants and voice-controlled applications have emerged as innovative tools for healthcare delivery. While the technologies show promise in areas like primary prevention and chronic disease management, their effectiveness in supporting self-management for patients with CVD remains underexplored. This study aims to evaluate the impact of voice-assisted AI technologies on CVD self-management, specifically focusing on cardiovascular-related mortality, health-related quality of life (HRQoL) and adherence to lifestyle modifications. METHODS AND ANALYSIS: A systematic review and meta-analysis will be conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. A comprehensive search will be performed across databases such as MEDLINE, Scopus, Embase and Cochrane Central Register of Controlled Trials (CENTRAL), from 2010 to 2025. The review will include randomised controlled trials (RCTs), non-RCTs and observational studies that evaluate voice-assisted AI interventions (eg, voice-controlled fitness apps, smart health assistants) aimed at CVD self-management. The primary outcome will be cardiovascular-related mortality. Secondary outcomes will include HRQoL, clinical outcomes (eg, high blood pressure), lipid profiles (eg, cholesterol and glucose levels) and lifestyle modifications (eg, dietary habits and levels of physical activity). Data management and analysis will be conducted using Comprehensive Meta-Analysis software V.2.0. The methodological quality of the included studies will be assessed using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for observational studies. The meta-analysis will use random-effects models, with heterogeneity assessed using Q and I² statistics. Subgroup analyses and meta-regression will be conducted to explore potential sources of heterogeneity. ETHICS AND DISSEMINATION: No formal ethical assessment is required, as this study involves analysis of publicly available secondary data. Findings will be disseminated through publications in peer-reviewed scientific journals, conference presentations and media coverage to inform healthcare providers, policymakers and patients. PROSPERO REGISTRATION NUMBER: CRD42024568702.
29 May 2026
Read appraisal →European respiratory review : an official journal of the European Respiratory Society
Validating exacerbations of asthma in electronic health records: a systematic review
BACKGROUND: Previous studies have shown that the algorithms and code lists used to define asthma exacerbations vary across different sources of data, if reported at all. Defining and validating asthma exacerbations in electronic health records (EHR) would help to improve future research on asthma using EHR by leading to more consistent and comparable evidence. METHODS: We systematically reviewed the literature to evaluate studies that define exacerbations of asthma in EHR and report which algorithms have the highest validity. An adapted version of the QUADAS-2 designed for this review was used to assess risk of bias. RESULTS: Of the studies yielded by the search, only five met the inclusion criteria. Eligible studies used algorithms that contained codes from versions or modifications of either the 9th or 10th revisions of the International Statistical Classification of Diseases and Related Health (ICD-9 or ICD-10), and validity scores varied. Using the ICD-9 code 493 within algorithms to detect asthma exacerbations, sensitivity scores varied from 44.8% to 91.28% and specificity was >85%. Using the ICD-9 code 493.xx as the principal and secondary diagnosis in claims data, validity measures were all >85%. Using the ICD-10 code J45, scores for sensitivity, specificity and negative predictive value were also all >85%. CONCLUSIONS: Algorithms have been used to identify asthma exacerbations in EHR with varying degrees of validity. Algorithms including the ICD-9 code 493.xx or the ICD-10 code J45 to detect asthma exacerbations had high validity scores. However, there was a risk of bias in these studies and urgent work is needed using robust methods to validate definitions for future research using EHR.
29 May 2026
Read appraisal →African journal of reproductive health
A systematic review of pregnancy outcomes and management in polycystic ovary syndrome
Polycystic Ovary Syndrome (PCOS), affects 5-20% of women of reproductive age, it is the leading cause of anovulatory infertility accounting for 70-90% of cases and resulting in lower natural conception rates and a significant contributor to adverse pregnancy outcomes. Following PRISMA 2020 guidelines, this systematic review synthesized evidence from 2014-2025, evaluating the evolving landscape of PCOS pregnancy management. It explores the relationship between PCOS and reproductive outcomes, details specific maternal and perinatal complications, and discusses the latest evidence-based interventions and emerging therapies to improve pregnancy outcomes and the long-term health of both mother and child. The findings revealed that the syndrome's pathophysiology driven by hyperandrogenism, insulin resistance, and obesity significantly increases the risks of early pregnancy loss, gestational diabetes, and pre-eclampsia. There is a paradigm shift toward individualized, multidisciplinary care. Evidence-based strategies highlight the superiority of letrozole for ovulation induction, the metabolic benefits of metformin, and the necessity of nuanced lifestyle interventions over simple weight-loss models. Furthermore, emerging research into immune-metabolic pathways, such as Interleukin-22, suggests novel therapeutic directions. The review concludes that recognizing PCOS as a high-risk obstetric condition and integrating early metabolic screening into standard care are essential to improving maternal and neonatal outcomes. Le syndrome des ovaires polykystiques (SOPK), qui touche 5 à 20 % des femmes en âge de procréer, est la principale cause d'infertilité anovulatoire (70 à 90 % des cas). Il entraîne une diminution des taux de conception naturelle et contribue significativement aux complications de la grossesse. Conformément aux recommandations PRISMA 2020, cette revue systématique a synthétisé les données probantes de 2014 à 2025, évaluant l'évolution de la prise en charge des grossesses chez les femmes atteintes de SOPK. Elle explore la relation entre le SOPK et les issues de la reproduction, détaille les complications maternelles et périnatales spécifiques et présente les interventions fondées sur des données probantes les plus récentes ainsi que les thérapies émergentes visant à améliorer les issues de grossesse et la santé à long terme de la mère et de l'enfant. Les résultats ont révélé que la physiopathologie du syndrome, caractérisée par un hyperandrogénisme, une résistance à l'insuline et une obésité, augmente significativement les risques de fausse couche précoce, de diabète gestationnel et de prééclampsie. On observe un changement de paradigme vers une prise en charge individualisée et multidisciplinaire. Les stratégies fondées sur des données probantes soulignent la supériorité du létrozole pour l'induction de l'ovulation, les bénéfices métaboliques de la metformine et la nécessité d'interventions nuancées sur le mode de vie plutôt que de simples programmes de perte de poids. De plus, les recherches émergentes sur les voies immunométaboliques, telles que l'interleukine-22, suggèrent de nouvelles pistes thérapeutiques. Cette revue conclut que la reconnaissance du SOPK comme une pathologie obstétricale à haut risque et l'intégration d'un dépistage métabolique précoce dans les soins courants sont essentielles pour améliorer les issues maternelles et néonatales.
29 May 2026
Read appraisal →JMIR mHealth and uHealth
Effects, Acceptability, and Use of a Dynamically Tailored Mobile What Do You Drink Intervention to Reduce Excessive Drinking Among Adolescents and Young Adults in the Netherlands: Randomized Controlled Trial
BACKGROUND: Excessive alcohol consumption among adolescents and young adults is a serious health problem. Dynamically tailored interventions could reduce their excessive drinking. We therefore developed "What Do You Drink" (WDYD), a 17-week dynamically tailored mHealth (mobile health) intervention providing personalized support on alcohol consumption. OBJECTIVE: We aim to evaluate the effectiveness, acceptability, and use of WDYD in reducing alcohol consumption of adolescents and young adults at risk. METHODS: We conducted a 2-arm, parallel-group randomized controlled trial using ecological momentary assessments. Recruitment was via an educational alcohol program, an online lifestyle monitor, social media advertisements, or news items on websites. Participants downloaded the standalone WDYD app, and when having given active informed consent, were randomized to the intervention or control group. Participants in the intervention group received dynamically tailored feedback sessions on alcohol consumption (wk 0-5, 7, 9, 13, and 17) and goal-monitoring reminders. Both groups completed an online baseline survey, 2 follow-up surveys (wk 9 and 33), and various ecological momentary assessments (7 daily assessments during wk 1, 7, 13, 19, 25, 31, and 33). Participants provided consent before randomization, in which they were informed that 2 study groups existed. After randomization, no disclosure of group assignment was provided, although participants could potentially infer it from receiving tailored sessions vs no tailored sessions. Primary outcomes were excessive drinking, binge drinking, and weekly alcohol consumption. Secondary outcomes were intrinsic motivation, self-confidence, and mood. Acceptability of WDYD was measured by survey questions; use was tracked via app data logs. RESULTS: Analyses were based on data from 1767 participants; 720 in the intervention group and 1047 participants in the control group. Almost half of them were female (2276/4795, 47.5%), and most (3471/4595, 72.4%) participants were aged 18-24 (median 19.40, IQR 2.92) years. The dropout rate was high, up to 96% (4603/4795) in the final 33rd week. No significant effect of WDYD was found on primary outcomes and mood, except for week 1 (excessive drinking: standardized β=-0.35, SE 0.15; 95% CI -0.64 to -0.05; binge drinking: standardized β=-0.36, SE 0.16; 95% CI -0.68 to -0.04; mood: standardized β=0.20, SE 0.06, 95% CI 0.08 to 0.32). Both groups reduced their alcohol consumption. Significant positive effects were found for intrinsic motivation and self-confidence up to 25 weeks (wk 25: standardized β=0.54, SE 0.24; 95% CI 0.06 to 1.02 for motivation; standardized β=0.72, SE 0.26; 95% CI 0.22 to 1.23 for self-confidence). Participants evaluated WDYD as acceptable and usable. CONCLUSIONS: WDYD did not significantly reduce excessive drinking compared to control, but improved motivation and self-confidence. High dropout rates highlight challenges in sustaining engagement in long-term mHealth interventions. Future research should explore strategies to enhance retention and optimize dynamic tailoring.
28 May 2026
Read appraisal →JMIR medical informatics
Usability and Usefulness of Machine Learning-Based Clinical Decision Support Software in Primary Care: Survey of Users in a Prospective Observational Study
BACKGROUND: The successful implementation of decision support systems promises to enhance high-quality care. However, the successful implementation of a clinical decision support system (CDSS) depends on user acceptance and adoption. A machine learning (ML)-based CDSS to assist primary care professionals treating urinary tract infections (UTIs) was implemented, and usability and usefulness were assessed through a questionnaire. OBJECTIVE: This study aimed to assess the system's usability by examining users' experiences with the software. A secondary goal was to assess users' attitudes toward evidence-based practice and innovation in health care. METHODS: In collaboration with the Netherlands Institute for Health Services Research (NIVEL) and Leiden University Medical Center (LUMC), Pacmed Ltd developed the CDSS. The cohort was mostly recruited at the care group level; practices within participating care groups were required to participate. Health insurers partly funded the research. Practitioners participated in the implementation study for 4 months. A survey based on the Unified Theory of Acceptance and Use of Technology (UTAUT) was sent to 263 general practitioners and assistants shortly after the implementation period. Furthermore, usage data were analyzed. RESULTS: Of the 34 participating practices that used the software, 30 (88%) submitted at least one survey response, with a mean of 2.23 responses per practice (SD 1.43). The CDSS was used throughout the pilot period, and 31 practices continued using the tool, with 9% dropping out during the first 8 weeks. Sixty-seven percent of respondents trusted the tool's output, and 73% found it understandable how the algorithm came to predictions. Sixty-five percent of respondents indicated that the information provided was useful in addition to the available guidelines, and 52% agreed that it supported their decision-making. However, many respondents were uncertain whether the tool improved patient care (46%) or patient outcomes (66%). Forty-eight percent of respondents found the software easy to integrate into their clinical workflow. CONCLUSIONS: The CDSS was perceived as trustworthy and easy to use. However, users were unable to determine whether the CDSS improved patient outcomes. In addition, the CDSS development could have benefited from including assistants as well as general practitioners more in the design phase of the software. Because assistants play an important role in UTI care, designing the software to better fit existing workflows may reduce the perceived time investment associated with using the tool. Finally, respondents reported strong motivation to contribute to further research in this field and indicated willingness to embrace change in health care delivery, which may also reflect selection bias in our sample.
28 May 2026
Read appraisal →PloS one
One out of four patients with pancreatic cancer experience psychological symptoms: A systematic review and meta-analysis
The death rate from pancreatic cancer is one of the highest of all cancers, with increasing incidence every year over the past decades. As the prognosis remains extremely poor, this trend brings not only a growing clinical challenge, but also a significant psychological toll for patients. In comparison to other types of cancer, our understanding of the psychological burden of such a deadly disease is still limited. Recognizing and addressing the psychological aspects of pancreatic cancer are crucial for comprehensive patient care. We, therefore, aimed to quantify the psychological burden of patients with pancreatic cancer. We conducted a systematic search (PROSPERO: CRD42022288805) of MEDLINE, Cochrane, and Embase databases to identify articles reporting on the prevalence of psychological symptoms among patients with pancreatic cancer. The symptoms examined were depression, anxiety, distress, fatigue, sleep disturbances. Study quality for the included studies was assessed using the Joanna Briggs Institute tool. Relevant data were extracted and exported for quantitative synthesis. The meta-analysis of the proportion of symptoms with a 95% confidence interval (CI) was conducted using frequentist random-effects models. Subset analyses were performed based on the severity of depression. A total of 28 articles were included in the meta-analysis and 31 in the systematic review. Our results showed that the proportion of depression (19 studies; 78,930 patients) was 0.27 (95% CI: 0.18-0.39). The proportion for anxiety (18 studies; 26,538 patients) was 0.29 (95% CI: 0.16-0.46; for distress (6 studies; 2746 patients) 0.43 (95% CI: 0.25-0.63); for fatigue (7 studies; 11 338 patients) 0.40 (95% CI: 0.21-0.63); and for sleep disturbances (3 studies; 10,645) 0.31 (95% CI: 0.06-0.77). These findings highlight the urgent need to integrate psychological care into pancreatic cancer treatment. Future research should explore sources of heterogeneity to better identify which approaches provide the most psychological benefit and tailor interventions to patient needs accordingly.
28 May 2026
Read appraisal →Annals of family medicine
Association of Advanced Access With Primary Care Performance: A Systematic Review
PURPOSE: Timely access to primary care remains a major challenge. Advanced access, an organizational model for appointment management, aims to improve accessibility by allowing patients to consult their health care professional in a timely manner. This systematic review evaluated its association with several key dimensions of primary care performance. METHODS: We conducted a comprehensive search in MEDLINE, Embase, Web of Science, CINAHL, and the Cochrane Library from inception to May 10, 2025. Randomized intervention studies, nonrandomized intervention studies, and observational studies comparing advanced access with traditional scheduling systems among patients in primary care were eligible. Outcomes were the wait time to an appointment, continuity of care, emergency department (ED) use, and patient satisfaction. Two independent reviewers selected studies, extracted data, and assessed risk of bias. We performed a narrative synthesis, separately analyzing universal and non-universal health care systems. RESULTS: Among 7,595 unique records identified, 29 studies were included. Of these, 23 evaluated appointment wait time, 13 examined continuity of care, 3 assessed ED use, and 13 evaluated patient satisfaction. Appointment wait time decreased in all 23 studies assessing this outcome, with 13 reporting statistically significant reductions. Continuity of care improved in 11 of 13 studies, of which 7 reported statistically significant improvements. All 3 studies evaluating ED use reported reductions in ED visits, although none demonstrated statistical significance. Patient satisfaction improved in 8 studies, with 3 reporting statistically significant improvements. Overall, findings were consistent across universal and non-universal health care systems. CONCLUSIONS: Advanced access appears to improve appointment timeliness, continuity of care, and patient satisfaction, and may help reduce avoidable ED use across diverse health care systems.
28 May 2026
Read appraisal →Journal of the American College of Cardiology
Combining Genomics With Lipid and Inflammatory Biomarkers to Predict Coronary Artery Disease Risk: UK Biobank Study
BACKGROUND: Coronary artery disease (CAD) polygenic risk score (PRS), low-density-lipoprotein cholesterol (LDL-C), lipoprotein(a) (Lp(a)), and high-sensitivity C-reactive protein (hsCRP) are biomarkers that predict CAD. It is unclear whether integrating genomics with lipid and inflammatory biomarkers could complement traditional risk scores in identifying people at risk of CAD. OBJECTIVES: This study assesses the predictive value of CAD PRS, LDL-C, Lp(a), and hsCRP for incident CAD across different age and sex groups. METHODS: Participants (n = 215,695) from the UK Biobank aged 40 to 69 years with baseline CAD PRS, LDL-C, Lp(a), and hsCRP values were followed for 12 years to assess the incidence of CAD. We evaluated a multivariable-adjusted Cox model that included all 4 biomarkers, net reclassification index, C-statistics, and population attributable risk across different age and sex groups. RESULTS: Over a 12-year follow-up, 4,721 men and 2,425 women developed CAD. The HRs for incident CAD associated with each biomarker elevation were 1.79 (95% CI: 1.70-1.89) for CAD PRS, 1.60 (95% CI: 1.48-1.66) for LDL-C, 1.20 (95% CI: 1.12-1.29) for Lp(a), and 1.64 (95% CI: 1.57-1.72) for hsCRP. CAD PRS demonstrated a stronger association in men (HR per SD: 1.49; 95% CI: 1.45-1.54) than women (HR per SD: 1.37; 95% CI: 1.31-1.44; P-interaction ≤ 0.001). All biomarkers conferred greater HRs at younger ages (P < 0.0001). Individuals with all biomarkers elevated had a 4.65-fold increased risk of CAD compared with those with no elevated biomarkers. A combined 4-biomarker model had a higher C-statistic of 0.753 compared with the pooled cohort equations (C-statistic of 0.740). The C-statistic of the combined 4-biomarker model was also higher in younger individuals in both sexes and yielded a 32.0% continuous net reclassification index when compared with the pooled cohort equations. CONCLUSIONS: CAD PRS, LDL-C, hsCRP, and Lp(a) show independent age- and sex-specific associations with CAD. Measuring all 4 biomarkers may improve midlife CAD risk prediction for both male and female patients.
28 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Psychological distress in cancer survivors: a population-based analysis and machine learning-based risk stratification
PURPOSE: As the number of cancer survivors increases, psychological distress has become an important issue. Using nationally representative data, we evaluated mental health outcomes among Korean cancer survivors compared with cancer-free controls and developed models to identify individuals at risk of psychological distress. METHODS: We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2021. Psychological outcomes were assessed using standardized questionnaires, and a composite distress outcome was constructed. Risk stratification models were developed among cancer survivors using logistic regression and machine learning algorithms, including random forest, XGBoost, LightGBM, support vector machines, k-nearest neighbors, and naïve Bayes. RESULTS: A total of 88,061 participants were included, comprising 3733 cancer survivors and 84,328 cancer-free controls. Compared with cancer-free controls, cancer survivors had higher odds of depressed mood (OR 1.33; 95% CI 1.18-1.51), suicidal ideation (OR 1.14; 95% CI 1.00-1.31), suicide planning (OR 1.91; 95% CI 1.37-2.65), and mental health counseling (OR 1.36; 95% CI 1.08-1.71). Among cancer survivors, multiple models were evaluated, with logistic regression showing the highest performance (AUROC 0.689), followed by XGBoost (0.686). In logistic regression, longer working hours, depression history, activity limitation, female sex, smoking, employment, low income, and distorted body image were independently associated with distress. SHAP analysis identified activity limitation, sex, and depression history as key factors. CONCLUSIONS: Cancer survivors experience increased psychological distress across multiple outcomes. Machine learning-based models may help identify individuals at higher risk of psychological distress, supporting risk-based assessment in survivorship care.
28 May 2026
Read appraisal →JMIR research protocols
Development of a Digital Multimodal Pain Intervention (CHRONIC): Protocol for a Randomized Controlled Trial Study
BACKGROUND: Chronic pain affects approximately 12 million individuals in Germany and significantly impairs quality of life. Although multimodal treatment approaches-combining physical, psychological, and behavioral strategies-are considered the gold standard, access to specialized multidisciplinary pain treatment, including physiotherapy and psychological interventions, is often hampered by long waiting times, which highlights the need for scalable, low-threshold treatment options. Digital health interventions, particularly those grounded in established therapeutic models, offer a promising solution to bridge this treatment gap. The German Digital Health Care Act has opened pathways for reimbursable digital applications, such as CHRONIC, which is grounded in acceptance and commitment therapy as a third-wave cognitive behavioral therapy framework and integrates selected cognitive behavioral techniques, mindfulness-based strategies, and physiotherapy into a structured web-based program. OBJECTIVE: This study protocol outlines a randomized controlled trial (RCT) aimed at evaluating the effectiveness of CHRONIC, a 12-week web-based, multimodal self-help program for individuals with chronic pain, with a focus on reducing pain intensity, reducing pain-related interference, and improving quality of life. METHODS: This is a monocentric, 3-arm RCT with assessments up to 6 months after baseline. A total of 200 participants with chronic nonmalignant pain will be randomized into one of three groups: (1) intervention with individualized psychological feedback, (2) intervention with standardized computer-generated feedback, and (3) treatment-as-usual waitlist control. Weekly modules in the intervention arms include psychotherapeutic video sessions, interactive acceptance and commitment therapy-based and cognitive behavioral therapy-based exercises, mindfulness practices, and physiotherapeutic training. Outcomes will be assessed via validated self-report instruments: West Haven-Yale Multidimensional Pain Inventory for pain intensity and interference, Assessment of Quality of Life-8 Dimensions for quality of life, German version of Chronic Pain Acceptance Questionnaire for pain acceptance, Patient Health Questionnaire-9, German version for depression, and Generalized Anxiety Disorder 7-item Scale for anxiety. Data will be analyzed using mixed models for repeated measures based on the matched ~6-month assessment. Missing data will be addressed using multiple imputation. RESULTS: Recruitment started in January 2026 and is projected to end in July 2026. As of January 22, 2026, 18 participants had been enrolled. Primary end point data collection is expected to be completed in January 2027, with primary analyses and dissemination planned for 2027. CONCLUSIONS: This study protocol describes an RCT designed to evaluate the clinical utility of CHRONIC as a scalable, low-threshold intervention for chronic pain. CHRONIC aims to address the multifactorial nature of chronic pain by integrating psychotherapeutic, physiotherapeutic, and mindfulness-based strategies into a single digital program. Future studies will be required to determine how this multimodal format compares to unimodal interventions. The findings aim to inform future digital health developments and contribute to the implementation of biopsychosocial care models in routine practice.
28 May 2026
Read appraisal →European journal of clinical pharmacology
Efficacy and safety of Ongericimab in patients with hypercholesterolemia: a systematic review and meta-analysis
BACKGROUND: Hypercholesterolemia represents abnormally elevated cholesterol levels and constitutes a major modifiable risk factor for cardiovascular diseases (CVDs). Low-density lipoprotein cholesterol (LDL-C) reduction remains the primary therapeutic target. However, many high-risk patients fail to achieve recommended LDL-C targets with conventional lipid-lowering therapies. Ongericimab is a new humanized recombinant monoclonal antibody targeting proprotein convertase subtilisin/kexin type 9 (PCSK9). We aimed to evaluate the efficacy and safety of Ongericimab compared to placebo in patients with hypercholesterolemia. METHODS: Following PRISMA guidelines, we searched PubMed, Scopus, Cochrane Library, Web of Science and Google Scholar through February 2025 for randomized controlled trials (RCTs) comparing Ongericimab versus placebo. Outcomes were pooled as mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CIs) using random-effects models. RESULTS: Five RCTs comprising 1421 patients were included. Ongericimab significantly reduced LDL-C across all dosing regimens: 150 mg every 2 weeks (MD -69.48%, 95% CI: -73.02 to -65.94), 300 mg every 4 weeks (MD -61.82%, 95% CI: -66.66 to -56.98), and 450 mg every 4 weeks (MD -73.11%, 95% CI: -89.56 to -56.65); all p < 0.00001. Significant reductions were also observed in lipoprotein(a) (MD range: -44.81% to -50.06%), apolipoprotein B, non-HDL cholesterol, triglycerides, and total cholesterol, along with significant increases in HDL cholesterol and apolipoprotein A1. Adverse event rates were comparable between groups, with a pooled reduction OR of 0.85 (95% CI: 0.73-0.99) for overall treatment-emergent adverse events, favoring Ongericimab. CONCLUSION: This meta-analysis demonstrates that Ongericimab is effective and safe for improving lipid parameters in patients with hypercholesterolemia and dyslipidemia. These findings support Ongericimab as a valuable therapeutic option for patients requiring additional LDL-C reduction beyond conventional therapy. Further long-term studies are recommended to confirm cardiovascular outcomes.
28 May 2026
Read appraisal →European journal of psychotraumatology
Biological and neurocognitive correlates of comorbid post-traumatic stress disorder and alcohol use disorder: a systematic review
Background: Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur, leading to greater clinical burden than either disorder alone. Despite this, little is known about the biological pathways linking these two disorders.Objective: We conducted a systematic review to synthesize evidence on molecular, genetic, neural, and cognitive mechanisms contributing to comorbid PTSD & AUD.Method: Following PRISMA guidelines, we performed a comprehensive search of five databases using PTSD-related, AUD-related, biological, and neurocognitive terms. Participants had to meet diagnostic criteria for both PTSD and AUD, and studies were required to have a comparator including controls, PTSD only, or AUD only. A critical appraisal was completed for all studies.Results: From 3904 identified papers, 14 met the inclusion criteria. Four studies examined the same molecular marker, with three papers derived from the same cohort, investigating baseline and stress-induced cortisol and adrenocorticotropic hormone, and found no differences unique to PTSD & AUD. One study linked low brain-derived neurotrophic factor and hazardous drinking to PTSD onset over 2 years following hospital admission. Genetic studies showed considerable overlap (72%) between PTSD and AUD in female twins, whereby the DRD2 A1 allele and the absence of the APOE ϵ2 allele were strongly associated with PTSD and drinking. Studies also reported lower neurometabolites, white matter integrity, and hippocampal volume in PTSD & AUD. Critical appraisal of these studies highlighted prominent selection bias (predominantly male and veterans) and limited justification of sample size.Conclusions: These findings suggest that PTSD & AUD may be characterized by distinct neurobiological alterations and genetic vulnerabilities relative to comparator groups. However, as there are currently insufficient data to support or refute these findings, this highlights the need for further research. PTSD and AUD frequently co-occur, leading to greater clinical burden than either disorder alone. Despite this, little is known about the biological pathways linking these two disorders.The current study aimed to review the existing molecular, genetic, neural, and cognitive evidence, and suggests similar impacted stress regulation across PTSD-only, AUD-only, and PTSD & AUD, yet distinct neural and genetic substrates among individuals with PTSD & AUD.Future research should include more female participants and a broader range of trauma types (currently dominated by veteran samples), and use large-scale neuroimaging and genetic datasets to help to identify mechanisms underpinning PTSD & AUD.
27 May 2026
Read appraisal →Journal of medical Internet research
Large Language Model-Generated Patient Instructions for Prescriptions in Primary Health Care: Preclinical Algorithm Validation
BACKGROUND: The application of generative artificial intelligence to simplify medication use instructions has the potential to enhance people's health by improving treatment adherence. OBJECTIVE: We evaluated the performance of large language models (LLMs) in generating medication usage instructions to complement prescriptions in primary health care. METHODS: This randomized, blinded experimental preclinical study used prescription-inducing scenarios, assigned to 62 health care professionals, to validate instructions generated by LLMs during electronic prescriptions. The instructions were generated by ChatGPT-4.0 (OpenAI), Llama3.1-8B (Meta), and Llama3.1-8B-RAG (Meta) using retrieval-augmented generation based on patient information leaflets. Performance metrics assessed adequacy, completeness, clarity, language simplification, usefulness, and errors in the generated instructions, with scores to analyze overall and individual metrics. RESULTS: The 3 models yielded high overall scores for producing qualified instructions (ChatGPT-4.0: median 88.4, IQR 22.8; Llama3.1-8B: median 66.5, IQR 50.9; Llama3.1-8B-RAG: median 79.9, IQR 34.4; Kruskal-Wallis test P=.003). Llama3.1-8B-RAG received evaluations with similar overall scores to ChatGPT-4.0 (post hoc test, P=.05) and similar to Llama3.1-8B (post hoc test, P=.44). ChatGPT-4.0 outperformed Llama3.1-8B (Bonferroni test, P<.001). Regarding specific domains, Llama3.1-8B-RAG received scores equivalent to those of ChatGPT-4.0 for adequacy (mean 6.24, SD 2.3 vs mean 6.82, SD 2.1; post hoc test, P=.54); completeness (mean 5.94, SD 2.2 vs 6.55, SD 1.9; post hoc test P=.38), clarity (mean 5.77, SD 2.4 vs mean 6.68, SD 1.9; post hoc test P=.09), and usefulness (mean 5.42, SD 2.4 vs mean 5.96, SD 2.2; post hoc test P=.63). ChatGPT-4.0 received higher scores in the language simplification criterion than Llama3.1-8B-RAG (mean 7.05, SD 1.5 vs mean 5.44, SD 2.6; post hoc test P<.001). Interrater variability in assigning scores ranged from 4.2% (n=3) to 85.8% (n=6) among primary health care professionals. Instructions leading to incorrect use of the medication had similar frequency among the models(ChatGPT-4.0: n=15, 22.7%; Llama3.1-8B: n=19, 22.8%; Llama3.1-8B-RAG: n=19, 22.8%; chi-square test P=.71). The frequencies of hallucination were similar (ChatGPT-4.0: n=7, 10.6%; Llama3.1-8B: n=9, 13.6%; Llama3.1-8B-RAG: n=6, 9.1%; chi-square test P=.67). CONCLUSIONS: The open-source LLM enhanced with external information presented similar performance to the closed-source model, except for ChatGPT4.0, which was superior in language simplification of messages. LLM generation demonstrated potential for instructing patients on medication use. Nonetheless, the introduction of this innovation into the electronic prescribing workflow demands prescriber validation for human oversight of the technology and requires a strategy for LLM performance governance. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.12688/verixiv.1359.1.
27 May 2026
Read appraisal →Journal of neurology
Man vs. Machine: can ML algorithms diagnose headaches as accurately as clinicians? A systematic review.
BACKGROUND: Headache disorders are frequently misdiagnosed. We aimed to systematically evaluate the diagnostic accuracy, methodological quality, and clinical applicability of artificial intelligence (AI) and machine learning (ML) models for classifying adult headache disorders against clinician diagnoses using the International Classification of Headache Disorders (ICHD) criteria. METHODS: In this systematic review, we searched PubMed, Embase, and the Cochrane Library (January 2015-December 2025) for AI/ML diagnostic headache studies. Two reviewers extracted data and assessed risk of bias using the QUADAS-2 tool with the QUADAS-AI extension. Main outcomes were sensitivity, specificity, area under the receiver operating characteristic curve (AUC-ROC), and risk of bias. RESULTS: We included 74 studies encompassing 154,856 participants. Models utilized traditional ML (n = 47), deep learning (n = 18), and hybrid or rule-based approaches (n = 9). Data inputs included neuroimaging (n = 27), multimodal datasets (n = 20), neurophysiological signals (n = 17), and clinical questionnaires (n = 10). Only 4 studies performed independent external validation. Overall sensitivity ranged from 47.5% to 100.0%, specificity from 50.4% to 100.0%, and AUC-ROC from 0.658 to 1.000. Models using structured questionnaires reported realistic accuracies (74-86%), whereas neuroimaging models frequently produced near-perfect, likely overfit estimates. Most studies (65 of 74) exhibited a high risk of bias driven by artificial case-control designs, data leakage, and absent external validation. CONCLUSIONS: AI-based headache diagnostic systems demonstrate promising but highly variable accuracy. Pervasive methodological flaws-specifically severe spectrum bias, data leakage, and a lack of independent external validation-currently preclude clinical implementation. Future studies require prospective, real-world validation to safely integrate these tools into practice.
27 May 2026
Read appraisal →The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
Integrated cell-free DNA and omics genetic scores for early detection of gestational diabetes: evidence from a nationwide multicenter study
BACKGROUND: Gestational diabetes mellitus (GDM) affects 15.6% of pregnancies globally, with Vietnam exhibiting one of the highest prevalences at 21%. Current diagnostic approaches at 24-28 weeks limit early intervention opportunities. We developed a multi-modal machine learning framework integrating cell-free DNA (cfDNA) structural features and genetic information for early GDM prediction at 10-12 weeks of gestation in Vietnamese women. METHODS: We analyzed blood samples from 1,086 pregnant women (435 GDM cases, 651 controls) collected at 9-12 weeks. Two parallel analytical pathways were employed: cfDNA profiling extracting cfDNA-specific features (fragment length, end motifs, GC content, nucleosome patterns), and whole-genome imputation generating predictions for ∼19,000 omics traits. Component scores were developed using TabPFN classifier and integrated via logistic regression into a unified master score. RESULTS: Genome-wide analysis identified five omics traits with significant GDM associations: HSD11B1, NEK7, COMMD10, KLRC4, and OCEL1. Component score optimization revealed distinct patterns-cfDNA scores peaked at 200 features (AUC = 71.53), while genetics-based scores improved with up to 2,000 omics traits (AUC = 77.21). The final master score, integrating three components (gbSC2000, gbSCBH, cfSC200), achieved AUCs of 86.82-87.19 across validation cohorts with 70% sensitivity and 89% specificity. Addition-deletion analysis confirmed that both cfDNA and genetic components provided essential, non-redundant contributions. CONCLUSIONS: This multi-modal framework demonstrates superior performance compared to single-biomarker approaches, enabling risk stratification from very low (4% GDM prevalence) to very high risk (90% prevalence). At the cutoff 0.4, the model identifies 78% of future GDM cases at 10-12 weeks while maintaining an 18% false-positive rate, potentially enabling early interventions to prevent GDM development and associated complications.
27 May 2026
Read appraisal →Journal of breast imaging
Breast Arterial Calcification as a Predictor for Future Cardiovascular Events and Mortality: A Systematic Review and Meta-analysis
OBJECTIVE: Breast arterial calcification (BAC) is a surrogate marker of cardiovascular disease (CVD); however, its associations with incident mortality and major adverse cardiovascular events (MACEs) have not been systematically evaluated. The association between BAC and incident MACE and whether this is influenced by the method of BAC assessment was examined. METHODS: PubMed, MEDLINE, and EMBASE were reviewed to June 2025 for studies comparing BAC status with incident MACE (composite of death, myocardial infarction [MI], stroke, heart failure). The primary outcome was all-cause mortality. Random-effects meta-analysis was performed using hazard ratios (HRs) with 95% CIs. Subgroup analysis was conducted by method of BAC measurement and restricted to screening mammography cohorts, PROSPERO registration (CRD42020202612). RESULTS: Of 1118 studies screened, 24 were included (236 475 participants; mean age 58.5 years). Breast arterial calcification presence associated with all-cause mortality (HR, 1.32; 95% CI, 1.20-1.45; P <.0001) (follow-up 0.55-26 years). Increased risk was observed for cardiovascular mortality (HR, 1.38; 95% CI, 1.14-1.66; P = .0009), heart failure (HR, 1.29; 95% CI, 1.20-1.37; P <.0001), stroke (HR, 1.2; 95% CI, 1.11-1.30; P <.0001), and MI (HR, 1.2; 95% CI, 1.15-1.26; P <.0001). When restricted to screening mammography cohorts without concurrent indications for cardiovascular investigation (5 studies, n = 85 647), associations remained significant for all-cause mortality (HR, 1.34; 95% CI, 1.14-1.58; P = .0004), cardiovascular mortality (HR, 1.38; 95% CI, 1.14-1.66; P = .0009), heart failure (HR, 1.48; 95% CI, 1.19-1.86; P = .0005), and stroke (HR, 1.34; 95% CI, 1.08-1.67; P = .008). Associations with incident outcomes were observed only in studies using quantitative BAC assessment (HR, 1.31; 95% CI, 1.19-1.44; P = .002). CONCLUSION: Breast arterial calcification is a promising prognostic marker of mortality and CVD risk. Recognition of this incidental finding may enable timely identification of at-risk individuals.
27 May 2026
Read appraisal →Clinical and experimental dermatology
The role of dermoscopy in optimizing surgical margins for keratinocyte cancers: updated evidence from a systematic review and meta-analysis
BACKGROUND: Keratinocyte cancer (KC) is the most common malignancy worldwide. Surgical excision is the primary treatment, with clear margin delineation critical for oncological and cosmetic outcomes. Dermoscopy, well established for diagnosis, has recently been included in updated British guidelines as an alternative method for surgical margin planning and may offer improved border visualization. OBJECTIVES: To update the existing evidence on dermoscopy-guided excision of KC, focusing on margin control and recurrence risk and incorporating newly published studies and re-evaluating its use considering evolving guideline recommendations. METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, EMBASE and CENTRAL were searched to October 2024. Eligible studies compared dermoscopy-guided with conventional surgical excision of histologically confirmed KC. The primary outcome was the incomplete excision rate. Risk of bias was assessed using ROBINS-I, and meta-analysis was conducted using a DerSimonian-Laird random-effects model. RESULTS: Ten studies (1151 patients; 1186 lesions) were included; 4 contributed to meta-analysis. Most focused on basal cell carcinoma; squamous cell carcinoma data were limited. Dermoscopy was associated with improved surgical precision and reduced incomplete excision (pooled odds ratio 0.30, 95% confidence intervals 0.27-0.34, P < 0.001; I² = 0%, P > 0.99), although all studies were observational and at moderate to serious risk of bias. Narrower margins were often achieved without compromising recurrence outcomes. CONCLUSIONS: Dermoscopy may enhance preoperative planning in KC excision, but evidence remains limited by methodological constraints. These findings support further high-quality trials to confirm clinical utility and define its role in future surgical guidelines.
27 May 2026
Read appraisal →Clinical and experimental dermatology
A systematic review of the barriers to diagnosis of vulval lichen sclerosus in primary care
BACKGROUND: Vulval lichen sclerosus (VLS) is a chronic, inflammatory genital skin condition causing itch, pain, anatomical changes and increased risk of vulval cancer. Diagnostic delay and misdiagnosis are common. Once diagnosed, VLS can be effectively treated using very strong topical corticosteroids. Most women with symptoms of VLS first present to primary care in the UK. OBJECTIVES: To identify patient and professional perspectives on barriers to diagnosis of VLS in primary care through systematic review and thematic synthesis of the literature. METHODS: Separate literature searches of seven databases relevant to patient and professional perspectives were conducted. Two reviewers screened titles and abstracts, with one performing a full text review. Data extracted were coded 'line by line', codes were organized into descriptive themes and subsequently developed into analytical themes. RESULTS: We identified 2468 references; a total of 56 studies met inclusion criteria. Six analytical themes were developed: (i) a medically challenging diagnosis; (ii) cultural and social taboos; (iii) education and knowledge gaps; (iv) feelings and attitudes; (v) inadequate health systems; and (vi) challenges in female genital examination. CONCLUSIONS: This review highlights obstacles for women in achieving a diagnosis of VLS. Education and knowledge gaps were reported by clinicians and patients. Clinicians lack knowledge of vulval skin disease and patients lack knowledge of vulval anatomy. Targeted, comprehensive education for clinicians could expedite diagnosis. Dismissive clinician attitudes compound patient feelings of anxiety and embarrassment, reinforcing taboos and stigma. Acknowledgement of embarrassment and stigma validates feelings, improving patient interactions. Future research priorities should include the development of a diagnostic tool and implementation of a complex intervention to expedite diagnosis.
27 May 2026
Read appraisal →Clinical and experimental dermatology
Novel and existing therapeutic interventions in psychogenic pruritus.
Psychogenic pruritus (PP) is a chronic itch disorder associated with psychological conditions lacking any dermatological or systemic cause. Diagnosis relies on excluding other aetiologies and identifying psychological stressors. Treatments include dermatological and psychiatric interventions such as topical steroids, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, antihistamines, antipsychotics and psychotherapy. However, efficacy remains inconsistent, necessitating a systematic review of current and emerging pharmacological options. This study reviews pharmacological treatments for PP published in the past decade, evaluating efficacy and therapeutic potential. A systematic literature search was conducted using PubMed, Embase and Google Scholar (November 2014 to November 2024) following the PRISMA guidelines (PROSPERO: 1000201). In total, 1034 articles were screened by two independent reviewers. Inclusion criteria focused on human studies evaluating pharmacological treatments for PP. Seven studies met the inclusion criteria. Levels of evidence were assessed using the Joanna Briggs Institute critical appraisal checklist. SSRIs, particularly escitalopram, showed symptom improvement in case reports. Naltrexone (an opioid antagonist) led to complete itch resolution in a patient refractory to SSRIs. Gabapentin reduced pruritus severity. A neurokinin-1 receptor (NK-1R) antagonist (serlopitant) demonstrated significant efficacy in a phase II trial. Biologics such as dupilumab showed promise in chronic pruritus. Targeted therapies, including SSRIs, naltrexone, opioid pathway modulators, NK-1R antagonists and biologics, show promise in the clinical management of PP, but further research through randomized controlled trials is necessary to establish their efficacy and optimize treatment strategies.
27 May 2026
Read appraisal →Clinical and experimental dermatology
Topical statins in the treatment of porokeratosis: a systematic review
Porokeratosis is a chronic disorder of keratinization associated with significant morbidity and no spontaneous resolution. Currently, there are no therapies approved by the US Food and Drug Administration (FDA). However, the off-label use of topical statins - targeting the mevalonate pathway - has shown promise as a novel therapeutic strategy. This systematic review aims to evaluate the efficacy and safety of topical statins in the treatment of porokeratosis. We conducted a systematic review of the PubMed, Semantic Scholar and Cochrane databases from 1 January 2015 to 15 February 2025, identifying clinical studies evaluating topical statin therapy (atorvastatin, fluvastatin, lovastatin, rosuvastatin or simvastatin) in patients with any subtype of porokeratosis. Twenty-four studies encompassing 95 patients met the inclusion criteria. Most publications (88%) were case reports. The majority of patients (79%) received compounded topical lovastatin 2% or simvastatin 2%, typically in combination with cholesterol 2%. Clinical improvement - defined as partial resolution of symptoms or reduction in lesion size - was observed in 92% of patients (87 of 95), with onset of response reported as early as 4 weeks. Adverse events were reported in 15% of patients, primarily mild, localized dermatological reactions. Two patients discontinued treatment due to side effects. Topical statins appear to provide preliminary evidence of some clinical benefits in porokeratosis by inhibiting the mevalonate pathway, supporting a promising and plausible mechanism-based approach. However, the use of off-label compounded formulations introduces variability in efficacy and safety due to lack of quality control. The absence of FDA-approved therapies for porokeratosis represents an ongoing unmet therapeutic need warranting further investigation in prospective, controlled studies. Together, these preliminary case reports indicating clinical benefit encourage the development of an FDA-approved, Good Manufacturing Practice-quality topical statin formulation that is carefully evaluated in rigorous, well-designed clinical trials that demonstrate safety and substantial evidence of effectiveness.
27 May 2026
Read appraisal →Journal of perinatal medicine
Effect of preterm birth on neonatal, infant, child, young adult and adult mortality: a systematic review and meta-analysis
OBJECTIVES: Preterm birth is associated with a higher risk of mortality. In 2020, the global incidence of preterm births was reported at 9.9 per 100 live births. This meta-analysis was undertaken to evaluate the effect of preterm birth on mortality among various age groups. METHODS: A thorough search was done on four electronic databases: "PubMed, Scopus, Web of Science, and Embase". Adhering to PRISMA 2020 guidelines, observational analytical studies published till 4th December 2024 were included. Screening of the studies was done by two independent reviewers in two stages: title/abstract, followed by full text review of the advanced articles. It was followed by data extraction. Study quality was assessed with the Newcastle Ottawa Scale. Meta-analysis using a random-effects model was done in R Studio. PROSPERO ID: CRD42024622282. RESULTS: Database search yielded 1775 unique studies. 23 studies met the final predefined eligibility criteria. Preterm babies showed an increased risk of mortality compared to term babies with a pooled relative risk of 6.12 (95 % CI: 3.16-11.84) for neonatal mortality, 11.84 (95 % CI: 6.88-20.37) for infant mortality and 1.88 (95 % CI: 1.24-2.83) for 1-5 year. However, it was similar in adult mortality with a pooled relative risk of 1.21 (95 % CI: 0.07-20.12). CONCLUSIONS: Preterm birth is strongly associated with increased risks of childhood mortality, especially in extreme and very preterm infants, but the risk persists even for late preterms.
27 May 2026
Read appraisal →Journal of perinatal medicine
Oral adjuvants supplemented to phototherapy as a therapeutic strategy for neonatal hyperbilirubinemia: a systematic review
INTRODUCTION: Neonatal jaundice is a common condition characterized by elevated serum bilirubin levels. Although usually benign, inadequate management may result in severe complications such as bilirubin encephalopathy and kernicterus. Phototherapy is the standard treatment; however, concerns regarding potential short- and long-term adverse effects have motivated the investigation of oral adjuvants as complementary therapies to accelerate bilirubin clearance and reduce phototherapy exposure. CONTENT: This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD420251071886). Randomized controlled trials published between 2010 and 2025 were included, evaluating full-term neonates (35-42 weeks, 2-4 kg) without Rh incompatibility. Searches were conducted in PubMed, Cochrane Central, Embase, and Web of Science. Of 193 identified records, 18 RCTs met eligibility criteria. The oral adjuvants assessed included probiotics, phenobarbital, ursodeoxycholic acid (UDCA), oral calcium, zinc sulfate, fenofibrate, and clofibrate. Lactobacillus reuteri demonstrated greater 24-hour reductions in total serum bilirubin (TSB) compared to controls, whereas Bifidobacterium strains primarily reduced phototherapy duration. Phenobarbital did not outperform phototherapy alone and was associated with longer hospitalization. UDCA showed substantial bilirubin reductions, although findings were heterogeneous. Zinc supplementation did not demonstrate consistent significant benefit. Fenofibrate produced statistically significant decreases in TSB across trials and showed the most consistent efficacy. Clofibrate also reduced bilirubin levels but with methodological variability and limited comparative data. SUMMARY: Oral adjuvants combined with phototherapy may enhance bilirubin reduction in term neonates, particularly fenofibrate. OUTLOOK: However, heterogeneity and potential bias limit definitive conclusions, emphasizing the need for large, multicenter randomized trials.
27 May 2026
Read appraisal →Scientific reports
Depressive symptoms are a key determinant of health-related quality of life in ICU survivors with psychological distress
Survivors of critical illness frequently experience persistent impairments in health-related quality of life (HRQoL), with psychological symptoms contributing substantially to this burden. The relative contribution of co-occurring depression, anxiety, and post traumatic stress symptoms remains insufficiently understood. To address this gap, we conducted a cross-sectional analysis of pre-randomization data from the PICTURE randomized controlled trial, a multicenter study of a brief primary care-based psychological intervention for post-traumatic stress disorder symptoms following critical illness, including 319 intensive care unit survivors. Clinical, demographic, and mental health assessments were obtained after ICU discharge. Latent profile analysis, random forest modeling, and quantile regression were applied to identify determinants of HRQoL measured by the EuroQol Five-Dimension Five-Level (EQ-5D-5L) index and visual analog scale (VAS). The mean EQ-5D-5L index was 0.71 (SD 0.27; median 0.81) and the mean EQ VAS score was 60.7 (SD 19.4; median 60.0), indicating considerable overall impairment. Depression, anxiety, and post-traumatic stress symptoms showed substantial overlap and formed four distinct symptom profiles associated with specific functional impairments. Screening positive for depression on the 2-item Patient Health Questionnaire (PHQ-2) with ≥ 3 points was associated with a median reduction of -0.13 (95% CI -0.19 to -0.07) on the EQ-5D-5L index and -12.45 points (95% CI -17.93 to -6.96) on the EQ VAS, exceeding clinical and demographic predictors. These findings indicate that depressive symptoms are a major determinant of impaired health related quality of life among intensive care survivors with psychological distress and support routine brief depression screening in post-intensive care follow up.Trial registration: ClinTrials.gov: NCT03315390 (Registration date: 2017-10-20); German Clinical Trials Register: DRKS-ID: DRKS00012589 (Registration date: 2017-10-17).
26 May 2026
Read appraisal →Neurology
Glucagon-like Peptide-1 Receptor Agonists and Risk of Nonarteritic Anterior Ischemic Optic Neuropathy: Systematic Review and Meta-Analysis
BACKGROUND AND OBJECTIVES: Recent observational studies have reported conflicting evidence regarding an association between glucagon-like peptide-1 receptor agonists (GLP-1RAs), particularly semaglutide, and nonarteritic anterior ischemic optic neuropathy (NAION). We aimed to synthesize the pooled evidence assessing the association between GLP-1RA use and NAION risk. METHODS: Embase, Medline, and Cochrane CENTRAL databases were searched from inception to April 5, 2025. Observational studies and randomized controlled trials comparing NAION risk in GLP-1RA users with non-GLP-1RA users were included. Title/abstract and full-text screening were conducted in duplicate by 2 independent reviewers. Discrepancies were resolved through discussion or adjudication by a third reviewer. Risk of bias was assessed using the Risk of Bias In Nonrandomized Studies of Interventions (ROBINS-I) tool, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation framework. Pooled relative risks (RRs) were estimated using Bayesian random-effects models, incorporating half-normal, between-study, and weakly informative priors. The RR with 95% credible interval (CrI) was computed to analyze the development of NAION associated with GLP-1RA exposure. RESULTS: Five studies were included in the primary analysis, encompassing 1,593,554 patients (682,456 semaglutide users and 911,098 non-GLP-1RA users). Semaglutide use was associated with a high probability of increased risk of NAION compared with non-GLP-1RA use (RR: 2.52, 95% CrI [1.56, 4.72], I2: 57.8%, P(RR > 1): 99.9%). This association was particularly pronounced among patients with diabetes (RR: 2.41, 95% CrI [1.57, 4.10], I2: 47.2%, P(RR > 1): 99.9%). The overall incidence of NAION across 5 studies and 7 comparisons, encompassing 1,460,760 patients (semaglutide: 1,108,542; dulaglutide: 326,282; and exenatide: 25,936) and 272 NAION events (semaglutide: 198; dulaglutide: 54; and exenatide: 20) was 85 cases per 100,000 GLP-1RA users (95% CrI [29, 263], I2: 98.8%, P(incidence >0.00001): 100%). The incidence of NAION across 1,108,542 semaglutide users was 118 cases per 100,000 (95% CrI [32, 451], I2: 98.8%, P(incidence >0.00001): 100%). Leave-one-out sensitivity analyses consistently supported these findings. DISCUSSION: Low-to-moderate certainty evidence indicates that semaglutide significantly increases risk of NAION relative to non-GLP-1RAs, particularly among patients with diabetes. These findings warrant further investigation and should inform clinical risk-benefit discussions.
26 May 2026
Read appraisal →Journal of medical Internet research
Virtual Reality Interventions for Stress Reduction in the General Population: Systematic Review and Meta-Analysis of Randomized Controlled Trials
BACKGROUND: Increasing mental demands across multiple life domains underscore the importance of effective individual stress management to mitigate the adverse health consequences of chronic stress. Growing evidence suggests that virtual reality (VR) interventions constitute an effective approach to stress reduction. OBJECTIVE: This systematic review and meta-analysis aimed to examine and compare application areas of VR interventions for stress reduction in the general population and to identify potential predictors of effectiveness based on sample characteristics and intervention design. METHODS: Five databases (MEDLINE, CINAHL, CENTRAL, PsycInfo, and Web of Science) were systematically searched for randomized controlled trials investigating the effectiveness of VR interventions for stress reduction in the general population. Studies were included if they primarily focused on stress reduction, included a neutral control condition, and reported a validated measurement of perceived stress. Trials targeting mental disorders or those conducted in the context of medical procedures were excluded. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias using the Cochrane Collaboration's tool. Effects were synthesized using pooled standardized mean differences, and relevant predictors were evaluated through subgroup analyses and meta-regressions. RESULTS: A total of 55 relevant studies met the inclusion criteria, with 37 investigating single-session and 18 multisession interventions (ranging from 1 to 42 sessions over 2 days to 6 months). The meta-analysis included 39 studies with 4024 participants (sample sizes 24-409; mean ages 19.2-70.6 years). Intervention types included VR-based nature exposure (21), biophilic architectural elements (6), guided meditation (9), interactive tasks (4), and other approaches (1). On average, VR interventions significantly reduced perceived stress level (-0.55, 95% CI -0.70 to -0.40; P<.001; I2=76%; 95% prediction interval [PI] -1.32 to 0.23), anxiety (-0.88, 95% CI -1.23 to -0.54; P<.001; I2=87%; 95% PI -2.07 to 0.31), and depression (-0.34, 95% CI -0.47 to -0.21; P<.001; I2=0%; 95% PI -0.47 to -0.21), and enhanced positive emotion (-0.64, 95% CI -0.84 to -0.46; P<.001; I2=62%; 95% PI -1.28 to -0.02). In addition, the decrease in systolic blood pressure was significant (-0.20, 95% CI -0.37 to -0.04; P=.02; 95% PI -0.37 to -0.04). Univariate linear regression analyses identified multiple sessions (R²=15%, P=.02) as a significant predictor of VR-based stress reduction. Further analyses of technical and content-related characteristics revealed that a higher image refresh rate (t15=-2.36, 2-tailed; P=.04) was associated with stronger intervention effects. CONCLUSIONS: This review highlights the considerable potential of VR interventions for reducing psychological stress in the general population and extends recent evidence by quantifying the effects of a broad range of VR-based stress reduction approaches and, for the first time, comparing diverse intervention characteristics. VR represents a promising alternative, particularly in contexts where access to real-life nature or conventional relaxation methods is limited or resource-intensive.
26 May 2026
Read appraisal →Journal of the International Society of Sports Nutrition
The effect of probiotic and synbiotic supplementation on sleep parameters in exercised population: a systematic review and synthesis without meta-analysis (SWiM) of randomized controlled trials
BACKGROUND: Sleep is crucial for recovery and optimal performance in athletes; however, poor sleep is common during periods of intensive training or competition. The microbiota-gut-brain axis suggests probiotics and synbiotics could modulate sleep, but evidence in exercised populations is limited. OBJECTIVE: To systematically review randomized controlled trials (RCTs) assessing the effects of probiotic and synbiotic supplementation on sleep in exercised populations, using a Synthesis Without Meta-analysis (SWiM) approach. METHODS: PubMed, Scopus, Web of Science, and ProQuest were searched up to September 2025. Eligible studies were RCTs including exercised individuals, testing probiotics or synbiotics, and reporting sleep outcomes. Data extraction, risk of bias assessment (RoB 2), and narrative synthesis followed SWiM guidelines. RESULTS: Six RCTs (n = 180) were included: four probiotic and two synbiotic interventions lasting 4-17 weeks. Populations included athletes from multiple sports across four continents. Nine of twelve primary sleep outcomes favored supplementation, with significant effects for probiotics (combined p < 0.01) and synbiotics (p < 0.001). Benefits were most consistent for subjective sleep quality and, in some cases, sleep latency. Secondary outcomes showed occasional reductions in stress, anxiety, and fatigue. CONCLUSION: Probiotic and synbiotic supplementation may improve sleep in exercised populations, especially perceived quality and latency. Evidence supports cautious, adjunctive use, but larger, standardized trials are needed to confirm effects.PROSPERO registration number: CRD420251151264.
26 May 2026
Read appraisal →Journal of medical Internet research
Association Between Wearable Device Adoption and Health-Related Lifestyle Behaviors: Retrospective Cohort Study
BACKGROUND: Wearable devices are increasingly adopted for personal health monitoring, but evidence on their long-term associations with health-related lifestyle behaviors in real-world population settings remains limited. OBJECTIVE: This study examined the longitudinal association between wearable device adoption and engagement in health-related lifestyle behaviors using a nationally representative panel dataset from South Korea. METHODS: We analyzed data from the 2016 and 2022 waves of the Korea Media Panel survey. Health-related lifestyle behaviors in the physical, social, and cultural domains were operationalized as estimated annual activity counts based on self-reported frequency measures. We used a difference-in-differences framework with generalized estimating equations to compare changes in these behaviors between new wearable adopters and nonadopters adjusting for demographic and socioeconomic characteristics. Relative changes were estimated using Poisson models with a log link, and subgroup analyses were conducted to explore variation across sociodemographic groups. As a sensitivity analysis, inverse probability of treatment weighting was additionally applied to assess the robustness of the findings to observed baseline imbalance. RESULTS: Wearable device adoption was associated with greater increases in total, physical, and cultural health-related lifestyle activities over time. In the difference-in-differences model, adopters showed greater relative increases in total activity (rate ratio [RR] 1.24, 95% CI 1.08-1.35), physical activity (RR 1.36, 95% CI 1.12-1.64), and cultural activity (RR 1.78, 95% CI 1.31-2.42) than nonadopters. Subgroup analyses showed limited evidence of consistent heterogeneity and should be interpreted cautiously. Sensitivity analyses using inverse probability of treatment weighting showed overall patterns broadly similar to those of the primary analyses. CONCLUSIONS: In this nationally representative panel study, wearable device adoption was associated with greater increases in total, physical, and cultural health-related lifestyle activities over time, whereas no clear association was observed for social activity. These findings should be interpreted as associative rather than causal given the observational design and the inability to directly assess parallel trends.
26 May 2026
Read appraisal →European journal of pediatrics
Safety and efficacy of liposomal iron for iron deficiency anemia in pediatric population: A systematic review and meta-analysis of randomized controlled trials
Iron deficiency anemia (IDA) remains a public health problem in children. Conventional iron therapy is effective but often causes gastrointestinal adverse effects that reduce adherence. Liposomal iron has been developed to enhance absorption and improve tolerability. This systematic review and meta-analysis evaluated the efficacy and safety of liposomal iron compared with conventional iron formulations in pediatric patients with IDA. We searched PubMed, Scopus, Web of Science, and the Cochrane Library up to February 21, 2026 for randomized controlled trials (RCTs) comparing liposomal iron with conventional oral iron in children with IDA. Analyses were performed using R software with the meta package. Continuous outcomes were pooled as mean differences (MDs) and dichotomous outcomes as risk ratios (RRs) with 95% confidence intervals (CIs) using a random-effects model. Subgroup analyses according to follow-up duration. Four RCTs involving 454 children were included. At 6 months, liposomal iron produced a significantly greater increase in hemoglobin compared with conventional iron (MD 0.96 g/dL, 95% CI 0.09-1.82; P = 0.03), although heterogeneity was substantial (I2 = 92.9%). No significant differences were observed at earlier time points. Liposomal iron significantly reduced total iron-binding capacity (MD - 35.52 μg/dL; P < 0.0001) and increased mean corpuscular hemoglobin (MD 1.83 pg; P < 0.0001). Liposomal iron was associated with fewer adverse events (RR 0.29; P = 0.02) and lower risk of constipation (RR 0.56; P = 0.02).Conclusion: Liposomal iron offered better tolerability and was non-inferior to conventional iron for most hematologic outcomes. Evidence remains preliminary and larger RCTs are needed to confirm its efficacy in pediatric IDA.
26 May 2026
Read appraisal →Pharmaceutical biology
Ginger-based formulations for allergic rhinitis disease: a systematic review and meta-analysis of experimental studies in animals and humans
BACKGROUND: Allergic rhinitis is a chronic non-communicable disease that adversely affects respiratory health and quality of life. Ginger-based formulations, owing to their anti-inflammatory and immunomodulatory properties, may offer a promising alternative therapeutic option. OBJECTIVE: To systematically review and meta-analyze evidence from animal studies and human randomized controlled trials assessing the efficacy of ginger-based formulations in allergic rhinitis. METHODS: A systematic search of the Cochrane Library, Embase, PubMed, and Scopus (April 2025) identified studies comparing ginger-based formulations with control interventions. Outcomes included clinical symptoms and relevant biomarkers. Risk of bias was assessed using the SYRCLE tool for animal studies and RoB2 for human studies. Meta-analyses were conducted using random-effects models, with results expressed as standardized mean difference (SMD) and 95% confidence intervals (CIs). RESULTS: Twenty-one studies (6 animal and 15 human studies) were included. In rodents, ginger-based formulations significantly reduced nasal rubbing (SMD = -1.99; 95%CI, -3.15 to -0.83), sneezing (SMD = -1.99; 95%CI, -2.78 to -1.20), and biomarkers (IL-4, IL-5, and OVA-specific IgE). In humans, ginger-based formulations significantly improved itching (SMD = -0.51; 95%CI, -0.79 to -0.24), runny nose (SMD = -0.59; 95%CI, -0.87 to -0.30), sneezing (SMD = -0.56; 95%CI, -0.75 to -0.37), total nasal symptom scores (SMD = -0.63; 95%CI, -1.00 to -0.26), and quality of life (SMD = -0.56; 95%CI, -0.87 to -0.24), and eosinophil levels. CONCLUSION: Ginger-based formulations improve symptoms and biomarkers of allergic rhinitis in both animal and human studies. As many interventions are multi-component, the observed effects are more appropriately attributed to the overall formulations rather than ginger alone. Further research is needed to explore mechanisms and clarify clinical applications.
26 May 2026
Read appraisal →Circulation journal : official journal of the Japanese Circulation Society
High Human Epididymis Protein 4 Levels Are Associated With Lower Systolic Function and Poor Prognosis in Heart Failure With Reduced Ejection Fraction
BACKGROUND: Human epididymis protein 4 (HE4) is a novel fibrosis marker expressed in activated myofibroblasts. Although we previously demonstrated its prognostic value in dilated cardiomyopathy, its significance in general heart failure with reduced ejection fraction (HFrEF) remains unclear. METHODS AND RESULTS: Serum HE4 concentrations were measured in 140 patients with HFrEF (left ventricular ejection fraction <40%) and followed for up to 3 years to assess cardiovascular (CV) death and heart failure hospitalization. Kaplan-Meier analysis revealed significantly higher CV event rates in the high HE4 group (above the median) than in the low HE4 group (log-rank P<0.001). Multivariate Cox regression analysis identified HE4 (ln[HE4]) as an independent predictor of adverse outcomes (hazard ratio 3.99; 95% confidence interval [CI] 2.05-7.75; P<0.001). In multivariate linear regression, HE4 was significantly associated with age, serum creatinine, plasma B-type natriuretic peptide, E/e', and global longitudinal strain (GLS; β=-0.083; 95% CI -0.111, -0.054; P<0.001). Combining HE4 and GLS demonstrated that patients with high HE4 and low GLS had the highest CV event rate (log-rank P<0.001). CONCLUSIONS: HE4 is an independent prognostic biomarker in HFrEF, and its association with GLS may reflect underlying myocardial dysfunction and fibrotic remodeling leading to adverse outcomes.
26 May 2026
Read appraisal →Circulation journal : official journal of the Japanese Circulation Society
Association Between Ventricular-Arterial Coupling and C-Reactive Protein in Patients at Risk for Heart Failure
BACKGROUND: Although ventricular-arterial coupling (VAC) and C-reactive protein (CRP) are associated with the pathogenesis of heart failure (HF), their association in patients at risk of HF remains unclear. METHODS AND RESULTS: VAC was assessed by arterial elastance (Ea) to left ventricular endsystolic elastance (Ees) ratio (Ea/Ees) using the noninvasive single-beat method in 112 hypertensive patients. Log-transformed high-sensitivity CRP (hs-CRP) and categorical hs-CRP were associated with Ea/Ees on univariate analysis. Categorical hs-CRP was independently associated with Ea/Ees after adjusting for atherosclerotic risk factors, cardiac function and vascular function (β=0.27, P=0.003). CONCLUSIONS: hs-CRP was independently associated with VAC assessed by Ea/Ees in patients at risk of HF.
25 May 2026
Read appraisal →European journal of clinical pharmacology
Ondansetron augmentation for obsessive-compulsive disorder: A systematic review and meta-analysis of randomized placebo-controlled trials
BACKGROUND: A substantial proportion of adults with obsessive-compulsive disorder (OCD) experience persistent symptoms despite optimized first-line treatment with exposure and response prevention and/or serotonin reuptake inhibitors (SRIs). Ondansetron, a selective 5-hydroxytryptamine-3 (5-HT3) receptor antagonist with plausible circuit-level relevance to cortico-striato-thalamo-cortical dysfunction, has been evaluated as an augmentation strategy. Still, evidence is dispersed across small randomized trials. METHODS: We conducted a PRISMA 2020-adherent systematic review and random-effects meta-analysis (PROSPERO: CRD420261302132). Embase (Ovid and Embase.com), MEDLINE, PubMed, and Scopus were searched from inception to 12 February 2026. Eligible studies were randomized, double-blind, placebo-controlled trials of oral ondansetron augmentation in adults (≥ 18 years) with OCD on stable background treatment. The primary outcome was change in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) total score, pooled at prespecified acute windows (week 4, ~week 8 primary, week 12). Secondary outcomes included Y-BOCS obsession and compulsion subscales. Risk of bias was assessed using RoB 2. Random-effects models (DerSimonian-Laird) were used; Wan's method was applied when required. RESULTS: Five trials (total N = 289) were included. Ondansetron augmentation was associated with greater improvement in Y-BOCS total score versus placebo at week 4 (MD 2.63; 95% CI 0.87-4.39; I²=62%); heterogeneity resolved after excluding one influential study (MD 1.94; 0.37-3.51; I²=0%). At week 8 (four trials; N = 244), benefit was larger (MD 5.53; 3.45-7.60; I²=48%) and remained robust in sensitivity analysis (MD 6.76; 5.81-7.71; I²=0%). At week 12 (three trials; N = 200), effects persisted (MD 6.41; 4.28-8.53; I²=55%) with reduced heterogeneity after excluding one study (MD 5.06; 2.82-7.30; I²=0%). In two trials reporting subscales (N = 214), obsessions improved at weeks 4 and 8 (overall MD 2.67; 1.66-3.67; I²=0%), while compulsions showed a smaller, later signal (overall MD 1.02; 0.19-1.86; I²=0%). Safety reporting was variably detailed across trials; known QT-prolongation considerations remain relevant for off-label use. CONCLUSIONS: In randomized, placebo-controlled trials, ondansetron augmentation was associated with greater improvement in clinician-rated OCD severity than placebo over short-term follow-up, with signals emerging by week 4 and persisting through 8-12 weeks. However, these findings should be interpreted cautiously because the evidence base is small, geographically concentrated, and partly influenced by individual studies. The current evidence should therefore be considered preliminary and hypothesis-generating rather than definitive. Larger multicenter trials with standardized background SRI optimization, preregistered outcomes, and rigorous safety monitoring are required before routine clinical adoption can be considered.
25 May 2026
Read appraisal →Neuroscience
The effects of acute psychosocial stress on binge urges, inhibitory control, negative urgency and eating pathology in Binge Eating Disorder
Stress is frequently reported as a trigger for binge episodes, yet it remains unclear how subjective and physiological stress responses interact with cognitive and affective mechanisms to increase binge eating risk. The present study investigated the effects of acute psychosocial stress on binge urges, focusing on the role of state- and trait-level vulnerabilities. Twenty-eight individuals with BED were randomized to either a Stress condition (n = 14) or No-Stress condition (n = 14). Following an acute psychosocial stressor, participants completed the Stop-Signal Task to behaviourally assess inhibitory control. Self-reported mood, binge urge ratings and saliva samples for stress biomarker detection were collected at three timepoints throughout the experimental session. Results demonstrated that acute psychosocial stress elicited marked increases in total mood disturbance, without corresponding physiological stress responses and significantly impaired inhibitory control. Notably, only subjective stress responses were associated with greater binge urges, whereas physiological stress responses were not. This dissociation highlights subjective stress reactivity as a clinically meaningful mechanism of risk in BED, underscoring the potential value of interventions that target stress perception and regulation to reduce binge eating vulnerability.
25 May 2026
Read appraisal →Lancet (London, England)
Updated trends in the global prevalence and burden of mental disorders, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023
BACKGROUND: The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. METHODS: Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. FINDINGS: We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. INTERPRETATION: A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. FUNDING: Gates Foundation, Queensland Health, and University of Queensland.
25 May 2026
Read appraisal →Scandinavian journal of primary health care
Responsible digital transformation in rural primary healthcare services: critical factors from a Norwegian case study
OBJECTIVE: To explore the critical factors that shape the potential for co-creating and implementing a virtual department for home-based healthcare in a rural municipality. METHODS: A qualitative case study was conducted in a rural municipality in Northern Norway. Data were collected through semi-structured interviews, focus groups, and co-creation workshops involving healthcare leaders, frontline staff, service users and relatives, and representative from the pensioners' federation. Thematic analysis was applied to identify organisational, contextual, and cultural factors influencing digital transformation. RESULTS: While the co-creation of virtual department for home-based healthcare showed potential for piloting, readiness for full implementation was limited. Six critical factors were identified: structural readiness, digital competence, technology in practice, cultural change, autonomy and care, and motivation and dedication. These factors highlight the importance of organisational culture, workforce capacity, and stakeholder engagement in shaping readiness for responsible digital transformation. CONCLUSION: Digital transformation holds potential for addressing healthcare challenges in rural municipalities, but success depends on more than technological efficacy. Effective coordination between bottom-up and top-down approaches is required to ensure responsible and sustainable transformation of primary healthcare services.
25 May 2026
Read appraisal →European journal of clinical pharmacology
Dysesthesia associated with GLP-1 agonist therapies: data-mining analysis and literature review
PURPOSE: An increasing number of anecdotal reports on social media platforms and medical blogs describe dysesthesia, particularly burning skin sensations, in association with glucagon-like peptide-1 receptor (GLP-1R) agonists. We performed a pharmacovigilance data-mining analysis to characterise cases of dysesthesia related to GLP-1R. METHODS: We conducted a disproportionality analysis using VigiBase data on GLP-1R (Anatomical Therapeutic Chemical classification: ATC code A10BJ) and tirzepatide, focusing on the HLT (High Level Term) "Paraesthesia and dysesthesia", with the Information Component (IC). Additionally, we reviewed all narratives of dysesthesia cases in the French Pharmacovigilance database to extract clinical and pharmacological characteristics. A literature review complemented this analysis. RESULTS: Exenatide was significantly associated with hypoesthesia or oral paraesthesia, semaglutide and tirzepatide with hyperaesthesia, and semaglutide with dysesthesia and burning sensation. Dysesthesia appears to be dose-dependent, occurring more frequently at higher doses and with more potent GLP-1R, whether used for weight management or type 2 diabetes. Discontinuation was often performed, followed by spontaneous favourable outcomes, and cases of rechallenge were observed. Skin burning sensations represent a distinctive form of dysesthesia. CONCLUSION: Pharmacovigilance quantitative and qualitative data strengthens evidence for dysesthesias associated with GLP-1R agonists already observed in clinical trials of semaglutide, tirzepatide, and retatrutide.
25 May 2026
Read appraisal →Rheumatology international
Home-based postural exercise as an adjunct to duloxetine improves sleep quality, physical quality of life, and trunk mobility in fibromyalgia: a randomized controlled trial
In fibromyalgia syndrome (FMS), current guidelines recommend combining pharmacological treatments such as duloxetine with exercise interventions. This randomized controlled trial aimed to evaluate the effectiveness of a home-based postural exercise program as an adjunct to pharmacological treatment in individuals with FMS. Fifty-one patients diagnosed with FMS according to the 2016 American College of Rheumatology criteria were randomly assigned to an exercise group (EG, n = 26) or a control group (CG, n = 25). Both groups received duloxetine therapy, while the EG additionally performed a home-based postural exercise program three times per week for four weeks. Outcomes included pain intensity, pressure pain threshold (PPT), sleep quality, anxiety and depression, quality of life, and trunk range of motion (ROM). Significant improvements over time were observed in pain intensity, psychological symptoms, sleep quality, quality of life, and PPT in both groups (p < 0.05). Significant group × time interactions favored the EG for sleep quality assessed using the Pittsburgh Sleep Quality Index (F = 11.07, p = 0.002, η²=0.184), the physical component of the Short Form-12 (F = 4.31, p = 0.043, η²=0.081), trunk flexion (F = 20.85, p < 0.001, η²=0.299), trunk extension (F = 8.34, p = 0.006, η²=0.146), and global trunk ROM (F = 35.10, p < 0.001, η²=0.417). No significant group × time interactions were observed for pain intensity, anxiety, depression, mental quality of life, or PPT (p > 0.05). Adding a home-based postural exercise program to pharmacological treatment may provide short-term additional benefits in sleep quality, physical quality of life, and spinal mobility in individuals with FMS; however, these findings should be interpreted cautiously due to the short intervention duration and absence of follow-up assessment.
25 May 2026
Read appraisal →Medicine
The effects of electroacupuncture and the Otago Exercise Program in older adults with sarcopenia: A randomized controlled study
BACKGROUND: The aim of this study was to investigate the effects of a combination of electroacupuncture (EA) and the Otago Exercise Program (OEP) for sarcopenia in older individuals and provide treatment recommendations for this patient population. METHODS: In this assessor-blinded randomized controlled trial, 120 older patients with sarcopenia were randomly divided into an OEP group (n = 58) and an EA + OEP group (n = 62). The OEP group received OEP 5 times/week, with each session lasting 30 minutes, for a duration of 12 weeks. In addition to OEP treatment, the EA + OEP group was treated with EA at ST31, ST32, GB34 and ST36 for 30 minutes 3 times/week for 12 weeks. The appendicular skeletal muscle mass-height index (ASM/H2) was the primary outcome. The secondary outcomes included grip strength, 4-m gait speed and 6-min walk distance. Outcomes were measured before initiation and at 6 and 12 weeks after initiation. RESULTS: Significant differences in ASM/H2, grip strength, 4-m gait speed and 6-min walk distance were detected between the 2 groups at week 12, whereas no differences were detected at weeks 0 and 6. In the EA + OEP group, as the treatment time increased, ASM/H2, grip strength, 4-m gait speed and 6-min walk distance increased significantly. In the OEP group, as the treatment time increased, no significant difference was found in ASM/H2, whereas grip strength, 4-m gait speed and 6-min walk distance increased significantly (P < .05). CONCLUSION: In older patients with sarcopenia, EA + OEP was associated with increased skeletal muscle mass, but no such effect was found for OEP alone. Moreover, EA + OEP was superior to OEP alone in terms of improving muscle strength and walking ability. EA + OEP may be considered an effective treatment for sarcopenia in older adults.
25 May 2026
Read appraisal →Journal of medical systems
Machine Learning-Predicted Risk Trajectories for Incident Chronic Kidney Disease and Associations with Post-CKD Outcomes
Chronic kidney disease (CKD) is a progressive condition where risk accumulates before clinical onset. However, strategies for evaluating CKD risk remain limited, and the trajectories of risk over time are poorly understood. We enrolled 51,156 individuals without CKD in the University of California health system between 2012 and 2024. A debiased XGBoost model was developed to predict CKD risk, and the predicted probabilities from this model at each visit were used to derive risk trajectories through latent class growth mixture modeling. The model achieved a time-dependent area under the curve of 0.95 (95% confidence interval (CI), 0.94-0.96), a C-index of 0.93 (0.92-0.94), and a Brier score of 0.027 (0.026-0.028) for predicting 5-year CKD occurrence. Similar predictive performance was observed for 1 to 4 years. Longitudinal patterns of predicted CKD risk revealed three distinct trajectories: gradual (75.9%), progressive (10.1%), and rapid increase (14.0%). Compared to the gradual trajectory, the progressive trajectory was associated with a higher risk of estimated glomerular filtration rate (eGFR) decline of ≥ 25% (adjusted hazard ratio (HR) 1.31; 95% CI, 1.06-1.61) and ≥ 50% (HR 1.59; 95% CI, 1.09-2.31) following CKD onset. The progressive and rapid trajectory was linked to an increased risk of cardiovascular events (HR 1.84; 95% CI 1.18-2.91) and all-cause mortality (HR 2.36; 95% CI 1.49-3.73). Our machine learning model demonstrated strong predictive performance for incident CKD risk and identified three distinct risk trajectories that were associated with different post-CKD outcomes, highlighting the importance of early risk monitoring.
25 May 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Utility of Acupuncture Therapy for Adult Chronic Daily Headache Prophylaxis: A Systematic Review and Meta-Analysis
BACKGROUND Chronic daily headache (CDH) management remains challenging due to limited efficacy of standard preventive pharmacotherapies. Acupuncture has shown promise in chronic headache management. This study evaluated its sustained prophylactic efficacy for CDH. MATERIAL AND METHODS Following PRISMA guidelines, we systematically searched PubMed, EMBASE, the Cochrane Library, CNKI, VIP, Sinomed, and Wanfang Data (inception to September 2025) for randomized controlled trials (RCTs) comparing acupuncture with other interventions for CDH. Primary outcomes included headache frequency, days, intensity, duration, and analgesic use; subgroup analyses covered treatment modality, CDH subtype, and duration. RESULTS Twenty-two RCTs (1449 patients) were included. Compared with control, acupuncture significantly reduced headache frequency (mean difference [MD], -0.32; P=0.001), headache days (MD, -0.72; P<0.00001), intensity (standardized mean difference [SMD], -0.63; P=0.001), duration (SMD, -1.18; P=0.0001), and analgesic use (MD, -0.52; P<0.00001) after the intervention. These benefits persisted during follow-up: headache days (standardized mean difference [SMD], -0.70; P<0.00001), intensity (SMD, -1.11; P=0.008), duration (SMD, -1.83; P=0.003), and analgesic use (SMD, -0.60; P=0.007) remained reduced; headache frequency showed a trend toward reduction (SMD, -0.47; P=0.05). Subgroup analyses revealed consistent efficacy across various CDH subtypes, including chronic migraine and chronic tension-type headache, treatment durations (4-12 weeks), and intervention strategies (acupuncture alone or combined with medication), indicating broad clinical applicability. CONCLUSIONS Acupuncture yields clinically meaningful, sustained improvements in CDH, supporting its role as an effective routine and adjunctive prophylaxis and broader application in this population.
25 May 2026
Read appraisal →Current urology reports
Association Between Ambient Temperature and Urolithiasis: A Systematic Review and Meta-analysis
PURPOSE OF REVIEW: The global incidence of urolithiasis has risen in recent decades. Emerging evidence suggests that higher ambient temperatures are linked to an increased risk of kidney-stone-related events, including acute renal colic, likely through physiological mechanisms such as increased urinary calcium excretion and greater supersaturation of calcium oxalate and calcium phosphate. This study aims to systematically review existing evidence on the relationship between ambient temperature and urolithiasis risk. RECENT FINDINGS: Of 892 records identified, 46 studies met the inclusion criteria for the systematic review, and 16 were included in the meta-analysis. Most studies reported a positive association between higher ambient temperatures and increased kidney stone-related events, with seasonal peaks occurring during summer months in the Northern Hemisphere and from December to March in Australia. Considerable heterogeneity was observed in exposure definitions, meteorological data sources, outcome ascertainment, and lag structures. Reported effect estimates ranged from RR 1.10 to 2.54. Meta-analysis showed that higher ambient temperature was associated with an increased risk of urolithiasis presentation (pooled RR 1.31, 95% CI 1.21-1.43; I²=86.7%). Subgroup analyses showed pooled RRs of 1.27 (95% CI 1.18-1.37) for stone colic, 1.33 (95% CI 1.06-1.67) for emergency visits, and 1.36 (95% CI 0.98-1.90) for hospitalizations. Associations were stronger at medium and long lag periods than at short lags. Most studies were rated as high risk of bias, primarily because of confounding and outcome measurement concerns. Sensitivity analyses supported the robustness of the findings. This systematic review highlights an association between higher ambient temperatures and increased presentations for kidney stone disease. Addressing environmental factors may be a valuable strategy for reducing nephrolithiasis incidence.
25 May 2026
Read appraisal →Rheumatology international
Cost-effectiveness of artificial intelligence interventions for musculoskeletal disorders of the spine: a systematic review
Musculoskeletal disorders (MSDs) represent a substantial global health burden, and artificial intelligence (AI)-based technologies are emerging as potential approaches for their management. However, evidence regarding the cost-effectiveness of these interventions remains limited. This systematic review synthesised the available evidence on the cost-effectiveness of AI-based technologies for managing MSDs of the spine. This systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. PubMed, Medline, CINAHL, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Directory of Open Access Journals (DOAJ) databases were searched. After title and abstract screening, the remaining articles underwent full-text review by two independent reviewers, who extracted economic outcome data comparing AI-based interventions versus control. A total of 347 studies were identified, with 59 duplicates removed and 251 excluded based on title and abstract. After full-text review, seven eligible studies were included in the review. These studies represented five countries (United States (n = 2), Germany (n = 2), Denmark (n = 1), Australia (n = 1) and South Korea (n = 1)). The studies adopted a healthcare perspective (n = 4), a societal perspective (n = 2) and a healthcare and societal perspective (n = 1). Time durations varied widely, from four weeks to twelve months in trials to three years or lifetime in models, with one study using a 20-month post-implementation period. The AI components of the interventions encompassed a range of technologies, including a deep learning-based diagnostic and exercise prescription platform, AI-driven chest radiograph screening, the self-BACK application, standardised Magnetic Resonance Imaging (MRI) protocols, the Back Pain Choices online decision support tool, and the Kaia back pain application. In three studies, AI-based interventions for MSDs of the spine showed consistent positive QALY gains. Across the seven studies, five interventions (71%) were found to be cost-effective or cost-saving, four (57%) were dominant, while two (29%) were not cost-effective, indicating that most AI-based and digital interventions for MSDs of the spine provide favourable economic value compared with standard care. This is the first systematic review to synthesise evidence on the cost-effectiveness of AI-based technologies for the management of MSDs of the spine. The results suggest that AI-based interventions have the potential to contribute to more efficient healthcare resource use and may support policy and decision-making. However, their impact on reducing the economic burden of MSDs of the spine and improving health outcomes is not yet conclusive, and further standardised economic evaluations are needed to strengthen the evidence base. PROSPERO registration number: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025642775 .
25 May 2026
Read appraisal →Medicine
Predicting poor wrist function recovery after internal fixation of distal radius fractures: A retrospective study based on multivariate analysis and machine learning models
This study aimed to identify independent risk factors associated with poor wrist function recovery 6 months after internal fixation of distal radius fractures (DRF) and develop machine learning models for early risk prediction. This retrospective study included 328 patients who underwent internal fixation for DRF at our hospital between January 2022 and June 2025. Wrist function was evaluated using the Cooney Wrist Score at 6 months postoperatively. Poor recovery was defined as a Cooney score <75. The overall incidence of poor wrist function recovery was 21.56% (71/328). Clinical variables including demographic characteristics, comorbidities, laboratory indicators, fracture type, postoperative pain scores, and rehabilitation compliance were collected. Rehabilitation compliance referred to patients' adherence to prescribed postoperative functional training and follow-up plans. Variables with P <.05 in univariate analysis were entered into multivariate logistic regression to identify independent risk factors. These variables were subsequently used to construct random forest (RF), XGBoost, and backpropagation (BP) neural network models. Model performance was evaluated using ROC curves and classification metrics. Multivariate analysis identified low rehabilitation compliance, age ≥65 years, AO type C fractures, postoperative visual analogue scale scores >3 at 1 week, and decreased serum albumin levels as independent predictors of poor wrist function recovery. Among the machine learning models, the RF model demonstrated the best performance (AUC = 0.939, accuracy = 0.946), followed by the BP neural network (AUC = 0.924). The XGBoost model showed comparatively lower predictive performance (AUC = 0.876). Poor wrist function recovery after internal fixation of DRF is influenced by multiple clinical factors. Machine learning models based on identified independent risk factors, particularly the RF model, show strong predictive ability and may assist clinicians in early risk stratification and individualized rehabilitation planning.
25 May 2026
Read appraisal →Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
Patterns of e-Cigarette Use and Smoking Cessation Outcomes: Secondary Analysis of a Large Randomised Controlled Trial to Inform Clinical Advice
INTRODUCTION: Limited data exist on how to use e-cigarettes (EC) to optimize smoking cessation. METHODS: We examined associations between patterns of EC use and outcomes at 1 year in a large trial (N = 886) comparing nicotine replacement therapy (NRT) and EC. RESULTS: Use of tobacco flavor was limited and associated with a lower smoking cessation rate compared to other flavors (relative risk; RR = 0.56, 95% CI = 0.35 to 0.89). EC users reduced nicotine strength over time. Abstainers using EC reported lower urges to smoke than abstainers using NRT at both weeks 1 (b = -0.25, 95% CI = -0.45 to -0.04) and 4 (b = -0.37, 95% CI = -0.58 to -0.16). Participants using both cigarettes and EC (dual users) at week 1 were more likely to stop smoking at week 4 than exclusive smokers (RR = 4.45, 95% CI = 1.96 to 10.10). Dual users at 4 weeks and 6 months were also more likely to achieve validated 50% reduction in smoke intake at 1 year (RR = 2.37, 95% CI = 1.36 to 4.11 and RR = 4.56, 95% CI = 2.71 to 7.66, respectively). CONCLUSIONS: Non-tobacco flavors were preferred and may be also more effective. Urges to smoke were lower in EC users than in users of NRT. Dual use was associated with a reduction in smoking and quitting smoking later on. IMPLICATIONS: Clinicians advising smokers wanting to use EC as a quitting aid can consider recommending non-tobacco flavors; explaining that EC reduce urges to smoke more than combination NRT; and reassuring those worried about dual use that such use is associated with reduced smoking and a higher chance of stopping smoking altogether later on.
25 May 2026
Read appraisal →PloS one
A hybrid BiLSTM and rule-based system for integrated diabetes prediction and personalized guidance
Diabetes is a common chronic disease that needs early diagnosis and proper management to avoid severe complications. While current Artificial Intelligence (AI) tools generate predictive information, they often lack an integrated element for post-diagnosis support in order to fill in this critical gap in patient self-management. This research proposes and validates a hybrid System which aims to bridge this gap. The methodology is based on a novel, fused dataset (PIMA and Type 2 Diabetes) that was carefully preprocessed following a leakage-safe protocol in order to increase generalizability. The system architecture is a combination of two different critical components: Strong Bidirectional Long Short term Memory (BiLSTM) model for prediction and rule based engine for creating personalized lifestyle recommendations. In order to validate the efficacy of the BiLSTM model, seven traditional machine learning (ML) models and standard deep learning (DL) models have been comparatively tested, in which BiLSTM model has demonstrated a better generalization and prediction performance. Rigorous 10-fold cross validation was used to validate the system, which came up with an accuracy of 84.02%, precision of 87.89%, and recall of 80.50%. This research concludes that by successfully combining the high-performance predictive engine and real-time guidance module, it is possible to develop a holistic clinically relevant tool to close the loop between diagnosis and proactive self-management.
25 May 2026
Read appraisal →Archives of women's mental health
Moderators, mediators, and components of a standalone smartphone application for postpartum depression: secondary analysis of a randomized controlled trial
PURPOSE: The purpose of this study was to identify potential moderators, mediators, and efficacious components of a standalone app intervention on postpartum depression symptoms and functional impairment. METHODS: A total of 264 women were randomized to intervention (Motherly app) or to an active control group. We analyzed depressive symptoms assessed by the Edinburgh Postnatal Depression Scale and functional impairment by the Clinical Global Impression at post-treatment as outcomes. Various potential moderators were assessed at baseline. Potential mediation variables were the level of behavioral activation (BA) measured by the Behavioral Activation for Depression Scale - Short Form and the Response-contingent positive reinforcement (RCPR) by the Reward Probability Index, at post-treatment. Intervention component analysis was evaluated using app engagement data. RESULTS: The results indicate that intervention effects on depressive symptoms were moderated by the number of children and pediatric consultations, with stronger effects observed among mothers with fewer children and higher consultation frequency. Functional impairment was moderated by time spent with the child, with greater improvements among mothers with lower caregiving demands. Mediation analyses showed BA and RCPR mediated the effect of our intervention on depressive symptoms and functional impairment. Total and BA achievements were significantly associated with reduction in depressive symptoms. CONCLUSION: Our findings suggest that our app intervention efficacy is influenced by maternal characteristics and childcare responsibilities. BA and RCPR are key mechanisms, and higher engagement with app components produce greater symptom reduction.
24 May 2026
Read appraisal →Calcified tissue international
Performance of Large Language Models in Answering Osteoporosis-Related Frequently Asked Questions: A Systematic Comparative Evaluation Based on International Associations
To systematically evaluate and compare the performance of large language models (LLMs) in answering osteoporosis-related frequently asked questions (FAQs) derived from international osteoporosis-related associations. A standardized question bank was constructed based on FAQs summarized from three international osteoporosis-related associations. Six LLMs were prompted to generate responses to all questions under uniform conditions. Two osteoporosis experts independently and blindly evaluated all responses using 5-point Likert scales for accuracy and comprehensiveness. Inter-rater reliability was assessed using Cohen's κ coefficient. Nonparametric statistical analyses, including Kruskal-Wallis tests with Dunn's post hoc comparisons and Wilcoxon signed-rank tests, were performed to compare models' performance. A total of 528 responses were generated from 88 association-based questions. Inter-rater agreement was good for both accuracy and comprehensiveness (κ = 0.668 and 0.702, respectively). Significant differences were observed among models, with Claude Sonnet 4.5 demonstrating the highest overall performance on association-based FAQs. Although most models showed solid medical knowledge and basic reasoning ability, substantial variability was observed across question types and prompt formulations. Current LLMs demonstrate promising potential as auxiliary tools for osteoporosis-related health management. However, it is necessary to optimize the strategies for integrating medical knowledge and designing prompts, so as to better improve the accessibility of its clinical application.
24 May 2026
Read appraisal →BMJ paediatrics open
Enhancing parental health knowledge through digital knowledge mobilisation tools: a randomised controlled trial and qualitative study
OBJECTIVE: To assess the effectiveness of blogshots (ie, image-based digital knowledge mobilisation tools) to increase knowledge and manage expectations with respect to six Choosing Wisely Canada (CWC) recommendations about common childhood conditions. DESIGN: Multimethod study including a non-pharmacological randomised controlled trial and qualitative interviews. SETTING: Online questionnaires and semistructured interviews across Canada. PARTICIPANTS: Parents or legal guardians of children under 5 years. INTERVENTION: Participants were randomly allocated to receive one of two sets of blogshots whereby a blogshot on a new CWC topic was delivered weekly over 3 weeks (Group A: pharyngitis (diagnosis), common cold, asthma; Group B: pharyngitis (treatment), bronchiolitis, otitis media). Study investigators were blinded to participant allocation. Baseline and follow-up (week 5, month 3, month 6) questionnaires were administered. Qualitative interviews contextualised intervention data. MAIN OUTCOME MEASURES: The primary outcome was change in knowledge. Secondary outcomes were change in expectations, intentions, actions over time and usability of the blogshots. RESULTS: 167 participants (n=133 (80%) mothers) were included in the final analysis (group A, n=85; group B, n=82). Baseline knowledge scores did not differ between groups. At follow-up 1, those who received the blogshot for a given topic scored significantly higher (p<0.001, d=0.30) on knowledge questionnaires, compared with those that did not. No differences were observed in knowledge scores between groups at follow-up 2 and 3. Participants expressed intentions to use the blogshots (eg, share with friends, physicians), as well as actions (eg, wait/watch approach vs seek healthcare) to manage their child's condition. Qualitative data (n=13 interviews) showed that blogshots are aesthetically pleasing and contain easy to read and understandable information. CONCLUSIONS: Blogshots can be an effective tool to disseminate child health information to parents. Due to the online dissemination, this approach could be scaled to a broader international level and applied to different health topics that are relevant across the world. TRIAL REGISTRATION NUMBER: NCT06005337.
24 May 2026
Read appraisal →International journal of yoga therapy
Systematic Review on the Effect of Yoga Nidra on Menstrual Disorders Among Adult Women
Menstrual disorders including amenorrhea, premenstrual syndrome, and dysmenorrhea significantly disrupt the normal menstrual cycle and negatively impact quality of life. Yoga nidra, a guided meditation technique, has been explored for its potential therapeutic benefits in menstrual health, although comprehensive evidence remains limited. The present systematic review aimed to assess the effect of yoga nidra on menstrual disorders by analyzing existing research and synthesizing findings. The review followed PRISMA guidelines and involved searches in PubMed/MEDLINE, Cochrane Library, Science Direct, and Google Scholar using keywords related to yoga nidra and menstrual disorders. Studies were selected based on predefined inclusion criteria. A total of seven randomized controlled trials were included. The findings indicated improvements across four key areas of women's health: (1) psychological well-being, (2) hormonal balance, (3) hematological profile, and (4) physiological parameters. These results suggest that yoga nidra may be an effective complementary therapy for managing menstrual disorders because of its noninvasive and low-cost nature. However, further high-quality randomized controlled trials are necessary to confirm its efficacy.
24 May 2026
Read appraisal →Scientific reports
A randomized controlled trial of adjunctive speleotherapy in asthma, COPD and long COVID
Speleotherapy (underground climate therapy) is a non-pharmacological intervention for chronic respiratory diseases. This randomized controlled trial investigated whether a 3-week speleotherapy course (6 sessions, 2 h/week) improves respiratory outcomes in patients on standard background therapy with asthma, COPD, or Long COVID, and whether it affects blood CO2 levels. The control group did not receive speleotherapy but continued their standard therapy. A total of 208 patients (asthma: n = 107; COPD: n = 59; Long COVID: n = 42) were enrolled across nine centers in Germany, Austria, and Italy. Assessments were conducted pre-intervention (T1), post-intervention (T2), and at 3-month follow-up (T3). Outcome measures included airway inflammation (FeNO), pulmonary function parameters (FVC% predicted values, FEV₁% predicted values, FEV₁/FVC, PEF% predicted values), and respiratory muscle strength (MIP and MEP in absolute values). In addition the following validated questionnaires were administered: Asthma Control Test (ACT), Asthma Quality of Life Questionnaire (AQLQ), COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), Nijmegen Questionnaire (NQ), and Fatigue Assessment Scale (FAS), along with the Long COVID questionnaire from the Median Clinic Group. CO2 levels were assessed via capillary blood (SpCO2) and end-tidal CO2 (PetCO2). Between-group comparisons used the Mann-Whitney U test; within-group changes were assessed with the Wilcoxon signed-rank test (Bonferroni-Holm corrected). In patients with asthma, the predefined primary endpoint (FeNO) showed no significant improvement. In contrast, patient-reported outcomes improved significantly, with clinically relevant gains in asthma control (ACT: p < 0.001) and asthma-related quality of life (total AQLQ: p = 0.005). Lung function parameters showed statistically significant but modest improvements at T2 (FVC: p = 0.011; PEF: p = 0.010; FEV₁ in participants < 70 years: p = 0.035). In patients with COPD, symptom burden improved according to CAT scores (p = 0.036), while no improvements in lung function were observed. Patients with Long COVID reported significant improvements in dysfunctional breathing (NQ: T2: p = 0.014), dyspnea (T2: p = 0.026; T3: p = 0.001), and "problems with stair climbing/muscle exertion" (T2: p = 0.042), as well as improvements in anxiety and sleep-related symptoms (T2: p = 0.021). No improvements in lung function were observed in this group. In the total cohort, the intervention group showed statistically significant improvements compared to controls in respiratory muscle strength (MIP: p = 0.002; MEP: p = 0.018) and dysfunctional breathing (NQ scores at T2: p = 0.007; T3: p = 0.017). In CO₂-rich speleotherapy centers, both SpCO₂ (p = 0.026) and PetCO₂ (p < 0.001) increased at T2. While speleotherapy did not improve FeNO, it was associated with clinically relevant improvements in patient-reported outcomes across disease groups. Changes in lung function and respiratory muscle strength were statistically significant but modest and should be interpreted with caution. Overall, speleotherapy may have direct effects on the airways and breathing regulation, with more consistent evidence for improvements in breathing patterns than for direct effects on the airways.Trial registration: DRKS00033365 (retrospectively registered).
24 May 2026
Read appraisal →Archives of osteoporosis
Management of osteoporosis in older men: a systematic review of randomized trials of pharmacological and non-pharmacological strategies
INTRODUCTION: Osteoporosis in older men is often underdiagnosed and undertreated, increasing the risk of fractures and functional decline. Despite its clinical relevance, evidence specific to this population remains limited. This systematic review evaluated the effectiveness of pharmacological and non-pharmacological interventions in reducing fracture risk and improving bone mineral density (BMD) in older men with primary or secondary osteoporosis. METHODS: Searches were conducted in PubMed, EMBASE, Scopus, Cochrane Library, Web of Science, SciELO, PEDro, and LILACS, in addition to gray literature sources. Randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological interventions were included. Analyses were performed using RStudio (v. 4.3.3), and risk of bias was assessed using the RoB 2 tool. Results Twelve RCTs were included (10 pharmacological, one nutritional, and one exercise-based). The mean age was 60.9 ± 5.2 years, with baseline T-scores of - 2.9 ± 0.3 at the lumbar spine and - 2.7 ± 0.4 at the femoral neck. Bisphosphonates and teriparatide showed modest improvements in BMD, while effects on fracture risk were inconsistent. Resistance exercise (60-90 min/day) and L-carnitine supplementation were associated with BMD benefits, although evidence was limited by methodological constraints. Risk of bias varied across studies. CONCLUSION: Pharmacological therapies improve BMD in older men; however, evidence remains insufficient to demonstrate consistent fracture risk reduction. Non-pharmacological interventions show potential benefits but are supported by limited evidence. Larger randomized trials with clinically relevant outcomes are needed.
24 May 2026
Read appraisal →Medicine
Global, regional, and national burden of clavicle, scapula, or humerus fracture in 204 countries and territories, 1990 to 2021: A systematic analysis from the Global Burden of Disease Study 2021
Clavicle, scapula, or humerus fracture represent a major public health challenge, yet their epidemiology and health burden remain poorly characterized. Using the Global Burden of Disease 2021 framework, we quantified incidence, prevalence, and years lived with disability (YLDs) of clavicle, scapula, or humerus fractures across 204 countries from 1990 to 2021. Estimates were stratified by age, sex, region, and socio-demographic index (SDI), and reported with 95% uncertainty intervals (UIs) from Bayesian models. Globally, the age-standardized incidence rate (ASIR) declined from 276.68 (95% UI: 219.06-346.71) per 100,000 person-years in 1990 to 220.94 (95% UI: 172.60-280.99) per 100,000 person-years in 2021, with an estimated annual percentage change of -0.78% (95% UI: -0.82% to -0.73%). High SDI regions showed the greatest ASIR (300.30 per 100,000 person-years), age-standardized prevalence rate (112.03 per 100,000 person-years), and age-standardized YLDs rate (3.72 per 100,000 person-years). In 2021, Eastern Europe had the highest ASIR (465.06 per 100,000 person-years), while Australasia led in age-standardized prevalence rate (151.42 per 100,000 person-years) and age-standardized YLDs rate (5.04 per 100,000 person-years). China ranked first in absolute prevalence (1.21 million, 95% UI: 1.04-1.39 million) and YLDs (40,235, 95% UI: 24,471-61,196). Despite declines in age-standardized rates, absolute cases increased substantially, highlighting demographic and regional disparities. Priority populations for targeted prevention include women aged ≥60 years and residents of high-SDI regions, as these strata accounted for the highest burden across incidence/prevalence/YLD rates.
24 May 2026
Read appraisal →Studies in health technology and informatics
Mapping Existing Evidence on Physicians' and Patients' Experiences with GenAI in Clinical Communication and Documentation: A Rapid Review
GenAI tools like chatbots and ambient scribes are increasingly used in clinical documentation, raising ethical and safety concerns. This rapid review maps existing evidence on experiences and attitudes of physicians and patients toward using GenAI in clinical communication and documentation. Structured searches were conducted in PubMed and Web of Science. Studies were screened using PICO criteria. Data were extracted and summarized descriptively, with high-order thematic analysis of research aims and emerging recommendations. 41 studies were included: 75.6% focused on physicians, 9.8% examined patient perspectives exclusively, and 14.6% included both. Some of the themes identified were usability, exploration of perceptions and expectations, acceptability, and ethical implications. Recommendations emphasized the need for diverse cohorts, real-world validation, and ethical considerations. Current literature was skewed toward physician perspectives. Broader, meaningful inclusion of patients is needed to support equitable and trustworthy GenAI integration in healthcare.
24 May 2026
Read appraisal →Studies in health technology and informatics
Design and Evaluation of an Episodic Guideline-Driven Decision Support Engine
Clinical guidelines (GLs) standardize care but are complex to implement. Most clinical decision support systems (CDSSs) assume continuous use, which does not reflect real-world episodic workflows. We developed and evaluated e-Picard, a CDSS providing GL-based recommendations for episodic, on-demand consultations, enabling prospective decision support informed by retrospective quality assessment. At runtime, e-Picard analyzes offline patient data, computes fuzzy-logic-based compliance, identifies missed actions and generates context-specific recommendations. The system was applied to longitudinal geriatric data managed under pressure ulcers (PU) and diabetes (DM) GLs. Manual technical validation using 3,110 PU and 12,538 DM data instances (43 PU and 82 DM patients) achieved ≥99% correctness and up to 98% completeness. Retrospective simulation on 1,000 patients per domain (57,860 PU and 100,940 DM data instances) demonstrated potential adherence improvements from 68%-69% to 89%-97% for PU and from 14%-15% to 60%-87% for DM, with higher consultation frequencies increasing compliance and reducing care variability. These results demonstrate that episodic CDSSs can deliver accurate, context-aware support even under intermittent use.
24 May 2026
Read appraisal →Studies in health technology and informatics
Electronic Health Record System Support for Physician-Patient Communication: National Cross-Sectional Survey on Outpatient Physicians' Experiences
The impact of digital patient engagement platforms (DPEPs) on interactions between physicians and patients has been widely studied from patients' perspectives. However, research into physicians' viewpoints remains scarce. This study aimed to identify electronic health record (EHR) characteristics that support physician-patient collaboration from the perspective of physicians working in outpatient care. A national cross-sectional survey of physicians' experiences with EHRs was conducted in Finland in 2021 where EHR coverage had reached 100% already in 2010. We selected the responses of 1983 physicians working in public sector outpatient clinics (primary and specialized care). Linear regression analysis was used to examine the relationship between eight EHR characteristics and perceived support for physician-patient collaboration and information exchange. Of these, rapid system responsiveness, ease of utilizing patient-provided data, support for adherence to treatment recommendations, assistance in preventing medication errors, and comprehensive and reliable patient data were found to be associated with support. The model accounted for 27% of the variance in the dependent variable. In addition to enhancing care outcomes, clinical decision support and easy access to patient data can aid physicians in interactions with patients. Further investigations should continue to analyze how these identified features could better support collaboration with patients - beyond DPEPs and visible interactions during appointments. Considering the rapid evolution of DPEPs, future studies should also take into account the depth of the DPEP-EHR integration.
24 May 2026
Read appraisal →Studies in health technology and informatics
Frameworks for Digital Health Engagement: A Scoping Review Protocol
Digital health technologies (DHTs) are increasingly integral to healthcare delivery, yet sustained engagement remains inconsistent across users and settings. This scoping review aims to map frameworks and instruments that conceptualise digital health engagement across adoption and sustained use. Searches were conducted in Scopus, Web of Science, ACM Digital Library, and PsycINFO. The review will clarify conceptual coverage and identify gaps in digital engagement.
24 May 2026
Read appraisal →Studies in health technology and informatics
Can NLP Detect Loneliness in Electronic Health Records? A Proof-of-Concept Study
Loneliness is clinically important but under-documented in electronic health records (EHRs), posing challenges for secondary use and computational phenotyping. This study evaluated whether natural language processing (NLP) methods can detect and classify loneliness severity from clinical notes. Patients with a loneliness survey (mild, moderate, severe) were identified, and notes within six months prior to the survey were retrieved. An expert-expanded lexicon was applied, and transformer models (RoBERTa, ClinicalBERT, Longformer) were fine-tuned for loneliness severity classification. Large language model-based summarization of social and psychiatric history was also tested as an alternative input representation. Performance was evaluated using accuracy, weighted-F1, and per-class F1. All models achieved modest accuracy (0.3 to 0.7), and struggled to identify severe loneliness, reflecting sparse and inconsistent documentation even among surveyed patients. While summarization marginally improved accuracy, gains primarily reflected mild predictions. Manual review of 100 social worker notes from severely lonely patients found explicit mentions of loneliness in only two cases, confirming that relevant documentation is exceedingly rare. These findings demonstrate that model performance is constrained by the sparse and inconsistent documentation of loneliness in EHRs, rather than by deficiencies in the modeling approach itself.
24 May 2026
Read appraisal →Studies in health technology and informatics
Usability of Mobile Health Apps from the Patient Perspective: A Systematic Review
Mobile Health (mHealth) apps are widely used to support care, but patient-focused usability evidence remains fragmented. We conducted a systematic review (January 2012-September 2025) of PubMed, IEEE Xplore, and Scopus to identify studies assessing usability from the patient perspective using standardized questionnaires or structured interviews. Of 490 records retrieved, 146 studies met the inclusion criteria. Fifteen disease categories were represented, most commonly mental health, neurology, metabolic/endocrine, and oncology. Overall, 24 distinct usability assessment methods were reported, and most studies relied on a single method. Among standardized instruments, the System Usability Scale (SUS) was most common (50 studies, 34.3%); the mean SUS score across these studies was 76.37, above the acceptability benchmark of 68. Overall, mHealth apps were generally rated as usable by patients, but future work should adopt mHealth-specific standardized measures, enroll larger samples, and report methods transparently to enable benchmarking and inform better app design.
24 May 2026
Read appraisal →Studies in health technology and informatics
Long Covid and Digital Health in Switzerland: Potentials and Limitations
Post-COVID-19 (or Long Covid) presents a complex and persistent health challenge affecting a growing number of individuals worldwide. Digital health interventions (DHIs) offer potential support for symptom monitoring, self-management, and information access. However, their availability, quality, and sustainability remain uncertain, particularly in smaller healthcare markets such as Switzerland. This study provides a descriptive assessment of ten representative DHIs for Long Covid available from Switzerland. Each tool was evaluated using a 19-item framework derived from validated instruments. Three independent reviewers tested all interventions on iOS and Android devices, with consensus ratings across five quality categories. Results showed strong usability (average 6.3/8) and practical usefulness (5/8), but consistent weaknesses in accessibility (3.7/8) and data protection (4.6/8). Total scores ranged from 14.7 to 26.3 out of 38. Several Swiss-based apps were discontinued during the study period, highlighting market fragility. Findings underscore the need for inclusive design, transparent data practices, and institutional support if DHIs are to complement Long Covid care sustainably.
24 May 2026
Read appraisal →Studies in health technology and informatics
Digital Health Tool Usability and Redesign: Preliminary Scoping Review Findings
Few usability or user experience studies report how insights resulted in improved digital health tool (DHT) design. Therefore, this paper reports on preliminary findings of a scoping review that examines this topic. A systematic search in five databases led to the inclusion of 102 studies that met the inclusion criteria, namely those reporting both usability evaluation and redesign outcomes. Categorisation of these studies identified four user groups: patients, healthcare professionals, public health users, and mixed groups. Many DTHs were web- (36%) or mobile-based (32%) applications, and most often newly developed (68%).
24 May 2026
Read appraisal →Studies in health technology and informatics
Electronic Patient Records, Real-Time Clinical Documentation and Burden: An Umbrella Review
This umbrella review synthesises evidence from reviews on clinicians' documentation burden (DB) associated with electronic patient records (EPRs) in hospital and primary care settings. Guided by Donabedian's model (structure, process, outcomes), it maps causes of burden, barriers to real-time documentation, and technological solutions. Following the Joanna Briggs Institute (JBI) methodology, searches across six databases identified 2,739 records, with 166 under full-text review. Findings of this review will inform strategies to optimise real-time EPR use while minimising DB.
24 May 2026
Read appraisal →Journal of ethnopharmacology
Efficacy and safety of medicine-food homology Shenqi paste in older adults with diabetic sarcopenia: A randomized, double-blind, placebo-controlled trial
ETHNOPHARMACOLOGICAL RELEVANCE: Diabetic sarcopenia (DS), an emerging diabetes complication, poses an increasing challenge to the elderly population. Shenqi paste (SQP) consists of 8 medicine-food homology substances: Astragalus membranaceus (Fisch.) Bge., Codonopsis pilosula (Franch.) Nannf., Polygonatum sibiricum Red., Dioscorea opposita Thunb., Poria cocos (Schw.) Wolf, Eucommia ulmoides Oliv., Hordeum vulgare L., and Ophiopogon japonicus (L.f.) Ker Gawl. SQP has shown potential benefits for sarcopenia in clinical practice. Its efficacy and safety in DS have not been validated in a randomized controlled trial. AIM OF THE STUDY: This study aimed to evaluate the efficacy, safety, and limitations, and provide insights into methods and strategies for utilizing SQP in DS management. MATERIALS AND METHODS: In this randomized, double-blind, placebo-controlled trial, community-dwelling older adults (≥60 years) with DS and spleen-kidney deficiency syndrome were allocated 1:1 to receive either SQP or placebo paste for 12 weeks. Primary outcomes were skeletal muscle mass index (SMI), handgrip strength, and five-time chair stand test (FCST) duration. Secondary outcomes included health-related scales and biochemical indicators. Assessments were conducted at the baseline (T0), week 6 (T1), and week 12 (T2). Safety evaluation included blood routine, liver and kidney function tests. Intention-to-treat analysis was applied to the primary outcomes data from all participants, with per-protocol analysis for sensitivity. Generalized estimating equations with covariate adjustment and t-tests or Wilcoxon rank-sum tests were used for statistical analysis. RESULTS: Of 90 randomized participants, the SQP group showed greater improvements in handgrip strength (T2: interact p < 0.001), SMI (T2: interact p < 0.001), and FCST (T2: interact p < 0.001) versus control. Secondary outcome measures of 74 participants, including frailty, nutrition, physical activity, sleep quality, depression, and TCM syndrome scores, significantly improved (p < 0.05), with significant fasting blood glucose reduction (T2: interact p = 0.018) and C-reactive protein decrease (T2: interact p < 0.001). There was no statistically significant difference in the change in the difference between the two groups in fasting insulin, glycated hemoglobin and insulin resistance index before and after intervention (p > 0.05). Within-group analysis demonstrated significant reductions of SQP group in inflammatory cytokines, and sarcopenia-related biomarkers (p < 0.001) post-intervention. No serious adverse events occurred. CONCLUSION: A 12-week SQP intervention enhanced muscle mass, strength, function, and metabolic and inflammatory profiles in older adults with DS, with good tolerability, supporting its potential as a safe, complementary therapy.
23 May 2026
Read appraisal →JMIR research protocols
Protocol for Monitoring Postpartum Hypertension Outcomes via a Smartphone App (MOMitor): Ecological Momentary Assessment
BACKGROUND: Postpartum hypertension defined as elevated blood pressure after childbirth, affects approximately 20% of women after delivery. Digital health interventions that include remote monitoring therefore, present an important opportunity to facilitate regular blood pressure assessment in this high-risk population. OBJECTIVE: The primary objective is to assess within- and between-person changes in hypertension status over the first 6 weeks postpartum using a smartphone-based ecological momentary assessment protocol. The secondary objective is to characterize the trajectory of hypertension indicators across the 6-week period and to compare hypertension screening results from week one and week six within participants. METHODS: This study uses a time-series design using data from prospectively enrolled patients within a large health system. Patients eligible for recruitment were women aged 18 years or older who spoke English, owned a smartphone, had a liveborn neonate, and were willing to download an app and respond to survey questions within the app. Throughout the study period, all participants received hypertension screening items that asked whether their blood pressure was greater than 140/90 mm Hg and whether they felt dizzy or lightheaded, short of breath, or had a severe headache. A subset of participants were additionally asked to report their blood pressure readings. We estimate within- and between-participant effects using a generalized linear mixed model for a positive hypertension screen during weeks one through six. The model includes both fixed and random effects, controlling for age, race, marital status, education, insurance status, mode of delivery, total number of pregnancies, and history of diabetes mellitus. RESULTS: The study was funded July 2021 and data collection was initiated in November 2021. Data collection for this study, per protocol, was completed in June 2025, though other participants continue to be enrolled in the ongoing parent study. Data analysis is expected to be completed by Spring 2026 with publication planned for Summer 2026. CONCLUSIONS: The study findings will provide insight into trajectories of hypertension outcomes in postpartum women and the utility for smartphone app-based remote blood pressure monitoring among postpartum women whose blood pressure was regularly tracked. Findings will provide evidence to support whether widespread implementation of this digital health surveillance approach to improve outcomes in maternal health, especially in the postpartum period, is clinically warranted.
23 May 2026
Read appraisal →Lancet (London, England)
Safety and efficacy of astegolimab for COPD with frequent exacerbations regardless of baseline blood eosinophil counts (ALIENTO and ARNASA): randomised, double-blind, placebo-controlled, phase 2b and 3 trials
BACKGROUND: Interleukin-33 and its receptor, ST2, are implicated in neutrophilic and eosinophilic inflammation during chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to assess the efficacy and safety of astegolimab, an anti-ST2 human IgG2 monoclonal antibody, which were evaluated in two COPD pivotal trials. METHODS: In two randomised, double-blind, placebo-controlled trials (phase 2b ALIENTO and phase 3 ARNASA), current or former smokers with COPD and a history of frequent exacerbations, irrespective of baseline blood eosinophils, were randomly assigned (1:1:1; stratification by smoking status and region) to receive subcutaneous astegolimab 476 mg every 2 weeks, every 4 weeks, or placebo, alongside optimised inhaled maintenance therapy over 52 weeks. The primary endpoint (analysed in participants receiving one or more doses) was annualised rate of moderate or severe exacerbations. Missing data were considered similar to data from other participants in the same treatment group with the same baseline characteristics. The trials were registered with ClinicalTrials.gov (NCT05037929 and NCT05595642). FINDINGS: In ALIENTO, 1301 participants (astegolimab every 2 weeks, n=433; astegolimab every 4 weeks, n=437; and placebo, n=431) initiated treatment between Oct 5, 2021, and Feb 19, 2024. In ARNASA, 1375 participants (astegolimab every 2 weeks, n=459; astegolimab every 4 weeks, n=459; and placebo, n=457) initiated treatment between Jan 9, 2023, and June 25, 2024. Adjusted rate ratios versus placebo for the primary endpoint were 0·85 (95% CI 0·72-1·00; p=0·049) for astegolimab every 2 weeks and 0·93 (0·79-1·10; p=0·38) for astegolimab every 4 weeks in ALIENTO, and 0·85 (0·72-1·01; p=0·068) for astegolimab every 2 weeks and 0·82 (0·70-0·98; p=0·024) for astegolimab every 4 weeks in ARNASA. Adverse events were balanced between treatments, with most participants experiencing one or more adverse events (1093 [84·0%] of 1301 participants in ALIENTO and 1176 [85·5%] of 1375 in ARNASA). The most common non-COPD adverse event was nasopharyngitis in ALIENTO and upper respiratory chest infection in ARNASA. Deaths occurred in 40 (3·1%) of 1301 participants in ALIENTO and in 44 (3·2%) of 1375 participants in ARNASA, and were balanced across treatment groups. Across both trials, a total of three deaths (0·1%) were considered to be related to treatment by investigators. INTERPRETATION: In ALIENTO, astegolimab every 2 weeks was associated with a lower annual rate of exacerbations versus placebo in patients with COPD and a history of frequent exacerbations. In ARNASA, these findings did not meet statistical significance. Together, these findings suggest a role for targeting the ST2/IL-33 pathway to reduce the frequency of COPD exacerbations in patients with limited treatment options. FUNDING: Genentech, a member of the Roche Group, and F Hoffmann-La Roche.
23 May 2026
Read appraisal →Journal of medical Internet research
Effectiveness of a Blended Intervention to Promote Physical Activity Among Office Employees: Randomized Controlled Trial
BACKGROUND: Regular moderate-to-vigorous physical activity (MVPA) reduces the risk of noncommunicable diseases, yet one-third of adults globally fail to meet MVPA recommendations. Office employees, among the least active groups, face heightened risks due to prolonged sedentary behavior and barriers like lack of time, fatigue, and low motivation. Although scalable, web-based interventions frequently face challenges, such as low engagement, high attrition, and limited personalization. Blended interventions, combining digital tools with interactive components, show promise but lack robust evidence among office employees. OBJECTIVE: This study aimed to evaluate the effectiveness of a theory- and evidence-based blended intervention in increasing MVPA among office employees. METHODS: This 24-week, 3-arm randomized controlled trial included 141 office employees, randomized equally into blended (web-based+electronic workshops [e-workshops]), web-based only, and control groups. The intervention was developed using the intervention mapping framework, ensuring a systematic, evidence- and theory-based design tailored to the needs of the target population. All participants accessed a study website; the control group used the "Library" module with general MVPA information, while intervention groups also accessed a tailored, theory-driven "Intervention" module. The blended group additionally attended 3 live e-workshops (weeks 2, 4, and 8). MVPA was objectively measured using hip-worn accelerometers at baseline (T1), postintervention (12 wk, T2), and follow-up (24 wk, T3). Retention, engagement, and acceptability were assessed. Analyses followed the intention-to-treat principle, and generalized linear mixed models were used to evaluate between-group differences at T2 and T3, adjusted for baseline MVPA, sex, and ActiGraph LEAP (Ametris) wear time. RESULTS: A total of 141 participants (mean age 32.1, SD 9.2 y; 75/141, 53.2% female) were randomized evenly across groups with comparable baseline characteristics, except for sex (P=.002). The blended group showed significantly greater MVPA increases than the control at T2 (β coefficient=0.247, 95% CI 0.013-0.480; P=.04) and T3 (β coefficient=0.373, 95% CI 0.139-0.607; P=.002), and greater increases than the web-based at T2 (β coefficient=0.287, 95% CI 0.062-0.512; P=.01) and T3 (β coefficient=0.368, 95% CI 0.138-0.597; P=.002). Sensitivity analyses confirmed the robustness of these findings. Retention and engagement rates were 83% and 56%, respectively. Participants reported high acceptability across all domains. CONCLUSIONS: A blended intervention integrating tailored web content with interactive e-workshops significantly increased MVPA at T2 and T3 compared with both web-based and control groups. This success stems from the rigorous intervention mapping framework, which systematically identified effective behavior change and habit formation theories, while the blended approach addressed key limitations of traditional and web-based methods. These findings underscore the potential of evidence- and theory-based blended approaches to address common barriers to MVPA and promote sustainable MVPA in workplace settings, offering promising opportunities for broader scalability and personalization.
23 May 2026
Read appraisal →Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
Mediators of the Effect of Opt-In Versus Opt-Out Treatment on Smoking Cessation in a Randomized Clinical Trial
INTRODUCTION: Smoking cessation interventions are effective. Most smokers do not receive them, in part because smokers are required to "opt-in". Changing the default (CTD) randomized clinical trial, conducted at a large academic medical center, demonstrated that CTD to providing treatment unless refused (opt-out) improved quit rates. The objective of this study was to evaluate if treatment participation and default-theory based variables explained the effect of opt-out on cessation. METHODS: We conducted a secondary analysis of CTD data (N = 739). Descriptive statistics and correlations of the baseline variables were provided. Structural equation models were employed to investigate whether the treatment assignment was causally mediated by a priori proposed mediators including perceived endorsement, counseling participation, and medication utilization. RESULTS: The mean age of the participants was 51.39 (SD = 14.71) years, among whom 349 (47.23%) were females, and the majority was White (428, 57.92%). The indirect effects from the opt-out treatment arm to counseling participation to smoking cessation (b = 0.201, 95% CI = 0.105 to 0.303), and from opt-out to perceived endorsement to counseling participation to smoking cessation (b = 0.010, 95% CI = 0.002 to 0.022) were significant. The indirect effect from opt-out to perceived endorsement to counseling participation to medication utilization to smoking cessation was marginally significant (b = .001, 95% CI = 0.000 to 0.003). CONCLUSIONS: The opt-out approach enhanced patients' sense that their counselor endorsed and/or recommended treatment, as well as counseling participation. The results partially support our hypothesis that the advantage of Opt-out care would increase treatment participation and would do so by psychological variables thought to underpin the efficacy of defaults. IMPLICATIONS: Our results strengthen evidence for the value of delivering smoking cessation as a default (opt-out rather than opt-in) by illuminating likely mechanisms of action. These include increasing participation in counseling and two default-based theoretical mechanisms, perceived endorsement and implied endorsement.
23 May 2026
Read appraisal →JMIR human factors
Support, Monitoring, and Reminder Technology for Mild Dementia (SMART4MD) for People With Mild Cognitive Impairment and Their Informal Caregivers: Cost-Effectiveness Analysis
BACKGROUND: Support, Monitoring, and Reminder Technology for Mild Dementia (SMART4MD), a customized tablet app, was developed to improve or maintain the quality of life of people with mild cognitive impairment (MCI) and their informal caregivers. OBJECTIVE: This study conducts an 18-month economic evaluation of the SMART4MD app, in addition to standard care, compared with standard care alone in Sweden and Spain, from a health care provider perspective. METHODS: In a pragmatic randomized controlled trial, people with MCI and their informal caregivers were randomized to the intervention and control groups. Health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured in 345 Swedish people with MCI and their informal caregivers, and in 347 Spanish people with MCI. RESULTS: The analysis showed higher incremental costs and lower QALYs for Swedish people with MCI than for controls, whereas higher incremental costs and higher QALYs were observed for Spanish people with MCI. The intervention was not found to be cost-effective for Swedish informal caregivers, with an ICER of €78,000/QALY (€1=US $1.16). CONCLUSIONS: The differing findings regarding cost-effectiveness for people with MCI in Sweden and Spain highlight the need for further research with extended follow-up, ideally involving a larger sample size and conducted across different national contexts. TRIAL REGISTRATION: ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699.
23 May 2026
Read appraisal →Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
Identifying Key Predictors of Smoking Cessation Success: Text-Based Feature Selection Using a Large Language Model
INTRODUCTION: The most effective way to reduce mortality and morbidity among current smokers is to quit smoking. Although about half of smokers attempted to quit, only one-tenth succeeded in 2022. Understanding key predictors of smoking cessation success would inform smoking cessation interventions and increase quitting rates. METHODS: We analyzed data from waves 5 and 6 of the Population Assessment of Tobacco and Health (PATH) study (December 2018 to November 2021). Using OpenAI's GPT-4.1, we identified the top 45 variables from wave 5 that are highly predictive of 12-month smoking abstinence in wave 6, based on descriptions of survey variables. We then validated the predictive power of the GPT-4.1-selected variables by comparing the performance of eXtreme Gradient Boosting (XGBoost) trained on different sets of variables. Finally, we derived insights into the top 10 variables, ranked according to their SHapley Additive exPlanations values. RESULTS: The performance of XGBoost trained with all possible wave 5 variables and the 45 selected variables was almost identical (AUC:0.749 vs AUC:0.752). The top 10 variables included past 30-day smoking frequency, minutes from waking up to smoking first cigarette, important people's views on tobacco use, prevalence of tobacco use among close associates, daily electronic nicotine product use, emotional dependence, and health harm concerns. CONCLUSIONS: The high predictive performance of XGBoost, when trained on the selected variables, underscores the efficiency and efficacy of GPT-4.1-based feature selection. The top 10 variables include various risk factors that have been previously reported in the literature for their influence on smoking behavior. IMPLICATIONS: Our findings do not establish causal relationships between the selected predictors and 12-month smoking abstinence. However, identifying these key predictors provides valuable insights into the factors highly associated with smoking cessation success. This study demonstrates the ability of OpenAI's GPT-4.1 to perform feature selection using only the textual descriptions of variables. The efficient and successful application of GPT-4.1 for variable selection highlights the potential of integrating artificial intelligence tools into tobacco research to guide resource-efficient and targeted intervention strategies.
23 May 2026
Read appraisal →Medwave
Effects of manual therapy on pain and function in patients with plantar fasciitis: A systematic review of the literature
OBJECTIVE: Plantar fasciitis is common and impairs people's ability to move. Manual therapy is frequently used to treat plantar fasciitis. However, its effects are inconclusive. For this reason, the purpose of this systematic review is to determine the effect of manual therapy on plantar fasciitis. METHODS: A systematic review of the literature was conducted, following the PRISMA checklist. Five databases (CINAHL, Scopus, PubMed, Web of Science, and OVID) were searched, along with a review of the gray literature and a manual search. Randomized clinical trials from 2014 to 2024 were selected that examined the efficacy of manual therapy in reducing pain intensity and improving function in patients aged 18 to 60 years with a clinical diagnosis of plantar fasciitis. Methodological quality (PEDro scale) and risk of bias (risk of bias scale) were assessed. RESULTS: Four randomized clinical trials (n = 224) were included, reporting controversial statistical differences in pain and function. In addition, two studies reported clinically relevant changes favoring manual therapy. PEDro scale scores ranged from 4 to 6, and three studies presented a high risk of bias. CONCLUSIONS: The effects of manual therapy on pain and function in patients with plantar fasciitis are uncertain. The evidence is limited, heterogeneous, and lacking in methodological rigor. A larger number of randomized clinical trials with more consistent, replicable protocols are needed to determine the contributions of manual therapy to improving pain and function in patients with plantar fasciitis. Similarly, the inconsistency and limited evidence on indicators of clinical significance in the selected studies preclude an assessment of the clinical impact of this intervention. PROSPERO REGISTRATION: CRD42024501550. OBJETIVO: La fascitis plantar es común y genera alteraciones en la capacidad de moverse de las personas. La terapia manual se aplica frecuentemente en la fascitis plantar. Sin embargo, sus efectos no son concluyentes. Por esta razón, el propósito de esta revisión sistemática es determinar del efecto de la terapia manual sobre la fascitis plantar. MÉTODOS: Se realizó una revisión sistemática de la literatura, considerando la lista de verificación de PRISMA. Se consultaron cinco bases de datos (CINAHL, Scopus, PubMed, y OVID) junto con consulta de la literatura gris y búsqueda manual. Se seleccionaron ensayos clínicos aleatorios de 2014 a 2024 que consideraron la eficacia de la terapia manual en el cambio de la intensidad del dolor y funcionalidad en pacientes con diagnóstico clínico de fascitis plantar entre 18 y 60 años. Se determinó la calidad metodológica (escala PEDro) y riesgo de sesgo (escala riesgo de sesgo). RESULTADOS: Se incluyeron cuatro ensayos clínicos aleatorizados (n = 224), que reportaron diferencias estadísticas controversiales para dolor y la funcionalidad. Además, dos estudios reportaron cambios clínicamente relevantes a favor de la terapia manual. Los puntajes de la escala PEDro variaron de 4 a 6, y tres estudios presentaron alto riesgo de sesgo. CONCLUSIONES: Los efectos de la terapia manual sobre el dolor y la funcionalidad en pacientes con fascitis plantar son inciertos. La evidencia es limitada, heterogénea y con bajo rigor metodológico. Es necesario un mayor número de ensayos clínicos aleatorizados, con protocolos más consistentes y replicables para concluir definitivamente sobre los aportes de la terapia manual en los efectos clínicos en el dolor y funcionalidad de pacientes con fascitis plantar. De igual forma, la inconsistencia y limitada evidencia de indicadores de significancia clínica en los estudios seleccionados, no permite evaluar el impacto clínico de esta intervención. REGISTRO DEL PROTOCOLO: PROSPERO CRD42024501550.
23 May 2026
Read appraisal →Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
The Public Health Impacts of Flavored Cigar Bans: A Systematic Review and Meta-Analysis
INTRODUCTION: This review summarizes research on the public health impacts of flavored cigar bans, which are policies that restrict the sale of cigars containing characterizing flavors. METHODS: A systematic literature search was conducted using PubMed, Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Applied Social Sciences Index and Abstracts. Studies were included if they evaluated the impact of a real-world or hypothesized flavored cigar ban. The primary outcome was tobacco use behavior. Secondary outcomes included retailer compliance, sales, and the tobacco industry response to flavored cigar bans. Two reviewers independently screened articles for inclusion, extracted data, and assessed study quality. We also conducted a meta-analysis using random effects models to pool estimates on tobacco use behavior after a flavored cigar ban. This review was registered with PROSPERO (CRD42023481603). RESULTS: Of 2,399 articles identified in the preliminary search, 55 were included in the review. Many real-world studies found declines in cigar use post-ban, specifically among youth. However, other studies found no significant changes in cigar use. Among studies examining sales, there were declines in flavored cigar sales but increases in sales of non-flavored cigars and other tobacco products. Among studies assessing hypothesized tobacco use behavior, pooled results indicate that 8% (95% CI: 2%, 27%) of flavored cigar users intend to quit tobacco altogether, 45% (95% CI: 39%, 50%) would switch to non-flavored cigars or cigarettes, and 41% (95% CI: 32%, 51%) would switch to other tobacco products. CONCLUSIONS: Flavored cigar bans may reduce cigar use and improve public health when policies are comprehensive and well-enforced. IMPLICATIONS: Overall, findings from this review suggest that flavored cigar bans may reduce tobacco use and have the potential to improve public health, but not all research is consistent. Several studies examining the impacts of flavored cigar bans on tobacco use found a decrease in cigar use among youth, but some found that there was no significant change in cigar use. Research on policy impacts among adults is limited. To maximize intended policy impact, monitoring of retailer compliance and the tobacco industry's response to flavored cigar bans is needed.
23 May 2026
Read appraisal →European journal of pediatrics
Application of machine learning to predict bronchiolitis severity in children: a single-centre retrospective cohort study
UNLABELLED: Several severity scores have been developed to assess disease severity in infants with bronchiolitis, but they often lack objectivity and may not reliably reflect clinical outcomes. We performed a single-centre retrospective cohort study including infants younger than 12 months admitted with a clinical diagnosis of bronchiolitis over three epidemic seasons (2021-2024). Cluster analysis was applied to identify groups of infants with similar clinical patterns, which were subsequently mapped to severity levels. A machine learning (ML) model was then trained to predict these severity levels using anamnestic and clinical variables available at admission. For comparison, the bronchiolitis risk of admission score (BRAS) and the respiratory severity score-heart rate (RSS-HR) were also calculated at admission. A total of 112 infants were included, and three severity levels were identified. Mild bronchiolitis corresponded to infants not requiring NICU admission or supplementary ventilation. Moderate cases involved infants needing supplementary ventilation without NICU admission. Severe bronchiolitis was associated with both NICU admission and supplementary ventilation. BRAS showed only a weak association with the newly defined clinical severity score (τ = 0.354, p < 0.001), while RSS-HR showed no significant correlation. In contrast, the ML model demonstrated strong predictive performance (τ = 0.731, p < 0.001 in the test set). A simplified decision tree based on three admission variables-age, retractions, and oxygen saturation-also showed good predictive ability (τ = 0.654, p < 0.001). CONCLUSIONS: A new dynamic approach for assessing bronchiolitis severity at hospital admission, capable of robust and adaptable prediction across clinical settings, has been elaborated. WHAT IS KNOWN: • Several bronchiolitis severity scores exist, but many lack validation, are subjective, and have limited applicability across settings, making early and accurate severity prediction difficult. WHAT IS NEW: • Our study introduces a three-level, outcome-based severity score and a dynamic ML tool, plus a simplified ARS decision tree, all outperforming conventional scores in predicting severity at admission.
23 May 2026
Read appraisal →BMJ open
Australian key stakeholder views regarding implementation of atrial fibrillation screening: a qualitative evaluation
OBJECTIVE: To understand the issues impacting atrial fibrillation (AF) screening and what needs to be considered for a successful national screening programme in Australia. DESIGN: Qualitative design using semistructured interviews and thematic analysis. SETTING: Australian Health. PARTICIPANTS: Six broad stakeholder groups were identified: charities/patient support, healthcare providers, professional bodies, government, research (including Indigenous health) and industry. METHODS: Semistructured interviews were conducted with 25 representative participants. Iterative thematic analysis was used. Coding was driven by the research questions (the current context; is a national screening programme warranted and approaches to a national screening programme) and an inductive approach where novel groupings of information were identified. FINDINGS: The key findings are grouped into four areas. (1) Current opportunistic general practitioner-led screening is ad hoc and fragmented. ISSUES: poor remuneration; lack of health sector collaboration and prioritisation; consumers lack awareness. (2) Systematic screening of all in-scope patients not considered feasible and concerns over lack of evidence. (3) Alternative approaches to increase screening include innovative approaches inside and outside general practice and use of smart technology. (4) Recommendations: (a) Support general practices and address remuneration and workflows; (b) Ensure a clear pathway to treatment; (c) Address data security, management and integration and sensitivity issues with wearable devices; (d) Promote collaboration between key organisations; (e) Address research gaps and (f) Generate culturally appropriate consumer education to promote consumer demand. CONCLUSIONS: Most stakeholders were broadly supportive of AF screening but agreed that current approaches were fragmented and not sufficient. If the forthcoming research evidence supports screening effectiveness on major outcomes, stakeholders envisaged a semi-systematic approach tailored to specific health settings, rather than a formalised systematic national screening programme.
23 May 2026
Read appraisal →Systematic reviews
Impact of the COVID-19 pandemic on diagnosis, and healthcare utilization, among patients with cancer (lung, breast, and pancreas) and cardiovascular diseases (HF, AF, hypertensive, and chronic ischemic heart disease) in Germany: two systematic reviews.
BACKGROUND: The COVID-19 pandemic and related non-pharmaceutical interventions (NPIs) (e.g., lockdowns and contact restrictions) disrupted routine healthcare delivery. In Germany, these measures affected diagnostic and treatment services for people with cancer and cardiovascular diseases, potentially delaying diagnosis and adversely influencing outcomes. We assessed whether and to what extent diagnosis, health utilization and health outcome among patients with selected cancer and cardiovascular conditions changed in Germany during the pandemic. METHODS: We conducted two systematic reviews of studies from Germany on selected cancers (breast, lung and pancreatic) and cardiovascular conditions (atrial fibrillation/flutter, heart failure, hypertensive and chronic ischemic heart disease). Protocols were registered in PROSPERO and the reviews were reported in accordance with PRISMA. We searched PubMed, Web of Science, Cochrane Library, Scopus, and Embase and screened grey literature. Outcomes included changes in new diagnoses, healthcare utilization, treatment, and disease-specific mortality during the pandemic (2020-2023) compared with the pre-pandemic period (2018-2019). Two reviewers independently screened records, extracted data, and assessed risk of bias using an adapted ROBINS-E tool. Owing to heterogeneity, we synthesized findings narratively. RESULTS: We screened 1991 records for cancer and 4,981 records for cardiovascular diseases, and included 9 cancer studies and 10 cardiovascular studies. For cancer, several studies reported a relative reduction in new breast and lung cancer diagnoses of up to 25% during lockdown periods; hospital admissions decreased by up to 9%. For cardiovascular conditions, hospital admissions for atrial fibrillation/flutter and heart failure decreased by up to 20%, particularly during pandemic peaks. Evidence on treatment delays, changes in treatment, and mortality was limited, and outcomes for other included diagnoses were often not reported. DISCUSSION: The available evidence indicates substantial reductions in hospital admissions and new diagnoses among patients with cancer and cardiovascular disease in Germany during the pandemic, suggesting major disruptions to care delivery. However, heterogeneity and gaps in the evidence base limit a comprehensive assessment of downstream outcomes. More comprehensive, linked data and further research are needed to quantify the full pandemic's impact and to strengthen health-system resilience for future crises.
23 May 2026
Read appraisal →Journal of medical Internet research
Toward Participatory Precision Health With Co-Designed Recommendations: Systematic Review of Just-in-Time Adaptive Interventions in Adolescents and Young Adults
BACKGROUND: The transition from adolescence to young adulthood (age 10-25 years) constitutes a sensitive developmental period marked by rapid biological, psychological, and social change, during which preventive health interventions can shape long-term outcomes. Mobile health tools offer accessible opportunities for tailored support for this population, but often adapt poorly to dynamic contexts, resulting in inconsistent engagement and effects. Just-in-time adaptive interventions (JITAIs), which tailor support in real time using ongoing data, are increasingly explored as precision health strategies. However, how these mechanisms are designed, implemented, and evaluated for adolescents and young adults (AYAs) has not been systematically reviewed. OBJECTIVE: This review aimed to synthesize the evidence on JITAIs developed for AYAs, examine how their adaptive mechanisms have been designed to support specific health goals and changing AYA contexts, and assess methodological reporting quality to inform future precision health intervention development. METHODS: We conducted a systematic review in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and SWiM (Synthesis Without Meta-Analysis) reporting guidelines. Twelve databases were searched for peer-reviewed studies published from 2013 to 2025. Eligible studies focused on participants aged 10 to 25 years and reported real-time adaptive mobile health interventions consistent with JITAI design principles. Two reviewers independently conducted screening, data extraction, and methodological quality appraisal using the Joanna Briggs Institute checklists. AYA coauthors contributed to all phases. Due to substantial heterogeneity in study populations, intervention content, adaptive mechanisms, comparators, and outcome measurements, findings were synthesized narratively, and no meta-analysis was conducted. RESULTS: A total of 61 unique interventions were included. JITAIs for AYAs addressed substance use (n=24, 39.3%), mental health (n=23, 37.7%), and physical health or chronic conditions (n=14, 23%). JITAI tailoring mechanisms relied predominantly on self-reported behavioral data. Decision rules were typically symptom threshold-based, and decision points were commonly daily or event-triggered. Methodological concerns with reporting on intervention administration, participant selection, and outcome measurement reliability were pervasive across all studies, limiting the interpretability of observed effects and cross-study comparisons. Ethical considerations, including researcher positioning and reflexivity, alongside the depth of reporting around participatory AYA engagement in design and implementation, were also inconsistent. CONCLUSIONS: This review contributes a novel perspective to AYA digital health by moving beyond intervention outcomes to examine how core adaptive mechanisms are operationalized for AYAs across multiple health domains, while also integrating AYA perspectives into the interpretation of findings and recommendations. Unlike prior reviews focused primarily on adults or specific conditions, it identifies broader contextual, methodological, and ethical considerations relevant to AYA precision health. These findings highlight the need for more transparent, contextually responsive, and youth-centered adaptive interventions, alongside more rigorous designs for evaluating adaptive intervention components in daily life contexts.
23 May 2026
Read appraisal →BMJ open diabetes research & care
Topical therapies for diabetic foot ulcers: a systematic review and network meta-analysis
OBJECTIVE: Diabetic foot ulcer (DFU) is a life-threatening complication associated with high amputation and mortality rates. While numerous topical therapies exist, their comparative efficacy and safety remain unclear. We aimed to compare the efficacy and safety of topical therapies for DFUs to identify optimal treatment strategies. RESEARCH DESIGN AND METHODS: We searched PubMed, Embase, and CENTRAL from inception to February 1, 2025, for randomized clinical trials (RCTs) evaluating topical therapies for DFUs. We excluded non-topical interventions to ensure clinically relevant comparisons. A Bayesian network meta-analysis was performed. The primary outcome was wound healing rate. RESULTS: We included 51 RCTs involving 6161 patients and 23 interventions. 12 topical therapies, including placenta-derived products, platelet-related products, ON101, epidermal growth factor, and tissue-engineered skin substitutes, significantly improved wound healing rates vs standard of care (SOC). Placenta-derived products showed the greatest efficacy (OR 7.85 (95% credible interval (CrI) 4.62 to 14.15)) and were the only intervention to significantly reduce adverse events vs SOC (0.25 (95% CrI 0.10 to 0.60)). No interventions differed significantly from SOC in time to wound healing, serious adverse events, or infections. CONCLUSIONS: Placenta-derived products and other biological or advanced topical therapies may demonstrate greater efficacy than the SOC in facilitating the healing of DFUs. Nevertheless, the certainty of evidence for most comparisons remains in the low-to-moderate range. These findings suggest potential benefits in integrating these therapies into the management of DFUs. However, high-quality RCTs are necessary to verify long-term outcomes.
23 May 2026
Read appraisal →BMJ open
Toolkit to prompt and support stopping antidepressants in general practice: an interview study exploring patient participants' experiences in the RELEASE trial.
OBJECTIVE: To explore patient experiences with the RELEASE (Redressing long-term antidepressant use) toolkit resources, including antidepressant hyperbolic tapering plans designed to minimise withdrawal symptoms as part of the RELEASE trial's implementation evaluation to understand what aspects of the toolkit work well and identify areas where refinement could enhance future implementation. The RELEASE intervention, a multistrategy intervention codesigned with general practitioners (GPs) and patients to prompt and support stopping long-term (>12 months) antidepressants, is being evaluated in an effectiveness-implementation hybrid type-1 cluster randomised controlled trial in general practice. STUDY DESIGN: One-to-one semistructured qualitative interviews using reflexive thematic analysis to identify patterns of shared meaning. SETTING: General practice, south-east Queensland, Australia. PARTICIPANTS: Adult participants (aged 18 years or older) taking an antidepressant long-term allocated to the intervention arm of the RELEASE trial. RESULTS: 31 participants with an average duration of antidepressant use of 16.5 years (range 1-30 years) were interviewed. Seven themes were identified. Across seven themes, participants described how the RELEASE toolkit resources prompted reflection on their antidepressant use, supported informed conversations with GPs, and offered tapering plans that were both structured enough to instil confidence and flexible enough to help participants feel in control of their tapering journey. They also identified barriers, including beliefs that very small tapering doses were unnecessary, difficulty accessing the mini-doses required for hyperbolic tapering and the challenge of managing withdrawal symptoms. For those who successfully stopped, the transition was associated with a renewed sense of autonomy. Participants also offered practical suggestions to strengthen the toolkit and its broader implementation. CONCLUSIONS: The RELEASE toolkit resources played a meaningful role in prompting and supporting informed shared decision-making and guiding attempts to stop antidepressants. Clearer messaging about the potential for withdrawal symptoms and access to mini-doses for tapering are needed to support patients to safely stop antidepressants. TRIAL REGISTRATION NUMBER: ACTRN12622001379707p; Pre-results.
23 May 2026
Read appraisal →BMJ open
Impact of COVID-19-related data drift on machine-learning prognostic models predicting 30-day opioid-related emergency department visits, hospitalisation or mortality: a population-level administrative data study in Alberta, Canada
OBJECTIVE: To develop machine-learning (ML) models during the COVID-19 pandemic and adjacent time periods to evaluate the impact of data drift on model performance. DESIGN: This prognostic study used population-level administrative health data to develop ML prediction models. SETTING: Alberta, Canada during 2019-2023. PARTICIPANTS: All patients over 18 who received at least one opioid dispensation from a community pharmacy within the province of Alberta between 2019-2023. EXPOSURE: Each opioid dispensation served as the unit-of-analysis. MAIN OUTCOMES/MEASURES: Opioid-related outcomes were identified from linked health administrative datasets. Light Gradient Boosting-machine models were developed on pre-pandemic, pandemic and endemic data and temporally validated on 2023 data (pre-pandemic model was also validated on 2020-2021 data) to predict the risk of emergency department visit, hospitalisation or mortality within 30-days of an opioid dispensation. We described key feature distributions across the study time period and changes in model prediction performance on the validation sets using relevant metrics. RESULTS: Among 1.2 million study participants representing over 13 million opioid dispensations, there were 59 809 (2.1%), 134 402 (2.4%) and 62 143 (2.3%) events reported in the pre-pandemic (2019), pandemic (2020 and 2021) and endemic (2022) time periods, respectively (estimated 2023 validation set pre-test probability of 2.8%). Notable differences in key features were observed in the 2020-2021 model relative to other years. In the 2023 validation set, discrimination performance was highest for the pre-pandemic and endemic models compared with the pandemic model (0.81, 0.83, 0.74, respectively). A similar trend regarding changes from pre-test to post-test probabilities in higher categories of predicted risk (23%, 40%, 16%) was observed. 2020-2021 had the lowest discrimination performance (0.71) and uninformative post-test probabilities (<10%). CONCLUSION: COVID-19 pandemic health data contributed to significant ML drift. Although ML approaches allow for quick re-training to mitigate drift, health regulators should approach ML prediction with caution when using pandemic-times data.
23 May 2026
Read appraisal →JMIR research protocols
A Large, Diverse, Urban Cardiovascular Health e-Cohort in Childhood and Adolescence: Protocol for the Young Hearts Study
BACKGROUND: Cardiovascular health (CVH), defined as a composite of 8 health factors and behaviors ranging from body composition to sleep duration, is strongly associated with the risk for future cardiovascular events in adults. However, there is little data on CVH among contemporary, diverse cohorts of children and adolescents. OBJECTIVE: This protocol describes the completed recruitment of a diverse pediatric e-cohort based in Chicago. We include details about ongoing longitudinal data collection for CVH behaviors, as well as neighborhood and environment-based socioeconomic factors, and linkage to electronic health records (EHRs) for direct capture of CVH factors. METHODS: Young Hearts (YH) uses a longitudinal cohort design, linking participant responses to annual electronic surveys to EHRs. Parents/guardians of children aged 0-17 years and adolescents aged 18 years are asked to complete surveys at 3 e-visits, completed annually in consecutive years. Adolescents aged 12-17 years are invited to complete surveys at each e-visit to provide self-reports of their data in addition to their parents/guardians. As adolescents reach the age of majority, they re-consent and complete their remaining e-visit data. Participants' clinical data are abstracted from EHRs at 6 health systems in Chicago and linked to their survey data. The main study outcome is the CVH score, adapted from the Life's Essential Eight framework for use in pediatric populations. We will also study component CVH behaviors and factors, each assessed using developmentally-appropriate measures, including body mass index, blood pressure, lipids, glycemic control, diet, physical activity, sleep, and smoking exposure. Our innovative study design will allow us to model trajectories of pediatric CVH from birth through 20 years of age. Funding for this study was provided by the National Heart, Lung, and Blood Institute (R01HL155864). RESULTS: The YH study, funded in March 2021, recruited, enrolled, and consented 7114 children and adolescents aged 0-18 years between April 2022 and February 2025. Baseline surveys have been completed by 6651 participants, of whom 3259 (49%) were female, and the mean age was 7.4 (SD 5.4) years. Data collection is still in progress, with completion anticipated in February 2027. We aim to publish results beginning in 2026. CONCLUSIONS: This study will define the epidemiology of cardiovascular risk factors in a diverse, contemporary cohort of US children and adolescents and identify behavioral and structural individual- and area-level economic, psychosocial, and lifestyle factors associated with identified disparities. We anticipate that the YH cohort will become an ongoing resource for pediatric CVH research.
23 May 2026
Read appraisal →ACS sensors
Urine-Based Noninvasive Detection of Prostate Cancer Using Human Olfactory Receptor-Embedded Nanodiscs
The diagnosis of prostate cancer (PCa) is limited by the low specificity of prostate-specific antigen (PSA) testing, which contributes to overdiagnosis and patient exposure to unnecessary invasive prostate biopsies. Here, we report a urine-based diagnostic platform that combines a six-member human olfactory receptor-embedded nanodisc (OR-ND) sensor array with fluorescence sensing and machine learning to detect PCa-associated volatile organic compounds (VOCs). Six ORs were reconstituted into lipid nanodiscs and evaluated using urine samples from a strictly curated subcohort of 40 PCa patients and 33 healthy controls (n = 73) to establish baseline sensor responsiveness. Subsequently, to ensure diagnostic robustness, machine learning classifiers were developed and cross-validated using an expanded data set of 290 samples, achieving an accuracy of 0.890 and an AUC of 0.964. Analysis of the full receptor data set revealed distinct response patterns, and statistical screening with correlation filtering identified OR2W1, OR51E1, and OR51E2 as the most informative features. Using these selected receptors, a random forest classifier achieved an accuracy of 0.890 and an AUC of 0.964, demonstrating high sensitivity and specificity. OR response patterns showed a closer association with Gleason score than with serum PSA levels, indicating that urinary VOC signatures capture tumor-related metabolic information complementary to conventional biomarkers. These results demonstrate that an OR-ND sensor array coupled with machine learning enables accurate and noninvasive detection and classification of PCa from urine samples. Our study provides a modular framework extensible to other VOC-associated diseases.
23 May 2026
Read appraisal →ACS sensors
Recent Advances in Electrospun Nanofiber-Based Wearable Sweat Sensors
Electrospun nanofibers, owing to their high porosity, flexibility, straightforward fabrication, and tunable physicochemical properties, have been widely employed in wearable sensors for gas detection, temperature monitoring, pulse measurement, gesture recognition, and other applications. In recent years, research on employing electrospun nanofibers in wearable sweat sensors has grown substantially. This paper provides the first comprehensive review of the research progress in electrospun nanofiber-based wearable sweat sensors, focusing on structural design, device fabrication, and potential applications. The review begins with a concise introduction to the fundamental aspects of electrospun nanofibers, including their formation principles, processing routes, material selection, and morphological characteristics. It then delves into the key components involved in constructing wearable sweat sensors based on electrospun nanofibers, such as reagent immobilization matrices, signal-enhancing materials, flexible substrates, and sweat collection components. A detailed analysis of the functional mechanisms of nanofibers in these contexts is provided, accompanied by an assessment of their advantages and limitations. Furthermore, recent applications of electrospun nanofiber-based wearable sweat sensors are systematically reviewed. Finally, the review discusses the challenges and potential future applications of electrospun nanofibers in wearable sweat sensors. This comprehensive overview aims to keep researchers informed of the latest advancements in the field and to stimulate further innovative developments.
23 May 2026
Read appraisal →Reproduction & fertility
Patient characteristics and lifestyle determinants of quality of life among women with endometriosis: a systematic review
ABSTRACT: Endometriosis is a chronic inflammatory disease presenting with debilitating symptoms strongly impacting patients' quality of life (QoL). Assessing QoL is crucial for understanding the full patient experience beyond clinical symptoms. This narrative systematic review specifically aimed to identify and describe non-pharmacological and non-surgical factors associated with QoL in women with endometriosis as reported in the literature. Following PRISMA guidelines, we systematically searched PubMed, MEDLINE, Web of Science, and Embase up to January 15, 2025, for case-control, cohort, randomized controlled trials, and cross-sectional studies. This study was registered in PROSPERO (registration number: CRD42023438457) Eligible studies assessed socio-demographic characteristics, lifestyle factors, symptoms, comorbidities, or coping strategies in relation to QoL among women with endometriosis. Twenty-one studies with a low risk of bias were included. A better QoL was related to favorable socioeconomic profiles (n = 3), high care satisfaction (n = 2), partner involvement (n = 1), healthier lifestyle habits (n = 1), and the use of coping therapeutic strategies. Poor QoL was associated with poor health (n = 5), more severe symptoms (n = 5), unhealthy lifestyle habits (n = 2), and ineffective use of coping strategies (n = 2). This review highlights a broad range of non-medical determinants of QoL, underscoring that clinical measures alone fail to capture the full patient experience. By consolidating evidence across diverse study designs, it offers a comprehensive overview of modifiable factors that could inform holistic, patient-centered approaches to endometriosis care. Further prospective and interventional studies are needed to clarify causal pathways and evaluate the effectiveness of targeted strategies to improve QoL. LAY SUMMARY: Endometriosis is a chronic disease affecting around 10% of women of reproductive age, associated with pain, infertility, and significant impacts on daily life. Because clinical measures alone fail to capture the full patient experience, assessing QoL is essential to understand the real burden of the disease. This review examined non-pharmacological and non-surgical factors that may be associated with QoL, such as lifestyle habits, socioeconomic conditions, health status, and coping strategies. Across 21 studies, we found that a better QoL was linked to good healthcare access, healthy habits, and effective coping mechanisms. Conversely, severe symptoms, poor health, and unhealthy lifestyles (smoking and alcohol use) were associated with worse QoL. The findings highlight the need for a more holistic approach to endometriosis care, combining psychological support, lifestyle guidance, and improved access to quality healthcare. Future research should use standardized QoL tools and robust study designs to develop evidence-based strategies that can meaningfully enhance patient well-being.
23 May 2026
Read appraisal →BMJ evidence-based medicine
Tramadol versus placebo for chronic pain: a systematic review with meta-analysis and trial sequential analysis
OBJECTIVES: The objective of our study was to assess the benefits and harms of tramadol vs placebo in adults with chronic pain. DESIGN: The research method was a systematic review of randomised clinical trials with meta-analysis. The review followed the Trial Sequential Analysis and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. DATA SOURCES: The Cochrane Library, MEDLINE, Embase, Science Citation Index and BIOSIS were searched for trials published from inception to 6 February 2025. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies were eligible for inclusion if they were published and unpublished randomised clinical trials comparing tramadol vs placebo in adults with any type of chronic pain. Risk of bias was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. MAIN OUTCOME MEASURES: The main outcome measures were pain level, adverse events, quality of life, dependence, abuse and depressive symptoms. RESULTS: We included 19 randomised placebo-controlled clinical trials enrolling 6506 participants. All outcome results were at high risk of bias. Meta-analysis and Trial Sequential Analysis showed evidence of a beneficial effect of tramadol on chronic pain (mean difference numerical rating scale (NRS) -0.93 points; 97.5% CI -1.26 to -0.60; p<0.0001; low certainty of evidence). However, the effect size was below our predefined minimal important difference of 1.0 point on NRS. Beta binomial regression showed evidence of a harmful effect of tramadol on serious adverse events (OR 2.13; 97.5% CI 1.29 to 3.51; p=0.001; moderate certainty of evidence), mainly driven by a higher proportion of cardiac events and neoplasms. It was not possible to conduct a meta-analysis of the quality of life due to a lack of data. Meta-analysis and Trial Sequential Analysis showed that tramadol increased the risk of several non-serious adverse events including nausea (number needed to harm (NNH) 7), dizziness (NNH 8), constipation (NNH 9), and somnolence (NNH 13) (all very low certainty of evidence). CONCLUSION: Tramadol may have a slight effect on reducing chronic pain levels (low certainty of evidence) while likely increasing the risk of both serious (moderate certainty of evidence) and non-serious adverse events (very low certainty of evidence). The potential harms associated with tramadol use for pain management likely outweigh its limited benefits.
23 May 2026
Read appraisal →JMIR human factors
Telemedicine Service Experience Questionnaire for Chinese Outpatients: Development and Validation Study
BACKGROUND: Telemedicine has rapidly expanded; however, standardized, telemedicine-specific patient-reported experience measures tailored to outpatient workflows are limited in many settings. OBJECTIVE: This study aimed to develop and psychometrically validate the Telemedicine Service Experience Questionnaire (TSEQ) for Chinese outpatients using telemedicine services. METHODS: We conducted a web-based survey among outpatients who completed a telemedicine consultation at Peking Union Medical College Hospital between July 1, 2021, to August 31, 2021, and who had used telemedicine services, using an adapted Chinese Patient Experience Questionnaire that encompasses 15 questions across 4 dimensions, to investigate patients' telemedicine consultation experiences. Item generation was informed by a literature review, workflow mapping, and expert review. We evaluated the factor structure using exploratory factor analysis and confirmatory factor analysis on the full sample with cross-validation. Reliability was assessed using Cronbach α and item-total correlations. RESULTS: In total, 3338 participants completed the survey (mean age 45.3, SD 17.8 y; n=2182, 65.4% female participants; n=1827, 54.8% with college education or above). The exploratory factor analysis of the final 14-item scale resulted in 4 factors. After scrutinizing the content, these factors were labeled "Service Efficiency," "Post-treatment," "Information Guidance," and "Humanistic Care," and they demonstrated good internal consistency (Cronbach α values of 0.876, 0.840, 0.962, and 0.876, respectively). Moreover, as the average variance extracted values were greater than 0.5 and the composite reliability values were greater than 0.7, the TSEQ scale has high convergent validity. Our findings suggest that the psychometric properties of the 14-item TSEQ are valid and reliable for assessing telemedicine service experience among Chinese outpatients. CONCLUSIONS: The TSEQ demonstrates a stable multidomain structure with satisfactory reliability and validity for evaluating outpatient telemedicine service experience in China. The instrument can support routine quality monitoring and guide targeted workflow improvements. Future studies should validate the TSEQ in multisite and postpandemic samples and examine measurement invariance across key subgroups.
22 May 2026
Read appraisal →JMIR formative research
Patients' mHealth Apps Usage and Data Privacy, Security, and Confidentiality Concerns: Exploratory Study
BACKGROUND: The Technology Adoption Model (TAM) offers a potential framework for elucidating the relationships between data privacy or security concerns and behavioral intention, perceived usefulness (PU), and perceived ease of use (PEOU) of mobile health (mHealth) apps, particularly for patients' self-care management. In Saudi Arabia, limited information is available on these pertinent research areas despite the government's relentless efforts to bolster the use of mHealth apps. OBJECTIVE: This study applies the TAM and the psychosociocultural framework to explore the influence of patients' data privacy and security concerns on the PU, PEOU, and behavioral intention to use mHealth apps for self-care management in Saudi Arabia. METHODS: A cross-sectional study was conducted by recruiting patients using mHealth apps for self-care from various provinces in Saudi Arabia. Research instruments were developed based on the components of 2 theories: the psychosociocultural framework and TAM, which were then piloted, validated, and distributed to participants via Google Forms. Linear regression models were performed to test the hypothesized relationships. RESULTS: Overall, 567 patients using mHealth apps participated in the study. Slightly more than one-third (217/567, 38.2%; range 35.6%-41.4%) of the participants expressed a high level of concern regarding data privacy, confidentiality, and security, with significant predictors being female gender, higher educational qualifications, and younger age groups (<46 years). About 18% to 25% of the variance in PU, PEOU, and behavioral intention to use mHealth apps was explained by the tested factors. Patients were more likely to have higher PU following a unit decrease in data confidentiality (β=.31; P=.01) and security concerns (β=.47; P=.01). The PEOU of mHealth apps increased as users demonstrated less concern regarding data privacy (β=.18; P=.001), confidentiality (β=.24; P<.001), and security (β=.43; P=.02). Likewise, behavioral intention to use mHealth apps also increased significantly following a reduction in respondents' concerns toward data privacy (β=.18; P=.02), confidentiality (β=.24; P=.03), and security issues (β=.36; P=.01). CONCLUSIONS: Specific demographic factors and concerns regarding data security and privacy influence patients' PU, PEOU, and behavioral intention to use mHealth apps for self-care management. Targeting the age-, education-, and gender-based differences regarding the usage of mHealth apps. Health care providers and policymakers may consider age-, education-, and gender-based differences when developing strategies to improve the adoption of mHealth apps among the Saudi patient population.
22 May 2026
Read appraisal →JMIR research protocols
Mobile Health Technology for Personalized Tobacco Cessation Support in Laos (Project Support Laos): Protocol for a Randomized Controlled Trial
BACKGROUND: Tobacco use remains the leading cause of preventable morbidity and mortality in Lao People's Democratic Republic (Lao PDR). Despite the prevalence of cigarette smoking in Lao PDR (51% in men and 7% in women), no national tobacco treatment programs are available. Therefore, the development and evaluation of sustainable tobacco cessation interventions suitable for widespread adoption in Lao PDR are pressing public health needs. OBJECTIVE: This project aims to adapt our theoretically and empirically based mobile health (mHealth) technology to help people quit smoking cigarettes in Lao PDR. METHODS: Our mHealth approach includes a fully automated, interactive, personalized, smartphone-delivered intervention for behavioral treatment. This project includes 2 main phases. In the first phase, we use formative research methods to adapt our intervention content to the sociocultural context, language, and communication styles of Laotians. In the second phase, we conduct a randomized controlled trial to evaluate the efficacy of our mHealth intervention. In the trial, adult smokers are recruited through 2 national hospitals: Setthathirath Hospital in Vientiane and Champasak Hospital in Champasak Province. Participants (n=500) are randomized to either the standard care (SC; n=250) or automated treatment (AT; n=250) group. SC consists of brief advice to quit smoking delivered by research staff, self-help written materials, and a 2-week supply of nicotine replacement therapy (transdermal patches). AT consists of all SC components plus a fully automated smartphone-based treatment program that involves interactive and personalized proactive messages, images, or videos. The primary health outcome of the trial is biochemically confirmed self-reported 7-day point prevalence abstinence 12 months post study enrollment. Secondary outcomes include abstinence at 3 and 6 months post enrollment. RESULTS: This study was approved by the ethical review boards of the respective domestic and international institutions. Data collection for the formative phase occurred from January 2022 to May 2023, and data analyses are ongoing. Data collection for the trial phase is ongoing and is expected to be completed by the end of 2026. CONCLUSIONS: If the proposed project is successful, it has the potential to transform health care services for tobacco treatment throughout Lao PDR and, ultimately, to significantly reduce tobacco-induced morbidity and mortality in the country. The AT's potential for widespread adoption and sustainability is enhanced by the direct involvement of Lao governmental stakeholders at multiple national institutes. Furthermore, the US-Lao collaborative work and capacity-building activities in this project will contribute to creating a knowledge base for mHealth research applications and advancing mHealth research capacity in Lao PDR.
22 May 2026
Read appraisal →JMIR formative research
Conceptualizing Acceptance and Knowledge as Process Variables in Internet-Delivered and Therapist-Supported Cognitive Behavioral Therapy and Acceptance and Commitment Therapy in Primary Care for Insomnia: Pilot Feasibility and Process-Oriented Randomized Controlled Trial
BACKGROUND: Internet-based interventions for insomnia show promise, but understanding the process variables, such as knowledge acquisition and psychological acceptance, is crucial for enhancing digital adherence and clinical effectiveness. OBJECTIVE: This study aimed to evaluate the feasibility, adherence, and preliminary clinical signals of 2 therapist-assisted interventions-internet-delivered cognitive behavioral therapy (iCBT) and internet-delivered acceptance and commitment therapy (iACT)-for insomnia in a primary care setting. METHODS: This was a pilot randomized controlled trial. Adults seeking help for insomnia (n=18) were recruited via primary care and randomized to either a 5-module iCBT or iACT program delivered via a secure digital platform with weekly therapist feedback. Blinding of participants and therapists was not possible due to the nature of the interventions. Primary outcomes included the Insomnia Severity Index; secondary outcomes included the 9-item Patient Health Questionnaire, 7-item Generalized Anxiety Disorder, and WHO Disability Assessment Schedule. A novel sleep knowledge test was used as a process variable. The data were analyzed using split-plot analyses of variance (intention-to-treat or last observation carried forward and complete case analysis) and nonparametric Friedman and Kruskal-Wallis tests. RESULTS: A total of 18 participants were randomized (iCBT: n=9; iACT: n=9). High attrition was observed, with only 33.3% (n=3) of iCBT and 55.6% (n=5) of iACT participants completing all modules. The iACT group demonstrated a significant within-group reduction in insomnia severity (P=.01, Friedman test), whereas iCBT results were nonsignificant (P=.10, Friedman test). No significant between-group differences were found for any clinical or process variables. Participants rated both treatments as credible (Credibility/Expectancy Questionnaire scores remained stable), though qualitative feedback indicated a need for more flexible, less burdensome content. CONCLUSIONS: This pilot study demonstrates that while internet-delivered insomnia treatments are feasible and credible in primary care, high attrition remains a significant barrier. Preliminary signals suggest that iACT may be a viable alternative to iCBT, potentially offering better adherence. Larger, fully powered pilot randomized controlled trials (estimated N=404) with refined recruitment and automated retention strategies are required to determine definitive comparative efficacy and the mediating role of sleep knowledge and acceptance.
22 May 2026
Read appraisal →PloS one
A collaborative approach to applying Natural Language Processing (NLP) to Domestic Homicide Reviews (DHRs): A study protocol
Since 2011, there has been a statutory requirement in England and Wales to conduct a Domestic Homicide Review (DHR) into any domestic abuse-related death: a multi-agency review into the death of a person aged 16 or over that appears resulting from violence, abuse or neglect from an intimate partner, family member or household member. However, analyses of large numbers of DHRs are rare. One of the core challenges is the time and effort required to analyse narrative text within reports. Doing so manually is both time-consuming and resource-intensive and is a primary reason why researchers typically focus on only a portion of the available data. Natural Language Processing (NLP)-a sub-branch of artificial intelligence that enables computers to interpret and process natural language-provides a viable and scalable alternative by offsetting much of the heavy data processing to a computer. This protocol outlines a study to assess the feasibility of applying NLP to DHRs. The study will take a collaborative approach which balances the speed and scale of automation with the embedded knowledge and expertise of practitioners. This approach helps to ensure that outputs of NLP are sensitive and transparent about the biases common within datasets on violence and abuse. Based on initial consultations, we identify the priority research questions for investigation. In addition, we outline details of an ongoing collaboration with one partner, Imkaan. The protocol describes the data access, and retrieval and analysis stages before summarising how feasibility will be evaluated. We anticipate that several challenges will emerge within this study and identify strategies for mitigation. We suggest that working with practitioners who hold deep contextual knowledge about the social realities of violence and abuse, including language, risks, and experiences, mean that tools can be developed that are accountable to communities and appropriately applied to real-world problems.
22 May 2026
Read appraisal →PloS one
A systematic review and narrative synthesis of the psychometric properties and biopsychosocial correlates of the English version of the Intuitive Eating Scale-2
Intuitive eating is an adaptive eating approach characterised by having unconditional permission to eat when you are hungry, eating for physical rather than emotional reasons, relying on internal hunger and satiety cues, and honouring your health and practising gentle nutrition. The Intuitive Eating Scale-2 (IES-2) is currently the most commonly-used intuitive eating measure but, to date, there has not been a systematic review of how it performs psychometrically outside of the student sample in which it was developed. This systematic review aimed to assess the psychometric properties of the IES-2, including its associations with other variables, across all studies that used it as a measure of intuitive eating and reported psychometric data. MEDLINE, PsycINFO, Scopus and Web of Science were searched in April 2022, May 2024 and June 2025, identifying 90 papers from diverse populations including college students, people from the general population/community, and people seeking treatment for eating disorders or weight management. Results were presented and synthesised narratively, and risk of bias was assessed using two domains from the COSMIN Risk of Bias checklist. Findings suggest that the IES-2 has good construct validity but underperforms psychometrically in other areas such as response distribution, subscale inter-correlations and dimensionality, particularly in relation to the 'Unconditional permission to eat' subscale. Alternative factor structures were reported on and a three-factor solution excluding the 'Unconditional permission to eat' subscale was found to have promising results. The review contributes a comprehensive account of the biopsychosocial correlates of the IES-2, as well as identifying that studies relating to weight or eating disorders often report mean scores that tend towards the extremes of the scale. Limitations include the exclusion of non-English translations of the IES-2, and future reviews would benefit from being conducted in other languages. PROSPERO registration: CRD42022299436. Funder: ESRC (ES/P000711/1).
22 May 2026
Read appraisal →Journal of medical Internet research
Large Language Models in Colorectal Cancer Care and Clinical Decision Support: Systematic Review
BACKGROUND: Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality worldwide. The complexity of guideline-concordant care and unstructured clinical data has driven demand for decision-support tools. Large language models (LLMs) show promise for processing clinical data and patient-provider communication, yet evidence is fragmented, and a CRC-specific synthesis across the full care continuum is lacking. OBJECTIVE: This systematic review evaluates the current applications, performance determinants, and clinical implications of LLMs across the continuum of CRC care. METHODS: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), we searched 6 databases (PubMed, Embase, Web of Science, Scopus, CINAHL, Cochrane) through April 1, 2026. Eligible studies were peer-reviewed original investigations of LLMs on CRC tasks with extractable outcomes; reviews, editorials, and abstracts were excluded. Two reviewers assessed quality with QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2), PROBAST (prediction model risk of bias assessment tool), and ROBINS-I (Risk of Bias in Nonrandomized Studies - of Interventions). Data on model types, applications, prompts, input/output formats, and outcomes were analyzed descriptively, with narrative synthesis per synthesis without meta-analysis (SWiM) guidelines. RESULTS: Of 8880 records, 37 studies met inclusion criteria (2023-2026), mostly from China and the United States, with GPT series most frequently evaluated. Overall risk of bias was low in 10/37 studies (27.0%), moderate in 14/37 (37.8%), unclear in 7/37 (18.9%), and high or serious in 6/37 (16.2%). Problematic domains included outcome measurement, intervention classification, patient selection, and lack of blinded assessment. LLMs showed utility in automating data extraction from clinical texts, supporting patient education, aiding diagnosis, and assisting clinical decision-making, with emerging visual interpretation and multimodal capacities. Domain-specific and multimodal models showed advantages over general-purpose models in certain tasks. Performance was significantly influenced by prompt design, from zero-shot queries to fine-tuning. Despite efficiency and outcome benefits, challenges persist regarding methodological quality, data privacy, and generalizability. CONCLUSIONS: This review provides an integrative framework synthesizing evidence across study designs and LLM categories in CRC care. Unlike prior reviews addressing gastroenterology broadly or limited to one design, it covers the full CRC continuum and, for the first time, comparatively evaluates general-purpose, domain-specific, and multimodal LLMs, clarifying how prompt engineering and heterogeneous metrics shape outcomes. Although findings support LLMs' clinical potential, results must be interpreted cautiously, given low overall evidence quality. Most studies lacked safeguards against bias-blinded assessment, confounder adjustment, or prospective multicenter validation. Substantial heterogeneity across tasks, LLM types, prompts, reference standards, and outcomes means reported advantages cannot be generalized. Future work should prioritize real-world integration via prospective multicenter validation, robust privacy frameworks, and rigorous human oversight. Amid rising global CRC burden and health care disparities, this review informs clinical translation, equitable scaling, and policy on LLM deployment.
22 May 2026
Read appraisal →The Journal of dermatological treatment
Sustained on/off-treatment disease control with abrocitinib for moderate-to-severe atopic dermatitis.
PURPOSE: Achieving sustained on- and off-treatment disease control is an important therapeutic goal in atopic dermatitis (AD). This study evaluated achievement of off-treatment disease control in patients randomized to placebo following 12 weeks of abrocitinib 200 mg. MATERIALS AND METHODS: In the phase 3 JADE REGIMEN study, patients with moderate-to-severe AD who achieved Investigator's Global Assessment (IGA) of 0/1 (with ≥2 grades of improvement) and ≥75% improvement in Eczema Area and Severity Index (EASI) after 12 weeks of abrocitinib 200 mg were randomized (1:1:1) to placebo, abrocitinib 100 mg, or abrocitinib 200 mg for 40 weeks. This post-hoc analysis evaluated patients by flare status (protocol flare definition: ≥50% loss of initial EASI post-randomization response and IGA score ≥2). EASI, IGA, Peak Pruritus Numerical Rating Scale (PP-NRS), and Dermatology Life Quality Index (DLQI) were evaluated. RESULTS: There were no off-treatment flares in 21.3% of patients in the placebo arm. The no-flare group had EASI, IGA, PP-NRS, and DLQI mean scores indicating clear/mild AD at week 52 (2.9, 1.0, 2.6, and 3.5, respectively). CONCLUSIONS: After 12 weeks of abrocitinib 200 mg, some patients achieved 40 weeks of sustained off-treatment disease control, with assessments demonstrating clear/mild AD, suggesting attainment of disease remission. TRIAL REGISTRATION: NCT03627767.
22 May 2026
Read appraisal →PloS one
Effect of an herbal supplement on quality of life in participants with insomnia: A randomized placebo controlled cross-over pilot trial
BACKGROUND: Insomnia is a common sleep disorder linked to poor quality of life. Patients with insomnia frequently rely on herbal supplements to improve sleep and quality of life; however, most supplements do not undergo rigorous testing to determine their effectiveness. The primary objective of the pilot trial was to test the effectiveness of the herbal supplement on sleep and quality of life. METHODS: In a double-blind, randomized, placebo-controlled, crossover pilot trial, participants were assigned study drinks consisting of the herbal supplement containing extracts from chicory and green tea or placebo for 7 days. This was followed by a crossover to the other arm after 2 weeks of a washout period. Participants were healthy individuals of the age of 50 years or more with insomnia. Study measures included subjective assessments of sleep, daytime sleepiness, fatigue, and quality of life via questionnaires. Habitual sleep patterns and sleep architecture were objectively evaluated by a 7-day accelerometry and polysomnography. RESULTS: Ten participants (9 women; age 59 ± 6 y; BMI 30 ± 10 kg/m2) with insomnia severity index of 21 ± 4 and wake after sleep onset (WASO) of 75 ± 33 min were enrolled in the study. The impact of placebo and supplement was different for measures related to daytime sleepiness and physical fatigue but not quality of life. No within and between treatment differences were observed for any objective measures of habitual sleep patterns or sleep architecture. Within group analysis showed improvement in subjective sleep quality, daytime sleepiness, and general fatigue after 7-day consumption of the placebo drink, but not after consumption of herbal supplement. There were no adverse events related to study participation. CONCLUSION: Compared to placebo drink, daily consumption of the herbal supplement for 7 days did not improve any aspect of quality of life or sleep in our pilot study participants with insomnia. Well controlled clinical trials are needed to confirm the claims related to supplements.
22 May 2026
Read appraisal →Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Safety and Immunogenicity of a Fourth Dose of Omicron BA.1-Adapted BNT162b2 COVID-19 Vaccines in Adults 18-55 Years Old
BACKGROUND: Emergence of severe acute respiratory syndrome coronavirus 2 sublineages warrants the use of sequence-adapted vaccines to provide protection against coronavirus disease 2019. METHODS: In this phase 3 trial, adults 18‒55 years old who had previously received three 30 μg doses of BNT162b2 vaccine were randomized to receive a 60 or 30 μg dose of bivalent Omicron BA.1‒adapted BNT162b2 comprising equal amounts of ancestral and monovalent messenger RNA BA.1 (bivalent BA.1) or a 60 μg dose of monovalent Omicron BA.1‒adapted BNT162b2 (monovalent BA.1). Safety (local reactions, systemic events, adverse events [AEs], and serious AEs) was the primary objective. Exploratory analyses assessed immune responses against Omicron BA.1, BA.4, and BA.5 subvariants and ancestral strain. RESULTS: Among the 1054 randomized participants who received monovalent BA.1 or bivalent BA.1, frequencies of local reactions, systemic events, and AEs were slightly higher with 60 µg monovalent BA.1 than either bivalent BA.1 dose level. One month after vaccination, bivalent BA.1 (30 and 60 μg) and monovalent BA.1 (60 μg) induced substantial neutralizing responses against Omicron BA.1 (50% neutralizing titer geometric mean fold rises [GMFRs], 15.4 [95% CI 12.4-19.2], 17.1 [13.7-21.4], and 24.6 [19.3-31.4], respectively) and ancestral strain (GMFRs, 6.2 [5.1-7.6], 7.3 [6.0-8.9], and 7.0 [5.7-8.7], respectively). In a smaller (n = 30/treatment arm) sentinel cohort, all study vaccines modestly neutralized Omicron BA.4 and BA.5. CONCLUSIONS: Bivalent and monovalent BA.1‒adapted vaccines had a safety profile similar to the original BNT162b2 30 μg and induced substantial neutralizing responses against Omicron BA.1 and ancestral strains. CLINICAL TRIALS REGISTRATION: NCT04955626.
22 May 2026
Read appraisal →BMJ open
Patient preferences and willingness-to-pay for AI-enabled blended type 2 diabetes care by digital experience and socioeconomic status: a discrete-choice experiment in China
OBJECTIVES: To elicit stated preferences and willingness-to-pay (WTP) for artificial intelligence (AI)-enabled blended care in type 2 diabetes mellitus (T2DM), and to examine preference heterogeneity by digital experience and socioeconomic status (SES). DESIGN: Cross-sectional discrete choice experiment (DCE). SETTING: 12 community health centres in Jiaozuo and Puyang, Henan Province, China. Data were collected between June and August 2025. PARTICIPANTS: 423 adults diagnosed with T2DM for at least 6 months, recruited using consecutive convenience sampling from routine follow-up appointments. Of 769 participants who completed the survey, 346 were excluded following prespecified data quality criteria (retention rate: 55.0%). OUTCOME MEASURES: Outcome measures included preference weights and WTP (in Chinese Yuan, ¥) for five DCE attributes: monthly subscription fee, recommendation source, feedback modality, in-person follow-up frequency and expert oversight, estimated using mixed logit models. Simulated uptake probabilities for tailored service packages across four user profiles were computed. RESULTS: Among 423 participants, 80.6% had never used AI tools. Price was the dominant driver of choice (62.7% relative attribute importance). Profound preference heterogeneity emerged across subgroups: rural residents (n=78) were highly price-sensitive but preferred physician endorsement (WTP ¥17.58 (US$2.55), 95% CI ¥5.98 to ¥29.17); female participants (n=224) valued guideline recommendations (WTP ¥18.45 (US$2.67), 95% CI ¥7.81 to ¥29.40); and diabetes app users (n=34) were the least price-sensitive but showed a negative preference for AI instant feedback, instead preferring human dietitian feedback. Expert oversight carried a consistent negative WTP across all profiles. Targeting tailored service bundles to intended subgroups increased uptake by 8-16 percentage points compared with non-targeted bundles. CONCLUSIONS: A 'digital experience paradox' exists whereby digitally experienced users view human interaction as a premium service, while underserved groups rely on specific trust markers such as physician endorsement. To avoid widening the digital divide, AI-enabled blended diabetes care must move beyond standardised models towards configurable, equity-driven service pathways.
22 May 2026
Read appraisal →The Cochrane database of systematic reviews
Artificial intelligence for detection and staging of Alzheimer's disease using retinal images
This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To determine the diagnostic accuracy of AI algorithm-based retinal image reading for detecting referral-requiring Alzheimer's disease in adults who have behavioral symptoms or cognitive decline in the primary care setting. Secondary objectives Where data are available, we will investigate heterogeneity by incorporating covariates in a metaregression.
22 May 2026
Read appraisal →Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Evaluating Personal and Environmental Decolonization Strategies for Children With Skin and Soft Tissue Infection and Their Households - A Randomized Clinical Trial
BACKGROUND: Staphylococcus aureus colonization predisposes to skin and soft tissue infection (SSTI). Given the waning effectiveness of decolonization, we evaluated periodic-personal decolonization and household environmental decontamination to reduce SSTIs among households affected by S. aureus. METHODS: Households of children with community-associated S. aureus SSTI participated in an open-label randomized trial. After baseline decolonization, households were randomized 1:1:1 to a 3-month decolonization intervention: (1) periodic-personal (twice weekly chlorhexidine bathing and monthly intranasal mupirocin application); (2) environmental-hygiene (weekly household surface disinfection and enhanced laundry measures); or (3) integrated-approach of both periodic-personal and environmental-hygiene. Over 9 months, participants and household surfaces were sampled at 5 study visits to detect S. aureus; SSTI incidence was recorded. The primary outcome was household-level cumulative SSTI at 3 months, comparing the integrated-approach to the combined personal-periodic and environmental-hygiene groups. RESULTS: Between 2015 and 2021, 196 index patients and their household contacts (n = 623) were enrolled. Cumulative SSTI incidence did not differ between groups during the 3-month intervention. In index patients and household contacts with SSTI in the year prior to enrollment, SSTI incidence was lower among the integrated-approach at 6- and 9-months compared to the combined periodic-personal and environmental-hygiene groups. In multivariable analyses, prior year SSTI was associated with subsequent SSTI; intervention group was not significant. All interventions reduced methicillin-resistant S. aureus, but not methicillin-susceptible S. aureus, personal colonization over 9 months. CONCLUSIONS: While an integrated-approach of prolonged personal and environmental decolonization reduced SSTIs among participants with prior year SSTI, prior SSTI strongly predicted SSTI incidence longitudinally. Novel prevention strategies are needed.
22 May 2026
Read appraisal →BMJ open respiratory research
Symptom-based rehabilitation in people with post-COVID-19 condition (RELOAD study): a randomised controlled trial
RATIONALE: Post-COVID condition (PCC) is characterised by persistent symptoms that impair health-related quality of life (HRQoL); rehabilitation (REHAB) strategies remain scarce. OBJECTIVE: To investigate the effect of a symptom-based REHAB programme versus usual care on HRQoL in people with PCC. METHODS: In this single-blind randomised controlled trial, a total of 132 people with PCC were randomised to either a REHAB group or a control group, with 104 completing the trial. The REHAB group received a multimodal 3-week REHAB programme tailored to the participant's primary symptom-based group (fatigue, cognitive problems or somatic symptoms); the control group received usual care. The primary endpoint was the between-group difference in change in HRQoL, measured by the 12-item Short Form Health Survey (SF-12) physical component summary (PCS) score at 3 weeks post baseline (intervention period). Changes from baseline to a 3-month follow-up after the intervention period were also analysed as a secondary measure. Additional outcomes included mental HRQoL (SF-12 mental component summary (MCS)), depression symptoms (Patient Health Questionnaire 9 (PHQ-9)) and anxiety symptoms (Generalized Anxiety Disorder 7 (GAD-7)). RESULTS: Participants (mean age 47±12.3 years, 90.4% not hospitalised during acute SARS-CoV-2 infection, 69.2% female) in the REHAB group (n=47) showed a significantly greater improvement in PCS compared with the control group (n=57) (mean difference (Δ) 2.9 points, 95% CI 0.2 to 5.7, p=0.038) at 3 weeks post baseline. This difference remained significant at the 3-month follow-up (Δ 4.2 points, 95% CI 1.5 to 6.9, p=0.003). The REHAB group also showed significant improvements in mental HRQoL (MCS: Δ 5.7 points, 95% CI 2.0 to 9.4, p=0.003), as well as in depression symptoms (PHQ-9: Δ -2.7 points, 95% CI -4.2 to -1.2, p<0.001) and anxiety symptoms (GAD-7: Δ -2.4 points, 95% CI -3.7 to -1.1, p<0.001) at 3 weeks post baseline compared with the control group. At the 3-month follow-up, the reduction in depression symptoms remained significant, while no significant differences were observed for mental HRQoL or anxiety symptoms. CONCLUSION: A symptom-based rehabilitation programme significantly improved HRQoL in individuals with PCC after 3 weeks, with some benefits persisting at 3 months. TRIAL REGISTRATION NUMBER: NCT05172206.
22 May 2026
Read appraisal →Psychological medicine
Global prevalence of prolonged grief disorder during the COVID-19 pandemic under standardized diagnostic frameworks: A systematic review and meta-analysis
Prolonged grief disorder (PGD), recently classified in ICD-11 and DSM-5-TR, is characterized by persistent and functionally impairing grief lasting beyond 6-12 months. The COVID-19 pandemic was accompanied by widespread mortality, social isolation, disrupted mourning rituals, and social disconnection, raising concerns about a potentially high burden of PGD during the pandemic period. We conducted a systematic review and meta-analysis, following PRISMA guidelines and PROSPERO registration (CRD42023463720), to estimate PGD prevalence under standardized ICD-11 and DSM-5-TR diagnostic frameworks and to examine potential moderators during the COVID-19 pandemic. PubMed, EMBASE, and the Cochrane Library were searched from inception to October 2024. Eligible studies included adults who experienced bereavement during the pandemic and were assessed using validated PGD instruments (PG-13-R, ICG, BGQ). Random-effects models were applied to pool prevalence estimates, with subgroup and meta-regression analyses. Thirteen studies comprising 5,766 participants were included. The pooled prevalence of PGD during the pandemic period was 24% (95% CI: 13%-36%), with the highest estimates observed in China (43%, 95% CI: 33%-54%). In the overall pooled analysis, studies applying DSM-5-TR criteria yielded lower prevalence estimates than those using ICD-11 criteria (18% vs.26%, p = 0.41). Digital interventions showed no statistically significant pooled effects (Hedges' g = -0.38, 95% CI: -0.90 to 0.14). The high and geographically heterogeneous prevalence of PGD observed during the COVID-19 pandemic underscores the need to strengthen mental health surveillance, standardized assessment, and service accessibility in large-scale public health emergencies, and provides important evidence to inform population-level interventions and resource allocation strategies.
22 May 2026
Read appraisal →Journal of medical Internet research
Receipt of Medicines Information From the Internet and Other Information Sources Among Adult Medicine Users in Developed Economies, 2010-2025: Systematic Review
BACKGROUND: The internet, social media, and digital health tools have transformed access and receipt of medicines information (MI), complementing or replacing traditional sources, such as physicians, pharmacists, and package leaflets. OBJECTIVE: This study aimed to examine the prevalence and patterns of adult medicine users' receipt of MI from electronic sources (eg, internet and social media) compared with traditional sources, and to assess trends in the receipt of MI in developed economies since 2010. METHODS: A systematic search was conducted in CINAHL, the Cochrane Library, ProQuest, Scopus (including Embase and MEDLINE), and Web of Science databases for peer-reviewed studies conducted and published between January 1, 2010, and December 31, 2025. Studies including adults (≥18 years) in developed economies were eligible. The review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Methodological quality and risk of bias were assessed using the Mixed Methods Appraisal Tool. Due to substantial heterogeneity, findings were synthesized narratively without meta-analysis. RESULTS: Twenty-six studies from 10 countries, involving 19,891 medicine users, were included. Most studies were cross-sectional surveys (n=19), with only one being a national long-term trend study. Physicians, pharmacists, and package leaflets consistently remained the most common MI sources, irrespective of patient group, country, or study design. No clear temporal trends in MI receipt were observed. Variations in the frequency of MI receipt were evident across research methods, medicine user groups, and types of medicines. Individuals with greater familiarity with the internet were more likely to receive MI from electronic sources, such as websites and social media. In most studies, MI obtained from social media was not distinguished from other internet-based sources. Half of the studies focused on heterogeneous medicine user groups (n=14), while the remainder examined specific medicine user groups (n=12). Although the methodological quality of the studies was generally acceptable, only 3 studies reported the use of an explicit theoretical framework. CONCLUSIONS: Traditional MI sources remain central for adult medicine users despite the growing role of electronic platforms. While the receipt of MI from electronic sources appears more common among internet-experienced users, no significant temporal trends in using these sources were identified. Further research is needed to better distinguish between different digital MI sources, including artificial intelligence-based MI sources, and to explore their evolving roles, implications for health-related decision-making, and associations with user characteristics and health contexts in the digital era. This review is innovative in systematically comparing traditional and electronic MI sources across developed economies and in highlighting methodological and conceptual gaps in existing research. By synthesizing cross-national evidence and identifying the need for clearer differentiation of digital MI subtypes, the study contributes to the field and informs the development of more targeted, reliable, and user-centered MI strategies in real-world health care settings.
22 May 2026
Read appraisal →BMJ (Clinical research ed.)
Calcium, vitamin D, or combined supplementation to prevent fractures and falls: systematic review and meta-analysis
OBJECTIVE: To assess the effect of calcium, vitamin D, or combined supplementation on fractures and falls in adults. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Trials included in systematic reviews from 2014, three databases (Medline, Embase, CENTRAL) to 19 February 2025, clinical trial registries, abstracts from scientific meetings, and references from included studies. ELIGIBILITY CRITERIA: Randomised controlled trials comparing calcium, vitamin D, or combined supplementation with placebo or no treatment in adults (≥18 years) not receiving drug treatment for osteoporosis. DATA EXTRACTION AND SYNTHESIS: The primary outcome was the risk of any fracture. Secondary outcomes included the risk of hip fracture, non-vertebral fracture, vertebral fracture, and falling, as well as the total number of falls. Pairs of reviewers independently screened trials, extracted data, and assessed risk of bias using the second version of Cochrane's risk of bias tool. Findings were synthesised using random effects meta-analyses and appraised using Grading of Recommendations Assessment, Development and Evaluation, with application of thresholds for absolute effects considered important. RESULTS: This review included 69 trials involving 153 902 participants. Participants in most of the trials were community dwelling (87%) and not at high risk of fractures or falls (73%). For the primary outcome of any fracture, little to no effect was found from use of calcium supplements (11 trials, 9067 participants; risk ratio 0.91, 95% confidence interval 0.81 to 1.01; moderate certainty), vitamin D supplements (36 trials, 92 045 participants; 1.00, 0.95 to 1.06; high certainty), or combined supplementation (15 trials, 51 126 participants; 0.91, 0.84 to 0.99; high certainty). Calcium, vitamin D, or combined supplementation appeared to have little to no effect on other fracture and fall outcomes, based largely on moderate to high certainty of evidence. The findings remained robust after an extensive exploration of heterogeneity across multiple subgroup analyses. Evidence for high risk patients or those requiring residential care was limited for many outcomes for calcium monotherapy and for combined supplementation. CONCLUSION: Based on absolute risk reductions and thresholds considered clinically meaningful, this review found little to no benefits from use of calcium, vitamin D, or combined supplementation on the prevention of fractures and falls. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023483915.
22 May 2026
Read appraisal →BMJ military health
Risk and protective factors for suicide-related outcomes among serving military personnel: a systematic review of cohort studies
INTRODUCTION: Understanding risk and protective factors for suicide-related outcomes (suicidal ideation, attempts, and deaths) among military personnel is key to the development and design of suicide prevention initiatives. Current literature has predominantly focused on ex-serving or a combination of ex-personnel and serving-personnel. Therefore, factors that may be pertinent for serving personnel are less understood. This review aims to identify risk and protective factors for suicide-related outcomes comprising serving military personnel. METHODS: The review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered on PROSPERO. A systematic literature search of academic databases on military personnel and suicide from 2004 was conducted. Two independent reviewers conducted study selection. Inclusion criteria included serving personnel, cohort study design, and suicide-related outcomes. Exclusion criteria were National Guard or reservists, and studies not in English. Data on study and participant characteristics, military-specific variables, and suicide-related outcomes were extracted. All studies were critically appraised. RESULTS: A total of 53 studies were included. Most studies were published in the past 10 years, comprised army personnel from the USA, and focused on suicide attempts. Overarching risk factor categories included adverse military experiences, deployment, repeated help seeking and support, junior rank, occupation and time in service and vulnerability factors within the military context. Since many of these risk factors are inherent to military service, they may potentially be considered non-modifiable. Despite a limited number of studies on protective factors, several studies found that unit cohesion reduced the likelihood of suicidal ideation and suicide attempts. CONCLUSIONS: Suicide prevention strategies within the military may be enhanced by targeting risk factors that are potentially modifiable. Less modifiable risk factors could potentially be targeted through improved personnel management practices, particularly in preparation for and after deployment among first-year personnel. Longitudinal research programmes that identify and examine risk and protective factors for serving military personnel are needed. PROSPERO REGISTRATION NUMBER: CRD42024558183.
22 May 2026
Read appraisal →Postgraduate medical journal
Efficacy of tirzepatide in glycemic control and weight management in adults with type 2 diabetes: a systematic review and meta-analysis of real-world studies
A systematic review and meta-analysis of real-world studies on tirzepatide is essential to strengthen evidence of its effectiveness in improving glycated hemoglobin (HbA1c) and body weight in patients with type 2 diabetes. 13 real-world studies (N = 89 296; duration 3-18 months) with moderate to serious bias revealed a mean HbA1c reduction of 0.91% (95% confidence interval [CI]: -1.04 to -0.79), weight loss of 9.7 kg (95% CI: -14.05 to -5.35), and body mass index decrease of 2.09 kg/m2 (95% CI: -3.27 to -0.92). Overall, 64% of tirzepatide users reached HbA1c <7%. Furthermore, tirzepatide lowered HbA1c (mean difference [MD] -0.38%; 95% CI: -0.44 to -0.33) and body weight (MD -6.27 kg; 95% CI: -9.22 to -0.33) more than the control. 47%, 23%, 9%, and 4% of tirzepatide users lost ≥5%, ≥10%, ≥15%, and ≥ 20% of their baseline weight, respectively. Tirzepatide's effects on HbA1c and weight in observational studies support clinical trial findings.
22 May 2026
Read appraisal →European journal of pediatrics
The effect of virtual reality glasses used during inhaler treatment on anxiety, fear and vital signs in children: a randomized controlled trial
UNLABELLED: This study aimed to determine the effect of virtual reality (VR) glasses used during inhaler treatment on anxiety, fear and vital signs in children. The study had an experimental, randomized controlled design. Participants were assigned to groups using a lottery method based on simple randomization. The random sequence was generated by physically mixing up 30 red (experimental) and 30 white (control) cards. All the data were collected and finalized by two trained researchers (Yasemin Özyer Güvener, a nurse researcher, and Şeyma Şimşirgil Kara, a pediatrician). Participants were recruited using a convenience sampling method from among individuals who met the inclusion criteria. In terms of baseline measurements, the experimental group had significantly higher mean pulse rate, fear scores, and anxiety scores (130.23 ± 14.64, 2.77 ± 1.25, and 4.60 ± 2.04, respectively) compared to the control group (118.83 ± 17.10, 2.07 ± 1.26, and 2.80 ± 2.07, respectively) (p = 0.007, p = 0.035, and p = 0.001, respectively). For post-intervention measurements, the experimental group had significantly lower mean fear and anxiety scores (0.443 ± 0.16 and 0.703 ± 0.22, respectively) compared to the control group (2.39 ± 0.16 and 3.197 ± 0.22, respectively) (p < 0.001 and p = 0.001, respectively). CONCLUSION: It was determined that VR glasses reduced anxiety and fear, increased oxygen saturation, and reduced respiratory and pulse rates. They can thus be used as an alternative method to reduce fear and anxiety levels and balance vital signs during inhalation therapy in children. WHAT IS KNOWN: • Virtual reality (VR) is an effective non-pharmacological method for reducing pain, anxiety, and fear in pediatric patients during various medical procedures. • VR applications create a sense of presence in a virtual world, limiting the impact of anxiety and fear in clinical settings. WHAT IS NEW: • Using VR glasses during the administration of inhaled medication significantly reduces anxiety and fear levels in children compared to traditional methods. • While evidence for VR use during inhalation therapy was previously limited, this study demonstrates its effectiveness as a promising alternative to improve treatment compliance and physiological responses in pediatric patients.
21 May 2026
Read appraisal →JMIR formative research
Comparing Stakeholders' Perspectives on Parkinson Disease Management and Digital Technologies: Exploratory International Survey
BACKGROUND: Parkinson disease (PD) is a progressive neurodegenerative disorder that poses complex challenges for persons with PD, informal caregivers, and health care professionals. With growing interest in digital and predictive artificial intelligence (AI) tools for disease management, understanding the needs and digital readiness of these stakeholder groups is crucial. OBJECTIVE: This work aims to (1) identify digital practices for PD management among persons with PD, at-risk individuals, caregivers, and health care professionals; (2) compare these practices across groups; (3) explore stakeholder desires for AI-based tools; and (4) assess alignments and gaps to inform tailored AI solutions. METHODS: An anonymous cross-sectional online survey of an exploratory nature was distributed (from December 2024 to October 2025) in 5 languages and completed by 255 respondents. Descriptive statistics summarized responses to 41 questions, including stakeholder-specific items. χ2 tests were performed to examine stakeholder differences in desired AI features. RESULTS: Interest in predictive AI was high across stakeholder groups. Symptom tracking was the most desired feature (selected by more than 76% of the respondents), and personalized treatment recommendations came second for both persons with PD and health care professionals; however, stakeholder priorities diverged in other areas. Health care professionals rated improving patient and informal caregiver engagement as significantly more important than persons with PD did, χ21 (n=205)=34.78, P<.001, and Cramer V=0.41. Despite considerable interest, the reported use of digital tools was limited, as most persons with PD did not use symptom-tracking apps or wearables, nor were they currently monitoring their condition, although many expressed intentions to begin. CONCLUSIONS: While predictive AI tools were viewed positively across groups, there were significant gaps in stakeholder preferences, highlighting the importance of tailored, context-aware design. Early diagnosis was not prioritized by persons with PD or health care professionals, likely reflecting the complexity of diagnosing PD in the absence of disease-modifying therapies. Coupled with the emphasis placed on preventive lifestyle guidance by persons with PD and those at risk, this highlights the importance of actionability in AI-based monitoring and prediction. Such actionability may also enhance perceived relevance and uptake, given that reported interest in digital health tools and self-tracking exceeded actual use. These findings offer early-stage insight to guide the development of future AI-based solutions for PD.
21 May 2026
Read appraisal →JMIR mental health
Efficacy of a World Health Organization-Guided Self-Help Intervention for Reducing Psychological Distress in Afghan Refugees: Randomized Controlled Trial
BACKGROUND: Common mental health disorders are highly prevalent among refugees. There is an urgent need to address the mental health burden in this population. OBJECTIVE: This study tested the efficacy of an individually supported self-help stress-management intervention developed by the World Health Organization-Doing What Matters in Times of Stress (DWM)-in reducing psychological distress and improving functioning among refugees in Indonesia, a major transit country in the Asia-Pacific region. METHODS: A single-blind randomized controlled trial with 303 Farsi-speaking refugees was conducted between June 2024 and June 2025. Participants with moderate to high psychological distress (Kessler Psychological Distress Scale [K10] score≥20) were randomly allocated to the facilitator-guided individual DWM condition (n=202) or a repeated assessment control condition (n=101). The primary outcome was psychological distress (K10 score) at the posttreatment assessment. Secondary outcomes were posttraumatic stress disorder symptoms, functional impairment, social functioning, and personally identified problems. RESULTS: Intent-to-treat analysis indicated that participants in the DWM condition showed greater reductions in K10 scores than those in the repeated assessment control condition (posttreatment: β=-.563, SE=0.124; P<.001; Cohen d=0.56; 1-month follow-up: β=-.447, SE=0.140; P=.002; Cohen d=0.45). Similarly, those participants in the DWM condition reported greater improvements in posttraumatic stress disorder symptoms, well-being, social functioning, functional impairment, and personally identified psychological problems. No serious adverse events were reported. CONCLUSIONS: The findings provide the first evidence for the effectiveness of DWM in reducing psychological distress and improving overall functioning among urban refugees living in a transit setting. Individually supported self-help interventions such as DWM mayoffer an effective, feasible, and scalable approach to improving mental health for refugees.
21 May 2026
Read appraisal →BMC public health
Little All Children in Focus (Little ACF) - evaluation of a parenting support programme for parents of children aged 1-2 years in Sweden: a randomised controlled trial
INTRODUCTION: The first two years of life affect health over the life course. Universal parenting support programmes may promote child health during these years but there is a lack of such evidence-based programmes. Our aim was to study the direct effects of a structured 4 sessions universal parenting programme for parents with children 1-2 years old, Little All Children in Focus, in Sweden. METHODS: A two-arm parallel randomised controlled superiority trial with 832 Swedish-speaking parents was conducted to evaluate the effectiveness of the Little All Children In Focus programme in comparison with an active control receiving four digital lectures on child development and parenthood. The participants completed questionnaires at baseline and post intervention measuring the primary outcomes: parenting self-efficacy and stress, coparenting quality, emotion regulation for parents and emotion regulation strategies for their children, and secondary outcome: child socioemotional development. A third research question concerned whether the intervention could engage and retain parents in groups. An intention-to-treat approach was applied using linear mixed models for analysing the effectiveness of the programme. RESULTS: Parents who participated in the programme demonstrated greater improvements in supportive emotion regulation strategies compared to the active control (β = 3.0, CI = 0.9 - 5.0), while no notable group differences emerged across the remaining outcome measures. The program demonstrated high levels of parental engagement and retention in group settings. CONCLUSIONS: Little All Children in Focus demonstrates potential in promoting supportive parenting emotion regulation strategies among Swedish speaking parents to 1-2-year-olds. The intervention also seems to have potential to engage parents. However, further evaluations must be conducted to provide a deeper understanding of the long-term impact of this universal parenting support programme. TRIAL REGISTRATION: The study protocol https://rdcu.be/eAxn2 was published at www. CLINICALTRIALS: gov with registration number: NCT05445141 (registered on July 06, 2022).
21 May 2026
Read appraisal →JMIR formative research
Impact of Restriction-Resumption Protocols on Mood and Anxiety in Healthy Adults: Randomized Controlled Trial
BACKGROUND: Simple behavioral and cognitive actions can reduce symptoms of anxiety and depression. However, there is limited research investigating whether restricting those same actions increases symptoms and whether resuming those actions reduces symptoms. OBJECTIVE: The primary aim was to examine the impact of restricting, then resuming (the "restriction-resumption protocol"), 5 groups of actions called the Things You Do (TYD), on symptoms of depression and anxiety. Participant satisfaction with life and perceptions of changes in behavior and mental health were also evaluated. METHODS: In total, 70 adults were randomly allocated to an intervention group (IG) or a control group (CG). IG participants completed a 3-phase protocol over 8 weeks: a 2-week baseline period (phase A), 2 weeks of restricted TYD actions (phase B), and a 4-week resumption phase (phase C). CG participants were instructed to maintain their usual activities and routines. Primary outcomes included symptoms of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and frequency of TYD actions. Secondary outcomes included satisfaction with life and perceived changes in mental well-being. Outcomes were measured weekly throughout the 8-week trial and again after the trial at week 9. RESULTS: Scores on outcome measures did not differ between groups during phase A and after the trial. However, by the end of phase B, IG participants showed significantly increased symptoms of depression and anxiety compared to CG participants (Ps<.001). Large within-group effect sizes were observed on the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 from baseline to the end of phase B (Cohen d>1.8) and from phase B to after the trial (Cohen d>1.9). Changes in satisfaction with life and evaluations of mental health corresponded with symptom changes. CONCLUSIONS: These findings demonstrate a relationship between the frequency of performing specific actions and symptoms of depression and anxiety. The restriction-resumption protocol has the potential to increase our understanding of causal mechanisms underlying common mental disorders and may lead to the development of new models of prevention and treatment. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12624001491550; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=388828&isReview=true.
21 May 2026
Read appraisal →Journal of medical Internet research
A Digital Toolkit for Weight Loss Maintenance in European Adults (NoHoW): 2×2 Factorial Randomized Controlled Trial
BACKGROUND: Digital approaches to weight management have the potential to produce cost-effective and scalable weight management solutions. Effective behavior change interventions typically promote self-regulation of energy balance behaviors, which may be enhanced by incorporating emotion regulation strategies. OBJECTIVE: This study aimed to evaluate the effectiveness of a digital behavior change toolkit for weight loss maintenance in European adults who had achieved ≥5% weight loss in the previous 12 months. We hypothesized that a combined intervention targeting self-regulation or motivation and emotion regulation would be more effective than either component alone, and that each would outperform an active control. METHODS: The Navigating to a Healthier Weight (NoHoW) trial was a 2×2 factorial randomized, single-blind, controlled trial involving 1627 adults who had achieved ≥5% weight loss in the previous 12 months (initial BMI ≥25 kg/m2) across 3 European centers (the United Kingdom, Denmark, and Portugal). The trial evaluated a digital toolkit for weight management subsequent to an initial ≥5% weight loss in the prior 12 months. Participants were assigned using adaptive stratified sampling to one of four groups: (1) self-regulation or motivation (n=403), (2) emotion regulation (n=416), (3) combined motivation and emotion (n=408), or (4) active control (generic content, regular self-weighing, and Fitbit use, n=400). The primary outcome was weight change from baseline to 12 months. Prespecified secondary outcomes included cardiometabolic markers. Linear models adjusted for recruitment center, sex, age group, BMI group, and pretrial weight loss. Subgroup analyses were conducted by sex. RESULTS: At 12 months, 76% (364/1627) of participants remained in the study. In the primary ITT analysis in all participants, none of the intervention arms (motivation, emotion, or combined) differed significantly from the active control for weight change at 12 months. Completer and per-protocol analyses produced similar patterns and did not change the overall interpretation. In the per-protocol sample, men regained 0.14 kg, and women regained 0.54 kg of their pretrial weight loss. Subgroup analyses indicated a small effect of the motivation intervention in men, but this was not clinically meaningful and did not alter the primary null findings. Nearly half of ITT participants regained weight, and no significant intervention effects were observed for cardiometabolic secondary outcomes. CONCLUSIONS: The NoHoW trial was the first large-scale, multicountry 2×2 factorial randomized controlled trial to evaluate a digital-only toolkit based on self-regulation or motivation and emotion regulation techniques for weight loss maintenance. NoHoW found no evidence in the primary ITT analysis that digital interventions targeting self-regulation or emotion regulation improved weight loss maintenance compared with the active control. A small subgroup effect in men should be interpreted cautiously and does not change this conclusion. The trial provides evidence on both the limitations and potential of digital behavior change interventions for long-term weight outcomes. Future digital interventions may benefit from enhanced engagement and tailored content to improve long-term weight outcomes.
21 May 2026
Read appraisal →JMIR formative research
Development, Feasibility, Acceptability, and Usability of an Artificial Intelligence-Powered Chatbot (Suzy) to Support Patients in Substance Use Disorder Recovery: Multiphase Study
BACKGROUND: Substance use disorder (SUD) remains a major public health crisis in the United States, with significant challenges in treatment access, retention, and workforce capacity. SUD care teams, including addiction medicine physicians and peer recovery coaches (PRCs), support patients receiving SUD treatment but face heavy workloads and burnout. Artificial intelligence (AI) innovations, particularly large language model (LLM)-based chatbots, may extend PRC support and provide patients with on-demand recovery support between clinic visits and PRC contacts. However, evidence on their development, feasibility, acceptability, and usability in addiction services remains limited. OBJECTIVE: This study describes the development, feasibility, acceptability, and usability of an AI-powered health coaching chatbot (Suzy) designed to support patients in SUD recovery. METHODS: A total of 2 clinicians, 5 researchers, and 2 technology developers led a small, multiphase pilot study. In the formative phase, they conducted focus groups and qualitative in-depth interviews with 12 health care professionals and 8 patients with substance use histories to specify chatbot functions and develop a rule-based chatbot. In phase 2, they conducted usability testing of the rule-based chatbot with 8 patients who reported substance use and completed standardized tasks, surveys, and qualitative interviews. Measures included the System Usability Scale (SUS), Net Promoter Score (NPS), and Single Ease of Use Question (SEQ). In phase 3, they developed an LLM-based chatbot co-designed and fine-tuned with PRCs and other SUD experts. RESULTS: Rule-based chatbot functions included craving management, appointment reminders, resource referrals, care team contacts, and goal setting. Usability task testing supported feasibility. In this small pilot sample, quantitative and qualitative feedback indicated acceptability and usability, with an average SUS score of 93 (benchmark 68), an NPS of 63 (benchmark 35), and a mean SEQ score of 6.5/7. Patients valued Suzy's approachable, nonjudgmental language and features that promoted accountability, self-monitoring, and 24/7 availability, while emphasizing that chatbots should supplement but not replace human support. The LLM-based chatbot development emphasized information accuracy, safety escalation protocols to mitigate risks of inappropriate chatbot responses, human-in-the-loop features, and expanded conversational flexibility and personal tailoring. CONCLUSIONS: In this pilot study, a rule-based chatbot designed to support SUD care demonstrated feasibility, usability, and acceptability. LLM-based chatbot development required more robust safety and emergency reporting features, while offering more patient-responsive conversational functions. By providing on-demand coaching, referrals, and reminders, Suzy may extend the reach of care teams, alleviate provider burden, and enhance patient engagement. Additional work is needed to understand how to best integrate Suzy into patients' recovery journeys to ensure human support remains accessible and prioritized. LLM evaluation was based on expert testing and safety review. Clinical effectiveness, including the impact on substance use, was not evaluated. Next steps include evaluating the LLM chatbot in real-world settings with larger samples and assessing its efficacy in reducing substance use.
21 May 2026
Read appraisal →Oral health & preventive dentistry
Screening for Periodontitis Using Blood Biomarkers and Demographic Data: A Machine Learning Study
PURPOSE: Periodontitis is a common chronic disease associated with systemic conditions such as diabetes and cardiovascular disease. Diagnosis typically relies on dental examinations and radiographs, which may be underutilised by individuals who avoid, delay, or lack dental care. This study evaluated the potential of routine blood biomarkers and demographic data for screening moderate-to-severe periodontitis. METHODS AND MATERIALS: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 adults aged ≥ 30 years (N = 3,338). Periodontal status was classified using CDC/AAP definitions. An XGBoost classifier was trained on 77 features spanning demographics, complete blood count, glycemic and hemo-globin markers, heavy metals, and additional biochemical assays. Model performance was assessed with Accuracy, Precision, Recall, and F1 score. SHapley Additive exPlanations (SHAP) were used for interpretability. Subgroup analyses were conducted by age and gender. RESULTS: The model achieved 61.1% Accuracy, 57.4% Precision, 94.6% Recall, and an F1 score of 71.5%. Performance was higher in males (F1 = 78.2) than in females (F1 = 63.9%). SHAP identified age, gender, blood cadmium, blood lead, and glycohaemoglobin (HbA1c) as top predictors. CONCLUSION: Routine blood biomarkers and demographics can be leveraged for non-dental screening of periodontitis, offering a feasible preventive strategy in primary care. The model achieved high recall, minimising false negatives, and identified biologically plausible predictors. This approach may help flag at-risk individuals, particularly in underserved populations, and support integration of oral health into general medical care.
21 May 2026
Read appraisal →Scientific reports
Use of machine learning and voice for multiclass classification of Parkinson's disease, chronic obstructive pulmonary disease, and healthy controls.
Parkinson's disease (PD) and chronic obstructive pulmonary disease (COPD) are prevalent conditions with substantial impact on quality of life and health care systems. Both disorders affect voice production through different physiological mechanisms, yet neither condition has a widely adopted objective biomarker for routine clinical use. Voice analysis has emerged as a non-invasive digital biomarker candidate, but existing studies have largely focused on binary classification within a single disorder or language. This study aimed to evaluate whether an unified multiclass machine learning (ML) framework applied to sustained vowel "a" phonation can discriminate between PD, COPD, and healthy controls (HC) across linguistically distinct cohorts. Sustained vowel recordings were analyzed from Swedish speaking individuals with COPD and HC, and English-speaking individuals with PD and HC, collected under comparable mobile recording conditions. Acoustic features included baseline voice measures and Mel Frequency Cepstral Coefficients. A soft voting ML framework integrating support vector machine, random forest, CatBoost, and light gradient boosting classifiers was trained using nested cross validation with hyperparameter optimization. Data were partitioned at the participant level into a development cohort and an independent test cohort. Model performance was evaluated using accuracy, macro averaged precision, recall, F1 score, receiver operating characteristic analysis, and confusion matrices. Model interpretability was assessed using Shapley additive explanations and vowel space analysis. The final soft voting classifier achieved robust multiclass discrimination on the participant disjoint independent test set, with an overall accuracy of 0.842 and a macro averaged F1 score of 0.839. Classification performance differed across groups, with the highest performance observed for PD, intermediate performance for HC, and lower performance for COPD. Misclassifications occurred primarily between HC and COPD, while confusion between PD and COPD was minimal. Feature attribution analysis revealed class dependent relevance patterns, and vowel space analysis demonstrated subtle but consistent group level differences. These findings demonstrate the feasibility of using an explainable soft voting machine learning framework applied to sustained vowel phonation to distinguish between neurologically and respiratory driven voice impairments across linguistic contexts. The study supports voice as a promising digital biomarker modality for multiclass clinical discrimination using mobile recordings.
21 May 2026
Read appraisal →The Journal of clinical psychiatry
Systematic Review and Meta-Analysis of Mood Stabilizers in the Treatment of Adolescent Patients With Nonsuicidal Self-Injury in China
Objective: Nonsuicidal self-injury (NSSI) refers to deliberate, repeated acts of damaging one's own body tissue without suicidal intent. The aim of this systematic review and meta-analysis was to explore the effectiveness of mood stabilizers in treating depressive adolescent patients with NSSI in China. Data Sources: Literature published before June 30, 2025, was included. Chinese databases searched included CBM (Chinese Biomedical Database), CNKI (China National Knowledge Infrastructure), WANFANG (Wanfang Database), and CSSCI (Chinese Social Sciences Citation Index); English databases included MEDLINE, Embase, and the Cochrane Library. Searches used the following keywords: [Bipolar disorder OR depression OR NSSI] AND [Mood stabilizer OR Lithium OR Valproate OR Carbamazepine OR Oxcarbazepine OR Lamotrigine OR Antipsychotic OR Antidepressant]. Study Selection: Chinese and English literature related to the treatment of NSSI with mood stabilizers in adolescent patients in China was searched. Editorials, comments, letters, reviews, and case reports were excluded. Randomized controlled trials conducted in China comparing mood stabilizer augmentation of basic therapy versus basic therapy alone for treating NSSI were included, and studies evaluating mood stabilizer treatment for NSSI using pre-post designs were also included. A total of 9 studies were included, 4 comparative studies by control group and 5 comparative studies of before and after treatment. Data Extraction and Synthesis: Indices of depression, anxiety, impulsivity, self-injury severity, and treatment response were synthesized and analyzed. Mean differences or standardized mean differences and 95% confidence intervals (CIs) were used for symptom change. Odds ratios and their 95% CIs were also used for binary outcomes. Results: Severity of anxiety, depression, impulsivity, and self-injury was significantly reduced following treatment with mood stabilizers. Compared to treatment without mood stabilizers, anxiety, depression, and self-injury were also significantly reduced, and the response rate was significantly improved in adolescents with depression and NSSI. The incidence of self-injury in these patients was significantly reduced by mood stabilizers. Conclusion: These results demonstrate the important role of mood stabilizers in treating NSSI and suggest that mood stabilization may be more critical than mere improvement of affective symptoms.
21 May 2026
Read appraisal →JMIR medical informatics
Machine Learning Prediction Model for Dyslipidemia and Its Association With Atherothrombotic Events in 3 Independent Cohorts From South Korea, Japan, and the United Kingdom: Algorithm Development and Validation Study
BACKGROUND: Dyslipidemia is a multifactorial and complex condition that warrants investigation through advanced analytical approaches such as machine learning (ML). Few previous ML studies predicting dyslipidemia have been validated across multiple international populations. OBJECTIVE: This study aimed to develop an ML model to predict the 5-year incidence of dyslipidemia using routinely collected health examination data. To ensure generalizability, the model was externally validated in populations from South Korea, Japan, and the United Kingdom. Furthermore, the clinical relevance of the model-derived risk was evaluated by examining its association with atherosclerotic outcomes, including acute myocardial infarction and cerebral infarction. METHODS: This study was conducted using 3 independent, large-scale, population-based cohorts. The discovery cohort from South Korea (n=471,650) was used for model training and internal validation, while 2 validation cohorts from Japan (validation A; n=7,255,685) and the United Kingdom (validation B; n=408,725) were used for external validation. We evaluated various ML-based models using 23 features extracted from regular health screening data to predict the new onset of dyslipidemia within 5 years. Shapley Additive Explanations values were calculated to assess feature importance. To ensure the robustness of the proposed ML model, we evaluated the risk of atherothrombotic events (acute myocardial infarction or cerebral infarction) based on the model probability (tertiles; T1, T2, and T3) using a Cox proportional hazards model. RESULTS: In the discovery cohort, soft-voting ensemble learning with Light Gradient Boosting Machine and categorical boosting exhibited performance metrics of area under the receiver operating characteristic curve (AUROC) of 0.783, precision of 37.9%, and area under the precision-recall curve of 0.469. The model showed moderate discriminatory performance in the external validation cohorts (cohort A: AUROC 0.744; precision 27.2%; and cohort B: AUROC 0.687; precision 5.07%). Shapley Additive Explanations value analysis identified smoking, alcohol intake, and physical activity as the most important features for predicting dyslipidemia. Finally, a higher model probability (T3 vs reference) was pronounced with an increased risk of acute myocardial infarction (adjusted hazard ratio 2.34, 95% CI 1.84-2.97) and cerebral infarction (adjusted hazard ratio 2.43, 95% CI 2.19-2.71). CONCLUSIONS: This multinational study developed and validated an ML-based model using routine health checkup data to predict the 5-year risk of new-onset dyslipidemia, which was also associated with atherosclerotic events.
21 May 2026
Read appraisal →BMC neurology
The impact of caffeine consumption on migraine: a systematic review.
BACKGROUND: Migraine is a common, disabling neurological disorder affecting over one billion people worldwide, characterized by recurrent unilateral, pulsating headaches lasting 4-72 h. Caffeine, a widely consumed psychoactive alkaloid found in coffee, tea, and other beverages, is frequently implicated as both a trigger and a treatment for attacks. OBJECTIVES: We aim to comprehensively evaluate the association between caffeine exposure and migraine by integrating observational evidence with Mendelian Randomization (MR) studies. METHODS: A comprehensive search was conducted through PubMed, Scopus, Web of Science, and the Cochrane Library till August 2025. We included primary studies assessing the impact of caffeine exposure on migraine risk. RESULTS: 19 studies (nine cross-sectional, seven MR, and three cohort) were included in our review. MR studies included over one million participants, while cross-sectional studies involved over 43,000 participants, and the cohort studies included 421 migraine cases. MR reflected lifelong genetic liability (population-level, chronic exposure) and associated with a reduced risk with overall odds ratio (OR) ranging from 0.53 to 0.71, with stronger associations reported in migraine with aura (ORs as low as 0.37-0.39). Observational studies captured short-term, acute effects and showed that abrupt withdrawal or acute excessive intake (≥ 3 drinks/day) can trigger attacks in some people (P = 0.024). While habitual moderate use was generally not linked to higher average migraine burden. CONCLUSIONS: Lifelong genetic liability to higher coffee/caffeine intake is associated with a reduced risk of migraine especially for migraines with aura. However, acute excessive intake or sudden changes in caffeine habits can trigger attacks in some people. More future large, well prospective cohorts and carefully designed MR studies are needed to confirm our results and clarify the precise impact of caffeine on migraine risk.
20 May 2026
Read appraisal →JMIR medical informatics
Extracting Social Determinants of Health From Electronic Health Records: Development and Comparison of Rule-Based and Large Language Model Methods
BACKGROUND: Social determinants of health (SDoH) are critical drivers of health outcomes but are often underdocumented in structured electronic health record (EHR) data. Instead, SDoH are more commonly recorded in unstructured clinical notes, and unlocking this information could have far-reaching implications for advancing population health research and informing clinical decision-making. OBJECTIVE: This study develops and systematically evaluates cost-efficient methods for extracting SDoH information from unstructured clinical text using rule-based natural language processing (NLP) and large language model (LLM)-based approaches. METHODS: We constructed a gold-standard annotated corpus comprising clinical text segments from 171 patients in the Mass General Brigham Research Patient Data Registry, covering 7 SDoH domain categories and 23 subcategories. A rule-based system (RBS) was developed and evaluated alongside 7 OpenAI GPT models (GPT-4o, 4.1, 4.1-mini, o4-mini, GPT-5, GPT-5-mini, and o3) under zero-shot and few-shot settings using multiple prompting strategies. We additionally implemented late-fusion ensemble approaches that combined outputs from rule- and LLM-based methods. Performance was assessed using precision, recall, and F1-score, alongside qualitative error analysis. RESULTS: The RBS achieved high precision for SDoH domain categories (0.96) but substantially lower recall (0.68). GPT-based models consistently outperformed the RBS in overall recall and F1-scores. The best domain-level performance was observed for GPT-5 and GPT-5-mini in few-shot settings (F1-score=0.89), while o4-mini achieved the highest subcategory-level performance (F1-score=0.88). A late-fusion ensemble integrating RBS and GPT outputs further improved domain-level performance (F1-score=0.92), with balanced precision (0.93) and recall (0.90), but did not improve subcategory-level performance. CONCLUSIONS: Recent GPT models with advanced reasoning capabilities, including the newly released mini models (eg, o4-mini and GPT-5-mini), demonstrated strong performance for SDoH extraction without task-specific fine-tuning and consistently outperformed the rule-based NLP system. Integrating rule- and LLM-based methods via late fusion further enhanced domain-level extraction performance. Our results demonstrate a cost-efficient framework for the accurate identification of SDoH from clinical text, facilitating downstream population health research and clinical informatics applications.
20 May 2026
Read appraisal →The British journal of dermatology
Artificial intelligence-based smartphone application for skin cancer detection: a prospective diagnostic accuracy study
BACKGROUND: Smartphone applications ('apps') that use artificial intelligence (AI) for skin cancer diagnosis may help with early detection. However, prospective studies assessing real-world performance are scarce. OBJECTIVES: To evaluate in an independent prospective study the diagnostic accuracy of a widely used skin cancer detection app and the effect of photographic conditions in a user-representative cohort of patients consulting for lesions of concern. METHODS: Between 1 February 2021 and 30 June 2023, participants presenting at an early-access consultation with a lesion of concern were consecutively enrolled. Following dermatological assessment, each lesion was photographed using the app. The app's convolutional neural network (CNN) generates a binary risk output and advice. A teledermatology review was performed in a subset of cases. The diagnostic accuracy of the CNN combined with teledermatology review was compared with final clinical or histopathological diagnosis. Performance was tested under different photographic conditions (angle, lighting, user) and with different smartphone models. The trial was registered with ClinicalTrials.gov (NCT05246163). RESULTS: A total of 1458 participants with 1904 lesions of concern were included. Of these, 185 (9.7%) were skin cancers, with 32 melanomas. Image capture was unsuccessful in 16.6% of lesions (n = 317/1904), despite optimal conditions. For successfully captured lesions, the CNN achieved a sensitivity of 82.5% and specificity of 76.8% for skin cancer detection. In-app teledermatology review was available for 65.7% (n = 1042/1587) of images. Combined CNN and teledermatology review resulted in increased specificity (86.8%; P < 0.001), with a sensitivity of 75.3%. Overall sensitivity in melanocytic lesions was lower than in nonmelanocytic lesions (71.0% vs. 76.3%; P < 0.001), whereas specificity was higher (90.0% vs. 84.9%; P < 0.001). A substudy demonstrated low image-capture success in user hands (28.9%) and variation in diagnostic performance between smartphone models. CONCLUSIONS: This independent, prospective study evaluated diagnostic performance of a widely used skin cancer detection app in a user-representative cohort. The findings highlight the importance of independent clinical validation of AI-based healthcare tools in real-world settings. Skin cancer is one of the most common cancers that affects people worldwide. Finding cancer early is important, especially for melanoma, a serious form of skin cancer. There is potential for smartphone apps to use AI to help people identify skin spots that may need medical attention. In this study, we evaluated a widely used app called SkinVision. People presenting with a worrisome spot at a dermatology appointment were invited to take part in this study. Altogether, 1458 people were included. The skin area of concern was assessed with the app. Using AI, the app produced a risk score. It also gave a final score. The final score was the AI risk score that may be combined with dermatology advice delivered remotely (‘teledermatology’). We compared the app scores with the doctor’s final diagnosis. We also studied the impact of things such as photo angle, lighting, type of smartphone and the person who took the photo. We found that over 16% of worrisome skin areas could not be captured by the app under ideal conditions. If participants were asked to take the photo themselves, this increased to over 70%. The app correctly identified skin cancers in 83% of cases but gave false alarms in 23%. The in-app teledermatology review reduced the number of false alarms, but this increased the number of missed skin cancers. Finally, we found important differences between different smartphones. Our findings highlight the importance of trialling apps like this with real patients in real-life setting before they are fully introduced to the public.
20 May 2026
Read appraisal →Journal of the American Heart Association
Residual Angina Following Complete Revascularization in the ISCHEMIA Trial: Frequency, Clinical Characteristics, Health Status, and Cardiovascular Outcomes
BACKGROUND: The frequency of residual angina and its impact on health status and death following anatomic complete revascularization in symptomatic patients with chronic coronary disease are unknown. METHODS: Data were analyzed from ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial participants randomized to invasive management with baseline angina (Seattle Angina Questionnaire Angina Frequency score <100), no prior coronary artery bypass graft surgery, and anatomic complete revascularization within 90 days of randomization. The primary outcome was frequency of residual angina after revascularization, defined as a Seattle Angina Questionnaire Angina Frequency score <100 within 6 months of randomization. Secondary outcomes included 6-month health status and medication use and 5-year all-cause and cardiovascular death. RESULTS: Among 2588 participants randomized to invasive management, 1442 (56%) had baseline angina and no prior coronary artery bypass graft surgery; 1034 underwent revascularization within 90 days, and 436 achieved anatomic complete revascularization. Of these, 184 (42.2%) had residual angina within 6 months. Baseline characteristics were similar between those with and without residual angina. Percutaneous coronary intervention was more common than coronary artery bypass graft surgery in those with residual angina (88% versus 80%, P=0.03). At 6 months, residual angina participants reported lower quality of life (Seattle Angina Questionnaire Quality of Life: 70±20 versus 83±20, P<0.001), greater physical limitation (Seattle Angina Questionnaire Physical Limitation: 84±20 versus 95±11, P<0.001), more dyspnea (Rose Dyspnea Scale score: 1±1.3 versus 0.4±0.8, P<0.001), and more antianginal medication use (P=0.006). Five-year all-cause and cardiovascular death did not differ significantly between groups. CONCLUSIONS: Residual angina is common (>40%) following anatomic complete revascularization for chronic coronary disease and is associated with reduced quality of life and greater antianginal medication use but no increase in death. REGISTRATION: Unique Identifier: NCT01471522.
20 May 2026
Read appraisal →JMIR medical informatics
The Impact of Electronic Health Records on Family Physicians During Simulated Virtual Encounters: Exploratory Mixed Methods Study
BACKGROUND: This exploratory study investigated the impact of computer use on physician performance during clinical simulations. Standardized patient (SP) scenarios used in family practice certification examinations were adapted to include the use of the electronic health record (EHR). OBJECTIVE: The goal was to compare the impact of EHR use during simulated virtual patient encounters on resident physicians' and staff physicians' patient-centeredness (PC) and overall clinical performance, as well as to measure the cognitive load (CL) imposed by EHR use. METHODS: Sixteen participants each completed 2 video telemedicine simulations with SPs. One simulation case included limited past medical history for the SP in the EHR, while the other did not. Participants were instructed to completely document the encounter using the EHR. Participants' self-perceived CL was measured using the raw National Aeronautics and Space Administration Task Load Index (NASA-TLX). Video recordings were analyzed for participant PC and overall clinical performance. In addition to interacting with the EHR, multiple participants also conducted internet searches. The proportion of time that participants spent interacting with the computer, either using the EHR or searching the internet, was calculated. Inductive qualitative coding of a subset of video recordings (18 of 32 encounters) was performed, with a focus on signs of stress/CL. All videos were assessed for usability problems. RESULTS: Staff physicians (n=6) scored higher on PC compared to resident physicians (n=10) for both cases, though differences were not statistically significant after correction for multiple comparisons (family-wise error rate). Physicians' overall CL, as measured by the raw NASA-TLX, was not significantly correlated with computer use. Exploratory qualitative data analysis found both verbal and nonverbal signs of stress/CL due to computer use while interacting with the SPs. The proportion of time displaying nonverbal signs of stress/CL was calculated for a subset of participants (6 resident physicians and 3 staff physicians). Participant interpretations of instructions to completely document the encounter using the EHR varied widely. It is likely that participants' usual style of documenting, either primarily during or after patient encounters, impacted their use of the EHR while SPs were present. CONCLUSIONS: Use of the computer during video telemedicine appointments may negatively impact physician PC and overall clinical performance. Exploratory qualitative coding identified both verbal and nonverbal signs of stress/CL when participants interacted with the computer and the patient simultaneously. Increased clinical experience helped to mitigate the negative impact of computer use. If the use of the EHR is included in physician certification examinations, clear instructions regarding which tasks must be completed in the EHR during interactions with SPs should be provided.
20 May 2026
Read appraisal →The British journal of dermatology
Evaluation and enhancement of the prognostic ability of the eighth edition of TNM staging in cutaneous malignant melanoma: a population-based study, using machine learning, of 111 871 patients
BACKGROUND: Melanoma is the fifth most common cancer in the USA and the UK, with global incidence on the rise. The TNM staging system guides treatment decisions and predicts patients' outcomes. OBJECTIVES: To evaluate the prognostic ability of the eighth edition TNM (TNM-8) staging system to predict overall (OS) and melanoma-specific survival (MSS) in cutaneous malignant melanoma (CMM), and to explore the potential of machine learning (ML) methods to enhance melanoma prognostication. METHODS: The records of adult patients diagnosed with CMM from 2018 to 2022 were extracted from the Surveillance, Epidemiology, and End Results (SEER) Program database. TNM-8 was evaluated using Kaplan-Meier plots and OS and MSS probabilities. Fine-Gray competing risk and accelerated failure time (AFT) models evaluated factors affecting MSS and OS, respectively. ML models were used to evaluate the predictive ability of TNM stages for OS and MSS, compared with that of multiple clinically important prognostic variables. RESULTS: Altogether, 111 871 patients with CMM were included in the analysis, with OS and MSS as survival endpoints. Most T (tumour), N (node), M (metastasis) and TNM-8 stage categories had distinct MSS and OS probabilities, except in the N1 and N2 stages at 12 months and in OS for TNM-8 stages 2 and 3 at 12, 36, 48 and 59 months. Fine-Gray and AFT models showed that age, sex, race/origin, tumour site, histological type, ulceration, Breslow thickness, mitotic rate, number of positive lymph nodes and M stage were important prognostic variables for MSS and OS. ML models showed that TNM had a higher predictive prognostic ability for MSS than OS and that including clinically important prognostic variables in addition to TNM stage has higher discriminative prognostic ability for OS and MSS (testing C-indices range 0.84-0.85 and 0.89-0.92, respectively) than using TNM staging alone (testing C-indices range 0.67-0.72 and 0.82-0.87, respectively). CONCLUSIONS: This proof-of-concept study demonstrated that although TNM staging retains prognostic value, adding important prognostic variables and using ML could improve prognostication for patients with melanoma. ML could be used to develop interactive clinical decision-support tools to improve the prognostication of individuals with melanoma. Cutaneous malignant melanoma is a common type of skin cancer. A guide called the ‘TNM’ is often used to decide what treatment patients should get. It also helps doctors decide how long patients need specialist care for. The guide is also used to help determine what the outlook for a patient might be. Lots of factors can affect the outcome for a person with the disease. These include a person’s age, sex and race. They also include factors related to the tumour, whether lymph glands are involved and whether the cancer has spread to other organs. Not all these factors are included in the current TNM guide. An accurate staging system is important. It will ensure that patients are followed-up and treated appropriately. This will help avoid unnecessary treatment or surveillance. In this study, we used a type of artificial intelligence (AI) to test how well the latest edition of the TNM can determine what the outlook for patients with melanoma is. We also used it to see if adding other important factors could improve its ability to predict the outlook for these patients. We included over 100,000 patients with melanoma from a large database called SEER. We found that using AI in addition to the current TNM guide could enhance the prediction of outcomes for patients with melanoma. The findings suggest that AI could be useful in helping health professionals predict outcomes for patients with melanoma.
20 May 2026
Read appraisal →Journal of medical Internet research
Understanding Remission of Long-Term Conditions Through Electronic Health Records: Scoping Review
BACKGROUND: Multiple long-term conditions (MLTCs) require complex and prolonged treatment regimens. Remission in long-term conditions (LTCs) is important for understanding disease progression and evaluating treatment effectiveness. Electronic health records (EHRs) are increasingly used to monitor clinical outcomes, but how remission is defined within EHRs remains unclear. OBJECTIVE: This study aimed to summarize and collate the previous literature on how remission of LTCs has been defined in EHRs. METHODS: Systematic electronic searches were performed on OVID MEDLINE, Embase, CINAHL EBSCO, the Cochrane Library, and the Bielefeld Academic Search Engine for eligible studies published from inception to November 27, 2025. Quantitative studies, published in any language, on adult populations, and using EHRs to assess remission of LTCs, were eligible for inclusion. Studies that did not clearly define remission and studies on cancer remission were excluded. Data were extracted from each eligible study using a structured table. Risk of bias was not assessed, in line with scoping review methodology. A narrative approach was taken to summarize and present data from the included studies. The number and characteristics of studies were described, both overall and by condition. Findings were discussed with clinicians and data experts to ensure applicability in clinical practice. RESULTS: Ninety-one studies were included. Sample sizes ranged from 12 to 72.9 million adults. Studies were conducted in 18 countries, with the majority being from the United States. The majority of included studies used a cohort study design. Studies assessed how remission was defined in 12 LTCs, including inflammatory bowel disease (41/91, 45.1%), type 2 diabetes (n=15, 16.5%), depression (n=15, 16.5%), alcohol or drug misuse (n=8, 8.8%), asthma (n=3, 3.3%), multiple sclerosis (n=3, 3.3%), epilepsy (n=1, 1.1%), anemia (n=1, 1.1%), chronic kidney disease (n=1, 1.1%), autoimmune pancreatitis (n=1, 1.1%), hypertension (n=1, 1.1%), heart failure (n=1, 1.1%), and MLTC (n=1, 1.1%). Remission was typically defined using a combination of clinical codes (n=7, 7.7%), validated rating scales (n=56, 61.5%), biochemical markers (n=29, 31.9%), absence of symptoms (n=10, 11%), absence of condition-specific events (eg, hospital admissions; n=4, 4.4%), and cessation of pharmacological treatments (n=26, 28.6%). There was substantial variation in the criteria and duration of follow-up used to define remission across studies. CONCLUSIONS: This review demonstrates that remission of LTCs can be identified and operationalized within EHRs, although remission criteria varied across studies. The review extends the literature on remission in EHRs by combining evidence synthesis and consultation with clinical and data experts to propose standardized comprehensive definitions to reliably define and implement remission of multiple LTCs in EHR-based research. This will allow cross-study comparisons and present an opportunity to advance understanding of disease trajectories and improve evaluation and monitoring of patient outcomes. Further research may apply, compare, and evaluate standardized definitions across different data sources to assess generalizability and further improve our understanding of remission of LTCs.
20 May 2026
Read appraisal →Journal of the American Heart Association
Incremental Prognostic Power of Coronary Flow Reserve and Artificial Intelligence-Enabled ECG-Derived Filling Pressure in Angina With Nonobstructive Coronary Arteries
BACKGROUND: Coronary flow reserve reflects microvascular function, whereas filling pressure indicates myocardial hemodynamic burden. In angina with nonobstructive coronary arteries, abnormalities in either could contribute to a supply-demand mismatch; however, their combined prognostic significance remains unclear. METHODS: Patients with angina with nonobstructive coronary arteries who underwent invasive coronary reactivity tests were studied retrospectively. Coronary microvascular dysfunction (CMD) was coronary flow reserve <2.5. An artificial intelligence-enabled ECG marker of elevated filling pressure (AIEFP) was applied as a scalable prognostic marker of myocardial hemodynamic stress. Associations with major adverse cardiovascular events were evaluated using Cox regression and propensity score overlap weighting. RESULTS: Among 1957 patients with angina with nonobstructive coronary arteries (median age, 51.8 years; 67.2% women), CMD+ was identified in 26.4% and AIEFP+ in 6.6%. Over 8 years, 204 patients (10.4%) experienced major adverse cardiovascular events. In nested models, both CMD (hazard ratio [HR]=1.42 [95% CI=1.13-1.78]; P=0.002) and AIEFP (HR=2.28 [95% CI=1.67-3.11]; P<0.001) remained associated with major adverse cardiovascular events after adjustment. Adding AIEFP to the base model improved model fitness (Δχ2=23.65, P<0.001; ΔAkaike Information Criterion=-21.7) and modestly improved discrimination (ΔHarrell concordance index=0.02, P=0.02). In a 4-group model, adjusted risks increased in a graded manner. Overlap-weighted analysis after covariate balance demonstrated distinct temporal risk trajectories: CMD+/AIEFP+ had the highest 1-year risk (12.7%), and AIEFP+ had the highest cumulative 8-year risk (57% in CMD- and 51.8% in CMD+). CONCLUSIONS: CMD and AIEFP provide complementary prognostic information, with AIEFP remaining significantly associated with outcomes after multivariable adjustment. A dual-axis framework integrating myocardial hemodynamic stress (AIEFP) and microvascular function (coronary flow reserve) may enhance risk stratification and enable identification of clinically distinct angina with nonobstructive coronary arteries phenotypes with divergent trajectories.
20 May 2026
Read appraisal →Journal of the American Heart Association
Association of Edoxaban Pharmacokinetics With Bleeding in Older Patients With Atrial Fibrillation Treated With Low-Dose Edoxaban: A Post Hoc Analysis of a Randomized Controlled Trial
BACKGROUND: Edoxaban is a direct oral anticoagulant used for stroke prevention in patients with atrial fibrillation (AF) and treatment of venous thromboembolism. We examined the relationship between trough edoxaban concentrations (E-trough) and prothrombin time (PT) and major bleeding in very old Japanese patients with atrial fibrillation and high bleeding risk. METHODS: In this post hoc analysis of the multicenter, randomized, double-blind, placebo-controlled ELDERCARE-AF (Study of DU-176b Aged 80 Years or Older) trial, patients were randomly assigned 1:1 to edoxaban 15 mg or placebo once daily. After 8 weeks of treatment, E-trough was determined and the incidence of major bleeding examined in each quartile. The incidence of major bleeding by PT was also examined. RESULTS: Data were obtained from 427 patients. E-trough (ng/mL) was ≤9.24 in the first quartile (107 patients), >9.24 to ≤13.6 in the second (111 patients), >13.6 to ≤21.6 in the third (103 patients), and >21.6 in the fourth (106 patients). Older age, lower body weight, lower creatinine clearance, and the presence of congestive heart failure were independent predictors of higher E-trough. Higher E-trough was associated with greater incidence of major bleeding (0.8%, 1.9%, 3.4%, and 4.7%/year, respectively, P=0.0408). There was a significant positive correlation between E-trough and PT (r=0.426, P<0.0001). Significantly more major bleeding events occurred in the longer (>13 seconds) versus shorter (≤13 seconds) PT subgroups (4.61% versus 0.98%/year, P=0.0060). CONCLUSIONS: Several factors were associated with higher E-trough and increased risk of major bleeding events. PT >13 seconds may be a useful predictor of the development of major bleeding. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02801669.
20 May 2026
Read appraisal →International journal of biometeorology
Machine learning and dose response effect models: an integrated approach to analyze the association between environmental variables and Cuneo Emergency Department admissions for Acute Otitis Media (2007-2015)
Acute otitis media (AOM) is a leading cause of pediatric Emergency Department visits, particularly among children under five years of age. Although its seasonal pattern is well established, the role of air pollution and meteorological factors remains unclear. This study aims to investigate their impact on daily AOM visits by integrating machine learning and epidemiological approaches. We conducted a retrospective analysis of pediatric AOM diagnoses (2007-2015) at S. Croce and Carle Hospital (Cuneo, Italy). Predictors included PM10, NO₂, O₃, and eleven meteorological variables. Ensemble machine learning models (Random Forest, XGBoost, and AdaBoost) were trained and validated using 10-fold cross-validation. Model interpretability was assessed through SHAP values. Distributed Lag Nonlinear Models (DLNM) were applied to estimate delayed exposure-response relationships over lag periods of 0-1, 0-3, 0-5, and 0-10 days, with results expressed as Relative Risks (RRs) and 95% Confidence Intervals (CIs). AdaBoost showed the best performance (R² = 0.974; MAE = 0.019 cases/day; cross-validated R² = 0.987). SHAP analysis identified mean temperature as the most influential predictor (44%), while PM10, NO₂, and O₃ each contributed approximately 10%. DLNM analysis confirmed a strong and consistent effect of temperature across all lag periods (RR > 1.20, CI > 1). Moderate associations were observed for NO₂ and PM10 (RR: 1.02-1.04). O₃ exhibited smaller but significant effects at shorter lags (RR = 1.01 at 0-1 days; RR = 1.02 at 0-3 days; CI > 1). Environmental factors, particularly temperature, play a significant role in pediatric AOM incidence. The integration of machine learning and DLNM enhances predictive accuracy and improves the understanding of exposure timing. These findings support the development of early warning systems and targeted preventive strategies under adverse environmental conditions. Further validation in larger urban settings is needed.
20 May 2026
Read appraisal →Acta dermato-venereologica
Pregnancy in Women with Atopic Dermatitis: A Systematic Review of Concerns and Challenges
Atopic dermatitis (AD) has negative individual and societal implications. However, the potential impact of ADatopic dermatitis on reproduction has only been sporadically investigated. We aimed to provide an overview of pregnancy in ADatopic dermatitis, with a specific focus on concerns, challenges, the number of children, and adverse pregnancy and birth outcomes. A systematic literature search was performed using EMBASE and PubMed up until 19th January 2026 for original articles in relation to reproduction in female ADatopic dermatitis. Twenty-four highly heterogeneous studies were included. Concerns about ADatopic dermatitis in relation to pregnancy and family planning were reported in >50% of the patients in three3 out of four4 studies. Conflicting results were seen regarding fertility and disease severity during pregnancy. Pregnancy rates were similar or increased based on two2 studies. Eleven studies addressed adverse pregnancy and birth outcomes, of which five5 studies unanimously reported a protective or indifferent effect of ADatopic dermatitis on pre-term birth, gestational diabetes and stillbirth. Outcomes such as gestational hypertension, preeclampsia and miscarriage showed divergent results. Overall, ADatopic dermatitis causes considerable worries in relation to family planning. However, this review implies, that pregnancy rates as well as complications in pregnancy and during childbirth in women with ADatopic dermatitis overall are consistent with women without ADatopic dermatitis.
20 May 2026
Read appraisal →BMJ quality & safety
Patient safety measures for virtual consultations in primary care: a systematic review
OBJECTIVES: With the growing adoption of virtual consultations in primary care, the need for tailored metrics to evaluate their safety became increasingly urgent. This systematic review seeks to identify and review existing safety measures that could be used for safety evaluation of virtual consultations in primary care. METHODS: This has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and followed a published protocol. A systematic literature search was performed in Ovid MEDLINE/PubMed, Embase and Cochrane Library databases from 2014 to 2024. Studies comparing virtual consultations with face-to-face consultations in the primary care setting were included. An inductive thematic analysis was performed to systematically extract and group the safety measures into overarching themes, with a narrative synthesis to summarise the results. RESULTS: A total of 47 studies (31 experimental and 16 observational studies) were included (n=2 223 697 patients). All studies assessed the safety of virtual versus face-to-face consultations via one or both of the following domains: (1) factors that influence the safety of virtual consultations and (2) tangible outcomes of virtual care safety. The former were categorised into provider-related, patient-related and system-related factors. Tangible outcomes were evident through three subthemes-adverse events, health outcomes and patient perception of safety. CONCLUSIONS: This review provides a systematic synthesis of measures for the safety evaluation of virtual consultations. Further research into patient and physician perspectives is needed to identify aspects and indicators not captured in this study, followed by a consensus study to finalise safety metrics. Ultimately, having a robust methodology for safety evaluation of virtual consultations in place will enable safety monitoring, root cause analyses and safety improvement. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42023464878.
20 May 2026
Read appraisal →Journal of the American Heart Association
Effect of Different Types of Whole Dietary Pulses on Established Therapeutic Lipid Targets for Cardiovascular Risk Reduction: An Updated Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials
BACKGROUND: Although dietary pulses are recognized by major clinical practice guidelines to reduce cholesterol and coronary heart disease risk, intake is low. There are no health claims for any pulse for cholesterol reduction, which could support uptake. We therefore conducted a systematic review and dose-response meta-analysis of randomized trials of the effect of different types of whole dietary pulses on lipid targets. METHODS: MEDLINE, Embase, and the Cochrane Library were searched through March 2025 for trials ≥3 weeks. The primary outcome was low-density lipoprotein-cholesterol. Secondary outcomes were other lipid targets. Independent reviewers extracted data and assessed risk of bias. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. RESULTS: Thirty-eight trials (52 trial comparisons, n=2095) with a median of 6 weeks and dose of 130 g/d (0.5-0.67 cup/d) showed that whole dietary pulses decreased low-density lipoprotein-cholesterol (mean difference, -0.14 mmol/L [95% CI, -0.19 to -0.08]), non-high-density lipoprotein-cholesterol (-0.22 mmol/L [95% CI, -0.30 to -0.14]), apoB (apolipoprotein B) (-0.08 g/L [95% CI, -0.13 to -0.03]) and high-density lipoprotein-cholesterol (-0.03 mmol/L [95% CI, -0.05 to -0.01]) with no effects on other lipids. Analyses by pulse type showed similar results. A linear inverse relationship was shown for beans up to 1 cup/d for low-density lipoprotein-cholesterol (coefficient, -0.25 mmol/L/0.5 cup [95% CI, -0.48 to -0.02]) and non-high-density lipoprotein-cholesterol (-0.45 mmol/L/0.5 cup [95% CI, -0.71 to -0.18]). Grading of Recommendations Assessment, Development, and Evaluation was moderate-to-high for all outcomes, except apoB (very low). CONCLUSIONS: Whole dietary pulses likely result in small important-to-moderate reductions in lipid targets and trivial reductions in high-density lipoprotein-cholesterol. Similar effects were observed across pulse types with an inverse dose-response gradient for beans up to 1 cup/d. Future studies on chickpeas, dried peas, and lentils are warranted. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023432826; Unique identifier: CRD42023432826.
20 May 2026
Read appraisal →BMC public health
Interventions against loneliness and social isolation in older adults- a systematic review.
BACKGROUND: Loneliness is a growing health and social challenge. The COVID-19 pandemic boosted feelings of loneliness for many people. To combat loneliness, a wide range of interventions have been developed and evaluated for their efficacy and effectiveness. As a result, many new interventions to alleviate loneliness have been developed, especially technological interventions. Therefore, the objective of this study was to conduct a comprehensive and up-to-date systematic review to identify interventions aimed at loneliness and social isolation among adults, 60 years and older published during or post-pandemic. METHODS: A comprehensive literature search was conducted for studies between 2020 and 2024 across five online databases: MEDLINE via PubMed, Web of Science, Scopus, Cochrane Library, and CINAHL. Title and abstract screening, critical appraisal of the studies, and data extraction were performed by two independent reviewers. A narrative approach was adopted to assess and integrate the diverse findings from the research. RESULTS: Ultimately, 79 studies were included in this systematic review. The results are structured based on the categorization of the interventions, which includes differentiation between analogue interventions, technological interventions and multicomponent (analogue and technological) interventions. The effectiveness of analogue interventions, particularly community-based interventions such as group meetings, social participation programs, and educational or psychological interventions, tended to be superior to that of technological interventions. CONCLUSIONS: The combination of analogue and technological interventions in particular produced promising results regarding a decrease of loneliness. Specific interventions must be tailored to the target group and setting and regularly reevaluated. The aim now should be to implement these interventions comprehensively and monitor their effectiveness over several years. Future research should focus on differentiating the circumstances under which various forms of intervention are effective. TRIAL REGISTRATION: PROSPERO systematic review registration: CRD42024538755.
20 May 2026
Read appraisal →The Journal of clinical endocrinology and metabolism
Predicting incident type 2 diabetes using wearable activity and polygenic risk: A survival-modeling study in All of Us
BACKGROUND: Evidence is limited on whether daily step counts are uniform across individuals or whether combining them with genetic risk improves prediction of type 2 diabetes (T2D), both essential for precision prevention. We aimed to assess whether objectively measured daily step count and Polygenic Risk Score (PRS) predict the incidence of T2D, and to evaluate the predictive performance of machine-learning models. METHODS: We conducted a prospective cohort study of 4589 adults in the National Institutes of Health's All of Us Research Program with valid Fitbit step data and whole-genome-derived PRS, excluding individuals with T2D before or within a 180-day lead-in period. Incident T2D was defined by HbA1c ≥ 6.5%, plasma glucose ≥126 mg/dL, or an All of Us T2D condition record. We evaluated Cox and machine-learning survival models. FINDINGS: Over a median of 2.92 years (15 340 person-years), 265 participants developed T2D (5.77% cumulative incidence; 17.27 per 1000 person-years). Risk-reducing thresholds were ∼7000 steps/day (P < .001) but differed by PRS group (∼7800 high vs ∼5800 low; P < .001). Each additional 1000 steps/day was associated with lower T2D risk (adjusted hazards ratio, 0.83; 95% CI, 0.79-0.88; P < .005), whereas each 1-SD higher PRS was associated with higher T2D risk (adjusted hazards ratio, 2.62; 2.32-2.96; P < .005). Adding steps to a clinical model increased the C-index from 0.748 to 0.774; adding PRS increased it to 0.867. Penalized Cox achieved the highest discrimination (C-index 0.859), followed by survival support vector machine (0.85) and classical Cox (0.846). Calibration was best with Random Survival Forests. INTERPRETATION: Step-count thresholds for reducing T2D risk varied across genetic risk groups, indicating that step counts do not confer uniform protection. Step counts and PRS provided independent, complementary predictive information, and their combination improved prediction of incident T2D.
20 May 2026
Read appraisal →Scientific reports
Cytokines and immunologic checkpoint molecules in predicting success of allergen immunotherapy.
There are large variations in how individual patients respond to allergen immunotherapy (AIT) against grass and/or birch allergy. There are currently no reliable biomarkers to predict which patients are likely to benefit from the treatment. The purpose of this study was to examine the potential of cytokine and soluble immunologic checkpoint molecule (ICM) levels as biomarkers for AIT success. Blood samples collected before starting AIT were analyzed for concentration of 92 different cytokines and 14 different ICMs. Traditional univariable statistical analysis was performed to evaluate differences between responders and non-responders. Furthermore, both unsupervised and supervised machine learning algorithms were used for multivariable analysis of differences between the responders and non-responders and to try to identify clusters within the subjects which could potentially be linked to endotypes of allergic rhinitis. Neither univariable nor multivariable analysis showed any significant correlations between AIT outcome and pre-treatment levels of cytokines or soluble ICM. In the cluster analysis, 4 clustering algorithms consistently grouped 48 of the 60 subjects into 3 distinct clusters. However, these clusters did not correlate with clinical characteristics, indicating that the clusters are unlikely to represent actual biological endotypes. The findings of this study did not provide evidence supporting the use of pre-treatment levels of cytokines and ICM as biomarkers for AIT outcome.
20 May 2026
Read appraisal →Scientific reports
A human-centric fuzzy decision support system for medical diagnosis using fuzzy cognitive maps
Medical decision support requires models that remain interpretable under uncertainty while still adapting to evolving data and expert knowledge. Fuzzy cognitive maps (FCMs) are attractive in this setting because they encode concept-level relations in a transparent graphical form. However, static expert-defined FCMs are often too rigid, whereas purely data-driven updates may weaken semantic consistency and drift away from clinically meaningful relations. This paper proposes a human-centric adaptive framework for fuzzy cognitive map-based medical decision support. The proposed Human-Centric Fuzzy Decision Support System (HCFDSS) combines data-driven weight adjustment with an explicit expert-correction operator, allowing the causal structure of the map to be refined without discarding domain knowledge. The method is formulated through a two-stage procedure: an inner reasoning loop updates concept activations for fixed weights, while an outer learning loop updates the weight matrix using a regularized objective together with bounded expert intervention. Under standard smoothness and boundedness assumptions, we establish sufficient conditions for stability of the inner reasoning dynamics and convergence of the outer weight-update operator. A numerical illustration shows how expert feedback can revise clinically important edges and alter the final diagnostic activation in an interpretable way. In addition, the paper reports a reproducible empirical evaluation involving synthetic medical scenarios and three public medical benchmark datasets from the UCI Machine Learning Repository, together with sensitivity analysis for expert intervention, preprocessing validation, robustness checks under missingness and imbalance, and expanded comparisons with mainstream machine-learning baselines. The proposed HCFDSS is positioned not as a replacement for high-capacity black-box predictors, but as a transparent and editable decision-support framework in which clinicians can inspect, question, and refine the learned relations. The main contribution of the present work is therefore methodological and theoretical, while the empirical evaluation clarifies the predictive-interpretability trade-off of the proposed framework under reproducible benchmark settings.
20 May 2026
Read appraisal →Archives of disease in childhood
Effects of metformin on anthropometric indices and hormones and adipocytokine concentrations in children with overweight or obesity: a systematic review and meta-analysis of randomised controlled trials
OBJECTIVE: The aim of this systematic review was to assess the effect of metformin on anthropometric indices, hormones and adipocytokine concentrations in children with overweight or obesity. METHODS: Eligible studies were searched via PubMed, Scopus, Cochrane Central Register of Controlled Trials, alongside clinical trial registries and the reference lists of included studies, from inception to October 2024. Screening was carried out independently by two reviewers, involving title-abstract screening for relevance, followed by full-text review for eligibility confirmation. Data extraction was performed by two independent investigators using an identical Excel spreadsheet. A meta-analysis was conducted using the random-effects model. RESULTS: A total of 19 original studies were deemed eligible for this systematic review. Metformin was more effective than placebo in improving Body Mass Index (BMI), BMI-Z score, body weight, fasting insulin and leptin concentrations (mean difference (MD) -1.07 kg/m2, 95% CI -1.62 to -0.52; MD -0.09, 95% CI -0.13 to -0.05; MD -3.20 kg, 95% CI -4.21 to -2.19; MD -3.38 μU/mL, 95% CI -6.00 to -0.75; MD -3.73 ng/mL, 95% CI -6.28 to -1.18, respectively). There was no difference between metformin and placebo on adiponectin and resistin concentrations, as well as adiponectin to leptin ratio. CONCLUSION: Metformin may have a role as an adjuvant therapy in managing overweight and obesity among the paediatric population. Regarding the concentrations of adipokines and hormones, the results are inconclusive. More randomised controlled trials with rigorous methodology and homogeneity in population and intervention characteristics are needed to shed light on this topic. TRIAL REGISTRATION NUMBER: PROSPERO CRD42023401732.
20 May 2026
Read appraisal →BMJ open
Implementation of a clinical decision support tool for postpartum depression: protocol for a prospective randomised clinical trial
INTRODUCTION: Perinatal mood and anxiety disorders affect more than one in five pregnant individuals. Despite the large percentage of individuals impacted by mood disorders, they continue to remain underdiagnosed and undertreated. Recent interventions such as risk prediction modelling offer opportunities to predict patients at risk prior to symptom onset. Leveraging technology platforms such as electronic health records allow for timely diagnosis and intervention. To date, there are no established clinical decision support (CDS) tools. We hypothesise that subjects who use a CDS aid will find them acceptable, appropriate and feasible. METHODS AND ANALYSIS: We will conduct a pilot randomised clinical trial at three Weill Cornell Medicine clinics with randomisation at the clinician level. Patients in the control arm will receive usual care, while those in the intervention arm will receive CDS. The primary implementation outcomes are the acceptability, appropriateness and feasibility. The effectiveness outcomes are mental health service utilisation, EuroQol 5 Dimensions questionnaire (EQ-5D), Edinburgh Postnatal Depression Scale and social support measured by the perceived support scale. We hypothesise that stakeholders will find the CDS acceptable, and the intervention arm will have lower mental health service needs compared with control. ETHICS AND DISSEMINATION: This study has been approved by the Weill Cornell Medicine Internal Review Board. IRB Protocol# 23-07026254. TRIAL REGISTRATION NUMBER: NCT06818734.
20 May 2026
Read appraisal →The Journal of clinical endocrinology and metabolism
Associations of Metabolic Phenotypes with Cardiac Structure and Clinical Outcomes: Insights from the UK Biobank
CONTEXT: Metabolic syndrome and obesity represent major cardiovascular risk factors, yet their combined effects on cardiac structure and clinical outcomes remain incompletely understood. OBJECTIVE: To examine associations between metabolic phenotypes, cardiac magnetic resonance imaging (CMR), and clinical outcomes. DESIGN: Prospective study with a median 5.1-year follow-up. SETTING: Population-based cohort from the UK Biobank. PARTICIPANTS: A total of 22 789 participants (mean age 64.1 ± 7.5 years, 52.6% female) were categorized as metabolically healthy nonobese (MHN) vs obese (MHO) or unhealthy nonobese (MUN) vs obese (MUO), based on obesity (body mass index ≥30 kg/m²) and metabolic status (prevalent diabetes or both hypertension and hyperlipidemia). MAIN OUTCOME MEASURE(S): Primary and secondary endpoints were major adverse cardiovascular events (MACE) and all-cause mortality, respectively. CMR included left ventricular ejection fraction (LVEF, %), end-diastolic volume (LVEDV, mL), myocardial mass (g), wall thickness (mm), cardiac output (L/min), and left atrial volume (mL). Linear regression and Cox proportional hazards models, adjusted for age, sex, and smoking, assessed associations between metabolic phenotypes, CMR, and clinical outcomes. RESULTS: In adjusted models, all phenotypes demonstrated increased WT (MHO: β=.53 [.50, .55]; MUN: β=.24 [.21, .27]; MUO: β=.66 [.61, .70]), compared to MHN. LVEDV was increased in obesity phenotypes (MHO: β=4.67 [4.07, 5.27]; MUO: β=5.14 [4.05, 6.22]) and decreased in MUN (β=-1.25 [-1.95, -.55]), while MUO showed reduced LVEF (β=-.48 [-.91, -.04]). MACE risk was increased in unhealthy phenotypes (MUN: adjusted hazard ratio (aHR) = 1.55 [1.16-2.07]; MUO: aHR = 1.95 [1.28-2.97]). All phenotypes showed increased all-cause mortality risk (MHO: aHR = 1.65 [1.23-2.21]; MUN: aHR = 1.41 [1.05-1.90]; MUO: 2.10 [1.41-3.15]). CONCLUSION: Metabolic phenotypes show distinct cardiac structural changes and increased mortality risk, supporting their potential in cardiovascular risk stratification.
19 May 2026
Read appraisal →The Journal of clinical endocrinology and metabolism
Mortality risk and causes of death in exogenous Cushing's syndrome: a systematic review and meta-analysis
CONTEXT: Chronic oral glucocorticoids (GCs) are widely prescribed for multiple diseases. Although long-term GC exposure causes systemic toxicity, the magnitude, dose-response relationship, and causes of GC-associated mortality remain incompletely defined. OBJECTIVE: To quantify overall and cause-specific mortality associated with chronic oral GC exposure and evaluate dose-response relationships across underlying disease groups. METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines (PROSPERO CRD42017067530). PubMed/MEDLINE, EMBASE, Cochrane Library, Web of Science, and CINAHL were searched from 1945 to March 2019. Eligible studies reported standardized mortality ratios (SMRs) or absolute deaths among adults receiving chronic oral GCs. Random-effects meta-analysis and mixed-effects meta-regression were used to synthesize mortality and dose-response associations across GC exposure metrics, exposure duration, and disease subgroups. RESULTS: One-hundred and sixteen studies encompassing 128 cohorts and 51 380 patients were included. Chronic GC exposure was associated with excess mortality (pooled SMR 1.87; 95%CI 1.32-2.61; I2 74.0%). The pooled proportion of death was 12.0% (95%CI 10-14%). Mortality risk was highest in inflammatory diseases (30.0%) and the vasculitides (18.0%). Higher cumulative dose (≥5 g prednisolone-equivalent), average daily dose >5 mg/day, and higher initial dose were each independently associated with increased mortality. Cardiovascular disease was the leading causes of death (25.6%), followed by malignancy (15.7%) and infection (13.4%). CONCLUSION: Chronic oral GC exposure was associated with increased mortality across disease groups, with higher cumulative and early-treatment doses correlating with higher risk. However, causal attribution remains uncertain due to confounding by indication, limited disease-severity data, and exposure misclassification. These findings support GC stewardship and targeted cardiovascular and infection risk mitigation, rather than indiscriminate dose reduction.
19 May 2026
Read appraisal →The Journal of clinical endocrinology and metabolism
Lifestyle intervention before and during fertility treatment in women with obesity or with overweight and PCOS-a RCT
CONTEXT: Lifestyle interventions are recommended for women with obesity and infertility, but trial evidence is scarce, and studies have not investigated interventions that continue during fertility treatment. OBJECTIVE: Evaluate effectiveness of a lifestyle intervention compared with usual care on fertility outcomes in women with obesity and infertility. DESIGN: The Obesity-Fertility randomized controlled trial (RCT), at an academic fertility clinic, included 127 women aged 18 to 40 years with infertility and obesity (body mass index ≥30 kg/m2, or ≥27 kg/m2 with polycystic ovary syndrome [PCOS]), excluding those unlikely to conceive naturally. The intervention group (IG) received a 6-month lifestyle intervention alone (individual follow-up with a dietician and kinesiologist, and group sessions) before adding fertility treatments. The control group (CG) received usual fertility care directly. Rate of live birth conceived within 18 months of randomization was analyzed. RESULTS: Compared to CG, the IG lost more weight (-3.21% ± 4.73% vs -0.40% ± 3.66%, P = .003) and waist circumference (-2.62 ± 4.46 cm vs -0.23 ± 3.81 cm, P = .01) at 6 months. The live-birth rate was 44.4% in the IG (n = 63) vs 35.9% in the CG (n = 64) (risk ratio [RR] = 1.24 [95% CI 0.81-1.90]). In IG vs CG, clinical pregnancy rates were 52.4% vs 37.5% (RR = 1.40 [0.94-2.07]) and natural pregnancy rates were 27.0% vs 12.5% (RR = 2.16 [1.01-4.64]). CONCLUSION: Compared with usual care, a lifestyle intervention alone for 6 months and then combined with fertility treatments did not increase the 18-month rate of pregnancies leading to a live birth, but significantly increased natural pregnancy rates, potentially reducing the need for costly assisted reproduction in this population.
19 May 2026
Read appraisal →JMIR mHealth and uHealth
Multimodal Personalized Mobile Health Just-in-Time Adaptive Intervention for Occupational Stress Management: Pilot Study
BACKGROUND: As digital health solutions gain traction, there is an urgent need for effective, person-centered stress management tools for employees. Advances in wearable stress monitoring and machine learning now enable the collection of high-resolution, real-time data and the delivery of personalized interventions with respect to both timing and content. Despite this technological progress, there remains a notable paucity of mobile health (mHealth) interventions that capitalize on these capabilities to implement just-in-time adaptive interventions (JITAIs). OBJECTIVE: This pilot study aimed to examine the preliminary effects of the RELAX mHealth app, which uses a JITAI framework to reduce occupational stress, with a particular focus on initial indications of stress reduction, the influence of the app's degree of personalization on these effects, and overall user experience. METHODS: A 2-arm randomized trial was conducted with 46 employees across two phases of 3 weeks each. Participants used the RELAX mHealth app, which adapts intervention timing based on real-time stress data and tailors content according to users' preferences. Stress was assessed via multiple heart rate variability (HRV) parameters measured with wearable sensors, alongside subjective questionnaires and ecological momentary assessment (EMA) questionnaires. Usability and user satisfaction were also evaluated. In the second phase, a group randomization was implemented, with two groups of different degrees of in-app personalization. RESULTS: The findings were mixed. While selected subjective stress indicators decreased from baseline to the end of the study, one physiological measure increased. Retrospective chronic stress (P=.048) and arousal related to the most recent stress event prior to EMA entry (P=.02) were reduced; however, the low frequency (LF)-to-high frequency (HF) ratio of HRV increased (P=.03). Other stress variables, such as work-related stress, valence of daily experiences, and momentary arousal, showed no change over the course of the study. No between-group differences were observed with respect to the assigned degree of personalization. Additionally, usability increased (P<.001), whereas satisfaction decreased at a trend level (P=.05). CONCLUSIONS: Although the results provide selective preliminary indications of stress reduction with app use, the variability of outcomes raises concerns about its current practical utility. The effects are also discussed with regard to the specific design of the prototype and the study setup. Technical issues and user discomfort were noted despite increasing usability over the study period, indicating areas for improvement in the developed prototype. Given the absence of a control group and the use of interventional arms only, no definitive conclusions about effects can be drawn. Nevertheless, this study highlights both the potential and the challenges of a personalized mHealth approach to occupational stress management. Further refinement of the app and more comprehensive evaluations are needed to fully understand the impact and functional usability of this JITAI-based approach in real-world settings.
19 May 2026
Read appraisal →PloS one
Facilitating the measurement and treatment of Behavioral and Psychological Symptoms of Dementia (BPSD) and understanding caregiver burden using wearable devices in Rural Taiwan-Protocol for a dyadic feasibility pilot study
INTRODUCTION: Alzheimer's disease (AD) prevalence rises with societal ageing. In clinical care, behavioral and psychological symptoms of dementia (BPSD)-including depression, agitation/aggression, apathy, and sleep disturbance-worsen patients' quality of life and substantially increase caregiver burden, more significantly than the cognitive symptoms. Standard BPSD assessments rely on caregiver-rated questionnaires that are cross-sectional and may be biased when caregivers are themselves older adults. Device-based measures (e.g., research-grade wrist actigraphy) can provide objective longitudinal data and novel features. In parallel, therapeutic wearables may improve sleep and mood in adults, and might improve BPSD if accepted by people living with dementia. METHODS: This dyadic pilot study will recruit 20 participants (n = 10 AD patients; n = 10 caregivers) from outpatient services and affiliated day-care/dementia hubs in rural Taiwan. Participants will wear Geneactiv continuously for 8 weeks and Re-Timer ≥30 min/day for 4 weeks. Device-based data will be processed with GGIR, a well validated R-package designed for processing accelerometer data. Questionnaire assessments include Pittsburgh Sleep Quality Index (PSQI), Neuropsychiatry Inventory Questionnaire (NPI-Q), Caregiver Burden Inventory (CBI), and a semi-structured interview based on the Taiwanese version of Quebec User Evaluation of Satisfaction with Assistive Technology (T-QUEST) at prespecified timepoints. DISCUSSION: Wearable devices may facilitate the measurement and treatment of specific BPSD, as well as reduce caregiver burden. If proven feasible even in rural Taiwan where both digital and health literacy and resources are limited, this model will inform how device-based dementia care model can be considered and applied in the context of global ageing.
19 May 2026
Read appraisal →Physiological measurement
EdgeECG: a lightweight edge-oriented network with dual criterion pruning for real-time ECG arrhythmia classification
Objective.Miniature electrocardiogram (ECG) devices can rapidly and accurately acquire real-time cardiac signals, enabling timely warnings for patients with heart disease. To achieve accurate arrhythmia classification on resource-constrained ECG edge devices, we propose EdgeECG, an ultra-lightweight neural network designed for deployment on low-power microcontrollers.Approach.EdgeECG is first designed with a compact convolutional architecture to ensure compatibility with resource-limited embedded platforms. A dual criterion pruning (DCP) strategy is then introduced to evaluate weight importance using both magnitude and median deviation for more precise model compression. In addition, quantization is applied to reduce storage cost and improve deployment efficiency on an STM32F103 microcontroller.Main results.Experimental results on the benchmark MIT-BIH arrhythmia dataset show that EdgeECG achieves an overall classification accuracy of 98.07%, outperforming several representative methods. In patient-independent record-level evaluation, the accuracy reaches 80.73%. The model contains only 2680 parameters and is successfully deployed on an STM32F103 microcontroller with 64 KB SRAM, achieving an inference latency of 0.025 s and an energy consumption of 0.156 mJ per inference. In addition, DCP reduces the number of non-zero parameters by nearly 50% while maintaining promising classification performance.Significance.EdgeECG provides an effective solution for five-class ECG arrhythmia classification on severely resource-constrained edge devices. Its compact architecture, effective pruning strategy, and successful deployment on an STM32F103 demonstrate its potential for low-power edge-based ECG analysis and wearable cardiac monitoring applications. The source code of EdgeECG is publicly available at:https://github.com/jyanhuang/EdgeECG-code.
19 May 2026
Read appraisal →Aesthetic surgery journal
Therapeutic Efficacy and Safety of Recombinant Botulinum Toxin Type A for Moderate to Severe Glabellar Lines: A Randomized, Controlled, Double-blind, Phase III Trial in Chinese Adults
BACKGROUND: Conventional botulinum toxin type A (BoNT/A) products include non-therapeutic accessory proteins vary in composition and manufacturing processes, which may contribute to differences in purity and biochemical characteristics. YY001 (Retoxin®) is a novel recombinant BoNT/A manufactured via E. coli expression to reduce impurities, improve purity, and minimize immunogenic risk. OBJECTIVES: To evaluate the efficacy, safety, and immunogenicity of YY001, a recombinant botulinum toxin type A (Chongqing Claruvis Pharmaceutical Co., Ltd., Chongqing, China), in the treatment of moderate-to-severe glabellar lines. METHODS: In this multicenter, randomized, double-blind, vehicle- and active-controlled Phase III trial, 529 adults aged 18-65 with moderate to severe glabellar lines were randomized 4:2:1 to receive a single 20 U injection of YY001, Botox®(Allergan Pharmaceuticals Ireland, Westport, Ireland), or vehicle. The primary endpoint was composite response rate (CRR) at Week 4, defined as a ≥2-grade improvement of glabellar line severity assessed by both investigator and participant. Secondary endpoints included onset time, duration, satisfaction, and safety. RESULTS: YY001 achieved a CRR of 86.7% at Week 4, significantly outperforming Botox® (66.7%, P < .0001) and vehicle (1.3%, P < .0001). It showed faster onset, longer median duration (97 days), and high participant satisfaction. Adverse events were mild and comparable across groups. Only one case of anti-drug antibody was observed; no neutralizing antibodies were detected. A 12-week follow-up and ethnically homogenous population may limit generalizability. CONCLUSIONS: YY001 demonstrated strong efficacy and a favorable safety profile than Botox®. Longer-term and multicenter studies are needed to assess durability, immunogenicity, and applicability across broader populations. LEVEL OF EVIDENCE: 1 (THERAPEUTIC): For image description, please refer to the figure legend and surrounding text.
19 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Effectiveness of survivorship programmes to enhance health-related quality of life of colorectal cancer survivors: a systematic review and meta-analysis of randomised controlled trials
PURPOSE: This study aimed to assess the effectiveness of the survivorship programmes by synthesising and analysing the available evidence to enhance health-related quality of life (HRQoL) amongst colorectal cancer (CRC) survivors. METHODS: Ten English-language databases were searched from inception to June 2025 in this systematic review and meta-analysis. All randomised controlled trials (RCTs) were included. Available data were pooled in a meta-analysis using RevMan (version 5.4.0). Two independent reviewers performed the database searches, extracted the data, assessed the methodological quality by using the Cochrane Risk-of-Bias tool (version 2) and evaluated the overall quality of findings by using Cochrane GRADE. RESULTS: A total of 22 RCTs involving 2949 CRC survivors were identified. The meta-analysis results (thirteen studies) indicated a significant improvement in the physical (standardised mean difference [SMD] = 0.52, 95% confidence interval [CI, 0.18, 0.86], P = 0.002, I2 = 88%) and mental domains of HRQoL (SMD = 0.4, 95% CI [0.06, 0.74], P = 0.02, I2 = 86%). Sensitivity analysis involved reducing the heterogeneity after removing one study. No publication bias was found. The overall quality of findings was from 'low' to 'moderate'. CONCLUSIONS: The detailed components of the survivorship programme can enhance HRQoL in physical and mental domains, indicating its potential as valuable evidence for health providers to support CRC survivors post-treatment. Future research should focus on expanding the delivery of such programme comprehensively by integrating mobile health into a nurse-led approach to optimise geographic diversity and improve social HRQoL.
19 May 2026
Read appraisal →Human vaccines & immunotherapeutics
Coverage and determinants of childhood immunization in Somalia: A systematic review and meta-analysis
Childhood immunization is a cost-effective public health intervention, yet coverage remains suboptimal in Somalia. This systematic review and meta-analysis aimed to pool childhood immunization coverage and its determinants in Somalia. The electronic database search strategy yielded 11 eligible cross-sectional studies conducted between 2010 and 2025. Using Comprehensive Meta-Analysis Version 5 (Biostat, Englewood, NJ, USA), the pooled coverage for receiving at least one vaccine was 57.9%, while completion of the four basic vaccines was 16.1%, Full immunization coverage was 42.2%. Children born in health facilities were more likely to be immunized than home births (AOR = 2.10; 95% CI: 1.87-2.35). Unexpectedly, mothers with ≥4 ANC visits had lower odds of child immunization (AOR = 0.27; 95% CI: 0.24-0.30). Maternal education increased immunization likelihood (AOR = 1.14; 95% CI: 1.09-1.20). Children in rural areas were likely to be immunized than urban counterparts (AOR = 1.55; 95% CI: 1.49-1.61). These findings highlight the urgent need to strengthen integrated maternal and child health services.
19 May 2026
Read appraisal →Drug discoveries & therapeutics
Trends in the prescription of constipation medications in Japan (fiscal years 2019-2023): A nationwide baseline study prior to the 2023 clinical guidelines.
Constipation is a common gastrointestinal disorder that markedly affects health and quality of life. In Japan, magnesium-based and contact laxatives have long been widely prescribed. Since the launch of lubiprostone in November 2012, several new agents with novel mechanisms have been introduced, and their use has increased. However, to our knowledge, no nationwide study has examined their use. This study aimed to analyze nationwide trends and regional differences in the prescription of medications for constipation. We used data from the Japanese National Health Insurance Claims and Specific Health Checkup Database Open Data from fiscal years (FYs) 2019 to 2023, covering the period when all currently available constipation medications were on the market in Japan, and prior to the inclusion of the drug selection flowchart in the Evidence-Based Clinical Guidelines for Chronic Constipation 2023. Prescription trends were evaluated using defined daily doses per 1,000 inhabitants per day (DID), and regional variations were assessed using standardized claim ratios (SCRs). The DID for contact laxatives decreased during the study period, whereas the DID for other constipation medications increased. Magnesium oxide showed the smallest regional variation, whereas polyethylene glycol and linaclotide showed the largest variations in FY 2019 and FY 2023, respectively. Throughout the 5-year period, the highest SCRs for contact laxatives were observed in Akita, Iwate, and Aomori prefectures. Our findings provide a comprehensive nationwide picture of evolving constipation treatment patterns and regional variations in Japan, establishing baseline data for evaluating the impact of guideline dissemination and evidence accumulation on clinical practice.
18 May 2026
Read appraisal →Drug discoveries & therapeutics
Efficacy and safety of filgotinib versus tocilizumab in active rheumatoid arthritis: A randomized, open-label, multicenter study with clinical and musculoskeletal ultrasound evaluation (TRANSFORM study)
Janus kinase (JAK) and interleukin-6 (IL-6) inhibitors are therapeutic options for patients with rheumatoid arthritis (RA) with inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs); however, no randomized controlled trial has compared their efficacy and safety. Since both act through the JAK-signal transducer and activator of transcription pathway, a comparative evaluation is warranted. We conducted a prospective, randomized, open-label trial at 55 centers in Japan, randomizing patients with active RA despite csDMARD therapy in a 1:1 ratio to receive 200 mg/day filgotinib or subcutaneous tocilizumab as monotherapy; the primary endpoint was American College of Rheumatology (ACR) 50 at week 12, and secondary endpoints included clinical disease activity indices, musculoskeletal ultrasonography scores, patient-reported outcomes, and serum biomarkers through 52 weeks. Twenty-six patients were enrolled (13 per group) before study termination due to insufficient recruitment, and descriptive analyses were performed. At week 12, ACR50 was achieved in 38.5% (5/13) patients in the filgotinib group and 46.2% (6/13) in the tocilizumab group (risk difference: -7.69%; 95% confidence interval: -42.26 to 28.8). Both groups showed early and sustained improvements in disease activity from week 2. The improvement in patient global assessment scores was greater with filgotinib at week 2 but the difference diminished thereafter, and serum IL-6 level decreased with filgotinib but increased with tocilizumab. Four serious adverse events occurred with filgotinib, including infections and cardiac events. Because this study was underpowered and the analysis was descriptive, larger studies are needed to confirm these findings and define optimal use. (The study was registered in the Japan Registry of Clinical Trials (https://jrct.niph.go.jp) as jRCTs071200107 and in ClinicalTrials.gov as NCT05090410.).
18 May 2026
Read appraisal →Scientific reports
RDE-DR: robust deep ensemble CNNs for automated diabetic retinopathy detection from fundus images
Diabetic retinopathy (DR) is a leading cause of preventable blindness, motivating the development of reliable automated screening systems. This work proposes a Robust Deep Ensemble for Diabetic Retinopathy detection (RDE-DR) by analyzing ensemble fusion strategies. Four pre-trained convolutional neural networks (ResNet50, VGG16, VGG19, and DenseNet121) are trained using CLAHE-enhanced APTOS 2019 fundus images and integrated through seven heterogeneous fusion mechanisms, including voting-based, rank-based, and fuzzy-integral-inspired strategies. A consistent evaluation protocol is adopted, incorporating threshold optimization and probabilistic calibration analysis to validate robustness, decision margins, and accuracy-precision trade-offs. Experimental results show that multiple fusion techniques achieve comparable high performance and stable behavior on the APTOS 2019 benchmark, with the best configuration reaching 98.64% accuracy, 98.40% precision, 98.92% recall, 98.66% F1-score, and 99.78% Area-Under-Curve (AUC). Beyond peak accuracy, the study provides insights into ensemble reliability, calibration characteristics, and practical design choices for medical image classification systems. These results show that integrating transfer learning with CLAHE preprocessing and ensemble fusion yields stable experimental performance on the APTOS 2019 benchmark, suggesting potential for future medical decision support.
18 May 2026
Read appraisal →Journal of pharmacokinetics and pharmacodynamics
Development of a novel rabeprazole modified release formulation to reduce the dosing frequency: A trial and triumph with physiologically based biopharmaceutics modeling.
Advanced in silico tools, such as physiologically based biopharmaceutics models (PBBM) and physiologically based pharmacokinetic models (PBPK), play a pivotal role in model-informed formulation development (MIFD). In the present study, these methodologies were utilized in the development of a novel rabeprazole modified-release (MR) formulation for improved patient compliance by reducing the dosing frequency relative to existing delayed-release (DR) formulation. A MR formulation containing combination of delayed release and pulsatile release components was designed based on the hypothetical dissolution targets. A PBBM was first established using literature-derived clinical data and used to simulate the performance of formulations with varied dissolution profiles. Initial MR formulation prototypes (once a day) were evaluated in pilot-1 bioequivalence (BE) study against reference formulation (twice a day) but results indicated infra bioequivalence outcome. After pilot-1 study, the formulation and the dissolution method were optimized and then model was refined to predict the pilot 1 outcomes. The validated model was then employed to select suitable pilot-2 prototypes and to prospectively predict their BE outcomes under fasted and fed conditions. The predicted BE ratios were in good agreement with the observed pilot-2 study results. Therefore, the same model was used to make prospective predictions with increased subjects to understand the in vivo performance of pivotal test formulation and lead to the successful bioequivalence outcome, product commercialization, ultimately aiding in increased patient compliance. This work highlights the value of a model-informed strategy in accelerating formulation optimization, reducing development timelines and costs, and strengthening decision-making within pharmaceutical development programs.
18 May 2026
Read appraisal →European journal of preventive cardiology
Targeting better hypertension control with the usage of the ESH smartphone application
AIMS: Uncontrolled blood pressure is a main issue in the management of hypertensive patients, while mobile health (mHealth) offers a new perspective. This study aimed to investigate the efficacy of an mHealth app-based intervention, the European Society of Hypertension (ESH) CARE, in the management of uncontrolled hypertensive patients. METHODS AND RESULTS: This was a two-arm randomized, controlled trial conducted among 107 hypertensive patients, with uncontrolled office (≥140/90 mmHg) and 24-h ambulatory blood pressure (≥130/80 mmHg). After antihypertensive drug treatment initiation or intensification, patients were 1:1 randomized to application assisted strategy (AAS) group or usual care group, with scheduled visits at 1 and 3 months. In ASS group there was a virtual visit, while in usual care group there was an office visit. At 6 months, there was a final visit assessment with office and ambulatory blood pressure (BP) measurement. The mean age of the total population (n = 107) was 52.9 ± 9.6 years, 50.5% were women, without any significant differences in the baseline characteristics. At 6 months, 50% in the usual care group and 78.2% in the AAS group (P = 0.002) achieved both systolic and diastolic ambulatory BP targets (<130/80 mmHg). Regarding office BP, there was a reduction of 19.9 ± 9.1/12.4 ± 7.7 mmHg in the usual care group and 25.1 ± 6.4/16.3 ± 6.3 mmHg in the AAS group, while regarding ambulatory BP, there was a reduction of 6.6 ± 9.2/3.3 ± 6.2 mmHg and 10.9 ± 9.1/6.4 ± 5.5 mmHg, respectively. CONCLUSION: Follow-up of hypertensive patients with the ESH Care App is feasible and contributes to a significantly better office and out-of-office BP control after 6 months. Uncontrolled blood pressure is a main issue in the management of hypertensive patients, while mobile health (mHealth) offers a new perspective. This study aimed to compare the efficacy of an mHealth app-based—ESH Care App—intervention to usual clinical care, in the management of uncontrolled hypertensive patients. Telemonitoring with the ESH Care App is associated with: Significantly improvement in office and ambulatory blood pressure control. Significantly greater reduction in office and ambulatory BP measurements.
18 May 2026
Read appraisal →African journal of reproductive health
Effect of a herbal galactagogic formula combined with auricular acupressure on breast milk production and hormonal profiles in women with postpartum hypogalactia: A randomized controlled study
Postpartum hypogalactia is a common condition that may impair breastfeeding and maternal-infant health. This randomized controlled study evaluated the efficacy of a herbal galactagogic decoction combined with auricular acupressure in improving lactation outcomes. A total of 104 women with postpartum hypogalactia were enrolled between July 2023 and June 2025 and randomly assigned to a control group (auricular acupressure alone, n=52) or an intervention group (auricular acupressure plus herbal decoction, n=52) for 2 weeks. Primary outcomes included breast milk production and formula supplementation, while secondary outcomes comprised serum hormone levels (estradiol, progesterone, and prolactin), symptom scores, psychological status, and clinical effectiveness. Both groups showed significant post-treatment improvements (P<0.05). Compared with the control group, the intervention group demonstrated lower estradiol and progesterone levels, higher prolactin levels, increased milk production, and reduced formula supplementation (P<0.05). Symptom scores and anxiety/depression levels were also significantly improved. The overall effective rate was higher in the intervention group (96.15% vs 80.77%, P<0.05), with comparable safety profiles. This combined therapy appears to be a safe and effective complementary approach for improving lactation in women with postpartum hypogalactia. L’hypogalactie post-partum est une affection fréquente pouvant compromettre l’allaitement et la santé maternelle et infantile. Cette étude randomisée contrôlée a évalué l’efficacité d’une décoction galactagogue à base de plantes associée à l’acupression auriculaire pour améliorer les résultats de lactation. Au total, 104 femmes atteintes d’hypogalactie post-partum ont été recrutées entre juillet 2023 et juin 2025 et réparties aléatoirement en un groupe témoin (acupression auriculaire seule, n=52) et un groupe intervention (acupression auriculaire associée à une décoction à base de plantes, n=52) pendant 2 semaines. Les critères de jugement principaux comprenaient la production de lait maternel et le volume de supplémentation en lait artificiel, tandis que les critères secondaires incluaient les niveaux hormonaux sériques (estradiol, progestérone et prolactine), les scores symptomatiques, l’état psychologique et l’efficacité clinique. Les deux groupes ont montré des améliorations significatives après le traitement (P<0,05). Comparé au groupe témoin, le groupe intervention présentait des niveaux plus faibles d’estradiol et de progestérone, des niveaux plus élevés de prolactine, une production de lait accrue et une réduction de la supplémentation (P<0,05). Les scores symptomatiques ainsi que les niveaux d’anxiété et de dépression ont également été significativement améliorés. Le taux global d’efficacité était plus élevé dans le groupe intervention (96,15 % vs 80,77 %, P<0,05), sans différence significative en termes d’effets indésirables. Cette thérapie combinée pourrait constituer une approche complémentaire sûre et efficace pour améliorer la lactation chez les femmes présentant une hypogalactie post-partum.
18 May 2026
Read appraisal →European journal of preventive cardiology
Effect of intensive blood pressure control in patients with resistant hypertension: insights from the STEP trial
AIMS: Resistant hypertension is defined as uncontrolled blood pressure (BP) despite the use of ≥3 antihypertensive drugs or controlled BP with ≥4 antihypertensive drugs. Whether intensive BP control is beneficial for the management of resistant hypertension is unknown. METHODS AND RESULTS: Intensive (<130 mmHg) BP control in patients is compared with standard (130-150 mmHg) BP control in patients with resistant hypertension, using the Strategy of Blood Pressure Intervention in Older Hypertensive Patients (STEP) trial data. Patients were divided into those with and without resistant hypertension. The primary outcome was a composite of cardiovascular events. Hazard ratios (HRs) were calculated using the Fine-Gray sub-distribution hazard model for primary and secondary events and the Cox regression model for all-cause death. In patients with resistant hypertension, intensive BP control was associated with a lower risk of primary outcomes (HR, 0.36; 95% CI, 0.14-0.93; P = 0.035). Results were consistent across different BP thresholds used to define resistant hypertension and in patients with true resistant hypertension. The benefit of intensive BP control was consistent across resistant hypertension status. Intensive BP control was not associated with an increased risk of adverse events in patients with resistant hypertension. Patients with resistant hypertension had increased cardiovascular risk compared with those without (HR, 1.78; 95% CI, 1.13-2.81; P = 0.012). CONCLUSION: Intensive BP control is associated with reduced risk of cardiovascular events in patients with resistant hypertension without increased risk of adverse events. REGISTRATION: https://www.clinicaltrials.gov/ct2/show/NCT03015311. The present study is a secondary analysis of the effect of intensive blood pressure control in patients with resistant hypertension in the STEP trial. Resistant hypertension is characterized as elevated blood pressure (BP) despite three antihypertensive agents or controlled BP with four or more agents. Intensive BP control in patients with resistant hypertension may reduce the risk of cardiovascular events. Further research is needed to investigate multifaceted treatment approaches, including both pharmacological and non-pharmacological interventions.Intensive blood pressure (BP) control is associated with a reduced risk of cardiovascular events and death in patients with resistant hypertension, compared with standard BP control, without increasing the risk of adverse events.Patients with resistant hypertension remain at higher risk of cardiovascular events compared with patients without resistant hypertension. Intensive BP control in this population may lower the risk of cardiovascular events.
18 May 2026
Read appraisal →The American journal of cardiology
CagriSema Versus Semaglutide Monotherapy or Placebo for Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with GRADE Assessment
The obesity epidemic is a major health burden that enhances susceptibility to a broad spectrum of metabolic-associated comorbidities, ranging from fatty liver disease and endocrine dysfunction to traditional risks like type 2 diabetes mellitus and cardiovascular disease. Glucagon-like peptide-1 receptor agonists, including semaglutide, facilitate weight loss alongside glucose metabolism. The dual therapy CagriSema, which combines semaglutide with cagrilintide was developed. We systematically searched MEDLINE (via PubMed), Web of Science, Scopus, and Cochrane Library, from inception to July 2025, for randomized controlled trials (RCTs) comparing CagriSema with semaglutide monotherapy or placebo in patients with obesity. Four RCTs (n = 4,419) were included (CagriSema: 3,055; control: 1,364). Pooled analysis showed that CagriSema significantly reduced percent weight loss (Cohen's d: -1.38; 95% CI: -1.84 to -0.91; I² = 94.8%). CagriSema also resulted in greater absolute weight loss (MD: -11 kg), waist circumference (MD: -9.41 cm), and systolic blood pressure (MD: -7.06 mmHg). Gastrointestinal adverse events were more frequent (RR: 1.32). CagriSema therapy was associated with superior weight reduction compared with semaglutide or placebo. In conclusion, CagriSema achieves greater weight loss than semaglutide or placebo but increases gastrointestinal adverse events, warranting careful tolerability monitoring and longer-term data.
18 May 2026
Read appraisal →Gut and liver
Global Prevalence of Functional Abdominal Pain Disorder among Children and Adolescents According to the Rome III and IV Criteria: A Systematic Review and Meta-Analysis
BACKGROUND/AIMS: Despite the global burden of functional abdominal pain disorder (FAPD) and its four subtypes (irritable bowel syndrome [IBS], functional dyspepsia [FD], abdominal migraine [AM], and functional abdominal pain not otherwise specified [FAP-NOS]), studies involving an estimation of FAPD prevalence based on the Rome III or IV criteria are limited. Therefore, we aimed to estimate the prevalence of FAPD and its four subtypes. METHODS: A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Google Scholar, and the Cochrane Library. Studies that were performed with the general population and applied Rome III or IV diagnostic criteria were included. Data were extracted to estimate the prevalence of FAPD using a random-effects model with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic. The study protocol was preregistered with PROSPERO (CRD420251004116). RESULTS: The overall prevalence of FAPD was 10.89% (95% CI, 9.51% to 12.48%), with pooled prevalence rates of 11.84% (10.29% to 13.61%) with the Rome III criteria and 8.42% (6.10% to 11.62%) with the Rome IV criteria. With the Rome III criteria, IBS had the highest prevalence, while FD had the lowest. In contrast, with the Rome IV criteria, the prevalence of IBS, AM, and FAP-NOS decreased, whereas FD became the most prevalent, affecting approximately one in 23 individuals, compared to one in 51 individuals affected by IBS, one in 68 individuals affected by AM, and one in 115 individuals affected by FAP-NOS. Additionally, females exhibited higher prevalence rates of FAPD and all its subtypes than males. CONCLUSIONS: The diagnostic criteria of Rome IV are stricter than those of Rome III, which likely affects the estimated prevalence of FAPD and its subtypes.
18 May 2026
Read appraisal →Environmental research
Association between air pollution and chronic cough: Evidence from a systematic review and meta-analysis of observational studies
BACKGROUND: Chronic cough is a common and debilitating respiratory symptom, yet its association with air pollution remains insufficiently understood. METHODS: We conducted a systematic review and meta-analysis of observational studies evaluating the association between air pollution and chronic cough. Searches of Medline, Embase, Scopus, and GeoBase were completed up to February 14, 2025. Studies were eligible if they reported quantitative associations between air pollution and exposures and chronic cough outcomes. Two reviewers independently screened studies, assessed quality, and extracted data. Random-effects models were used to estimate pooled odds ratios (ORs) with 95% confidence intervals. RESULTS: Of 1250 articles screened, 53 studies were reviewed, and eight were included in meta-analysis. Pooled ORs per 10 μg/m3 increase in exposure were 1.10 (95% CI: 0.99-1.22) for PM2.5 and 1.04 (95% CI: 1.02-1.06) for NO2. Heterogeneity was low to moderate (I2: 18.9% for PM2.5; I2: 0.0% for NO2), and there was no evidence of publication bias (Egger's test p = 0.98 and 0.47, respectively). Stratified analyses revealed stronger associations in adults and males. Evidence on progression from chronic cough to more severe respiratory conditions was limited, highlighting a critical gap for evidence-informed clinical follow-up and public guidance to prevent progression. CONCLUSION: Our findings highlight that chronic cough is an overlooked consequence of air pollution exposure and emphasize the need for health care professionals to consider environmental factors when managing persistent cough. Strengthening air quality control and early detection strategies could help reduce the respiratory disease burden.
18 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Effects of yoga on depressive symptoms in breast cancer patients: a meta-analysis of randomized controlled trials
BACKGROUND: While yoga is known to benefit depression in breast cancer patients, its efficacy as an adjunct to diverse treatment regimens remains unclear. This study evaluated yoga's efficacy in alleviating depression during varied breast cancer therapies and supports its clinical integration as a complementary intervention. METHODS: Following PRISMA 2020 guidelines, we systematically searched for RCTs in English and Chinese. Literature quality was assessed using the Cochrane Risk of Bias tool. Data were analyzed with Review Manager 5.4.1, including subgroup analyses by treatment type and assessment scale. RESULTS: Analysis of 21 studies showed yoga significantly reduced depression levels [SMD = -0.58, 95% CI (-0.83, -0.32), P < 0.00001]. Subgroup analyses revealed a significant combined mean difference among the surgery group [SMD: -1.04], the postoperative radiotherapy group [SMD: -2.47], and the postoperative chemotherapy group [SMD: -0.46]. The group receiving postoperative radiotherapy demonstrated a significantly greater improvement in depression. Subgroup analyses of scale-assessed effects confirmed the validity of the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression Scale (CESD), the Hospital Anxiety and Depression Scale (HADS), and the Zung Self-Rating Depression Scale (SDS). The HADS demonstrated a greater effect size [SMD = -1.19, 95% CI (-2.13, -0.24), P = 0.01]. CONCLUSIONS: The impact varied among those undergoing different treatment regimens. Notably, the degree of improvement in depression appeared to be greater in the postoperative radiotherapy group. HADS is a practical self-assessment scale that has demonstrated considerable improvement and is recommended for use in breast cancer patients with depression.
18 May 2026
Read appraisal →Journal of global health
Unveiling the gap in heart failure: a Brazilian Unified Health System study.
BACKGROUND: Heart failure (HF) decompensation is the leading cause of hospitalisations in developed countries and the third most common cause in Brazil. Underdiagnosis or misdiagnosis thereof remains a critical challenge and with significant implications. At the patient level, it delays appropriate treatment and disease management. At the health system level, it leads to inefficient population health strategies, distorted epidemiological estimates, and suboptimal resource allocation. Addressing this hidden HF population is therefore essential for improving disease surveillance, optimising care pathways, and supporting more effective and equitable health system planning in Brazil. In this sense, we aimed to quantify underreporting of HF in individuals in Brazil and to estimate their mortality trends. METHODS: We identified potential HF patients using a guideline-based flowchart that combines ICD-10 codes (e.g. I21, I25, I42) and HF-related procedures (e.g. echocardiography, B-type Natriuretic Peptide (BNP) testing). Then, we developed a machine learning model for early prediction of HF using the Brazilian Department of Informatics of the Unified Health System (Departamento de Informática do Sistema Único de Saúde) mortality information system and ambulatory information system records, 2018-2022. A CatBoost algorithm was trained on a balanced cohort of patients (10 000 with HF and 9 995 without HF), restricting predictors to ≥12 months before the first I50 code to prevent leakage. Key predictors included age, chronic kidney disease, echocardiography, and lipoprotein disorders. We validated model performance in independent cohorts, including a low-prevalence cohort (~2% HF). Finally, we derived underreporting estimates via deterministic sensitivity analysis across scenarios from 0-100%. RESULTS: The proxy identified approximately 54 000 potential HF cases/y that were unreported in ambulatory data, with deterministic analysis suggesting 12-41% underestimation. Mortality analysis showed that around 200 000 deaths could be linked to unreported HF. The CatBoost model achieved an area under the curve (AUC) of 0.91 (balanced cohort; accuracy = 0.82, recall = 0.81, F1 = 0.82) and maintained strong discrimination in low-prevalence settings (AUC = 0.84, sensitivity = 0.82), with excellent calibration (Brier = 0.124-0.136; ECE = 0.01-0.03). CONCLUSIONS: We found that HF underreporting in Brazil is substantial and carries significant mortality implications. Our ML model demonstrates high accuracy in early risk stratification using routine administrative data, aligning with clinical pathways. Implementing it as a screening tool could optimise resource allocation, but ethical considerations around false positives warrant careful deployment. Future work should focus on clinical validation and cost-effectiveness analysis within the Brazilian Unified Health System. Furthermore, our findings highlight significant implications for public health and clinical HF management, emphasising the necessity of strategies that promote early detection of HF and precise case recording. Addressing underestimation is crucial to optimise healthcare resources and improve patient outcomes. The results underscore the importance of accurate diagnosis and comprehensive management approaches for better HF case tracking. Further research should explore the public health impact of these underestimations in Brazil, particularly regarding its health system's financial resources.
18 May 2026
Read appraisal →World journal of urology
Comparative study on the efficacy of large language models (LLMs) in health management for patients with urological and andrological diseases: a multidimensional quality evaluation and applicability analysis
PURPOSE: This study aims to evaluate the efficacy of large language models (LLMs) in health management for urological and andrological conditions by comparing two Chinese LLMs: DeepSeek and Kimi. METHODS: The responses of DeepSeek and Kimi to 30 questions on six urological and andrological diseases were quantitatively assessed using quality assessment tools, expert assessments, and readability metrics. RESULTS: In quality assessments, DeepSeek outperformed Kimi in only two instances: responses to "What are the surgical options for kidney stones?" (PEMAT-AI: P = 0.012; DISCERN-AI: P = 0.024) and "What are the treatment modalities for bladder cancer?" (PEMAT-AI and DISCERN-AI: P < 0.001). Expert assessments revealed that DeepSeek demonstrated superior accuracy and safety compared to Kimi only in addressing "Dietary considerations for kidney stone patients" (accuracy: P < 0.001; safety: P = 0.02). No statistically significant differences were found in quality assessments or expert assessments between the models for disease-specific categories. However, Kimi outperformed DeepSeek in readability evaluations. CONCLUSION: Both DeepSeek and Kimi exhibit substantial efficacy and clinical applicability in managing urological and andrological diseases. To enhance their practical use, Kimi requires improvements in accuracy and safety, while DeepSeek should focus on improving readability.
18 May 2026
Read appraisal →European journal of pediatrics
Prevalence of common respiratory viruses of infants with respiratory tract infections in European countries in the past decade: a systematic review and meta-analysis comparing between the pre-COVID-19, pandemic, and post-COVID-19 periods
UNLABELLED: The purpose of this study is. to determine the leading cause of respiratory tract infections over the decade; this review examined the proportions of airway viruses in infants with respiratory tract infections in Europe before, during, and after the COVID-19 pandemic. The protocol for this systematic review was registered in the PROSPERO database (CRD42024497097). Literature searches in PubMed, Embase, Scopus, and Web of Science (WoS) identified 20,453 studies reporting respiratory viral testing in Europe over the past decade (2012/13-2022/23). Eligible studies were English-language full-text or grey articles with low risk of bias and complete data, and reports that explicitly provided the number of positive airway virus cases (n, virus) and the total infant population (N). Risk of bias was assessed using the Hoy et al. scoring system. Pooled prevalence estimates (pooled proportion [95% CI]) were calculated for pre-, during-, and post-COVID-19 periods using proportional meta-analysis with the MetaProp package in R. Fifty studies before, ten studies during, and 18 studies after the COVID-19 pandemic were eligible for proportional meta-analyses of viral testing in infants. Before the pandemic, the predominant viruses in infants with respiratory infections were Respiratory Syncytial Virus (RSV) (0.48 [0.41-0.56]), Human rhinovirus (HRV) (0.24 [0.18-0.29]), and Influenza virus (IV) (0.08 [0.04-0.12]). Post-pandemic, the leading viruses were RSV (0.63 [0.51-0.75]), HRV (0.25 [0.11-0.40]), and IV (0.10 [0.00-0.20]) again. CONCLUSIONS: RSV and HRV remained the two most identified viruses in infants with respiratory infections, pre- and post-COVID-19 pandemic. Interestingly, both RSV and IV were suppressed during the pandemic. The trajectory dynamics of respiratory viruses were divergent, with resilient viruses (RSV, HRV, and IV) regaining dominance more rapidly than persistently suppressed viruses. WHAT IS KNOWN: • The COVID-19 pandemic induced an infection precautions policy, which reduced the spread of respiratory infectious diseases. • Respiratory Syncytial Virus (RSV) was estimated as one of the most common causes of respiratory infections in infants. Still, there are no reports summarising the geographical distributions of the various viral agents of infant respiratory diseases. WHAT IS NEW: • This meta-analysis shows that the prevalence of RSV and HRV infections in infants remains high in Europe following the COVID-19 pandemic and the associated precautionary policy. Furthermore, RSV proportionally experienced a marked reduction during COVID-19 pandemic (lockdown periods). However, the immunological debt may have led to a re-emergence in RSV positivity after the lockdown periods. • Our proportional meta-analysis indicates the heterogeneous post-pandemic recovery patterns of each respiratory virus commonly identified in infants, where HRV was shown to be resilient whilst RSV was rapidly rebound.
18 May 2026
Read appraisal →Scandinavian journal of primary health care
Shoulder-to-shoulder: healthcare professionals' experiences of learning during electronic health record implementation in municipal primary care.
BACKGROUND: Formal training is commonly used in electronic health record (EHR) implementation, but often fails to address healthcare professionals' ongoing, context-specific learning needs. There is limited knowledge of how learning unfolds in practice when such training is experienced as insufficient, particularly in municipal healthcare services. METHODS: This qualitative study examined learning processes during the implementation of a new EHR system in a municipal healthcare institution in Central Norway. Data was generated through interviews and observation, and was analyzed thematically. RESULTS: Participants experienced formal training as poorly aligned with their digital competencies and everyday clinical work. Limited time and staffing further constrained participation in formal training and follow-up. Alongside formal training, employees engaged in peer-based learning practices embedded in everyday work, described as 'shoulder-to-shoulder' learning. These practices became particularly important due to limited time and staffing, enabling rapid problem-solving and mutual support, while also reinforcing shared responsibility for learning. Rather than merely compensating for inadequate training, shoulder-to-shoulder learning emerged as an important adaptive practice that supported problem-solving and collaboration during EHR implementation. CONCLUSION: Learning to use EHR systems in municipal primary care should be understood as a socially embedded and ongoing process. While formal training may provide initial orientation, implementation strategies should also recognize and support peer-based learning practices that support ongoing learning and collaboration during periods of organizational change.
18 May 2026
Read appraisal →Journal of the International Society of Sports Nutrition
Creatine monohydrate for lean mass, strength, and bone density in postmenopausal women: a systematic review and meta-analysis
BACKGROUND: Menopause is accompanied by accelerated losses in muscle mass and strength and declining bone density. Whether creatine monohydrate benefits postmenopausal women are uncertain. METHODS: We systematically reviewed randomized, placebo-controlled trials examining creatine supplementation, with or without resistance training (RT), in postmenopausal women. MEDLINE, Embase, Scopus, Web of Science, SPORTDiscus, and Cochrane CENTRAL were searched from 2000 to August 2025, supplemented by trial registries and reference-list screening. Eligible studies included postmenopausal women aged ≥40-45 years, intervention durations ≥6 weeks for primary analyses, and outcomes including DXA-derived lean mass, one-repetition maximum (1RM) strength, bone mineral density, physical function, and safety. Dual screening, duplicate extraction, and Cochrane RoB 2 assessment were performed. Random-effects meta-analysis used the Paule-Mandel estimator for τ² with Hartung-Knapp-Sidik-Jonkman adjustment. Heterogeneity (τ², I²), 95% prediction intervals, subgroup analyses by RT status, exploratory dose/duration meta-regression, small-study effects, and GRADE certainty were assessed. RESULTS: Seven RCTs (n = 608 randomized; duration 12-104 weeks, median 38 weeks) enrolled postmenopausal women (mean age ≈ 62 y). Lean mass (k = 5; n = 338) favored creatine: mean difference (MD) + 0.37 kg (95% CI + 0.05 to + 0.69; I² = 25%; τ² = 0.01; 95% PI -0.10 to + 0.84). Leg-press 1RM (k = 3; n = 111) improved with creatine: MD + 7.5 kg (95% CI + 2.2 to + 12.8; I² = 0%). Benefits were evident when creatine ≥ 5 g·day⁻¹ was combined with RT; trials using ≤ 3 g·day⁻¹ without RT showed no measurable effect. Bone density was unchanged overall. Adverse events were mild and similar to placebo; renal indices were unchanged. Risk of bias was mostly "some concerns;" one large, preregistered, double-blind RCT was at low risk. CONCLUSIONS: In postmenopausal women, creatine, particularly ≥ 5 g·day⁻¹ with RT, yields small but meaningful gains in lean mass and strength without evidence of harm. Effects on bone density remain unclear.Registration: This review was not prospectively registered. De-identified data and supplementary materials were deposited on OSF after completion of the analysis (DOI: 10.17605/OSF.IO/BVTRZ).
18 May 2026
Read appraisal →Environmental pollution (Barking, Essex : 1987)
A systematic review of low-level ambient fine particulate matter (PM2.5) exposures and adverse cardiovascular health outcomes
Associations between exposure to fine particulate matter and impacts in the cardiorespiratory system are well-established, but associations are expected to vary based on exposure duration and concentration. Domestic and international agencies set standards and guidelines for PM2.5 in part to protect public health. This systematic review explores if associations exist between adverse cardiovascular endpoints and PM2.5 exposure when the concentrations are below regulatory standards. In total, 1349 documents were screened, with 95 articles meeting criteria (i.e. peer-reviewed, PM2.5 concentrations reported, cardiovascular endpoints measured). Of the included articles, 67% (64 articles) observed significant associations with adverse cardiovascular endpoints with variable findings based on specific cardiovascular endpoints (e.g. direct measurements - 69% of articles, cardiovascular endpoints - 44% of articles, events and mortality - 76% of articles, and biomarkers - 67% of articles). While not universally consistent, significant associations were observed between PM2.5 exposure and adverse cardiovascular effects, even at levels deemed compliant with current regulations. This review highlights the necessity for further research across diverse geographical settings and populations to clarify the implications of low-level PM2.5 exposure on cardiovascular health. The findings advocate for a review of regulatory standards for PM2.5 exposure in the context of cardiovascular health.
17 May 2026
Read appraisal →Computers in biology and medicine
LADNET: An MRI-based deep learning approach for Alzheimer's disease detection.
Alzheimer's disease (AD) is considered a leading form of dementia, found in the majority of individuals, and it accounts for the highest prevalence of all the types of dementia. It is a gradually progressing condition which can begin with mild memory impairment and may lead to the inability to engage in meaningful conversations in the future. In addition to that, it is also capable of reacting appropriately to the environment around it. According to official data, there has been an increase in reported cases of AD-related mortality in recent years, along with rising rates of the disease itself. Therefore, it is beneficial for patients to be diagnosed with AD as early as possible in order to maximize their chance of survival. In medical field, deep learning (DL) is employed in many applications, especially the identification of Alzheimer's disease, has shown considerable success. Based on the fact that these methods are capable of acquiring and extracting features from extensive datasets autonomously, they are highly suitable for analyzing intricate medical images with the aid of these methods. Design the Lightweight Alzheimer's Disease Net (LADNET) model for the current task. Accurate detection of AD using magnetic resonance imaging (MRI)-based scans is presented in this work. The model classifies the three dementia types, namely Mild Dementia (MD), Moderate Dementia (MDD), and Very Mild Dementia (VMD), while also accurately categorizing the non-demented (ND) category based on the severity of the condition. We measure the performance of the model we recommend against a publicly available Kaggle dataset that contains over six thousand images from four different types of images. LADNET model achieves 99.4% accuracy and 99% AUC, outperforming existing methods. With a lightweight design of approximately 1.2 million parameters and fast inference (4.2 ms per image), LADNET demonstrates strong potential for practical clinical deployment, where it could help extract biomarker information from conventional MRIs, potentially reducing patient burden and diagnostic costs.
17 May 2026
Read appraisal →Clinica chimica acta; international journal of clinical chemistry
A laboratory-driven clinical decision support system algorithm for personalized and automated cardiovascular risk stratification in primary care patients.
OBJECTIVE: To develop and evaluate an automated clinical decision support system (CDSS) capable of computing both categorical and exact-percentage cardiovascular risk (CVR) in routine clinical practice. METHODS: We developed and implemented an automated CDSS (AlinIQ®) for CVR assessment within the Clinical Laboratory Department of Hospital Universitari i Politècnic La Fe (València, Spain), applied to patients referred from Primary Care. The analytical profile-requested either via automatic trigger or proactive clinician order-included total cholesterol, HDL-C, LDL-C, non-HDL-C, triglycerides, lipoprotein(a) [Lp(a)], serum creatinine, and estimated glomerular filtration rate. Additional required inputs were smoking status, systolic blood pressure, country of origin, and age at diabetes onset. The CDSS automatically computed SCORE2, SCORE2-OP, SCORE2-Diabetes, and SCORE2 Asia-Pacific, generating both categorical strata and exact-percentage CVR. Lp(a)-adjusted CVR was derived using coefficients from the Spanish Atherosclerosis Society. Following the ESC 2025 Focused Update, patients meeting predefined clinical criteria for moderate, high, or very high CVR were directly assigned to the corresponding category without SCORE calculation. The system also incorporated modifying risk factors, generating standardized interpretive comments and personalized lipid targets. RESULTS: Over one month, 2289 screenings were requested; 189 (8.3%) were excluded. A total of 171 patients (7.5%) were classified as high risk based on score-based calculation (164 [95.9%] triggered automatically), and 29 (1.6%) as very high risk (23 [79.3%] triggered automatically). 119 individuals (6.8%) were reclassified to a higher risk category after Lp(a)-based adjustment. CONCLUSION: This CDSS provides a scalable and reproducible framework for laboratory-driven cardiovascular prevention.
17 May 2026
Read appraisal →Journal of affective disorders
Biological age acceleration associated with mental and behavioural disorders: Evidence from the UK biobank cohort.
BACKGROUND: Mental and behavioural disorders may accelerate biological ageing, but comprehensive evidence integrating observational and causal approaches is lacking. METHODS: We performed observational and Mendelian randomisation (MR) analyses. First, 502,411 UK Biobank participants (78,674 with ICD-10 Mental and Behavioural Disorders) were propensity score matched (1:1). Biological Age Acceleration (BAA = biological age - chronological age) was regressed on mental and behavioural disorder status, and robustness checks were conducted using heteroscedasticity-robust and cluster-robust standard errors. Second, two-sample MR assessed causal effects of genetic liability to six mental and behavioural disorders on four ageing biomarkers, using strong genetic instruments (F > 10) and validated through sensitivity analyses including MR-Egger, Cochran's Q, and leave-one-out tests. RESULTS: Ever having a diagnosis of a mental and behavioural disorder was associated with higher BAA (β = 0.261, 95% CI: 0.229-0.293, P < 0.001). Strongest associations were observed for disorders of psychological development (β = 0.717), organic mental and behavioural disorders (β = 0.395), and mental and behavioural disorders due to psychoactive substance use (β = 0.338). BAA increased with comorbidity count (P-trend <0.001). MR indicated potential causal effects of depression (OR = 5.12 for frailty index), insomnia (OR = 2.04 for frailty index), and anxiety (OR = 1.06 for frailty index) on accelerated ageing, with no evidence of horizontal pleiotropy (MR-Egger intercept P > 0.05). Bipolar disorder was associated with slower epigenetic ageing (OR = 0.71 for GrimAge). Alcohol use disorder increased facial ageing (OR = 1.02). Schizophrenia showed no significant associations. CONCLUSIONS: Mental and behavioural disorders are observationally and robustly linked to accelerated biological ageing, with a dose-response by comorbidity. Genetic evidence supports potential causal roles for depression, insomnia, and anxiety in promoting ageing, while bipolar disorder may relate to slower epigenetic ageing. Biological ageing should be considered in the long-term management of mental health.
17 May 2026
Read appraisal →Journal of affective disorders
Adverse events related to buspirone: a real-world pharmacovigilance study using the FAERS database
Buspirone, a widely used anxiolytic, has incompletely characterized adverse effects. This study aimed to comprehensively characterize buspirone's safety profile by a large-scale analysis of real-world data from the Food and Drug Administration Adverse Event Reporting System (FAERS) database, covering Q1 2006 to Q1 2025. We collected 1744 buspirone-related adverse event reports and analyzed them utilizing various signal detection techniques, including proportional reporting ratio (PRR), reporting odds ratio (ROR), multi-item gamma Poisson shrinker (MGPS), and Bayesian confidence propagation neural network (BCPNN). The most common adverse events were categorized into nervous system disorders and psychiatric disorders, with "dizziness" (n = 141), "anxiety" (n = 133), "drug interaction" (n = 86), "serotonin syndrome" (n = 83), and "tremor" (n = 71) being the most frequently reported. Notably, several safety issues linked to suicide exhibited considerable signals. In addition to the adverse events already listed on the package insert, our research identified unanticipated adverse events associated with improper buspirone use, including "drug abuse" (n = 43), "intentional overdose" (n = 30), and "drug level increased" (n = 17). These findings indicated a potential risk of abuse with buspirone exposure during therapeutic use. Moreover, the study detected a relatively rare but noteworthy signal associated with abnormal body weight, such as "obesity" (n = 19), which merits further attention. The median time to onset for adverse events was 10 days (IQR:16). In conclusion, this pharmacovigilance research underscored the safety hazards related to prolonged buspirone usage, confirmed known risks and identified novel safety signals. These findings enriched the awareness of buspirone's safety profile and provided evidence-based guidance in clinical settings.
17 May 2026
Read appraisal →Journal of rehabilitation medicine
Efficacy of ultrasound-guided intra-articular hyaluronic acid injection in the management of adhesive capsulitis: a randomized controlled trial
OBJECTIVE: To compare the efficacy and safety of ultrasound-guided intra-articular hyaluronic acid injection versus supervised rehabilitation in patients with frozen-phase adhesive capsulitis. DESIGN: Single-center, parallel-group, randomized controlled trial with 26-week follow-up. SUBJECTS/PATIENTS: Forty-six adults aged 40-70 years with clinically and radiologically confirmed frozen-phase adhesive capsulitis. METHODS: Participants were randomly assigned to receive either three weekly ultrasound-guided intra-articular hyaluronic acid injections or supervised physical therapy twice weekly for six weeks. Outcomes assessed at baseline and at weeks 4, 6, 8, and 26 included the Shoulder Pain and Disability Index (SPADI) and shoulder range of motion. RESULTS: Both groups achieved significant within-group improvements in SPADI and range of motion over 26 weeks (all p < 0.01 vs. baseline). No statistically significant between-group differences were observed in total SPADI or its pain and disability subscales at any follow-up time point (all p > 0.05). At week 26, the hyaluronic acid group's mean total SPADI decreased from 43.0 ± 17.7 to 16.1 ± 12.8 (p < 0.01), while the rehabilitation group improved from 52.0 ± 18.4 to 23.2 ± 21.8 (p < 0.01). Pain subscores were reduced by 64.3% (hyaluronic acid) and 56.1% (rehabilitation); function subscores decreased by 60.9% and 54.8%, respectively (all p < 0.01). Both groups showed significant gains in active and passive flexion, abduction, and external rotation, without significant between-group differences (all p > 0.05). No treatment-related adverse events were observed. CONCLUSION: Ultrasound-guided hyaluronic acid injection and supervised rehabilitation produced comparable and clinically meaningful improvements in pain, function, and shoulder mobility in frozen-phase adhesive capsulitis.
17 May 2026
Read appraisal →European journal of cancer (Oxford, England : 1990)
Aflibercept and 5-FU vs. FOLFOX as 1st line treatment for older adults or frail elderly patients with metastatic colorectal cancer - The randomized phase 2 AIO / IKF ELDERLY trial (AIO-KRK-0117 / IKF 629)
BACKGROUND: Fluoropyrimidines + angiogenesis inhibitor or dose-reduced doublets are used for (frail) elderly patients with metastatic colorectal cancer (mCRC). This non-comparative trial evaluated two 1st line regimens for patients not eligible for full-dose combinations. METHODS: This open-label, multicenter, phase II study randomized untreated mCRC patients ≥ 70 years ± frailty 1:1 to dose reduced mFOLFOX7 in Arm A or aflibercept (4 mg/kg) plus dose reduced mLV5FU2 in Arm B. Primary endpoint was the 6-months PFS rate (PFS@6), secondary endpoints included safety, overall survival (OS), overall response rate (ORR), patient reported outcomes and overall treatment utility (OTU). FINDINGS: The full analysis population comprised 120 patients (62 Arm A, 58 Arm B; 63% male), with a median age of 78.5 years. 82% frail patients were included. PFS@6 was 68% [95%CI 56%;80%] in Arm A and 46% [32%;59%] in Arm B. Median PFS was 7.9 and 5.5 months, median OS was 20.4 and 19.0 months and ORR was 47% and 22% in Arm A and B, respectively. At 3 months, 52% in Arm A and 35% in Arm B had a good OTU. Most frequent grade ≥ 3 AEs in Arm B were hypertension (41%) and proteinuria (10%). More patients in arm B had treatment-related SAEs grade ≥ 3 (17% in arm B and 5% in arm A). INTERPRETATION: Both regimens were feasible in this (frail) elderly population. Dose-reduced mFOLFOX7 and, to a lesser extent, 5-FU/aflibercept showed good PFS and 3-month OTU. Although most patients were regarded frail, survival rates were promising, most likely due to effective further-line treatments.
17 May 2026
Read appraisal →Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention
Injuries from falling out of bed in infants under 1 year of age: a systematic review
CONTEXT: Falls from beds are a leading cause of unintentional injuries in infants under 1 year of age. While most cases result in mild outcomes, the potential for severe injuries, such as skull fractures or intracranial haemorrhages, exists. Despite the prevalence of these incidents, no systematic review has focused specifically on injuries from bed falls in this specific age. OBJECTIVE: To evaluate the risk and severity of injuries caused by falls from beds in infants under 1 year of age through a systematic review. DATA SOURCES: We searched in PubMed, Embase, Cochrane Library and Lilacs Scielo for studies published between 1984 and December 2024. STUDY SELECTION: We included observational studies that reported injuries from falls from beds in infants under 1 year. DATA EXTRACTION: We extracted the relevant data from the included study details, recruitment setting, study design, sample size and outcome measures. We conducted a quality assessment using the Newcastle-Ottawa Scale. RESULTS: Out of 297 initially identified studies, three met inclusion criteria, comprising a total of 2034 infants under 1 year of age. Most falls resulted in minor or no injuries. Warrington et al reported <1% of cases leading to concussion or fractures. Samuel et al identified two cases of intracranial haemorrhage and linear skull fractures without intervention. Kolulu et al observed significant injuries, including skull fractures and cerebral contusions, in 10.2% of infants. CONCLUSIONS: Falls from beds are frequent in infants under 1 year, with most resulting in minor outcomes. However, serious injuries occur in around 5% of infants below 1-year old, emphasising the need for prevention strategies and clinical guidelines for managing post-fall assessments. Further research is required to refine understanding and improve prevention and management practices. PROSPERO REGISTRATION NUMBER: CRD42024626255.
17 May 2026
Read appraisal →Psychological medicine
Effectiveness of a one-year smoking cessation intervention for people with severe mental illness: results of the KISMET cluster-randomized controlled trial
BACKGROUND: This study evaluated the effectiveness of a one-year smoking cessation intervention for people with severe mental illness compared with treatment as usual (TAU) in outpatient mental healthcare. METHODS: The KISMET study is a pragmatic cluster-randomized controlled trial conducted in 21 outpatient mental healthcare teams in the Netherlands. Eleven teams delivered the KISMET intervention comprising cognitive-behavioral and peer support, combined with optional pharmacological reatment. Ten teams participated in the TAU condition. We collected data between October 2022 and July 2024. The primary outcome was self-reported smoking cessation at 12 months, verified through exhaled carbon monoxide levels below 10 parts per million. Secondary outcomes included depression and anxiety (HADS), severity of psychotic symptoms (PANSS-6), quality of life (SF-12), disease self-management (PAM-13), lipid profile, blood pressure, body mass index, glucose level, and physical fitness. Crude and adjusted linear and multivariable logistic regression and mixed model analyses were performed. RESULTS: Eighty-nine participants were included in the KISMET intervention and 44 in TAU. Smoking cessation rates were significantly higher in the KISMET group at 3 months (OR 12.1, 95% CI 1.4 to 103.7) and at 12 months (OR 4.2, 95% CI 1.0 to 17.2) but not at 6 months (OR 1.9, 95% CI 0.5 to 6.9). No significant differences between groups were found for secondary outcomes. Dropout rates were 58% in the intervention and 32% in the TAU group. CONCLUSIONS: The KISMET intervention shows potential without signs of physical or psychopathological complications. However, results must be interpreted with the high dropout rates in mind.
17 May 2026
Read appraisal →PloS one
Multi class photoplethysmography-based deep model for cardiovascular disease classification
BACKGROUND: cardiovascular disease is the leading global cause of mortality. Photoplethysmography (PPG), widely embedded in consumer wearables, offers a scalable diagnostic modality. However, prior approaches are often constrained by handcrafted features, binary classification, and poor generalizability, limiting their clinical impact. METHODS: A deep hierarchical convolutional neural network (CNN) was designed to extract both morphological and rhythmic characteristics directly from raw photoplethysmography (PPG) signals. The architecture employs progressively structured convolutional filter hierarchies to capture multi-scale signal features. To enhance signal stability and training efficiency, a dual-stage normalization strategy was implemented, consisting of Z-score standardization followed by Min-Max scaling. In addition, batch normalization and dropout regularization were incorporated to improve model generalization and reduce the risk of overfitting. The proposed framework was trained and evaluated on a multi-source dataset comprising 612 patients and 2,448 annotated PPG segments distributed across six diagnostic classes: atrial fibrillation (AF), heart failure (HF), acute coronary syndrome (ACS), cerebral vascular accident (CVA), deep vein thrombosis (DVT), and normal sinus rhythm (NSR). RESULTS: The model achieved an overall accuracy of 93.48%, a macro-average F1-score of 0.9386, and a Cohen's Kappa of 0.8968, indicating "almost perfect" agreement. AF and HF were detected with flawless precision and recall (1.000), while ACS achieved high sensitivity (recall 0.964). Errors were primarily confined to physiologically related conditions (e.g., ACS vs. CVA). Inference efficiency was demonstrated with <5 ms per segment on consumer-grade hardware, confirming feasibility for real-time applications. CONCLUSION: The proposed framework advances beyond lightweight but underpowered or overly complex models by combining representational depth with computational efficiency. Limitations include the need for external, multi-center validation and explainability integration. This study establishes a robust foundation for PPG-based, multi-class cardiovascular diagnostics, supporting clinical decision support and next-generation wearable health technologies.
17 May 2026
Read appraisal →Journal of medical Internet research
Digital Patient Decision Aid for Antiobesity Medications: Mixed Methods Study of Human-Centered Design and Usability Evaluation
BACKGROUND: The global burden of obesity continues to rise, highlighting the need for patient-centered approaches to weight management. Shared decision-making is particularly important in the selection of antiobesity medications (AOMs), as treatment options differ in mechanism, effectiveness, side effects, routes of administration, and cost. Despite this preference-sensitive context, only a few patient decision aids (PDAs) have been culturally and clinically adapted for use in Asian populations. OBJECTIVE: This study aims to design, develop, and evaluate a digital PDA, OptiWeight, to support shared decision-making for AOM selection, incorporating perspectives from health care professionals and patients. METHODS: This mixed methods, multicenter study, conducted between August 2022 and November 2025, applied a 4-stage human-centered design process. An evidence-informed prototype was developed based on clinical guidelines, followed by 2 rounds of usability testing using think-aloud protocols to assess navigation structures, perceived usability (System Usability Scale [SUS]), and cognitive workload (NASA Task Load Index [NASA-TLX]). Semistructured interviews with health care professionals specializing in weight management, guided by the Consolidated Framework for Implementation Research, informed clinical implementation and workflow integration. Finally, patients with overweight or obesity evaluated usability, cognitive workload, and overall user experience in outpatient settings. Qualitative data were analyzed using content analysis, and 1-way analysis of variance examined changes in usability and workload across stages. RESULTS: A total of 174 individuals were included across all study stages (usability testing among adults: n=78; health care professional interviews: n=18; and clinical evaluation among patients: n=78). Iterative usability testing comparing system- and user-controlled navigation structures revealed complementary strengths and limitations, leading to the adoption of a hybrid navigation structure supporting both sequential guidance and flexible comparison. Additional design requirements included the use of icon arrays to enhance risk comprehension and localization features such as treatment cost displays and clarification of socially impactful side effects. Perceived usability increased from initial testing to clinical evaluation (SUS: 60.53-73.65, P<.001), meeting good usability thresholds, while cognitive workload decreased (NASA-TLX: 40.35-16.69, P<.001). CONCLUSIONS: Through a systematic human-centered design process integrating health care professional and patient perspectives, OptiWeight addresses the lack of culturally adapted PDAs for AOM decision-making in Mandarin-speaking populations while capturing user needs-particularly regarding navigation flexibility and risk visualization. The final tool demonstrated good usability and feasibility, and workflow considerations suggest potential for integration into routine weight-management care. Further research is needed to evaluate its impact on decision quality and real-world implementation outcomes.
17 May 2026
Read appraisal →JMIR mental health
Factors Influencing the Initiation and Continued Engagement of Digital Mental Health Tools Among Adults: Theory of Planned Behavior-Informed Systematic Review
BACKGROUND: Digital mental health tools (DMHTs) offer scalable support, but engagement varies. Understanding the shapes of initiation and ongoing use is essential for effective design and implementation. OBJECTIVE: This study aims to synthesize determinants of adults' initiation and engagement with DMHTs, organized through two lenses: (1) psychological factors aligned with the theory of planned behavior (TPB) and (2) design and access features. METHODS: A systematic search of 9 databases (June 2025) identified qualitative and mixed methods primary studies reporting end-users' experiences with DMHTs. Studies were screened and reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality appraisal used quality assessment with diverse studies (QuADS). Data were synthesized using a framework-guided thematic approach, mapping findings to TPB constructs and complementary design and access domains. RESULTS: A total of 22 studies met inclusion criteria. Findings clustered into 2 interdependent domains. TPB constructs explained how beliefs, social expectations, and perceived control shaped decisions to start and persist with DMHTs. Design and access features frequently acted through these same pathways, especially by altering perceived behavioral control (PBC), with cost, connectivity, device constraints, and time flexibility affecting feasibility, with content design and privacy shaping perceived value and trust. Perceived fit (goals, cultural or linguistic relevance, and routine alignment) consistently influenced both initiation and continuation. Several features operated bidirectionally; depending on context, the same feature could facilitate or hinder engagement. CONCLUSIONS: Engagement with DMHTs is jointly determined by users' beliefs and the design and access conditions within which tools are offered. Implementation should pursue a dual strategy, strengthening willingness to seek support (addressing attitudes, norms, and perceived control) while engineering low-effort, trustworthy, and context-appropriate experiences. Priorities include equity-focused policies (data costs, devices, and connectivity), transparent data practices, co-design with diverse communities, and consistent, theory-informed outcome measures.
17 May 2026
Read appraisal →European journal of pediatrics
Leveraging artificial intelligence to predict non-adherence to pediatric immunization schedules: a systematic review
UNLABELLED: Immunization is one of the most effective interventions to prevent infectious diseases. Identifying individuals at risk of non-adherence to immunization schedules could enable early interventions to improve coverage. With the increasing availability of large datasets with sociodemographic, medical, and geographic data, artificial intelligence (AI) offers new possibilities for identifying predictive patterns. We performed a systematic literature review of original studies that used AI to predict immunization non-adherence in children. Searches were conducted in PubMed, Embase, and Web of Science and no restrictions were applied regarding publication year, language, or study design. Study characteristics, dataset size, AI methods, performance metrics, and validation approaches were extracted. Risk of bias was assessed using PROBAST + AI. A total of 843 records were identified; after screening, 12 studies were included. Nine of 12 studies were conducted in low- and middle-income countries, used cross-sectional survey data, and analyzed vaccines from routine immunization schedules. Model performance was generally high; 9/12 studies reported an accuracy or an area under the receiver operating characteristic curve exceeding 80%, but no study conducted external validation. Predictors clustered into seven categories: maternal, paternal, family, child, geographic, wealth, and others. Among maternal and child-related factors, prenatal care and previous immunization history had a high predictive weight. CONCLUSION: AI demonstrates a promising potential for identifying individuals at risk of vaccine non-adherence. However, the lack of external validation raises concerns about model overfitting and limits real-world applicability. Demographic health surveys were routinely repeated across countries and time periods and could therefore represent an ideal resource for external validation. WHAT IS KNOWN: • Geographic, sociodemographic, and medical factors contribute to non-adherence to the immunization schedule. • Identifying these individuals can guide early interventions to improve immunization coverage. WHAT IS NEW: • Artificial intelligence can reveal unknown influential factors; prenatal care and delivery setting emerged as key factors in this systematic review.
17 May 2026
Read appraisal →JMIR human factors
A Chronic Pain Self-Management Mobile App (Dolodoc): Cross-Sectional Acceptability Study
BACKGROUND: Approximately 19% of adults in Europe are affected by chronic pain, which reduces the quality of life. Pain-management mobile health (mHealth) apps offer a promising solution for self-management, but user engagement and adherence can limit their clinical impact. User experience design and research play a crucial role in optimizing usability and long-term adoption of digital health interventions. OBJECTIVE: This study aims to evaluate the user experience of Dolodoc, a mobile app for chronic pain self-management, using a mixed methods approach that assesses acceptability through a content quality survey and examines use by analyzing overall use patterns. METHODS: A cross-sectional acceptability study of the main content of Dolodoc was conducted among patients with chronic pain recruited from the Geneva University Hospitals pain center and through snowball sampling. Participants rated 84 evidence-based self-management strategies by using a 5-point Likert scale based on 5 acceptability criteria: understandability, motivation, feasibility, relevance, and alignment with the related quality-of-life dimension. To reduce participant fatigue and avoid random responses, the 84 strategies were randomly divided across survey versions. Use was assessed through metrics collected over 6 months with Piwik PRO Analytics to observe real-world use behaviors among Dolodoc users. RESULTS: In the acceptability study, 33 participants rated the self-management strategies positively across all dimensions. On a scale from -2 to 2, the strategies were well understood (mean 1.47, SD 0.76), motivational (mean 1.12, SD 0.96), feasible (mean 1.01, SD 1.05), relevant (mean 0.99, SD 1.09), and aligned with the dimensions (mean 1.33, SD 0.89). The use study demonstrated that 60% (486/802) of the patients used Dolodoc only once, indicating that long-term adherence remains a challenge. Within Dolodoc, pain tracking, useful links, and medication logging were the most actively used features. CONCLUSIONS: This study highlights the gap between acceptability and long-term adherence to mHealth solutions. Improving personalization and accessibility could increase user engagement and long-term adherence. Future iterations of the app should incorporate tailored interventions and real-time feedback mechanisms. In addition, leveraging a digital navigation follow-up could facilitate user adoption and sustained engagement.
17 May 2026
Read appraisal →JMIR mHealth and uHealth
Smartphone Apps for Cannabis Cessation: Quality Assessment and Content Analysis
BACKGROUND: Over the past 2 decades, global rates of cannabis use have risen significantly, especially among young adults. This has corresponded to an increase in cannabis-related problems and hospitalizations. Thus, there has been significant interest in developing new interventions that can help facilitate cannabis cessation and reduce hospitalization rates. Specifically, mobile apps have emerged as scalable and accessible stand-alone or adjunct interventions that can help individuals with cannabis use disorders. OBJECTIVE: This study aimed to evaluate the quality of free cannabis cessation apps available on both the Apple App Store and Google Play Store, focusing on the analysis of their features, content, and adherence to evidence-based practices. METHODS: A systematic search was conducted in April 2023 using a variety of keywords. The apps were deemed eligible if they were free, available in English, accessible on both the Apple App Store and the Google Play Store, and related to cannabis cessation. Eligible apps were used for at least 1 month and were rated on the Mobile App Rating Scale by 2 reviewers. Interrater reliability was excellent, with a weighted Cohen κ of 0.893 (95% CI 0.835-0.943). RESULTS: Four apps were included in the analysis, namely, "Grounded-Quit Weed," "Quit Weed," "Marijuana Addiction Calendar," and "Marijuana Anonymous." The mean overall quality score of the apps was 3.4 out of 5, indicating poor to acceptable quality. The apps scored the highest on the "functionality" section and the lowest on the "information" section. Of the 4 apps, 3 focused on tracking cannabis use and duration of abstinence, whereas 1 focused on peer support. A limited number of cannabis cessation apps were identified, and those that were available were of low quality due to a lack of evidence-based information. CONCLUSIONS: This study is the first to evaluate the current availability and quality of mobile apps designed for cannabis cessation. Unlike previous research that broadly assessed cannabis-related mobile apps, this study focuses on the limited number of free cannabis cessation tools, reflecting what is most available to the general population. The findings highlight a significant gap between the growing demand for virtual cessation tools and the quality of existing options. With the rising global prevalence of cannabis use disorders, there is an increasing need for robust, accessible, and evidence-based therapeutic options. While mobile health apps may be a viable option to support cannabis cessation, the current landscape is limited by poor quality apps and a lack of evidence-based information. From a real-world perspective, this study highlights the need for users to exercise caution when relying on current cannabis cessation apps and underscores the urgent need for the development and evaluation of new evidence-based digital interventions.
17 May 2026
Read appraisal →Journal of affective disorders
Intolerance of uncertainty and depression in children and adolescents: Systematic review and meta-analysis
BACKGROUND: Intolerance of uncertainty (IU) is a development and maintenance factor for depression and anxiety. Previous reviews found that it associated with anxiety in children and adolescents. However, there was insufficient evidence at the time to review its association with depression in this population. METHOD: 20 studies investigating the relationship between IU and depression in children and adolescents were identified. Random effects meta-analysis was used to aggregate cross-sectional associations, with age, gender, and measure as moderators. A narrative review of longitudinal findings from relevant studies (K = 6) was also conducted. RESULTS: Meta-analysis of cross-sectional associations found an overall effect size of r = 0.47. There was limited evidence that age or gender moderated the effect, however there was a significant moderating effect of measure. Namely, when including studies using 'child-friendly' measures (i.e., developed and normed with children as opposed to adults), the effect size was r = 0.37. Another analysis revealed that the inhibitory IU subscale was more strongly associated with depression than prospective IU. Longitudinal findings suggested that the association between IU and depression persists over time. LIMITATIONS: Studies were limited to those published in English and including general population samples (e.g., typically developing, without significant medical needs). CONCLUSIONS: There is a medium-strong association between IU and depression symptoms in children and adolescents. However, it may be overestimated by the use of IU measures that are not child-friendly. Future research can further extend the evidence-base through careful measure selection, as well as longitudinal and experimental designs.
17 May 2026
Read appraisal →European journal of preventive cardiology
Cuffless Blood Pressure Monitoring Devices: Technical Foundations and Clinical Implications
Cuffless blood pressure (BP) monitoring devices represent a promising innovation in hypertension management. This scientific statement provides a comprehensive update on these emerging technologies, their specific validation requirements, their potential clinical applications, and their present and future challenges. These devices generate considerable interest by enabling non-invasive BP measurement without arterial occlusion, thereby eliminating the discomfort associated with traditional cuff-based monitoring, particularly during sleep. The technologies on which these devices are based comprise a heterogeneous group, primarily utilizing pulse wave propagation time or waveform analysis through contact or non-contact sensors. They can be categorized as continuous or intermittent, automated or manual, calibration-free or requiring cuff/demographic calibration, and wearable or stationary. This technological diversity necessitates validation protocols distinct from those used for conventional cuff-based monitors, with specific requirements for each device category. Potential clinical applications include widespread out-of-office BP monitoring, unbiased assessment of circadian BP patterns and BP variability, improved detection of nocturnal hypertension, enhanced treatment adherence and long-term BP control, and continuous monitoring in hospital settings. Additionally, their lower cost compared with conventional technologies could enhance the early detection of hypertension in resource-limited settings. However, due to insufficient accuracy validation, this scientific statement does not recommend their use in clinical decisions in spite of their potential interest, in line with international guidelines not recommending their use in hypertension management. Key challenges ahead include developing standardized validation protocols, establishing normative BP data, managing the resulting burden on clinicians in handling huge volumes of data, exploring additional haemodynamic parameters, and advancing sensor technology, mathematical models, and algorithms.
16 May 2026
Read appraisal →African journal of reproductive health
Evaluation of the effects of probiotic supplementation on the ecology and inflammatory factors of female vaginal flora: a systematic review and meta-analysis
This meta-analysis systematically evaluated the effects of probiotic supplementation on vaginal microbiota and inflammatory factors in women. PubMed, Embase, Web of Science, CNKI, and Wanfang were searched from inception to January 2026 for randomized and controlled studies. Outcomes included vaginal pH, Nugent score, and inflammatory cytokines (IL-4, IL-6, IL-10, TNF-α). Fifteen studies were included. Compared with controls, probiotics did not significantly reduce IL-4, IL-6, IL-10, or TNFα levels, nor did they significantly improve Nugent score. However, probiotic supplementation significantly reduced vaginal pH (OR = 0.36, 95% CI: 0.15-0.89; P = 0.03), indicating improved maintenance of a weakly acidic vaginal environment. Sensitivity analyses showed generally stable results, although heterogeneity remained substantial for several outcomes. Overall, probiotics appear effective in modulating vaginal acid-base balance but show limited evidence for improving inflammatory cytokine profiles or restoring vaginal microbiota structure. Current data are insufficient to support routine probiotic use for optimizing vaginal microbiota and inflammatory status. Further high-quality, well-designed randomized controlled trials are required to clarify their clinical benefits. Cette méta-analyse a évalué de manière systématique les effets de la supplémentation en probiotiques sur le microbiote vaginal et les facteurs inflammatoires chez les femmes. Les bases de données PubMed, Embase, Web of Science, CNKI et Wanfang ont été consultées depuis leur création jusqu’en janvier 2026 afin d’identifier des études randomisées et contrôlées. Les critères de jugement comprenaient le pH vaginal, le score de Nugent et les cytokines inflammatoires (IL-4, IL-6, IL-10, TNF-α). Quinze études ont été incluses. Comparativement aux groupes témoins, les probiotiques n’ont pas réduit significativement les concentrations d’IL4, IL-6, IL-10 ou TNF-α, ni amélioré significativement le score de Nugent. En revanche, la supplémentation en probiotiques a significativement réduit le pH vaginal (OR = 0,36 ; IC à 95 % : 0,15–0,89 ; P = 0,03), indiquant un meilleur maintien d’un environnement vaginal faiblement acide. Les analyses de sensibilité ont montré des résultats globalement stables, bien qu’une hétérogénéité substantielle persiste pour plusieurs critères. Dans l’ensemble, les probiotiques semblent efficaces pour moduler l’équilibre acido-basique vaginal, mais les preuves restent limitées quant à leur capacité à améliorer les profils cytokiniques inflammatoires ou à restaurer la structure du microbiote vaginal. Les données actuelles sont insuffisantes pour recommander l’utilisation systématique des probiotiques dans l’optimisation du microbiote vaginal et du statut inflammatoire. Des essais contrôlés randomisés de haute qualité sont nécessaires pour confirmer leurs bénéfices cliniques.
16 May 2026
Read appraisal →PloS one
D-dimer and lower limb ultrasound as prognostic factors for recurrent deep venous thrombosis and pulmonary embolism: A systematic review and meta-analysis
Venous thromboembolic disease is a chronic, recurrent condition. The optimal duration of anticoagulation therapy remains uncertain. We aim to evaluate D-dimer and lower limb ultrasonography as prognostic tools for the recurrence of venous thromboembolism. A search was conducted on May 28, 2022, in the Medline, Embase, and Cochrane databases. Inclusion criteria encompassed cohort studies, case-control studies, and clinical trials. Two reviewers independently screened all records and analyzed studies for inclusion/exclusion criteria, as well as risk of bias, using a structured framework (PROSPERO ID: CRD42022341082). The initial search yielded 4652 titles and abstracts. After removing 777 duplicates and reviewing 3875 titles and abstracts, 48 articles providing information on D-dimer and/or lower limb ultrasonography as prognostic factors were finally included. Very low-certainty evidence suggests that both residual vein thrombosis (RVT) at anticoagulation discontinuation and a positive post-treatment D-dimer are significantly associated with an increased risk of recurrent venous thromboembolism (VTE). For RVT, the pooled analysis showed a two-fold increase in risk (OR 2.00, 95% CI 1.02 to 3.94; I² = 85.7) while for positive D-dimer, the risk was similarly elevated (OR, 2.48; 95% CI, 1.85-3.33; I² = 56.0). In conclusion, very low-quality evidence suggests that abnormal D-dimer and RVT are associated with recurrent VTE; however, this association is inconsistent due to significant heterogeneity and wide prediction intervals. These biomarkers should be interpreted with caution as isolated predictors in clinical practice.
16 May 2026
Read appraisal →African journal of reproductive health
Domestic violence during pregnancy and its maternal and reproductive health consequences in mainland China: A systematic review and meta-analysis
Domestic violence during pregnancy represents a serious public health concern. This study conducted a systematic review of quantitative data to examine its prevalence, factors influencing it, and associated health outcomes in Mainland China. Following PRISMA 2020 guidelines, a meta-analysis of 25 studies was performed using random-effects models, alongside assessments of heterogeneity (I²) and publication bias. The analysis revealed a pooled prevalence of approximately 20%, with psychological violence identified as the most prevalent form. Key contributing factors included socio-economic disadvantage, restricted decisionmaking autonomy, and risky behaviors by partners. Exposure to domestic violence substantially heightened the likelihood of antenatal depression or anxiety, pregnancy complications, and negative birth outcomes such as low birth weight and preterm delivery. Although some heterogeneity was noted, the associations were consistently observed. These findings highlight the significant prevalence and severe health impacts of domestic violence during pregnancy, emphasizing the urgent need for comprehensive maternal healthcare approaches in China. Such strategies should integrate domestic violence screening, mental health services, and initiatives promoting socio-economic empowerment. La violence domestique pendant la grossesse constitue un problème de santé publique grave. Cette étude a réalisé une revue systématique des données quantitatives pour examiner sa prévalence, les facteurs l'influençant et les conséquences sanitaires associées en Chine continentale. Conformément aux directives PRISMA 2020, une méta-analyse de 25 études a été effectuée en utilisant des modèles à effets aléatoires, ainsi que des évaluations de l'hétérogénéité (I²) et du biais de publication. L'analyse a révélé une prévalence globale d'environ 20 %, la violence psychologique étant identifiée comme la forme la plus répandue. Les principaux facteurs contributifs comprenaient les désavantages socio-économiques, une autonomie décisionnelle restreinte et les comportements à risque des partenaires. L'exposition à la violence domestique augmentait considérablement la probabilité de dépression ou d'anxiété anténatales, de complications de la grossesse et d'issues défavorables à la naissance, telles qu'un faible poids de naissance et un accouchement prématuré. Bien qu'une certaine hétérogénéité ait été notée, les associations ont été constamment observées. Ces résultats soulignent la prévalence significative et les impacts sanitaires graves de la violence domestique pendant la grossesse, mettant en évidence le besoin urgent d'approches globales en matière de soins de santé maternelle en Chine. De telles stratégies devraient intégrer le dépistage de la violence domestique, des services de santé mentale et des initiatives favorisant l'autonomisation socio-économique.
16 May 2026
Read appraisal →Archives of women's mental health
Multidimensional psychological and neurophysiological effects of moderate- and low-intensity exercise on pregnant women: an integrative systematic review and Bayesian framework network meta-analysis
BACKGROUND: Pregnancy-related mental health disorders are an increasingly important global public health concern. Exercise interventions have gained attention as safe, non-pharmacological strategies for improving maternal psychological and neurophysiological well-being. However, comparative evidence regarding different exercise modalities and intensities remains limited. OBJECTIVE: This study aimed to systematically evaluate and rank the effects of different prenatal exercise modalities and compare moderate- versus low-intensity exercise protocols on maternal mental health and neurophysiological outcomes during pregnancy. METHODS: A Bayesian network meta-analysis was conducted following PRISMA-NMA guidelines. PubMed, Embase, Cochrane Central, and PsycINFO were systematically searched. Thirty-six randomized controlled trials involving 4,577 pregnant participants were included. Methodological quality was assessed using the Cochrane RoB 2.0 tool. Treatment effects were ranked using the surface under the cumulative ranking curve method. RESULTS: Moderate-intensity aerobic training showed the strongest effect on reducing prenatal depression, with a SUCRA value of 0.89. Yoga-based interventions were particularly effective for anxiety reduction, with a SUCRA value of 0.76, and ranked second in the overall outcome evaluation, with a SUCRA value of 0.82. Neurophysiological findings indicated that yoga showed the greatest benefit for cortisol regulation, whereas aquatic exercise demonstrated distinctive anti-inflammatory effects. Subgroup analyses suggested that moderate-intensity exercise tended to produce greater reductions in depression, while low-intensity exercise showed comparable or superior effects on anxiety and cortisol modulation. Meta-regression further indicated that interventions conducted three times per week and lasting more than 12 weeks were associated with larger effect sizes. The certainty of evidence ranged from moderate to high across primary comparisons. CONCLUSION: This network meta-analysis provides a preliminary evidence hierarchy for prenatal exercise interventions. Moderate-intensity aerobic exercise may be most beneficial for reducing prenatal depression, while yoga appears particularly suitable for anxiety and cortisol regulation. These findings offer clinicians a reference framework for individualized prenatal exercise recommendations and support the integration of exercise into maternal mental healthcare.
16 May 2026
Read appraisal →Journal of global health
Global prevalence of underweight and overweight/obesity among migrant workers: a systematic review and meta-analysis
BACKGROUND: Migrant workers are increasingly recognised as a nutritionally vulnerable population due to unstable working conditions, disrupted food environments, and limited access to health services. However, global estimates of malnutrition in this group remain fragmented. We aimed to identify the global prevalence of underweight and overweight/obesity among migrant workers and identify key moderating factors. METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines. We searched seven databases without restrictions on language, region, or year of publication. Observational studies reporting the prevalence of underweight (body mass index (BMI) < 18.5 kg/m2) or overweight/obesity (BMI ≥ 25 kg/m2) among migrant workers were included. We calculated pooled prevalence estimates using generalised linear mixed models with random effects. We assessed heterogeneity with I2 and Cochran's Q statistics. Moderator analyses were conducted using meta-regression and subgroup comparisons. Further, we appraised study quality using the Joanna Briggs Institute tools, and assessed the certainty of the evidence using GRADE. RESULTS: We included 30 studies involving 135 404 migrant workers with a mean age of 32.3 years (standard deviation = 11.1). The pooled prevalence was 4.7% (95% confidence interval (CI) = 3.1, 6.9) for underweight and 43.7% (95% CI = 39.8, 47.6) for overweight/obesity, suggesting a substantial double burden of malnutrition. Underweight was more common among local migrants and in lower-middle-income settings, particularly in South Asia, whereas overweight/obesity was more common among international migrants, especially in high-income countries and in Europe and Central Asia. Moderator analyses identified female proportion, destination country or region, income level, and marital status as significant moderators for both outcomes. CONCLUSIONS: Migrant workers experience a substantial double burden of malnutrition, although the pattern varies across migration contexts. Undernutrition remains a concern in lower-income settings, whereas overweight and obesity are more common in high-income settings. Integrating nutrition-sensitive strategies into labour and migration health policies, including healthier food environments, routine nutritional screening, and culturally appropriate interventions, may help reduce health inequalities in this population. REGISTRATION: INPLASY: 202540030.
16 May 2026
Read appraisal →European journal of preventive cardiology
Effect of incretin-based therapies on blood pressure: a systematic review and meta-analysis
AIMS: Hypertension and obesity frequently coexist and synergistically increase cardiovascular (CV) risk. Incretin-based therapies with glucagon-like peptide-1 receptor agonists (GLP-1-RAs), gastric inhibitory polypeptide (GIP)/GLP1-RAs, and glucagon/GIP/GLP-1RAs lead to substantial weight loss. However, their antihypertensive efficacy and safety profile have not been comprehensively quantified. Our study aimed to evaluate the effects of incretin-based therapies on office systolic blood pressure (BP) (SBP), diastolic BP (DBP), all-cause mortality, and key safety outcomes, i.e. hypoglycaemia and pancreatitis episodes, in adults with overweight or obesity. METHODS AND RESULTS: We searched PubMed, EMBASE, and ClinicalTrial.gov from inception to 30 April 2024 for randomized controlled trials (RCTs) comparing incretin-based therapy with placebo and ≥1 month of follow-up. The primary outcome was change in SBP; secondary outcomes were change in DBP, all-cause mortality, hypoglycaemia, and pancreatitis. Random effects meta-analyses generated mean differences (MDs) or risk ratios (RRs) along with 95% confidence intervals (CIs). Heterogeneity was explored with I2 statistics, subgroup analyses, and meta-regression. Eighty-five RCTs encompassing 90 977 participants (median follow-up time 8 months) met the eligibility criteria. GLP1-RAs reduced SBP by 3.4 mmHg (95% CI 2.8-4.0) and DBP by 0.9 mmHg (95% CI 0.5-1.2). A higher weight loss was significantly associated with a greater reduction in BP. The most significant BP reduction was associated with dual (SBP 5.1 mmHg; DBP 1.8 mmHg) and triple (SBP 6.6 mmHg; DBP 2.1 mmHg) receptor agonists. All-cause mortality was reduced by 18% (RR 0.82, 95% CI 0.76-0.90). Incretin-based therapy did not increase the risk of hypoglycaemia (RR 1.05, 95% CI 0.83-1.33) or pancreatitis (RR 0.84, 95% CI 0.61-1.15). CONCLUSION: Incretin-based therapy led to a modest but clinically meaningful BP reduction and lower all-cause mortality in adults with overweight or obesity, without excess in hypoglycaemia or pancreatitis episodes. There was a significant association between weight loss and the reduction in SBP and DBP. Dual and triple agonists exhibited the most pronounced antihypertensive effect. These findings support the use of incretin-based therapies as part of an integrated and multidisciplinary approach to managing obesity and hypertension, with multiple agonists showing particular promise. Our findings also underscore the need for long-term RCTs to clarify weight-independent mechanisms and the durability effect of BP reduction. Incretin-based therapy, now widely used for weight loss, also modestly reduces blood pressure and mortality, providing an additional health benefit to people with obesity or diabetes.Across 85 clinical trials (more than 90 000 adults), incretin-based therapy lowered systolic blood pressure by about 3 mmHg; the most significant falls occurred with the dual and triple agonists, and every kilogram lost made the reduction larger.Incretin-based therapy use was associated with an 18% lower mortality, with no increase in hypoglycaemia or pancreatitis episodes, supporting their safe dual role in weight control and cardiovascular protection.
16 May 2026
Read appraisal →JMIR mHealth and uHealth
Engagement of Users in Digital Health Applications: Scoping Review
BACKGROUND: Mobile health (mHealth) uses mobile technology as a tool for prevention and health promotion. Research indicates that user engagement is crucial for effective mHealth interventions and improved health outcomes. However, many studies report low adoption rates, rapid decline after initial use, and a lack of acknowledgment of user implications in achieving outcomes. Thus, conceptualizing participation in mHealth is essential to identify key determinants for engaging users. OBJECTIVE: This scoping review aims to identify and characterize the attributes and definitions of user engagement in mHealth, examine engagement methods, and analyze barriers and facilitators influencing participation. METHODS: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, Scopus, Web of Science, and PubMed databases were searched for publications between 2000 and 2025 with a 2-stage selection process. RESULTS: Out of 2489 articles identified, 1416 were screened, and 52 met the inclusion criteria. Half were recently published in the last 5 years (2020-2025). Existing literature focused on digital interventions for specific populations and health topics. Analysis revealed four main perspectives on engagement in mHealth: (1) usage metrics, (2) subjective user experiences, (3) a hybrid approach that combines both, and (4) a goal-oriented perspective (behavior change or health outcomes). CONCLUSIONS: To understand the complexity and multifactorial nature of participation, it is relevant to conceptualize it as a dynamic mechanism enabling users to achieve their objectives. Both quantitative use and subjective user experience should be integrated to reach the optimal intervention dose. Recognizing users' evolving needs, uniqueness, and their socioenvironmental context interdependence, it is essential to involve users in all stages (design, implementation, and iterative evaluation of mHealth). Findings will inform an e-Delphi study to establish consensus on engagement criteria.
16 May 2026
Read appraisal →European journal of preventive cardiology
Visit-to-visit blood pressure variability and cardiovascular outcomes: a systematic review and dose-response meta-analysis
AIMS: Visit-to-visit blood pressure variability (VVV BPV) is a recognized risk factor for cardiovascular disease (CVD) that is underutilized in clinical practice. The reliability of electronic health record (EHR) data in estimating BPV and predicting CVD remains uncertain. This study compared BPV estimation methodologies using EHR vs. non-EHR data and examined dose-response associations with CVD. METHODS AND RESULTS: A systematic review and meta-analysis was conducted across five databases (MEDLINE, Scopus, EMBASE, CINAHL, and Web of Science) for studies published from January 2012 to August 2024. Studies assessing VVV BPV in adults and its association with CVD outcomes (e.g. myocardial infarction, stroke, heart failure, and cardiovascular mortality) were included. A dose-response meta-analysis (DRMA) evaluated BPV thresholds linked to increased CVD risk using standard deviation (SD) and coefficient of variation (CV). A total of 4926 studies were screened, 49 of which met the inclusion criteria. No consensus has emerged on BPV estimation methodologies, although non-EHR studies have followed stricter protocols. The meta-analysis showed that VVV BPV predicted any CVD outcome. Effect sizes were comparable between EHR [the hazard ratio (HR): 1.17, 95% confidence interval (CI): 1.09-1.24] and non-EHR (HR: 1.14, 95% CI: 1.10-1.17) studies (P-value = 0.468). A BPV threshold of SD 6.72 mmHg or CV 9.05% was linked to a 10% higher CVD risk. CONCLUSION: The EHR data reliably estimate BPV, yielding effect sizes similar to those of non-EHR sources. A non-linear dose-response relationship suggests that a higher BPV increases CVD risk. Visit-to-visit blood pressure variability needs to be incorporated into clinical practice, and further research is required to identify strategies to implement and scale up into routine workflow. Visit-to-visit blood pressure variability (VVV BPV) is capable of predicting CVD development in 6 years. However, its clinical use remains limited, and the reliability of electronic health records (EHR) in measuring BPV is uncertain. Having a standard deviation of VVV BPV ≥6.72 mmHg or a coefficient of variation of VVV BPV ≥9.05% mmHg is linked to a 10% higher CVD risk. Blood pressure variability estimates from EHR data were comparable to those from non-EHR studies, suggesting that EHR-based BPV assessment is reliable for CVD risk evaluation.
16 May 2026
Read appraisal →European heart journal
Artificial intelligence-based quantification of breast arterial calcifications to predict cardiovascular morbidity and mortality
BACKGROUND AND AIMS: Women are underdiagnosed and undertreated for cardiovascular disease (CVD). Automatic quantification of breast arterial calcification (BAC) on screening mammography can identify women at risk for CVD. This study aimed to determine whether artificial intelligence-based automatic quantification of BAC from screening mammograms predicts CVD and mortality beyond PREVENT scores in a large, racially diverse, multi-institutional population. METHODS: This retrospective cohort study included 123 762 women from two healthcare systems who had screening mammograms. Breast arterial calcification was quantified using a transformer-based neural network for segmentation. Breast arterial calcification severity was categorized as zero (0 mm2), mild (>0-10 mm2), moderate (>10-25 mm2), and severe (>25 mm2). Kaplan-Meier analysis, Cox proportional hazards, and Fine-Gray competing event models were used to examine the association between BAC and major adverse cardiovascular events (MACE). RESULTS: Breast arterial calcification was detected in 16.1% (internal cohort) and 20.6% (external cohort) of women and provided significant prognostic value incremental to the PREVENT score. In PREVENT adjusted models, a clear dose-response was observed. Compared with zero BAC, mild [internal: hazard ratio (HR) 1.32, 95% confidence interval (CI) 1.10-1.59; external: HR 1.28, 95% CI 1.17-1.39], moderate (internal: HR 1.75, 95% CI 1.23-2.50; external: HR 1.79, 95% CI 1.55-2.06), and severe BAC (internal: HR 3.29, 95% CI 2.15-5.05; external: HR 2.80, 95% CI 2.36-3.32) were all prognostic for any MACE. Each 1 mm2 increase in BAC conferred an additional 2%-3% risk for MACE (P < .001). CONCLUSIONS: Automatically quantified BAC is an independent predictor of MACE and mortality, adding prognostic value to the PREVENT score. This approach may provide an opportunistic cardiovascular risk assessment during routine mammography screening without additional radiation exposure to guide earlier and more effective preventive care for women.
16 May 2026
Read appraisal →Journal of affective disorders
Sex differences in cognitive function trajectories and influencing factors in older adults: A machine learning study based on CHARLS and HRS
BACKGROUND: Identify the influencing factors that respectively affect the differences in cognitive function trajectories between China and the United States, and explore the reasons for gender and transnational differences. METHODS: Five waves of data from the China Health and Retirement Longitudinal Study (CHARLS) and the Health and Retirement Study (HRS) were utilized, and Latent Class Growth Models (LCGMs) was employed to identify cognitive trajectories. The optimal machine learning (ML) model was adopted and the Boruta algorithm was used to screen the variables. The SHAP value is used to explain the ranking of feature importance. RESULTS: The XGBoost model performs best among the six ML models. Education was the top influencing factor across groups. Family factors mattered more in China, while U.S. medical and endowment insurance had stronger effects. Men were more affected by external social networks; women were influenced by family responsibilities and community environments. CONCLUSION: Differences were linked to public services, social roles, and traditional culture. These results support the development of tailored interventions targeting gender-specific and culture pathways at the individual, family, society and community levels, offering actionable insights for promoting cognitive health in aging populations globally.
16 May 2026
Read appraisal →Journal of medical Internet research
A Digital Diabetes Self-Management Education and Support Program Integrated With Continuous Glucose Monitoring for Type 2 Diabetes: Randomized Controlled Trial
BACKGROUND: Previous research has demonstrated that the use of continuous glucose monitoring (CGM) can improve glycemic control in people with type 2 diabetes when used regularly alongside a digital diabetes self-management education and support (DSMES) program. However, to date, there is limited evidence showing the benefits of a digitally delivered DSMES program combined with real-time CGM for adults with type 2 diabetes. OBJECTIVE: The objective of this study is to evaluate the impact of a DSMES program coupled with CGM on hemoglobin A1c (HbA1c) and CGM-derived glycemic measures compared to usual care for adults with type 2 diabetes over 6 months. METHODS: Participants with type 2 diabetes and HbA1c of 8% or higher (64 mmol/mol) who were not using mealtime bolus insulin (aged 26-83 y; mean HbA1c 9.6%, SD 1.4% [mean 81.2 mmol/mol, SD 15.8 mmol/mol]) were randomly assigned to a digital DSMES+CGM integrated solution (n=51) or usual care (n=49) for 6 months. The primary outcome was HbA1c. The secondary outcomes were CGM-derived glycemic measures, including glucose management indicator, percent time in range 70 to 180 mg/dL, percent time above range (>180 mg/dL), percent time below range (<70 mg/dL), and mean glucose. Linear mixed effects models were used for intention-to-treat analyses. RESULTS: HbA1c was lower among the intervention group versus the usual care group at 3 months (difference=-0.7%, 95% CI -1.4% to -0.1% or difference=-8.1 mmol/mol, 95% CI -15.5 to -0.7 mmol/mol; P=.03) and at 6 months (difference=-0.6%, 95% CI -1.4% to 0.2% or difference=-6.9 mmol/mol, 95% CI -15.7 to 1.9 mmol/mol; P=.12) but only reached statistical significance at 3 months. CGM-derived glycemic measures, including glucose management indicator (difference=-0.9%, 95% CI -1.7% to -0.1%; P=.03), time in range (difference=14.6%, 95% CI 1.0% to 28.2%; P=.04), time above range (difference=-14.9%, 95% CI -29.0% to -0.9%; P=.04), and mean glucose (difference=-36.4 mg/dL, 95% CI -70.0 to -2.9 mg/dL; P=.03), also significantly improved for the intervention group versus the usual care group at 6 months. CONCLUSIONS: The combination of digital DSMES+CGM is effective for supporting adults with type 2 diabetes in managing their condition and has the potential to reduce the risk of long-term health complications.
16 May 2026
Read appraisal →Journal of affective disorders
Prediction models for longitudinal trajectories of depression and anxiety: a systematic review
BACKGROUND: Prediction of atypical health trajectories may enable early intervention. We systematically reviewed the existing literature on models for predicting longitudinal depression and/or anxiety trajectories. METHODS: MEDLINE, Embase and APA PsycINFO were searched (from inception to 31-Jan-2025). We included population-based studies of children and adults (aged 3-65 years). Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST-AI) tool. RESULTS: Seven of the nine included studies were in adult populations with a diagnosis of depression or anxiety at baseline; two focused on child and adolescent populations. Only one study included anxiety trajectories. Identified trajectories typically comprised three to four groups including: chronic/persistent-high, stable-low, increasing/worsening, and improved/remitted groups. Various supervised predictive modelling methods were used. The number of final predictors included in models ranged from three to 152. Family and own/personal psychiatric history were the most common predictors but were not always important for model performance. Models including more predictors did not always perform better. Overall risk of bias was high in all studies. No studies were externally validated and no studies assessed the clinical utility of models. CONCLUSION: This review highlights a need for robust, validated models that can forecast future risk of persistent or worsening anxiety and depression, especially in young people where early intervention is possible.
16 May 2026
Read appraisal →PloS one
Optimising supervised machine learning algorithms predicting cigarette cravings and lapses for a smoking cessation just-in-time adaptive intervention (JITAI).
This study aimed to optimise the balance between participant burden and algorithm performance for predicting high-risk moments in a smoking cessation just-in-time adaptive intervention (JITAI) by systematically varying ecological momentary assessment (EMA) prompt frequency, predictor count, and training data source. Thirty-seven participants completed 16 EMAs per day for the first 10 days of their smoking cessation attempt, reporting mood, context, behaviour, cravings, and smoking lapses. Random forest algorithms predicting lapses and cravings were evaluated in terms of F1-score and ROC-AUC via mixed effects models accounting for clustering within individuals. Performance across out-of-sample individuals ranged from excellent to poor but was, on average, modest. Lapse prediction outperformed craving prediction, particularly for ROC-AUC (Median F1-score: Lapses 0.436 [IQR 0.180-0.625], Cravings 0.400 [IQR 0.048-0.649]; Median ROC-AUC: Lapses 0.659 [IQR 0.514-0.809], Cravings 0.628 [IQR: 0.510-0.729]). A substantial proportion of configurations fell below commonly used minimum performance thresholds, particularly for F1-score. Reducing EMA frequency had outcome- and metric-dependent effects. Lapse F1-scores improved with fewer prompts (16 EMAs: 0.254 [IQR 0.081-0.500], 3 EMAs: 0.588 [IQR 0.353-0.667]), while ROC-AUC showed a slight, inconsistent decline (16 EMAs: 0.661 [IQR 0.520-876], 4 EMAs: 0.613 [IQR 0.494-0.786], 3 EMAs: 0.704 [IQR 0.567-0.809]). For cravings, both metrics declined with fewer prompts (F1-score: 16 EMAs: 0.470 [IQR 0.141-0.745]; 3 EMAs: 0.333 [IQR 0.000-0.600]; ROC-AUC: 16 EMAs 0.700 [IQR 0.582-0.811], 3 EMAs 0.544 [IQR 0.421-0.676]). Feature reduction had negligible impact on lapse prediction (F1-score: all features 0.435, selected features 0.441; ROC-AUC: all 0.660, selected 0.657), but slightly reduced craving performance (F1-score: all 0.410 [IQR 0.117-0.646], selected 0.400 [IQR 0.000-0.650]; ROC-AUC: all 0.632, selected 0.622). Including participant-specific data improved lapse F1-scores (None 0.286 [IQR 0.000-0.571], 30 pc 0.542 [IQR: 0.329-0.667]), but not ROC-AUC (None 0.655 [IQR: 0.512-0.786], 30 pc 0.694 [IQR 0.513-0.852]); and impaired craving ROC-AUC (None 0.650 [IQR: 0.544-0.734], 30 pc 0.614 [IQR 0.493-0.730]; F1-score: None 0.424 [IQR 0.143-0.649], 30 pc 0.400 [IQR 0.000-0.703]). Overall, EMA-based machine learning detected lapse risk but showed modest overall performance and substantial inter-individual variability. Algorithms using higher EMA density, larger predictor sets, and participant-specific training data did not consistently outperform over more parsimonious approaches. However, machine learning prediction alone is unlikely to be sufficient for real-world JITAI implementation and may be best combined with complementary rules-based approaches.
16 May 2026
Read appraisal →BMJ open gastroenterology
Development and validation of multivariable prognostic machine learning models to identify patients at risk for inadequate bowel preparation when undergoing colonoscopy: a prospective, multicentre study
OBJECTIVE: Inadequate bowel preparation impairs the accuracy of colonoscopy and increases the burden on patients and healthcare systems. Consequently, the quality of bowel preparation is an important quality indicator. We aim to develop and validate multivariable prognostic models for the identification of patients at risk of inadequate bowel preparation using machine learning (ML). METHODS: Demographic and clinical data from consecutive patients ≥18 years of age who underwent colonoscopy at six centres in Germany were prospectively collected. Adequate bowel preparation was defined as Boston Bowel Preparation Scale ≥6 with a value ≥2 in each colonic segment. We used statistical and ML methods to build prognostic models and to compare them to published models. RESULTS: Overall, we analysed 2652 patients, including 699 (26.4%) inpatient procedures. The mean patient age was 57.6 years (SD 16 years), and 48.9% were women. In 1401 (52.8%) patients, the indication was screening or surveillance, and 1035 (39%) patients had a first-time colonoscopy. The rate of inadequate bowel preparation was 16%. Sensitivities, specificities and areas under the curve of predictive models obtained by generalised boosting models, Ranger, support vector machine (radial), CatBoost and Net Regularised Generalised Linear Models were 0.51-0.86, 0.52-0.83 and 0.71-0.74, respectively. They were only marginally superior to a logistic regression model. All models had high negative predictive values >0.9 for inadequate bowel preparation. To detect one patient with inadequate bowel preparation, 8-10 patients need to be evaluated. CONCLUSIONS: Predictive models to identify patients at risk for inadequate bowel preparation obtained by ML showed comparable results compared with a logistic regression model. TRIAL REGISTRATION NUMBER: DRKS00018878.
16 May 2026
Read appraisal →The British journal of general practice : the journal of the Royal College of General Practitioners
Does recommending healthy diets in general practice benefit secondary prevention of cardiovascular disease? A systematic review and meta-analysis.
BACKGROUND: Suboptimal diet is the main preventable risk factor globally for cardiovascular disease (CVD), posing major burden for primary care. However, healthy dietary recommendations' evidence in patients with established CVD is unclear. AIM: Systematically review and meta-analyse dietary patterns' effect on CVD patients' all-cause and CVD mortality, and CVD recurrence. METHOD: Publication databases were searched for randomised controlled trials (RCTs) (≥6 months follow-up) and prospective cohort studies. Random-effects meta-analysis calculated relative-risks (RR) and 95% confidence-intervals (95% CI). Cochrane bias risk tools assessed study quality. RESULTS: Screening 28 291 abstracts identified 41 articles meeting inclusion criteria. Nineteen articles from 14 unique RCTs conducted 1956-2020, enrolling 14 065 CVD patients, compared fat-replacement, Mediterranean, low-fat, low-sodium, and high-fibre diets with minimal/no dietary advice. Pooled results showed no diet intervention significantly impacted mortality/CVD outcomes. However, stratified meta-analysis revealed a Mediterranean-diet significantly reduced CVD mortality (RR: 0.40; 95% CI: 0.19, 0.83). Twenty-two cohort studies, conducted 1976-2017 for 104 386 CVD patients, predominantly assessed a Mediterranean diet (60%), showing greatest healthy dietary pattern adherence significantly reduced all-cause mortality by 29% (0.71; 0.65, 0.78), CVD mortality by 25% (0.75; 0.66, 0.84), and CVD recurrence by 17% (0.83; 0.75, 0.92). Overall, there was considerable between-study heterogeneity (RCTs: I2 = 34-60%, cohorts: I2 = 49-76%) partly explained by disparate geographical locations, and studies were mainly classified as of some concerns (65% RCTs) or high bias risk (52% cohorts). CONCLUSION: GPs providing healthy dietary advice, particularly the Mediterranean diet, likely enhances CVD secondary prevention. However, cogent studies with clearly defined diets are required to bolster the evidence.
16 May 2026
Read appraisal →Thorax
Measurement properties of the sit-to-stand test in community-dwelling people with chronic obstructive pulmonary disease: a COSMIN systematic review
BACKGROUND: The sit-to-stand (STS) test can assess physical function in people with chronic obstructive pulmonary disease (COPD); however, there are multiple versions. No study has used current guidelines to assess the measurement properties of the STS tests in people with COPD. METHODS: We conducted a systematic review using current COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Full text peer-reviewed publications were included if they assessed the measurement properties (validity, reliability and/or responsiveness) of at least one STS test among community-dwelling people with COPD. We searched six databases and imported results into Covidence where title/abstract screening and full text selection was completed independently and in duplicate. Extraction was conducted independently and in duplicate using the COSMIN extraction file. We assessed study risk of bias (very good, adequate, doubtful or inadequate), measurement property quality (sufficient, indeterminate or insufficient) and overall certainty of evidence (high, moderate, low or very low) using the COSMIN recommended tools. RESULTS: We assessed 2577 titles/abstracts and 102 full texts for inclusion; 30 publications met eligibility. Seven unique STS tests were located with the most common being the 1 min STS test (n=14, 39%), 5-repetition STS test (n=10, 28%) and the 30 s STS test (n=8, 22%). Where assessed, reliability was sufficient for the 1 min, the 5-repetition and the 30 s STS tests. Only the 1 min STS test had high-quality evidence of sufficient construct validity, while the 30 s STS test was the sole test with at least moderate quality evidence of sufficient responsiveness. CONCLUSIONS: The 1 min STS test has the most robust measurement properties for cross-sectional assessments while the 30 s STS test is more robust to assess change.
16 May 2026
Read appraisal →The British journal of general practice : the journal of the Royal College of General Practitioners
Are non-injectable anticipatory medications a viable end-of-life intervention in the community? A systematic review and narrative synthesis.
BACKGROUND: The anticipatory prescribing of injectable medications for symptom management at the end-of-life is an established practice in the UK. Transmucosal and inhaled routes of administration offer alternatives to injections, when patients are no longer able to take medications orally. Their evidence base in the community setting has not been established. AIM: To systematically review and synthesise the published, peer-reviewed evidence regarding the clinical practice and effectiveness, including patients', family caregivers' and healthcare professionals' views, of transmucosal and inhaled anticipatory medications for symptom management at the end-of-life in the community. METHOD: Ten literature databases were searched from inception to February 2025, using terms for non-injectable anticipatory medications, or kits, combined with end-of-life terms. Two journals were hand-searched from 2015 to 2025. References and citations of included papers were searched. Gough's Weight of Evidence Framework was used to appraise the included studies and inform the narrative synthesis. RESULTS: Fifteen papers were included, reporting the use of transmucosal routes, of which nine used a standardised medication kit. The limited evidence of clinical effectiveness, and the views of patients, family caregivers, and healthcare professionals, suggested that transmucosal medications were effective at relieving patients' symptoms and enabling patients to die at home. CONCLUSION: The evidence regarding transmucosal anticipatory medications in the community suggests that they are acceptable, clinically effective, and contribute to reducing unplanned hospital attendances, but is limited and should be treated with caution. Further research is needed to assess whether they offer viable alternatives to injectable anticipatory medications in the community.
16 May 2026
Read appraisal →Journal of affective disorders
An exploratory randomized controlled trial of an AI-enabled mental health intervention for generalized anxiety.
Generalized Anxiety Disorder (GAD) is prevalent and often co-occurs with depression, contributing to significant disability and healthcare burden. Although treatments such as CBT and SSRIs are effective, access remains limited. This exploratory, randomized controlled trial evaluated the effectiveness of an AI-powered mental health app (PATH) in reducing symptoms of anxiety and depression. A total of 316 UK-based participants (aged 19-70) were randomized to either the intervention group (PATH) or a control group (NHS self-help website). The intervention provided evidence-based strategies including CBT-informed chat therapy and interactive tools. Anxiety (GAD-7) and depression (PHQ-9) scores were measured at baseline, two, eight, and twelve weeks. Of the 316 randomized participants, 235 completed the post-intervention assessment (33.0% attrition in the intervention group vs. 18.5% in the control group). Retention at 8-week and 12-week follow-ups was 77.4% and 54.0%, respectively. At two weeks, the intervention group showed significantly lower GAD-7 and PHQ-9 scores compared to control, with medium effect sizes. At eight weeks, those who continued using the app showed significant reductions in both anxiety and depression, while those who discontinued still showed medium improvements in anxiety. Effects were maintained at twelve weeks, with moderate to large effect sizes. Findings suggest that PATH significantly reduces anxiety and depressive symptoms, particularly with continued use. These results support the app's potential as a scalable, accessible digital intervention to address mental health treatment gaps.
16 May 2026
Read appraisal →Thorax
Clinical impact of customised positive airway pressure (PAP) therapy interfaces (3DPiPPIn): a single site randomised controlled trial
INTRODUCTION: Positive airway pressure (PAP) therapy is the recognised treatment for sleep disordered breathing (SDB), delivered via a tight-fitting face mask (interface). Conventional interfaces do not consider facial geometries, often resulting in poor fit and ineffective therapy. Three-dimensional (3D) printing of customised interfaces may improve comfort and outcomes. OBJECTIVES: To evaluate the clinical impact of customised versus conventional oronasal interfaces in adults with obstrcutive sleep apnoea (OSA). The primary outcome was residual Apnoea Hypopnea Index (AHI) at 6 months; secondary outcomes included interface leak, therapy concordance and patient reported symptoms. METHODS: A randomised controlled trial with 160 adults naïve to PAP therapy and diagnosed with SDB (AHI ≥15 events/hour). Randomisation was minimised by age and ethnicity. Structured light facial scans (POP2, Revopoint, China) were used to produce 3D printed moulds (Fuse 30+, Formlabs, Massachusetts, USA) for silicone injected oronasal customised interface cushions.AHI was compared using quantile regression to account for the skewed distribution of the AHI data. Secondary outcomes were compared using logistic, quantile and linear regressions. RESULTS: 160 participants were recruited (intervention: 82, control: 78). Customised interfaces were associated with a 1.5 (events/hour) increase in AHI (p=0.059), higher interface leak (difference in medians 30.0 L/min, 95% CI 7.36 to 40.14, p<0.0001) and lower compliance (difference in compliance 0.78, 95% CI 0.05 to 1.54, p=0.04) at 6 months. CONCLUSIONS: This trial did not demonstrate customised oronasal interfaces were superior to conventional interfaces. Future research should focus on addressing design and manufacturing limitations before any potential advantages can be evaluated. TRIAL REGISTRATION NUMBER: ISRCTN74082423.
16 May 2026
Read appraisal →Environmental research
Mental health benefits of specific blue space types and characteristics: A systematic evidence map.
Natural environments support mental health and wellbeing, yet limited evidence exists about which types or characteristics are most beneficial. This is particularly true for blue spaces (natural or manmade outdoor environments featuring water). This evidence map investigates the mental health and wellbeing benefits associated with specific blue space types (e.g. coast, river) and characteristics (e.g. sounds). Following PRISMA guidelines, specific keywords were used to search for articles published from inception to March 2025. A total of 139 papers were included, examining the relationships between specific blue space types or characteristics and mental health. Coastal environments were the most frequently studied blue space (94 studies). Affect was the most assessed mental health outcome (74 studies). Most studies were conducted in European and Asian countries. Most studies compared blue spaces to urban or a green space environments, rather than other blue spaces. Only six studies directly compared different blue space types within the same study. Overall, the current evidence base does not allow for comparisons between different blue space types or characteristics, due to the limited number of direct comparisons and substantial heterogeneity across study designs, outcome measures, geographical contexts, blue space descriptions, and study populations. Future research should prioritize direct comparisons between different blue spaces, preferably including the detailed descriptions and analyses of specific characteristics, and examine the role of amount and type of exposure to better inform evidence-based recommendations for blue spaces and mental health.
16 May 2026
Read appraisal →The Journal of neuroscience : the official journal of the Society for Neuroscience
Stable Mechanoreceptive Somatotopy in Chronic Low Back Pain: Is Cortical Map Reorganization a Myth?
Chronic low back pain (CLBP) has been linked to maladaptive cortical plasticity in sensorimotor regions, which may contribute to pain persistence through less distinct ("smudged") somatotopic maps of afferent input from the back. However, empirical support for such functional reorganization, especially in the primary somatosensory cortex (S1), is limited. To delineate precise sensory representations of the back in humans and test for altered somatotopic processing in CLBP, we utilized an MR-compatible pneumatic vibration device and applied frequency-specific vibrotactile stimuli at nine thoracolumbar paraspinal sites in 45 patients with CLBP and 41 healthy controls (53 females in total). Representational similarity analysis was employed via a whole-brain searchlight method, and the neural representational patterns were contrasted against theoretical models including a segmental (based on anatomical proximity), simple (upper vs lower back division), and a random model. In addition, a machine learning classifier was trained to predict afferent input from the upper versus lower back in healthy controls and tested in CLBP patients. Both groups displayed well-organized segmental representations spanning somatosensory, motor, and posterior parietal cortices. Posterior parietal regions exhibited the best model fits, followed by S1. No evidence for differences in representational patterns between groups was found. In CLBP patients, these patterns did not show associations with pain duration, severity, and self-reported back perception. The classifier, trained on healthy controls, accurately predicted upper versus lower back afferent input in CLBP patients. These findings indicate preserved cortical maps of the back in CLBP, challenging the hypothesis of sensory cortical reorganization in this condition.
16 May 2026
Read appraisal →Journal of affective disorders
Sociodemographic and clinical predictors of digital mental health intervention engagement among treatment-seeking psychiatric outpatients
BACKGROUND: Digital mental health interventions (DMHIs) have shown promise improving depression, anxiety, and psychiatric distress, yet real-world engagement remains low. Increasing engagement has great potential to improve the impact of DMHIs, but little is known about the drivers of engagement in naturalistic settings. To better understand predictors of engagement, we examined sociodemographic and clinical characteristics associated with DMHI usage among a large clinical sample of adults. METHOD: 1223 adults (74% White, 68% women, Mage = 36.8 years) with scheduled intake appointments for outpatient psychiatric services were randomized to either a mindfulness-based app (Headspace) or a CBT-based app (SilverCloud). Usage data were automatically collected, and participants were neither required nor compensated to use the apps. RESULTS: Participants engaged with their assigned DMHIs a median of 8 days, with 88.2% of participants using their assigned DMHI at least once. Participants engaged with Headspace for more than twice as many days [IRR (95% CI) = 2.4 (2.1, 2.7)] as SilverCloud. Female sex, white race, a college degree, and older age up to 60 predicted greater engagement. Further, depression severity was associated with engagement in a non-linear manner for those assigned to Headspace, with less engagement at minimal/mild and severe symptoms compared to moderate and moderately-severe symptoms. CONCLUSIONS: These findings indicate meaningful differences in engagement between DMHIs based on sociodemographic and clinical characteristics. There may be opportunities to improve engagement by tailoring DMHI offerings, with a particular emphasis on meeting the needs of less-engaged populations.
16 May 2026
Read appraisal →The British journal of general practice : the journal of the Royal College of General Practitioners
Which transitions count? A systematic hermeneutic review of the literature on transitions of care.
BACKGROUND: Transitions of care are defined as critical moments along the care continuum for patients as they navigate changes in their health status or level of care. Researchers suggest that the existing research on transitions of care is largely descriptive and lacking in theoretical depth, which limits its application to different clinical contexts. AIM: We therefore aim to review the existing literature and theoretical frameworks on transitions of care, with a focus on primary care settings. METHOD: We undertook a systematic hermeneutic review - an approach that emphasises analytical reading, including identifying key concepts and building interpretations across a large and heterogeneous body of literature. Our initial search yielded 1640 articles, and we included 54 sources in our review. RESULTS: Despite interdisciplinary discussions, the main narratives of transitions of care centered around hospitals, with limited consideration for transitions in community settings. Moreover, using re-hospitalisation admission rates as the primary metric to measure the effectiveness of transitions of care initiatives fails to capture the negotiations required by patients and staff. This highlights the undercurrent of a positivist and biomedical approach, and the influence of broader health policy in shaping the methods and narratives used to define transitions. CONCLUSION: We consider this gap pertinent, given the increasing complexity of care delivered in community settings through remote chronic care models. In response, we suggest further engagement with theory to deconstruct our focus on settings and re-conceptualise transitions of care, which are also marked by changes in practices, materials, and people.
16 May 2026
Read appraisal →The British journal of general practice : the journal of the Royal College of General Practitioners
Pollution to prevention: digital decision support for air pollution and exercise counselling in general practice.
BACKGROUND: Outdoor exercise supports physical, mental, and social wellbeing. However, exposure to air pollution during activity can increase cardiorespiratory risk. The Royal College of Physicians (A Breath of Fresh Air, 2025) urges clinicians to address environmental determinants of health, including air quality, during routine care, including annual checks. Patients increasingly use digital tools providing air-quality data and actionable behavioural recommendations, yet the quality, evidence base, and integration of these tools into clinical workflows remain unclear. AIM: To evaluate digital tools that help patients modify exercise behaviour based on air-pollution exposure to inform the development of a custom chatbot to support exercise counselling in primary care. METHOD: A scoping review of app libraries, grey literature, and peer-reviewed studies identified digital tools providing air-quality data with actionable exercise recommendations. Data extraction covered functionality, pollutants, validation, and quality using the Mobile App Rating Scale (MARS) and Behaviour Change Technique Taxonomy (BCTTv1). RESULTS: Seven tools were identified: IQAir, Plume Labs, BreezoMeter, EPA AirNow, PurpleAir, airTEXT, and AirTrack. MARS scores ranged from 2.9 to 4.3 (mean = 3.6/5.0), highest for functionality and aesthetics but lower for information accuracy and engagement. Behaviour change content was limited to general health information, and no tools demonstrated formal validation or clinical integration. CONCLUSION: Existing tools provide accessible air-quality data but lack individualised recommendations for exercise. Insights informed a custom chatbot embedding air-quality and exercise advice into GP cardiorespiratory annual reviews. Next steps include further development of the custom chatbot and pilot implementation in general practice to assess feasibility, clinician uptake, and patient outcomes.
16 May 2026
Read appraisal →The British journal of general practice : the journal of the Royal College of General Practitioners
A systematic review of blood pressure monitor validation studies
BACKGROUND: Good hypertension care requires accurate blood pressure (BP) measurement with BP monitors validated as accurate. The British and Irish Hypertension Society maintains a peer-reviewed list of validated monitors, independent of commercial interests. The list informs National Institute for Health and Care Excellence hypertension guidance and NHS monitor procurement. An updated universal standard protocol for BP device validation was introduced in 2018. AIM: Review the literature to establish which validation protocols are now being used; has this changed since publication of the universal protocol, and what proportion of recently published BP monitor validations fully meet protocol validation criteria? METHOD: Systematic review searches of Medline and Embase from 2018 to September 2025 identified BP monitor validation studies. Citations and full texts were screened independently by two authors. Included studies were reviewed independently by two authors against checklists of protocol criteria. Disagreements were resolved through discussion and/or arbitration by lead authors. RESULTS: Seven reviewers screened 1780 unique citations, reviewing 216 full texts to date. Nine reviewers have double-extracted data from 157 publications reporting 197 device validation studies. Overall, 104 (63%) used universal protocols. While 184 (93%) validations were reported as successful by authors, only 146 (74%) fulfilled all protocol criteria on review. Thus, we considered 51 (26%) published successful validations inadequate, due to non-fulfilment of key validation criteria and/or violations of BP measurement protocols such as incomplete BP range coverage. CONCLUSION: This review highlights inadequacies in current journal peer-review processes, justifying our approach to provide impartial guidance for health professionals, purchasers, and the public.
16 May 2026
Read appraisal →The British journal of general practice : the journal of the Royal College of General Practitioners
Perinatal mental health training and supervision for primary care and community-based staff: a systematic review
BACKGROUND: Perinatal mental health problems are common yet often under-detected and under-treated in primary care and community services. International guidelines call for integration of mental health into perinatal care, but clarity is lacking on how best to equip non-specialist providers. Training and supervision programmes exist but vary widely in content and delivery, and their effectiveness and feasibility across settings are not comprehensively synthesised. AIM: To evaluate the effectiveness of perinatal mental health training for primary care and community-based providers on provider competence, maternal outcomes, and implementation in routine care. METHOD: Seven databases and grey literature were systematically searched to September 2025. Eligible studies evaluated training delivered to health or community providers involved in perinatal care. Due to heterogeneity, findings were narratively synthesised. Risk of bias was assessed using RoB-2 and ROBINS-I; certainty of evidence appraised using GRADE. RESULTS: Of 707 citations screened, 39 studies were included, spanning high- and low-income countries and involving over 10,000 providers. Interventions varied in intensity and modality, including novel approaches such as extended reality simulation and cascade 'train-the-trainer' models. Training consistently improved provider knowledge, skills, attitudes, and confidence, and was associated with increased screening and referral, particularly when supported by supervision or system-level integration. Patient outcomes were less frequently assessed; where reported, some studies showed reductions in depressive symptoms and improvements in broader maternal outcomes, though findings were mixed. CONCLUSION: Training enhances provider capacity in perinatal mental health, but evidence on patient impact, sustainability, cost-effectiveness, and equity remains limited, highlighting priorities for future research and policy.
16 May 2026
Read appraisal →Journal of medical Internet research
Understanding Patient-Reported Offenses in Electronic Health Records: Cross-Sectional Mixed Methods Survey
BACKGROUND: Patients' access to their electronic health record (EHR) supports their participation and satisfaction with care. Despite the benefits, some patients have been upset after reading their EHR. Additionally, health care professionals are concerned that patients, particularly those with mental health conditions, may be offended, and they have expressed a need for further guidelines on how to write EHRs. Experiences among various patient groups are essential to support the relationship between patients and professionals. However, prior studies have often focused on single patient groups or specific clinical contexts, leaving a limited understanding of differences across multiple patient groups. OBJECTIVE: This study aimed to determine whether certain patient groups are more likely to feel offended while reading their EHRs and which information is perceived as offensive and to provide a comparison across multiple patient groups using a mixed methods approach. METHODS: A cross-sectional survey was conducted via the Finnish national patient portal using a web-based patient survey, adopting a mixed methods approach. The survey included multiple-choice and open-ended questions. The total sample comprised 4681 respondents. The survey respondents were placed into 4 patient groups: those who had received care for mental health, cancer, or other conditions and those who had received no care. Associations between the type of care and patients who felt offended were estimated using multivariate binary logistic regression. Inductive content analysis (n=502) was conducted to identify information perceived as offensive in the EHR. RESULTS: The patients who had received mental health care (166/654, 25.4%) or cancer and mental health care (9/39, 23.1%) were more likely to be offended by information in their EHR compared to the other groups (cancer care: 37/375, 9.9%; other conditions care: 383/3316, 11.6%; no care: 22/206, 10.7%; other conditions care: odds ratio 0.37, 95% CI 0.29-0.46; P<.001; model A). Additionally, female patients, those with bad or very bad health conditions, and patients with bachelor's or master's degrees were significantly more likely to feel offended. Errors, the health care professionals' disrespectful language, and perceived unnecessary information were the most frequently mentioned reasons for being offended. Patients with mental health care reported more often that unnecessary information and professionals' opinions and word choices were experienced as offensive compared to other patients. CONCLUSIONS: This study contributes new knowledge by identifying differences across multiple patient groups. Although a minority of patients felt offended by their EHR, health care professionals should consider that some patients, particularly those who have received mental health care or cancer and mental health care, may be offended by specific information or word choices in their EHRs. To address this, health care professionals should receive education on how to write their notes in a neutral tone and avoid potentially offensive topics. Improving the quality of EHRs could strengthen the relationship between patients and professionals.
15 May 2026
Read appraisal →Journal of neurology
The effects of computerized cognitive training on cognitive function in patients with mild cognitive impairment: a systematic review and meta-analysis
BACKGROUND: We sought to quantify the effects of computerized cognitive training (CCT) on patients with mild cognitive impairment (MCI), to inform the development of clinical non-pharmacological intervention strategies. METHODS: We searched PubMed, Cochrane Library, Embase, and Web of Science databases from 2007 to February 2026 for randomized controlled trials (RCTs) of CCT in patients with MCI. Outcomes including global cognition, specific cognitive domains, psychosocial functioning, and activities of daily living were analyzed separately by stata 18 and Review Manager 5.4. RESULTS: We included 30 studies and 2056 participants. Our meta-analysis revealed that, compared with control conditions, CCT led to a significant moderate improvement in overall cognitive function, standardized mean difference (SMD) = 0.62, 95% confidence interval (CI) = 0.43-0.81; I2 = 73%. Subgroup analysis showed that intervention characteristics-including session duration, training device, total intervention length, weekly frequency, sample size, and assessment tools-yielded similar improvements in global cognition, with no statistically significant differences between subgroups. These findings indicate that the cognitive benefits of CCT are consistent and robust. CONCLUSION: This systematic review and meta-analysis shows CCT significantly improves global cognitive function in MCI patients, with stable benefits across subgroups. Despite clear overall effects, high heterogeneity, varying training protocols and assessment tools exist. Further large, long-term RCTs are needed to clarify CCT's long-term effects and support its standardized clinical application. TRIAL REGISTRATION: PROSPERO International prospective register of systematic reviews CRD420261328762; https://www.crd.york.ac.uk/PROSPERO/view/CRD420261328762 .
15 May 2026
Read appraisal →Current allergy and asthma reports
Pharmacotherapeutic Medication Adherence in Patients With Allergic Rhinitis: A Systematic Review and Meta-Analysis
PURPOSE OF REVIEW: Medication adherence is essential for effective management of allergic rhinitis (AR), yet real-world adherence to guideline-recommended pharmacotherapies remains poorly characterized. This systematic review and meta-analysis aims to estimate pooled adherence proportions to prescribed intranasal corticosteroids and oral antihistamines in adults with AR, further stratified by adherence measurement method and geographic region. RECENT FINDINGS: Twelve studies encompassing 191,103 AR patients were included. Overall pooled adherence to both intranasal corticosteroids and oral antihistamines was 43%, with substantial heterogeneity across studies. Adherence estimates differed significantly by measurement method with self-reported adherence consistently exceeding pharmacy refill-based estimates for both medication classes. Significant geographic variation was also observed, with intranasal corticosteroid adherence ranging from 17% in North America to 61% in Asia, and oral antihistamine adherence ranging from 26% in North America to 48% in Northern and Western Europe. Peters' test did not indicate any significant publication bias and a Leave-One-Out (LOO) sensitivity analysis showed that no single study had a disproportionate effect on the overall effect size. Adherence to pharmacotherapy in AR is suboptimal, highly method-dependent, and varies significantly across geographic regions. These findings suggest that reported adherence rates are not only influenced by patients' behaviour, but also by the methods used to measure adherence and the broader healthcare environment. Integrating methodological rigour with geographic stratification provides more informative benchmarks for clinical practice and highlights the need for context-sensitive strategies to improve real-world AR management. Future research should prioritize standardized adherence measurement and prospective studies in underrepresented regions.
15 May 2026
Read appraisal →Journal of affective disorders
Machine learning and SHAP-based interpretation of dietary antioxidants' impact on comorbid MDD and suicidal ideation.
OBJECTIVE: To develop and validate a machine learning model for predicting major depressive disorder (MDD) with suicidal ideation (SI) by incorporating dietary antioxidants, and to elucidate the specific contribution of these antioxidants in the prediction. METHODS: Data were obtained from NHANES 2007-2010. Dietary antioxidants, including vitamins, minerals, and polyphenols, were the primary predictors. Demographic, lifestyle, and health-related variables were also included. Collinear variables were removed, class imbalance was corrected, and data were normalized prior to modeling. Twelve machine learning algorithms were compared using a systematic benchmarking protocol within the sklearn framework: Random Forest (RF), LightGBM, AdaBoost, XGBoost, Extra Trees, CatBoost, Gradient Boosting Decision Trees, Support Vector Machine, Decision Tree, Gaussian Naïve Bayes, Stochastic Gradient Descent, and K-Nearest Neighbors. SHapley Additive exPlanation (SHAP) values were calculated to interpret feature contributions within the best-performing model. RESULTS: A total of 9306 participants were included, of whom 247 with MDD comorbid with SI. After preprocessing, 31 dietary antioxidants and 9 demographic and health-related variables were retained for modeling. The RF classifier achieved the highest performance with an accuracy of 83%, precision of 0.825, recall of 0.838, area under the ROC curve of 0.927, and F1 score of 0.831. SHAP analysis identified vitamin C, kaempferol, myricetin, peonidin, luteolin, eriodictyol, hesperetin, pelargonidin, and zinc as the most influential predictors. CONCLUSION: The RF model exhibited superior predictive capability for comorbid MDD and SI. SHAP analysis highlighted the critical roles of dietary antioxidants, particularly vitamin C and kaempferol, in predicting these outcomes.
15 May 2026
Read appraisal →Journal of medical Internet research
Machine Learning and Deep Learning Models for Predicting Future Falls in Community-Dwelling Older Adults: Systematic Review and Meta-Analysis of Longitudinal Evidence
BACKGROUND: Machine learning (ML) and deep learning (DL) show promise for fall risk prediction, but prior reviews focused mainly on real-time fall detection, in-hospital falls, or conventional statistical models. The performance of ML-DL-based models for predicting future falls in community-dwelling older adults remains unclear. OBJECTIVE: This study aimed to review ML-DL studies for predicting future falls among community-dwelling older adults and meta-analyze discrimination where feasible. METHODS: Six databases were searched from inception to September 23, 2024, with updates on August 31, 2025, and February 28, 2026. We included longitudinal studies developing or validating ML-DL models to predict future falls in community-dwelling adults aged ≥60 years and excluded real-time detection, simulated or no fall, and inpatient studies. Risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Areas under the curve (AUCs) were meta-analyzed using Hartung-Knapp-Sidik-Jonkman random-effects models with 95% CIs. Heterogeneity, 95% prediction intervals (PIs), sensitivity analyses, and subgroup analyses were conducted. RESULTS: After screening 10,253 records, 28 (0.3%) studies were included; 18 (64.3%) focused on general older adults. Prediction horizons ranged from 3 months to 7 years, and fall incidence ranged from 1.6% to 46.6%. Twenty-three (82.1%) studies applied ML, and 5 (17.9%) studies used DL. Input modalities included text (n=18, 64.3%), sensor (n=5, 17.9%), image (n=1, 3.6%), and multimodal data (n=4, 14.3%). Common predictors included age, sex, fall history, depression, and basic daily activities. Only one model underwent external validation. Calibration reporting was sparse. All models were rated at high risk of bias. Ten models were meta-analyzed, yielding a pooled AUC of 0.79 (95% CI 0.69-0.87) with extreme heterogeneity (τ2=0.64; τ=0.80; I2=99.8%; Q=4128.99). The confidence-distribution bootstrap PI was 0.20 to 0.99, indicating substantial uncertainty in expected performance across new populations. Subgroup analyses indicated moderation by sample size and population type, with higher discrimination in specific populations than in general samples; however, the specific population subgroup included only 2 studies. Although all participants were community dwelling, some cohorts were recruited through clinically enriched pathways rather than general community sampling. CONCLUSIONS: ML-DL models show potential for identifying community-dwelling older adults at elevated future fall risk; however, wide PIs, limited external validation, and high risk of bias suggest real-world performance may be optimistic. The pooled AUC should be interpreted as a summary of reported discrimination under study-specific conditions, predominantly from internally validated, high-risk-of-bias models, rather than as a robust estimate of transportable real-world performance. This review extends prior reviews by focusing on community-dwelling settings and by integrating PROBAST, Hartung-Knapp-Sidik-Jonkman meta-analysis, PIs, and modality-specific synthesis to evaluate both discrimination and uncertainty. Findings support the use of ML-DL models for proactive fall prevention while emphasizing the need for validation and context-specific implementation.
15 May 2026
Read appraisal →Journal of affective disorders
Systematic review and meta-analysis of intranasal esketamine for treatment-resistant depression: Evidence from real-world studies
BACKGROUND: Intranasal esketamine has demonstrated efficacy and safety for treatment-resistant depression in randomized controlled trials, however the generalizability of these findings to clinical practice remains unclear. This systematic review and meta-analysis aimed to synthesize real-world evidence of intranasal esketamine in patients with treatment-resistant depression. METHODS: A systematic search was conducted in PubMed, Embase, and PsycINFO up to April 2025 to identify observational studies reporting clinical outcomes of intranasal esketamine in adults with treatment-resistant depression. Standardized mean changes in depressive symptoms and odds ratios for remission were calculated. Random-effects meta-analyses were performed, followed by meta-regression to explore potential moderators. The study protocol was prospectively registered in PROSPERO (CRD420251025075). RESULTS: Nine studies were included in the final synthesis. The analyses demonstrated that intranasal esketamine showed substantial effectiveness, with an effect size of Hedges' g = -1.98 (95% CI -2.94 to -1.03; p < 0.0001). Patients were about five times more likely to achieve remission at three months compared with the induction phase (OR = 5.1, 95% CI 2.29-11.39). Treatment effectiveness was not influenced by factors such as gender or the presence of comorbidities, such as anxiety, personality, or substance use disorders. The pooled prevalence of any adverse event, based on studies that reported safety data, was 82% (95% CI 69-92). The most frequent was dissociation, reported in 49% of patients (95% CI 37-62). CONCLUSIONS: This study provides consistent real-world evidence supporting that Intranasal esketamine was associated with meaningful symptom reduction and rising remission rates over time in real-world settings. Given the observational nature of the evidence and the absence of control groups, effect sizes should be interpreted with caution. Nonetheless, these findings provide valuable insight into esketamine's effectiveness and tolerability in routine practice and highlight the need for controlled comparative studies to guide long-term treatment strategies.
15 May 2026
Read appraisal →Computers in biology and medicine
Dual-model deep learning for Alzheimer's prognostication
Disease-modifying therapies for Alzheimer's disease demand precise timing decisions, yet current predictive models require longitudinal clinical observations and provide no uncertainty quantification-rendering them impractical at the critical first-visit encounter when treatment decisions must be made. We developed PROGRESS (PRognostic Generalization from REsting Static Signatures), a dual-model deep learning framework that transforms a single baseline cerebrospinal fluid (CSF) biomarker assessment into actionable prognostic estimates without requiring prior clinical history. The framework addresses two complementary clinical questions: a probabilistic trajectory network predicts individualized cognitive decline parameters with calibrated uncertainty bounds that achieve near-nominal coverage, enabling honest prognostic communication rather than false precision; and a deep survival model estimates time-to-conversion from mild cognitive impairment to dementia. Using data from over 3000 participants across 43 Alzheimer's Disease Research Centers in the National Alzheimer's Coordinating Center database, PROGRESS substantially outperforms existing approaches including Cox proportional hazards, Random Survival Forests, and gradient boosting methods for survival prediction. Risk stratification identifies patient groups with seven-fold differences in conversion rates, enabling clinically meaningful treatment prioritization. Leave-one-center-out validation demonstrates robust generalizability, with survival discrimination remaining strong across all held-out clinical sites despite heterogeneous measurement conditions spanning four decades of assay technologies. By combining superior survival prediction with trustworthy trajectory uncertainty quantification, PROGRESS bridges the gap between biomarker measurement and personalized clinical decision-making-providing the prognostic timeline that current staging approaches cannot offer.
15 May 2026
Read appraisal →BMC endocrine disorders
Effects of digital and remote exercise interventions on HbA1c in type 2 diabetes: a systematic review and network meta-analysis
BACKGROUND: To compare the effects of different digitally and remotely deliveredexercise interventions on glycated hemoglobin (HbA1c) in adults with type 2diabetes mellitus (T2DM) using a network meta-analysis (NMA), and to clarifythe relative effectiveness of distinct delivery models. METHODS: A systematic review and network meta-analysis of randomized controlledtrials was conducted following PRISMA-NMA guidelines and prospectivelyregistered in PROSPERO (CRD420261288210). Major databases were searched frominception to November 11, 2025. Exercise-centered digital and remoteinterventions were categorized as digital exercise interventions (DEX),structured exercise prescription (SEP), multi-behavior lifestyle interventions(MBLI), and tele-exercise/tele-rehabilitation (TEX). The primary outcome waschange in HbA1c. RESULTS: Fifty-four RCTs were included. Compared with control, TEX demonstratedthe greatest reduction in HbA1c (MD -0.51%, 95% CrI -0.88 to -0.14), followedby MBLI (MD -0.32%, 95% CrI -0.51 to -0.13). SEP showed a non-significanttrend, and DEX did not significantly reduce HbA1c. SUCRA rankings favored TEX(0.87), followed by MBLI (0.66), SEP (0.62), and DEX (0.24). Subgroup analysessuggested that HbA1c reductions with TEX and MBLI were more evident among olderadults (≥60 years) and those with longer diabetes duration（>10 years）;however, network inconsistency was detected in these subgroups, and findingsshould be interpreted cautiously. CONCLUSIONS: Digitally and remotelydelivered exercise interventions differ in their effectiveness for HbA1ccontrol in T2DM. Interventions incorporating ongoing professional supervisionare associated with the most consistent glycemic benefits, whereas largelyautomated approaches show limited effects, highlighting the importance ofdelivery structure and supervision intensity.
15 May 2026
Read appraisal →Neurology. Clinical practice
Clinical Meaningfulness of Donanemab in Early Symptomatic Alzheimer Disease: Data From the Randomized Phase 3 TRAILBLAZER-ALZ 2 Trial
BACKGROUND AND OBJECTIVES: Understanding the meaningfulness of clinical trial outcomes is essential for people living with Alzheimer disease (AD) and their clinicians to make evidence-based shared treatment decisions in real-world clinical care. Donanemab, a monoclonal antibody targeting the insoluble form of β-amyloid found in plaques, significantly slows cognitive and functional decline of AD in participants with mild cognitive impairment (MCI) or mild AD-related dementia. This analysis reviews the efficacy of donanemab across various clinical outcome assessments, using both published data and new complementary analyses to provide context on its potential benefits for patients and caregivers. METHODS: We present findings from prespecified and post hoc analyses from the TRAILBLAZER-ALZ 2 trial. Clinical outcomes assessed were Integrated AD Rating Scale (iADRS), comprising the 13-item AD Assessment Scale-Cognitive Subscale (ADAS-Cog13) and AD Cooperative Study-Instrumental Activities of Daily Living (ADCS-iADL); Clinical Dementia Rating (CDR)-Sum of Boxes (CDR-SB) for clinical severity and individual cognitive and functional domains; CDR-Global for clinical severity stage progression; meaningful within-patient change (MWPC); and ADCS-Activities of Daily Living dependence score. RESULTS: Donanemab reduced the risk of progression from MCI to mild AD by 33% (hazard ratio [HR] = 0.67; 95% CI 0.52-0.87; p = 0.003) and from mild to moderate AD by 50% (HR = 0.50; 95% CI 0.33-0.78; p = 0.002). In addition, donanemab reduced MWPC risk over 76 weeks by 38% for CDR-SB (HR = 0.62; 95% CI 0.52-0.75; p < 0.001) and 30% for iADRS (HR = 0.70; 95% CI 0.58-0.84; p < 0.001). Donanemab-treated participants exhibited significant slowing of clinical progression across multiple ADAS-Cog13 and ADCS-iADL items and all CDR-SB cognitive and functional domains. Donanemab also slowed progression of dependence least-squares mean change difference, -0.14 [95% CI -0.24 to -0.04; p = 0.007]), representing 23% slowing of progression (95% CI 6.17%-40.32%), and reduced risk of progression to requiring in-home support by 27% (HR = 0.74; 95% CI 0.59-0.91; p = 0.005). DISCUSSION: These results add to the evidence and further support clinically meaningful donanemab-mediated effects on cognition and function for patients and their caregivers and may aid communication of realistic treatment expectations and informed decision-making. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov NCT04437511. Submitted: June 17, 2020; First patient enrolled: June 19, 2020. clinicaltrials.gov/study/NCT04437511 EudraCT Number 2020-000077-25. Start date of recruitment: June 19, 2020. clinicaltrialsregister.eu/ctr-search/trial/2020-000077-25/results.
15 May 2026
Read appraisal →Translational psychiatry
Acute placebo responsiveness predicts longitudinal expectation effects in antidepressant treatment
Positive treatment expectations are known to enhance antidepressant efficacy. Experimental placebo studies aim to provide mechanistic insights into this association, yet their findings have not been clearly linked to clinical expectation effects within individual patients. In a randomized crossover trial, 61 participants with major depressive disorder (31 women, 30 men) completed an emotion classification task and mood assessments after administration of a saline nasal spray labeled as either oxytocin (sham oxytocin treatment, deceptive placebo) or saline (control). Forty-five participants subsequently underwent antidepressant treatment and were monitored weekly for treatment expectations and depressive symptoms, with follow-ups extending to three months. Using linear mixed-effect models, we examined trajectories of clinical expectation effects and their prediction by experimental placebo-induced changes in emotional processing. Sham oxytocin treatment acutely induced positive expectations, improved mood, and shifted emotional processing toward positivity. Longitudinal modeling revealed that weekly reductions in depressive symptoms were predicted by higher treatment expectations reported the preceding week. These clinical expectation effects were most pronounced in individuals exhibiting strong acute placebo responses in emotional processing. Overall, our findings indicate that positive treatment expectations facilitate critical aspects of emotional processing in depression and that individual responsiveness generalizes across different treatments and time windows. Experimental placebo assessments offer an ecologically valid model for elucidating mechanisms and predictors of clinical expectation effects and highlight expectation sensitivity as a promising target for treatment optimization.
15 May 2026
Read appraisal →BMJ mental health
Emulated trial of artificial intelligence use and subsequent depressive outcomes in a survey of US adults
BACKGROUND: Generative artificial intelligence (AI) use has been suggested to have adverse mental health consequences but a causal relationship has not been examined. OBJECTIVE: To simulate a randomised controlled trial of AI use in a work, school or personal context by applying target trial emulation to multiple waves of data from a nationally representative survey. METHODS: We conducted a target trial emulation using non-probability survey data from three waves of a nationally representative survey conducted between 18 June 2024 and 8 January 2025. Participants aged ≥18 years reported generative AI use frequency at baseline. High-frequency use was defined as multiple times per week or more. The primary outcome was depressive symptom severity measured using the Patient Health Questionnaire 9-item (PHQ-9) at follow-up. Generalised causal forests assessed heterogeneity of treatment effects. FINDINGS: Among 19 099 participants assessed at baseline, 2862 (15.0%) reported AI use at least multiple times per week. A subset of 3109 (16.3%) returned for follow-up. In the primary weighted analysis, high-frequency use was not significantly associated with change in PHQ-9 score at follow-up (mean difference -0.18, 95% CI -0.94 to 0.59; p=0.65). Multiple sensitivity analyses using alternate outcome definitions also did not identify significant causal effects. Generalised causal forests yielded no significant evidence of heterogeneity of effect (p=0.81). CONCLUSIONS: In an emulated randomised trial among US adults, generative AI use was not associated with subsequent depressive symptoms. This result does not support the premise that AI use causes greater depressive symptoms, although adverse outcomes among vulnerable individuals cannot be excluded. CLINICAL IMPLICATIONS: AI use is unlikely to cause increased depressive symptoms among most US adults. Continued monitoring should clarify potential risks among vulnerable populations.
15 May 2026
Read appraisal →BMJ open
Developing and validating an electronic health record-embedded AI model for managing multimorbid hospitalisation risk in patients with chronic RESpiratory disease (AiRES): a study protocol
BACKGROUND: Chronic respiratory diseases (CRDs), such as asthma and chronic obstructive pulmonary disease (COPD), are heterogeneous conditions with a high multimorbidity burden. However, existing risk assessment instruments prioritise physiological measures while overlooking systemic comorbidities. We aim to develop and validate an electronic health record (EHR)-embedded artificial intelligence (AI) model-AiRES (AI in patients with RESpiratory disease)-to predict the 30-day, 90-day and 180-day risks of all-cause and index-disease hospitalisations. This model represents a first step towards a clinical decision support tool for personalised multimorbidity management in patients with CRD. METHOD AND ANALYSIS: Patients aged ≥18 years with a validated case definition of asthma and COPD will be identified from Singapore health administrative data (2012-2020). Candidate predictors will include age, sex, ethnicity, housing type, and comorbidities, measured across multiple care settings as visit frequency, grouped at quarterly intervals in Year 1 and annually for Years 2 and 3 over a 3-year lookback window. We will predict 30-day, 90-day, and 180-day risks of (1) all-cause and (2) asthma/COPD-specific hospital admissions using up to five randomly selected index dates per individual. Three machine learning algorithms-logistic regression (LR) with Lasso regularisation, eXtreme Gradient Boosting, and Categorical Boosting-will be trained using 10-fold cross-validation (CV) with an ensemble feature selection strategy. The optimal model, selected based on performance and feature importance, will be benchmarked against two reference models: a full LR and a Zero-Inflated Negative Binomial regression with hospitalisation history as the sole predictor. Discrimination and calibration will be assessed using internal-external cluster-based and temporal CV. Clinical utility will be evaluated using decision curve analysis. ETHICS AND DISSEMINATION: This study obtained ethics approval from the National University of Singapore (NUS-IRB-2024-849). Results will be published in international peer-reviewed journals.
15 May 2026
Read appraisal →European respiratory review : an official journal of the European Respiratory Society
Exploring the role of cold air in airway hyperresponsiveness and asthma diagnostic testing: a systematic review and meta-analysis
BACKGROUND: Asthma is a heterogeneous disease, making uniform diagnosis challenging, resulting in both under- and overdiagnosis. We conducted a systematic review and meta-analysis to summarise the data on diagnostic accuracy of a cold air bronchial challenge test (CACh) in exercise-induced bronchoconstriction and asthma. METHODS: Databases (PubMed, Embase, Web of Science core collection, Cochrane Library and the Cumulative Index to Nursing and Allied Health Literature via EBSCO) were systematically screened for articles evaluating the use of CACh as a diagnostic tool in exercise-induced bronchoconstriction and asthma. A random-effects model was used to calculate the effect on the reduction in forced expiratory volume in 1 s (FEV1) by CACh in healthy controls compared to patients with asthma. Risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-Comparative. This study is registered with PROSPERO (www.crd.york.ac.uk/PROSPERO/ identifier number CRD42021290350). RESULTS: After screening and removal of duplicates, 39 studies were included. Aggregate sensitivity and specificity of a FEV1 decrease ≥10% after CACh were 0.808 and 0.959, respectively. The weighted mean difference in percentage FEV1 decrease after CACh for patients with asthma compared to healthy controls was -17.58. High heterogeneity (I2=99) was mainly explained by differences in reference tests to diagnose asthma. Application of the trim-and-fill method to account for publication bias imputed eight studies, resulting in a notable reduction in heterogeneity. The overall effect (a significant decrease in FEV1 in patients with asthma) remained statistically significant (-8.18, p<0.001). CONCLUSION: Our study shows the high sensitivity and specificity and possible clinical implications of a CACh in the diagnosis of asthma. Further research is needed to confirm this.
15 May 2026
Read appraisal →BMJ open
Prevalence of anxiety and depression in adults who are high users of healthcare services and magnitude of associated costs: a systematic review
OBJECTIVES: Anxiety and depression are common and associated with higher use of general healthcare services. The aims of this systematic review were to (1) estimate the prevalence of anxiety and depression in adults who are high or costly users of general healthcare services in comparison to routine users and (2) estimate the magnitude of healthcare costs associated with the presence of anxiety and depression. DESIGN: Systematic review of the available literature. DATA SOURCES: MEDLINE, PsycINFO, EMBASE, CINAHL, PROSPERO and Cochrane Library were systematically searched without language restriction from inception to 1 April 2019 and updated on 25 October 2022, 16 October 2024 and 18 February 2026. ELIGIBILITY CRITERIA: Eligible studies described adults aged ≥18 years who were defined as high or costly general healthcare users and where the prevalence and/or associated costs of anxiety and/or depression were quantified. DATA EXTRACTION AND SYNTHESIS: Three reviewers independently extracted information on study characteristics, exposure and outcomes. RESULTS: From the 38 412 identified articles, 27 studies from 10 countries (in Europe, North America and Asia) involving 6 145 907 participants met eligibility criteria and were included. There were wide variations in the estimated prevalence of anxiety (3.8-67.2%) and depression (4.7-77.9%) among high healthcare users. The prevalence of both disorders was higher among high healthcare users than routine users in all studies with non-high user comparator groups. Only four studies investigated healthcare costs associated with depression. These uniformly reported that general healthcare costs are higher for those with depression than those without. No studies investigated costs associated with anxiety. CONCLUSIONS: Anxiety and depression are over-represented among high or costly healthcare users, although accurate quantification of the magnitude of difference is precluded by significant methodological heterogeneity and variability in definitions used. Improved identification of covert mental health problems is essential for the provision of effective interventions for patients and healthcare expenditure reduction. Future research should prioritise a standardised approach, with agreed definitions for high and/or costly healthcare use in different contexts. PROSPERO REGISTRATION NUMBER: CRD42018102628.
15 May 2026
Read appraisal →The New England journal of medicine
Ensitrelvir for Covid-19 Postexposure Prophylaxis in Household Contacts
BACKGROUND: Ensitrelvir, an oral inhibitor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 3C-like protease, is approved in Japan for the treatment of mild-to-moderate coronavirus disease 2019 (Covid-19). Previously, no antiviral agents were approved for postexposure prophylaxis in household contacts of patients with Covid-19. METHODS: In this double-blind, randomized, placebo-controlled trial, we randomly assigned persons who were SARS-CoV-2-negative on local diagnostic testing but were household contacts of a patient with Covid-19 (the index patient) to receive either ensitrelvir (375 mg on day 1 and 125 mg daily on days 2 through 5) or placebo within 72 hours after symptom onset in the index patient. The primary end point was Covid-19 (defined by a central laboratory-confirmed positive reverse-transcriptase-polymerase-chain-reaction assay and the presence of ≥1 of 14 prespecified Covid-19 symptoms lasting ≥48 hours) by day 10 in a household contact in the modified intention-to-treat population (all the participants who underwent randomization, had a central laboratory-confirmed negative RT-PCR test for SARS-CoV-2 at baseline, and received at least one dose of the trial drug or placebo). RESULTS: The modified intention-to-treat population included 1030 participants in the ensitrelvir group and 1011 in the placebo group. The mean age of the participants was 42.4 years; 71.1% had undergone randomization within 48 hours after symptom onset in the index patient, and 37.0% had at least one risk factor for severe Covid-19. The incidence of Covid-19 was lower in the ensitrelvir group than in the placebo group (2.9% vs. 9.0%; risk ratio, 0.33; 95% confidence interval [CI], 0.22 to 0.49; P<0.001). The incidence of adverse events during the trial was similar in the two groups (15.1% in the ensitrelvir group and 15.5% in the placebo group), as was the incidence of serious adverse events (0.2% in each group). No Covid-19-related hospitalizations or deaths were reported. CONCLUSIONS: Ensitrelvir administered to household contacts of a patient with Covid-19 within 72 hours after symptom onset in the index patient was effective in preventing Covid-19 in the contacts. (Funded by Shionogi; SCORPIO-PEP Japan Registry for Clinical Trials number, jRCT2031230124; ClinicalTrials.gov number, NCT05897541.).
15 May 2026
Read appraisal →Journal of the American College of Cardiology
Global Hypertension 2000 to 2020: Trends, Disparities, and Progress in Awareness, Treatment, and Control
BACKGROUND: Hypertension is the leading preventable risk factor for premature death worldwide. Accurate estimates of prevalence and control are critical for developing public health priorities. OBJECTIVE: This study sought to examine global variations in hypertension prevalence, awareness, treatment, and control by world economic region and compare secular changes from 2000 to 2020. METHODS: A systematic search of MEDLINE from January 1995 to November 2024 was supplemented with manual searches of article references. Population-based cross-sectional surveys reporting age- and sex-specific hypertension prevalence and using standardized blood pressure measurement methods were included. Sex- and age-specific prevalence by country was applied to population counts to calculate the number with hypertension regionally and worldwide. Country-specific percentages of awareness, treatment, and control were applied to numbers of adults with hypertension to obtain regional and global estimates. Hypertension was defined as mean systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive medication. RESULTS: We included 287 studies conducted in 6,060,567 adults from 119 countries. In 2020, 33.0% (95% CI: 32.5%-33.5%), or 1.71 (95% CI: 1.65-1.77) billion, of the world's adults had hypertension: 30.1% (95% CI: 29.4%-30.9%), or 395 (95% CI: 394-396) million, in high-income countries and 33.4% (95% CI: 32.8%-33.9%), or 1.32 (95% CI: 1.26-1.38) billion, in low- and middle-income countries. From 2000 to 2020, age-standardized prevalence decreased by 2.7% and absolute burden increased by 76 million in high-income countries compared with increases of 5.8% in prevalence and 651 million in absolute burden in low- and middle-income countries. From 2000 to 2020 in high-income countries, awareness increased from 57.7% to 69.2%, treatment from 42.9% to 66.3%, and control from 16.4% to 40.2%. More modest increases were observed in low- and middle-income countries: awareness from 29.1% to 46.1%, treatment from 20.7% to 30.8%, and control from 6.4% to 13.6%. CONCLUSIONS: The burden of hypertension is increasing, as are disparities between high-income countries and low- and middle-income countries. Urgent efforts are needed to address hypertension worldwide, particularly in low- and middle-income countries.
15 May 2026
Read appraisal →PloS one
Health related quality of life among hypertensive adults living in rural Vietnam: Results from a cluster-randomised controlled trial
BACKGROUND: There is a growing burden of hypertension (HTN) among adults living in rural Vietnam, which is associated with reduced health related quality of life (HRQoL). Few community-based interventions have, however, attempted to improve the quality of life in patients with uncontrolled HTN. This study aimed to examine the impact of a multi-component intervention on HRQoL in adults with uncontrolled HTN. METHODS: This cluster-randomized controlled trial was conducted in sixteen communities (8 intervention and 8 comparison) living in a rural setting in Vietnam (2017-2022). Consenting adults with uncontrolled HTN were enrolled. The comparison arm received training sessions about HTN prevention and management and patient education materials. The intervention arm received information similar to the comparison group and three enhancement components, namely a storytelling intervention, home blood pressure (BP) self-monitoring, and expanded community health worker services. The primary outcome was the differential change in HRQoL over 12-month follow-up period, measured using the 12-Item Short Form Health Survey (SF-12), which generates a Physical Component Summary (PCS-12) and a Mental Component Summary (MCS-12). The total HRQoL score was calculated as the sum of PCS-12 and MCS-12, with higher scores indicating better HRQoL. RESULTS: A total of 671 patients were studied; their mean age was 66 years and 55% were women. At the 12-month follow-up, the intervention group showed a significant increase in their PCS-12 with a multivariable-adjusted difference of 4.2 points (95% CI: 2.0-6.4) compared with the control group. While the MCS-12 scores increased for both groups, their differential change over 12 months was not statistically significant (multivariable-adjusted difference: 1.4 points; 95% CI: -0.6; 3.5). CONCLUSION: Our results demonstrate that a multicomponent intervention effectively improved overall HRQoL with a significant impact on physical health-related HRQoL in individuals with uncontrolled HTN. TRIAL REGISTRATION: ClinicalTrials.gov, Registration number: https://clinicaltrials.gov/study/NCT03590691, (registration date July 17, 2018).
15 May 2026
Read appraisal →Journal of medical Internet research
Leveraging Text Messaging and Behavior Theory to Improve Colorectal Cancer Screening in Federally Qualified Health Centers: Cohort Study
BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Despite recommendations for screening to begin at the age of 45 years, significant disparities persist, particularly among medically underserved populations. OBJECTIVE: This study examines the effectiveness of SMS text messaging reminders in improving CRC screening rates across 2 large federally qualified health centers (FQHCs) serving vulnerable populations. METHODS: The study included 4822 adults aged ≥45 years, receiving care at 2 large FQHC networks in Texas and California. Participants were assigned to one of four groups: (1) control (no SMS text messages), (2) single-outreach SMS text overdue message, (3) three-week SMS overdue and reminder text messages, and (4) six-week SMS text messages that were informed by behavior theory. Data were collected from May 2023 to July 2024. The outcome measure was a binary indicator of whether the participant underwent 1 of 3 CRC tests, fecal immunochemical test, colonoscopy, and Cologuard, within 90 days of completing the SMS text messaging reminders. Independent variables included demographic, geographic, clinical, and primary care access variables. Multivariate logistic regression models were used to examine associations between CRC screening completion and the SMS text messaging reminder groups, adjusting for covariates. Adjusted odds ratios (aORs) and 95% CIs were reported. RESULTS: In the combined 3-test model, patients in the single-outreach SMS text message (aOR 1.22, 95% CI 1.00-1.47) and the 3-week SMS text message (aOR 1.27, 95% CI 1.05-1.53) groups had higher odds of completing the screening test compared to those in the control group. Within the fecal immunochemical test-only model, patients in the 3-week SMS text message group (aOR 1.25, 95% CI 1.00-1.56) were more likely to complete the screening test. Within the Cologuard-only model, patients in the 3-week SMS text message group (aOR 7.01, 95% CI 1.96-25.07) and the 6-week SMS text message group (aOR 5.75, 95% CI 1.53-21.61) had significantly higher odds of CRC screening completion. CONCLUSIONS: The findings highlight that moderate-frequency SMS text messaging reminders can effectively increase CRC screening rates in FQHCs; however, critical factors include the timing and frequency of these reminders. The 3-week intervention was associated with improved screening uptake, whereas the 6-week theory-informed intervention did not demonstrate a significant advantage over the control group, potentially reflecting a ceiling effect or message fatigue associated with more frequent messaging. Additionally, the study highlights unique screening patterns that contradict previous literature, underscoring the importance of a tailored approach for vulnerable communities.
15 May 2026
Read appraisal →JMIR aging
Leveraging Multimodal Large Language Models for Fall Risk Reduction in Older Adults in the Home: Proposed Model Design
This research letter proposes a novel model design leveraging natively multimodal large language models to identify fall risks and generate visualizations of recommended home environmental modifications, aiming to improve the accessibility and impact of personalized fall prevention advice for older adults. Through a pilot rating study, this work demonstrates that multimodal large language models can generate safe and actionable advice to reduce fall risk in lived spaces of older adults, and also generate realistic edits based on original images. While this concept needs further testing and clinical comparison, it highlights a promising avenue for further innovation of fall prevention tactics.
15 May 2026
Read appraisal →PloS one
Emotion-focused therapy and forgiveness in the older population: Protocol for a feasibility randomized controlled trial
Over recent decades, Emotion-Focused Therapy, aging, and forgiveness have garnered significant attention in the field of psychology. However, there is a lack of studies on Emotion-Focused Therapy and forgiveness specifically tailored for older adults. This article presents a protocol designed to assess the feasibility and acceptability of a randomized controlled trial of Emotion-Focused Therapy aimed at resolving emotional injuries in individuals aged 65 and older, within the context of interpersonal offenses. Feasibility will be evaluated through recruitment and retention rates, as well as adherence to the intervention protocol. Acceptability will be assessed based on perceived treatment credibility, participants' expectations regarding outcomes, levels of engagement, and overall satisfaction with the intervention. The study is structured as a two-arm, parallel-group randomized trial with a waiting list control. We propose recruiting a sample of 70 participants, randomly assigned to either an immediate intervention group, which will receive Emotion-Focused Therapy over twelve weekly sessions, or a control group that will receive the same therapy after a twelve-week waiting period. Data will be collected in the beginning, middle, and at the end of therapy, and in two planned follow-ups (three and six months after therapy). Once this protocol is implemented, if the therapy proves to be feasible, acceptable, and shows promising results, the findings will inform a large-scale randomized clinical trial to advance the understanding of this treatment for individuals aged 65 + .
15 May 2026
Read appraisal →Journal of the American College of Cardiology
Blood Pressure Levels and Outcomes in Type 2 Diabetes: Dose-Response Meta-Analysis of 5.87 Million Cohort Participants
BACKGROUND: The dose-response relationships between systolic and diastolic blood pressure (SBP and DBP) levels and risks of all-cause mortality, cardiovascular and renal outcomes in type 2 diabetes remain poorly characterized, particularly at lower blood pressure (BP) levels. OBJECTIVE: This study aimed to examine risk patterns of major clinical outcomes across a wide range of BP levels in participants with type 2 diabetes. METHODS: We systematically searched PubMed, Embase, and Web of Science from inception to November 30, 2024, for cohort studies assessing associations of BP levels with all-cause mortality, cardiovascular, and renal outcomes. One-stage mixed-effects dose-response meta-analysis was conducted to assess the curvilinear associations. RESULTS: A total of 89 cohorts from 113 articles of 5,875,364 participants with type 2 diabetes were identified. A J-shaped association was observed for SBP with all-cause mortality. J-shaped associations were also observed for SBP with cardiovascular events and for DBP with all-cause mortality, with flattened risks at lower BP levels. After excluding studies with participants who had baseline cardiovascular diseases or cancer, a significantly lower risk of cardiovascular events was observed at lower SBP levels, as well as a flattened risk of all-cause mortality. Positive linear or monotonic trends were observed for renal events, estimated glomerular filtration rate decline, and development or progression of albuminuria. CONCLUSIONS: In type 2 diabetes, BP is linearly or monotonically associated with most cardiovascular and renal outcomes. Low SBP does not appear to be associated with an elevated risk of all-cause mortality compared with higher BP targets, suggesting that previously reported associations are likely due to reverse causation and unmeasured confounding.
15 May 2026
Read appraisal →Journal of the American College of Cardiology
Single-Pill Low-Dose Triple Combination Therapy vs Standard-Dose Monotherapy in Patients With Mild-to-Moderate Hypertension
BACKGROUND: Single-pill low-dose combination (LDC) antihypertensive therapy is an emerging strategy for improving blood pressure (BP) control. Although previous phase II and pragmatic studies suggested promise, these are the first phase III, double-blind, active-controlled trials comparing a single-pill ultra-low-dose triple combination with standard-dose monotherapy. OBJECTIVES: In these studies, we sought to compare a single-pill combination of 1.67 mg amlodipine, 16.67 mg losartan potassium, and 4.17 mg chlorthalidone (LDC-ALC) with standard-dose monotherapy-5 mg amlodipine or 50 mg losartan potassium-in patients with mild-to-moderate hypertension. METHODS: HM-APOLLO-301 (Study 301, May 2022-June 2023) and HM-APOLLO-302 (Study 302, March-December 2024) were multicenter, randomized, double-blind, active-controlled, phase III studies in South Korea. Study 301 compared LDC-ALC and amlodipine; Study 302 compared LDC-ALC and losartan. Adults (≥19 years of age) with systolic blood pressure (SBP) 140 to <180 mm Hg and diastolic blood pressure (DBP) <110 mm Hg after 4-week placebo run-in were randomized to 8 weeks of treatment. The primary endpoint was SBP reduction at week 8, assessed first for noninferiority, then for superiority. RESULTS: In Study 301, LDC-ALC exhibited noninferiority to amlodipine in reducing SBP at week 8 (upper bound of 1-sided 97.5% CI: 2.8 mm Hg [<3 mm Hg noninferiority margin]), and similar efficacy (least-squares mean change: -19.1 vs -19.9 mm Hg; 95% CI: -1.5 to 3.1; P = 0.495), with similar DBP reduction and blood pressure control rate. In Study 302, LDC-ALC was both noninferior (upper bound of one-sided 97.5% CI: -0.6 mm Hg) and superior to losartan (least-squares mean change: -19.9 vs -16.4 mm Hg; 95% CI: -6.6 to -0.2; P = 0.037) in SBP reduction at week 8, with greater DBP reduction and a higher blood pressure control rate than losartan. Adverse events were similar between groups (LDC-ALC vs amlodipine: 11.7% vs 13.9%; LDC-ALC vs losartan: 6.4% vs 3.3%), with ≤1% treatment withdrawals and no serious drug-related events. CONCLUSIONS: Single-pill LDC-ALC achieved BP reductions similar to those with amlodipine and greater than those with losartan monotherapy over 8 weeks, with similar short-term tolerability. These findings support LDC-ALC as an effective and well tolerated alternative initial therapy for mild-to-moderate hypertension, expanding the set of validated strategies alongside established monotherapies. (A Study to Evaluate Efficacy and Safety of HCP1803 in Patients With Essential Hypertension [HM-APOLLO-301; NCT05362110]; A Study to Evaluate Efficacy and Safety of HCP1803 Compared to RLD2001-1 in Patients with Essential Hypertension [HM-APOLLO-302, NCT06438172]).
14 May 2026
Read appraisal →Journal of the American College of Cardiology
Natriuretic Peptide Receptor-1 Agonist for Resistant Hypertension: A Randomized Phase 2 Trial
BACKGROUND: XXB750 is a potent and long-acting human monoclonal antibody agonist of the natriuretic peptide receptor-1 (NPR-1), the receptor for atrial natriuretic peptide and B-type natriuretic peptide. Activation of NPR-1 may lower blood pressure (BP) in patients with resistant hypertension through increases in the second messenger cyclic guanosine monophosphate. OBJECTIVES: The aim of this study was to determine the effect of NPR-1 agonism on 24-hour BP. METHODS: This phase 2, multicenter, randomized, double-blind, placebo-controlled trial evaluated 4 once-monthly subcutaneous doses of XXB750 (30 mg, 60 mg, 120 mg, and 240 mg) administered at baseline, week 4, and week 8 in patients with resistant hypertension. Resistant hypertension was defined as 24-hour systolic BP (SBP) ≥135 mm Hg despite treatment with 3 or 4 guideline-directed antihypertensive agents. The primary endpoint was the dose-response relationship of XXB750 vs placebo in reducing the mean 24-hour SBP from baseline to week 12. RESULTS: The study population (N = 189) had a mean age of 61 years, was 69% male, 61% White, 20% Asian, and 14% Black/African American, and had a baseline mean 24-hour ambulatory BP of 148/81 ± 11/10 mm Hg. Plasma concentrations of XXB750 dose-dependently increased in the XXB750 groups, and XXB750 dose-dependently increased plasma and urine cyclic guanosine monophosphate concentrations by week 12. However, paradoxically, there was no significant dose-dependent change from baseline in mean 24-hour SBP at week 12. In fact, none of the doses of XXB750 had a greater BP-lowering effect than placebo. Changes in ambulatory BP were not affected by the development of anti-drug antibodies. Although there were no changes from baseline in urinary sodium excretion, there were small increases in plasma renin levels in the XXB750 groups. Adverse events with XXB750 were numerically higher than with placebo. Adherence to background antihypertensive medications, assessed by drug assays in 88 patients with available plasma samples, was consistent across all treatment groups at both baseline and week 12. CONCLUSIONS: XXB750, an NPR-1 agonist, had a neutral effect on 24-hour ambulatory SBP in patients with resistant hypertension, despite showing a robust dose-response relationship for engagement of the target of pharmacologic action as indicated by increases in cyclic guanosine monophosphate levels. (An Efficacy, Safety, Tolerability and Dose Finding Study of XXB750 in Resistant Hypertension Patients; NCT05562934).
14 May 2026
Read appraisal →Journal of the American College of Cardiology
Efficacy of Tonlamarsen in Patients With Uncontrolled Hypertension: The KARDINAL Phase 2 Randomized Clinical Trial
BACKGROUND: Angiotensinogen production represents the rate-limiting step in activation of the renin-angiotensin-aldosterone system. Tonlamarsen is an investigational antisense oligonucleotide directed against hepatic angiotensinogen synthesis; its efficacy and safety among patients with hypertension are unknown. OBJECTIVES: The aim of this study was to assess the safety and efficacy of 90 mg tonlamarsen administered subcutaneously once monthly for 5 months compared with a single dose of tonlamarsen and subsequent placebo. METHODS: This randomized, placebo-controlled trial enrolled adults with office systolic blood pressure (BP) >135 mm Hg receiving 2 to 5 antihypertensive medications. Participants entered a 3-part treatment period with monthly administration of the study drug, consisting of a 4-week placebo lead-in, followed by 4-week active run-in with a single dose of tonlamarsen and subsequent randomization to 4 additional doses of tonlamarsen or matching placebo for 16 weeks. The coprimary endpoints were the between-group differences in the change from baseline to week 20 in plasma angiotensinogen and in office systolic BP. RESULTS: A total of 279 participants received placebo lead-in, 206 received 90 mg tonlamarsen during the active run-in, and 198 were randomized. The mean BP among randomized participants before and after the placebo lead-in was 147/90 and 147/89 mm Hg, respectively. Following active run-in with tonlamarsen, the mean BP was 140/87 mm Hg. Twenty weeks following the first dose of tonlamarsen, least squares (LS) mean percentage changes in plasma angiotensinogen levels were -23.0% (95% CI: -27.8% to -18.2%) with a single dose of tonlamarsen and subsequent placebo and -67.2% (95% CI: -71.9% to -62.4%) with monthly tonlamarsen administration, with a LS mean difference of -44.1% (97.5% CI: -51.9% to -36.4%; P < 0.0001). The LS mean changes in office systolic BP were -6.7 mm Hg (95% CI: -9.8 to -3.5 mm Hg) for participants following a single dose of tonlamarsen and subsequent placebo and -6.7 mm Hg (95% CI: -9.8 to -3.6 mm Hg) for participants treated with monthly tonlamarsen, with a LS mean difference of -0.1 mm Hg (95% CI: -4.5 to -4.4 mm Hg; P = 0.97). Serious adverse events were infrequent and similar between treatment groups. CONCLUSIONS: Among individuals with uncontrolled hypertension, monthly tonlamarsen administration was more effective at lowering plasma angiotensinogen compared with a single tonlamarsen dose, but there was no additional BP reduction. (A Study to Investigate Tonlamarsen for the Treatment of Adults With Uncontrolled Hypertension [KARDINAL]; NCT06864104).
14 May 2026
Read appraisal →Physiological measurement
A teacher-student deep learning framework for enhanced clinical screening of heart failure from 12-lead electrocardiograms
Objective.Identifying heart failure (HF) from electrocardiograms (ECGs) is challenging due to the lack of definitive features. This study aims to develop a deep learning-based clinical decision support system, CTTSnet, for accurate and automated HF screening using ECGs.Approach.We propose a novel teacher-student framework, CTTSnet, which synergistically integrates a transformer as the teacher and a convolutional neural network as the student. This architecture combines global context-awareness with efficient local feature extraction. The model was trained and evaluated on a large-scale, real-world dataset of 27 018 ECGs and further validated on two external public datasets to assess generalizability.Main results.CTTSnet achieved an AUROC of 0.941 on the primary clinical dataset, surpassing strong baselines. The model attained an accuracy of 87.3%, with a recall of 88.6% and specificity of 85.8%. External validation on two additional public datasets further confirmed the model's generalizability.Significance.CTTSnet provides a scalable, high-accuracy tool for HF triage from routine ECG recordings. Its potential clinical value lies in assisting early identification of patients at risk of HF, thereby helping reduce missed diagnoses and facilitating timely referral for further evaluation.
14 May 2026
Read appraisal →Current heart failure reports
Emerging Artificial Intelligence Tools for the Screening of Structural and Valvular Heart Disease
PURPOSE OF REVIEW: Structural heart disease (SHD) encompasses diseases involving the heart valves, chambers, walls, and muscles. Current diagnostic methods have limited accessibility and predictive value. This review aims to present recent advances in artificial intelligence (AI)-guided tools in the screening of SHD and valvular heart disease (VHD), and to present challenges and opportunities for their use in clinical practice. RECENT FINDINGS: AI-guided models trained on ECGs, chest X-rays, and coronary artery calcium scans have a high accuracy in the diagnosis of SHD, heart failure, low left ventricular ejection fraction, and VHD. Some of these models can highlight the signals that influence their predictions, improving explainability. The use of AI in screening for SHD and VHD could lead to earlier diagnosis, enhanced accuracy, and better accessibility. However, outcome data on earlier diagnosis using these tools is required before broad deployment.
14 May 2026
Read appraisal →JMIR mental health
Machine Learning for Comparative Antidepressant Selection in Major Depressive Disorder: Systematic Review
BACKGROUND: Major depressive disorder (MDD) affects approximately 1 in 6 adults during their lifetime, yet antidepressant selection relies predominantly on trial-and-error, with response rates of only 42% to 53%. While machine learning (ML) models have shown promise in predicting treatment outcomes, most focus on single treatments rather than comparative selection across therapeutic alternatives, limiting their clinical utility for the medication choice decisions that clinicians face in practice. OBJECTIVE: This systematic review evaluates ML approaches that examine 2 or more pharmacological interventions for predicting treatment outcomes in MDD, with a focus on their capacity to facilitate comparative treatment selection between medications or medication classes for individual patients. METHODS: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched PubMed, Scopus, and Web of Science for studies published from 2015 to 2025. We included studies involving adults with MDD that used ML models to predict treatment outcomes across 2 or more pharmacological treatments and reported medication-specific prediction outcomes. Risk of bias was assessed using PROBAST-AI (Prediction Model Risk of Bias Assessment Tool for Artificial Intelligence). We conducted a narrative synthesis organized by modeling strategies, data integration approaches, validation methodologies, and performance patterns. RESULTS: From 5370 initial records, 19 studies met the inclusion criteria, with dataset sample sizes ranging from 49 to 77,226 participants. Studies employed 3 distinct modeling strategies: drug-specific supervised models trained independently for each medication, subtype- or trajectory-based approaches using clustering methods to identify differential response patterns, and a unified differential prediction framework generating calibrated cross-treatment predictions. Performance varied substantially, with area under the curve values ranging from 0.59 to 0.95 and classification accuracies between 62% and 95.4%, though high performance was concentrated in studies with small samples, high-dimensional neurobiological features, and internal-only validation. Only 7 studies conducted external validation, which generally yielded more conservative performance estimates. Feature informativeness was more consistently associated with performance variation than algorithm complexity. Most studies did not formally distinguish between prognostic features predicting general outcomes and predictive features identifying differential medication responses, and none applied formal explainability techniques. CONCLUSIONS: ML for comparative antidepressant selection remains in an early stage of development. Only 1 study implemented a unified framework directly supporting patient-level treatment ranking. Key barriers to clinical translation include insufficient distinction between prognostic and predictive markers, limited cross-trial validation, near-absent calibration reporting, and absent explainability. Future research should prioritize unified comparative frameworks with calibrated predictions, rigorous external validation on diverse cohorts, explicit modeling of heterogeneous treatment effects, and integration of explainability into model development.
14 May 2026
Read appraisal →Journal of the American College of Cardiology
Behavioral Economics and Medication Adherence for Hypertension: A Randomized Clinical Trial
BACKGROUND: Nonadherence to antihypertensive medications is common. Mobile health (mHealth)-based behavioral economic interventions may improve adherence, but remain largely untested, especially in vulnerable populations. OBJECTIVE: The study sought to test whether an mHealth incentive lottery would lower systolic blood pressure (SBP) and improve adherence. METHODS: BETTER-BP (Behavioral Economics Trial To Enhance Regulation of Blood Pressure) was a randomized trial conducted in 3 safety-net clinics in New York City. Eligible participants were adults with hypertension prescribed at least 1 antihypertensive medication, with SBP >140 mm Hg, and poor self-reported adherence. In the intervention arm, an incentive lottery was administered via SMS messaging. All participants received passive adherence monitoring. The intervention lasted 6 months, with continued monitoring until 12 months. The primary clinical endpoint was change in SBP at 6 months. The primary process endpoint was adequate antihypertensive medication adherence (≥80% days adherent) from baseline to 6 months. RESULTS: Four-hundred participants (265 intervention:135 control) were enrolled with median age 57 years, 60.5% women, 61.5% Hispanic, and 20.3% non-Hispanic Black. Over 70% had Medicaid or no insurance. At 6 months, intervention arm participants were twice as likely to achieve adequate adherence (71% vs 34%; adjusted risk ratio: 2.04; 95% CI: 1.58-2.63), but there was no significant change in mean SBP (-6.7 mm Hg intervention vs -5.8 mm Hg control; P = 0.62). From 6 to 12 months, adherence was similar (31% intervention vs 26% control; adjusted risk ratio: 1.17; 95% CI: 0.83-1.65). CONCLUSIONS: In a diverse safety-net population, the BETTER-BP intervention doubled the rate of adequate antihypertensive medication adherence but did not reduce SBP at 6 months.
14 May 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Metabolic, demographic, and behavioral risk factors predict brain structural variability in the general population: an analysis of the human connectome project young adults
BACKGROUND: Understanding whether commonly available metabolic, demographic, and behavioral factors can explain variability in brain structure may support the development of accessible predictive approaches. This study aims to evaluate the ability of machine learning regression models to predict brain structural measures in young, neurologically healthy adults using clinically accessible risk factors. METHODS: Data were drawn from the Human Connectome Project Young Adults dataset, including 1082 participants aged 22-37. Predictors comprised metabolic measures (systolic and diastolic blood pressure, hematocrit, body mass index, hemoglobin A1C, thyroid stimulating hormone) and demographic/behavioral variables (age, gender, race, education level, smoking history, alcohol use). Brain structural parameters from MRI included gray matter (GM) and white matter (WM) volumes, surface areas, and cortical thickness. Distance correlation (dcor) guided feature selection, followed by machine learning modeling. Model performance was evaluated using normalized mean absolute error (NMAE), normalized root-mean-squared error (NRMSE), and coefficient of determination (R²). SHAP values were used for feature interpretation. RESULTS: XGBoost consistently outperformed other algorithms, showing strong predictive accuracy for total brain segmentation, supratentorial, and total GM volumes (NMAE < 0.35, R² > 0.80). In contrast, cortical surface predictions (left superior frontal) showed moderate performance (NMAE > 0.50, R² < 0.60). SHAP analysis highlighted age, gender, education level, and diastolic and systolic blood pressure as the most influential predictors of brain structure. CONCLUSIONS: The findings highlight the methodological value of regression-based approaches for estimating brain structural variability and support their potential role as complementary tools for brain health research.
14 May 2026
Read appraisal →Annals of work exposures and health
Occupational mechanical exposures and upper-body musculoskeletal disorders: an overview of systematic reviews
OBJECTIVES: The aim was to provide a comprehensive overview of systematic reviews with meta-analyses of the association between occupational mechanical exposures and upper-body musculoskeletal disorders. METHODS: A systematic literature search was conducted in PubMed, Web of Science, Embase, and CINAHL. Systematic reviews were considered eligible if they included occupational mechanical exposures and provided weighted measures of association in relation to specific musculoskeletal disorders. From each systematic review, data on eg databases searched, exposure, outcome, effect estimates, and quality of evidence of the association were extracted. The methodological quality of each systematic review was assessed using AMSTAR 2. RESULTS: The screening of 1,756 articles resulted in the inclusion of 17 systematic reviews with meta-analysis covering 6 musculoskeletal disorders: subacromial pain syndrome (n = 3), lateral epicondylitis (n = 2), carpal tunnel syndrome (n = 7), Dupuytren's disease (n = 4), hand-arm vibration syndrome (n = 1), and hand osteoarthritis (n = 1). The weighted odds ratios from the meta-analyses generally ranged between 1.5 and 3.0. Approximately 35% of the included systematic reviews assessed the quality of evidence of the association, and among these, 48% graded the evidence as being low to very low. CONCLUSIONS: In general, this overview found an increased risk associated with most mechanical exposures in relation to specific upper-body musculoskeletal disorders. However, grading of evidence quality was rarely applied, and when present, showed substantial variability. Future research related to primary studies should prioritise high-quality prospective studies and objective exposure assessments, and systematic reviews would benefit from standardised methodologies and improved reporting transparency to further strengthen the evidence quality.
14 May 2026
Read appraisal →Journal of molecular neuroscience : MN
Development and Validation of a SHAP-Interpretable Machine Learning Model for Stroke Risk Prediction Using Circulating MicroRNA Biomarkers
BACKGROUND/OBJECTIVE: Stroke remains a leading cause of morbidity and mortality worldwide. Circulating microRNAs (miRNAs) have emerged as promising non-invasive biomarkers for cardiovascular disease diagnosis and risk stratification. However, their integration into predictive models remains limited by challenges in feature selection, model robustness, and interpretability. This study aims to develop an interpretable machine learning framework for predicting stroke incidence using serum miRNA signatures. METHODS: We analyzed serum miRNA expression profiles from 1,785 human samples (173 stroke patients and 1,612 non-stroke controls) obtained from the GEO dataset GSE117064. Differential expression analysis was performed to identify significantly dysregulated miRNAs using linear modeling and empirical Bayes moderation. LASSO logistic regression was then applied to select predictive miRNA features. Five supervised machine learning classifiers-logistic regression, support vector machine (SVM), random forest, XGBoost, and k-nearest neighbors-were evaluated using 10-fold cross-validation. The best-performing model (SVM) was further interpreted using Shapley Additive exPlanations (SHAP) to assess individual miRNA contributions to prediction. To validate the robustness and clinical generalizability of the identified signatures, quantitative real-time PCR (qPCR) and Next-Generation Sequencing (NGS) were performed on independent sets of serum samples. The pre-trained SVM model was applied to the NGS data to verify its classification performance in an external cohort. RESULTS: A total of 604 miRNAs were differentially expressed between stroke and non-stroke groups, including 206 downregulated and 398 upregulated candidates. LASSO regression identified 66 non-zero-coefficient miRNAs with potential predictive value. Among the classifiers tested, the SVM model achieved the highest average accuracy of 0.9983 and perfect AUC (1.0000), demonstrating superior performance and stability. SHAP analysis revealed that a subset of miRNAs, including hsa-miR-3648, hsa-miR-1290, and hsa-miR-6765-3p, had the greatest impact on classification outcomes, providing mechanistic insights and enhancing model interpretability. qPCR results preliminarily supported the differential expression patterns of key miRNAs. Furthermore, NGS analysis of an independent validation cohort (n = 10) demonstrated distinct hierarchical clustering of the selected biomarkers. The pre-trained SVM model preliminarily supported its cross-platform validity by classifying these external samples with an overall accuracy of 80% (sensitivity 80%, specificity 80%), suggesting the potential generalizability of the identified miRNA panel across different quantification platforms. CONCLUSIONS: This study demonstrates the utility of integrating differential expression analysis, regularized feature selection, and machine learning with SHAP-based interpretation to identify and validate serum miRNA signatures predictive of stroke. The successful external validation using NGS highlights the robustness of the identified biomarkers and their potential for cross-platform application. The results provide a transparent, data-driven framework for biomarker discovery in clinical risk prediction and support the development of non-invasive diagnostic tools for stroke detection.
14 May 2026
Read appraisal →Journal of medical systems
VR-Based Physical Activity and Self-Management Interventions for Glycemic Control and Behavioral Outcomes in Type 2 Diabetes: A Systematic Review and Meta-Analysis
A growing body of original research has recently investigated virtual reality (VR)-based interventions for physical activity and self-management, yet yielded inconsistent results. This systematic review and meta-analysis aims to evaluate the effectiveness of VR-based physical activity and self-management interventions in improving glycemic control and modifying health-related behaviors among patients with type 2 diabetes mellitus (T2DM). A total of 10 studies involving 1,005 adults with T2DM were included, comprising 5 randomized controlled trials (RCTs), 1 non-randomized controlled trial (nRCT), and 4 self-controlled before-after studies. Of these, participants in the intervention groups received VR-based interventions, including immersive or interactive VR programs for diabetes self-management education or physical activity promotion, with most intervention durations ranging from 8 to 24 weeks. Control groups received traditional approaches, including routine care, in-person diabetes self-management programs, and content-equivalent 2D websites. The pre-post intervention analysis revealed that glycated hemoglobin (HbA1c) levels decreased significantly post-intervention (mean difference (MD) = -0.50, 95% CI: -0.92 to -0.08, p = 0.02). While VR-based physical activity and self-management interventions did not demonstrate superior efficacy to traditional intervention methods in glycemic control or behavioral outcomes, their unique advantages - including enhanced adherence, greater accessibility, and reduced spatiotemporal constraints - position them as a viable alternative for diabetes management. Nevertheless, the field requires more rigorously designed RCTs to establish efficacy and a systematic exploration of VR implementation protocols to maximize therapeutic benefits.
14 May 2026
Read appraisal →European journal of pediatrics
Wheeze detection in real-world pediatric care: AI applied to smartphone lung auscultation.
UNLABELLED: Smartphone-based lung auscultation, combined with artificial intelligence (AI), may offer a promising alternative for pediatric respiratory telemonitoring. The aim of our study was to evaluate the performance of an AI model on wheeze detection from pediatric respiratory sounds recorded via smartphone. An observational cross-sectional study was conducted at the Pediatric Department of a Portuguese tertiary hospital, including children aged 0-17 years (pre-school, school-aged, and adolescent), with or without respiratory disease. Respiratory sounds were recorded at four locations using smartphone microphones and independently classified by at least 2 blinded annotators for quality and presence of wheezes. A hybrid convolutional-recurrent neural network (CNN + LSTM) trained on public electronic stethoscope databases was used to detect wheezes. AI model performance was assessed using positive predictive value, sensitivity, specificity, accuracy, and F1-score. A total of 217 children (59.9% male; median 10 [Q1-Q3 4.5-13] years) were included. From 2020 respiratory sound recordings, 1500 (74.3%) met quality criteria. Manual annotation identified 271 recordings with wheezes, whereas AI detected 217, most frequently in pre-school children (64.5% AI; 53.9% manual). The model achieved an overall accuracy of 87% (95% CI 86-89) and an F1-score of 61% (95% CI 56-66). The best accuracy was found in adolescents (92%, 95% CI 90-94) and the best global F1-score in pre-school children recordings (64%, 95% CI 58-71). CONCLUSION: This study supports the feasibility of AI-assisted analysis of smartphone-recorded pediatric respiratory sounds in real-world settings. Future multicenter studies with larger datasets and model fine-tuning using smartphone recordings are expected to improve AI model performance and generalizability. WHAT IS KNOWN: • Continuous monitoring of pediatric respiratory diseases is essential to improve outcomes and reduce healthcare and family burden. • Smartphone lung auscultation is feasible in children but AI wheeze detection models have only been applied to recordings from electronic stethoscopes. WHAT IS NEW: • First study applying an AI model to detect wheezes in smartphone-recorded lung sounds. • Quality recordings were obtained across all pediatric age groups and the AI model performance showed promising results, comparable to studies using electronic stethoscopes.
14 May 2026
Read appraisal →JMIR mental health
Therapeutic Interventions Targeted at Problematic Use of Digital Technology: Systematic Review and Meta-Analysis of Evidence
BACKGROUND: Problematic use of digital technology has increased across the world. Despite growing research, evidence on treatment effectiveness across digital behaviors remains fragmented. OBJECTIVE: This study aimed to systematically evaluate and compare the effectiveness of therapeutic interventions targeted at problematic use of digital technology across various behavioral domains. METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines (PROSPERO: CRD420251052442). Electronic searches of PubMed, Scopus, and Embase (up to April 2025) were conducted. It identified 125 eligible studies, including 73 randomized controlled trials (RCTs), 32 non-RCTs, 14 pre-post studies, and 6 pilot studies. The interventions that were assessed in these studies included psychological therapies, digital or web-based programs, exercise-based interventions, pharmacological treatments, neuromodulation, parent-focused programs, virtual reality-based interventions, educational programs, and multicomponent approaches. Random-effects meta-analyses using standardized mean differences (SMDs) were performed. RESULTS: For problematic internet use, psychological treatments showed a strong effect (effect size=-2.68; P<.001). Digital interventions also showed significant benefit (effect size=-1.16; P<.001). For smartphone addiction, psychological treatments (effect size=-1.49; P<.001) and exercise-based programs (effect size=-3.07; P=.001) showed significant improvement. For gaming disorder, psychological treatments showed improvement (effect size=-1.01; P=.02), but results were mixed. There were limited studies to calculate pooled results for social media addiction, pornography use, gambling, screen time, and over-the-top content watching. No treatment studies were found for problematic over-the-top content watching. High heterogeneity and evidence of small-study effects were observed in several studies. CONCLUSIONS: Overall, structured psychological therapies showed the most consistent benefit. These findings support structured interventions that aim for control of use and reduce cues linked to high use. Evidence remains limited for several emerging digital behaviors. More high-quality studies are needed in clinical settings and for less-studied forms of digital addiction.
14 May 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Efficacy and safety of CGRP monoclonal antibodies for cluster headache: a systematic review and network meta-analysis of randomized controlled trials
INTRODUCTION: Cluster headache (CH) is a severe unilateral trigeminal autonomic cephalalgia with limited well tolerated therapies. Calcitonin gene related peptide monoclonal antibodies, including galcanezumab, fremanezumab, and eptinezumab, have established efficacy in migraine and are under evaluation in CH. This study assesses their efficacy and safety using pairwise and network meta analysis. METHODS: PubMed, Embase, Scopus, and ClinicalTrials.gov were searched through April 2025. Randomized controlled trials enrolling adults with episodic or chronic CH were included. The primary endpoint was change in weekly attack frequency. Secondary outcomes included subtype specific effects and adverse events. Frequentist random effects network meta analysis and pairwise meta analysis were performed in R. RESULTS: Five trials with approximately 1,000 participants were included. No agent demonstrated statistically significant reduction in weekly attack frequency versus placebo, although consistent numerical improvements were observed. Dose specific network estimates showed mean differences of - 0.81 for galcanezumab 300 mg, - 0.17 for eptinezumab 400 mg, 0.71 for fremanezumab 675/225 mg, and - 1.27 for fremanezumab 900/225 mg. Pooled dose estimates were - 0.81 for galcanezumab, - 0.27 for fremanezumab, and - 0.17 for eptinezumab. Pairwise meta analysis yielded a pooled mean difference of - 0.41. Subgroup analysis indicated minimal change in chronic CH and greater numerical reduction in episodic CH. CONCLUSION: CGRP monoclonal antibodies demonstrate modest directional reductions in attack frequency without statistical significance. Signals appear more pronounced in episodic CH, supporting the need for adequately powered, subtype specific trials.
14 May 2026
Read appraisal →JMIR aging
Self-Identified Age Cohorts and Personal Experience Sharing in Pseudonymous Online Spaces: Natural Language Processing Analysis of Reddit
BACKGROUND: While older adults' social media use has been widely studied for its instrumental benefits, such as accessing health information or maintaining family ties, research has largely focused on identity-based platforms that mirror offline social networks, leaving pseudonymous, interest-driven environments such as Reddit underexplored. Although older adults actively participate in these spaces to share personal narratives and engage beyond their existing social roles, the literature has yet to center their own voices, with most existing work focusing on caregivers or younger users discussing older adults rather than older adults speaking for themselves. OBJECTIVE: Integrating a life course perspective with the concept of subjective age cohort, this study examines how Reddit users who explicitly self-identify as being in their 50s, 60s, or 70s engage in self-expression and personal experience sharing within pseudonymous online spaces. METHODS: Using data collected via the Reddit application programming interface, this study analyzed posts and comments from 848 self-identified older Reddit users, including 488 future older adults in their 50s (57.5%) and 360 current older adults in their 60s and 70s (42.5%) identified through age-based flairs in the subreddit r/AskOldPeople. A fine-tuned large language model (BLOOM-560m; F1-score=0.96) classified 4,055,275 sentences into three personal experience domains: (1) health and wellness, (2) personal relationships and identity, and (3) professional and financial life. Chi-square analysis compared domain distributions across age groups. BERTopic topic modeling identified thematic patterns within each domain. RESULTS: Of 569,107 personal experience sentences identified, personal relationships and identity comprised the largest share (n=268,212, 47.1%), followed by professional and financial (n=186,768, 32.8%) and health and wellness (n=114,127, 20.1%). Chi-square analysis revealed significant between-group differences (χ22=34.7; P<.001): current older adults shared proportionally more about health and wellness, whereas future older adults shared more about relationships and identity. Topic modeling further revealed qualitatively distinct emphases within each domain. Future older adults' posts frequently discussed menopause, depression, and friendships, while current older adults more frequently addressed chronic illness, aging, and financial security. Both groups used pseudonymity to disclose sensitive or stigmatized topics. CONCLUSIONS: This study demonstrates that older adults' personal experience sharing on pseudonymous platforms is shaped by the simultaneous interplay of life course stage, age cohort background, and platform affordances, rather than by any single factor. Pseudonymous environments such as Reddit enable disclosures of health vulnerabilities, contested social identities, and emotional experiences that are structurally discouraged on identity-based networks, and this has direct implications for how digital inclusion is conceptualized and practiced. Beyond operational literacy, supporting older adults' expressive inclusion in interest-based, pseudonymous online communities represents a meaningful yet underaddressed dimension of digital participation policy.
14 May 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Oral antipyretics for fatigue alleviation and exercise enhancement in adults with multiple sclerosis: a systematic review and meta-analysis
AIMS: This review aims to explore the potential role of oral antipyretics (aspirin (ASA)/ acetaminophen), commonly known for fever and pain control, in managing fatigue, temperature regulation, and exercise capacity in patients with Multiple Sclerosis (MS), with a focus on nursing implications for symptom management. DESIGN: A systematic review of existing clinical studies assessing the effects of aspirin/ acetaminophen on MS-related fatigue, thermoregulation, and exercise performance. DATA SOURCES: Electronic databases including Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PubMed, Scopus, Web of Science, Wiley, Google Scholar, and ClinicalTrials.gov were searched up to March 2024. REVIEW METHODS: Quality assessment was conducted using the Cochrane risk of bias tool 2. to evaluate the methodological rigor of included studies. Outcomes analyzed included clinically assessed fatigue scores, exercise endurance, and post-exercise thermoregulation, with attention to potential risks associated with aspirin use. RESULTS: After assessment of 57 reports for eligibility, only seven studies met inclusion criteria; results indicated that aspirin pretreatment significantly improved Time to Exhaustion (TTE) in heat-sensitive MS patients (p = 0.013), though one study reported no significant effect. Aspirin reduced post-exercise temperature rise by 56%, but this was not statistically significant in one trial (p = 0.178), while another showed significant reductions (p = 0.002). CONCLUSION: Aspirin and acetaminophen may offer benefits in alleviating fatigue, enhancing thermoregulation, and improving exercise endurance in MS patients. These findings suggest that nurses should consider the potential role of aspirin in symptom management, with further research needed to confirm efficacy and safety. IMPACT: This review highlights a potential adjunct therapy for nurses to incorporate into comprehensive MS care, emphasizing symptom control and quality of life improvements. PATIENT OR PUBLIC CONTRIBUTION: Not applicable. TRIAL REGISTRATION: This review is PROSPERO registered having ID CRD420251000875.
14 May 2026
Read appraisal →Molecular neurobiology
Gut Microbiota Dysbiosis and Neuroinflammation in Alzheimer's Disease: a Systematic Review of Mechanistic Insights
This systematic review aims to identify microbial species associated with Alzheimer's disease and clarify how they influence Alzheimer's disease pathology, including immune system interactions and blood-brain barrier integrity. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 18 studies were analyzed, revealing significant differences in gut microbiota composition between patients with Alzheimer's disease and controls. Key findings include reduced beneficial bacteria, such as Faecalibacterium prausnitzii and Roseburia hominis and increased pro-inflammatory species like Escherichia coli. Mechanistically, Escherichia coli produces lipopolysaccharides, triggering the release of pro-inflammatory cytokines such as tumor necrosis factor-alpha. This response correlates with elevated YKL-40 levels and reduced beneficial bacteria like Turicibacter. Additionally, reductions in butyrate-producing bacteria impair blood-brain barrier integrity, while bile acid metabolism disruptions impair signaling pathways, exacerbating amyloid-beta aggregation. These findings highlight the interplay between gut microbiota-derived metabolites and neuroinflammation, suggesting that targeting the gut microbiota for novel diagnostic and therapeutic approaches in Alzheimer's disease.
14 May 2026
Read appraisal →BMJ open
Mapping the evidence on stillbirth prevention across the reproductive continuum: an umbrella review
OBJECTIVES: To collate and appraise evidence from existing systematic reviews and meta-analyses on interventions to prevent stillbirth and reduce perinatal mortality across the reproductive continuum, including preconception, antenatal, intrapartum and immediate newborn periods. DESIGN: Umbrella review synthesising evidence from systematic reviews, including meta-analyses where available. DATA SOURCES: A comprehensive search was conducted in CENTRAL (via Cochrane Register of Studies Online), PubMed, Embase and Web of Science, along with trial registries (WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and ISRCTN Registry), from inception to 12 January 2026. ELIGIBILITY CRITERIA: Systematic reviews and meta-analyses synthesising randomised controlled trials or quasi-experimental studies that reported stillbirth, perinatal mortality, fetal loss or fetal death were included. Reviews focused exclusively on predefined high-risk populations were excluded. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and assessed methodological quality using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty ratings were extracted as reported by the original review authors. Evidence synthesis followed a structured framework adapted from Ota et al, integrating direction of effect and certainty of evidence based on pooled estimates and GRADE assessments. Publication overlap was assessed using the Corrected Covered Area index where relevant. RESULTS: A total of 116 systematic reviews were included, synthesising evidence from randomised controlled and quasi-experimental studies across preconception, antenatal, intrapartum and immediate newborn periods. Evidence from individual reviews showed clear benefit for several interventions, including balanced energy-protein supplementation, home visits by community health workers, birth preparedness interventions, labour induction at or beyond 37 weeks of gestation and skilled or community-based intrapartum care, primarily for reducing perinatal mortality. Reduced antenatal visit schedules compared with standard care were associated with a possible increase in stillbirth or perinatal mortality, indicating potential harm. Many interventions-such as group antenatal care (ANC), nutritional education, case-note provision, routine ultrasound or Doppler monitoring, antibiotic treatment for bacterial vaginosis, antiretroviral therapy in pregnancy and several pharmacological or hormonal interventions-demonstrated unknown or inconclusive effects on stillbirth or perinatal mortality, largely due to imprecision and heterogeneity. CONCLUSIONS: This umbrella review identifies a range of interventions with evidence of effectiveness across the reproductive continuum, particularly those addressing maternal nutrition, continuity of ANC and quality intrapartum and newborn care. However, substantial evidence gaps remain, especially for interventions widely implemented without strong supporting evidence. These findings highlight the need for context-specific implementation research and prioritisation of proven strategies in low- and middle-income countries, where the burden of stillbirth remains highest. PROSPERO REGISTRATION NUMBER: CRD42024531100.
14 May 2026
Read appraisal →JMIR medical informatics
Expert Evaluation and Consensus on GPT-4o Summaries of Clinical Letters: Validation and Results of the Framework and Implementation of AI Tools Project
BACKGROUND: Large language models (LLMs) are increasingly used to summarize clinical documents; yet, automated metrics often inadequately capture clinical relevance and safety. In the initial phase of the "Framework and Implementation of AI Tools," an expert-driven, cocreated evaluation methodology was established to assess LLM-generated discharge letter summaries, combining prompt design considerations with intuitive expert appraisal. OBJECTIVE: This study aimed to quantify expert agreement and interrater reliability on LLM summaries of discharge letters, identify frequent and clinically relevant errors, and evaluate practical implications for integrating LLMs into documentation workflows. METHODS: Thirty expert-curated synthetic Dutch discharge letters were summarized. Thirty-one clinicians from Flemish care settings (1 university hospital, 2 private hospitals, and 2 general practice circles) evaluated the summaries. The evaluation framework consisted of 61 binary layout items assessing whether required sections and formatting were correctly present, 33 content items (correct or complete vs incorrect, subcategorizing missing, irrelevant, and hallucinated information), a 4-point global quality rating, and an open comment. Statistical analyses included descriptive statistics, mixed effects ordinal regression on the global score, consensus (agreement per question or letter) percentages, interrater reliability (Cohen κ, intraclass correlation coefficient [ICC], Fleiss κ, and prevalence index), and thematic synthesis of comments. RESULTS: Layout adherence was high (88%), especially in the conclusion section. The positive response rate for content was overall moderate (78%), with the best performance observed in the medical history section and the lowest performance observed in the medication section, which also showed the highest rate of hallucinations and the weakest interrater consensus. Across all sections, missing information was the most common error. Nearly 70% of global ratings were "good" or "very good." Higher positive response rates for content predicted better global scores (β=.079; P<.001), while layout and participant specialty were not relevant to global scoring. Consensus was high for the layout questions (median 96.8%, IQR 90.2%-100%) and somewhat lower for content (median 83.9%, IQR 67.7-96.8), with the lowest agreement in the medication section. Interrater agreement was moderate (median Cohen κ=0.36, IQR 0.29-0.43; range 0.07-0.56), but overall reliability was high (ICC 0.945, 95% CI 0.942-0.948), indicating strong consistency at the global level despite interrater variability. The prevalence index demonstrated that high ICC values were partly driven by the strong prevalence of affirmative responses in layout items, while content items showed more balanced distributions and lower agreement. CONCLUSIONS: Our framework offers a robust approach for evaluating LLM-generated discharge summaries, balancing usability and clinical relevance. Semantic integrity, especially regarding medication details, was identified as a key vulnerability. Perceived overall quality was driven by a positive response rate for content. High ICC values for global score, with lower item-level agreement lead toward the need for clearer, context-specific prompts and standardized evaluation criteria to reduce interrater variability. Human oversight and targeted automated checks for omissions and hallucinations are essential for safe clinical deployment.
14 May 2026
Read appraisal →European journal of heart failure
Effect of influenza vaccination in patients with decompensated heart failure: a systematic review and meta-analysis
AIMS: In patients with heart failure (HF) influenza vaccination has shown beneficial effects in preventing cardiac decompensations. However, no conclusive results have been achieved in the few studies that have evaluated the impact of vaccination during episodes of acute HF (AHF) decompensation. We conducted a systematic review and meta-analysis to determine the possible effects of influenza vaccination on all-cause mortality in patients diagnosed with AHF. METHODS: PubMed, Medline, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews databases were searched for longitudinal studies comparing patients with AHF vaccinated against influenza with unvaccinated patients. The primary outcome selected for meta-analysis was 1-year all-cause mortality, and secondary outcomes consisted of other outcomes reported in at least in two different studies. Statistical heterogeneity was determined by calculating the I² statistic. Individual adjusted results were pooled using a random effects model. Sensitivity analysis was run for the primary outcome by removing each individual study and then re-doing the meta-analysis. RESULTS: Up to 30 June 2025, five observational cohort studies examining the effect of influenza vaccination on 1-year all-cause mortality in AHF patients had been published. Statistical heterogeneity was low (I2 = 33.7%), meaning that between-study results were consistent. Pooled analysis of confounder-adjusted hazard ratio (HR) for all-cause mortality in vaccinated patients was 0.89 (95% CI 0.83-0.96) compared with unvaccinated patients. All sensitivity analyses rendered very similar results. In-hospital and 90-day mortality were reported in three and two studies and showed similar reductions in risk, with an adjusted odds ratio of 0.85, 95% CI 0.70-1.01, and adjusted HR of 0.86, 95% CI 0.76-0.96; respectively. Isolated data from single studies suggest no effect on hospitalization following discharge after the AHF episode. CONCLUSIONS: Influenza vaccination is associated with a lower short- and long-term all-cause mortality in patients with decompensated HF; however, as all the studies included in this meta-analysis were observational, these results could be subject to residual confounding and causality cannot be directly inferred from them.
14 May 2026
Read appraisal →BMC psychiatry
N-acetylcysteine for patients with alcohol use disorder, post-traumatic stress disorder, and their co-occurrence: a systematic review of placebo-controlled randomized trials
INTRODUCTION: Alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD) are thought to be significant global contributors to the burden of mental illness. According to recent WHO epidemiological estimates, 3.9% of people worldwide have experienced PTSD at some point in their lives; this number rises to roughly 5.6% among those who have experienced trauma. NAC has shown promise in reducing PTSD symptoms and cravings in veterans, according to recent trials. Our analysis aims to resolve the conflict between results and determine whether NAC is an effective add-on therapy for PTSD, AUD, and co-occurring PTSD/AUD. METHODS: We conducted this study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, following our protocol (CRD420251170956). We searched PubMed, Scopus, Cochrane CENTRAL, Embase, EBSCO, and the Web of Science for relevant studies. Only randomized placebo-controlled trials were included. The primary outcomes were severity of PTSD and alcohol craving, while secondary outcomes were anxiety, depression, and alcohol use patterns and biomarkers. RESULTS: Seven randomized, double-blind, placebo-controlled trials were included in this meta-analysis, enrolling a total of 566 participants. There were no significant differences between NAC and placebo in craving (SMD= -0.40, 95% CI [-1.05, 0.25], P = 0.22, I² = 56.1%). Regarding PTSD severity, the PCL scale pooled analysis demonstrated no significant difference between NAC and placebo (SMD = 0.04, 95% CI [-0.40, 0.48], P = 0.8) (I² = 65.9%, P = 0.05), while the CAPS scale pooled analysis demonstrated no significant difference between NAC and placebo (SMD = -0.13, 95% CI [-0.50, 0.24], P = 0.49) (I² = 54.8%, P = 0.109). Leave-one-out sensitivity analysis showed that exclusion of the Back et al. (2025) study resulted in a significant effect favoring NAC (SMD = -0.35, 95% CI [-0.70, -0.01], P = 0.04), with no observed heterogeneity (I² = 0%). CONCLUSION: Our meta-analysis indicates that N-acetylcysteine, when compared to placebo, does not demonstrate consistent efficacy in reducing the primary symptoms of AUD or PTSD in broad patient populations. However, the treatment is relatively safe. A noteworthy signal of potential efficacy for PTSD symptoms emerged in a sensitivity analysis, suggesting that the therapeutic promise of NAC should not be entirely dismissed. CLINICAL TRIAL NUMBER: Not applicable.
14 May 2026
Read appraisal →European journal of clinical pharmacology
Comparison of loop diuretics for chronic heart failure: a systematic review and meta-analysis
BACKGROUND: Loop diuretics relieve congestion in chronic heart failure (CHF). We systematically reviewed randomised clinical trials (RCTs) evaluating their effects. METHODS: A systematic search was conducted across major databases. We included RCTs that compared a loop diuretic to another loop diuretic, placebo, or "no intervention". The primary outcome was all-cause mortality, and secondary outcomes were all-cause hospitalisation, serious adverse events (SAEs), and change in body weight (kg). RESULTS: This review included 23 RCTs that enrolled 4,902 patients. Treatment with alternative loop diuretics (torsemide, azosemide and piretanide) compared with furosemide did not reduce all-cause mortality (risk ratio 1.00, 95% CI 0.89, 1.12); I2 = 0%; p = 0.95), nor did it reduce all-cause hospitalisations (risk ratio 0.99, 95% CI 0.84, 1.17); I2 = 53,46%, p = 0.92). In a pooled analysis of alternative loop diuretics (including torsemide and piretanide) the risk of SAEs was higher compared to furosemide (risk ratio 1.32, 95% CI 1.03, 1.68); I2 = 0%), although this finding was based on a limited number of trials with inconsistent definitions and should therefore be interpreted cautiously. The pooled meta-analysis of change in body weight did not show a difference between loop diuretics (mean difference 0.00 kg, 95% CI -1.19, 1.20; I2 = 92.43), indicating substantial heterogeneity. Azosemide resulted in a significant weight loss reduction compared to furosemide (mean difference - 1.00 kg, 95% CI -1.42, -0.58) based on a single small study. CONCLUSIONS: The choice of loop diuretic did not seem to influence the risk of mortality. In a pooled analysis of torsemide and piretanide, the risk of SAEs was higher when compared to furosemide, but the certainty of this finding is limited. Azosemide was associated with weight loss compared to furosemide in one small trial.
14 May 2026
Read appraisal →Cancer metastasis reviews
Risk of cancer incidence and mortality in patients with chronic pain: A systematic review and meta-analysis
Evidence from experimental studies suggests that pain may influence cancer development. We conducted a systematic review (registration osf.io/ms437) of the epidemiological studies assessing whether chronic pain, with minimal or non-inflammatory features, increases the risk of cancer incidence or mortality. The search used Scopus and Web of Science up to 11/03/2025. Quality assessment used the Newcastle-Ottawa Scale. Study characteristics and outcomes were analysed using narrative synthesis, with random-effects meta-analysis and meta-regression conducted where appropriate. A total of 23 studies (12 prospective, 11 retrospective) met the inclusion criteria, of which six were rated as high quality. The outcome data synthesis indicates a small increase in cancer mortality rate ratios, and a potential increase in a subset of organs. A total of three body site-specific analyses suggest that chronic pain may be associated with higher incidence for breast (SIR 2.12-4.8) and prostate (SIR 1.49-5.59) cancers, and with increased mortality for lung cancer (MRR 3.09, 95% CI 1.45-6.62). Ten studies were included for meta-analysis, including four studies rated as high quality. Meta-analysis of hazard ratios showed no association between cancer-related mortality and pain (HR 1.00, 95% CI 0.97-1.04), with consistent estimates across pain subtypes in meta-regression. Our review and meta-analysis do not support an overall association between chronic pain and increased risk of cancer mortality or incidence and highlight multiple methodological and conceptual obstacles to exploring this relationship, including reverse causation and confounding factors such as pain and opioid use association. High-quality studies that rigorously address reverse causation and confounding are warranted.
14 May 2026
Read appraisal →BMJ open
Pilates during pregnancy for maternal musculoskeletal pain and discomfort: a systematic review and meta-analysis
OBJECTIVES: The predominant concern during pregnancy is musculoskeletal pain, often accompanied by additional discomforts such as anxiety and insomnia. Pilates, as a low-impact mind-body exercise, may be beneficial in managing musculoskeletal pain and associated symptoms in adults. This systematic review and meta-analysis aimed to synthesise the evidence on the effectiveness of Pilates for alleviating musculoskeletal pain and other discomforts during pregnancy. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Scopus, TRIP Medical Database, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to 14 January 2026. ELIGIBILITY CRITERIA: Randomised controlled trials and prospective non-randomised controlled studies that compared Pilates with other prenatal care modalities for improving musculoskeletal pain and discomfort were eligible. DATA EXTRACTION AND SYNTHESIS: Two researchers independently extracted data using standardised forms with subsequent cross-verification. Risk of bias was assessed using the Cochrane Risk of Bias V.2.0 tool. Meta-analyses were performed using random-effects models. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: 13 studies were included in the systematic review, of which 10 contributed data to the meta-analysis. Primary outcomes were pain intensity and disability level. Pain intensity was assessed using Visual Analogue Scale (range 0-10). Moderate-certainty evidence demonstrated that Pilates significantly reduced musculoskeletal pain during pregnancy (mean differences (MD)=-2.59, 95% CI -4.19 to -1.00; I²=91%, p=0.001). Low-certainty evidence suggested that Pilates reduced pregnancy-related disability (standardised mean differences (SMD)=-1.82, 95% CI -2.99 to -0.66; I² = 93%, p=0.002). Secondary outcomes comprised sleep quality and psychological status. Multivariate meta-analysis showed significant improvements in psychological status (SMD=-0.86, 95% CI -1.31 to -0.42; τ²=0.4, I²=86%, p=0.0005) but did not yield statistically significant improvements in sleep quality (MD=-1.93, 95% CI -4.70 to 0.84; I²=93%, p=0.17). Both secondary outcomes were supported by very low-certainty evidence. Risk of bias assessment rated three studies as high risk, three as unclear risk and seven as low risk. Formal assessment of publication bias was not feasible owing to the limited number of studies (fewer than 10 per outcome). CONCLUSION: This meta-analysis demonstrates that, compared with standard care, structured prenatal Pilates significantly alleviates musculoskeletal pain and disability while also enhancing psychological status. PROSPERO REGISTRATION NUMBER: CRD42024628027.
14 May 2026
Read appraisal →European journal of heart failure
Finerenone, polypharmacy, and clinical outcomes in heart failure: pre-specified analysis from the FINEARTS-HF trial
AIMS: Patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) have a high comorbidity burden, which may necessitate numerous medications. Patients and clinicians may be hesitant about initiating another medication, especially among those already experiencing polypharmacy. This pre-specified analysis sought to examine the efficacy and safety of adding finerenone based on the concomitant medication number. METHODS: In the FINEARTS-HF trial, baseline medication use was collected in all 6001 participants with HFmrEF/HFpEF. Clinical outcomes and treatment effects were assessed by the categories of total medication count ('non-polypharmacy': ≤4 medications; 'polypharmacy': 5-9 medications; and 'hyper-polypharmacy': ≥10 medications) and as continuous variables. The primary outcome was a composite of cardiovascular death and total HF events. RESULTS: Overall (age: 72 ± 10 years; 46% women), the total number of medications at baseline ranged from 0 to 29 (mean: 8.4 ± 3.6), with 3588 (60%) meeting polypharmacy and 1878 (31%) meeting hyper-polypharmacy. Incidence rates for the primary outcome increased across medication categories: non-polypharmacy, 10.2; polypharmacy, 12.3; and hyper-polypharmacy, 26.1 per 100 person-years. The treatment benefits of finerenone in reducing the primary outcome were consistent across the spectrum of total medication count (Pinteraction = 0.94). Any serious adverse events and study drug discontinuation were not more frequent with finerenone vs placebo, regardless of polypharmacy categories. CONCLUSION: In FINEARTS-HF, >90% of patients with HFmrEF/HFpEF met the criteria for polypharmacy or hyper-polypharmacy, and these patients faced excess risks of cardiovascular events. Finerenone safely reduced cardiovascular death and total HF events across a broad range of baseline medication use.
14 May 2026
Read appraisal →PloS one
Efficacy and safety of the ayurvedic formulation 'Trikatu' as an add-on to standard care in dyslipidemia: Study protocol for a randomized, double-blind, placebo-controlled trial evaluating lipid parameters, and gut microbiota.
BACKGROUND: Dyslipidemia is a leading modifiable risk factor for cardiovascular disease (CVD), with early and sustained LDL-C reduction offering significant preventive benefits. However, in low- and middle-income countries, long-term adherence to statin therapy remains alarmingly low, highlighting the need for culturally acceptable and safer adjunctive options. Trikatu, a classical Ayurvedic formulation traditionally known to enhance metabolism, may offer supportive benefits in lipid regulation. This study protocol was developed to assess the efficacy and safety of Trikatu as an add-on to standard statin therapy on lipid parameters and assess changes in gut microbiota in response to the intervention and identify microbial correlates associated with favorable lipid outcomes. METHODS: This randomized, double-blind, placebo-controlled clinical trial is being conducted at AIIMS Bhubaneswar, a tertiary care center. Total 170 participants (aged 25-60 years) with moderate to high Atherosclerotic cardiovascular disease (ASCVD) risk. Dyslipidemia, as defined by the 2019 ACC/AHA Guidelines and indicated for statin therapy, will be randomized in a 1:1 ratio to receive either Trikatu (1000 mg) or matching placebo, administered orally twice daily after food for 12 weeks along with standard statin therapy (dose/intensity as per guidelines). Primary outcome includes change in fasting serum LDL-C from baseline to 12 weeks. Secondary outcomes include changes in total cholesterol, HDL-C, triglycerides, glycemic markers (fasting glucose, HbA1c, insulin, HOMA-IR), inflammatory and metabolic markers (hs-CRP, TNF-α, IL-6, adiponectin, ghrelin, ApoA1, ApoB), resting blood pressure, and gut microbiota. The proportion of participants achieving normal cholesterol levels (<200 mg/dL) will also be assessed. Drug compliance and any adverse events will also be recorded. DISCUSSION: In individuals with moderate to high ASCVD risk, achieving and sustaining optimal lipid control remains a cornerstone of cardiovascular prevention. However, poor long-term adherence to statin therapy, especially in low-resource settings, limits real-world impact. By assessing Trikatu, effects on lipid profiles, glycemic and inflammatory markers, and gut microbiota, the study aims to explore its potential to augment cardiovascular risk reduction in a holistic and culturally acceptable manner. If proven effective and safe, Trikatu could serve as a valuable complementary strategy in dyslipidemia management. CLINICAL TRIAL REGISTRATION: Clinical Trial Registry of India (CTRI/2023/04/051942) Registered on 25/04/2023.
13 May 2026
Read appraisal →JMIR mHealth and uHealth
Contribution of Longitudinal Mobile Health Measures in the Dynamic Track of Patients With Major Depressive Disorder: Multiple Centers, Prospective Cohort Study Using Functional Data Analysis and Machine Learning
BACKGROUND: Continuous follow-up for patients with major depressive disorder (MDD) is essential for treatment decisions and a better prognosis. There remains limited evidence regarding the critical issue of depression variation trajectory prediction using mobile health (mHealth) measures. Moreover, the temporal dynamics of mHealth measures have not been fully modeled in previous studies, and the poor patient adherence to mHealth records poses great challenges to the dynamic feature modeling. OBJECTIVE: This study aimed to examine the contribution of mHealth measures in predicting depression variation trajectory for patients with MDD, with full consideration of the temporal dynamics of mHealth measures. METHODS: A total of 229 patients with MDD from a multiple-center, prospective cohort were included. A 12-week follow-up was conducted involving the collection of the Hamilton Depression Rating Scale (HAMD-17), along with patient-reported outcomes (Immediate Mood Scaler and Altman Self-Rating Mania Scale) via mobile devices and sleep duration through wearable wristbands. We used functional data analysis to extract dynamic features from the sparse mHealth records, rather than aggregating the data to a single scalar summary measure through collapsing over time. Subsequently, 3 machine learning models were applied to predict the depression variation trajectory classes based on the baseline characteristics and these extracted dynamic features. RESULTS: Based on the variation of HAMD-17 scores within 12 weeks, the participants were labeled into 4 classes through the k-means algorithm. The classes included stable decline (n=93), fluctuate decline (n=44), fast decline (n=60), and delayed and fluctuate (n=32), in light of the shape of depression trajectories. With both baseline features and dynamic features of the mHealth measures, accuracy rates for the overall data were 54.35%, 60.87%, and 56.52%, for the stable decline patients were 78.95%, 84.21%, and 73.68%, for the nonstable decline patients were 59.26%, 62.96%, and 70.37% based on the 3 machine learning models, respectively. The results were significantly superior to the prediction obtained without mHealth measures (with an overall accuracy below 50%) and only showed a marginal reduction in accuracy relative to the ideal prediction with assessment obtained from clinical visits. Moreover, in the construction of the most accurate prediction model, dynamic features of the Immediate Mood Scaler, the Altman Self-Rating Mania Scale, and sleep duration emerged as the most influential predictors, ranking first, third, and fourth, respectively, in terms of their relative importance. CONCLUSIONS: Longitudinal mHealth measures show potential in depression variation trajectory monitoring for patients with MDD even under poor patient adherence. Our work provides practical help in alleviating the follow-up burden for patients with MDD and validates the effectiveness of mHealth measures in clinical applications.
13 May 2026
Read appraisal →PloS one
Burden and predisposing factors of physical inactivity among adults in Africa: Systematic review and Meta-analysis
INTRODUCTION: Physical inactivity is a primary driver of global mortality, data on its specific impact in Africa remains fragmented. We conducted this study to provide the first comprehensive pooled prevalence and identify predisposing factors contributing to physical inactivity among African adults. METHOD: We searched PubMed, Scopus, Embase, and Google Scholar for studies published between March 1, 2010, and March 31, 2025. A quality assessment of the studies was performed through the Newcastle-Ottawa Scale (NOS). The random-effect (DerSimonian) model was used to calculate the aggregated rates of physical inactivity among adults and their predisposing factors. Heterogeneity was assessed using the I2 statistic, along with subgroup and sensitivity analyses. Publication bias was evaluated using Egger's test, and all analyses were performed in STATA, version 17. RESULTS: This systematic review and meta-analysis included 34 studies with a total of 41,521 participants. The pooled prevalence of physical inactivity was 45% (95% CI: 35%-55%), and there was considerable heterogeneity (I2 = 98.4%). The highest prevalence of 57% (95% CI: 0.33, 0.81) I2 = 97.7 seen in 2013 and the lowest prevalence 28% (95% CI: 0.03, 0.53) I2 = 94.3%) observed in 2011. This study identified that, being female (OR = 1.87; 95% CI: 1.55, 2.25), Adults aged ≥ 60, (OR=2.18; 95% CI:1.98,4.77), being obese (OR=3.52; 95% CI: 2.26,5.49), urban dweller (OR=1.91, 95% CI:1.24,2.95), being overweight (OR=2.03; 95% CI: 1.61,2.68), depression symptom (OR= 1.34;95% CI: 1.07,1.68) and more drinking of alcohol (OR=1.73; 95% CI: 1.18,2.64), were significant predisposing factors associated with prevalence of physical inactivity. CONCLUSION: A high level of physical inactivity was observed amongst the African adults. Our findings indicate that female gender, older age, being overweight and obese, high levels of alcohol consumption and depression are significant predictors of physical inactivity in the African population. Promoting awareness about the positive impacts of regular exercise on health among women and an elderly age group could effectively lower the chances of hypokinetic diseases.
13 May 2026
Read appraisal →JMIR human factors
The Quality and Characteristics of Digital Mental Health Apps: Mixed Methods Study
BACKGROUND: There are around 20,000 mental health apps available in app stores. The Organisation for the Review of Care and Health Apps (ORCHA), a United Kingdom digital health compliance company, has assessed a number of digital mental health apps with regard to their quality, professional and clinical assurance, data privacy, and user experience. This study analyzes the data that were collected by ORCHA when they assessed mental health apps. OBJECTIVE: This study aimed to examine the characteristics of mental health apps regarding their quality, target users, features, underpinning evidence, and data privacy. METHODS: A dataset comprising ORCHA Baseline Review assessments of over 2000 digital health apps, including 436 mental health apps, was used. This study uses exploratory data analysis to gain insight into the quality and characteristics of mental health apps. Methods such as descriptive and inferential statistics, k-modes clustering, and association rule mining were used to explore the quality of mental health apps as well as reveal insights into the different cost types, target users, app features, data types, and evidence of app content. RESULTS: Information provision, data capture, and data sharing were the most common features within the 436 mental health apps. The examined apps primarily targeted the following groups: adults (n=229, 52.5%), everyone (n=184, 42.2%), and teens (n=135, 31%). The cost of apps has not been linked to the quality of mental health apps, although paid apps or apps with in-app purchases may include additional services. Indicated user acceptance or benefit is the most common type of evidence provided by these mental health apps. A total of 241 (55.3%) apps included a qualified professional in app development, and 251 (57.6%) apps provided evidence within the app that the developer validated any guidance with relevant reliable information sources or references. Usage data and email were the most commonly collected data types. Association rule mining showed that email, IP address, name, and usage data are often co-collected by the same apps. K-modes cluster analysis showed that mental health apps can be categorized into 2 clusters, where one cluster of apps (n=182, 41.7%) collected more data than apps in the other cluster. CONCLUSIONS: Mental health apps are commonly targeted for everyone to use, but many apps are targeted toward teens or adults. Our study suggests that many publicly available mental health apps did not take the precautions (such as the involvement of appropriate health professionals, literature references, or conducting tests) to ensure that their content is valid and research based. Greater effort on behalf of mental health app developers is needed to ensure that the public is provided with high-quality apps. Moreover, our study indicates that the mental health apps that collect more data tend to score better on the ORCHA Baseline Review assessment.
13 May 2026
Read appraisal →Oral health & preventive dentistry
Prevalence and Risk of Dental Erosion Linked to Carbonated Drinks in Adolescents: A Systematic Review and Meta-Analysis
PURPOSE: To determine the prevalence of dental erosion due to carbonated beverage consumption among adolescents and the association between both variables through a systematic review and meta-analysis. METHODS AND MATERIALS: This study was conducted in accordance with the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines for systematic reviews. A comprehensive literature search was performed in PubMed, Scopus, Web of Science, LILACS, and SciELO. Observational studies were included, and the PEO framework was used to identify dental erosion and non-erosion (outcome) and intake of carbonated beverages (exposure) in adolescents (population). The prevalence of dental erosion and odds ratio (OR) with 95% confidence interval (95%CI) to determine the risk of carbonated beverages were estimated with MedCalc V.23.0.2 and Review Manager (RevMan V.5.4.1) software, respectively. A P value 0.05 was considered to indicate statistical significance. RESULTS: A total of 24 studies met the eligibility criteria. The pooled sample included 21,541 adolescents, and the overall erosion prevalence was 37.6% (95%CI 26.3, 49.7%). The meta-analysis revealed a significant association between carbonated beverage consumption and dental erosion (OR = 1.98, 95%CI: 1.42-2.77; 7785 participants; I2 = 80%; P 0.0001). CONCLUSION: Dental erosion is a prevalent condition among adolescents, with a pooled prevalence of 37.6%. Carbonated beverage consumption among adolescents is associated with a 98% increased risk of dental erosion.
13 May 2026
Read appraisal →The Journal of dermatological treatment
Beyond efficacy: pulse duration is crucial for adverse events in pulsed dye laser therapy for rosacea
BACKGROUND: Pulsed dye laser (PDL) is widely used for erythematotelangiectatic rosacea (ETR); however, the influence of pulse duration remains unclear. OBJECTIVE: To compare the efficacy and tolerability of 6 and 10 ms PDL pulse durations for ETR. METHODS: In this single-center, prospective, randomized controlled study, 80 patients with ETR received single PDL treatment using either a 6 or 10 ms pulse duration (9-11 J/cm2, 7 mm spot size). Erythema was assessed by blinded dermatologists using the Clinical Erythema Assessment (CEA) and telangiectasia scores, and Rosacea Area and Severity Index (RASI). ImageJ analysis measured the Relative Intensity of Redness (RIR) and Percentage of Erythema Area (PEA). Adverse events were recorded on days 3 and 7, and patient global assessment (PGA) and symptom improvement were evaluated at week 4. RESULTS: Both groups showed significant improvements in CEA, RASI, RIR, and PEA (p < 0.001), with no significant between group differences. However, edema (p < 0.05) and purpura (p < 0.001) were more frequent with the 6 ms setting. No significant differences were observed between the groups on the PGA, erythema improvement scale, or symptom improvement scale. CONCLUSION: Both pulse durations effectively reduced erythema, but 10 ms demonstrated more favorable tolerability.
13 May 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Improved Cardiac Function and Glycemic Control in Elderly Diabetic Patients Through Structured Case Management After CABG
BACKGROUND Elderly patients with both coronary heart disease (CHD) and diabetes mellitus (DM) undergoing off-pump coronary artery bypass grafting (CABG) face high risks of perioperative glucose fluctuations and impaired recovery. We evaluated the impact of a structured, multidisciplinary case management model on cardiac function and glycemic control in this population. MATERIAL AND METHODS This single-center, randomized controlled trial enrolled 168 elderly (≥65 years) patients with CHD and type 2 DM scheduled for off-pump CABG. Patients were randomized (1: 1) to a control group (CG, n=84; routine care) or an observation group (OG, n=84). The OG received routine care plus a 6-month multidisciplinary intervention including individualized cardiac rehabilitation, modified Mediterranean diet, psychological support, and intensified follow-up. The primary endpoint was 6-month left ventricular ejection fraction (LVEF); HbA1c was a key secondary endpoint. RESULTS All 168 randomized patients were analyzed. At 6 months, the observation group demonstrated significantly superior primary outcomes. LVEF was significantly higher in the OG (mean difference: 6.2%, P<0.001), and HbA1c was significantly lower (mean difference: 1.3%, P<0.001). The intervention group also showed significant improvements in secondary endpoints, including reduced left ventricular diameters (LVESD, LVEDD), an improved lipid profile (P<0.05), longer 6-minute walk test distance, and higher Diabetes-Specific Quality of Life (DSQL) and Activity of Daily Living (ADL) scores (P<0.0001). CONCLUSIONS Structured, multidisciplinary case management significantly improved cardiac function, metabolic control, and functional capacity in elderly diabetic patients after off-pump CABG, validating its efficacy for this high-risk group.
13 May 2026
Read appraisal →Lancet (London, England)
Long-term effects of colonoscopy screening on colorectal cancer incidence and mortality: a multicountry, population-based randomised controlled trial
BACKGROUND: We previously reported the 10-year effects of colonoscopy screening on colorectal cancer incidence and mortality. Here, we report the effects after 13 years of follow-up. METHODS: In this multicountry, population-based randomised controlled trial, 84 583 men and women aged 55-64 years at enrolment from Norway, Poland, and Sweden were randomly allocated (1:2) to colonoscopy screening or no screening and analysed. The primary outcomes were colorectal cancer incidence and mortality after 10-15 years of follow-up in intention-to-screen analyses, with first analysis after 10 years, and repeated every other year or at longer intervals. This trial is registered with ClinicalTrials.gov, NCT00883792, and is ongoing. FINDINGS: At 13 years of follow-up, colorectal cancer incidence was 375 colorectal cancers (1·46%) of 28 217 individuals in the screening group and 912 colorectal cancers (1·80%) of 56 366 individuals in the no-screening group. The risk ratio (RR) was 0·81 (95% CI 0·71-0·90) in intention-to-screen analyses and 0·55 (0·33-0·81) in per-protocol analyses. The risk for proximal colorectal cancer was 129 (0·51%) in the screening group versus 283 (0·56%) in the no-screening group (RR 0·91 [0·71-1·09]), and the risk for distal colorectal cancer was 224 (0·87%) in the screening group versus 563 (1·11%) in the no-screening group (RR 0·79 [0·65-0·89]; interaction p<0·0001). In men, the colorectal cancer risk was 214 (1·69%) of 14 154 in the screening group and 541 (2·19%) of 28 247 in the no-screening group (RR 0·77 [0·64 to -0·88]); in women, the risk was 161 (1·24%) of 14 063 in the screening group versus 371 (1·43%) of 28 119 in the no-screening group (RR 0·87 [0·70 to 1·02]; interaction p<0·0001). Colorectal cancer mortality was 106 (0·41%) of 28 217 in the screening group and 236 (0·47%) of 56 366 in the no-screening group (intention-to-screen RR 0·88 [0·68-1·08], per-protocol RR 0·70 [0·26-1·25]). The observed colorectal cancer mortality in the non-screening group (0·47%) was substantially lower than expected at the time of designing the trial (0·82%). INTERPRETATION: One colonoscopy significantly reduced colorectal cancer incidence but not mortality over 13 years. Colorectal cancer mortality was lower in both study groups than when the trial was designed. FUNDING: The Norwegian Research Council, the Nordic Cancer Union, the Norwegian Cancer Society, and the Health Fund of South-East Norway.
13 May 2026
Read appraisal →Expert review of vaccines
Population-level impact of HPV vaccination: a global systematic review of ecological, cross-sectional, and cohort studies
BACKGROUND: Human papillomavirus (HPV) causes approximately 4.5% of cancers globally, with the highest burden in low- and middle-income countries (LMICs). Since their introduction in 2006, HPV vaccination programs have led to substantial declines in HPV-related outcomes, although impact varies across settings. RESEARCH DESIGN AND METHODS: We conducted a systematic review to evaluate the population-level impact of HPV vaccination on HPV infection, cervical intraepithelial neoplasia grade 2 or higher (CIN2+), genital warts, invasive cervical cancer (ICC), and oropharyngeal cancer (OPC), and examined the influence of coverage, age at initiation, and vaccine type. The review followed PRISMA 2020. RESULTS: Of 13,549 records screened, 63 were included: 9 assessed HPV infection, 24 on CIN2+, 25 on genital warts, and 7 on ICC. Greatest reductions were observed in settings with at least 70% coverage and early vaccination prior to sexual debut, typically achieved through school-based programs. Reported declines ranged from 58-100% for HPV infection, 30-88% for CIN2+, 60-90% for genital warts, and 70-88% for ICC. CONCLUSIONS: HPV vaccination offers strong protection, especially when delivered early and at high coverage within schools. Expanding access and prioritizing underserved populations are essential to achieving global cancer prevention goals. Limitations include heterogeneity across designs, outcome definitions, and follow-up.
13 May 2026
Read appraisal →Vaccine
The immune response of the mRNA vaccine CS-2034 as a heterologous booster before and after breakthrough infection: A follow-up study.
BACKGROUND: The emergence of highly mutated SARS-CoV-2 variants challenges vaccine protection. Evaluating long-term immune protection from boosters is crucial. The experiment compares neutralizing antibody dynamics and ACE2-RBD binding inhibition induced by mRNA and inactivated vaccine boosters, and assesses the impact of breakthrough infections and age on immune responses. METHODS: This study is based on a previous randomized, double-blind, parallel controlled trial. Healthy participants aged ≥18 who had received ≥3 inactivated COVID-19 vaccine doses. Volunteers (32 aged 18-59 and 32 ≥ 60) were stratified by age and vaccine type (24 mRNA, 8 inactivated in each age group). Pregnant women, those with severe chronic diseases or a history of allergies are excluded. Neutralizing antibodies were measured via microneutralization assay, and ACE2-RBD binding inhibition by high-sensitivity electrochemiluminescence. The study assessed changes in antibody levels and ACE2-RBD binding inhibition pre- and post-infection across age groups to evaluate vaccine efficacy and durability. (Registed number: ChiCTR2200064575). RESULTS: The neutralizing antibody titers from mRNA vaccine showing stronger and more consistent responses against the original strain and variants like XBB and BA.5. After breakthrough infections, mRNA-vaccinated individuals show a significant and lasting boost in antibodies, while the increase in inactivated vaccine recipients is modest. By age, mRNA-vaccinated people over 60 experience a faster antibody decline post-vaccination, whereas the inactivated vaccine group sees an initial rise at three months before declining. For ACE2-RBD binding inhibition, mRNA vaccines maintain higher early-phase rates, while inactivated vaccines show a delayed rise at three months followed by decline. CONCLUSIONS: mRNA vaccines induce stronger neutralizing antibodies and broader immunity than inactivated vaccines. Breakthrough infections boost antibody levels more in mRNA recipients than in inactivated vaccine recipients. Antibody decline is faster with mRNA vaccines in people over 60, while inactivated vaccines show a modest but weaker antibody increase against variants in the elderly.
13 May 2026
Read appraisal →Integrative psychological & behavioral science
The Human Mind in Dialogue With its Replica AI - a Historical Perspective
Although artificial intelligence has exploded for the last couple of years, the idea of comparing the human mind with a computer is not new. One may say that Alan Turing started this movement, and this idea got off to a flying start in psychology through the symposium arranged by the "Special Interest Group in Information Theory" at Massachusetts Institute of Technology Sept. 10-11, 1956. This symposium was sponsored by IBM, and Noam Chomsky presented for the first time his ideas about a transformational generative grammar. There were several contributors to the cognitive revolution, but Chomsky's presentation of a linguistic system with a level of precision comparable with mathematics was symptomatic for how a cognitive model for the human mind aimed to be conceptualized. This has brought the question about artificial intelligence to the core of psychology, namely how it can be understood as a model for the human mind. Psychology and its understanding of the human mind have changed along the last 500 years of the Western psychology. After a short presentation of some of the premises for artificial intelligence of today and some aspects of the idea behind the computational mind, these perspectives are compared with the very early use of the term 'psychology' in the early 16th century. The role of classical logic as a model for the human mind was at stake back then and one of the main factors that paved the way for psychology was that Aristotelian logic was criticized and questioned as a model for the human mind. On the other hand, the importance of classical logic has never been completely outdated Consequently, for the last 500 years Western psychology can in many ways be characterized as an incessant battle about the role of logic in the understanding of the human mind. However, the conclusion is that AI of today presupposes an understanding of the human mind that has been outdated for more than 500 years.
13 May 2026
Read appraisal →Stress (Amsterdam, Netherlands)
Safety and efficacy of ashwagen (a standardized withania somnifera extract) in stress and anxiety with hypertension and associated cardiometabolic risk factors: a randomized, placebo-controlled trial
Stress and anxiety are prevalent mental health conditions that often coexist with cardiovascular comorbidities, resulting in a complex interplay between psychological and physiological processes, partly mediated through activation of the hypothalamic-pituitary-adrenal (HPA) axis. Ashwagen®, a standardized extract of Withania somnifera (Ashwagandha), has demonstrated adaptogenic and anxiolytic properties in preclinical and clinical studies. This study aimed to evaluate the safety and efficacy of Ashwagen® in managing stress and anxiety in patients with pre-existing hypertension and associated cardiometabolic risk factors. A randomized, double-blind, placebo-controlled Phase III clinical trial was conducted over 60 days in 60 patients diagnosed with stress, anxiety, and pre-existing hypertension with cardiometabolic risk profiles. Participants received either Ashwagen® (300 mg capsule) or placebo twice daily. Efficacy assessments included validated psychological scales-Hamilton Anxiety Rating Scale (HAM-A), Generalized Anxiety Disorder-7 (GAD-7), Perceived Stress Scale (PSS), Clinical Global Impression-Improvement (CGI-I), Epworth Sleepiness Scale (ESS), and Fatigue Severity Scale (FSS)-along with serum cortisol, triglycerides, LDL, and blood pressure measurements. Ashwagen® significantly reduced anxiety and stress markers compared with placebo. HAM-A, GAD-7, and PSS scores decreased by 26.94%, 50.77%, and 30.47%, respectively, in the Ashwagen® group. Cortisol levels declined by 28.99% and triglycerides by 13.00%, with favorable trends in LDL and blood pressure. No serious adverse events were reported. Ashwagen® was found to be a safe and effective adjunctive integrative intervention for stress and anxiety management in patients with pre-existing hypertension.
13 May 2026
Read appraisal →Journal of medical systems
Feasibility, Adherence, Acceptance and Usability of a Multimodal Telemonitoring for Pediatric Post-COVID Syndrome: A Bicentric Pilot Study
Existing healthcare infrastructure struggles to meet the complex care required for pediatric Post-COVID Syndrome (pPCS). Telemonitoring offers potential to enhance care access, reduce patient burden, and ensure continuity. This study introduces and evaluates a novel, multimodal telemonitoring concept for pPCS with high translational potential for broader pediatric chronic and post-infectious conditions. Telemonitoring included a patient app, digital sensors (spirometer, smartwatch), Patient Reported Outcome Measures, chat/video consultations (VC), and a medical telemonitoring platform. Patients aged 12-17 years with diagnosed PCS were recruited from two pPCS outpatient university clinics in Bielefeld and Munich, Germany. Monitoring lasted three months. Evaluation focused on feasibility, adherence, acceptance, and usability, using monitoring data, the System Usability Scale (SUS), Technology Usage Inventory (TUI), and a custom survey completed by patients and parents. 30 patients (mean age: 15y ± 1.9; 57% female (17/30); mean Baseline Bell-Score: 36.4) and 30 parents participated. Adherence was high, with an average of 3.4 (smartwatch) to 4.6 (spirometry) measurements/week. Questionnaire response rate was 86% (411/480) and 97% (58/60) of VCs were conducted. SUS scores indicated very high usability (patients: 81.25/100; parents: 75.42/100). TUI results showed low skepticism, and high interest. Telemonitoring supported symptom management independent of in-person visits, despite sensor connectivity issues. This is the first study to demonstrate successful integration of telemonitoring in pPCS, with high adherence and positive feedback from all stakeholders supporting its potential. Despite occasional technical challenges and resource needs, this concept shows promise for broader hybrid telemonitoring care implementation in PCS and other post-infectious syndromes. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), trial registration number: DRKS00029354. Registered 07 February 2023 - Retrospectively registered https://drks.de/search/en/trial/DRKS00029354/entails.
13 May 2026
Read appraisal →Vaccine
Factors affecting human papillomavirus vaccination: A review of individual, interpersonal, and structural factors affecting vaccine uptake among adolescents.
BACKGROUND: Human papillomavirus (HPV) related cancers, particularly cervical cancer, remain a major public health challenge in low- and lower-middle-income countries (LLMICs), which bear a disproportionate share of global HPV-attributable mortality. Despite the availability of safe and effective vaccines for nearly two decades, vaccination coverage remains low in LLMICs. Several barriers ranging from health misinformation to systemic delivery challenges have hindered efforts to scale up vaccination programs in these settings. OBJECTIVES: This systematic review aims to identify and synthesize the behavioral and structural factors influencing HPV vaccine uptake among adolescents in LLMICs. Guided by a multi-level behavioral health framework, findings were categorized across: individual, interpersonal, and structural domains. METHODS: A comprehensive search of seven databases identified 639 records, of which 34 empirical studies met inclusion criteria. Eligible studies focused on HPV vaccination uptake among adolescents in World Bank-defined LLMICs and were assessed for thematic relevance. Data extraction emphasized barriers and facilitators to uptake. RESULTS: Individual-level barriers included limited awareness, misconceptions about HPV and the vaccine, and fear of side effects. Interpersonal dynamics-particularly parental consent, gendered norms, and community endorsement-shaped adolescent vaccine decision-making. Structural barriers included vaccine stock-outs, weak delivery infrastructure, and limited reach among out-of-school youth. School-based delivery models, trusted healthcare workers, and community sensitization emerged as key facilitators. CONCLUSIONS: Improving HPV vaccine coverage in LLMICs requires coordinated, multi-level interventions that simultaneously address behavioral and structural determinants. Findings highlight the critical role of community engagement, flexible delivery models, and long-term sustainability planning to ensure effective implementation. These insights have direct implications for national immunization policy, health system strengthening, and achievement of global cervical cancer elimination targets in resource-limited settings. Tailoring implementation to the contextual realities of LLMICs will be essential to advancing equity in HPV-related cancer prevention.
13 May 2026
Read appraisal →Journal of medical Internet research
Efficacy, User Engagement, and Acceptability of Cognitive Behavioral Therapy-Oriented Psychological Chatbots for Adults With Depressive and/or Anxiety Symptoms: Systematic Review and Meta-Analysis of Randomized Controlled Trials
BACKGROUND: Cognitive behavioral therapy (CBT) is the most examined psychotherapy for depression and anxiety, but delivery faces significant barriers such as limited access, cost, and time constraints. CBT-oriented psychological chatbots offer a promising means of addressing these challenges. Yet, their overall efficacy, user engagement, and acceptability have not been systematically synthesized. OBJECTIVE: This study aimed to evaluate the efficacy, user engagement, and acceptability of CBT-oriented chatbots for adults with depressive and/or anxiety symptoms. METHODS: A systematic search of 9 databases, including PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, PsycINFO, CINAHL, China National Knowledge Infrastructure, WanFang, and VIP Databases, was conducted from inception to February 2026. Eligibility criteria included randomized controlled trials comparing CBT-oriented chatbots with control groups in adults with depressive and/or anxiety symptoms. Risk of bias (ROB) was assessed using the Cochrane ROB tool. Random-effects meta-analyses (Hartung-Knapp-Sidik-Jonkman adjustment) calculated pooled effect sizes (Hedges g), 95% CIs, and 95% prediction intervals (PIs). Heterogeneity was evaluated using the I² statistic, and Galbraith plots were used to identify outliers for subsequent sensitivity analyses. Subgroup and meta-regression analyses examined potential moderators. The certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Data on user engagement and acceptability were extracted and synthesized using narrative and quantitative methods where available. RESULTS: Twenty-nine eligible randomized controlled trials were included. CBT-oriented psychological chatbots produced a moderate reduction in depressive symptoms at postintervention (g=-0.55, 95% CI -0.70 to -0.40, 95% PI -1.23 to 0.13) and a small reduction in anxiety symptoms (g=-0.26, 95% CI -0.37 to -0.14, 95% PI -0.67 to 0.15). At follow-up, effects were small for depression (g=-0.32, 95% CI -0.55 to -0.09, 95% PI -0.93 to 0.29) and nonsignificant for anxiety (g=-0.19, 95% CI -0.43 to 0.04, 95% PI -0.84 to 0.46). Subgroup and meta-regression analyses revealed that anxiety outcomes were significantly moderated by clinical profiles-showing distinct advantages for comorbid symptoms-and the proportion of female participants. The CBT-oriented chatbots received an adequate level of engagement that complied with digital intervention standards. Although user satisfaction ratings were generally favorable, technical limitations and repetitive interaction patterns remain to be addressed to enhance overall acceptability. Regarding the limitations of evidence, the overall certainty was rated as very low to low, predominantly driven by high ROB and substantial heterogeneity. CONCLUSIONS: This study innovatively isolates CBT-oriented chatbots from broader digital interventions, providing a precise, methodology-driven evaluation of theoretically grounded therapeutics. This review brings critical evidence to the field that these tools yield significant short-term relief, particularly for comorbid anxiety profiles. In the real world, CBT chatbots offer profound potential as scalable, low-barrier first-line tools. To sustain engagement, future developments must evolve from rigid rule-based scripts toward adaptive, large language model-driven architectures while ensuring clinical safety.
13 May 2026
Read appraisal →PloS one
Maternal body mass index and the risk of early-onset Group B Streptococcus disease in newborns: A systematic review and meta-analysis
BACKGROUND: Early-onset group B Streptococcus disease (EOGBS) remains a leading cause of neonatal morbidity and mortality. The incidence can be substantially reduced by intrapartum antibiotic prophylaxis in women with defined risk factors. However, the role of high prepregnancy body mass index (BMI) as a risk factor remains unclear. This systematic review and meta-analysis therefore aimed to evaluate the association between maternal BMI and the risk of EOGBS, as well as related proxy outcomes, including intrapartum vaginal GBS colonization and rectovaginal or urinary GBS colonization before term. METHODS: We systematically searched MEDLINE, Embase, and Cochrane CENTRAL on the 28th of January 2026, for studies examining the relationship between pregestational BMI and EOGBS or its proxy outcomes. Eligible studies included observational and interventional designs but not case reports and conference abstracts. Risk of bias was assessed using the QUIPS tool. Random-effects meta-regression and sensitivity analyses were performed. RESULTS: We identified 19 eligible observational studies reporting data from a total of 3,707,047 women, encompassing 277,887 cases. For the risk of EOGBS and its proxy outcomes, assuming a log-linear association, our meta-regression showed a 2.4% increase in the odds ratio (OR) per unit increase in BMI. This corresponds to an OR of 1.4 (95% CI 1.1-1.6) for a BMI of 35 and 1.7 (95% CI 1.3-2.3) for a BMI of 45, compared to a normal BMI of 22.3. One very large study on 1,971,346 live singleton births with 780 EOGBS cases, found a hazard ratio of 2.4 (95% CI 1.7-3.4) for a BMI of 35.0-39.9 compared to normal BMI (18.5-24.9). CONCLUSIONS: Although the overall association appears modest, incorporating BMI may improve prevention strategies for EOGBS .
13 May 2026
Read appraisal →Vaccine
Effect of time-of-day vaccination on the antibody response to mRNA and protein COVID-19 vaccine in adults
Time-of-day vaccination has been suggested as a feasible method to boost COVID-19 vaccine immunogenicity particularly in high-risk groups. However, several studies report inconsistent findings. We explored if time-of-day vaccination influences antibody responses to a fourth dose of mRNA (Moderna bivalent vaccine; mRNA-1273.214/mRNA-1273.222) or protein (Novavax; NVX-CoV-2373) COVID-19 vaccine as part of a randomised controlled trial (RCT) in Melbourne, Australia. Furthermore, we assessed if time-of-day vaccination effects differed by vaccine type or sex. At day 28 post-vaccination, antibody responses to all SARS-CoV-2 variants tested were higher for morning compared to afternoon vaccination in the Moderna group. Males in the Moderna group responded with higher antibodies to all SARS-CoV-2 variants tested after morning vaccination while responses in females were unaffected by time-of-day vaccination. Time-of-day vaccination had no effect on the response to Novavax, regardless of sex. Larger randomised trials are needed to confirm these findings to optimise vaccine timing strategies.
13 May 2026
Read appraisal →Archives of women's mental health
Who is screened for perinatal mental health? findings from an academic health system in California.
PURPOSE: To identify sociodemographic characteristics, prenatal healthcare utilization, and health factors associated with completed mental health screenings during pregnancy and postpartum, respectively. METHODS: We examined electronic medical records (EMR) data on documented perinatal mental health screenings from over 6000 patients who delivered singleton infants within one academic healthcare system in California between 2021 and 2023. Dependent variables included having at least one Edinburgh Postnatal Depression Scale (EPDS) score documented in the EMR during (1) pregnancy and (2) postpartum, among those who completed postpartum care within 12 weeks of delivery. We used univariate frequencies to determine rates of completed screenings and logistic regression models to identify patient characteristics associated with completed screenings in each time period. RESULTS: Overall, 67% of patients completed screenings in pregnancy and 56% completed screenings in postpartum. In pregnancy, patients who were White, multiparous, did not prefer English, began prenatal care in the third trimester, and completed 10 or fewer prenatal care visits each had lower odds of completed screenings than their counterparts. In postpartum, patients who were White, privately insured, had vaginal deliveries, and had term births (at least 37 weeks of gestation) each had lower odds of completed screenings than their counterparts. CONCLUSIONS: Although California law requires perinatal mental health screening in pregnancy and postpartum , the identified inequities in screening suggest additional efforts are needed to ensure all perinatal patients are screened for mental health in accordance with the law. These efforts should be tailored to the populations least likely to be screened in order to achieve universal perinatal mental health screening.
13 May 2026
Read appraisal →Archives of women's mental health
Influences of adverse childhood experiences and weekly pregnancy stress on postpartum mental health symptoms: a machine learning examination
PURPOSE: The goal of this study was to understand how the timing, level, and fluctuation of pregnancy stress affected women's postpartum mental health while also considering their experiences of early life stress (adverse childhood events; ACEs). We hypothesized that overall stress level, as well as stress during particular pregnancy weeks, would influence postpartum mental health. We further hypothesized that fluctuations in weekly perceived stress levels across pregnancy would influence postpartum mental health among women who had experienced ≥ 4 ACEs. METHODS: We collected information on ACEs and weekly stress data from our participants during pregnancy (15 weeks until parturition). Women's depressive and anxiety symptoms were assessed at six-months postpartum. We employed a machine learning approach to explore the predictive utility of timing, level, and fluctuation of pregnancy stress on postpartum mental health symptoms. RESULTS: For all women, higher average stress level across all weeks of pregnancy predicted greater postpartum depressive and anxiety symptoms. Additionally, women with a history of ≥ 4 ACEs were susceptible to stress levels in weeks 20 of pregnancy (depressive symptoms only) and 26 (depressive and anxiety symptoms). Lastly, greater variability in stress levels across pregnancy was also associated with greater depressive symptoms for the women with ≥ 4 ACES. CONCLUSION: In addition to overall stress level, timing of pregnancy stress and fluctuations in stress levels across pregnancy are associated with postpartum mental health for women with a history of substantial ACEs, with implications for focused mental health interventions during pregnancy for these women.
13 May 2026
Read appraisal →Med (New York, N.Y.)
Mazdutide 9 mg in Chinese adults with a body mass index ≥30 kg/m2 but without diabetes: A phase 2 randomized controlled trial
BACKGROUND: Once-weekly dual glucagon and glucagon-like peptide-1 receptor agonist mazdutide, administered at 4 and 6 mg, provides substantial weight loss in Chinese adults with overweight or obesity. This trial aimed to evaluate the efficacy and safety of mazdutide 9 mg in Chinese adults with obesity. METHODS: In this randomized, double-blind, placebo-controlled phase 2 trial (NCT01904913), participants with a body mass index (BMI) ≥30 kg/m2 and without diabetes were randomized 3:1 to receive mazdutide 9 mg or placebo for 24 weeks. The primary endpoint was the percentage change in body weight from baseline to week 24. FINDINGS: Eighty participants were randomized and received mazdutide 9 mg (n = 60) or placebo (n = 20). At week 24, the mean percentage change in weight from baseline was -12.78% with mazdutide 9 mg and 1.80% with placebo (treatment difference: -14.58% [95% confidence interval (CI) -18.00, -11.16], p < 0.0001). Weight reduction ≥5% was achieved by 81.7% of participants with mazdutide after 24-week treatment, while no participants with placebo achieved this threshold. Mazdutide treatment was associated with greater improvements in cardiometabolic risk factors vs. placebo. The most common adverse events included nausea (50.0% with mazdutide vs. 0% with placebo), diarrhea (38.3% vs. 10.0%), and vomiting (36.7% vs. 10.0%), predominantly mild to moderate in severity. CONCLUSIONS: Mazdutide 9 mg was safe and led to substantial weight reductions in Chinese adults with a BMI ≥ 30kg/m2 but without diabetes after 24-week treatment. These results support further clinical development of mazdutide 9 mg for the treatment of obesity. FUNDING: This study was sponsored by Innovent Biologics.
12 May 2026
Read appraisal →European journal of nutrition
Association of daily diet and incidence of head and neck cancer: a prospective cohort study of UK biobank participants
PURPOSE: The association between daily diet and head and neck cancer (HNC) remains unclear. Therefore, this study aimed to systematically investigate the relationship between different types of diet and incident HNC. METHODS: This cohort study analyzed UK Biobank (UKB) data (2006-2021, n = 480,577) using Cox proportional hazards models to evaluate the associations between daily diet and incident HNC and its subtypes: laryngeal cancer (LC), oral cancer (OC), and oropharyngeal cancer (OPC). Subgroup analyses were further performed for sex, age, body mass index (BMI), and smoking status. RESULTS: This large prospective study identified significant dietary associations with head and neck cancer (HNC) risk during 11.8 years of follow-up. Protective associations emerged for moderate dried fruit consumption (Hazard Ratio (HR) = 0.77-0.81), daily milk intake (> 299 mL/day, HR = 0.71), and regular coffee drinking (HR = 0.77-0.84). Conversely, elevated risks were observed with frequent red meat (≥ 4 times/week, HR = 1.20), non-oily fish (≥ twice/week, HR = 1.45), refined grains (≥ 3 bowls or slices/week, HR = 1.14), and habitual salt addition (HR = 1.21). Subtype-specific patterns include the protective effects of whole grains and vegetables against laryngeal cancer and reduced oral cancer risk with limited poultry consumption. Notable variations were observed in sex (sex-specific milk/oily fish effects), age (differential fruit/vitamin impacts), and BMI (heightened red meat risk in normal-weight individuals). CONCLUSION: Our findings demonstrated significant associations between dietary patterns and HNC risk, identifying both protective and risk-enhancing food components. These results highlight the potential of dietary interventions in HNC prevention, with varying effects across cancer subtypes and demographic groups.
12 May 2026
Read appraisal →Journal of the International Society of Sports Nutrition
Carbohydrate supplementation for endurance exercise in the heat: a systematic review with practical recommendations
BACKGROUND AND OBJECTIVES: Endurance exercise performance is impaired by heat stress. Although the mechanisms are not yet fully understood, heat-induced increases in glycogenolysis may play a role. Therefore, carbohydrate supplementation recommendations may differ for endurance exercise in hot environments. This systematic review aims to investigate the efficacy of carbohydrate supplementation for endurance performance in hot environments. METHODS: Electronic databases, including PubMed, the Cochrane Library, MEDLINE, and SPORTDiscus were searched through to April 14, 2026 for studies evaluating endurance performance outcomes under heat stress in response to carbohydrate supplementation. Studies were included if the participants were healthy, aged 18-65 years, and at least recreationally active. A hot environment was defined as an ambient temperature >23 °C. Studies were required to involve an endurance-based and continuous exercise protocol lasting >30 min and a direct performance measure. This cutoff was selected based on evidence indicating glycogen stress at ~40 min under heat stress. In total, 3151 records were identified, and nine randomized, crossover studies met the inclusion criteria. Risk of bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias. Primary outcomes (endurance performance and carbohydrate oxidation rates) and secondary outcomes (including gastrointestinal symptoms, thermoregulation, and hydration markers) were extracted. Mean carbohydrate intake rates were calculated, and a narrative synthesis was performed. RESULTS: Mean carbohydrate ingestion rates ranged between 14 and 140 g·h-1, and the exercise trial duration ranged between ~50 and 152 min. Carbohydrate supplementation resulted in equivocal benefits to endurance performance: five studies found significant (p < 0.05) positive effects for carbohydrates (increases of 13.4%-19.3% in time to exhaustion and 3.3%-12.7% in time trial), and four studies found no significant effects. Although nonsignificant, three studies reported average improvements of 6.7%-11.6%, which may be meaningful in elite athletes. Most studies reported no differences in the respiratory exchange ratio between trials, indicating a preferential reliance on glycogen, which is in line with the literature. Carbohydrate ingestion during exercise in the heat did not influence markers of hydration, thermoregulation, or fatigue compared with placebo. Given that prior research shows gastrointestinal symptoms is common in endurance events in hot environments, the absence of symptom investigations in seven out of nine studies reviewed has important implications for interpreting findings. Overall, the results suggest that carbohydrate intake may not reduce glycogen breakdown during endurance performance in heat. Future research should help to better understand the underlying reasons, including any moderating effects of gastrointestinal distress. CONCLUSIONS: Carbohydrate intake during endurance exercise in the heat does not consistently improve exercise performance. Athletes may focus on maintaining hydration during exercise and practice gut-training, based on the wider literature. Future studies should fill the gaps in research, namely, the measurement of gastrointestinal symptoms, the mechanisms of exogenous carbohydrate use in heat, and different modes of exercise, including running, to enable the development of robust, evidence-based recommendations.
12 May 2026
Read appraisal →Current heart failure reports
Face-to-Face and Internet-based Cognitive Behavioral Therapy for Patients with Heart Failure: an Umbrella Review of Systematic Reviews and Meta-analyses
PURPOSE OF REVIEW: The present study aims to provide an up-to-date umbrella review of existing meta-analyses of randomized control trials (RCT) of cognitive behavioral therapy (CBT) among patients with heart failure (HF). RECENT FINDINGS: The umbrella review covered five meta-analyses published in the past five years with 18 primary studies (conducted between 2010 and 2022) of 1,687 non-duplicated patients aged 51.63 to 77.40. Primary studies originated from the USA, Sweden, Netherlands, China, Iran, and Philippines. Common benefits of CBT included depressive symptoms (89%), quality of life (56%), anxiety symptoms (39%), self-care (33%), 6-minute walk distance (33%), and health status (17%). Evidence varied depending on the timepoint of follow-up assessment and the specific measurement used to evaluate the outcome. No meta-analyses pooled the effect sizes for iCBT and analyzed the specific therapeutic elements in CBT. No meta-regression was performed. Individual participant data meta-analyses with meta-regression should be performed to identify common moderators and factors that can influence treatment adherence. The current research would also benefit from additional RCT evidence focusing specifically on iCBT for patients with HF.
12 May 2026
Read appraisal →Current oncology reports
Physicians' Knowledge and Experiences of Counseling on Complementary, Alternative, and Integrative Medicine in Cancer Care: a Qualitative Systematic Review
PURPOSE OF REVIEW: The increasing use of complementary, alternative, and integrative medicine (CAIM) among patients with cancer raises questions about physicians' knowledge and counseling practices in this area. This qualitative systematic review used a narrative synthesis approach to explore physicians' understanding and experiences with CAIM counseling in cancer care. RECENT FINDINGS: A systematic search of MEDLINE, EMBASE, and AMED, supplemented by hand-searching reference lists, identified 35 eligible studies. Analysis revealed four key themes: limited knowledge and training on CAIM; concerns about CAIM safety and efficacy; recognition of CAIM's role in holistic cancer care; and challenges in patient-physician communication regarding CAIM. Physicians acknowledge the importance of CAIM in person-centered cancer care but express concerns about its safety and effectiveness, underscoring the need for improved CAIM education and training. Future research should include perspectives from medical trainees and other healthcare providers to enhance counseling practices and support integrative cancer care.
12 May 2026
Read appraisal →Journal of medical systems
Use of Generative Artificial Intelligence in the Management of Low Back Pain: a Scoping Review
BACKGROUND CONTEXT: Low back pain (LBP) is common and a major cause of disability globally. Generative artificial intelligence (GenAI) such as ChatGPT may have the potential to improve LBP, but it is unknown how GenAI is being used in clinical care settings. PURPOSE: This scoping review aimed to map and synthesise the existing literature on the use of GenAI in the management of LBP across all settings. STUDY DESIGN: This review followed the scoping review methodology of the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. METHODS: We searched the Cochrane Library, Medline, Scopus, Embase, Web of Science, CINAHL, and preprint platforms for studies published between January 2012 and July 2025, on the use of GenAI in the management of LBP across all healthcare settings. The included studies were categorised according to the primary purpose of GenAI implementation. RESULTS: A total of 31 studies were included. Seventeen studies evaluated GenAI as a potential support tool for diagnosis and treatment, including answering specific questions about LBP (n = 8), generating advice from clinical cases (n = 4), and generating advice from diagnostic imaging (n = 5). Eight studies examined the use of GenAI to provide educational advice for patients. Other uses included research support (n = 5) and clinical documentation support (n = 1). GenAI advice for the management of LBP demonstrated higher agreement when using simpler tasks, more detailed prompts, or newer generation models. Reported errors in GenAI advice included inconsistency with guidelines or clinicians' advice, hallucination, low accuracy for complex questions, sensitivity to prompt design, and challenges with interpretability. CONCLUSION: Thirty-one studies reported the use of GenAI in LBP management, mainly supporting diagnosis and treatment planning, patient education, research, and clinical documentation. Despite authors' claims about promising uses of GenAI, it typically requires further refinement or review by human end-users. Critically, no studies addressed end-user experience, or clinical effectiveness, underscoring the need for robust clinical evaluation beyond the lab-based environment.
12 May 2026
Read appraisal →Vaccine
Enhancing uptake of respiratory vaccinations in asthma and chronic obstructive pulmonary disease (COPD) patients: a systematic review.
INTRODUCTION: Despite influenza, pneumococcal and COVID vaccines being widely recommended for patients with chronic respiratory disease, vaccination rates in this cohort remain low. The aim of this systematic review is to identify interventions which are effective in increasing respiratory vaccination rates in adults with chronic obstructive pulmonary disease (COPD) or asthma. METHODS: The inclusion and exclusion criteria for the study can be found in the PROSPERO protocol (PROSPERO registration no: CRD42025588565). A search was run across four databases (MEDLINE, Embase, CENTRAL and ClinicalTrials.gov) in February 2025, which returned 2537 studies. Eleven studies were deemed to meet the study inclusion/exclusion criteria and these were narratively synthesised: four randomised clinical trials (RCTs), six longitudinal studies and one observational cohort study. Risk of bias was assessed using the Cochrane's Risk of Bias (RoB-V2) and ROBIN-I-V2 tools. Studies were categorised according to the COM-B model of behaviour change. RESULTS: All 11 studies consisted of COPD populations, with four studies also including asthma patients. Interventions focused on patient education, with/without involvement of a healthcare professional (HCP). Nine of the eleven studies showed a statistically significant improvement in influenza and/or pneumococcal vaccination rate with an intervention. No studies assessing COVID vaccine uptake in this population were suitable for inclusion. Most studies targeted patients' capability to get vaccinated through improving patients' and HCPs' knowledge. Fewer studies focused on social opportunity (e.g. support from other patients/HCPs) or automatic motivation (e.g. reminders). DISCUSSION: The published literature in this area is currently limited. Most studies are non-randomised and are at high-risk of bias, making meta-analysis not possible. Further research should assess the practicalities (physical opportunity) of vaccination, especially in low-income economies (where most respiratory patients reside) and standardising research methods to allow for future meta-analysis. OTHER: There is no funding for this review.
12 May 2026
Read appraisal →Journal of medical Internet research
Efficacy of Technology-Based Interventions on the Reduction of Loneliness: Systematic Review and Meta-Analysis
BACKGROUND: Loneliness is a widespread public health concern linked to increased risks of health problems. As populations age, the demand for effective interventions to mitigate loneliness continues to grow. OBJECTIVE: This meta-analysis aimed to examine the effectiveness of technology-based interventions in reducing loneliness. METHODS: A systematic literature search was conducted in Web of Science, PsycInfo, PubMed, Scopus, Google Scholar, Embase, and the Cochrane Library in August 2024. We included randomized controlled trials that examined the effectiveness of technology-based interventions compared with any control group in reducing loneliness across all age groups. Nonrandomized studies, qualitative research, and studies lacking sufficient statistical data for effect size calculation were excluded. After screening 1089 records, 7 studies involving 580 participants met the inclusion criteria. Data were extracted by 3 independent reviewers, with discrepancies resolved by a fourth reviewer. The risk of bias was assessed using the Cochrane risk-of-bias tool. A random-effects model was used to synthesize effect estimates, with standardized mean differences as the primary effect size metric. Heterogeneity was assessed using the Q statistic and I² index, and a prediction interval was calculated to estimate the expected range of true effects. RESULTS: We found a small and statistically nonsignificant overall effect of technology-based interventions on loneliness (pooled standardized mean difference=-0.21, 95% CI -0.59 to 0.17; 95% prediction interval -1.14 to 0.63). Substantial between-study variability was present (I²=57%; τ²=0.08; τ=0.28), and the prediction interval indicated that true effects in future studies may range from substantial reductions to moderate increases in loneliness. Differences between intervention types could not be examined due to the limited number of eligible studies. The Egger test showed significant funnel plot asymmetry (t5=-5.47; P=.003). However, since the trim-and-fill method identified no missing studies, the asymmetry is unlikely to be fully explained by publication bias. CONCLUSIONS: Unlike previous reviews, which focused primarily on older populations or included nonrandomized studies, this meta-analysis provides a rigorous synthesis of only randomized controlled trials across the lifespan. Our findings do not provide evidence for a reliable reduction in loneliness following technology-based interventions. Moderate heterogeneity indicates that effects differ across studies, and the limited number of eligible trials prevented the analysis of potential moderators. By incorporating robust prediction intervals and a broader age demographic, this study offers a more comprehensive view of the variability of intervention outcomes compared with existing literature. The wide prediction interval suggests that intervention effects may vary across settings. In practice, technology-based approaches should be viewed as supportive tools that require careful tailoring rather than universal solutions to loneliness.
12 May 2026
Read appraisal →Vaccine
Effect of neonatal BCG vaccination on oral herpes in early childhood: A nested study within a randomised controlled trial
BACKGROUND: Bacille Calmette-Guérin (BCG) vaccine, primarily used against tuberculosis, has off-target (non-specific) immunomodulatory effects, including potential protection against recurrences of latent herpes simplex virus (HSV) infections. Recurrent episodes of HSV herpes labialis (oral 'cold sores') affect a substantial proportion of the population, including young children, and there is currently no effective preventive intervention. METHODS: This pilot study, nested within the MIS BAIR randomised controlled trial (RCT), explored whether neonatal BCG vaccination, compared with no BCG vaccination, reduces the incidence and recurrence of herpes labialis during the first five years of life. FINDINGS: Among the 563 children (44% of 1272 randomised) who completed the 5-year follow-up, children in the BCG group were less likely to develop herpes labialis, compared with the control group (5% vs 8%; 38% relative risk reduction, p = 0.1). Risk of recurrence was significantly lower in the BCG group (33% vs. 71%; 53% relative risk reduction, p = 0.02). BCG-vaccinated children also reported a later onset of symptoms and a reduced impact on fluid intake during episodes. INTERPRETATION: This exploratory study suggests a protective role for neonatal BCG against HSV in children. However, its limitations, including its sample size, incomplete follow up and lack of virological confirmation, mean further studies are needed to confirm these findings. FUNDING: National Health and Medical Research Council (NHMRC) of Australia and others, as detailed in the acknowledgements.
12 May 2026
Read appraisal →BMJ open
Prevalence and types of anxiety disorders among patients with cardiac conditions and elevated HADS-A scores: findings from the initial screening phase of the Heart and Mind trial in Denmark
OBJECTIVES: To identify whether patients with arrhythmia, heart failure or ischaemic heart disease presenting with anxiety symptoms measured by the Hospital Anxiety and Depression Scale (HADS) have identifiable anxiety according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) and, if so, which type of anxiety disorder based on the SCID. DESIGN: Initial screening data from the Heart and Mind randomised clinical trial. SETTING: Patients with arrhythmia, heart failure or ischaemic heart disease were screened using HADS, and patients with a HADS-anxiety (HADS-A) score≥8 were invited to participate. Participants were interviewed by trained cardiac nurses using the SCID to determine whether they met the criteria for anxiety and, if so, the type of anxiety disorder. RESULTS: Of the 7816 patients who completed the HADS questionnaire, 1803 (23%) had a HADS-A score≥8. Among these, 398 (22%) agreed to the SCID interview, and 336 (84%) met the diagnostic criteria for an anxiety disorder. The mean age was 61 years, with 40% being female. The mean HADS-A score was 11.3 (SD=2.7). The most common types of anxiety were generalised anxiety disorder (61%), panic disorder (23%) and specific phobia (8%). CONCLUSIONS: The majority of individuals identified by the instrument also met the diagnostic criteria for an anxiety disorder. Generalised anxiety disorder and panic disorder were the most prevalent subtypes. Anxiety was common across the cardiac population, underscoring the need for routine assessment and targeted intervention in clinical practice. TRIAL REGISTRATION NUMBER: NCT04582734.
12 May 2026
Read appraisal →Journal of clinical oncology : official journal of the American Society of Clinical Oncology
Radiographic Progression With and Without Prostate-Specific Antigen Rise in Patients With Advanced Prostate Cancer Treated With Enzalutamide
PURPOSE: In patients who received enzalutamide, we characterized the development of radiographic progression (rPD) without prostate-specific antigen (PSA) rise or progression in metastatic hormone-sensitive prostate cancer (mHSPC) and nonmetastatic castration-resistant prostate cancer (nmCRPC). METHODS: We conducted a post hoc analysis in two phase III trials (N = 2,551; ARCHES [ClinicalTrials.gov identifier: NCT02677896]; PROSPER [ClinicalTrials.gov identifier: NCT02003924]) for co-occurrence of rPD ± Prostate Cancer Working Group 2/3-defined PSA progression, and rPD ± any PSA rise from baseline/nadir by treatment. Kaplan-Meier methods were used for overall survival (OS) outcomes. RESULTS: In ARCHES, 3.5% and 8.5% of 574 patients with mHSPC treated with enzalutamide plus androgen-deprivation therapy (ADT) had no PSA rise or PSA progression at rPD, respectively. Of 79 patients with rPD who received enzalutamide plus ADT, 25.3% had no PSA rise and 62.0% did not meet PSA progression criteria compared with 7.4% and 38.3% of 188 patients with rPD treated with ADT alone, respectively. In PROSPER, 4.4% and 10.3% of 933 patients with nmCRPC treated with enzalutamide plus ADT had no PSA rise or PSA progression, respectively, at rPD. However, of 187 patients with rPD who received enzalutamide plus ADT, 21.9% had no PSA rise and 51.3% did not meet PSA progression criteria compared with 3.6% and 18.8% of 224 patients treated with placebo/ADT, respectively. Liver metastases were >5-fold higher in enzalutamide-treated patients with rPD events versus control, although sample size was small. Compared with no rPD, enzalutamide-treated patients with rPD ± PSA rise or progression had worse OS. CONCLUSION: Given the frequent discordance and poor prognosis of imaging-based progression in the absence of PSA changes during enzalutamide treatment in mHSPC and nmCRPC, periodic surveillance using imaging is recommended.
12 May 2026
Read appraisal →BMJ open
Understanding patient preferences, experiences and engagement with ambulatory heart rhythm monitoring: a scoping review.
OBJECTIVE: To review the literature reporting patient preferences for ambulatory heart rhythm monitoring (AHRM) and what factors affect experience and engagement. BACKGROUND: The prevalence of arrhythmia continues to rise and contributes significantly to outpatient care burden. There is limited understanding of patient experience and compliance with monitoring. As innovative technologies are developed and healthcare strategies move towards surveillance and prevention, understanding this is key. METHODS: A scoping review was conducted using guidance from the Joanna Briggs Institute and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The review included studies of adults under investigation or surveillance for arrhythmia with a range of devices (Holter monitor, patch device, event recorder, mobile cardiac telemetry, external and implantable loop recorders, wearables and other implantable cardiac devices) in ambulatory care settings worldwide. The final search was conducted on 3 January 2026 across Medline (PubMed), Embase (Ovid), Web of Science (Clarivate Analytics), Cumulative Index to Nursing and Allied Health Literature (EBSCOhost), PsycINFO (Ovid) and Google Scholar. Quantitative, qualitative, mixed methods, multiple methods and any type of review articles were included. RESULTS: 54 studies were eligible for inclusion from the initial search that identified 1320 articles. Two overarching themes emerged from the quantitative and qualitative data: patient factors and device factors affecting experience and engagement. Patient factors included clinical and demographic factors, education and expectations, experience and preferences and impact on daily life and healthcare. Device factors could be common to several devices, for example, skin irritation or device specific, for example, the nature of activation. CONCLUSION: Patient and device factors influence preferences for and experience and engagement with AHRM. While existing literature is incomplete and heterogeneous, it identifies key considerations that should be integrated into the development and testing of novel approaches for arrhythmia surveillance in healthcare contexts. REGISTRATION: https://doi.org/10.17605/OSF.IO/6K3W8 (Open Science Framework).
12 May 2026
Read appraisal →Psychological medicine
Cognitive effects of intravenous Ketamine in treatment-resistant depression: A systematic review
Intravenous (IV) low-dose ketamine has emerged as a promising treatment for patients with treatment-resistant depression (TRD). However, its impact on cognitive functioning remains unclear. This systematic review examines the cognitive and executive effects of IV ketamine in TRD, focusing on their relationship to depressive and suicidal outcomes. A systematic search of Cochrane, MEDLINE, Embase, and PsycINFO databases was conducted up to May 15, 2025, using the terms depression, cognition, and ketamine. This review was conducted in accordance with the PRISMA guidelines, and the protocol was registered in PROSPERO (ID: 1160487). Risk of bias was evaluated using the Cochrane RoB 2 tool for randomized trials and the ROBINS-I tool for non-randomized studies. Twenty-one studies, comprising approximately 900-1,180 participants with TRD, assessed cognitive domains of processing speed, working memory, attention, verbal and visual memory, cognitive flexibility, and executive control. Procognitive effects were frequently observed in processing speed and working memory, while attention results were preserved or modestly improved, and verbal and visual memory results were heterogeneous. Executive control, particularly inhibitory performance on Stroop paradigms, improved in several trials. Two studies directly examined cognition as it relates to suicidal behaviors. No cognitive deterioration was reported. Subanesthetic IV ketamine appears to preserve and enhance specific cognitive functions in TRD, notably across processing speed, working memory, and executive control. These procognitive effects, particularly in executive control, may mediate ketamine's antisuicidal action. Standardized longitudinal studies are warranted to clarify their durability and clinical significance.
12 May 2026
Read appraisal →American journal of epidemiology
Building the mountain mama & baby cohort: study design, protocol, and early prenatal clinic-based recruitment outcomes
Prenatal e-cigarette and cannabis use are increasing. Though concerning, the risks associated with these emerging exposures are unclear due to methodological limitations of available research. To address these gaps, the Mountain Mama & Baby Study prospectively enrolled a cohort of pregnant women in their first trimester during their initial telehealth visit with a nurse navigator at West Virginia University Medicine obstetric clinics. The study's goals were to (1) demonstrate the feasibility of our recruitment methodology and the representativeness of the sample, (2) establish first and third trimester exposure rates and describe the epidemiology of prenatal e-cigarette and cannabis use, and (3) explore associations between prenatal e-cigarette and cannabis exposure and adverse maternal-infant outcomes. This report describes the rationale, study design, protocol, and the feasibility and generalizability of recruitment. We enrolled 417 of 920 eligible participants (45.3%; 95% CI, 42.1% to 48.6%), exceeding our 20% benchmark. Enrolled participants and those nonenrolled were similar across most sociodemographic characteristics (eg, age, race/ethnicity, marital status, rurality, area deprivation). The Mountain Mama & Baby Study will provide clinicians, pregnant women, and public health practitioners with critical information on the potential harms of prenatal e-cigarette and cannabis use, guiding the design of interventions and recommendations.
12 May 2026
Read appraisal →Physiological measurement
A multimodal fusion network for heart sound abnormality detection and classification
Objective.Accurate physiological assessment of cardiac function from heart sounds remains challenging due to background noise, variable heart rates, and the need for reliable cardiac-cycle segmentation. This study aimed to develop a fully E2E deep learning framework that extracts diagnostic information directly from raw heart sound recordings for cardiac abnormality detection and classification.Approach.We propose HS-MMNet, an E2E multi-modal deep learning framework designed for physiological heart sound analysis. Recordings are preprocessed (normalization and 25-400 Hz bandpass filtering) and divided into fixed-length 2.5 s segments. A Convolution Head with multi-atrous spatial pyramid and channel-spatial attention extracts fine-grained local temporal patterns from the filtered 1-D waveform. A Transformer Head captures long-range spectro-temporal dependencies from Log-Mel spectrograms. These hypotheses are iteratively fused by a novel multi-hypothesis cross-attention module with cyclic query-key-value assignment and a hypothesis-mixing MLP, enabling rich cross-site interaction and effective suppression of noise and non-informative regions. Recording-level classification is obtained via a fully connected layer.Main results.On the PhysioNet/CinC Challenge 2016 dataset, HS-MMNet achieved 94.80% accuracy, 92.10% sensitivity, 96.85% specificity, 87.50% precision, and 89.74%F1-score, outperforming all previously reported methods. On the balanced five-class Yaseen dataset (normal, aortic stenosis, mitral regurgitation, mitral stenosis, mitral valve prolapse), it attained 99.60% macro-averaged precision, recall, andF1-score with only four misclassifications in 1000 recordings, establishing new state-of-the-art (SOTA) benchmarks.Significance.HS-MMNet represents an advance in automated physiological measurement from heart sounds. By eliminating cardiac cycle detection and multi-channel requirements while achieving SOTA diagnostic performance, it provides a practical, scalable solution for accurate cardiovascular screening with primary-care and low-resource settings.
12 May 2026
Read appraisal →European journal of pediatrics
Diagnostic accuracy of artificial intelligence versus 263 pediatric clinicians for childhood exanthems
Pediatric exanthematous diseases pose diagnostic challenges because clinical presentations overlap. To determine whether current artificial intelligence (AI) models achieve diagnostic accuracy within or above the performance distribution of pediatric residents and specialists for common rash-associated diseases. Participants and AI models were evaluated against definitive diagnoses confirmed by clinical features, laboratory findings, and consensus of two pediatric infectious disease specialists. A volunteer sample of 263 pediatric clinicians: 107 residents (years 1 through 4) and 156 specialists. Each clinician completed a blinded multiple-choice questionnaire with a clinical photograph and accompanying clinical data per case. The same cases were presented to three AI models: ChatGPT, Gemini, and Copilot. Among 263 clinicians (107 residents, 156 specialists), specialists scored higher than residents (median, 46 [IQR, 42-50] vs 41 [IQR, 36-46]; P < .001; r = 0.32). ChatGPT correctly diagnosed 53 of 61 cases (86.9%), Gemini 50 (82.0%), and Copilot 44 (72.1%). Both ChatGPT and Gemini exceeded the upper bound of the specialist population median 95% CI (47.17). All three AI models scored above the resident 95% CI upper bound (42.76). Disease-level accuracy ranged from 0% (insect bites, all models) to 100% (9 conditions, all models). Fourth-year residents scored higher than first- and second-year residents (P = .001; ε2 = 0.13).Conclusions: AI models given clinical data alongside images matched or exceeded specialist-level performance for pediatric exanthems. Accuracy varied by disease; failures clustered in conditions that require contextual reasoning. Physician oversight remains necessary where AI accuracy is lowest. What is Known • Childhood exanthematous diseases pose significant diagnostic challenges due to their overlapping clinical presentations. • Artificial intelligence models are becoming increasingly proficient in accurately diagnosing these conditions. What is New • In this diagnostic accuracy study of 61 cases evaluated by 263 clinicians and 3 artificial intelligence models, ChatGPT (86.9%) and Gemini (82.0%) exceeded the 95% CI upper bound of the specialist population median. Disease-level accuracy ranged from 0 to 100% across models • Artificial intelligence models given clinical data alongside images can match or exceed specialist-level accuracy for common pediatric exanthems, but failures in context-dependent diagnoses require physician oversight.
12 May 2026
Read appraisal →Journal of medical Internet research
Why We Need Patients and Community at the Center of AI Health Communication Research
Holderried and colleagues tested whether artificial intelligence (AI)-generated, patient-centered information can help people understand what they need to do after being discharged from a hospital. Participants demonstrated stronger comprehension when they viewed the simplified, patient-centered information rather than a standard letter. This work adds to the available early-phase evidence of AI supporting hospital discharge communication. To meaningfully progress this area of research, we now need to carefully consider how to enhance the design and evaluation of patient-facing AI health communication tools. In this commentary, we argue that equity and consumer engagement remain underrepresented in studies on patient-facing AI health communication tools and describe possible approaches to address this issue.
12 May 2026
Read appraisal →Neurology
IV Fosphenytoin for Acute Trigeminal Neuralgia: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial
BACKGROUND AND OBJECTIVES: Trigeminal neuralgia (TN) is a debilitating condition characterized by sudden, severe facial pain. IV medications for acute TN exacerbations have not been investigated in randomized controlled trials (RCTs). Oral medications are often insufficient for acute attacks, and surgery is not immediately available. We conducted an RCT to evaluate IV fosphenytoin therapy (IFT) as a rapid-acting rescue treatment for acute TN exacerbations. We hypothesized that, compared with placebo, IFT would reduce acute TN pain. METHODS: This multicenter, double-blind, placebo-controlled phase 3 trial was conducted at 6 institutions (April 2023-April 2024). Patients with classical or idiopathic TN who were experiencing TN exacerbation (numerical rating scale [NRS] score ≥5) were recruited from emergency and outpatient settings, and all study drugs were administered during hospital admission. Participants were randomized 1:1 to IFT (initial dose: 18 mg/kg, maintenance: 7.5 mg/kg for 4 days) or placebo. The primary end point was the change in NRS pain scores from baseline to 120 minutes after the initial dose. Secondary end points included attack frequency, the proportion achieving ≥50% NRS score improvement, and adverse events. Data were collected by blinded personnel and analyzed using repeated-measures mixed-effects models. RESULTS: Of 31 participants screened, 22 were randomized; 1 placebo-assigned participant did not meet the NRS ≥5 criterion and was excluded, leaving 21 for analysis (IFT: 11; placebo: 10). Participants had a mean age of 65.2 years (range 42-83; 8 men, 13 women). Compared with placebo, IFT significantly reduced pain (NRS change: -6.1 vs -2.4; between-group difference -3.8; 95% CI -6.4 to -1.1; p = 0.008), decreased attack frequency within 24 hours (2.5 ± 5.3 vs 16.1 ± 19.6, difference -13.6; 95% CI -26.4 to -0.7), and increased the proportion achieving ≥50% NRS improvement (90.9% vs 40.0%, difference 50.9%; 95% CI 5.6%-81.6%). Adverse events (somnolence, hypotension, and nausea) were mild and transient. DISCUSSION: IFT provided rapid and well-tolerated pain relief in acute TN exacerbations. Although findings are preliminary because of the small sample size, IFT may be a viable short-term treatment option, meriting further investigation. TRIAL REGISTRATION INFORMATION: Japan Registry of Clinical Trials, jRCT2011220043. Registered March 3, 2023. First enrollment April 25, 2023. jrct.mhlw.go.jp/en-latest-detail/jRCT2011220043. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that in patients with acute TN exacerbations, IV fosphenytoin is superior to placebo in reducing pain intensity at 120 minutes.
12 May 2026
Read appraisal →The aging male : the official journal of the International Society for the Study of the Aging Male
SPISE index and ensemble machine learning refine cardiovascular risk stratification in stage 0-3 CKM syndrome
BACKGROUND: While the single-point insulin sensitivity estimator (SPISE) shows promise as an insulin resistance biomarker, its association with cardiovascular disease (CVD) in early CKM stages (0-3) remains underexplored. METHODS: We analyzed 6480 participants with CKM stage 0-3 from the China Health and Retirement Longitudinal Study. CVD outcomes were assessed relative to SPISE index levels. An ensemble machine learning model was employed to predict CVD risk. RESULTS: 6480 subjects were enrolled, of whom 967 developed CVD. After stratifying participants into SPISE quartiles (Q1-Q4) and adjusting for covariates, higher quartiles were linked to a lower CVD risk. This study developed an LR+GMM (Logistic Regression + Gaussian Mixture Model) ensemble model to predict CVD risk using five strong predictors: SPISE, high-density lipoprotein cholesterol (HDL-c), diastolic blood pressure (DBP), body mass index (BMI), and glycated hemoglobin (HbA1c). The model performed well, achieving an accuracy (ACC) of 0.986 and an area under the receiver operating characteristic curve (AUC) of 0.932. CONCLUSIONS: The SPISE index is a significant inverse predictor of CVD risk in individuals with stage 0-3 CKM syndrome. The LR+GMM ensemble model, incorporating the SPISE index and four clinical metrics, demonstrated outstanding predictive performance.
12 May 2026
Read appraisal →BMJ mental health
Mental health in university students: an umbrella review grading the evidence for psychosocial interventions
QUESTION: Psychological distress is increasingly prevalent among university students, raising concerns about their mental health. This review aimed to assess the strength and credibility of evidence on the efficacy of psychosocial interventions for improving mental health in this population. STUDY SELECTION AND ANALYSIS: We conducted an umbrella review of systematic reviews (SRs) with meta-analyses of randomised controlled trials assessing psychosocial interventions among university students. Searches were performed in Medline, PubMed, Cochrane Central, PsycINFO, CINAHL, Epistemonikos and Campbell Collaboration from 1 January 2014 to 1 February 2026. Data on intervention type, comparator, outcome and study-level effect sizes were analysed using inverse-variance random-effects models with restricted maximum likelihood estimation of between-study heterogeneity (τ²). Strength of associations was evaluated according to umbrella review criteria, reporting quality using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) and certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). FINDINGS: A total of 34 SRs were identified. After excluding overlapping syntheses, 28 unique meta-analyses from 12 SRs were included. Mindfulness-based interventions versus inactive controls for distress (standardised mean difference (SMD) -0.40; 95% CI -0.53 to -0.28) showed highly suggestive evidence (class II; GRADE: low; AMSTAR: high). Seven associations provided suggestive evidence (Class III): mindfulness-based interventions versus inactive controls for anxiety (SMD -0.54; 95% CI -0.81 to -0.27) and depression (SMD -0.52; 95% CI -0.65 to -0.39); cognitive-based interventions versus inactive controls for anxiety (SMD -0.48; 95% CI -0.62 to -0.34) and depression (SMD -0.60; 95% CI -0.75 to -0.45); cognitive-based interventions versus active controls for well-being (SMD -0.30; 95% CI -0.42 to -0.18); positive psychology interventions versus inactive controls for distress (SMD -0.22; 95% CI -0.35 to -0.10); and multimodal interventions versus inactive controls for distress (SMD -0.85; 95% CI -1.32 to -0.87). The remaining associations were weak or non-significant, generally supported by low or very low certainty and mostly low or very low reporting quality. CONCLUSIONS: The most robust evidence emerged for mindfulness and cognitive-based interventions, with some support also for positive psychology approaches. These interventions appear to improve depression, anxiety, distress and well-being among university students, though further rigorous research is needed. PROSPERO REGISTRATION NUMBER: CRD42023493618.
12 May 2026
Read appraisal →Scandinavian journal of pain
Breathing therapy as a supplement to opioid management for complex chronic non-cancer pain conditions - a systematic review
OBJECTIVES: The purpose of this systematic review was to analyze whether breathing therapy is effective in reducing pain, improving health-related quality of life, improving physical functioning/activity, and improving sleep quality in patients suffering from complex chronic non-cancer pain conditions (CNCP). CONTENT: An electronic literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane Library, PEDro, and PsycINFO from inception to October 2024. The inclusion criteria were randomized clinical trials (RCT) examining breathing therapy as a sole or central intervention component in adult patients with CNCP. From 2,369 abstracts, a total of 10 RCTs (n=638) met the inclusion criteria. The population in the selected studies were patients with chronic neck pain, chronic low back pain, fibromyalgia, or tension-typed headache. Breathing therapy significantly improved pain and/or health-related quality of life in six studies. However, the quality of the included RCTs ranged from high to critically low, and substantial heterogeneity in participants, intervention, and methods prevented synthesis of results across studies. SUMMARY: This systematic review highlights breathing therapy as a promising pain management strategy in patients suffering from CNCP. We evaluated two RCTs examining similar daily slow diaphragmatic breathing for 15 min to have a low risk of bias; both demonstrating statistically significant relevant pain reduction up to 37 %. However, the strength of recommendations for clinical practice depends on the level of evidence as indicated by a risk of bias assessment (internal validity), consistency of results between studies, and generalizability (external validity). Based on the findings of this systematic review evidence of breathing therapy invention in patients suffering from CNCP conditions remains sparse. OUTLOOK: Striving to eliminate or minimize opioid management for complex CNCP, high-quality research is needed to reinforce the evidence base for non-pharmacological interventions such as breathing therapy to support modern pain management rather than former traditional pharmacological treatment. Trial registry number: PROSPERO #CRD42023460181.
12 May 2026
Read appraisal →Journal of medical Internet research
The Digital Exposome: A Life Course Framework for Health in the Digital Age
Digital technologies are reshaping human behavior, health care delivery, and population health; however, their cumulative effects across the lifespan remain underexplored. This viewpoint argues that exposures arising from interactions with digital technologies should be formally integrated into exposome science as a distinct, measurable component of the human environment. Our aims are to (1) redefine the digital component of the exposome (the digital exposome) within the broader exposome framework, (2) examine its life course implications for health and equity, and (3) outline a research and policy agenda to enable its systematic measurement and integration into clinical and public health practice. Digital technology-related exposures can confer benefits such as enhanced health monitoring, personalized interventions, improved access to care, and the promotion of healthy behaviors. However, they may also introduce potential risks, including mental health challenges, cognitive and circadian disruptions, sedentary lifestyles, exposure to misinformation, and widening inequities among vulnerable populations. Despite their ubiquity, digital technology-related exposures remain poorly integrated into clinical medicine, epidemiology, or public and global health policies. Drawing on interdisciplinary evidence from exposure science, epidemiology, and digital phenotyping research, we propose a refined conceptual definition of the digital exposome grounded in the classical exposome domains. We propose redefining the digital exposome as the full spectrum of exposures resulting from interactions or proximities with digital technologies and their combined influence on health across the lifespan. This framework conceptualizes digital technology-related exposures as a dynamic set of environmental influences operating through sociotechnical, behavioral, and biological pathways over the life course. To operationalize this framework, we discuss practical approaches using validated behavioral instruments, objective device use logs, ecological momentary assessments, smartphone-based digital phenotyping, and wearable sensing technologies. Systematic measurement, large-scale longitudinal studies, and harmonized exposure metrics are needed to characterize the cumulative health impacts of digital environments more accurately. Emerging tools such as digital markers or biomarkers and digital phenotypes offer promising opportunities to link real-world technology use with physiological and biological outcomes, thereby supporting precision medicine and population health strategies. Ethical governance, privacy safeguards, and equity considerations must be embedded from the start, drawing on emerging exposomethics frameworks. Recognizing the digital exposome as a modifiable determinant of health offers a foundation for evidence-based guidance, prevention strategies, and policy interventions suited to increasingly digital societies. By integrating digital technology-related exposures into exposome science, clinical practice, and public health research, this viewpoint seeks to foster interdisciplinary dialogue, guide future empirical work, and support the development of safer and more equitable digital environments across the lifespan.
12 May 2026
Read appraisal →Scientific reports
Hypnotic safety suggestions reduce cortisol awakening response and morning heart rate in daily life.
With stress being causally linked to the most frequently occurring mental and physical health problems, effective coping with acute stress is essential for promoting overall well-being and building long-term stress resilience. However, most interventions aimed at improving stress regulation require extended periods of training and practice. In a previous study, we demonstrated that the Jena Safety Anchor-a brief, hypnosis-based intervention-effectively reduced subjective stress responses in a controlled laboratory setting using the Trier Social Stress Test (TSST). The present study examined whether this effect extends to everyday life. A total of 80 participants (n = 40 female) were randomly assigned to either a hypnosis group or a control group (n = 40 per group). Over the course of two weeks, all participants collected saliva samples at home to assess their cortisol awakening response (CAR), an indicator of anticipatory stress, reflecting the body's preparation for expected demands upon waking. Additionally, all participants continuously recorded their heart rate via smartwatches during the two data collection weeks. The hypnosis group received a single guided session of the Jena Safety Anchor at the end of the first week, while the control group came to the laboratory but received no intervention. CAR was measured via three saliva samples taken within one hour after waking on specified days. Morning heart rate was measured between 6 and 9 a.m. Results revealed a significant reduction in CAR and morning heart rate in the hypnosis group during the second week, following the intervention. In contrast, no change in CAR and morning heart rate was observed in the control group. These findings show that a single session of the Jena Safety Anchor can effectively reduce physiological stress anticipation in the morning. This points to its potential as a rapid, low-effort intervention for enhancing stress coping and fostering resilience. It offers a promising approach to mental health promotion that is both time-efficient and easily integrated into everyday routines.
12 May 2026
Read appraisal →Tobacco control
Impact of Instagram and TikTok influencer marketing on perceptions of e-cigarettes and perceptions of influencers in young adults: a randomised survey-based experiment
BACKGROUND: Pairing e-cigarettes with healthy lifestyle contexts in influencers' promotional social media posts may increase e-cigarette use risk among young adults. This study examined the effects of e-cigarette and healthy lifestyle content on young adults' perceptions of influencer credibility, harm perceptions of, and susceptibility to use, e-cigarettes. METHODS: In this survey-based online, repeated-measures experiment (2023), California young adults (N=1494, Mage=23 (SD=1.8); 63% female, 51% Hispanic) were randomly shown 10 (total) Instagram and TikTok videos, featuring influencers promoting e-cigarettes alongside healthy lifestyle activities (experimental group), or a healthy lifestyle activity alone (control). After watching each video, participants rated perceived influencer credibility (eg, honesty). After watching all videos, harm perceptions of e-cigarettes were assessed among all participants and susceptibility to e-cigarette use was assessed among e-cigarette never-users. Harm perceptions and susceptibility outcomes were compared between groups (experimental vs control) and between participants who perceived influencers as credible versus non-credible, using binomial generalised linear mixed effects models. RESULTS: Participants in the experimental group were more likely to report lower harm perceptions (adjusted OR (AOR) 1.12; 95% CI 1.03; 1.21) and higher susceptibility to e-cigarette use (AOR 1.22, 95% CI 1.11; 1.34), than participants in the control condition. Similar results were found when influencers were perceived as credible, but not when they were perceived as non-credible. CONCLUSIONS: Social media influencers' posts promoting e-cigarette use along with healthy activities may contribute to young adult e-cigarette use. Decreasing perceived credibility of influencers could decrease the negative effects of their promotional posts. TRIAL REGISTRATION NUMBER: NCT06433466.
12 May 2026
Read appraisal →JMIR medical informatics
Cough Audio Recognition for Early Detection of Respiratory Diseases: Algorithm Development and Validation Study
BACKGROUND: Coughing is a common clinical symptom and a protective respiratory reflex closely associated with various respiratory system diseases. The acoustic characteristics of cough sounds are influenced by underlying pathological factors, with distinct acoustic signatures corresponding to different etiologies. Through rigorous analysis of these sounds, rapid identification and preliminary diagnosis of related conditions may be achieved. This approach holds great potential for broad application in mobile health and ubiquitous health platforms. OBJECTIVE: This study aimed to explore the application of acoustic analysis of cough sounds in the diagnosis of respiratory diseases to enhance the diagnostic efficiency of health care professionals. METHODS: In this study, we conducted extensive data collection, including voluntary cough audio recordings from patients diagnosed with respiratory diseases (eg, chronic obstructive pulmonary disease, lung cancer, COVID-19, and pneumonia) and from healthy participants. A total of 2610 audio samples were collected. We incorporated a channel attention mechanism (CAM) into the final convolutional block of each residual block in the ResNet18 neural network, thereby constructing the CAM-ResNet18 neural network model. The recorded cough audio samples were converted into spectrograms to form the input dataset for model training. The CAM-ResNet18 model was trained on the training set of this dataset, with iterative parameter adjustments until convergence was achieved. Finally, spectrograms from the test set were fed into the pretrained model for accurate classification of the cough-related conditions. RESULTS: Experimental results on the collected audio dataset demonstrate that the proposed CAM-ResNet18 model achieves an accuracy of 83.9% and an average F1-score of 82.52% in classifying 5 types of cough sounds. In comparison, the traditional ResNet18 model achieves an accuracy of 78.16% and an average F1-score of 78.29%, indicating a clear performance improvement with the integration of the CAM. CONCLUSIONS: The experimental results validate the effectiveness of the proposed method, highlighting its significant potential for application in clinical diagnosis.
12 May 2026
Read appraisal →Journal of epidemiology and community health
Children's views of obesity, body size and weight: systematic review of UK qualitative evidence
BACKGROUND: Understanding views about body size and weight is key to addressing both obesity and weight stigma. The views of younger children are not well understood and may differ in important ways from those of adults and young people. This review aimed to fill this gap. METHODS: Systematic review of qualitative evidence. We searched 19 database sources in February 2025 and included qualitative studies from the UK published since 2008 reporting data on children's (4-12 years) views of obesity, body size, body shape or weight. We assessed study quality using the Critical Appraisal Skills Programme checklist and conducted a thematic synthesis of the data. RESULTS: We included 34 studies. Study quality overall was fairly high. Children reported a range of perceived impacts of body weight, including health impacts, limitations on activities, bullying and teasing, which generated negative perceptions of overweight and fear of fatness. Ideas about body shape may be influenced by family members and by media or social media content. Children identified diet and physical activity as the main influences on body weight. There may be differences in views between girls and boys at older ages, although both are concerned about weight. We found very little data on differences relating to ethnicity or socioeconomic status. Children with overweight or obesity reported a pervasive experience of negative attitudes and bullying, which could be a barrier to participating in activities. CONCLUSION: Children, including very young children, generally hold very negative views of overweight and obesity. Overweight is seen to be linked with unhealthiness, limited agency and with being bullied. These links may influence how children understand messages about weight and health. PROSPERO REGISTRATION NUMBER: CRD42025650306.
12 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
A systematic review of the assessment model for palliative care needs in cancer patients
BACKGROUND: Timely palliative care can reduce the disease burden and improve quality of life in patients with cancer. Although several studies have developed assessment models for palliative care needs in cancer patients, the quality and clinical applicability of these models remain unclear. OBJECTIVE: To systematically review existing assessment models for palliative care needs in patients with cancer, with a focus on their characteristics, predictors, risk of bias, and applicability. METHODS: A systematic search was conducted in PubMed, Cochrane Library, Embase, Web of Science, CINAHL, Scopus, China National Knowledge Infrastructure (CNKI) through September 12, 2025. Data extraction and evaluation were rigorously performed by two researchers based on the Prediction Model Risk of Bias Assessment Tool (PROBAST). RESULTS: A total of 5714 articles were identified, and eight studies were included, which covered 24 models for assessing palliative care needs. The sample size of the included studies ranged from 179 to 54,628, with areas under the curve ranging from 0.724 to 0.998. The models in all the included studies encompassed four categories of predictive factors: general demographic data, symptom/functional assessments, laboratory indicators, and treatment status. Five studies were rated as having a high risk of bias, primarily due to high risks associated with participants and conclusions, with generally low applicability. CONCLUSION: Existing models demonstrate potential for identifying patients with cancer who have increased palliative care needs using routinely collected clinical data. Commonly included predictors were symptom burden, functional status, laboratory parameters, treatment-related factors, and demographic characteristics. However, the overall body of evidence is constrained by a substantial risk of bias, particularly arising from inappropriate data sources, limited sample sizes, suboptimal handling of continuous variables, insufficient reporting of missing data, and the lack of robust internal or external validation. In addition, many models adopted mortality-based surrogate outcomes rather than clinically meaningful indicators of palliative care needs. Therefore, the currently available models should be interpreted with caution, and further high-quality model development and external validation are required before they can support broader routine clinical implementation. Future research should prioritize clinically actionable outcomes and incorporate patient-, caregiver-, and family-level factors to improve the relevance of these models for referral decisions and care planning.
12 May 2026
Read appraisal →Antiviral therapy
Factors associated with immunological non-response in HIV patients receiving antiretroviral therapy in Southeast Asia: A systematic review
ObjectiveThis systematic review summarizes factors associated with immunological non-response (INR) among people with HIV on antiretroviral therapy (ART) in Southeast Asia.MethodsWe conducted a systematic search of PubMed, ScienceDirect, DOAJ, and Lens.org for studies published between 2010 and 2025. Observational studies examining immunological outcomes following ART initiation and related factors were included. Study quality was assessed using the Newcastle-Ottawa Scale, and results were synthesized using a harvest plot.ResultTen eligible studies were included in the synthesis, comprising a total of 6,988 participants with substantial heterogeneity observed across studies. Factors associated with INR included age, sex, baseline CD4 cell count, HIV RNA levels, and co-infections. Among these factors, baseline CD4 cell count at the initiation of ART emerged as the most consistently associated determinant; lower baseline CD4 levels were linked to a higher risk of INR even with virological suppression.ConclusionThis review highlights baseline immunological status at ART initiation as a key predictor of immunological non-response in Southeast Asia. These findings underscore the critical importance of early HIV diagnosis and timely initiation of ART to prevent advanced immune damage and optimize immunological recovery.
12 May 2026
Read appraisal →Journal of global health
Folate and global health review series, part 3: syntheses on cardiovascular, cerebrovascular, and metabolic diseases.
BACKGROUND: Cardiovascular and metabolic diseases account for an increasing share of morbidity and mortality globally. Folic acid supplementation has been linked to a lowered risk of stroke and some metabolic indicators due to its involvement in homocysteine and one-carbon metabolism and its role in the production of nitric oxide; however, the evidence on these associations is inconclusive. METHODS: We searched MEDLINE, Embase, CINAHL, the Cochrane Library, and the Database of Abstracts of Reviews of Effects from inception to February 2024 for systematic reviews and meta-analyses investigating the associations of folate (dietary intake, supplementation, or blood concentrations) with any cardiometabolic outcome. We performed screening, data abstraction, and risk of bias assessment in duplicate, and assessed the credibility of the evidence using predefined criteria. RESULTS: We identified 113 unique associations from 49 reviews. The included syntheses mostly had low risk of bias of and provided pooled risk estimates from intervention trials or prospective cohorts. A larger volume of evidence was available for composite cardiovascular outcomes, coronary heart disease, and stroke compared to other outcomes. No association reached a convincing or highly suggestive level of credibility. Six directional associations and five null associations met the criteria for a suggestive level of credibility. Three dose-response relationships, all at suggestive levels of credibility, supported an association between higher dietary folate intake and a reduced risk of coronary heart disease and stroke. CONCLUSION: The available evidence on the association between folate status and cardiometabolic outcomes primarily focuses on secondary prevention of cardiometabolic diseases and substantially underrepresents low- and middle-income countries. More large-scale studies are warranted to validate a relationship between folate status and cardiometabolic events or indicators. Overall, the evidence landscape around folate and cardiometabolic diseases appears to be limited both in volume and scope. REGISTRATION: PROSPERO: CRD42021265041.
12 May 2026
Read appraisal →Palliative & supportive care
Manic and hypomanic states in cancer patients: A systematic review
OBJECTIVES: While there have been reports on the relationship between cancer and depression, reports on the association between cancer and manic states, a reciprocal state of depression, have been relatively few. Therefore, we conducted a systematic review on the relationships between cancer and manic states, focusing on their etiology, clinical course, and impact on cancer treatments. METHODS: A systematic review was conducted using four electronic databases, following the PRISMA guidelines. The scope of the study included research on manic or hypomanic states associated with cancer in patients with no prior history of mental illness, published from 1950 to August, 2021. The study protocol was registered with PROSPERO (CRD42020182372). RESULTS: Fifty-six studies, including 67 cases, were identified. The etiology of manic states in cancer patients was classified into organic, drug-induced, and psychogenic, with steroids being the most predominant causative agent. Approximately half of the patients discontinued cancer treatment following the onset of manic states. This was associated with a low rate of pharmacological treatment during the acute and maintenance phase of mania. The onset of manic states was most frequent during cancer treatment; however, about 15% of the cases exhibit manic symptoms before cancer diagnosis. SIGNIFICANCE OF RESULTS: This systematic review illustrated the clinical characteristics of manic state regarding differences in the etiology, timing of onset, pharmacological treatments, duration to remission, recurrence, and impact on cancer treatment. Manic states, which are comorbid with cancer, have significant clinical impacts on cancer prognosis. Therefore, appropriate pharmacological treatment for manic states is critical to consolidate appropriate cancer treatment. A substantial proportion of patients exhibit manic symptoms prior to the diagnosis of cancer, warranting further investigation into the possibility of the concept of "premonitory mania."
12 May 2026
Read appraisal →The New Zealand medical journal
The impact of cultural concordance between health professionals and patients: a narrative review
AIM: The aim of this article is to summarise international evidence on the impacts of cultural/ethnic concordance between patients and health professionals and to discuss the implications for New Zealand. METHOD: Database searches were conducted from August to September 2025 using Scopus, Embase and PubMed, using key terms related to health outcomes and cultural/ethnic concordance. RESULTS: A total of 25 relevant systematic reviews, meta-analyses and research studies were included for analysis. Overall, evidence is predominately from the United States of America and findings are variable. Cultural concordance is associated with improved communication quality, trust, satisfaction and perceived respect. Concordance is also associated with improved healthcare utilisation, medication adherence and uptake of preventative interventions. Some studies found concordance was associated with differences in clinical decision-making. Impact on clinical outcomes is mixed, with some studies finding concordance has a positive impact on caesarean section rates, diabetes management, surgical outcomes and addiction treatment, while others found no impact. CONCLUSION: Cultural concordance between patients and their health professionals matters, with evidence of impact on patient experience, communication quality, engagement and adherence, clinical decision-making and some clinical outcomes. Findings are inconsistent: the strength of association and groups which see the greatest benefit vary between studies. To reduce health inequities, we need to increase the diversity of the workforce and train all health professionals to provide non-racist, equitable care.
12 May 2026
Read appraisal →Journal of medical Internet research
Automated Approaches of Text Simplification of Patient Education Materials: Scoping Review
BACKGROUND: Patient education materials (PEMs) often exceed the American Medical Association's (AMA) recommended sixth-grade reading grade level (RGL). While artificial intelligence (AI) offers potential for automated text simplification, concerns persist regarding linguistic quality, content fidelity, and the understandability of simplified PEMs by laypeople. OBJECTIVE: This scoping review maps existing evidence on automated language processing technologies for simplifying PEMs for laypeople. METHODS: Following the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guideline, 5 bibliographic databases (Ovid MEDLINE, Embase, CINAHL, PsycInfo, and IEEE Xplore) were systematically searched from 2019 to May 2025, supplemented by reference screening and gray literature searches. Eligible sources were peer-reviewed empirical studies published in English that examined large language models (LLMs), AI-supported writing assistants, AI-based conversational agents, or AI-supported tools designed for automatic text simplification of PEMs. Targeted outcomes included linguistic quality (ie, linguistic comprehensibility, linguistic correctness) and content fidelity (ie, factual accuracy, factual completeness) of simplified PEMs. Excluded sources comprised rule-based systems, manual text simplification, non-laypeople target groups, and technology-focused performance metrics. Results were synthesized via thematic analysis across the domains of targeted outcomes. In accordance with JBI methodology, a risk-of-bias assessment was not performed. RESULTS: A total of 31 eligible studies met the inclusion criteria, examining various LLMs, including OpenAI's GPT series, Gemini, Bard, Claude, Copilot, and Llama. Specifically, GPT-4.0 achieved the most consistent improvements in standardized readability metrics (eg, the Flesch-Kincaid Grade Level [FKGL]). However, achieving predefined target RGLs remained challenging across all LLMs, particularly at lower RGLs. Findings on content fidelity were inconsistent: despite high content similarity scores, content accuracy was often compromised. CONCLUSIONS: This is the first scoping review to comprehensively synthesize evidence on automated technologies for text simplification in PEMs. The review identified 2 critical validation gaps. First, no study examined the linguistic correctness (eg, grammar and typographical errors) of automatically simplified PEMs. Second, and most notably, the understandability of the simplified PEMs was assessed exclusively by experts, with no empirical evaluation involving laypeople. Although LLMs effectively reduce text complexity as measured by objective readability metrics, reliance on these formulas represents a critical limitation, as they serve merely as structural proxies. Improvements in readability do not guarantee the maintenance of content accuracy or laypeople's understandability. Current evidence is further limited by the lack of systematic prompt quality evaluation and the predominant focus on English-language PEMs in US contexts, restricting generalizability. This review provides a foundation for future research by highlighting the need for validated evaluation frameworks that encompass layperson testing and content verification. For clinical practice, LLMs should currently serve as assistive tools, with mandatory expert review remaining essential to verify content fidelity before disseminating LLM-simplified PEMs to laypeople.
12 May 2026
Read appraisal →Scandinavian journal of primary health care
Identifying factors influencing acceptance of artificial intelligence among general practitioners in Danish general practice: a cross-sectional web-based survey study
BACKGROUND: Despite rapid advances in artificial intelligence (AI), its adoption in Danish general practice remains limited and decentralized, relying on individual general practitioners' (GPs') decisions. This study aimed to evaluate Danish GPs' acceptance of AI and the importance of factors derived from established technology-acceptance models. METHODS: A cross-sectional web survey was conducted from mid-September 2024 to March 2025, using a culturally adapted version of a previously validated tool. The survey included 42 items: nine background items and 33 items covering 11 factors, including Medical and Non-Medical Performance Expectancy, Effort Expectancy, Social Influence (Medical and Patient), Facilitating Conditions, Perceived Trust, Anxiety, Professional Identity, Innovativeness and Behavioral Intention. Descriptive statistics, subgroup comparisons and Cronbach's alpha were provided. RESULTS: A total of 109 GPs and residents responded, with 84.4% (n = 92) completing the survey. Attitudes toward AI were generally neutral to positive, with mean scores above neutral in seven of the 11 factors. The most positive factors measured were Medical and Non-Medical Performance Expectancy. Scores related to Behavioral Intention were also high. Lower scores appeared in Perceived Trust, Facilitating Conditions and Anxiety. Older GPs (60 years and above) reported lower scores on Non-Medical Performance Expectancy and Social Influence (Medical); GPs in smaller cities showed more positive attitudes across several factors. Cronbach's alpha indicated good internal consistency on all but two scales. CONCLUSION: In summary, Danish GPs demonstrate a strong intention to adopt AI. However, issues persist as significant barriers regarding Anxiety, Perceived Trust and Facilitating Conditions. Implementation strategies considering context and clinician demographics are recommended.
11 May 2026
Read appraisal →International health
Global trends in travel-related antimicrobial resistance: a systematic review, 2020-2024
Antimicrobial resistance (AMR) is a growing global health threat, with international travel playing a key role in the spread of resistant bacteria. This systematic review examines trends in travel-associated AMR from 2020 to 2024. A search of PubMed, Scopus and Web of Science identified 10 studies involving 359 AMR isolates. Using the Newcastle-Ottawa scale, the study quality was assessed and findings were synthesised to identify patterns in prevalence, diversity and geographic spread. Results revealed a consistent rise in travel-associated AMR, particularly from regions such as Southeast Asia and Africa, which acted as major sources of diverse resistant pathogens. These include extended spectrum beta-lactamase-producing Escherichia coli, multidrug-resistant (MDR) Corynebacterium diphtheriae and colistin-resistant Enterobacterales. The number of MDR strains increased over time, making up 15.3% of cases by 2024. Healthcare exposure during travel emerged as a significant risk factor. Overall, the prevalence and diversity of AMR bacteria linked to travel have risen steadily, highlighting the urgent need for global cooperation. Enhanced surveillance, antimicrobial stewardship, infection control measures and international collaboration are essential to curb the spread of these dangerous pathogens.
11 May 2026
Read appraisal →American journal of epidemiology
Predicting first onset of suicide attempt among children with suicidal ideation or non-suicidal self-injury using machine learning: a prospective population-based cohort study
While children with suicidal ideation or non-suicidal self-injury (NSSI) are at high risk of suicide, most do not attempt suicide. This study aims to identify predictors of first suicide attempts among children with suicidal thoughts or NSSI. We utilized longitudinal data from the Adolescent Brain and Cognitive Development study to examine a broad range of risk factors in children reporting suicidal ideation (N = 344, mean age = 9.93) or NSSI (N = 261, mean age = 9.88) at baseline, predicting first attempt of suicide during a 4-year follow-up. Predictive models were developed through bivariate feature selection followed by Discrete-Time Random Survival Forest machine learning, identifying predictors of subsequent suicide attempts. During the follow-up, 40 of 344 children (11.6%) with suicidal ideation, and 32 of 261 children (12.3%) with NSSI at baseline initiated suicide attempts. For suicidal ideation, risk for attempting suicide increased with caregiver-reported NSSI, witnessing domestic violence, severity of suicidal thoughts, being female, online social screen use, and less parental supervision. For NSSI, risk of suicide attempt increased with witnessing domestic violence, anxiety disorders, caregiver-reported NSSI, being female, and disruptive, impulse control, and conduct disorders. Our findings shed light on the development of population-based suicide prevention strategies for children.
11 May 2026
Read appraisal →Tobacco control
Vaping cessation interventions: a systematic review and meta-analysis
OBJECTIVE: Electronic nicotine delivery systems (ENDS), such as e-cigarettes, have surged in popularity. While long-term risks remain unclear, known dangers include nicotine addiction, E-cigarette or Vaping Use-Associated Lung Injury and potential extrapulmonary effects on the heart, immune system and neurodevelopment. Addressing ENDS addiction may require strategies akin to smoking cessation. However, evidence is lacking; there are no currently approved vaping-cessation aids. The objective of this review is to summarise the available literature addressing interventions for vaping cessation. DATA SOURCES AND STUDY SELECTION: A librarian-assisted search was conducted in MEDLINE, Embase and Scopus, as well as preprints in Europe PMC, Open Science Framework, and the grey literature searches until January 2024. Six included studies used self-report methods to determine the abstinence rate, while one study used cotinine-level-verified self-reported abstinence. We included randomised controlled trials (RCTs) that examine 'rates of vaping cessation' outcomes. An intention-to-treat approach was used for data extraction, and random-effects meta-analyses models were applied. DATA SYNTHESIS: Seven RCTs were included, which studied pharmacological therapy, digital interventions and/or educational content. The primary meta-analyses demonstrated a statistically significant increase in the odds of achieving 7-day point prevalence abstinence (PPA) (OR 1.52, 95% CI 1.15 to 2.01, number of participants=3244, moderate-certainty) and continuous abstinence (OR 2.71, 95% CI 1.31 to 5.61, number of participants=164, low-certainty) following intervention. A non-significant increase in odds was noted at 30-day PPA (OR 1.32, 95% CI 0.72 to 2.42, number of participants=1994, very low certainty). CONCLUSIONS: Vaping cessation interventions increase 7-day PPA rates at 1-12 months follow-up and this was consistent across prespecified subgroup analyses of the intervention type, outcome and duration of follow-up. More high-quality studies with reproducible findings are needed to enhance the certainty of the evidence and guide clinical interventions. PROSPERO REGISTRATION NUMBER: CRD42022383670.
11 May 2026
Read appraisal →International journal of health care quality assurance
Understanding trust in mandatory telemedicine use during COVID-19: a modified health belief model approach
PURPOSE: This study explores the determinants of trust in telemedicine when its use was mandated during the COVID-19 pandemic in South Korea. It extends the health belief model by incorporating two service related constructs: service quality and perceived cost. DESIGN/METHODOLOGY/APPROACH: An online survey was conducted with 288 individuals who were confirmed COVID-19 patients and required to use telemedicine services during isolation. Partial least squares structural equation modeling was applied to examine the relationships between health beliefs including perceived severity, perceived susceptibility and self-efficacy, service perceptions such as service quality and perceived cost, trust in telemedicine and behavioral intention to use telemedicine services. FINDINGS: The results showed that self-efficacy, service quality and perceived cost positively influenced trust in telemedicine. In contrast, perceived severity and perceived susceptibility did not have a meaningful impact. Trust was found to be a key factor in shaping patients' intention to continue using telemedicine services. Overall, the proposed model was supported, highlighting the importance of confidence and service related perceptions in building trust under mandatory usage conditions. ORIGINALITY/VALUE: This study provides empirical evidence on trust formation under mandatory telemedicine use, a scenario rarely explored in the literature. It demonstrates that trust is primarily driven by users' self-efficacy and service perceptions rather than by health risk perceptions, offering practical guidance for enhancing remote care engagement during policy enforced use conditions.
11 May 2026
Read appraisal →The Journal of dermatological treatment
Comparative efficacy and safety of oral azithromycin versus doxycycline in moderate-to-severe Acne vulgaris: a systematic review and meta-analysis
BACKGROUND: Acne vulgaris is a chronic inflammatory disease and is one of the leading causes of dermatological morbidities among young adults. Doxycycline is widely recommended as first-line therapy for moderate to severe acne; however, its use is limited. OBJECTIVE: To systematically compare the efficacy and safety of oral azithromycin pulse therapy versus doxycycline in patients with moderate to severe acne vulgaris. METHODS: This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive literature search on different databases was performed. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models based on heterogeneity. RESULTS: A total of 23 comparative studies comprising 2,769 patients were included. Pooled analysis demonstrated a statistically significant improvement in global acne severity favoring azithromycin (GAGS reduction: MD 1.81; 95% CI 1.28-2.34; I2 = 0%). Azithromycin achieved a significantly greater reduction in non-inflammatory lesion counts (MD -7.56; 95% CI -14.33 to -0.79). No significant differences were observed in inflammatory lesion reduction (MD 1.08; 95% CI -0.03 to 2.18). CONCLUSION: Oral azithromycin pulse therapy appears to have similar efficacy, better tolerability, and fewer side effects as compared to doxycycline.
11 May 2026
Read appraisal →Chinese medical journal
Artificial intelligence in atopic dermatitis: Current applications and future perspectives.
Atopic dermatitis (AD) is a prevalent and burdensome chronic skin disease, with profound effects on patient quality of life. Advancing its diagnosis and management remains a pressing clinical need. Artificial intelligence holds growing promise in addressing this challenge. This review outlines the current landscape of AD and explores the expanding role of AI in its care-from improving diagnostic accuracy and objective severity scoring to predicting therapeutic outcomes and personalizing treatment strategies. While these technologies are poised to transform dermatology practice, their successful integration will depend on overcoming technical and practical barriers through collaborative, interdisciplinary efforts. Further research and thoughtful implementation are essential to translate AI's potential into better, more precise patient care.
11 May 2026
Read appraisal →Journal of medical Internet research
Effects of Stand-Alone Digital Lifestyle Interventions on Weight-Related Outcomes in Adults With Overweight or Obesity: Systematic Review and Meta-Analysis of Randomized Controlled Trials
BACKGROUND: Obesity is a major global health concern, and scalable digital solutions are urgently needed. While digital lifestyle interventions (DLSIs) have shown promise, prior meta-analyses often included hybrid formats with human support, limiting insights into the effectiveness of fully digital interventions. OBJECTIVE: This study aimed to evaluate the independent effects of standalone DLSIs-defined as interventions delivered exclusively via digital platforms without in-person or adjunctive support-on anthropometric and dietary outcomes in adults with overweight or obesity. METHODS: We searched MEDLINE, Embase, PsycINFO, Web of Science, and the Cochrane Library from inception through March 4, 2026. Eligible studies were randomized controlled trials (RCTs) evaluating stand-alone DLSIs in adults with overweight or obesity. Interventions were included if they targeted diet or physical activity exclusively through digital platforms. We included fully automated, asynchronous, or one-to-many synchronous systems without individualized support. Studies involving hybrid interventions, including one-to-one synchronous human interaction, nonadult populations, or non-RCT designs, were excluded. Two independent reviewers performed study selection and data extraction. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool (Cochrane Bias Methods Group). Meta-analysis used a random-effects model with the Hartung-Knapp-Sidik-Jonkman method, and heterogeneity was assessed using I2 statistics. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: A total of 19 RCTs involving 3556 participants were included. Stand-alone DLSIs significantly improved anthropometric outcomes compared to controls (standardized mean difference 0.26, 95% CI 0.14-0.38; 95% prediction interval [PI] -0.16 to 0.68; P<.001; 19 studies; n=3556; I2=56.1%), corresponding to an additional weight loss ranging from 2.62 kg to 6.55 kg, depending on the baseline body weight. Significant improvements were also found in dietary outcomes (standardized mean difference 0.26, 95% CI 0.04-0.48; 95% PI -0.29 to 0.81; P=.008; 8 studies; n=1365; I2=57.5%). Subgroup analyses for anthropometric outcomes revealed significant differences only by control group type (P<.001), with waitlist controls showing the largest effect. For dietary outcomes, no significant subgroup differences were found (P>.05). While most studies showed a low risk of bias, substantial statistical heterogeneity was observed in some outcomes. Consequently, the certainty of evidence for both outcomes was rated as moderate. CONCLUSIONS: This review is innovative as it is the first to isolate the pure efficacy of stand-alone DLSIs by excluding synchronous human support. Our findings provide moderate-certainty evidence that these tools are effective for weight management and dietary improvement without human intervention. While stand-alone DLSIs offer a highly scalable, cost-effective first-step intervention, the PIs included zero, and substantial heterogeneity was observed, suggesting that benefits may vary across settings. Future research should identify user characteristics that maximize engagement with unguided digital tools.
11 May 2026
Read appraisal →BMJ global health
Transforming reproductive healthcare delivery through telemedicine services expansion: evidence from a mixed-methods pilot evaluation in rural Ghana
BACKGROUND: In 2021, Ghana's National Comprehensive Abortion Care Standards and Protocols recognised telemedicine as an approved delivery model for early medical abortion (EMA). Following a successful pilot in Accra, MSI Reproductive Choices Ghana expanded their telemedicine model to more rural areas and broadened their package of sexual and reproductive health (SRH) services to include fertility evaluation. This study evaluates the expanded model. METHODS: A mixed-methods evaluation (January 2024 to March 2025) drew on routine clinical data, courier and call centre tracking, client feedback surveys, and qualitative, individual in-depth interviews with telemedicine clients to assess clinical safety, service utilisation and user experience. Quantitative analysis included descriptive statistics and unadjusted logistic and ordinal regression. Qualitative interviews with clients explored feasibility, acceptability and implementation challenges. A deductive, thematic analysis was conducted with the support of Delve qualitative research software and guided by the Consolidated Framework for Implementation Research. RESULTS: A total of 2721 clients accessed telemedicine services, with 70.0% receiving EMA and 29.5% short-term contraceptive methods. Among EMA clients reached for follow-up, 96.9% reported complete abortion with no further intervention. Satisfaction was high: 89.4% would recommend the service, and 78.2% would use it again. Qualitative findings highlighted that clients valued privacy, convenience and autonomy, particularly in stigmatised or crowded spaces. Barriers to accessing services included unclear eligibility criteria, limited digital access and misperceptions that the service was for abortion only. Most clients contacted the service between 4 and 6 weeks' gestation. Post-abortion contraception uptake was 24.8%, with no significant variation by age or location. Nearly half of clients reported having no other way to access care. CONCLUSIONS: Telemedicine is a feasible, safe and acceptable model for SRH delivery in Ghana. Findings will inform national scale-up and strategies to strengthen equity, communication and service integration.
11 May 2026
Read appraisal →European heart journal
Cardiovascular benefit of continuous positive airway pressure according to high-risk obstructive sleep apnoea: a multi-trial analysis
BACKGROUND AND AIMS: Randomized trials of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) in patients with cardiovascular disease have not detected reduced risk of major adverse cardiovascular and cerebrovascular events (MACCEs). This study tested whether the cardiovascular benefit of CPAP occurs preferentially in high-risk OSA, characterized by greater OSA-related heart rate acceleration or hypoxaemia. METHODS: In a post hoc analysis of pooled Randomized Intervention with Continuous Positive Airway Pressure in Coronary Artery Disease and Obstructive Sleep Apnoea, Impact of Continuous Positive Airway Pressure on Patients with Acute Coronary Syndrome and Nonsleepy Obstructive Sleep Apnoea, and Sleep Apnoea Cardiovascular Endpoints Study randomized trials; outcomes were stratified by high-risk OSA status, defined by heart rate response following OSA respiratory events >9.4 b.p.m. (third tertile) or oxygen desaturation area under baseline (hypoxic burden) > 87.1% min/h (third tertile). Cox mixed models quantified the CPAP treatment effect on MACCE (including cardiovascular mortality, myocardial infarction, and stroke) within high-risk OSA and the difference vs low-risk status (primary test). Secondary analyses examined participants without excessive sleepiness (Epworth <11 points) or without increased blood pressure (systolic/diastolic <140/90 mmHg). RESULTS: In 3549 participants, 16.6% and 16.3% reached the MACCE endpoint with CPAP (n = 1778) and usual care (n = 1771), respectively. The CPAP treatment effect was greater in participants with vs without high-risk OSA [interaction hazard ratio (iHR) .69, 95% confidence interval (CI) .50-.95, Pinteraction = .024; Nhigh-risk = 1832]. The differential effect was stronger in those without excessive sleepiness (iHR .59, 95% CI .41-.84; Nhigh-risk = 1509), or without increased blood pressure (iHR .54, 95% CI .36-.81; Nhigh-risk = 1244). Continuous positive airway pressure benefits in high-risk OSA were observed alongside harm in low-risk OSA. CONCLUSIONS: Continuous positive airway pressure preferentially improves cardiovascular outcomes in high-risk OSA, while harm in low-risk OSA may counteract this effect. These findings provide a pathway to identify patients likely to benefit.
11 May 2026
Read appraisal →European journal of pediatrics
Oral dextrose gel vs standard care for the treatment of hypoglycemia in high-risk neonates: an open-label randomized controlled trial
UNLABELLED: To determine whether 40% dextrose gel with oral feeds reduces NICU admission for asymptomatic hypoglycemia compared with standard care with oral feeds in at-risk neonates within 48 h of life. Secondary objectives were to assess rebound and recurrent hypoglycemia, hyperglycemia, and exclusive breastfeeding at discharge and at 6 weeks. Open-label randomized controlled trial conducted at a tertiary hospital in South India between April 2023 and May 2024. Neonates born at ≥ 35 weeks of gestation with asymptomatic hypoglycemia within the first 48 h of life were randomly assigned to receive either 200 mg/kg of oral 40% dextrose gel with oral feeds or standard care with oral feeds alone. The primary outcome was NICU admission for hypoglycemia. A total of 193 neonates were enrolled, with 98 in the standard care group and 95 in the gel group. Baseline characteristics were comparable. NICU admission for hypoglycemia occurred in 4.2% in gel group and 12.2% in standard care group (RR 0.34, 95% CI 0.11-1.03; p = 0.06), with a number needed to treat of 13. Exclusive breastfeeding was higher in gel group at discharge (97% vs 76%; p < 0.001) and at 6 weeks (90% vs 69%; p < 0.001). Rebound hypoglycemia, recurrent hypoglycemia, and hyperglycemia were similar between groups. CONCLUSION: Oral dextrose gel was associated with fewer NICU admissions, but the primary outcome did not reach statistical significance. Improved breastfeeding rates were observed as secondary outcomes. These findings should be interpreted cautiously and confirmed in adequately powered studies. TRIAL REGISTRATION: Clinical Trials Registry of India (CTRI/2023/02/050027). WHAT'S KNOWN: • Oral 40% dextrose gel is an eff ective fi rst-line treatment for neonatal hypoglycemia and has been shown to reduce treatment failure and intravenous glucose use in previous trials. • Existing evidence is predominantly from high-income settings, with limited randomized data from low- and middle-income countries assessing pragmatic outcomes such as NICU admission. WHAT IS NEW: • In this open-label randomized controlled trial, oral dextrose gel was associated with fewer NICU admissions for hypoglycemia (4.2% vs 12.2%) and higher exclusive breastfeeding rates at discharge and 6 weeks compared with standard care. • These fi ndings support the potential utility of dextrose gel as a simple, low-cost intervention for managing neonatal hypoglycemia in resource-limited settings.
11 May 2026
Read appraisal →BMJ open
Does previous pregnancy experience improve folic acid supplementation uptake? A systematic review and meta-analysis.
OBJECTIVE: To examine whether multiparous women have more or less folic acid uptake than primiparous women. OUTCOMES: Preconceptional, periconceptional and postconceptional folic acid use among all pregnant women and high risk pregnant women. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE-Ovid, CINAHL Ultimate, Scopus and ProQuest Medical. ELIGIBILITY CRITERIA: Observational epidemiological studies comparing folic acid use between primiparous and multiparous women, published in English from January 1994 to June 2024. DATA EXTRACTION AND SYNTHESIS: Two reviewers screened all papers meeting the eligibility criteria. One reviewer completed data extraction and assessed study quality using an adapted version of the Newcastle-Ottawa Scale. Three other reviewers independently assessed 10% of the studies as a quality check. Random-effects (DerSimonian and Laird) meta-analyses combined results for each outcome. Heterogeneity, risk of publication bias and certainty of evidence were assessed. RESULTS: Of the 10 982 records identified, 81 studies involving 826 855 women were included in the review. 27 studies were conducted in Europe, 22 in Asia, 11 in North America, 7 in Africa, 7 in Australia, 5 in the Middle East and 2 in South America. Multiparous women were consistently less likely to take folic acid before and during pregnancy than primiparous women. For preconceptional use, the odds were 29% lower among multiparous women (adjusted OR (aOR): 0.71; 95% CI 0.64 to 0.78; n=25 studies; I2=88.67%), and 58% lower in multiparous high-risk women (aOR: 0.42, 95% CI 0.27 to 0.64; n=3 studies; I2=27.28%). For periconceptional use, the odds were 32% lower among multiparous women (aOR: 0.68; 95% CI 0.63 to 0.74; n=28 studies; I2=85.46%). Postconception, the odds were 21% lower among multiparous women (aOR: 0.79; 95% CI 0.74 to 0.85; n=33 studies; I2=85.91%). By the second trimester, there was no significant difference between the two parity groups (aOR: 0.96; 95% CI 0.87 to 1.05; n=4 studies; I2=0.00%). The certainty of evidence was low for preconceptional, periconceptional and postconceptional uptake due to heterogeneity, and moderate for preconceptional uptake among high-risk women. CONCLUSIONS: Multiparous women were less likely to take folic acid preconceptional, periconceptional and postconceptionally, despite their previous pregnancy experience. Barriers to folic acid supplement uptake among multiparous women need to be identified, and strategies to address them in preconception, antenatal and interconception care should be investigated. PROSPERO REGISTRATION NUMBER: CRD42024553241.
11 May 2026
Read appraisal →BMJ open
Potential harms of social prescribing: a global umbrella review and dark logic model
OBJECTIVES: Social prescribing has provided a lifeline to people, capturing the importance of quality support offered via community connections. It has not been exempt from difficulties, resulting in low-quality evidence on effectiveness in part due to high drop-out rates and lack of controls. While these have been the focus of recent research, less attention has been paid to the safety implications of social prescribing. This review aims to understand safety implications of social prescribing interventions and to build a dark logic model of how harms are produced. DESIGN: Using review of review (umbrella) methodology, we searched nine databases to June 2024. DATA SOURCES: Medline/Ovid, Embase, PsycINFO, Cochrane Library/Wiley, Web of Science and Scopus) were searched from 1 January 2010 to 3 June 2024. ELIGIBILITY CRITERIA: Included reviews were systematic/scoping/narrative reviews or meta-analyses, which synthesised primary data collected from any person in receipt, involved in delivery or the commissioning of social prescribing interventions. The context of the review was social prescribing interventions/services based in primary healthcare (statutory) or third sector (non-statutory) in any country. Only reviews that were published in English and in peer-reviewed journals were included. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data from included reviews using the Typology of Harms Framework (which includes five categories of harms associated with interventions: physical, psychological, group/social, equity and opportunity harms) and to build a dark logic model to understand what contributes to these harms. RESULTS: Sixteen reviews were included, reporting on social prescribing research including a link worker. Of the identified harms, we found that opportunity harms (harm related to the cost, inappropriate or ineffective interventions) were most reported. There was also evidence extracted to suggest plausible psychological, equity (impact caused by inequity in provision, delivery or access) and group/social harms (impact that overly or inadvertently excludes a person). No physical harms were identified. CONCLUSIONS: Social prescribing, as with any delivery of care, has the potential to cause harm. We identified a range of potential harms (psychological, group/social, equity or opportunity harm) from social prescribing; however, it is unlikely to be an exhaustive list. We provide two clear outcomes: (1) the need for robust design of social prescribing research, including collection of data on the incidence and prevalence of harms, (2) recognition of the potential for harm from social prescribing and to address these where practicable.
11 May 2026
Read appraisal →Journal of medical Internet research
Characterizing Physical Activity Trajectories Preceding Incident Major Depressive Disorder Diagnosis With Consumer Wearable Devices in the All of Us Research Program: Retrospective Nested Case-Control Study
BACKGROUND: Low physical activity (PA) is a well-established risk factor for major depressive disorder (MDD). However, the temporal dynamics of PA preceding an incident clinical diagnosis of MDD remain poorly characterized, particularly using long-term, objective measures collected in real-world settings. OBJECTIVE: This study aimed to characterize trajectories of wearable-measured PA during the year preceding incident MDD diagnosis and identify the timing of within-person changes. METHODS: We conducted a retrospective nested case-control study using linked electronic health record and wearable (Fitbit) data from the All of Us Research Program. Adults with at least 6 months of valid Fitbit PA data in the 12 months preceding diagnosis were included. Incident MDD cases were identified based on a first electronic health record-recorded diagnosis and matched to MDD-free controls on age, sex, BMI, and calendar time of diagnosis, with up to 4 controls per case. Daily steps and moderate to vigorous PA (MVPA) were aggregated into monthly averages. Linear mixed-effects models were used to compare prediagnostic PA trajectories between cases and controls over a retrospective time scale from -12 to 0 months. Among cases, within-person contrasts were used to identify when PA levels first showed statistically significant deviations relative to levels observed 12 months before diagnosis. Exploratory analyses assessed heterogeneity by demographic factors. RESULTS: The analytic cohort included 4104 participants (n=829, 20.2% incident MDD cases and n=3275, 79.8% matched controls; n=3355, 81.7% women; median age 48.4, IQR 36.3-61.3 years). Compared with controls, individuals who developed MDD exhibited consistently lower overall PA and significant downward trajectories in both daily steps and MVPA during the year preceding diagnosis (global trajectory tests; P<.001 for both outcomes). Differences widened progressively over time, indicating accelerating declines as diagnosis approached. Among cases, statistically significant changes in daily step counts emerged approximately 4 months before diagnosis (-145, 95% CI -253 to -37 steps vs month -12; P=.02) and reached -428 (95% CI -531 to -326) steps at diagnosis (P<.001). Declines in MVPA emerged approximately 5 months before diagnosis (-2.48, 95% CI -4.32 to -0.64 minutes; P=.02) and reached -5.61 (95% CI -7.35 to -3.86) minutes at diagnosis (P<.001). Furthermore, exploratory analyses suggested heterogeneity in prediagnostic trajectories across demographic subgroups, including steeper declines among men, more pronounced reductions in activity intensity at older ages, and persistently lower activity levels with flatter trajectories among individuals with obesity. CONCLUSIONS: Unlike prior studies lacking objective PA assessment before MDD diagnosis, this study linked wearable and clinical data to characterize long-term prediagnostic trajectories in real-world settings. We observed sustained within-person declines emerging 4 to 5 months before diagnosis, providing insights into temporal dynamics preceding clinical recognition. These findings suggest that wearable-based monitoring may offer scalable early signals for risk stratification, prevention, and intervention for MDD.
11 May 2026
Read appraisal →Palliative & supportive care
Relational-temporal dignity at the end of life: Ethical foundations for the DiRePal model in the algorithmic age
OBJECTIVES: The increasing presence of artificial intelligence (AI), electronic patient-reported outcomes (ePROMs), and digital infrastructures in palliative care is transforming how clinical encounters are organized and how suffering is interpreted. These technological shifts heighten the risk of relational compression and a reduction of dignity to measurable outputs. This paper proposes the DiRePal model (Relational-Temporal Dignity in Palliative Care) as a philosophical framework to re-examine dignity beyond coherent narrative identity or autonomy-centered ethics, emphasizing relational presence, temporal sensitivity, and structural conditions of care. METHODS: A philosophical-ethical analysis informed by narrative identity (P. Ricoeur), ethics of alterity (E. Levinas), capabilities theory (M. Nussbaum), and care ethics (J. Tronto). Critical readings of dignity frameworks, AI ethics, and digital health literature were synthesized to develop a relational-temporal account of dignity and 2 operational concepts: the temporal dignity indicator and the architecture of prudence. RESULTS: While digital tools can enhance communication and support anticipatory care, they also risk reducing patients to data profiles, narrowing listening practices, and eroding opportunities for narrative, silence, and relational presence. The DiRePal model reframes dignity as a fluctuating, co-constructed achievement that depends on temporal attentiveness, ethical listening, institutional conditions, and prudent integration of AI and ePROMs. It further expands dignity to include post-biographical dimensions such as memory, grievability, and digital legacy. SIGNIFICANCE OF RESULTS: End-of-life care in the algorithmic age requires an ethics that recognizes dignity as relational, temporal, and structurally mediated. The DiRePal model offers clinicians and institutions a conceptual grammar to resist technological reductionism, protect time for presence, and safeguard the narrative and post-biographical continuity of persons whose voices may be fragmented, vulnerable, or digitally extended.
11 May 2026
Read appraisal →JMIR formative research
The Role of Trust in Text Messaging for Promoting Patient Portal Activation Among Low-Income Patients: Quality Improvement Project
BACKGROUND: The increasing reliance on patient portals for electronic health records has widened the digital health care access gap, particularly among low-income and Medicaid-insured populations. However, resources exist to assist low-income patients with portal enrollment; in obtaining a free smartphone; and, in New York, in obtaining low-cost internet. Automated bidirectional SMS text messaging offers a scalable and cost-effective strategy for identifying low-income patients' digital health needs and eligibility for resources by using screening questions and providing tailored information on how to access available resources. OBJECTIVE: This study aimed to increase portal access among low-income patients using automated bidirectional SMS text messaging and assess its feasibility and acceptability. METHODS: This quality improvement initiative involved sending automated, bidirectional SMS text messages in English to 12,381 Medicaid-insured and/or low-income patients from a primary care practice. Messages assessed patients' digital health needs and provided adaptive, personalized resources and assistance for enrolling in the patient portal and for accessing digital technology. We assessed response rates and follow-up portal enrollment rates. We surveyed participants regarding the acceptability, appropriateness, and usability of the SMS text messaging intervention, as well as their subsequent use of the patient portal. We performed descriptive statistics and a binomial probability test. RESULTS: In total, 9.2% (1140/12,381) of patients responded to the SMS text messages, with 3.9% (481/12,381) opting out and 5.3% (659/12,381) actively engaging. Among respondents, 71.1% (469/659) completed the follow-up survey. Respondents were predominantly female (336/469, 71.6%), with ages ranging from 18 to 65 years or older. Most respondents rated the message's clarity (420/469, 89.6%), its usefulness (400/469, 85.2%), and the demonstration of care by their health team (350/469, 74.6%) favorably. Concerns regarding privacy (61/469, 13%) and trustworthiness (71/469, 15%) were noted. Notably, 71% of initially unenrolled patients activated their patient portals after the intervention (P=.007), exceeding the hypothesized expectations. CONCLUSIONS: Automated bidirectional SMS text messaging had mixed effects on promoting patient portal use among low-income patients. Response rates to SMS text messages were low when delivered from an unknown phone number. Among responders, most reported that these messages were useful and that they would recommend them to others. Research is needed to determine optimal strategies for introducing the program and vendor phone numbers to patients to improve engagement.
11 May 2026
Read appraisal →JMIR human factors
Identifying Skill and Usability Barriers to Digital Health Tool Use Among Older Adult Patients in US Safety Net Clinics: Mixed Methods Study
BACKGROUND: Despite their benefits, digital health tools often face adoption barriers because of the digital divide. Identifying the fundamental user skills required to effectively navigate these tools and the usability barriers is essential to addressing disparities in use. OBJECTIVE: This study aimed to identify the skill and usability barriers to using digital health tools. METHODS: This study included English-, Spanish-, or Cantonese-speaking patients, aged ≥50 years, who received care at an urban safety net health system in the United States. Participants completed a survey examining sociodemographic characteristics and digital health tool use and were observed and video recorded as they navigated four digital health care tasks: (1) launch a video visit, (2) visit a health website through a URL, (3) log in to the patient portal, and (4) sign up for a patient portal account. Participants who could not independently perform the tasks received additional support. Tasks were conducted in English, while instructions and additional assistance were provided in each participant's preferred language. Video recordings were thematically coded to identify the fundamental skills needed for effective digital tool use and usability barriers in the design of digital tools. We examined whether task independence was associated with participant demographics and thematic categories using Kruskal-Wallis, χ2, and Fisher exact tests. RESULTS: In total, 74% (34/46), 52% (31/60), 71% (44/62), and 70% (43/61) of participants (N=64) independently completed digital tasks 1, 2, 3, and 4, respectively. Older age, minoritized races and ethnicities, non-English language preference, lower educational attainment, access to cellular data only or no internet access, and lack of a portal account were associated with a higher likelihood of requiring assistance or being unsuccessful at completing each task (P<.001, except for older age [P=.004]). The qualitative coding of video recordings identified 3, 4, and 6 categories of typing, navigation, and human-computer interaction (HCI) skills, respectively, as fundamental skills required to independently complete digital tasks. χ2 and Fisher exact tests indicated significant associations between most typing, navigation, and HCI categories and independent task completion. We coded usability barriers as one of 6 learnability challenges or 3 operability challenges. CONCLUSIONS: This study identified that independent use of digital health tools requires fundamental typing, navigation, or HCI skills as well as high usability of digital tools. The inclusion of 4 different digital tasks added specificity to the type of skills and usability considerations necessary to ensure accessibility of digital health tools to diverse older adults. This study underscores the need for vendors to cocreate digital health tools with historically excluded end users in mind. As health care systems expand digital tool adoption, they must distinguish fundamental skill gaps from usability barriers, as each may require different intervention strategies.
10 May 2026
Read appraisal →The Journal of dermatological treatment
A safety checklist before initiating second-generation immunomodulating drugs for inflammatory dermatoses: a systematic review
BACKGROUND/AIM: Second-generation immunomodulating drugs for inflammatory dermatoses have expanded over the past decades. Contraindications and special warnings must be considered before starting any treatment, but identifying all relevant safety information can be time-consuming. The objective is to provide an overview of contraindications, special warnings, and boxed warnings with the aim to establish a safety checklist, covering second-generation immunomodulatory therapies. METHODS: We identified contraindications, special warnings and boxed warnings provided by the European Medicines Agency and the US Food and Drug Administration, for second-generation immunomodulating drugs approved for inflammatory dermatoses. Both topical and systemic therapies were included. RESULTS: Most drug classes had warnings related to infections. Herpes zoster was listed for anti-CD20, IL-12/23i, INFi, JAKi and TYK2i, where hepatitis reactivation was reported for anti-CD20, TNFi, IL-17i, anti-BAFF, JAKi and TYK2i. Malignancy risk including skin cancer was mentioned for most classes, except IL-23i, IL-17i, IL-13i, IL-4/13i, IL-31i, IL-36i and PDE4i. Other serious warnings included neurological, cardiovascular, thrombotic, hepatic, renal, gastrointestinal, and psychiatric adverse events. CONCLUSION: This work provides a simple stepwise approach to managing contraindications and special warnings. Our safety checklist gives clinicians a rapid overview of contraindications, special warnings, and boxed warnings for the available drug classes approved for inflammatory dermatoses.
10 May 2026
Read appraisal →European journal of pediatrics
The effect of motivational interviewing on internet addiction and digital game addiction in adolescents: a randomized controlled trial
UNLABELLED: The purpose of this study was to measure the effect of motivational interviewing on both reducing internet addiction and digital game addiction in adolescents. A parallel-group randomised controlled trial was adopted. The study population consisted of ninth-grade (14-15 years of age) high school students in a city in Turkiye. The study was completed by 88 participants (experimental: 44; control: 44). The data were collected using a Personal Information Form, the Young Internet Addiction Test, and the Digital Game Addiction Scale. The experimental group received a preparatory session and five weekly motivational interviewing sessions. Instruments were administered to both groups before (pre-test) and after the intervention (post-test), and at follow-up tests 3 and 6 months after the final session. The data were analysed using the two-way mixed design and the Bonferroni Comparison Test. The mean scores of internet addiction and digital game addiction decreased significantly after the motivational interviewing in the experimental group compared to the control group (p < 0.001) in both the post-test and follow-up tests. CONCLUSION: The present study concluded that motivational interviewing may be associated with reductions in mitigating symptoms of internet addiction and digital game addiction behaviours among adolescents. Motivational interviewing could be implemented to reduce internet addiction and digital game addiction behaviours. Trial registration: The study was registered on a clinical trial database (NCT06721702). The study started on December 11, 2023 (actual date on which the first participant was enrolled). WHAT IS KNOWN: • Internet addiction and digital game addiction are two increasingly important problems among adolescents. • Digital games and online activities negatively affect adolescents' physical, social, and psychological health. WHAT IS NEW: • Motivational interviewing was an effective technique to reduce online gaming and internet addiction. • A motivational interviewing program comprising at least six sessions could be implemented to promote behavioural change in adolescents.
10 May 2026
Read appraisal →European journal of heart failure
Efficacy of finerenone in patients with heart failure and mildly reduced or preserved ejection fraction: a prespecified analysis of heart rate and heart rhythm in the FINEARTS-HF trial
AIMS: The association between heart rate (HR) and clinical outcomes is well understood in patients with heart failure with reduced ejection fraction (HFrEF) but less clear in those with HFmrEF/HFpEF, especially among individuals with atrial fibrillation (AF). In a prespecified analysis of the FINEARTS-HF trial, we examined the association between baseline HR and clinical outcomes by heart rhythm and evaluated finerenone's effect across the spectrum of HR. METHODS: The primary outcome was a composite of cardiovascular death and total (first and recurrent) HF events. Heart rhythm (sinus rhythm or AF) was determined from the baseline ECG. Patients with pacemaker rhythm or missing HR/rhythm data were excluded. RESULTS: Among patients with sinus rhythm (SR n = 3497; 62%), higher baseline HR was associated with a higher incidence rate for the primary outcome. In patients with AF (n = 2190; 38%), no association between HR and outcomes was observed. The effect of finerenone on the primary outcome was consistent across the HR spectrum, regardless of rhythm (P for interaction = 0.96 in SR; 0.49 in AF). In patients with SR, there was no significant HR change with finerenone versus placebo. In AF patients, finerenone led to a small but statistically significant HR reduction: a placebo-corrected decrease of 1.35 bpm (95% CI: 0.41-2.29) from baseline to 12 months. CONCLUSIONS: Among patients with HFpEF/HFmrEF in FINEARTS-HF, higher baseline HR was associated with a higher risk of the primary outcome in patients with SR but not in those with AF. Finerenone's effect on the primary outcome was consistent across the HR spectrum, irrespective of rhythm. TRIAL REGISTRATION: ClinicalTrials.gov NCT04435626.
10 May 2026
Read appraisal →Journal of physiology and biochemistry
Effects of acute, subacute, and chronic exercise on plasma s-Klotho levels: a systematic review and meta-analysis
Exercise exerts beneficial effects on multiple physiological systems, influencing biomarkers associated with aging processes and chronic diseases. This systematic review and meta-analysis aimed to evaluate the acute, subacute, and chronic effects of exercise on s-Klotho levels in healthy individuals and patients with chronic diseases. A comprehensive search was conducted in electronic databases. Included studies were randomized and non-randomized studies assessing the effects of aerobic, resistance, or combined exercise on s-Klotho levels. Interventions were classified as acute (single session), subacute (< 12 weeks), or chronic (≥ 12 weeks). Risk of bias was assessed using RoB 2 and ROBINS-I tools, and quality of evidence was evaluated with the GRADE framework. Forty-one studies were included in the qualitative synthesis, and 30 in the meta-analysis, comprising 2,765 participants (18-85 years). Twenty-five involved healthy individuals, while 21 included patients with chronic diseases. Acute and subacute aerobic exercise increased s-Klotho levels in healthy individuals (SMD 0.69; 95%CI 0.41-0.97) and diseased populations (SMD 0.62; 95%CI 0.11-1.12). Chronic exercise (12-36 weeks) showed significant increases in healthy (SMD 0.57; 95%CI 0.33-0.82) and diseased populations (SMD 1.51; 95%CI 0.87-2.16). Resistance exercise thrice weekly demonstrated the highest effect (SMD 1.60; 95%CI 0.81-2.38). Most studies had high risk of bias, with quality of evidence ranging from very low to moderate. Exercise significantly increases s-Klotho levels, with acute and subacute aerobic sessions benefiting healthy and diseased populations, while chronic resistance exercise elicited greater responses in diseased populations. Despite promising findings, low methodological quality suggests cautious interpretation.
10 May 2026
Read appraisal →Current urology reports
Artificial Intelligence in Urologic Documentation: A Review of Emerging Capabilities and the Ongoing Need for Human Oversight
PURPOSE OF REVIEW: Clinical documentation continues to expand in volume and complexity, spanning outpatient encounters, inpatient summaries, patient-portal communications, and educational materials. These growing demands contribute to clinician burden and reduce time available for direct patient care. Artificial intelligence (AI) has emerged as a potential strategy to streamline documentation workflows. This review evaluates current AI applications in clinical documentation, with illustrative examples from urologic practice. RECENT FINDINGS: Ambient AI scribes can capture the bulk of outpatient encounters and generate structured draft notes that clinicians edit rather than write de novo. Large language models have shown promise in assisting with inpatient documentation and discharge summaries, often producing drafts that are coherent, readable, and shorter than physician-authored text. AI tools can also simplify patient education materials and translate dense radiology reports into accessible language. Across these domains, however, studies consistently demonstrate that AI-generated content remains vulnerable to factual errors, omissions, hallucinations, and misaligned emphasis, reinforcing the need for clinician oversight. Overall, emerging evidence supports a complementary relationship between clinicians and AI. Used as supervised drafting aids rather than autonomous authors, AI tools have the potential to ease documentation burden and create more time for direct patient care without diminishing the clinician's role in shaping the medical record.
10 May 2026
Read appraisal →Lancet (London, England)
Once-weekly semaglutide versus placebo in patients with alcohol use disorder and comorbid obesity: a randomised, double-blind, placebo-controlled trial
BACKGROUND: Alcohol use disorder accounts for 5% of deaths worldwide annually, and there is an urgent need for new therapeutic interventions. Preclinical and initial human studies indicate that the GLP-1 receptor agonist semaglutide might reduce alcohol drinking. This study evaluated the efficacy of semaglutide once-weekly in treatment-seeking patients with alcohol use disorder and comorbid obesity. METHODS: In a 26-week, single-centre, randomised, double-blinded, placebo-controlled trial, treatment-seeking participants with moderate to severe alcohol use disorder and comorbid obesity were assigned (1:1) to receive once-weekly semaglutide (2·4 mg subcutaneously) or placebo (saline subcutaneously), in addition to standard cognitive behavioural therapy. The primary endpoint was a reduction in the number of heavy drinking days assessed after 26 weeks of intervention, analysed with an ANCOVA model. Analysis adhered to the intention-to-treat principle, and missing outcome data were addressed using multiple imputations. Safety was assessed in all treated patients. The trial is registered at ClinicalTrials.govNCT05895643, and is complete. FINDINGS: From June 10, 2023, to Feb 4, 2025, 108 participants (53 women and 55 men) were enrolled, with 54 participants in each of the semaglutide and placebo treatment groups, and all were included in the data analysis. Overall, 88 participants (81%) completed the full intervention. Semaglutide was associated with a reduction in heavy drinking days (-41·1 percentage points from baseline, 95% CI -48·7 to -33·5) compared with placebo (-26·4, -34·1 to -18·6; estimated treatment difference -13·7 percentage points, -22·0 to -5·4; p=0·0015), and had substantial effects on multiple secondary alcohol-related and somatic outcomes. Adverse events were transient, generally mild to moderate gastrointestinal effects, and occurred more frequently in the semaglutide group. INTERPRETATION: Semaglutide showed robust therapeutic effects in treatment-seeking participants with obesity and alcohol use disorder and this trial supports previous preclinical and clinical findings suggesting GLP-1 receptor agonists as a potential novel treatment target for alcohol use disorder. FUNDING: The Research Foundation, Mental Health Services (Capital Region of Denmark), the Novo Nordisk Foundation, the Novavi Foundation, the Hartmann Foundation, and the Augustinus Foundation.
10 May 2026
Read appraisal →Current osteoporosis reports
The Use of Statistical Shape and Appearance Modelling for Predicting Osteoporotic Fracture Risk
PURPOSE OF REVIEW: Osteoporotic fractures remain a major cause of morbidity and mortality worldwide. Current clinical assessment metrics (e.g., bone mineral density) are limited in their ability to identify fracture risk and bone strength. Statistical Shape and Appearance Modelling (SSAM) offers a method to quantify anatomical geometry and density patterns. This review examines advancements in SSAM for osteoporosis research. RECENT FINDINGS: Recent literature demonstrates that SSAM can capture detailed bone geometry and internal density distribution. Increasingly, these models are combined with computational analytics, including finite element analysis and machine learning, to assess the mechanical and structural behavior of bone. SSAM provides a robust quantitative framework for bone research. Notably, SSAM is used to reconstruct 3D subjects from clinical 2D images for biomechanical evaluation. Although clinical adoption remains limited by generalizability, the advancement of deep learning and complex SSAM pipelines supports its potential for osteoporosis screening and fracture risk prediction.
10 May 2026
Read appraisal →European journal of heart failure
Erythropoiesis-stimulating agents to reduce heart failure hospitalization: a systematic review and meta-analysis
AIMS: Anaemia is common in patients with chronic heart failure (CHF), worsening functional status and prognosis. The role of erythropoiesis-stimulating agents (ESAs) to reduce hospitalization remains unclear. METHODS AND RESULTS: A pre-registered systematic search was performed of randomized controlled trials in adults with CHF and anaemia, comparing any ESA at any dose versus placebo or no treatment.Fourteen trials were included with 3128 participants, with moderate quality of evidence for most outcomes and variable risk of bias. Meta-analysis during 5604 person-years of follow-up demonstrated no significant difference in first CHF hospitalization comparing ESAs with control: Peto odds ratio (OR) 0.93, 95% CI 0.78-1.10, P = .37; trial heterogeneity I2 = 36%. ESAs significantly reduced total CHF hospitalization with 622 events/2698 person-years, compared with 761/2914 person-years for control: incidence rate ratio 0.81, 95% CI 0.73 to 0.90, P < .001; no heterogeneity between trials, I2 = 0%. There were no significant differences between treatment groups for all-cause mortality (OR 1.01, 95% CI 0.86-1.18, P = .88; I2 = 35%) or incident adverse events. Patients randomized to ESAs increased their haemoglobin level [mean difference (MD) 1.6 g/dL compared with control, 95% CI 1.6-1.7, P < .001] and exercise tolerance (MD 69 metres, 95% CI 17-122, P = .009), with lower NYHA class on follow-up (MD -0.73 class, 95% CI -1.11 to -0.36, P < .001). CONCLUSION: ESA treatment in patients with CHF and mild anaemia can reduce recurrent CHF hospitalization and improve functional capacity, without any impact on adverse events. Including ESAs in CHF management could be considered in patients with anaemia at high risk of recurrent hospital admissions.
10 May 2026
Read appraisal →Sleep & breathing = Schlaf & Atmung
What is the most effective non-pharmacological treatment for poor sleep quality in Chronic obstructive pulmonary disease patients? a systematic review.
BACKGROUND: Chronic obstructive pulmonary disease (COPD) features poor sleep quality due to nocturnal dyspnea and psychological distress, leading to increased hospital admissions and reduced quality of life. Considering patient preference and existing evidence, non-pharmacological intervention, i.e. cognitive behavioral therapy for insomnia (CBT-I), on sleep for COPD patients had its potential efficacy. However, current guidelines do not include sleep management as standard care, and there is a lack of comprehensive reviews on this topic. This systematic review hence evaluated the effectiveness of non-pharmacological treatments for poor sleep in COPD patients. METHODS: Literature identification was conducted through MEDLINE, CINHAL PLUS, AMED and ScienceDirect under PRISMA guidance. Randomized controlled trials, cohort studies and cross-sectional studies regarding poor sleep quality among COPD population were retrieved. Abstract, title and full text screening were performed by the author and assessed by a second reviewer. Risk of bias and quality appraisal was done with JBI scale. RESULTS: 12 articles (783 patients) were identified, including 9 randomized controlled trials, 1 cohort study and 2 cross-sectional studies. The risk of bias (quality) was ranked: low (high) for 3, moderate (moderate) for 7 and high (low) for 2. Several interventions were identified (number of study): CBT-I (2) and cognitive behavioral therapy (1), pulmonary rehabilitation (PR) (2), progressive muscle relaxation technique (PMRT) (2), non-invasive ventilation (NIV) (3), relaxation exercise (RE) (1) and therapeutic touch (TT) (1). Significant improvement in sleep quality was reported in PMRT, TT and RE. CONCLUSION: PMRT, TT and RE showed improvement in sleep quality in COPD patients yet unable to rank their effectiveness as heterogeneous outcome measures across studies. No substantial evidence was capable to demonstrate effectiveness of CBT-I, CBT, PR and NIV to explicit COPD patients. Moreover, future research including combination of non-pharmacological treatments is needed.
10 May 2026
Read appraisal →European journal of cancer (Oxford, England : 1990)
Sex differences in efficacy and toxicity of first-line treatment of metastatic colorectal cancer: An analysis of 18,041 patients in the ARCAD CRC database.
BACKGROUND: Greater toxicity of adjuvant chemotherapy in females has been reported previously, but the impact of patients' sex on chemotherapy (CT)+/-targeted therapies for non-resectable, metastatic colorectal cancer (mCRC) has remained unclear. We compared efficacy and toxicity of first-line chemotherapy, with or without targeted therapies, between male and female mCRC patients. METHODS: Twenty-seven randomized trials from the ARCAD CRC database were included. Primary endpoint was overall survival (OS); secondary endpoints were progression-free survival (PFS), overall response rate, toxicity (according to NCI-CTCAE). Analyses were performed within three treatment groups: A) CT alone, B) CT+bevacizumab, and C) CT+epidermal growth factor receptor inhibitor. OS and PFS were estimated using Kaplan-Meier method. Associations with sex were assessed using study-stratified Cox models adjusted for age, performance status, body mass index, and CT backbone. RESULTS: Baseline data from 18,041 patients were analysed; among 15,271 included in outcome analyses, no sex differences in OS or PFS were observed. Adjusted OS hazard ratios (95% confidence interval) for females versus (vs.) males were: A: 1.01 (0.95-1.08, P = .69), B: 0.96 (0.89-1.04, P = .36), C: 0.97 (0.87-1.10, P = .67). Females experienced higher toxicity, including grade 1-4 and 3-4 nausea (71.8% vs. 60.5% and 7.5% vs. 4.8%), vomiting (47.7% vs. 35.5% and 6.6% vs. 4.4%), and neutropenia (52.4% vs. 44.4% and 29.2% vs. 18.8%) (P < .001). Conversely, rash (grade 1-4 and 3-4) was more frequent in males (29.6% vs. 24.3% and 5.1% vs. 3.7%, P < .001). CONCLUSIONS: Despite higher chemotherapy-related toxicity in females, treatment efficacy was similar between sexes. Rash was more common in males, highlighting that patients' sex modulates toxicity profiles in both directions. Strategies to reduce adverse events in female patients are warranted.
10 May 2026
Read appraisal →Journal of biopharmaceutical statistics
Revolutionizing cardiovascular disease classification through machine learning and statistical methods
BACKGROUND: Cardiovascular diseases (CVDs) include abnormal conditions of the heart, diseased blood vessels, structural problems of the heart, and blood clots. Traditionally, CVD has been diagnosed by clinical experts, physicians, and medical specialists, which is expensive, time-consuming, and requires expert intervention. On the other hand, cost-effective digital diagnosis of CVD is now possible because of the emergence of machine learning (ML) and statistical techniques. METHOD: In this research, extensive studies were carried out to classify CVD via 19 promising ML models. To evaluate the performance and rank the ML models for CVD classification, two benchmark CVD datasets are considered from well-known sources, such as Kaggle and the UCI repository. The results are analysed considering individual datasets and their combination to assess the efficiency and reliability of ML models on the basis of various performance measures, such as precision, kappa, accuracy, recall, and the F1 score. Since some of the ML models are stochastic, we repeated the simulation 50 times for each dataset using each model and applied nonparametric statistical tests to draw decisive conclusions. RESULTS: The nonparametric Friedman - Nemenyi hypothesis test suggests that the Extra Tree Classifier provides statistically superior accuracy and precision compared with all other models. However, the Extreme Gradient Boost (XGBoost) classifier provides statistically superior recall, kappa, and F1 scores compared with those of all the other models. Additionally, the XGBRF classifier achieves a statistically second-best rank in terms of the recall measures.
10 May 2026
Read appraisal →The British journal of psychiatry : the journal of mental science
Characterisation of serious mental illness trajectories through transdiagnostic clinical features
BACKGROUND: Electronic health records (EHRs), increasingly available in low- and middle-income countries (LMICs), provide an opportunity to study transdiagnostic features of serious mental illness (SMI) and its trajectories. AIMS: Characterise transdiagnostic features and diagnostic trajectories of SMI using an EHR database in an LMIC institution. METHOD: We conducted a retrospective cohort study using EHRs from 2005-2022 at Clínica San Juan de Dios Manizales, a specialised mental health facility in Colombia, including 22 447 patients with schizophrenia (SCZ), bipolar disorder (BPD) or severe/recurrent major depressive disorder (MDD). Using diagnostic codes and clinical notes, we analysed the frequency of suicidality and psychosis across diagnoses, patterns of diagnostic switching and the accumulation of comorbidities. Mixed-effect logistic regression was used to identify factors influencing diagnostic stability. RESULTS: High frequencies of suicidality and psychosis were observed across diagnoses of SCZ, BPD and MDD. Most patients (64%) received multiple diagnoses over time, including switches between primary SMI diagnoses (19%), diagnostic comorbidities (30%) or both (15%). Predictors of diagnostic switching included mentions of delusions (odds ratio = 1.47, 95% CI 1.34-1.61), prior diagnostic switching (odds ratio = 4.01, 95% CI 3.7-4.34) and time in treatment, independent of age (log of visit number; odds ratio = 0.57, 95% CI 0.54-0.61). Over 80% of patients reached diagnostic stability within 6 years of their first record. CONCLUSIONS: Integrating structured and unstructured EHR data reveals transdiagnostic patterns in SMI and predictors of disease trajectories, highlighting the potential of EHR-based tools for research and precision psychiatry in LMICs.
9 May 2026
Read appraisal →Journal of clinical ultrasound : JCU
Integrative Machine Learning Model Leveraging DCE-MRI and PSA Values for Advanced Risk Stratification in Prostate Cancer
PURPOSE: Accurate grading of prostate cancer is critical for treatment strategies and risk stratification. This study aims to develop a machine learning (ML) model integrating Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) pharmacokinetic parameters with Prostate-Specific Antigen (PSA) values to predict ISUP grade metastatic risk groups. METHODS: This retrospective study included 102 patients with histologically confirmed prostate cancer. DCE-MRI pharmacokinetic parameters (Ktrans, Kep, Ve, CER, MaxSlope, IAUGC) were standardized. The dataset was balanced using the Synthetic Minority Oversampling Technique and split into training, validation, and test sets. ML models, including Random Forest, were evaluated using Area Under the Curve (AUC) values. RESULTS: The Random Forest classifier achieved the highest performance, with an AUC of 0.92. Precision-recall analysis identified an optimal threshold of 0.3, balancing sensitivity and specificity for high-risk group detection. SHAP analysis highlighted PSA, MaxSlope, and Kep as key predictors contributing to model accuracy. CONCLUSION: Integrating DCE-MRI parameters with PSA values using ML algorithms enhances the prediction of ISUP grade metastatic risk groups. This method provides a robust tool for metastasis screening and personalized treatment in prostate cancer.
9 May 2026
Read appraisal →International journal of medical informatics
Development of an interpretable machine learning model for predicting 4-year chronic kidney disease risk in elderly hypertensive patients
INTRODUCTION: Age and hypertension are key drivers of renal impairment, predisposing older hypertensive adults to faster kidney function decline and higher mortality. We aim to develop an interpretable machinelearning model to predict 4-year chronic kidney disease (CKD) risk in this population. METHODS: Our study incorporated 4,142 hypertensive patients from the Health and Retirement Study (HRS) 2010 and 2012 cohorts for model development and internal validation, with additional temporal validation performed within the HRS 2006 and 2008 cohorts. External validation was conducted using three distinct subcohorts derived from the China Health and Retirement Longitudinal Study (CHARLS) database. Feature selection was implemented through an integrated LASSO-Boruta algorithm, followed by model construction using eight machine learning approaches. Discriminative performance was rigorously evaluated through multiple metrics, including receiver operating characteristic (ROC) curve analysis, accuracy, sensitivity, specificity, and Brier score. The optimal model underwent interpretability analysis via SHapley Additive exPlanations (SHAP) to elucidate decision-making mechanisms and was subsequently deployed as a web-based clinical prediction tool. RESULTS: Using a combined LASSO-Boruta strategy, we identified nine routinely available predictors for model development. In the training set, SVM achieved the highest AUC (0.735), closely followed by XGBoost (0.734); notably, in the temporal validation cohort, XGBoost was the only model with an AUC > 0.700 (0.702). Overall performance metrics derived from confusion matrices, together with Brier scores, suggested that XGBoost provided a favorable balance between sensitivity and specificity while maintaining acceptable probabilistic calibration. Calibration curves further suggested that XGBoost showed relatively stable agreement between predicted and observed risks across datasets, supporting its selection for subsequent SHAP-based interpretation and web deployment; SHAP identified age as the leading contributor to CKD risk. CONCLUSIONS: We developed an interpretable model using routine clinical indicators to predict 4-year CKD risk in elderly hypertensive adults, with applicability across Asian and Caucasian populations.
9 May 2026
Read appraisal →The Journal of asthma : official journal of the Association for the Care of Asthma
Prediction model for cardiovascular mortality risk in asthma patients based on machine learning
BACKGROUND: Asthma is a common chronic respiratory disease, cardiovascular disease (CVD) mortality constitutes a major public health concern. At present, no personalized tools are available to accurately estimate CVD mortality risk in this population. Accordingly, a machine learning model was developed to predict incident CVD mortality of asthma. METHODS: Data were extracted from NHANES (2007-2012). Predictors were selected by LASSO and multivariable Cox regression. Discrimination and calibration were quantified with ROC curves and calibration curves, nomogram and web calculator were subsequently deployed. Incremental predictive value relative to ASCVD risk and Framingham risk scores were assessed with the integrated discrimination improvement and net reclassification improvement. Six machine learning algorithms were trained, and feature importance of the optimal model was interpreted with SHAP values. RESULTS: Among 2,033 adults participants with asthma, with mean age 44 years, and they comprised 834 males (41.02%) and 1199 females (58.98%). Twelve variables (age, sex, smoking, hypertension, diabetes, CKD, SBP, LYM, UA, K, FENO, and PEF) were retained as predictors of CVD mortality. Calibration was stable across training sets (C-index = 0.863) and validation sets (C-index = 0.832). The pulmonary function test augmented NHANES model outperformed both ASCVD risk and Framingham risk scores. RF and XGB model achieved the highest discrimination. CONCLUSION: A machine learning model integrating routine clinical and pulmonary function test indices was developed. The model enables accurate estimation of long term CVD mortality risk with asthma, facilitating early identification of high risk individuals and informing personalized preventive strategies.
9 May 2026
Read appraisal →Journal of diabetes science and technology
Explainable Machine-Learning Models to Predict Weekly Risk of Hyperglycemia, Hypoglycemia, and Glycemic Variability in Patients With Type 1 Diabetes Based on Continuous Glucose Monitoring
BACKGROUND AND OBJECTIVE: The aim of this study was to develop and validate explainable prediction models based on continuous glucose monitoring (CGM) and baseline data to identify a week-to-week risk of CGM key metrics (hyperglycemia, hypoglycemia, glycemic variability). By having a weekly prediction of CGM key metrics, it is possible for the patient or health care personnel to take immediate preemptive action. METHODS: We analyzed, trained, and internally tested three prediction models (Logistic regression, XGBoost, and TabNet) using CGM data from 187 type 1 diabetes patients with long-term CGM monitoring. A binary classification approach combined with feature engineering deployed on the CGM signals was used to predict hyperglycemia, hypoglycemia, and glycemic variability based on consensus targets (time above range ≥5%, time below range ≥4%, coefficient of variation ≥36%). The models were validated in two independent cohorts with a total of 223 additional patients of varying ages. RESULTS: A total of 46 593 weeks of CGM data were included in the analysis. For the best model (XGBoost), the area under the receiver operating characteristic curve (ROC-AUC) was 0.9 [95% confidence interval (CI) = 0.89-0.91], 0.89 [95% CI = 0.88-0.9], and 0.8 [95% CI = 0.79-0.81] for predicting hyperglycemia, hypoglycemia, and glycemic variability in the interval validation, respectively. The validation test showed good generalizability of the models with ROC-AUC of 0.88 to 0.95, 0.84 to 0.89, and 0.80 to 0.82 for predicting the glycemic outcomes. CONCLUSION: Prediction models based on real-world CGM data can be used to predict the risk of unstable glycemic control in the forthcoming week. The models showed good performance in both internal and external validation cohorts.
9 May 2026
Read appraisal →Abdominal radiology (New York)
Advancing osteoporosis opportunistic screening: multicenter validation of a deep learning algorithm using abdominal CT scans
OBJECTIVES: To develop and do multicenter validation on an algorithm that screens for osteoporosis from abdominal CTs. METHODS: This is a diagnostic accuracy study with retrospective data from January 2022 to July 2022 consisting of two steps: a segmentation step of the lumbar vertebral bodies, involving outpatient non-contrast abdominal CTs from Diagnósticos da América S/A (Dasa), and a multicenter validation step incorporating data from four additional institutions. The segmentation employed a 2D UNet with a ResNet34 backbone. We determined the Pearson correlation coefficient (r) between the mean of the slices' mean attenuations (MSMA) on CT scans against the bone mineral density (BMD) on recent DEXA scans, calculated AUCs and performance metrics for osteoporosis prediction, including 95% confidence intervals, and evaluated calibration plots. RESULTS: The multicenter validation included 504 participants (median age, 66 years, interquartile range 56-72; 388 women). A linear regression analysis showed an r of 0.62 (95% CI, 0.56-0.67) between MSMA (HU) and BMD (g/cm2). The AUCs (95% CI) for distinguishing between normal and osteoporosis were 0.96 (0.89, 1.0) for the internal dataset and 0.82 (0.74, 0.89) for the external dataset, and the performance metrics (95% CI), for a globally optimized threshold of 202.6 HU, were 100% sensitivity (44, 100) and 91% specificity (84, 95) for internal data and 79% sensitivity (61, 90) and 81% specificity (76, 84) for external sites. MSMA was independently associated with osteoporosis on a mixed-effects logistic regression analysis. The model showed good calibration, with Brier score of 0.054. CONCLUSION: We developed and performed a multicenter validation of a DL model for osteoporosis prediction on CT.
6 May 2026
Read appraisal →Journal of affective disorders
Gaborformer: A method for depression detection through hybrid acoustic feature extraction and fusion
Depression, a complex and heterogeneous mental disorder, poses significant challenges for timely and effective detection, highlighting the need for advanced methodologies. Current technologies often fail to fully leverage deep learning's potential, potentially overlooking critical speech features. To address this, we propose Gaborformer, a novel framework for depression detection through hybrid acoustic feature extraction and fusion. Our approach introduces classified iterative neighborhood component analysis (CINCA) for feature selection, reducing dimensionality and extracting highly correlated depressive speech features. We design GaborNet, integrating learnable Gabor filters with CNN to fuse features, and incorporate a Conformer model to capture depression-related characteristics from high-dimensional signals. Extensive validation on the DAIC-WOZ and MODMA datasets demonstrates the efficacy of our approach, significantly outperforming previous studies. Our analysis underscores the importance of features such as MFCC and LSP in speech-based depression detection (SDD). Code is available at https://github.com/staygoldboy/gaborformer.
6 May 2026
Read appraisal →Computer methods in biomechanics and biomedical engineering
Modified mutual information feature selection algorithm to predict COVID-19 using clinical data
The COVID-19 pandemic has profoundly impacted health, emphasizing the need for timely disease detection. Blood tests have become key diagnostic tools due to the virus's effects on blood composition. Accurate COVID-19 prediction through machine learning requires selecting relevant features, as irrelevant features can lower classification accuracy. This study proposes Modified Mutual Information (MMI) for feature selection, ranking features by relevance and using backtracking to find the optimal subset. Support Vector Machines (SVM) are then used for classification. Results show that MMI with SVM achieves 95% accuracy, outperforming other methods, and demonstrates strong generalizability on various benchmark datasets.
6 May 2026
Read appraisal →European radiology
Enhancing vertebral fracture prediction using multitask deep learning computed tomography imaging of bone and muscle
OBJECTIVES: To develop and externally validate a computed tomography (CT)-based multitask learning model to predict fracture risk. MATERIALS AND METHODS: This study was conducted in two parts, using a multitasking learning approach. We developed a cross-sectional vertebral fracture (VF) detection model using abdominal CT scans of 2553 patients aged 50-80 years. Then, we leveraged this detection model within a multitask learning framework to develop a longitudinal VF prediction model over a 5-year follow-up period. External testing was performed on 1506 patients from two independent hospitals. The performance was compared between the single-task and multitask models, bone-only and bone+muscle images, and image-only and clinical models. RESULTS: For the cross-sectional fracture detection model, the mean age of the patients was 76.2 years, and 66.7% were female. In the classification task for detection of VF, the model using both bone and muscle showed an area under the receiver operating characteristic curve (AUROC) of 0.82 in the development set and 0.80 in the external test sets. Using multitask learning, the bone + muscle image model showed a c-index of 0.68 and had superior performance than the bone-only model in the external test set for 2-year, 3-year, and 5-year AUROCs (0.79 vs. 0.75, 0.71 vs. 0.68, and 0.71 vs. 0.68, respectively, all p < 0.01). Also, the multitask model significantly outperformed the Fracture Risk Assessment Tool (FRAX) (c-index: 0.68 vs. 0.66, p < 0.01). CONCLUSION: The CT-based multitask learning model integrating both bone and muscle data showed superior predictive performance for VFs compared with models using bone images only and traditional clinical models. KEY POINTS: Question Vertebral fracture risk remains underestimated in many individuals undergoing CT scans for other reasons, highlighting the need for improved opportunistic prediction tools. Findings A multitask deep learning model integrating both bone and muscle features from CT scans demonstrated superior performance compared to bone-only and traditional clinical models, including FRAX. Clinical relevance The proposed model enables accurate vertebral fracture risk prediction using routinely acquired CT scans, facilitating early identification and intervention without the need for additional tests.
6 May 2026
Read appraisal →Journal of medical virology
A Triage Model for HR-HPV Positive Women Based on Methylation of Human and HPV Genes
The aim of this study is to develop a machine learning triage model for HR-HPV positive women based on methylation patterns of human and HPV genes to predict the risk of CIN2 +, and to compare its performance with traditional detection techniques. A total of 512 eligible women participated in the study, with exfoliated cervical cell specimens collected for methylation analysis of both human and HPV genes. Highly methylated gene fragments related to cervical cancer were identified through high density, high association, high MHL (Methylation Haplotype Load) screening and Logistic regression. The samples were divided into a training set and a validation set at a ratio of 7:3, and a machine learning triage model was constructed using CIN2+ as the outcome. Among 512 HR-HPV positive women, 174 (34.0%) had CIN2 +. To construct the random forest model, 10 high methylation human gene fragments were identified from a pool of 45 genes, along with HPV 16, 18, and 52 L2 genes. In the validation set, the random forest model identified 45 samples as positive (38 were true positives) and 112 samples as negative (96 were true negatives). The model achieved an AUC of 0.9, and DeLong test confirmed its performance was significantly superior (p < 0.001) to HPV 16/18 genotyping and cytology testing. The random forest model constructed based on methylation patterns of human and HPV genes demonstrated strong predictive efficacy for CIN2+ in HR-HPV positive women, and may optimize the triage method in cervical cancer screening.
5 May 2026
Read appraisal →Menopause (New York, N.Y.)
Deciphering the predictors of endometrial nonbenign lesions in asymptomatic postmenopausal women via explainable machine learning
OBJECTIVES: Timely identification of endometrial nonbenign lesions led to improved outcomes, but there was a lack of effective predictive models for asymptomatic endometrial thickening. The aim of this study was to develop a strong machine learning (ML) model for assessing the risk of endometrial malignancy in asymptomatic patients after menopause. METHODS: This retrospective study was designed to collect data from 971 postmenopausal asymptomatic women with endometrial thickening. The bootstrap resampling method was used for model training, internal validation, and external validation. With 41 easily accessible characteristics, multifactor regression and least absolute shrinkage and selection operator regression were performed for feature selection. Nine ML algorithms were applied to build a model. To explain the final model and rank feature importance, the SHapley Additive exPlanation (SHAP) method was utilized. Meanwhile, a nomogram was developed to facilitate model interpretation. RESULTS: The comprehensive methodologies identified parity, Doppler flow signals, endometrial thickness, cancer antigen 125, and D-dimer as significant predictors. The logistic regression (LR) model demonstrated superior performance compared with other ML algorithms, achieving an accuracy of 88%, a sensitivity of 78%, a specificity of 98%, and an area under the receiver operating characteristic curve of 0.81. Furthermore, individualized predictions of endometrial malignancy were visualized through a force plot generated by SHAP analysis. A nomogram based on the LR model was subsequently constructed, showing area under the receiver operating characteristic curve values of 0.82, 0.82, and 0.81 for the training, internal validation, and external validation cohorts, respectively. The calibration curve demonstrated excellent consistency. CONCLUSIONS: We developed an LR-based nomogram model and interpreted using the SHAP method, which provided visual insights for detecting endometrial nonbenign lesions in asymptomatic postmenopausal women. This approach would aid clinicians in providing individualized treatment and help avoid unnecessary invasive surgeries.
5 May 2026
Read appraisal →Journal of applied gerontology : the official journal of the Southern Gerontological Society
Anomaly Detection Technologies for Dementia Care: Monitoring Goals, Sensor Applications, and Trade-offs in Home-Based Solutions-A Narrative Review
Anomaly detection technologies are increasingly used to monitor people living with dementia (PLwD) in home settings, addressing critical behaviors such as wandering, sleep disturbances, and agitation. This narrative review examines technologies used for detecting behavioral anomalies, the activities they monitor, and the trade-offs between their benefits and limitations. A systematic search across MEDLINE, IEEE Xplore, ACM Digital Library, and Web of Science identified 78 studies, categorized through thematic analysis. Three primary motivations emerged: early diagnosis, safety monitoring, and reducing caregiver stress while promoting autonomy. Technologies include GPS tracking, wearables, environmental sensors, and smart home systems, each with benefits like real-time alerts and non-intrusive monitoring but also challenges such as user compliance, false positives, and privacy concerns. While these systems enhance safety and autonomy, improving sensor accuracy, integrating AI for personalized interventions, and addressing ethical concerns are essential for long-term effectiveness and supporting the well-being of both PLwD and caregivers.
5 May 2026
Read appraisal →International journal of medical informatics
BackTracker: Machine learning to identify kinematic phenotypes for personalised exercise management in non-specific low back pain.
BACKGROUND: Low back pain (LBP) is a leading cause of global disability. Most cases are non-specific (NSLBP) and lack identifiable causes. Early active management is endorsed by clinical guidelines; however, exercises are rarely customised despite substantial variability in impairments. Existing classification systems can support targeted rehabilitation but require extensive clinical training and lengthy assessment procedures, limiting timely personalised care. OBJECTIVE: This study used AI methods to identify the two most common motor control impairments (MCIs)-flexion and extension patterns (FP/EP)-in NSLBP. The approach used spinal silhouettes extracted from movement videos to enable self-phenotyping and guide personalised exercise selection. METHODS: Data were collected from a research fellowship involving ninety NSLBP participants classified by an expert physiotherapist (LS) into FP or EP MCIs. Participants performed standard forward- and backward-bend tasks recorded in the sagittal plane. Pose estimation and instance segmentation techniques were applied to extract motion features and spine silhouettes. From each participant, a curated set of 80 black-and-white back images captured at specific bending angles was produced. These features were used to train a feedforward neural network. Model performance was assessed using five-fold cross-validation with accuracy, sensitivity, specificity, F1 score and AUC. RESULTS: The model achieved a diagnostic accuracy of 91.91% (95% CI 84.8-99.1) for backward-bend videos, exceeding reported inter-examiner agreement rates for trained physiotherapists. Robustness was supported by a mean AUC of 0.9422. Accuracy was lower for forward-bend images (86.69%), combined tasks (86.29%), or PROMs alone (63.82%). Adding PROMs to forward- or backward-bend tasks provided only modest improvements (66.32% and 71.62%, respectively). CONCLUSION: The model reliably distinguished between FP and EP NSLBP subgroups, demonstrating the potential of AI to support timely personalised rehabilitation. The integration of PROMs with motion features reduced classification accuracy, suggesting that self-reported outcomes may provide limited benefit when tailoring exercises to specific physical impairments.
5 May 2026
Read appraisal →Microvascular research
OPU-NET-DADENA: Optimized deep learning ensemble with u-net segmentation for early detection of diabetic retinopathy
One of the most significant microvascular complications of diabetes mellitus (DM) is diabetic retinopathy (DR). In the early stages, patients with DR may not exhibit any noticeable symptoms. It is a diabetic disorder that damages retinal blood vessels in the eyes. At first, there are no symptoms or sporadic visual issues. When it worsens, it affects both eyes and can lead to partial or total blindness. A person who already has DM is therefore constantly at a higher risk of developing the condition. Early identification can prevent the possibility of total and irreversible blindness. Therefore, needs an efficient and early diagnosis system. So, this paper proposes a new deep-learning methodology in a specific Deep Siamese DenseNet for early detection of DR. The proposed method is accomplished through various steps, such as Data Collection, Preprocessing, Augmentation, Segmentation, Feature Extraction, Feature Selection, and Detection. An adaptive histogram equalization approach named Contrast Limited Adaptive Histogram Equalization (CLAHE) is used to preprocess input images, which reduces amplification of noise. Then, the segmentation is done by the Optimized U-NETs. Next, features of the contrasted retinal images are extracted by residual attention EfficientNet (RA-EfficientNet). Then, the optimal features are selected by a hybrid Reptile Search Algorithm (RORS). Finally, the deep learning methodology includes DarkNet, DenseNet 201, and NasNetMobile used to detect diabetic retinopathy at an early stage. The model is implemented in MATLAB and evaluated using accuracy, precision, F-score, specificity, sensitivity, MCC, NPV, FPR, and FNR. The proposed approach achieves 99.33% accuracy and 98.32% precision, outperforming previous methods that reported accuracies of 95-97% and precisions of 94-96%, demonstrating its effectiveness for reliable early detection of DR.
5 May 2026
Read appraisal →Molecular psychiatry
A five-year risk prediction model of cardiovascular disease in individuals with bipolar disorder: a nationwide register study from Sweden
Cardiovascular disease (CVD) risk prediction models for the general population may not provide accurate predictions in individuals with bipolar disorder (BD) who have elevated risks of cardiometabolic conditions and premature mortality. Therefore, we aimed to: 1) develop a five-year CVD risk prediction model in this population by using nationwide register data from Sweden, 2) investigate whether the performance improved when we considered additional risk factors, including psychiatric comorbidity, psychotropic medication, and socio-demographic variables, compared to using established CVD risk factors only, and 3) whether machine learning approach provided improvements compared to standard logistic regression models. We followed 33,933 persons with BD aged 30-82 years old, without previous CVD, from the date of BD diagnosis registered between 2007-2014, for up to five years. The logistic regression model containing only established risk factors yielded an area under the receiver operating characteristic curve (AUC) of 0.76 (95% confidence interval 0.74-0.78) in the test dataset, while the logistic regression model and the best performing machine learning model including additional predictors yielded similar results (AUC was 0.77 (0.75, 0.79) in both models). The performance of logistic regression models slightly improved with additional predictors when continuous risk scores were used. In conclusion, standard logistic regression and established CVD risk factors may be sufficient to predict CVD in individuals with BD when using population register-based data from Sweden. External validation across diverse healthcare settings and rigorous assessment of clinical impact will be crucial next steps before implementing these models in clinical practice.
4 May 2026
Read appraisal →IEEE transactions on bio-medical engineering
Multi-Stage Respiratory Sound Analysis: Confidence-Driven Wheeze and Crackle Detection
OBJECTIVE: Accurate detection of adventitious respiratory sounds, such as wheezes and crackles, is essential for diagnosing and managing respiratory conditions. This study introduces a multi-stage, confidence-driven framework for automated pediatric auscultation analysis, performing a three-way classification of normal, wheeze, and crackle sounds to improve diagnostic accuracy. METHODS: We develop a comprehensive pipeline integrating anomaly-specific segment selection, segment-level classification, and confidence-based fusion. Our contrastive variational recurrent neural network (CVRNN) enhances feature extraction, while a confidence-weighted aggregation strategy refines final predictions. The system is validated using a diverse pediatric dataset from 742 subjects (aged 1-59 months) from seven countries. RESULTS: The multi-level framework is evaluated across three stages. The anomaly-specific segment selection achieves 98.47 $\%$ recall, identifying adventitious regions. Next, segment-level classifiers improve sensitivity, achieving balanced accuracies of 72.15 $\%$ (wheeze) and 68.1 $\%$ (crackle). This performance surpasses state of the art systems on the same dataset and demonstrates enhanced balanced performance in detecting both crackle and wheeze sounds, which present different challenges to automated systems given their markedly different acoustic profiles. Finally, the confidence-driven fusion outperforms traditional aggregation methods, yielding a final three-way classification of 62.12 $\%$. CONCLUSION: Our confidence-based multi-stage approach enhances automated respiratory sound classification by prioritizing high-certainty segment predictions, aligning with expert physician annotations. SIGNIFICANCE: This framework advances computer-aided respiratory diagnostics, improving early detection and monitoring of pediatric respiratory conditions. By integrating expert-inspired segmentation with machine learning-driven confidence estimation, it has potential to enhance clinical workflows and screening for pulmonary diseases, particularly in resource-limited settings.
4 May 2026
Read appraisal →Journal of affective disorders
Plasma metabolomics identifies lipid mediators linking depression and cognitive decline in late-life depression.
BACKGROUND: Late-life depression (LLD) features recurrent episodes and frequently co-exists with cognitive impairment, which predicts worse outcomes and progression to dementia. Evidence indicates a bidirectional depression-cognition relationship, but objective biological tools to capture severity and this interplay are scarce. METHODS: This study compared 110 patients with LLD between depressive episodes and remission phases. Based on untargeted liquid chromatography-mass spectrometry (LC-MS) metabolomics analysis of plasma samples, we identified key metabolites and developed four predictive machine learning models (GLMNet, LDA, Naive Bayes, and cTree). Additionally, Spearman rank correlation analysis and mediation analysis were conducted to further investigate the relationships and mediating effects of the key metabolites. RESULTS: The diagnostic model based on key metabolites selected by the random forest algorithm showed good discriminatory performance in distinguishing LLD Episodes (AUC = 0.824). Tridecanoylcarnitine (Car(13:0)), PC(P-16:0/22:6), and SM(d18:1/22:0) were significantly downregulated during the depressive episode. Tridecanoylcarnitine (Car(13:0)) negatively correlated with depressive severity (p < 0.001) and positively with Mini-Mental State Examination scores. PC(P-16:0/22:6) was associated with both emotional and cognitive impairments. Mediation analysis supported that Tridecanoylcarnitine (Car(13:0)) and PC(P-16:0/22:6) partially mediated the depression-cognition relationship, explaining 22.0 % and 26.9 % of the variance, respectively (p < 0.05). CONCLUSION: This study reveals specific lipid metabolic dysregulation in LLD and identifies key metabolites significantly associated with both depressive severity and cognitive function. It further supports their mediating role in the comorbidity between depression and cognitive impairment. These metabolites may serve as potential targets for simultaneously regulating depression and cognition. The machine learning model developed provides a new auxiliary tool for the objective assessment of LLD.
4 May 2026
Read appraisal →PloS one
Interpretable multivariate survival models: Improving predictions for conversion from mild cognitive impairment to Alzheimer's disease via data fusion and machine learning
Accurately predicting which individuals with mild cognitive impairment (MCI) will progress to Alzheimer's disease (AD) can improve patient care. This study examines the role of quantitative MRI (qMRI), cognitive evaluations, apolipoprotein [Formula: see text]4 (APOE [Formula: see text]4), and cerebrospinal fluid (CSF) biomarkers in Cox survival models to predict progression from MCI to AD. Data from 564 participants in the ADNI study, who transitioned from MCI to AD, were analyzed. The data set included 330 features encompassing qMRI, cognitive assessments, CSF biomarkers, and APOE [Formula: see text]4 status. Advanced machine learning (ML) methods were applied to evaluate the importance of these data sources, select relevant features, and develop interpretable Cox survival models within a cross-validation framework. The top optimized model achieved a sensitivity of 0.69, 95% CI [0.63, 0.76], and a specificity of 0.87, 95% CI [0.83, 0.90], and used all data sources. The results demonstrated that combining qMRI features with cognitive assessments, CSF biomarkers, and APOE [Formula: see text]4 status, analyzed using the BSWiMS model, resulted in a substantial improvement in the ability to predict progression from MCI to AD, achieving 81% precision and 87% specificity. These results exceed those obtained with other models evaluated. Finally, biomarker analysis showed that cognitive scores are the most relevant features to predict conversion, followed by CSF and qMRI biomarkers. These findings highlight the value of integrating multiple data sources in highly interpretable Cox survival models for the early identification of individuals at risk for AD.
4 May 2026
Read appraisal →Sports health
Evaluation of Exertional Sweat Loss Estimates in Wearable Technology
BACKGROUND: Wearable technology shows promise for monitoring exertional sweat loss, yet its accuracy requires evaluation. This study evaluated the accuracy of 2 commercially available smartwatches for estimating sweat loss compared with gold standard methods. HYPOTHESIS: Sweat loss values measured via wearable technology will be determined accurate compared with gold standard methods. STUDY DESIGN: Cross-sectional. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 111 participants (age, 40 ± 14 years; height, 171.0 ± 8.9 cm; body mass, 70.8 ± 14.7 kg; VO2max, 46.8 ± 8.7 ml/kg/min) completed up to 4 running trials under varying conditions (indoor/outdoor, distances from 2.5 km to 20 km, and interval runs). Sweat loss estimates from each smartwatch were compared with criterion measurements based on change in nude body mass pre- and postexercise. Validity statistics included tests for error (mean absolute error [MAE], mean absolute percentage error [MAPE]), linearity (Lin's concordance correlation coefficient [CCC], Pearson's [r], and Deming regression), equivalence (CI for difference in means), and Bland-Altman plots for bias assessment. Stratified analyses by sex, weight, and fitness category were also completed, along with a chi-square test of independence. RESULTS: Both devices demonstrated acceptable overall correlation (CCC range, 0.71 to 0.90) but substantial errors in estimating exertional sweat loss (MAPE range, 25.38% to 33.21%). Stratified analyses yielded similar results, with no additional analyses meeting the combined validity thresholds. CONCLUSION: Wearable devices offer a promising and convenient tool for general sweat loss tracking but lack the precision to replace laboratory methods for hydration management. Traditional methods remain essential for the most accurate measurements. CLINICAL RELEVANCE: Wearable devices provide an accessible option for sweat loss monitoring. This study highlights their potential for general tracking while emphasizing the need for laboratory methods when accuracy is critical, ensuring better guidance for hydration strategies in sports performance and health applications.
4 May 2026
Read appraisal →PloS one
Auditing the impact of social media's policy shift on anti-vaccine discourse: A large language model-driven empirical study
The sudden termination of X's (formerly Twitter) misinformation policy on November 23, 2022, provides an opportunity to assess the effects of lifting content moderation restrictions on vaccine-related discourse. This study examines changes in the prevalence, thematic composition, and engagement of anti-vaccine discourse following X's policy shift, analyzing tweets from a seven-day period before and after the policy termination (November 16-30, 2022), excluding the announcement date itself from regression analyses. Using GPT-4o for stance classification, thematic categorization, and stance consistency assessment, with validation through external benchmarks and cross-annotator agreement, we find that anti-vaccine tweets increased significantly post-policy (OR = 1.60, 95% CI: 1.50-1.72), particularly via retweets, suggesting content amplification. Sensitivity analyses excluding highly retweeted content revealed that the policy change was also associated with increased creation of new anti-vaccine content. Thematically, health concerns over vaccination became more prominent, while conspiracy-related and anti-mandate narratives declined in relative prevalence. Stance consistency in quote tweets increased, indicating reinforced ideological alignment in anti-vaccine discourse. These results suggest that content moderation policies may constrain both the volume and amplification of anti-vaccine content, with policy removal associated with rapid shifts in discourse patterns.
3 May 2026
Read appraisal →JMIR aging
The Effectiveness of Digital Interventions to Increase Preventive Care Uptake in Older Adults: Systematic Review
BACKGROUND: Older adults face increasing health risks associated with aging and chronic disease; yet, uptake of recommended clinical preventive services remains low. Digital health interventions have the potential to enhance access and engagement, but their effectiveness in older adult populations remains unclear. OBJECTIVE: This systematic review aimed to examine the range and types of digital clinical preventive service interventions and assess their impact on preventive care uptake among older adults. METHODS: We conducted a systematic review of peer-reviewed research literature published since 2014. Eligible studies included experimental and quasi-experimental designs evaluating digital interventions targeting community-dwelling adults aged 60 years and older. Interventions focused on high-priority preventive services, including cancer screening and adult immunizations. Data were extracted using a standardized form and synthesized narratively due to heterogeneity in study designs and outcomes. RESULTS: In total, 24 studies involving over 1.3 million participants from 11 countries were included. Interventions used a range of digital tools, including telephone calls, SMS text messages, patient portals, and video-based education. While some digital and automated interventions demonstrated modest improvements in preventive services uptake, results were mixed. Interventions incorporating personalized elements (eg, tailored telephone counseling or in-person education) were generally more effective than generic, automated communications. Few studies reported on digital literacy support or intervention reach, and engagement with digital platforms was often low. CONCLUSIONS: Digital interventions can support modest improvements in preventive services uptake among older adults, particularly when personalized or combined with human interaction. However, assumptions of digital fluency and limited reporting on engagement constrain generalizability. Future research should prioritize inclusive design, detailed reporting, and strategies that address digital equity to better support older adult populations.
3 May 2026
Read appraisal →World journal of urology
Thulium fiber laser versus Holmium laser enucleation of the prostate: 24-month outcomes from a prospective randomized non-inferiority trial
PURPOSE: To compare 24-month outcomes of Thulium fiber laser enucleation of the prostate (ThuFLEP) and Holmium laser enucleation of the prostate (HoLEP). METHODS: A 24-month follow-up analysis of a prospective randomized trial including 150 patients (ThuFLEP n = 74, HoLEP n = 76) was conducted. Primary outcome was non-inferior International Prostate Symptom Score (IPSS) and quality of life (QoL) reduction. Secondary outcomes included urinary continence, medication use reduction, erectile and ejaculatory function, and late adverse events. RESULTS: At 24 months, non-inferiority of ThuFLEP regarding IPSS and QoL was confirmed (p = 0.03). Median IPSS improved from 21 preoperatively to 3 after ThuFLEP and from 20 to 4 after HoLEP (p < 0.001), with no significant intergroup differences at any time point (all p > 0.1). Median QoL improved from 4 to 1 in both groups (p < 0.001), likewise without significant differences at any time point (all p > 0.3). Continence rates improved from 74.0% preoperatively to 90.0%, pad usage decreased from 89.8% to 25.4% and ICIQ-SF decreased from 5 to 3 points (all p < 0.001), without intergroup differences (all p > 0.1). Use of medication for lower urinary tract symptoms decreased from 89.4% to 7.7% (p < 0.001). Ejaculatory function declined, while ejaculation-related bother remained unchanged and erectile function improved modestly, all without intergroup differences (all p > 0.1). Three late adverse events occurred exclusively in the ThuFLEP group, without statistical significance (p > 0.1). CONCLUSION: ThuFLEP remains non-inferior to HoLEP for patient-reported functional outcomes at 24 months and demonstrates comparable safety, continence, medication use reduction, and sexual function results over time. Both techniques represent effective, durable and safe surgical options for treating benign prostatic obstruction. TRIAL REGISTRATION NUMBER: DRKS00032699 (18.09.2023, retrospectively registered).
3 May 2026
Read appraisal →European respiratory review : an official journal of the European Respiratory Society
Rural versus urban living and COPD: a systematic review
Chronic obstructive pulmonary disease (COPD) is a leading cause of global morbidity and mortality. Emerging evidence suggests disparities in COPD outcomes between rural and urban populations, but no prior review has synthesised these differences globally. Five databases (Medline, Embase, Emcare, CINAHL and Cochrane Central) were searched in May 2025. Eligible peer-reviewed studies directly compared rural and urban populations in at least one of four measures of COPD burden: prevalence, symptom burden, exacerbations or mortality. Study quality was assessed and narrative synthesis was conducted due to heterogeneity in outcome measures. Of 1339 screened studies, 32 met inclusion criteria, spanning 13 countries. COPD prevalence was higher rurally in 83% (15/18) of studies, with 11/15 demonstrating statistical significance. This pattern was consistent across geographical distributions. Total exacerbation rates were higher rurally in 60% (3/5) of studies, although hospitalisations varied significantly. 50% (6/12) of studies reported higher hospitalisation rates in urban areas and 5/12 studies reporting higher rates in rural areas. 86% (6/7) of studies demonstrated higher mortality rurally and symptom burden was higher amongst rural residents in 67% (4/6) of studies; however, the majority of these were conducted in the USA. This review highlights consistent rural-urban inequalities in COPD prevalence and outcomes, reflecting the impact of healthcare inequities, socioeconomic deprivation and environmental exposures on COPD burden in rural areas. Targeted interventions promoting equitable healthcare access, health education, transition to cleaner fuels and rural access to smoking cessation and pulmonary rehabilitation services are essential to mitigate these disparities and improve outcomes in rural populations.
3 May 2026
Read appraisal →PloS one
Clinical manifestations of bed bug bites: A systematic review of case reports
IMPORTANCE: Clinical characterization of bed bug (Cimex spp.) bite manifestations remains limited. OBJECTIVE: This systematic review synthesizes case reports to describe dermatological, systemic, and psychological outcomes of bed bug bites. EVIDENCE REVIEW: Following PRISMA guidelines, multiple databases, including Pubmed and Scopus, were searched using terms such as "bed bug," "Cimex lectularius," "Cimex hemipterus," "case report," and "case series." Extracted data included demographics, species, lesion type, anatomical distribution, and clinical manifestations. Quantitative and qualitative analyses were conducted. RESULTS: Eighty-four patients were included: 76 with C. lectularius (90.5%) and, 8 with C. hemipterus (9.5%). Sex distribution was balanced (47.6% females, 52.4% males), and mean ages were similar (females 37.5 ± 22.1, males 42.3 ± 21.27 years; p = 0.332). Extremities were commonly affected, arms were reported in 71.4% of cases, legs in 59.5% and trunk in 34.5%. Psychological symptoms were registered in a handful of case reports (Anxiety 9.5%, Stress 9.5%, Hopelessness 9.5%). Systemic symptoms, generally associated with anemia, were reported in cases related to severe infestations in neglected patients. Some differences in systemic and local signs and symptoms were detected depending on age group. CONCLUSIONS: Bed bug bites predominantly affect exposed extremities, although with variable dermatologic patterns that can be confused with other arthropod bites. Psychological manifestations were reported in a small subset of cases, while systemic complications were rare.
3 May 2026
Read appraisal →Circulation
Prognostic Factors for Long-Term Risk of Stroke After Transient Ischemic Attack or Minor Stroke: A Systematic Review and Meta-Analysis
BACKGROUND: Patients with a transient ischemic attack (TIA) or minor stroke have an increased risk of subsequent stroke that persists for at least 10 years. We aimed to identify prognostic factors associated with long-term risk of stroke in this patient group and estimate their population attributable fraction (PAF). METHODS: A systematic review was performed of MEDLINE, Embase, and Web of Science for cohort studies including patients with TIA or minor stroke that evaluated factors for subsequent stroke over a follow-up period of ≥1 year. We pooled hazard ratios adjusted for relevant confounders using random-effect meta-analysis and determined the PAF of factors based on their pooled prevalence and adjusted hazard ratio. We assessed certainty of evidence using the grading of recommendations, assessment, development, and evaluation approach. The study is registered in PROSPERO (CRD42023476551). RESULTS: From 14 732 identified citations, we included 28 cohort studies comprising 86 810 patients with TIA or minor stroke (median age, 69 years [interquartile range, 65-71]; 52%-60% male patients). Factors that had high certainty evidence of association with increased long-term risk of stroke included older age (adjusted hazard ratio, 1.04 per year increase [95% CI, 1.02-1.05]); male sex (1.25, 1.15-1.36; PAF 13.0% [95% CI, 7.8-18.7]); atrial fibrillation (1.34, 1.18-1.52; 3.8% [95% CI, 0.3-9.9]); diabetes (1.52, 1.32-1.75; 7.7%, 3.1-14.1); hypertension (1.60, 1.31-1.94; 19.3%, 8.4-31.6); ischemic heart disease (1.67, 1.28-2.18; 10.7%, 2.8-22.9); history of stroke or TIA before the index event (1.70, 1.43-2.02; 12.0%, 5.2-21.4); smoking (1.29, 1.05-1.60; 11.2%, 1.0-30.7); ABCD2 (age, blood pressure, clinical features, duration of TIA, and presence of diabetes) score of ≥4 (1.59, 1.31-1.94; 18.0%, 2.9-39.9); presence of acute infarct on neuroimaging (1.97, 1.41-2.74; 19.0%, 5.2-38.9), including diffusion-weighted imaging-positive lesions (1.86, 1.02-3.37; 14.0%, 7.0-25.0); minor stroke as index event (1.75, 1.35-2.27 versus TIA; 28.0%, 10.2-47.6); presentation with aphasia or dysarthria (1.45, 1.24-1.69; 19.2%, 0.2-53.1); presentation with paresis (1.45, 1.15-1.84; 22.0%, 3.8-43.4); and etiologic stroke subtypes, including cardioembolism (2.16, 1.53-3.05; 14.6%, 3.1-33.5), large-artery atherosclerosis (2.19, 1.68-2.86; 13.2%, 5.1-25.5), and small-vessel disease (1.69, 1.14-2.49; 16.8%, 5.0-34.3). CONCLUSIONS: These findings can help identify patients with a particularly enduring risk of stroke who are most likely to benefit from ongoing monitoring and treatment and facilitate the development and implementation of targeted stroke prevention strategies.
3 May 2026
Read appraisal →PloS one
Prevalence of perinatal depression in Ethiopia: An umbrella review of systematic review and meta-analysis studies
BACKGROUND: Perinatal depression is a significant public health concern that affects women during pregnancy and the postpartum period. Despite being acknowledged globally, the burden of perinatal depression is particularly profound in low and middle-income countries, such as Ethiopia. This umbrella review is therefore intended to systematically consolidate findings on perinatal depression among Ethiopian women to better understand its prevalence, thereby highlighting the gaps in current research and informing future interventions. METHODS: This umbrella review used the PRIOR checklist for the reviews of systematic review and meta-analytic studies. The review protocol has been registered on PROSPERO: CRD42023495174. PubMed, EMBASE, and PsycINFO databases were searched for the presence of systematic review and meta-analysis studies. The quality of included articles has been evaluated with a measurement tool to assess systematic review and meta-analysis studies (AMSTAR). A novel graphic approach with an estimated corrected covered area (CCA) has been used to determine the degree of overlap of primary studies in the systematic review and meta-analysis studies. The weighted random effect model was used during the meta-analysis. RESULT: A total of 28 unique primary studies and 8 systematic reviews, and meta-analysis studies with 15,592 participants were included in this umbrella review. The pooled prevalence of perinatal depressive symptoms in the included systematic review and meta-analysis studies ranges from 20.1% to 25.8%. The pooled umbrella prevalence of perinatal depressive symptoms among women in Ethiopia was 22.49% (95 CI%:21.38, 23.59). The pooled umbrella analysis revealed that the antenatal and postnatal depressive symptoms were 22.76% (95% CI: 19.9, 25.62) and 21.75% (95% CI: 21.03, 22.48), respectively. In addition, the pooled prevalence of perinatal depression in studies that included 10 or below primary studies is 22.86% (95%CI:20.39, 25.33), and in those that included below 10 primary studies, it was 22.10% (95%CI: 21.55, 22.65). The novel graphic presentation depicted a very high degree of overlap of primary studies in the included systematic reviews and meta-analysis studies; corrected covered area (CCA) of 25.5%. Four of the included studies (fifty percent) had high methodological quality, and the remaining four relied on a moderate quality range. CONCLUSION: The pooled overall, antenatal, and postnatal prevalence of depression symptoms was high in Ethiopia, with no significant difference during the antenatal and postnatal period. An improved understanding of perinatal depression will therefore guide policymakers and health practitioners in developing targeted strategies to alleviate this mental health challenge.
3 May 2026
Read appraisal →JMIR research protocols
Geriatric Telemanagement of Health Conditions (GET HEALTH) in Nursing Home Residents Recently Discharged From the Hospital: Protocol for a Before-After Study
BACKGROUND: Nursing home (NH) residents have a high burden of multimorbidity and disability and are frequently hospitalized. Comprehensive geriatric assessment might reduce hospitalization. However, few geriatricians are working in NHs. Technology might be used to overcome this problem. OBJECTIVE: This study aims to verify if a geriatric telemanagement model improves patient outcomes in NH residents recently discharged from the hospital. METHODS: Clinical outcomes of NH residents recently discharged from the hospital are compared before and after the implementation of GTM, where a geriatrician evaluates each patient during televisits with NH staff and discusses the case with the general practitioner. NH residents aged ≥70 years readmitted to NHs after hospitalization in the 3 years prior to the COVID-19 pandemic (2017-2019) represent the control group enrolled in the retrospective preintervention phase. The primary outcome of the study is the hospital readmission rate during 6-month follow-up. Health technology assessment evaluates the cost-effectiveness of model implementation. RESULTS: A total of 333 NH residents were included in the preintervention retrospective study. Data collection started in February 2022 and was completed in February 2023. A total of 104 NH residents were recruited in the intervention study, from March 2024 to March 2025. Data analysis is currently in progress. CONCLUSIONS: Currently, NHs in Italy are striving to manage the complexity of older patients who are often hospitalized. A geriatric telemanagement model might reduce hospitalizations, and therefore negative outcomes, as well as health care costs in this vulnerable population.
3 May 2026
Read appraisal →Neurology
Idiopathic Intracranial Hypertension Prevalence and Hormonal Contraception: A Meta-Analysis
BACKGROUND AND OBJECTIVES: Women's health advice in people living with idiopathic intracranial hypertension (IIH) is inconsistent, primarily due to an enduring concern that hormonal contraception (HC), including oral contraceptive pills (OCPs) and hormonal intrauterine devices (IUDs), might be associated with a higher prevalence of IIH. This systematic review and meta-analysis examines whether a meaningful association exists between HC use and IIH prevalence. METHODS: Systematic searches of Ovid MEDLINE, Embase, and the Cochrane Library were conducted from their inception to May 14, 2025. Gray literature and citation lists were also reviewed. Observational studies comparing HC use among women with IIH to controls without IIH were included. Noncomparative studies and pharmacovigilance analyses were excluded. Two independent reviewers conducted data extraction, assessed the quality of studies using the Newcastle-Ottawa Scale, and appraised the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A random-effects meta-analysis using the Mantel-Haenszel method in Review Manager 5.4 was conducted to evaluate the association between HC use and IIH prevalence, the primary outcome of interest, with leave-one-out sensitivity analyses and subgroup analyses stratified by HC modality. RESULTS: A total of 13 studies (nIIH = 5,351 and ncontrol = 669,260; mean age = 33.3 years; 100% female) were included. HC use was not significantly associated with IIH prevalence (odds ratio [OR] 0.93, 95% CI 0.69-1.24, p = 0.60, I2 = 82%; n = 12 studies). Subgroup analyses revealed no significant associations for OCPs (OR 0.91, 95% CI 0.72-1.16, p = 0.45, I2 = 25%; n = 6 studies), IUDs (OR 1.45, 95% CI 0.61-3.44, p = 0.39, I2 = 92%; n = 5 studies), or medroxyprogesterone acetate injections (OR 1.21, 95% CI 0.84-1.74, p = 0.30, I2 = 2%; n = 2 studies). Findings were largely robust in sensitivity analyses. Quality assessments ranged from poor to good, with the certainty of evidence rated as very low to low. DISCUSSION: The meta-analysis found no significant association between HC use and IIH prevalence, with consistent results across various HC modalities. This evidence provides confidence to reassure patients with IIH and clinicians that the directed use of HC should be continued as appropriate. The limited quality of available evidence and considerable heterogeneity highlights the necessity for large-scale, well-designed studies, particularly in diverse patient populations, to validate these findings.
3 May 2026
Read appraisal →JMIR formative research
Comparing Perceptions of ChatGPT Use in Health Attitude Contexts Among Users and Nonusers: Cross-Sectional Study
BACKGROUND: In light of the growing use of artificial intelligence (AI) in health care, individuals' access to and use of health information are transforming. ChatGPT, an AI chatbot, provides immediate responses to health queries, with the potential to influence health-related attitudes, thereby raising concerns related to privacy, reliability, and security. OBJECTIVE: This study aimed to investigate the perceived usefulness, risks, anxiety, and social influence of ChatGPT on health attitudes among users and nonusers in Saudi Arabia. METHODS: A cross-sectional study was conducted using an online survey based on a validated tool. In total, 337 participants aged 18 years and older responded to questions assessing their perceptions of ChatGPT on health-related attitudes. RESULTS: Data showed that 76.1% (194/255) of the respondents used ChatGPT, with the majority being younger and more highly educated. The main uses for health-related purposes were health education (43/194, 22.2%) and physical activity guidance (31/194, 16%). The analysis showed that users considered ChatGPT useful for health-related decisions, with 45.9% (89/194) finding it easy to learn and use, but concerns about privacy (106/194, 54.7%) and reliability (87/194, 44.9%) remained. Among nonusers, security risks (39/61, 63.9%) were the major barrier to using AI-based tools for health purposes, and 68.9% (42/61) found such tools attractive and engaging. There were no statistically significant differences between users and nonusers across all examined sociodemographic characteristics (P>.05). CONCLUSIONS: The study established the potential of ChatGPT in improving health decision-making and revealed cultural, privacy, and trust issues that may affect its implementation. These findings underscore the importance of strengthening the security of AI-based applications to enhance public acceptability of related health policies and to support the safe integration of tools such as ChatGPT into the health care system.
3 May 2026
Read appraisal →JMIR mHealth and uHealth
Alcohol Use Trajectories During the First 72 Weeks of WHOOP Wearable Platform Membership: Observational Cohort Study
Among 30,000 new wearable device users (11.6 million person-days), self-reported alcohol consumption significantly declined over 72 weeks, with the daily probability of drinking decreasing by 5.8 percentage points (P<.001) and reductions across age and biological sex.
2 May 2026
Read appraisal →JMIR mental health
The Effectiveness and Mechanisms of Action of App-Based Interventions for Improving Mental Health and Workplace Well-Being: Randomized Controlled Trial
BACKGROUND: Depression is the most common mental health disorder worldwide and frequently leads to workplace absence. As face-to-face treatment can be difficult to access, app-based interventions are a popular solution, although their effectiveness in working populations and their mechanisms of action are unclear. Deficits in executive function may contribute to the onset and maintenance of depression, and executive function training is proposed to improve symptoms by enhancing executive function. Responders to cognitive behavioral therapy (CBT) show improvements in executive function, suggesting that this may be one mechanism of action. OBJECTIVE: This study investigated the effectiveness of app-based interventions (executive function or CBT-based) for reducing depressive and anxiety symptoms and improving workplace well-being, and assessed whether changes in executive function mediated improvements. METHODS: A total of 228 participants (147 female participants) with mild-to-moderate symptoms of depression and anxiety were recruited online and randomly assigned to a waitlist control group, an executive function training group (NeuroNation app, Synaptikon GmbH), or a self-guided CBT group (Moodfit app, Roble Ridge LLC) for a 4-week intervention period. Participants assigned to the active intervention groups were asked to use their apps a minimum of 21 times during the intervention. Participants completed measures of depressive symptoms, anxiety symptoms, and workplace well-being, and a working memory task at baseline, postintervention, and follow-up (12 weeks). RESULTS: Executive function training reduced anxiety (β=-2.79; P=.004) and depressive (β=-2.77; P=.02) symptoms at follow-up but not at postintervention, and it did not affect workplace well-being. There were no reductions in depressive or anxiety symptoms in the self-guided CBT group, though workplace well-being was improved at postintervention (β=3.72; P=.02) and follow-up (β=4.46; P=.02). Improvements in executive function did not mediate intervention-related changes in symptoms or workplace well-being. Self-reported adherence rates were high (executive function training: 48/54, 89%; self-guided CBT: 52/54, 96%), although attrition was high at follow-up (58% missing). CONCLUSIONS: These results suggest that app-based executive function training may be effective at managing symptoms of anxiety and depression in a working population, while self-guided CBT apps may improve workplace well-being. However, improving executive function did not appear to be a mechanism of action of either intervention.
2 May 2026
Read appraisal →Stroke
Preterm Delivery and Long-Term Risk of Maternal Stroke: Systematic Review and Meta-Analysis
BACKGROUND: Adverse pregnancy outcomes are linked to increased risk of maternal cardiovascular disease. However, the association between preterm delivery (PTD) and long-term risk of stroke in the mother remains uncertain, particularly in the case of spontaneous PTD. METHODS: A systematic review and meta-analysis were performed to provide an up-to-date synthesis of the evidence on the association between PTD and long-term maternal stroke. PubMed, CINAHL, and Web of Science were searched for relevant articles published between January 1, 2000, and May 6, 2025. Eligible studies included cohort and case-control studies examining populations of parous women. Primary exposure was defined as any PTD; secondary exposures were spontaneous PTD and medically indicated PTD. The primary outcome was defined as any stroke; secondary outcomes were ischemic and hemorrhagic stroke. Two reviewers screened studies, extracted data, and performed quality assessments. Pooled unadjusted and adjusted effect estimates (as defined by the original study) were calculated separately using random effects inverse variance models. RESULTS: Eleven thousand twenty-five studies were screened for eligibility. Across 21 studies including a total of 8.7 million participants, PTD was consistently associated with increased stroke risk. The follow-up period ranged from 8 to 57 years. The primary meta-analysis demonstrated a positive association between any PTD and any stroke (adjusted risk ratio [aRR], 1.66 [95% CI, 1.34-2.05]). A high level of heterogeneity was observed (I2=97%, τ2=0.15), possibly due to variations in exposure definition, outcome ascertainment, and follow-up durations. Spontaneous PTD (aRR, 1.37 [95% CI, 1.15-1.64]) and medically indicated PTD (aRR, 2.08 [95% CI, 1.70-2.54]) were associated with any stroke. PTD was positively associated with ischemic (aRR, 1.59 [95% CI, 1.45-1.75]) and hemorrhagic stroke (aRR, 1.44 [95% CI, 1.06-1.94]). CONCLUSIONS: Women who have experienced a PTD, including spontaneous PTD, may be at increased risk of stroke in later life. These women may benefit from targeted cardio-metabolic preventive interventions postpartum to reduce their risk.
2 May 2026
Read appraisal →The Cochrane database of systematic reviews
Vitamin D for preventing acute respiratory infections in children up to five years of age
RATIONALE: Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality in children under five years of age and contribute to healthcare visits and hospitalisations globally. Vitamin D deficiency is common amongst pregnant women and young children. Given that vitamin D supplementation is safe, affordable, and easy to administer, its potential to reduce ARI-related healthcare visits holds substantial public health relevance. This review evaluates the benefit and harm of vitamin D supplementation in preventing ARI-related healthcare visits in young children, aiming to inform supplementation policies during pregnancy and early childhood. OBJECTIVES: To determine the benefit and harm of vitamin D supplementation for preventing ARIs in children up to five years of age. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, Web of Science, WHO Global Index Medicus, and four clinical trial registries on 18 March 2025. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs) comparing vitamin D to placebo, or a higher dose (≥ 1000 IU) versus a lower dose (≤ 1000 IU) administered from early pregnancy through to five years of age. We excluded studies involving children with chronic respiratory or systemic conditions. OUTCOMES: Critical outcomes: 1) healthcare visits made by children for an ARI: (a) the proportion of children with healthcare visits made for ARIs; (b) the mean number of healthcare visits made for ARIs per child; and 2) hypercalcaemia: the number of pregnant women and children with hypercalcaemia. RISK OF BIAS: We assessed risk of bias using the Cochrane risk of bias (RoB) 1 tool for outcomes reported in the summary of findings tables. SYNTHESIS METHODS: We synthesised outcome data using meta-analyses, calculating risk ratios (RR) for dichotomous, and mean differences (MD) for continuous outcomes, each with 95% confidence intervals (CI). Where meta-analysis was not feasible, we summarised the results narratively. We used GRADE to assess the certainty of the evidence for pre-specified outcomes. INCLUDED STUDIES: We included 107 RCTs involving 31,521 participants. Vitamin D supplementation was administered during pregnancy, early childhood, or both, and in some cases to both infants and lactating mothers. Interventions used vitamin D2, D3, both, or unspecified forms, with dosages ranging from daily administration to large single or quarterly boluses. Most were delivered orally, typically on a daily schedule, but also weekly or quarterly, over durations ranging from a single dose to 18 months. Settings included hospitals, day-care centres, communities, and homes. SYNTHESIS OF RESULTS: Vitamin D supplementation may result in a slight reduction in the proportion of children who make ARI-related healthcare visits compared to placebo (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.91 to 1.00; P = 0.03; 10 studies, 2447 participants; low-certainty evidence), but probably does not reduce the mean number of ARI-related healthcare visits per child (mean difference (MD) 0.07, 95% CI -0.06 to 0.20; P = 0.32; 3 studies, 561 participants; moderate-certainty evidence). Comparisons between higher and lower doses of vitamin D probably do not reduce the proportion of children making ARI-related healthcare visits (RR 0.94, 95% CI 0.81 to 1.10; P = 0.46; 2 studies, 1382 participants; moderate-certainty evidence), and do not reduce the mean number of ARI-related healthcare visits per child (MD -0.10, 95% CI -0.59 to 0.39; P = 0.69; 1 study, 579 participants; low-certainty evidence). No cases of hypercalcaemia were reported among pregnant women in trials comparing vitamin D supplementation with placebo. In higher versus lower dose comparisons, supplementation may result in little to no difference in the risk of hypercalcaemia among pregnant women (RR 1.61, 95% CI 0.60 to 4.31; P = 0.34; 6 studies, 2379 participants; low-certainty evidence). Similarly, the evidence that vitamin D supplementation has little to no effect on the risk of hypercalcaemia in children, when compared with placebo, is very uncertain (RR 0.81, 95% CI 0.53 to 1.24; 7 studies, 1542 participants; very low-certainty evidence) and may result in little to no difference in the risk of hypercalcaemia in children when higher doses are compared to lower doses (RR 1.23, 95% CI 0.82 to 1.85; 7 studies, 1287 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: We found low-certainty evidence that vitamin D supplementation during pregnancy or early childhood may result in a slight reduction in the proportion of children under five years of age who make ARI-related healthcare visits, but probably does not reduce the mean number of healthcare visits for ARIs per child. This finding highlights the need for large, well-designed, placebo-controlled trials to confirm the potential benefit. We found moderate-certainty evidence that higher-dose vitamin D supplementation, compared with lower doses, probably does not reduce the proportion of children making healthcare visits for ARIs and does not reduce the mean number of ARI-related healthcare visits per child. Hypercalcaemia occurs infrequently in both pregnant women and children receiving vitamin D supplementation. Where hypercalcaemia could be measured, specifically in children receiving vitamin D versus placebo, vitamin D supplementation may have little to no effect on the risk of hypercalcaemia (very low-certainty evidence). In both children and pregnant women, a higher dose of vitamin D compared to a lower dose may result in little to no difference in the risk of hypercalcaemia (low-certainty evidence). FUNDING: This Cochrane review had no dedicated funding. REGISTRATION: Protocol (2022) DOI: 10.1002/14651858.CD015111.
2 May 2026
Read appraisal →Psychological medicine
Intrinsic regional brain activity differences and its relationship with neurotransmitter and gene expression in postpartum depression: a voxel-based meta-analysis
BACKGROUND: Inconsistent findings persist across resting-state functional imaging studies of regional brain alterations in postpartum depression (PPD), while connections to transcriptional profiles and neurotransmitter systems remain largely uncharacterized. METHODS: We performed a whole-brain voxel-wise meta-analysis of resting-state functional imaging studies comparing PPD patients and healthy controls using SDM-PSI software. JuSpace toolbox analyzed atlas-based nuclear imaging-derived neurotransmitter maps, and transcriptional data were sourced from the Allen Human Brain Atlas. RESULTS: Our systematic review identified 12 functional imaging studies (475 PPD patients, 504 controls). Patients with PPD displayed increased resting-state functional activity in the left inferior occipital gyrus and left precuneus as well as decreased resting-state functional activity in the right amygdala and left precentral gyrus. These functional alterations spatially overlapped with serotonergic, dopaminergic, and VAChT systems. Transcriptional analysis revealed PPD-related gene enrichments in ion channel function (transmembrane transport, gated/passive channels) and channel complexes. CONCLUSIONS: The meta-analysis revealed functional alterations within the DMN, limbic, and primary sensorimotor systems in PPD patients. These changes were linked to neurotransmitter alterations and genetic modulations underlying brain dysfunction. Collectively, these findings advance mechanistic understanding of PPD pathophysiology.
2 May 2026
Read appraisal →Lancet (London, England)
Clinical and bacteriological effectiveness of three different short-course antibiotic regimens and single-dose fosfomycin for uncomplicated lower urinary tract infections in women (SCOUT): a pragmatic, multicentre, open-label, randomised clinical trial
BACKGROUND: Most guidelines recommend nitrofurantoin, fosfomycin, and sometimes pivmecillinam for uncomplicated urinary tract infections (UTIs), but direct comparisons between these antibiotics are needed. This study evaluated the effectiveness and safety of a single dose of fosfomycin compared with two doses of fosfomycin and short-course regimens of nitrofurantoin and pivmecillinam in women with UTI symptoms. METHODS: This phase 4, pragmatic, multicentre, parallel-group, open-label, randomised clinical trial was conducted in Spanish primary care centres from 2022 to 2024. Women aged 18 years or older with at least one UTI-specific symptom (dysuria, urinary urgency, urinary frequency, or suprapubic tenderness) and a positive urine dipstick test for either nitrites or leukocyte esterase were randomly assigned (1:1:1:1) to one of four treatments: a single 3 g dose of fosfomycin, two 3 g doses of fosfomycin, nitrofurantoin (100 mg three times per day for 5 days), or pivmecillinam (400 mg three times per day for 3 days). Doctors and patients were not masked to group assignment. The primary outcome was the proportion of patients with clinical resolution (defined as the disappearance of all infection symptoms) at day 7. This trial is registered with ClinicalTrials.gov (NCT04959331) and EudraCT (2021-001332-26) and is completed. FINDINGS: Of the 804 patients assessed for eligibility between April 4, 2022 and Nov 14, 2024, 768 patients were randomly allocated (191 to the single-dose fosfomycin group, 194 to the two-dose fosfomycin group, 190 to the nitrofurantoin group, and 193 to the pivmecillinam group). Patients had a median age of 48 years (IQR 34-63). Race and ethnicity data were not collected. Among the 720 women with available data included in the primary analysis, single-dose fosfomycin had the lowest proportion of clinical resolution (109 [59%] of 185 patients), while nitrofurantoin had the highest (128 [74%] of 172 patients; difference 15·5 percentage points [95% CI 5·9 to 25·1] vs single-dose fosfomycin; p=0·0168), followed by pivmecillinam (127 [70%] of 182; difference 10·9 percentage points [1·1 to 20·6]; p=0·2352) and the two-dose fosfomycin group (122 [67%] of 181; difference 8·5 percentage points [-1·4 to 18·3]; p=0·6935). Adverse events occurred in 38 (19·9% [95% CI 14·9 to 26·1) of 191 patients who received single-dose fosfomycin, 51 (26·3% [20·6 to 32·9]) of 194 who received two-dose fosfomycin, 51 (26·8% [21·0 to 33·6]) of 190 who received nitrofurantoin, and 41 (21·2% [16·1 to 27·5]) of 193 who received pivmecillinam. Most adverse events were mild and self-limiting, primarily gastrointestinal. Four serious adverse events occurred, of which one was related to the study treatment (one case of pyelonephritis in the pivmecillinam group). INTERPRETATION: Nitrofurantoin was the most effective treatment and single-dose fosfomycin the least effective treatment for UTIs. Adverse events were mild. The role of fosfomycin as a first-line antibiotic for uncomplicated UTI should be re-evaluated. FUNDING: Carlos III Institute of Health, Spanish Ministry of Science and Innovation, and European Regional Development Fund.
2 May 2026
Read appraisal →Molecular neurobiology
Establishing a Diagnostic Model Based on Plasma CDR1as and Alpha-Synuclein for Mild Cognitive Impairment in Type 2 Diabetes
Emerging evidence implicates cerebellar degeneration-related protein 1 antisense transcript (CDR1as) and alpha-synuclein (α-Syn) in diabetes and cognitive decline, suggesting their potential to serve as biomarkers. This study aimed to evaluate their diagnostic efficacy for type 2 diabetes mellitus-associated mild cognitive impairment (T2DM-MCI) and establish a corresponding diagnostic model using machine learning. T2DM-MCI-associated differentially expressed genes were identified from the hippocampus using the Gene Expression Omnibus and predictive databases. The study involved 529 T2DM patients in two phases (training set = 408, test set = 121). Levels of plasma CDR1as, α-Syn, Aβ1-40/1-42, and ApoE genotype were detected. Three diagnostic models were identified using least absolute shrinkage and selection operator (LASSO) and logistic regression. Their performance was assessed using the area under the curve (AUC), net reclassification index (NRI), and integrated discrimination improvement (IDI). The best-performing model was selected from nine machine learning algorithms. Personalized risk assessment was achieved with the SHapley Additive exPlanations (SHAP). Bio-informatics analysis identified CDR1as and α-Syn as potential biomarkers. Their inclusion in multi-modal panels markedly improved diagnostic accuracy. The Random Forest (RF) model outperformed eight other machine learning classifiers (AUC = 0.975, 95% CI: 0.946-0.999) with the lowest Brier score (0.054). When evaluated on a test set, the RF model maintained robust performance (AUC = 0.901, accuracy = 0.850). An online diagnostic tool was established ( https://www.xsmartanalysis.com/model/list/predict/model/html?mid=6734&symbol=816GyBh9ag1Wr9367341 ). The study preliminarily identified CDR1as and α-Syn as promising biomarkers for T2DM-MCI. Integrating these markers with conventional blood tests showed potential clinical utility for improving diagnostic precision.
2 May 2026
Read appraisal →Behavioural brain research
Non-pharmacotherapy for craving in methamphetamine use disorder: A systematic review and network meta-analysis of randomised controlled trials
OBJECTIVES: We evaluated the effects of non-pharmacotherapy on quality of life (QOL) and craving in individuals with methamphetamine use disorder (MUD), ranking the efficacy of various protocols. METHODS: We searched multiple databases for randomized controlled trials from inception to Dec 2025. The analysis included 53 studies with 3174 participants, investigating interventions such as exercise, transcranial magnetic stimulation (TMS), transcranial direct current stimulation, behavioral therapy, and acupuncture. The protocol was prospectively registered in PROSPERO (CRD42023443291). RESULTS: For craving reduction, both exercise and TMS demonstrated statistically significant benefits compared to conventional rehabilitation. Combined aerobic/resistance exercise and 10 Hz repetitive TMS targeting the left dorsolateral prefrontal cortex emerged as the most effective specific protocols within their respective categories. Furthermore, preliminary evidence from a limited number of studies indicated that exercise, acupuncture, and behavioral therapy improved patients' QOL. CONCLUSION: This study confirms that several non-pharmacotherapies are effective for managing craving in MUD. Exercise and TMS are particularly promising for reducing craving. The findings, synthesized within a novel "Intervention-Circuit-Symptom" integrative framework, provide a robust evidence base to inform clinical decision-making and guide the future development of MUD treatment guidelines.
1 May 2026
Read appraisal →Scandinavian journal of primary health care
Overdiagnosis in atrial fibrillation screening with wearables
PURPOSE: Wearable technologies are increasingly used to screen for atrial fibrillation (AF), often outside formal clinical pathways. While this holds promise for early detection, the impact on patient outcomes remains unclear. We aimed to examine the hypothesis whether intermittent and continuous AF screening using wearable-like technologies leads to overdiagnosis in asymptomatic, high-risk individuals. METHODS: This hypothesis-generating analysis draws on available RCTs screening asymptomatic, high-risk individuals for AF using wearable-like ECG technologies. It is not a systematic review, as the field remains too early-stage for formal evidence synthesis. Eligible studies included either intermittent (≥10 recordings) or continuous monitoring for ≥1 week, reflecting typical smartwatch use. Primary outcomes included AF diagnoses, anticoagulant use, and adverse events. Overdiagnosis was inferred when excess AF detection did not translate into improved clinical outcomes. Analyses used Mantel-Haenszel random-effects models. RESULTS: Continuous screening nearly tripled AF diagnoses (OR 2.84; 95% CI, 1.61-5.02) and doubled anticoagulant use compared to controls. Intermittent screening showed a non-significant 1.8-fold increase. Neither method significantly reduced adverse outcomes. A pooled analysis revealed a marginal reduction in negative events (OR 0.94, 95% CI 0.90-0.99). Overdiagnosis estimates varied by method, ranging from 8-29% based on persistent differences in cumulative incidence after the screening period has ended and 47-65% based on increased diagnoses and treatment during the screening phase that are not followed by improved patient-relevant outcomes. CONCLUSION: Wearable-enabled screening for AF in high-risk patients increases diagnosis and treatment without clear benefit in clinical outcomes. These findings support the hypothesis of overdiagnosis and findings highlight the need for cautious integration of consumer technologies into primary care. Further trials with extended follow-up in low-risk populations are needed to clarify when AF detection improves outcomes versus when it leads to unnecessary medicalisation and harm.
30 Apr 2026
Read appraisal →The Cochrane database of systematic reviews
Cognitive behavioural therapeutics for insomnia symptoms in the perimenopause through to the early postmenopausal period
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary Objective i) To assess the effects of cognitive behavioural therapy for insomnia (CBT-I) and cognitive behavioural therapy for menopausal symptoms (CBT-M) on sleep disturbances in women in perimenopause through to the early postmenopausal period. Secondary Objectives i) To assess the effects of CBT-I and CBT-M on vasomotor symptoms in women in perimenopause through to the early postmenopausal period. ii) To assess the impact of socioeconomic status on the effectiveness of CBT-I and CBT-M, in order to determine the interventions' impact on health equality.
28 Apr 2026
Read appraisal →The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi
Toward Precise Risk Stratification after the Functional Cure of Chronic Hepatitis B
Chronic hepatitis B remains a major global health challenge despite the advances in antiviral therapy. Although hepatitis B surface antigen (HBsAg) seroclearance is considered a functional cure, liver-related complications, particularly hepatocellular carcinoma, may still occur after viral clearance. This residual risk reflects the lasting impact of host and liver factors rather than ongoing viral activity. Conventional prediction models have attempted to stratify the residual risk after a functional cure but remain limited in their ability to guide individualized management. Recent advances in machine learning have enabled more precise risk stratification by capturing complex host-driven determinants of the long-term outcomes. These approaches support a shift from uniform surveillance toward risk-adaptive monitoring strategies. Nevertheless, post-cure management is emerging as a new clinical priority as more patients achieve a functional cure. Therefore, a functional cure should be viewed not as the end of the disease, but as the beginning of a phase requiring personalized risk assessment and surveillance.
28 Apr 2026
Read appraisal →JMIR dermatology
Public Interest in Janus Kinase (JAK) Inhibitors for Alopecia Areata: A Google Trend Analysis
Public interest in Janus kinase (JAK) inhibitors for alopecia areata increased following media coverage and the 2022 US Food and Drug Administration (FDA) approval of baricitinib, highlighting the need for patient education and physician guidance on appropriate indications and treatment selection for hair loss disorders.
28 Apr 2026
Read appraisal →PloS one
Effects of a spore-forming probiotic blend on bowel habits and physical well-being in adults with functional constipation: A randomized, double-blind, placebo-controlled trial
We aimed to evaluate the efficacy and safety of a spore-forming probiotic blend containing Clostridium butyricum IDCC 1301, Weizmannia coagulans IDCC 1201, and Bacillus subtilis IDCC 1101 for improving bowel function and well-being in adults with functional constipation (FC). In a randomized, double-blind, placebo-controlled trial, 78 adults with FC (Rome IV criteria) received either probiotic blend (n = 40) or placebo (n = 38) daily for 4 weeks. Primary outcomes were changes in weekly spontaneous bowel movements (WSBM) and stool form. Secondary outcomes included physical functioning scores from the 36-Item Short Form Health Survey. The probiotic blend group showed significant improvements in irritant bowel movements (p = 0.0458), incomplete evacuation (p = 0.0374), and abdominal pain before defecation (p = 0.0090). Stool consistency shifted toward normal types (Bristol types 3-4, p = 0.0176). Physical functioning improved only in the probiotic blend group (p = 0.0300). Probiotic blend effectively alleviated symptoms of FC and improved physical well-being. Trial registration: Clinical Research Information Service (CRIS), KCT0010085.
28 Apr 2026
Read appraisal →BMJ open
Breastfeeding initiation and continuation among women on medicines: a systematic review and meta-analysis
OBJECTIVES: Breastfeeding provides essential health benefits for infants and mothers, yet initiation and continuation can be influenced by maternal medication use. Uncertainty regarding medication safety may lead to early discontinuation or avoidance of necessary treatment. We conducted a systematic review and meta-analysis to estimate the prevalence of breastfeeding initiation and continuation at 6 months post partum among women using medications. DESIGN: Systematic review and meta-analysis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. DATA SOURCES: PubMed, Web of Science, Academic Search Premier (EBSCO) and Google Scholar were searched up to 30 November 2024. ELIGIBILITY CRITERIA: For selecting studies: We included cohort, cross-sectional and observational studies reporting breastfeeding initiation at birth and continuation at 6 months post partum among women aged ≥18 years using medications during pregnancy or post partum. Studies reporting medication type and duration of breastfeeding were prioritised. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened, extracted and coded data using standardised methods. Risk of bias was assessed using validated tools. Pooled prevalence estimates were calculated using a random effects meta-analysis and meta-regression was performed to explore factors associated with breastfeeding outcomes. Findings were summarised in GRADE evidence profiles and synthesised qualitatively. RESULTS: Of 286 retrieved articles, 29 met the inclusion criteria and 28 were included in the meta-analysis. 14 (48%) were cohort studies reporting breastfeeding prevalence while using medications. The pooled prevalence of breastfeeding initiation among women on medication during pregnancy or post partum was 75.2% (95% CI 69.8% to 80.7%; range 14-98%), with high heterogeneity (I²=99.2%, p<0.001). Overall prevalence of breastfeeding at 6 months post partum was 53.2% (95% CI 43% to 63%). Meta-regression showed that women in high-income countries were less likely to initiate (β=-0.27, 95% CI -0.54 to -0.00, p=0.04) or continue breastfeeding at 6 months (β=-0.27, 95% CI -0.54 to -0.01, p=0.04). Women using antidepressants (β=-0.45, 95% CI -0.87 to -0.02, p=0.04) and opioids (β=-0.50, 95% CI -0.93 to -0.08, p=0.02) were less likely to continue breastfeeding at 6 months. Women living with HIV on ART in low- and middle-income countries had higher continuation rates, likely due to supportive public health programmes. CONCLUSION: Breastfeeding initiation among women using medications is generally high, but continuation declines substantially, particularly among women on psychotropic, opioid or antiepileptic drugs. HIV status, medication type, healthcare support and national guidelines influence breastfeeding outcomes. Targeted interventions, including provider education, medication-specific lactation guidance and supportive workplace policies, are essential to promote sustained breastfeeding among women using medications.
27 Apr 2026
Read appraisal →BMJ mental health
Using electronic health records to evaluate a children and young people's social prescribing service: challenges and implications for research and practice
BACKGROUND: Preliminary evidence indicates that social prescribing (SP) can improve children and young people's (CYP) well-being but is limited by small non-representative samples and often relies on descriptive statistics. Given the wide implementation of SP in the UK, administrative records provide a unique opportunity to understand current practice and assess impacts on well-being. OBJECTIVES: (1) To understand the quality of data captured in SP administrative records. (2) To explore which CYP are currently receiving SP and what SP entails in practice. (3) To assess the impact of SP on well-being. METHODS: We used administrative records from one CYP SP service in England. Records were extracted from Joy, an online platform for managing SP. Over 18 months, 770 age-eligible CYP were referred to SP, 203 of whom were successfully discharged and completed two pre-post measures of well-being (the short Warwick-Edinburgh Mental Wellbeing Scale; SWEMWBS) at least 7 days apart. We used descriptive statistics, a paired t-test to assess changes in well-being and linear regressions with interactions to test effect modification. FINDINGS: Missing data was the largest issue, with ethnicity missing for 94% of CYP. A lack of detail and inconsistent recording for both individual characteristics and SP practices also presented challenges. Despite this, we identified that most CYP were referred by their GP, followed by their school, with 97% referred because of their mental health. The most common pathway was to receive SP for around 90 days, with 10-15 link worker contacts and 6 contact hours. Following SP, SWEMWBS scores improved by 3.72 points (t(202)=17.50, 95% CI 3.30 to 4.14, p<0.001), a 20% relative increase. Exploratory analyses suggested that this increase was greater for those with lower baseline well-being. CONCLUSIONS: Despite numerous challenges with missing data and data quality, we found that CYP well-being increases following SP (as it is currently implemented). The moderate effect size was consistent with larger studies of adults. CLINICAL IMPLICATIONS: Further development of online platforms is needed to monitor access to, nature of and efficacy of SP. For those working in SP, we recommend more training, implementation of standardised guidelines and designated time to update records.
27 Apr 2026
Read appraisal →Heart (British Cardiac Society)
Revascularisation strategies for non-acute myocardial ischaemic syndromes
BACKGROUND: Contemporary guidelines by the European Society for Cardiology and American College of Cardiology/American Heart Association for the treatment of non-acute myocardial ischaemic syndromes dispute the value of revascularisation and differ in their recommendation to perform revascularisation. A Bayesian network meta-analysis was performed, evaluating the strength of evidence for the comparative incremental effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) over medical therapy on long-term outcomes. METHODS: A hierarchical Bayesian network meta-analysis was designed (PROSPERO CRD42024541215, date 20 May 2024), including randomised controlled trials (RCTs) published between 2005 and 10 June 2025, which consisted of three initial treatment modalities: optimal medical therapy (OMT), PCI+OMT and CABG+OMT. The primary outcome was all-cause mortality at maximum follow-up; secondary outcomes were trates of the rates of myocardial infarction, stroke and re-revascularisation at maximum follow-up, expressed in HRs and 95% credible intervals (CrIs), accompanied by surface under the cumulative ranking curve (SUCRA) scores. RESULTS: 10 RCTs, comprising 10 742 patients, were included. For all-cause mortality, the estimated median HR of CABG+OMT versus OMT was 0.84 (95% CrI 0.68-1.07); the HR of PCI+OMT versus OMT was 0.93 (0.79-1.16); and the HR of CABG+OMT versus PCI+OMT was 0.91 (0.71-1.13). The SUCRAs of a CABG+OMT strategy ranking as the optimal revascularisation treatment regarding mortality, myocardial infarction, stroke and re-revascularisation were 88.1%, 99.7%, 17.5% and 99.5%, respectively. Results were consistent across sensitivity analyses, including in the node-splitting models. CONCLUSIONS: This Bayesian network meta-analysis found that an initial CABG (+OMT) revascularisation strategy was associated with higher probabilities of optimal outcomes, with the exception of stroke, compared with an initial PCI (+OMT) revascularisation strategy, although CrIs overlapped, suggesting that some uncertainty remains. PROSPERO REGISTRATION NUMBER: CRD42024541215.
27 Apr 2026
Read appraisal →BMJ health & care informatics
AI-generated clinical summaries: errors and susceptibility to speech and speaker variability
OBJECTIVES: To evaluate whether variability in patients' communication style (personality), international English-accents (human and synthetic) and speech impairments affects the accuracy of a Clinical AI Scribe (CAIS) and identify where performance degrades to inform pre-deployment validation and monitoring. METHODS: We conducted simulated primary-care consultations using trained actors. For personality types, four scenarios were enacted, each with five patient-personality types. For accents, transcripts of consultations were used to generate combinations of seven accents across five scenarios. The CAIS produced summaries that were compared with transcripts, and errors classified as omissions, factual inaccuracies or hallucinations. For speech impairments, public recordings representing five profiles were transcribed and word-recognition accuracy calculated. RESULTS: Personality types showed no statistically significant differences in errors (all p>0.05). Extraversion had the highest total errors (median 3.5). Across accents, comparisons were non-significant for both patient and doctor voices (patients: p=0.851; doctors: p=0.980). Omissions predominated, with low rates of hallucinations and factual inaccuracies. Omissions were slightly higher for Chinese-accented and Indian-accented doctors (both medians 3.0). Conversely, speech impairments differed: cleft palate and vowel disorders were near-perfect, whereas phonological impairment markedly reduced recognition (p<0.001). DISCUSSION: Operationally, CAIS deployment should include clinician-in-the-loop verification, subgroup performance monitoring (accents, impairments) and predefined 'switch-off' criteria for severe phonological patterns. High-quality synthetic voices are a pragmatic proxy for accent testing when balanced corpora are unavailable. CONCLUSIONS: Under controlled conditions CAIS performance was broadly stable across communication styles and most accents, but vulnerable to specific speech characteristics, particularly phonological impairment, in this single-system simulation study.
27 Apr 2026
Read appraisal →BMJ paediatrics open
Metabolically obese normal weight phenotype in children and adolescents aged 3 to 18 years: a systematic review
BACKGROUND: Children with normal Body Mass Index (BMI) may still exhibit adverse metabolic profile-termed as the metabolically obese normal weight (MONW) phenotype, placing them at increased risk of long-term cardiometabolic complications. OBJECTIVE: To systematically synthesise the evidence of the MONW phenotype in children and adolescents aged 3-18 years, and to identify early-life determinants. METHODS: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and searched PubMed/ MEDical Literature Analysis and Retrieval System On-Line (MEDLINE), Scopus, Web of Science (WoS), Google Scholar, Embase and Cochrane Library for studies from 2000 to January 2026. Observational studies of children and adolescents aged 3-18 years with normal BMI and at least one metabolic abnormality were included. Two reviewers independently screened the studies, extracted data and assessed risk of bias. Searches were conducted between March 2025 and January 2026, and 11 studies met the predefined inclusion and exclusion criteria. RESULTS: The reported prevalence of MONW ranged from 10.6% to 56.2%, varying by diagnostic criteria and population. Children with MONW consistently showed higher visceral adiposity, insulin resistance (IR), dyslipidaemia, hypertension, impaired glucose metabolism and elevated markers of low-grade inflammation despite having normal BMI. Early-life determinants included extremes of birth weight, rapid infant weight gain, adverse maternal metabolic status, unhealthy dietary patterns and sedentary behaviour. Overall risk of bias across studies was judged to be low to moderate, with the main concerns relating to residual confounding and use of heterogeneous MONW definitions. CONCLUSIONS: MONW represents a clinically relevant but under-recognised paediatric phenotype. Reliance on BMI alone may delay identification of vulnerable children. Early risk stratification integrating metabolic proofing and central adiposity measures may enable timely prevention of long-term metabolic disease. Harmonised operational definitions of MONW and robust longitudinal life-course studies are required to inform evidence-based screening thresholds and preventive interventions.
27 Apr 2026
Read appraisal →PloS one
Effects of peppermint (Mentha x piperita L.) oil on cardiometabolic outcomes in patients with pre- and stage 1 hypertension: A placebo randomized controlled trial.
Hypertension represents the predominant risk factor for cardiovascular disease morbidity and mortality; with significant healthcare utilization and expenditure. Pharmaceutical management is habitually adopted; although its long-term effectiveness remains ambiguous, and accompanying adverse effects are disquieting. Peppermint, which is rich in menthol and flavonoids, may exert potential benefits relevant to hypertension. This trial aimed to explore the effects of twice-daily peppermint oil supplementation in individuals with pre- and stage 1 hypertension. A 20 day, parallel randomized, placebo-controlled trial was adopted (NCT05561543). 40 individuals with pre- and stage 1 hypertension were randomly assigned to receive 100 μL per day of either peppermint oil or peppermint-flavoured placebo. The primary trial outcome was the between-group difference in systolic blood pressure from baseline to 20 days. Secondary outcome measurements were the between-group differences in anthropometric, haematological, diastolic blood pressure/resting heart rate, psychological wellbeing, and sleep efficacy indices. Statistical analysis was conducted on an intention-to-treat basis using baseline-adjusted linear regression models comparing post intervention values between trial arms with the corresponding baseline value entered as a covariate; adjusted mean differences (b), 95% confidence intervals, and effect sizes (d) were calculated. In relation to the primary outcome, adjusted systolic blood pressure at 20 days was significantly lower (b = -8.48 mmHg, 95% CI = -14.24 to -2.73, d = -0.94) in the peppermint trial arm (baseline = 130.05 mmHg, 20 days = 121.97 mmHg) than in placebo (baseline = 130.93 mmHg, 20 days = 131.05 mmHg). Loss to follow-up (N = 1) and adverse events (N = 1) were low, both occurring in the peppermint arm, and compliance was very high in the peppermint (93.3%) trial arm. Given the substantial health and economic burden associated with hypertension worldwide, these findings suggest that twice-daily peppermint supplementation may represent a simple, low-cost, and well-tolerated strategy to support blood pressure reduction in this population. Trial registration ClinicalTrials.gov NCT05561543.
27 Apr 2026
Read appraisal →PloS one
Protocol for a randomized pilot trial of COMPASS, an open‑source, culturally adapted cognitive behavioral therapy program for forcibly displaced Venezuelan adults in Peru
Task-sharing approaches have shown promise in low-resource settings, yet few culturally adapted interventions have been systematically evaluated for forcibly displaced populations. Since 2016, over 1.7 million Venezuelans have migrated to Peru, facing significant barriers to healthcare and elevated risks of anxiety, depression, and post-traumatic stress disorder (PTSD). This protocol describes COMPASS (Cognitive-behavioral Open-source Mental-health Program Adapted for migrants, Sustainably delivered by lay providers and Supported by evidence). COMPASS is a transdiagnostic, open-source cognitive behavioral therapy program co-designed with forcibly displaced populations. This protocol describes the procedures for an ongoing randomized pilot trial with n = 90 forcibly displaced Venezuelan people (Clinicaltrials.gov: NCT06635486). COMPASS guides, or lay providers, trained through an intensive apprenticeship model, will deliver 6-12 weekly remote sessions. Primary outcomes include changes in anxiety, depression, and PTSD symptoms, assessed with validated Spanish-language measures. Secondary outcomes include feasibility (recruitment, retention, fidelity) and acceptability (therapist and participant ratings). Exploratory outcomes will examine integration, migration experiences, and demographic moderators of intervention effectiveness. Analyses will follow the intention-to-treat principle, using descriptive statistics and regression models to evaluate symptom trajectories across baseline, post-intervention, and 3- and 6-month follow-ups. This study represents the first effectiveness evaluation of an open-source, lay-delivered CBT program tailored for forcibly displaced people in Peru. Findings will inform feasibility, acceptability, and preliminary effectiveness of COMPASS, with potential to expand scalable, culturally relevant mental health services for forcibly displaced populations in resource-constrained settings worldwide.
27 Apr 2026
Read appraisal →JMIR medical informatics
Deep Learning Model Using Transfer Learning for Detecting Left Ventricular Systolic Dysfunction: Retrospective Algorithm Development and Validation Study
BACKGROUND: Artificial intelligence-augmented electrocardiogram (AI-ECG) models for detecting left ventricular systolic dysfunction (LVSD) often exhibit degraded performance in patients with comorbidities. OBJECTIVE: This study aimed to introduce and validate a recalibration method using longitudinal patient data to enhance prediction accuracy and simulate its clinical utility for ongoing monitoring. METHODS: We conducted a multicenter, retrospective cohort study using data from 2 hospitals in Korea. A dataset of paired transthoracic echocardiograms (TTEs) and electrocardiograms (ECGs) matched within a 2-week interval was constructed, separating pairs into baseline (first for each patient) and follow-up assessments. In addition to conventional supervised learning, we developed a patient-wise recalibration strategy that incorporated historical left ventricular ejection fraction measurements and prior AI-ECG outputs to adjust for future predictions, thus empirically mitigating confounding effects. Pretraining was also implemented to enhance the model's performance. RESULTS: The recalibrated 12-lead DeepECG LVSD model achieved an area under the receiver operating curve of 0.956 (95% CI 0.946-0.965) for internal validation and 0.940 (95% CI 0.936-0.945) for external validation of follow-up TTE-ECG pairs. The uncalibrated 12-lead DeepECG LVSD model also showed modest performance, with an area under the receiver operating curve of 0.953 (95% CI 0.941-0.965) in the internal validation and 0.947 (95% CI 0.943-0.951) in the external validation when tested on baseline TTE-ECG pairs. Recalibration yielded statistically significant improvements in the 12-lead DeepECG LVSD models (P<.001), with enhanced and more balanced performance across all clinical subgroups. CONCLUSIONS: Patient-wise recalibration improved accuracy and consistency across various comorbidities by mitigating performance degradation and bias. This broadens the application of AI-ECG for LVSD detection from low-risk screening to high-risk longitudinal monitoring.
27 Apr 2026
Read appraisal →Journal of medical Internet research
Effectiveness of Digital Serious Games on Knowledge and Attitudes in Public Health Education: Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials
BACKGROUND: Inadequate health literacy and low engagement challenge public health education. Digital serious games show potential to enhance health knowledge and attitudes. However, the comparative effectiveness of different game formats is unclear. OBJECTIVE: This study aimed to evaluate and compare the effectiveness of different digital serious game formats in improving public health knowledge and attitudes. METHODS: This systematic review and Bayesian network meta-analysis followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Seven databases (PubMed, CINAHL, Embase, PsycINFO, Cochrane Library, Scopus, and Web of Science) were searched from January 2000 to October 2025. An updated search in February 2026 identified no additional studies. Eligible studies were randomized controlled trials (RCTs) involving nonprofessional participants comparing digital serious games with traditional or noninteractive education. Standardized mean differences and 95% credible intervals were pooled using Bayesian network models with random effects. Subgroup analyses examined population characteristics, intervention duration, health topic, and delivery format. Risk of bias was assessed using the Cochrane risk-of-bias tool, and evidence certainty was rated using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Forty randomized controlled trials from 19 countries (N=8764 participants) were included. Digital serious games significantly improved knowledge (standardized mean difference 0.66, 95% CI 0.32-0.99; I²=89.1%) and attitudes (standardized mean difference 0.50, 95% CI 0.27-0.76; I²=80.7%) compared with traditional education. Multisession interventions showed larger effects than single-session interventions for knowledge (0.76 vs 0.43) and attitudes (0.53 vs 0.30), with greater improvements among adolescents, nonpatient populations, and Asian studies. Network meta-analysis showed low heterogeneity (I²=8% for knowledge; 3% for attitudes). Mobile app-based, computer-offline, and web-based games ranked highest for knowledge; computer-offline, web-based, and virtual reality games ranked highest for attitudes. Evidence certainty was moderate for knowledge and low-to-moderate for attitudes. CONCLUSIONS: Digital serious games improve public health knowledge and attitudes across diverse contexts. Using a Bayesian network meta-analysis of randomized controlled trials, this review compares the relative effectiveness of different game formats. Mobile app-based, computer-offline, and web-based games most improved knowledge; computer-offline, web-based, and virtual reality formats most improved attitudes. Multisession interventions were more effective than single-session ones, particularly for adolescents and nonpatient populations. These findings guide scalable digital health education strategies. Future research requires adequately powered trials, longer follow-up, and standardized frameworks.
27 Apr 2026
Read appraisal →ACS sensors
A Temperature-Pressure Dual-Mode Flexible Patch Sensor with Temperature Compensation and Pressure Decoupling Functions for Pulse Detection and Recognition
Accurate and continuous detection of human pulse waves is critical for long-term health monitoring and physiological assessment during physical activity. However, most conventional flexible pulse sensors are single-mode, making them susceptible to interference from both ambient and physiological temperature fluctuations. Developing integrated dual-mode sensors remains challenging due to the difficulty in effectively decoupling pressure and temperature signals. Herein, we report a dual-mode flexible patch sensor featuring a unique "compass-like" structural design. The sensor demonstrates a broad pressure detection range (50 Pa-200 kPa) and rapid response/recovery times (60/96 ms), while its integrated temperature-sensing unit achieves a high resolution of 0.1 °C. Through unique structural design, the sensor achieves robust pressure decoupling of the temperature signal, with resistance fluctuations of only 0.102% under pressures up to 30 kPa. This independent temperature signal is subsequently utilized as a reference for the real-time temperature compensation of the pressure signal. The compensated pressure signal exhibits minimal temperature drift (41 × 10-6 °C-1 across 5-45 °C), enabling stable, interference-resistant monitoring of radial artery pulse waves under dynamic thermal conditions. Furthermore, when integrated with a ResNet-based deep learning model, the sensor successfully classifies diverse pulse signals with an accuracy of 97.6%. This research provides an effective solution for interference-resistant wearable electronics, offering significant potential for intelligent disease diagnosis and sports health management.
27 Apr 2026
Read appraisal →Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
Antenatal psychological interventions may ameliorate postpartum depression: a systematic review and meta-analysis
BACKGROUND: This study aimed to systematically evaluate the effects of psychological interventions during pregnancy on the intervention outcomes and incidence rate in women with postpartum depression. METHODS: Databases (PubMed, Medline, Web of Science, Cochrane Library, EMBASE) were searched from inception to December 2024 for randomised controlled trials assessing prenatal psychological interventions (e.g., mindfulness, psychosocial support) in pregnant women without severe mental illness. Primary outcomes included Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Scale-10 (PSS-10), Spielberger State-Trait Anxiety Inventory (STAI) scores, and PPD incidence within 6 weeks postpartum. Quality was assessed using the Cochrane risk-of-bias tool; meta-analysis was performed with RevMan 5.3. RESULTS: A total of 10 articles were included, with 6700 study subjects in total, including 3345 in the intervention group and 3355 in the control group, all of which were randomised controlled trials. The incidence rate of postpartum depression in the intervention group was significantly reduced (OR = 0.73, 95% CI [0.57-0.95], P = 0.02). The scores of EPDS, PHQ-9, PSS-10, and STAI in the intervention group were all lower than those in the control group. CONCLUSION: Psychological interventions during pregnancy can significantly reduce postpartum depression-related scale scores and incidence rates, and improve depressive symptoms, anxiety, and perceived stress. However, due to the heterogeneity of intervention types, this study cannot determine the optimal intervention method and thus provides preliminary evidence for clinical prevention. Clinicians should select interventions based on resource availability and individual characteristics of pregnant women, while future studies should focus on direct comparisons of different intervention types to provide more targeted guidance. Postpartum depression is a common mental health problem that affects many women after childbirth. It can harm both the mother’s well-being and the baby’s development. This study combined data from ten clinical trials, including 6,700 participants, to evaluate whether psychological interventions during pregnancy can help prevent postpartum depression. The results showed that women who received psychological support—such as mindfulness training, counselling, or group therapy—had fewer depressive symptoms, lower anxiety and stress levels, and a significantly reduced incidence rate compared with those who received routine care. These findings suggest that providing psychological care during pregnancy is an effective way to reduce the risk of postpartum depression and to promote mental health for both mothers and infants. Early psychological support should be considered an important part of prenatal care.
26 Apr 2026
Read appraisal →Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
ACT on Vaping: Pilot Randomized Controlled Trial of a Novel Digital Health App With Text Messaging for Young Adult Vaping Cessation
BACKGROUND: There is no published evidence to support the efficacy of any digital vaping cessation program for young adults (YAs) at differing levels of readiness to quit. In this pilot randomized controlled trial, we evaluated the preliminary acceptability and efficacy of a program for vaping cessation based on acceptance and commitment therapy (ACT on Vaping), delivered via a smartphone app and text messaging. METHODS: YAs aged 18-30 (n = 61) were randomized 1:1 to ACT on Vaping (n = 31) or incentivized text message control (n = 30). Outcome data were collected at 3 months post-randomization. Results were compared against a priori benchmarks for acceptability (satisfaction of ≥3.5 on 5-point scale) and efficacy relative to control (meeting at least one of three): ≥1-point difference in Contemplation Ladder change scores; ≥5 percentage difference in 24-hour quit attempts, ≥5 percentage difference in cotinine-confirmed 30-day point prevalence abstinence (PPA) from all non-therapeutic nicotine/tobacco. RESULTS: Satisfaction with ACT on Vaping averaged 3.8, exceeding the acceptability benchmark. A higher proportion of participants in the ACT on Vaping arm reported a 24-hour quit attempt (87.5% vs. 75.9%), exceeding the efficacy benchmark. Both changes in quit readiness (+0.96 in ACT on Vaping vs. +0.72 in control) and cotinine-confirmed 30-day PPA (4.2% in ACT on Vaping vs. 0% in control) were descriptively higher for ACT on Vaping but did not reach the benchmark level for efficacy. CONCLUSIONS: ACT on Vaping had promising acceptability and preliminary efficacy. A fully powered trial of ACT on Vaping is warranted to evaluate its efficacy. IMPLICATIONS: Digital interventions are a promising yet under-researched approach for reaching and supporting YAs to quit vaping. This proof-of-concept pilot randomized controlled trial evaluated a novel mobile health application and associated text messaging program (ACT on Vaping) for young adult vaping cessation and found preliminary evidence for acceptability and efficacy relative to an incentivized text message control arm, warranting evaluation in a fully powered trial as a next step. TRIAL REGISTRATION: NCT05897242.
26 Apr 2026
Read appraisal →JMIR mental health
Effectiveness of a Fully Automated Mobile Therapeutic Versus a General Chatbot in Reducing Depression and Anxiety and Improving Well-Being: Feasibility Randomized Controlled Trial
BACKGROUND: Given the increasing prevalence of depression and anxiety disorders and enduring barriers to care, there is a critical need for alternative treatment options. Generative artificial intelligence (AI) chatbots show promise for increasing access to mental health care, though more direct research is needed to establish their efficacy. OBJECTIVE: This pilot study aimed to test the efficacy of a generative mental health chatbot rooted in solution-focused therapy compared to the general-purpose ChatGPT and an assessment-only control (AOC) group on depression, anxiety, and well-being. METHODS: A total of 185 English-speaking adults were recruited online and randomly assigned to one of three groups: AI therapy, ChatGPT, or AOC. Of these, 147 eligible participants filled out a pretreatment assessment. Over a 3-week period, the AI therapy group (n=44) was instructed to complete 3 structured, fully automated app-based sessions per week (9 total), while the ChatGPT group (n=60) was instructed to engage in 9 unstructured conversations with ChatGPT (GPT-4o-based models). The control group (n=43) received no intervention. In the AI therapy group, 39% (n=17) completed all sessions, as did 62% (n=38) of those in the ChatGPT group. Primary outcome measures, self-assessed online at baseline and postintervention, included the Patient Health Questionnaire-9 (PHQ-9), Overall Depression Severity and Impairment Scale (ODSIS) (depression), 7-item Generalized Anxiety Disorder Scale (anxiety), and World Health Organization Well-Being Index (5-item version) (well-being). Linear mixed effects models were used for data analysis. RESULTS: Compared to AOC, both the AI therapy group (d=-0.47; P=.01) and the ChatGPT group (d=-0.44; P=.02) demonstrated significant reductions in depression scores measured by PHQ-9. The AI therapy group showed nonsignificant reductions in anxiety (d=-0.37; P=.11) and ODSIS depression scores (d=-0.25; P=.22) and an increase in well-being (d=0.12; P=.53) compared to AOC. Similarly, a nonsignificant reduction in anxiety (d=-0.27; P=.22) and ODSIS depression scores (d=-0.12; P=.53) and an increase in well-being (d=0.20; P=.29) were observed in the ChatGPT group compared to AOC. The AI therapy group did not significantly outperform the ChatGPT group on any outcomes (PHQ-9: b=-0.19; d=0.03; P=.87; 7-item Generalized Anxiety Disorder Scale: b=-0.57; d=-0.11; P=.62; ODSIS: b=-0.59; d=-0.13; P=.50; and WHO: b=-0.38; d=-0.07; P=.69). CONCLUSIONS: Both the structured generative AI chatbot and ChatGPT showed a significant reduction in depression scores compared to the control group. No significant effects were observed across other outcomes, although descriptive trends indicated improvements in anxiety. While the AI therapy group showed descriptively better outcomes for depression and anxiety, differences between groups were not significant. A larger sample and longer intervention may be needed for the emerging trends to yield clinically meaningful effect sizes.
26 Apr 2026
Read appraisal →European journal of hospital pharmacy : science and practice
How to manage the overwhelming amount of database-detected interactions? A focus group meeting study on the management of database-detected risks of drug interactions.
OBJECTIVES: Database-assisted screening may help detect the risks of drug interactions, but less than 10% of flagged interactions have clinical manifestations, potentially leading to alert fatigue among healthcare providers. To address this issue, this study aimed to develop a concise framework to support the management of database-indicated interaction risks. METHODS: A grounded theory approach was used to design, evaluate and develop the framework. Participants included healthcare professionals and laypersons with experience using narrow therapeutic index medications, as well as individuals recommended by them. Two focus group discussions were conducted (N1=6 and N2=5), each lasting approximately 2 hours and following the same agenda. In one case, a follow-up one-on-one interview was held because the participant indicated further insights at the end of the session. RESULTS: Participants identified key decision-making questions for the framework, including the evidence base for interacting drugs, severity and documentation level of the interaction, availability of safer alternatives, and the presence of confounding factors. The framework was considered useful and, following refinement, potentially suitable for clinical implementation. A key insight was that integration into healthcare curricula is essential for achieving long-term impact. Overall, the proposed tool may assist in managing interaction risks in diverse clinical scenarios and reduce alert fatigue among healthcare professionals. CONCLUSION: Although further clinical validation is needed, the framework provides a foundation for improving the management of database-detected drug interactions.
26 Apr 2026
Read appraisal →Archives of orthopaedic and trauma surgery
Analysis of mental health outcomes in major versus minor upper extremity amputations: a retrospective national database study
BACKGROUND: Upper extremity amputations are associated with developing psychiatric conditions. The aim of this study is to identify differences in mental health outcomes for patients undergoing major versus minor upper extremity amputations. METHODS: Data were obtained from the PearlDiver database between 2010 and 2022 using Current Procedural Terminology and International Classification of Diseases codes. Patients aged 10 and above without prior mental health diagnoses or antidepressant prescription records who underwent upper extremity amputations were stratified by major (shoulder disarticulation, arm, forearm, wrist, transmetacarpal) versus minor (single metacarpal, digit, phalanx) amputations. Demographic characteristics and rates of mental health diagnoses, antidepressant prescriptions, and psychotherapy care were assessed for 90 days and one year postoperatively, using Welch's T-tests and Pearson's chi-squared tests. RESULTS: Patients with major amputations had increased risk of mental health diagnoses at 90 days (OR: 3.29, p < 0.001) and at one year (OR: 2.01, p < 0.001). Both groups had higher rates of mental health diagnoses than the general population. Patients undergoing major amputations had higher odds of starting antidepressants at 90 days (OR 3.82, p < 0.001) and at one year (OR 2.38, p < 0.001). Psychotherapy care was significantly increased after major amputations at 90 days (OR 5.47, p < 0.001) and at one year (OR 4.18, p < 0.001). CONCLUSIONS: Mental health disorders, antidepressant use, and psychotherapy care are significantly higher for major upper extremity amputations compared to minor amputations. Surgical teams should provide mental health resources to mitigate negative effects from mental health needs after upper extremity amputation. LEVEL OF EVIDENCE: III.
26 Apr 2026
Read appraisal →The British journal of ophthalmology
Ethnic and dose-dependent differences in atropine efficacy for myopia control: a systematic review and meta-analysis
BACKGROUND/AIM: Clinical uncertainty remains regarding optimal atropine concentration, treatment duration and potential differences in efficacy for myopia control between Asian and non-Asian children. This systematic review and meta-analysis evaluated the efficacy of different concentrations of atropine for myopia control, comparing outcomes among East Asian, South Asian and white European children. METHODS: Five databases were searched for randomised controlled trials (RCTs) including children ≤16 years with myopia who received atropine treatment. Thirty-four RCTs with ≥12 months of follow-up were included. Weighted mean differences (WMD) in spherical equivalent refraction (SER) progression and axial length (AL) elongation were pooled by atropine concentration and ethnicity. RESULTS: Compared with controls, atropine significantly reduced myopia progression across all concentrations: <0.1% (WMD in SER: 0.44 (95% CI 0.35 to 0.52) dioptres (D)/year; AL: -0.20 (95% CI -0.24 to -0.16) mm/year), 0.1% to <0.5% (0.81 (95% CI 0.50 to 1.13) D/year) and ≥0.5% (1.06 (95% CI 0.88 to 1.24) D/year; -0.36 (95% CI -0.40 to -0.33) mm/year). The pooled effect on SER and AL progression across all concentrations was greater in East Asians (0.63 (95% CI 0.50 to 0.76) D/year; -0.26 (95% CI -0.31 to -0.20) mm/year) than in South Asians (0.40 (95% CI 0.11 to 0.70) D/year; -0.13 (95% CI -0.21 to -0.05) mm/year) or white Europeans (0.18 (95% CI 0.11 to 0.25) D/year; -0.11 (95% CI -0.16 to -0.05) mm/year). CONCLUSION: Atropine slows myopia progression in a dose-dependent manner in studies with 1-5 years of follow-up. Efficacy appears greater in Asian children, particularly East Asians, who also exhibit greater photopic pupil dilation. These findings support the role of atropine in myopia control and highlight the importance of ethnicity-specific considerations when prescribing and tailoring treatment strategies. PROSPERO REGISTRATION NUMBER: CRD42023454104.
26 Apr 2026
Read appraisal →JMIR aging
The Associations Between Digital Exclusion and Physical or Cognitive Function in Middle-Aged and Older Adults: Systematic Review and Meta-Analysis
BACKGROUND: Digital exclusion posed a significant challenge, especially in middle-aged and older adults, which affected their health outcomes. However, the evidence regarding the associations of digital exclusion on physical or cognitive function outcomes was controversial, and no systematic review had been performed to synthesize the pooled associations. OBJECTIVE: This study aimed to explore the relationship between digital exclusion and physical or cognitive function in middle-aged and older adults. METHODS: We conducted a systematic review and meta-analysis of cohort and cross-sectional studies, including Chinese or English publications retrieved from PubMed, Embase, Web of Science, PsycINFO, Scopus, CNKI, and Wanfang databases up to August 31, 2024. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS). The pooled effect size was calculated based on odds ratios (ORs), hazard ratios, risk ratios, and 95% CIs. This study was registered on PROSPERO (CRD42024585459). RESULTS: Nineteen studies met the inclusion criteria, including 13 cohort studies and 6 cross-sectional studies, which had moderate-to-low risk of bias. The pooled analysis indicated that digital exclusion had prospective associations with decreased basic activities of daily living (incidence rate ratio 1.35, 95% CI 1.12-1.64, I2=94.7%) and instrumental activities of daily living (incidence rate ratio 1.46, 95% CI 1.13-1.89, I2=96.2%), or cross-sectional association with activities of daily living (OR 1.23, 95% CI 0.41-3.73, I2=91%), with no statistical significance in the prospective association with frailty (OR 1.21, 95% CI 0.92-1.59, I2=95.2%). There were prospective associations between digital exclusion and dementia (hazard ratio 1.78, 95% CI 1.43-2.22, I2=0%), decreased Mini-Mental State Examination scores (OR 1.96, 95% CI 1.39-2.75, I2=0%), as well as cross-sectional associations with Mini-Mental State Examination scores (OR 2.90, 95% CI 2.07-4.07, I2=0%), and no statistical significance in the prospective association with cognitive impairment (risk ratio 2.08, 95% CI 0.98-4.44, I2=78.2%). CONCLUSIONS: Our findings indicated the negative associations of digital exclusion with physical and cognitive functions. Future research and clinical practice should consider designing digital interventions and services that match the physical and cognitive capacities and preferences of middle-aged and older adults, thereby improving digital engagement and reducing the harms associated with digital exclusion. Policies should focus on expanding access, reducing financial barriers, and improving digital literacy. However, due to the presence of heterogeneity and publication bias, the results should be interpreted cautiously.
26 Apr 2026
Read appraisal →JMIR mHealth and uHealth
A Deep Neural Network for Interpreting Wearable Electrocardiogram Data in Atrial Fibrillation: Prospective Observational Diagnostic Accuracy Study
BACKGROUND: Atrial fibrillation (AF) and atrial flutter (AFL) are common arrhythmias associated with the risk of ischemic stroke, which can be reduced with anticoagulation therapy. Thus, early diagnosis of AF and AFL is essential. However, diagnosis may be challenging due to the paroxysmal and asymptomatic nature of these arrhythmias. OBJECTIVE: Current diagnostic workflows involve time-consuming and resource-intensive manual review of noisy signals and prolonged recordings. We evaluated a mobile system that combines a wireless wearable single-lead chest strap electrocardiogram (ECG) and a novel deep neural network (DNN)-based artificial intelligence (AI) method for detecting AF/AFL episodes, AF/AFL burden, and rhythm change and estimated the delay in the detection of rhythm change from AF/AFL to sinus rhythm. We also assessed the rhythm classification performance. METHODS: A total of 116 patients with recent-onset AF or AFL undergoing cardioversion were monitored using a mobile single-lead chest strap ECG system. Simultaneously, a 3-lead Holter ECG served as the reference. The DNN-based AI analyzed the single-lead chest strap ECG data to detect AF/AFL, non-AF/AFLrhythm, and noninterpretable segments, as well as to estimate AF/AFL burden and detect rhythm change. Performance metrics included sensitivity, specificity, positive predictive value, negative predictive value, and intraclass correlation coefficient for AF and AFL burden estimation. RESULTS: The sensitivity and specificity for detecting AF/AFL were 91.9% (204.9/223.0 h) and 99.6% (242.4/243.5 h), respectively. The sensitivity for detecting AF was 96.2% (191.5/199.0 h), whereas it was 55.8% (13.4/24.0 h) for detecting AFL. The positive predictive value and negative predictive value for AF/AFL detection were 99.5% (204.9/206.0 h) and 93.1% (242.4/260.5 h), respectively. The intraclass correlation coefficient between the AF/AFL burden estimated by the DNN-based AI method and that derived from the physician-interpreted reference ECG was 0.96 (95% CI: 0.94-0.97; P<.001). Rhythm change detection occurred within 1 minute in most cases. CONCLUSIONS: The mobile single-lead chest strap ECG system powered by a DNN-based AI algorithm demonstrated strong performance in detecting AF, estimating AF burden, and recognizing rhythm change to sinus rhythm. This AI-driven approach enables automated and accurate rhythm analysis, supporting clinical decision-making. Further validation in real-world ambulatory settings is warranted.
25 Apr 2026
Read appraisal →The New England journal of medicine
Oral Nirmatrelvir-Ritonavir for Covid-19 in Higher-Risk Outpatients
BACKGROUND: Nirmatrelvir-ritonavir has been shown to reduce progression to severe illness from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in unvaccinated high-risk outpatients. The effectiveness of nirmatrelvir-ritonavir in persons who have been vaccinated, infected naturally, or both is unclear. METHODS: In two open-label platform trials (PANORAMIC in the United Kingdom and CanTreatCOVID in Canada), we enrolled higher-risk adults (≥50 years of age or ≥18 years of age with coexisting conditions) in the community who tested positive for SARS-CoV-2 and had been unwell for 5 days or less. The participants were randomly assigned to receive usual care plus nirmatrelvir (300 mg)-ritonavir (100 mg) twice a day for 5 days or to receive usual care alone. The primary outcome was hospitalization or death from any cause within 28 days after randomization. RESULTS: From December 8, 2021, to September 30, 2024, a total of 3516 participants in the PANORAMIC trial and 716 participants in the CanTreatCOVID trial underwent randomization. In the PANORAMIC trial, 14 of 1698 participants (0.8%) in the nirmatrelvir-ritonavir group and 11 of 1673 participants (0.7%) in the usual-care group were hospitalized or died (adjusted odds ratio, 1.18; 95% Bayesian credible interval, 0.55 to 2.62; probability of superiority, 0.334). In the CanTreatCOVID trial, 2 of 343 participants (0.6%) in the nirmatrelvir-ritonavir group and 4 of 324 participants (1.2%) in the usual-care group were hospitalized or died (adjusted odds ratio, 0.48; 95% Bayesian credible interval, 0.08 to 2.23; probability of superiority, 0.830). In a substudy involving 634 participants, viral load was reduced by the end of treatment with nirmatrelvir-ritonavir. Serious adverse events with nirmatrelvir-ritonavir were reported in 9 participants in the PANORAMIC trial and in 4 participants in the CanTreatCOVID trial. CONCLUSIONS: In two open-label trials, nirmatrelvir-ritonavir did not reduce the incidence of hospitalization or death among vaccinated higher-risk participants with SARS-CoV-2 infection. (Funded by the National Institute for Health and Care Research, and others; PANORAMIC ISRCTN number, 2021-005748-31; CanTreatCOVID ClinicalTrials.gov number, NCT05614349.).
25 Apr 2026
Read appraisal →PloS one
The journey to diagnosis and care of functional neurological disorder (FND).
PURPOSE: Functional neurological disorder (FND) is a common condition, associated with high disability and healthcare costs, and poor treatment access. This qualitative study aimed to explore participants' experiences of being diagnosed with functional neurological disorder (FND), accessing treatment, and navigating life after diagnosis. Participants were drawn from a randomised feasibility study of eye movement desensitisation and reprocessing therapy for people with FND (MODIFI, Trial Registration: NCT05455450 (www.clinicaltrials.gov)). METHODS: Reflexive thematic analysis was used to analyse the data from eighteen semi-structured interviews with participants diagnosed with FND. RESULTS: Six main themes were identified: (1) the process of seeking a diagnosis and initial relief from the physical struggles, (2) receiving a diagnosis of FND, (3) treatment for FND, (4) the burden of FND in day-to-day life, (5) the need to assert agency and return to normal, and (6) hopes for the future. CONCLUSION: The findings emphasize the need for personalised and compassionate care for individuals suffering from FND, underpinned by increased service provision within the healthcare system.
25 Apr 2026
Read appraisal →The Journal of clinical endocrinology and metabolism
Pharmacological interventions to improve bone density in functional hypothalamic amenorrhea: a systematic review and network meta-analysis of randomized clinical trials
CONTEXT: Women with functional hypothalamic amenorrhea (FHA) are at high risk of poor bone health. When lifestyle measures fail to restore menses, pharmacological interventions are needed for bone health, but comparative efficacy remains unclear. OBJECTIVE: To compare the efficacy of available pharmacological interventions to improve bone mineral density (BMD), in women with FHA, employing network meta-analysis (NMA). DATA SOURCES: Medline, Embase, Emcare, Cochrane CENTRAL, ISRCTN, and ClinicalTrials.gov were searched up to 20 September 2025. STUDY SELECTION: Eligible randomized-controlled trials evaluated pharmacological interventions for lumbar spine (LS), femoral neck (FN), or total hip (TH) BMD in women with FHA. Two independent reviewers screened titles, abstracts, and texts. DATA EXTRACTION: Two reviewers independently extracted data following the Preferred Reporting Items for Systematic Reviews-network meta-analysis guidelines. Outcomes were expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using random-effects NMA. Evidence certainty was assessed with CINeMA. DATA SYNTHESIS & RESULTS: Thirteen randomized-controlled trials (n = 897 participant observations across all pharmacotherapy comparisons) were included (LS BMD: n = 897; FN BMD: n = 370; TH BMD: n = 750). Transdermal hormone replacement therapy (HRT) was superior to control (placebo or no intervention) for LS BMD with SMD: 0.34 (0.03, 0.64) and FN BMD with SMD: 0.57 (0.04, 1.10). Oral HRT and the combined oral contraceptive pill (COCP) showed no significant benefit for any BMD site. Teriparatide was superior to transdermal HRT and COCP for LS BMD with SMDs: 1.48 (0.38, 2.59) and 1.75 (0.66, 2.83), but not FN or TH BMD. CONCLUSIONS: Transdermal HRT and teriparatide improve LS BMD in women with FHA, with transdermal HRT also improving FN BMD. STUDY REGISTRATION: PROSPERO (CRD42024576872).
25 Apr 2026
Read appraisal →Journal of medicinal chemistry
The Discovery of RGH-706, a Highly Efficacious MCH1 Receptor Antagonist, for the Treatment of Obesity and Insatiable Hunger
The discovery and characterization of a novel 2,3,4,5-tetrahydro-1H-[1,4]diazepino[1,7-a]indole derivative MCH1 receptor antagonist (37) is disclosed. Starting from our previously investigated pyrazino[1,2-a]indole series and utilizing a scaffold hopping strategy, pyrimidine- and 1,4-diazepine-fused indole derivatives were designed and synthesized. Among these, only the prototype molecule containing the 2,3,4,5-tetrahydro-1H-[1,4]diazepino[1,7-a]indole scaffold emerged as a chemically stable and potent MCHR1 antagonist. Previous SAR knowledge coupled with an ex vivo occupancy assay helped us to optimize this advanced lead to our candidate (37). The high MCHR1 potency and excellent receptor occupancy profile of 37 translated into statistically significant body weight loss after 14 days in a DIO mice study, supporting the potential use of this compound as a weight loss agent. Compound 37 (RGH-706) has successfully completed a phase I (SAD & MAD) clinical study in the indication of obesity, followed by an exploratory Phase II study in patients with Prader-Willi Syndrome (PWS).
25 Apr 2026
Read appraisal →JMIR human factors
Personalizing Mobile Apps for Health Behavioral Change According to Personality: Cross-Sectional Validation of a Preference Matrix
BACKGROUND: Mobile health (mHealth) apps are increasingly used to support healthy lifestyle behaviors through features such as health tracking and personalized reminders. Personalized messaging, tailored to users' profiles, has been shown to improve engagement and retention in health-related contexts. Prior research has linked personality traits, based on the Big Five model, to preferences for specific app mechanisms, leading to the development of a preference matrix for personalizing mHealth apps. This matrix comprises 15 mechanisms derived from behavior change techniques and gamification elements, intended to guide developers in optimizing engagement according to user profiles. OBJECTIVE: This study aimed to validate this preference matrix by examining whether the associations between mechanisms and Big Five personality traits reported in the literature align with user preferences observed in an experimental setting. METHODS: A cross-sectional study was conducted using an online survey that collected demographic data, mHealth app usage, and personality traits. Participants were presented with mockups illustrating 15 mechanisms and were asked to select their preferred options. Logistic regression and ordinal logistic regression analyses were performed to examine associations between personality traits, mechanism selection, and motivation scores. All analyses were adjusted using the Bonferroni correction to account for multiple comparisons. RESULTS: A total of 214 participants completed the survey (mean age 29.42, SD 10.41 y; n=118, 55.1% women; n=89, 41.6% men; n=5, 2% identifying as other; and n=2, 1% nonrespondents). Higher conscientiousness significantly increased the likelihood of selecting the collection mechanism (eg, collecting badges or points; odds ratio [OR] 1.87, 95% CI 1.27-2.75). For competition (eg, competing with other users), conscientiousness (OR 3.22, 95% CI 1.73-6.00) and agreeableness (OR 1.93, 95% CI 1.08-3.45) were significant predictors. Preferences for rewards (eg, virtual incentives such as points or virtual currency) were associated with conscientiousness (OR 2.36, 95% CI 1.53-3.63) and neuroticism (OR 1.97, 95% CI 1.36-2.86). Additionally, 4 mechanisms-self-monitoring, progression, challenge, and quest-were selected by more than half of the participants, independent of personality traits. CONCLUSIONS: The findings partially validate the proposed preference matrix. Conscientiousness consistently emerged as a key predictor of preference across multiple mechanisms, highlighting its central role in engagement with gamified mHealth features. While some mechanisms appear to have universal appeal, others show personality-specific preferences, underscoring the value of combining baseline mechanisms with targeted personalization strategies in mHealth app design.
25 Apr 2026
Read appraisal →The British journal of ophthalmology
Multimodal artificial intelligence for retinal detachment diagnosis using fundus imaging and patient questionnaires
BACKGROUND/AIMS: This study aimed to develop a multimodal artificial intelligence (AI) system that integrates fundus imaging and patient questionnaire data to achieve clinician-level diagnostic accuracy for diagnosing retinal detachment (RD). METHODS: Ultra-widefield fundus images and comprehensive patient questionnaires were collected from patients with RD and healthy controls at Tsukazaki Hospital. A multimodal model was developed using the Contrastive Language-Image Pretraining framework to classify RD cases, alongside separate image-only and questionnaire-only models for comparison. Per-image and per-subject analyses were conducted to assess model performance. RESULTS: The multimodal model outperformed single-modal models in per-image and per-subject assessments. It achieved accuracy, recall and F1 scores of 0.899±0.054, 0.902±0.043 and 0.902±0.048 in the per-image analysis and 0.893±0.071, 0.949±0.044 and 0.873±0.074 in the per-subject analysis, respectively. The AI model's overall diagnostic accuracy was slightly lower than that of human clinicians; however, it exhibited a higher recall rate, indicating improved detection of true RD cases. CONCLUSION: Integrating fundus imaging with patient questionnaire data significantly improves AI-based RD diagnosis. Future research needs to focus on expanding the dataset and refining the questionnaire design to further improve model performance.
25 Apr 2026
Read appraisal →The British journal of ophthalmology
Incidental ocular surface squamous neoplasia in pterygia: a systematic review and meta-analysis
AIMS: Differentiating pterygium from ocular surface squamous neoplasia (OSSN) is important for guiding management. This meta-analysis evaluates the prevalence and risk factors for incidental OSSN in clinically diagnosed pterygia. METHODS: Ovid Embase, MEDLINE, Cochrane Library and Web of Science were systematically searched from January 2000 to February 2025. Included studies analysed ≥100 clinically diagnosed pterygia via histopathology. Random-effects meta-analysis assessed the prevalence of incidental OSSN among pterygia. Risk factors were evaluated using the Mantel-Haenszel and inverse variance methods, and meta-regression analysed the influence of publication year, geographic proximity to the equator, and country-level ultraviolet (UV) radiation exposure. RESULTS: 12 studies, comprising 8688 specimens, identified 202 cases of incidental OSSN (pooled prevalence=1.32%, 95% CI 0.41% to 4.21%, I2=95.3%). Meta-regression revealed that lower OSSN prevalence was associated with greater distance from the equator (OR 0.49, 95% CI 0.28 to 0.83, p<0.01), while higher prevalence was associated with greater UV exposure (OR 2.20, 95% CI 1.17 to 4.14, p=0.01). Publication year had no effect (p=0.98). Age (p=0.18), sex (p=0.45) and lesion location (p=0.60-0.82) did not differ between incidental OSSN cases and benign pterygia. Incidental OSSN prevalence also did not differ between primary and recurrent pterygia (p=0.23). Regional analyses revealed variation in prevalence: Europe (0.29%), Asia (0.76%), North America (1.03%), Oceania (8.57%) and South America (14.97%). CONCLUSIONS: This meta-analysis, based on low- to very low-certainty evidence, identified a 1.32% pooled prevalence of incidental OSSN in clinically diagnosed pterygia, highlighting the potential influence of UV exposure and equatorial proximity. The overlap in demographic and lesion characteristics between benign pterygia and OSSN underscores diagnostic challenges.
25 Apr 2026
Read appraisal →BMJ open diabetes research & care
Sex differences in glycemic outcomes: a systematic review and meta-analysis of diabetes treatments
UNLABELLED: Sex differences in glycemic outcomes following insulin therapy remain underexplored despite biological and psychosocial factors that may influence individual responses. This systematic review examines sex-specific differences in glycemic control to guide personalized diabetes care and promote health equity. We searched PubMed, Scopus, Cochrane Library, and Google Scholar (August 2014-December 2025) for randomized and observational studies involving adults of both sexes on insulin. Twenty-four studies were included, with certainty of evidence assessed using GRADE. In type 1 diabetes, women showed no significant difference in achieving HbA1c <7% (RR 1.05, 95% CI 0.91 to 1.22; very low certainty) and toward higher time-in-range (SMD 0.78, -0.01 to 1.57; moderate certainty). In type 2 diabetes, men were more likely to achieve HbA1c targets (RR 0.86, 95% CI 0.72 to 1.03; low certainty), while women required higher weight-adjusted insulin doses (SMD 0.55, 0.23 to 0.86; very low certainty). Hypoglycemia risk showed opposing trends in inpatient (RR 0.78, 95% CI 0.33 to 1.83; very low certainty) versus outpatient settings (RR 1.08, 95% CI 0.61 to 1.89; low certainty) with substantial heterogeneity (I2>70%). These findings suggest that sex-related differences in glycemic outcomes vary by diabetes type and treatment context. Given the low certainty and heterogeneity of current evidence, results should be interpreted as hypothesis-generating. This review supports the consideration of biological sex within a broader, individualized diabetes management framework and highlights the need for future sex-stratified analyses with rigorous control of lifestyle and physiological factors. INTRODUCTION: Sex differences in glycemic outcomes following the same insulin therapy in diabetes remain underexplored. Numerous factors, encompassing both biological and psychosocial aspects, could potentially influence individual responses to insulin therapy. This systematic review examines sex-specific differences in glycemic control to guide personalized diabetes care and promote health equity. METHODS: PubMed, Scopus, Cochrane Library, and Google Scholar were searched (August 1, 2014-December 31, 2025) for randomized and observational studies. Eligible studies included adults of both sexes on insulin reporting sex-specific data for predefined outcomes. Data on glycated hemoglobin (HbA1c), blood glucose metrics, hypoglycemia, and insulin dose were extracted. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations. RESULTS: Twenty-four studies were included. In type 1 diabetes, women showed no significant difference in achieving HbA1c <7% (risk ratio (RR) 1.05, 95% CI 0.91 to 1.22; very low certainty) and toward higher time-in-range (standardized mean difference (SMD) 0.78, -0.01 to 1.57; moderate certainty). In type 2 diabetes, men were more likely to achieve HbA1c targets (RR 0.86, 95% CI 0.72 to 1.03; low certainty), whereas women required higher weight-adjusted insulin doses (SMD 0.55, 0.23 to 0.86; very low certainty). Hypoglycemia risk showed opposing trends in inpatient (RR 0.78, 95% CI 0.33 to 1.83; very low certainty) versus outpatient settings (RR 1.08, 95% CI 0.61 to 1.89; low certainty), with substantial heterogeneity (I2 >70%). CONCLUSION: Sex-related differences in glycemic outcomes under insulin therapy were observed, with patterns varying by diabetes type, treatment context, and outcome. Given the low certainty and heterogeneity of the evidence, these findings should be interpreted as hypothesis-generating rather than directive for clinical practice. The results support consideration of biological sex as one component within a broader, individualized diabetes management framework. Future studies should prioritize sex-stratified analyses with rigorous control of polypharmacy, body composition, and lifestyle factors to determine whether sex-specific insulin strategies provide meaningful clinical benefit. PROSPERO REGISTRATION NUMBER: CRD420251144696.
25 Apr 2026
Read appraisal →The Journal of clinical endocrinology and metabolism
Health and adverse events associated with extended oral bisphosphonates among postmenopausal women: a systematic review
BACKGROUND: International guidelines recommend the use of oral bisphosphonates (oBP) for up to 5 years in the treatment of postmenopausal osteoporosis. However, benefits and risks of extending oBP therapy beyond this duration remain uncertain. AIM: To determine the health outcomes (bone mineral density [BMD], fracture risk) and adverse effects (atypical fracture, osteonecrosis of the jaw [ONJ]) of extended oBP therapy beyond 5 years among postmenopausal women. METHODOLOGY: A systematic search of Medline©, EMBASE©, and CINAHL© was conducted from inception to 15 March 2024. Interventional and observational studies published in English were included. Two authors independently performed screening, quality appraisal using the NIH Quality Appraisal tool, and data extraction. The review followed PRISMA guidelines and was registered on PROSPERO (CRD42024475332). High heterogeneity precluded meta-analysis. RESULTS: Eleven studies (4 controlled trials, 7 observational) were included: 3 rated as good quality, 7 as fair, and 1 as poor. Extended oBP therapy beyond 5 years increased BMD at the hip (3/3 studies), femoral neck (3/3 studies) and lumbar spine (5/5 studies). Prolonged oBP use reduced clinical vertebral fracture risk (1/6 studies) but increased the risk of atypical fractures (3/3 studies) and incomplete atypical femoral fractures (1/1 study). None of the included studies assessed or reported ONJ. CONCLUSION: Substantial heterogeneity and limited high-quality evidence preclude definitive conclusions regarding extended oBP use in postmenopausal women. While extended treatment may improve bone density and reduce vertebral fractures, it could also increase atypical fractures. Future high-quality studies are required to inform decisions regarding optimal treatment duration.
25 Apr 2026
Read appraisal →Neurology
Virtual vs In-Person Neurologic Ambulatory Care: A Case-Control Study of Subsequent Health Care Utilization
BACKGROUND AND OBJECTIVES: Implementation of telemedicine expanded options for outpatient neurology care. It remains uncertain which new neurology patients can be appropriately evaluated virtually. We compared subsequent health care utilization after virtual vs in-person new patient neurology visits across 3 academic medical centers. METHODS: We conducted a retrospective multicenter cohort study of adults with a new outpatient neurology visit from September 2020 through December 2021 using the Vizient Clinical Data Base and Clinical Practice Solutions Center databases. Virtual and in-person patients were matched 1:1 using propensity scores incorporating demographics, clinical characteristics, time period, and previous health care utilization. Outcomes were analyzed overall and stratified by neurologic chief complaint category and institution. We compared rates of subsequent neurologic clinic follow-up, emergency department (ED) visits, and hospitalizations after virtual and in-person encounters. Testing and all-cause ED visits/hospitalizations were also assessed. RESULTS: We identified 10,428 virtual and 36,767 in-person neurology new outpatient visits. After propensity score matching, 8,202 virtual visits were matched to 8,202 in-person visits. Neurology follow-up within 90 days did not differ between virtual and in-person visits (24.6% vs 23.7%, p = 0.18). Thirty-day neurology clinic follow-up was slightly lower after virtual visits, whereas follow-up at 6 months and 1 year was similar between groups. Neurologic ED visits and hospitalizations within 90 days were similar (0.9% vs 0.8%, p = 0.23 and 1.8% vs 1.7%, p = 0.47, respectively). All-cause ED visits and hospitalizations within 90 days were also comparable (1.8% vs 1.7%, p = 0.59 and 2.2% vs 1.8%, p = 0.13, respectively). Analyses by chief complaint found that 90-day follow-up was higher after in-person visits for dementia, whereas 30- and 90-day follow-up was higher after virtual visits for Parkinson disease and multiple sclerosis, and 90-day follow-up was higher after virtual visits for headache. Testing was more frequent after in-person visits for certain chief complaints. DISCUSSION: In this propensity score-matched multicenter cohort, new neurology patients seen virtually had similar downstream utilization as those seen in-person, including comparable 90-day follow-up and similar neurologic and all-cause ED visits and hospitalizations. Although follow-up varied modestly by chief complaint and testing was more frequent after some in-person visits, no major differences emerged overall.
25 Apr 2026
Read appraisal →BMJ open
Course of psychological symptoms and the initial management strategies in general practice using electronic health records in the Netherlands
BACKGROUND: Patients who consult their GP about psychological complaints, such as feeling anxious or depressed, are often initially given a psychological symptom diagnosis. However, it remains unclear whether these symptoms will develop into psychiatric conditions, which is crucial for informing patients about their prognosis and guiding GPs in their management. AIMS: To explore the course of psychological symptom diagnoses and compare GPs' management strategies for (a) psychological symptom diagnoses that persisted for more than a year and (b) those that changed into psychiatric conditions during the first year of care. METHODS: We performed a retrospective cohort study using the Family-Medicine Network database. We included all episodes of care (EoC) that started with a psychological symptom diagnosis between 2008 and 2021. We performed negative binomial analyses and logistic regression analyses to compare management strategies and number of contacts between EoC that changed into psychiatric conditions and persistent psychological symptoms (>1 year) during the first year of care. RESULTS: Out of the 14 633 EoC that started with a psychological symptom diagnosis, 79.4% resolved within 1 year, 12.8% persisted as psychological symptoms and 7.8% changed into psychiatric conditions. In EoC that changed into psychiatric conditions, as compared with EoC that persisted as psychological symptoms, we observed a significantly higher number of contacts with the GP (RR=1.76, 95% CI 1.63 to 1.91) as well as an increased total number of interventions (RR=1.71, 95% CI 1.58 to 1.84). CONCLUSION: Most psychological symptoms remain for only a short period of time and only a few persist or change into psychiatric conditions. Future research should investigate the factors that influence patients' decisions to seek further help from their GPs as well as those that contribute to the transition from psychological symptom diagnoses to a psychiatric condition.
25 Apr 2026
Read appraisal →The New England journal of medicine
Transdermal Estradiol Patches in Locally Advanced Prostate Cancer
BACKGROUND: Transdermal estradiol (tE2) is an alternative to luteinizing hormone-releasing hormone (LHRH) agonists as androgen-deprivation therapy in patients with prostate cancer. With tE2, testosterone is suppressed, and the side effects of estrogen depletion due to LHRH agonists and the thromboembolic side effects of oral estrogen are mitigated. METHODS: In this phase 3, noninferiority, randomized trial, we assigned men with locally advanced (M0 and N0 or N+) prostate cancer to receive tE2 patches (100 μg of estradiol every 24 hours) or LHRH agonists. The primary outcome was 3-year metastasis-free survival. The noninferiority margin was 4 percentage points; this corresponded to a target hazard ratio of 1.31, as derived from the observed 3-year metastasis-free survival in the LHRH agonist group. Secondary outcomes included castrate levels of testosterone (<1.7 nmol per liter), overall survival, and safety. RESULTS: Between 2007 and 2022, we recruited 1360 patients at 75 U.K. centers. The median age of the patients was 72 years (interquartile range, 68 to 77); 85% had a T3 tumor stage and 65% an N0 nodal stage. Observed 3-year metastasis-free survival was 87.1% with tE2 and 85.9% with LHRH agonists (hazard ratio for confirmed metastasis or death, 0.96; upper limit of the one-sided 95% confidence interval [CI], 1.11, which met the criterion for noninferiority). Among patients continuing the assigned treatment, castrate levels of testosterone were sustained during the first year after randomization in 85% in each group. Observed 5-year overall survival was 81.1% with tE2 and 79.2% with LHRH agonists (hazard ratio for death, 0.90; 95% CI, 0.75 to 1.07). During treatment, hot flashes occurred in 44% of the patients who received tE2 and 89% of those who received LHRH agonists (grade ≥2 events, 8% and 37%, respectively) and gynecomastia in 85% and 42% (grade ≥2 events, 37% and 9%). CONCLUSIONS: In patients with locally advanced prostate cancer, tE2 was noninferior to LHRH agonists for 3-year metastasis-free survival, with a lower incidence of hot flashes but a higher incidence of gynecomastia. (Funded by Cancer Research U.K. and the U.K. Research Institute Medical Research Council; PATCH ClinicalTrials.gov number, NCT00303784; STAMPEDE-1 ClinicalTrials.gov number, NCT00268476.).
24 Apr 2026
Read appraisal →Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
Health Hazards of E-Cigarettes and Heated Tobacco Products: a Comprehensive Analysis of Hazardous Substances and Regulatory Gaps
INTRODUCTION: Ingredients and products of electronic cigarettes (ECs) and heated tobacco products (HTPs) formed during heating are aerosolized and inhaled. Hazard information on ingredients and emissions is often unavailable. Our objective was to identify and classify substances in the ingredients and emissions of ECs and HTPs based on scientific hazard classifications. METHODS: Ingredient data were collected from the European Union (EU) Common Entry Gate, a mandatory notification system for tobacco and related products. Substances in ECs and HTPs emissions were identified with a systematic literature review and classified into three categories based on existing health hazard classifications. Category 1 substances (i.e., highest potential health hazard) were regarded as high-priority substances for research and quantification. Categories 2 and 3 included potentially harmful substances and substances lacking sufficient toxicological data respectively. RESULTS: A total of 134 of the 1740 identified substances were classified in Category 1. Several substances possess Carcinogenic, Mutagenic, or Reprotoxic properties, prohibited as tobacco additives. Most substances lacked sufficient toxicity data and were classified in Category 3. CONCLUSION: Our classification can be used for monitoring and enforcement, ensuring proactive management of potential risks. Therefore, we recommend strengthening the enforcement of existing bans. Implications: This study identifies and classifies 1740 substances found in the ingredients and emissions of ECs and HTPs, including 134 hazardous chemicals, among which are carcinogens, mutagens, and reproduction toxicants. This indicates regulatory gaps and the need for stricter enforcement of existing bans. The findings provide a valuable tool for policymakers and public health professionals for monitoring and mitigating risks.
24 Apr 2026
Read appraisal →Journal of medical economics
Cost-effectiveness of tirzepatide versus semaglutide for patients with obesity or overweight in the US: evidence from the SURMOUNT-5 head-to-head phase-3 trial
PURPOSE: This study evaluated the cost-effectiveness (from the United States [US] societal perspective) of tirzepatide at its maximum-tolerated-dose (MTD) compared to semaglutide (MTD), both administered adjunct to a reduced-calorie diet and increased physical activity. The analysis focused on individuals with obesity (body mass index [BMI] ≥ 30 kg/m2), or overweight (BMI ≥27 to <30 kg/m2 + ≥1 obesity-related complication), using data from the head-to-head Phase-3 SURMOUNT-5 trial (patients without type 2 diabetes [T2D]). PATIENTS AND METHODS: This patient-level simulation modeling study assessed the cost and long-term clinical outcomes of tirzepatide (MTD) versus semaglutide (MTD), using data from the SURMOUNT-5 trial population. The modeled population were at risk of developing obesity-related complications including cardiovascular disease (CVD) and obstructive sleep apnea (OSA), amongst others. These outcomes were modeled using cardiometabolic parameters including weight, systolic blood pressure, high-density lipoprotein, glycated hemoglobin (HbA1c) and total cholesterol, by assessing their impact on healthcare and wider societal costs, quality of life, and mortality. Incremental cost-effectiveness ratios (ICERs; cost/quality-adjusted life year [QALY]) and incremental net health benefit (iNHBs) were calculated, and uncertainty was assessed through sensitivity and scenario analyses. RESULTS: Tirzepatide (MTD) was estimated to be less costly and more efficacious compared to semaglutide (MTD) with per patient cost savings of $41,688, 0.506 QALYs gained and positive iNHB of 0.784, indicating a net health benefit for tirzepatide. The model predicted that per 1,000 patients, 70 fewer patients will develop T2D, 10 fewer will develop CVD with tirzepatide (MTD) and patients spend 3.07 more years living with moderate/severe OSA when treated with semaglutide (MTD). CONCLUSION: Based on this simulation model, using head-to-head SURMOUNT-5 trial data, tirzepatide (MTD) had lower total costs and higher QALYs compared to semaglutide (MTD). This supports that tirzepatide (MTD) is a cost-effective treatment option for individuals with obesity or overweight compared to semaglutide (MTD). This study focused on evaluating the cost-effectiveness of two weight management drugs, tirzepatide and semaglutide, for adults in the US who are overweight or have obesity. Using data from the SURMOUNT-5 trial, the analysis showed that tirzepatide was more effective and less costly, providing better weight loss and health benefits compared to semaglutide.The findings revealed that for every 1,000 individuals treated with tirzepatide, there were 70 fewer cases of type 2 diabetes and 10 fewer cases of heart disease compared to those treated with semaglutide. Additionally, patients on semaglutide experienced a longer duration living with moderate or severe sleep apnea. The study highlighted that tirzepatide led to greater improvements in reducing weight and returning blood sugar levels to normal. Over a lifetime, tirzepatide was found to save $41,688 per patient and provide an additional 0.5 quality-adjusted life years (QALYs; a measure that helps compare how much different treatments improve both length and quality of life), emphasizing its advantages both financially and health-wise.Tirzepatide also demonstrated a reduction in absenteeism (when people are not at work because of illness or health problems) and presenteeism (when people are at work but not fully productive because they are unwell), meaning fewer days lost from work compared to semaglutide, thus highlighting productivity benefits. Overall, the research supports that tirzepatide offered a more cost-effective and beneficial treatment option for weight management in the US healthcare context compared to semaglutide.
24 Apr 2026
Read appraisal →PloS one
Hepatitis C distribution across diverse population groups in the Eastern Mediterranean Region: An umbrella review
BACKGROUND: Hepatitis C virus (HCV) remains a major public health challenge in the Eastern Mediterranean Region (EMR), with prevalence varying across population groups. This umbrella review summarizes the distribution of HCV infection across diverse populations in the region. METHODS: We conducted an umbrella review of systematic reviews with meta-analyses reporting HCV prevalence in the EMR. PubMed, Web of Science, Scopus, Iranian databases, including Magiran and the Scientific Information Database (SID), were searched. Google Scholar was additionally screened to ensure comprehensive coverage. Pooled estimates were extracted across four population groups: apparently healthy individuals; those with clinical or healthcare-associated exposure risk; patients co-infected with hepatitis viruses or other liver-related diseases; and key populations at increased risk (groups disproportionately affected due to their behaviors and higher vulnerability). For time-period analyses, meta-analyses were grouped into two intervals (before 2015 vs. 2015 and after) based on the median year of data collection of primary studies. Pooled prevalence was calculated using a random-effects model in STATA version 17. RESULTS: A total of 55 meta-analyses were included. The pooled HCV prevalence was 31.0% (95% CI: 27.0-38.0) among key populations, and also 31.0% (95% CI: 12.0-49.0) among patients co-infected with other hepatitis viruses or liver-related diseases. Those with clinical or healthcare-associated exposure risk showed a prevalence of 28.0% (95% CI: 23.0-32.0), whereas the apparently healthy population had the lowest prevalence at 2.0% (95% CI: 1.0-2.0). Subgroup analysis indicated a decline in prevalence among clinically exposed populations after 2015, from 29% to 10%, coinciding with the direct-acting antivirals (DAAs) and strengthened infection-control practices. The highest prevalence was observed among key populations in Libya, healthcare-exposed populations in Morocco, and apparently healthy individuals in Egypt. CONCLUSION: Variation in HCV prevalence across populations in the EMR highlights the need for population-specific strategies to support progress toward World Health Organization elimination targets.
24 Apr 2026
Read appraisal →Journal of medical Internet research
Exploring Patient Perspectives on the Use of Artificial Intelligence to Inform Joint Decision-Making for Patients With Multiple Conditions in Primary Care in the United Kingdom: Qualitative Study
BACKGROUND: Multimorbidity, living with 2 or more long-term health conditions, is increasing globally and now affects over one-quarter of adults in England. People with multiple long-term conditions (MLTC) face complex health and treatment challenges, often experiencing fragmented care within systems oriented toward single-disease management. Artificial intelligence (AI) has the potential to support clinicians and patients by analyzing complex health data, optimizing treatment strategies, and predicting disease trajectories. OBJECTIVE: The OPTIMAL (Optimizing Therapies, Disease Trajectories, and AI-Assisted Clinical Management for Patients Living with Complex Multimorbidity) project aims to develop AI-enabled tools to support shared decision-making in primary care. This study explored how patients with MLTC perceive the use of AI to inform joint decision-making in primary care. METHODS: Semistructured interviews were conducted via telephone or video call with 29 adults living with MLTC between July and November 2023. Participants were recruited through general practitioner practices via the Clinical Practice Research Datalink and community-based organizations across the West Midlands. Interviews were transcribed verbatim and analyzed thematically using an inductive approach. Members of a patient advisory group were involved in developing study materials, refining the interview guide, and reviewing emerging findings to ensure relevance and authenticity. RESULTS: Participants identified potential benefits of AI in enhancing consultation efficiency and accuracy, improving access to information for patients and clinicians, promoting early detection of health changes, and reducing health care inequalities. However, concerns were raised about the loss of human interaction, data privacy and security, transparency of algorithms, and the potential for bias and inequity in AI systems. Trust and acceptance varied by age and familiarity with technology. Some participants expressed uncertainty about what AI entails and how it could be used in primary care. CONCLUSIONS: Patients with MLTC viewed AI-assisted decision-making in primary care with cautious optimism. While many recognized potential benefits for coordination and personalization of care, others expressed reservations about privacy, fairness, and the risk of diminished human connection.
24 Apr 2026
Read appraisal →JMIR formative research
Multimodal Sentiment and Emotion Analysis Framework for Personalized Health Coaching Messages: Proof-of-Concept Study
BACKGROUND: Text generation approaches in health care communication have evolved along 2 major paths. The first path involves generative adversarial networks, progressing from basic architectures to specialized variants like Text-to-Text Generative Adversarial Network (TT-GAN) and Time and Frequency Domain-Based Generative Adversarial Network (TF-GAN), which address challenges in discrete text generation through techniques such as Gumbel-Softmax and reinforcement learning. The second path emerges from transformer-based architectures, particularly Generative Pretrained Transformer-2 (GPT-2), which uses extensive pretraining and self-attention mechanisms to generate contextually appropriate text. GPT-2's transformer architecture enhances persuasive health communication by generating personalized messages using various strategies like task support, dialogue support, and social support for effective health interventions. OBJECTIVE: This study aimed to use GPT-2 as a generative method to construct persuasive text in a dataset and compare the performance of sentiment analysis and emotion detection analysis. METHODS: We combined sentiment analysis tools (VADER [Valence Aware Dictionary and Sentiment Reasoner] and TextBlob) with emotion detection methods (Text2Emotion and NRCLex [National Research Council Lexicon]) to analyze health coaching messages across different persuasive types: reminder, reward, suggestion, and praise. RESULTS: TextBlob and VADER achieved accuracies of 57% and 69%, respectively, while RoBERTa (robustly optimized BERT approach)-sentiment outperformed them with an accuracy of 88%. Emotion detection showed a high prevalence of "joy" and "happy" labels (93.69% positive skew). While transformers excel in accuracy, lexicon-based models like VADER offer a better performance-efficiency balance for real-time health communication systems. For emotion detection, all categories showed perfect accuracy (1.0), while trust showed mixed results, with precision, recall, and F1-score values ranging from 0.81 to 0.96. The emotion detection analysis revealed varying success rates across different emotions, with some categories, such as anger and neutral, showing reasonable performance and others, such as trust, showing mixed performance. CONCLUSIONS: This research contributes to understanding the emotional dynamics of persuasive health communication and highlights both the capabilities and limitations of current natural language processing tools in analyzing health-related persuasive messaging. This proof-of-concept study using synthetically generated data establishes a methodological framework for multimodal sentiment and emotion analysis. The findings require validation with real-world health coaching messages before clinical deployment.
24 Apr 2026
Read appraisal →European journal of preventive cardiology
i-CARE: a smartphone-based intervention to enhance cardiac rehabilitation in coronary artery disease-a randomized controlled trial
AIMS: The global shortage of healthcare professionals creates challenges in managing chronic diseases. This study evaluated a remotely delivered, theory-based self-care support intervention, 'Internet-based CArdiac Rehabilitation Enhancement (i-CARE)', delivered through a smartphone application to enhance self-management in patients with coronary artery disease (CAD). METHODS AND RESULTS: In this assessor-blinded, two-arm randomized controlled trial conducted at two regional hospitals in Hong Kong, community-dwelling adults with angiographically confirmed CAD were randomly assigned (1:1) to standard care or the i-CARE intervention. i-CARE included personalized risk assessment, skill-building, and app-based support to improve self-care behaviours. The primary outcome was change in CAD self-care behaviours; secondary outcomes were self-reported health status, health-related quality of life (HRQoL), physiological, and biomarkers. Of 294 participants randomized (n = 147 per group), the i-CARE group showed significant greater improvements in self-care maintenance [β = 4.055, 95% confidence interval (CI) 1.420-6.691, P = 0.003] and self-care confidence (β = 5.609, 95% CI 1.089-10.129, P = 0.015) at 3 months, sustained at 6 months. For secondary outcomes, the intervention also resulted in significant reductions in systolic (β = -3.725, 95% CI -7.322 to -0.128, P = 0.042) and diastolic (β = -2.153, 95% CI -4.228 to -0.079, P = 0.042) blood pressure and improvements in HRQoL at 3 months (β = 0.208, 95% CI 0.073-0.343, P = 0.003), with persistent benefits for diastolic blood pressure and HRQoL sustained at 6 months. No significant differences were observed for cardiac-specific health status, blood glucose, lipid profile, or waist-to-height ratio. CONCLUSION: Remotely delivered i-CARE intervention effectively promote self-care among CAD patients and may help address critical healthcare workforce shortages, while also conferring secondary benefits in blood pressure and HRQoL. Cardiac rehabilitation is a comprehensive management approach with proven clinical benefits to delay disease progression. However, the participation rate in cardiac rehabilitation remains low due to common barriers such as time constraints and need for transportation to centres. Mobile health applications offer innovative solutions to overcome these barriers providing multidimensional support to meet the complex needs of coronary artery disease (CAD) patients and enhance their self-management capabilities. This study aimed to evaluate the effects of an internet-based Cardiac Rehabilitation Enhancement (i-CARE) intervention among community-dwelling adults with angiographically diagnosed CAD to enhance self-care behaviours. The findings showed promising potential of digital health interventions to improve self-care behaviours, blood pressure control, and health-related quality of life in CAD patients.
24 Apr 2026
Read appraisal →JMIR medical informatics
Modeling Diabetes Risk and Progression With Public Health Data: Ontology-Guided, Simulation-Capable Digital Twin Study
BACKGROUND: Digital twins (DTs) offer a paradigm for health care by enabling data-driven, simulation-capable representations of individual health trajectories. However, DT development remains limited by the scarcity of standardized, temporally structured, and multidomain data suitable for modeling chronic disease progression. Most existing DT studies rely on narrowly scoped or proprietary datasets, restricting generalizability. Public health datasets, such as the Midlife in the United States study, provide rich biopsychosocial information but are underused due to structural complexity and lack of semantic integration frameworks. OBJECTIVE: This study aimed to develop and evaluate an ontology-guided, agent-orchestrated framework for constructing offline, simulation-capable, and progression-aware DTs from public health datasets. Using diabetes as a case study, the framework integrates agent-based orchestration, medical ontologies, and large language model (LLM)-assisted semantic reasoning with machine learning to support explainable feature structuring, risk prediction, and predictive "what-if" progression analysis. METHODS: A 6-stage DT framework was developed and applied to Midlife in the United States wave 2 (baseline) and wave 3 (follow-up) data. Ontology- and LLM-assisted feature selection identified predictors across biological, behavioral, psychosocial, and socioeconomic domains. Cleaned and harmonized data were used to train predictive models (random forest, eXtreme gradient boosting, and logistic regression) to estimate diabetes onset at follow-up. A state-transition simulator was implemented to model between-wave progression dynamics, quantify transitions across low-, medium-, and high-risk states, and evaluate predictive "what-if" scenarios such as weight reduction and lifestyle improvement. Model performance was assessed using accuracy, F1 score, area under the receiver operating characteristic curve (AUC), and calibration metrics. RESULTS: From 9976 candidate variables, ontology- and LLM-guided selection retained the top 200 relevant predictors spanning biological, behavioral, psychosocial, and socioeconomic domains. Predictive modeling achieved strong discrimination, with random forest (AUC=0.82, accuracy=0.76) and eXtreme gradient boosting (AUC=0.81, accuracy=0.75) outperforming logistic regression (AUC=0.78). The state-transition simulator reproduced realistic progression patterns: 33.9% (1414/4174) of participants changed risk states between waves, and the high-risk group increased from 10.8% (451/4174) to 32.2% (1344/4174). Next-state prediction accuracy reached 92.5%. Predictive "what-if" analyses showed that with a simulated 10% weight reduction, model-estimated diabetes cases decreased by 98 (from 576 to 478). A placebo test (0% weight change) produced less than 0.3% difference in risk distribution, confirming model stability. CONCLUSIONS: This study presents a foundational, ontology-guided, and agent-orchestrated framework for constructing offline, simulation-capable, and progression-aware DTs from public datasets. By combining semantic reasoning, multidomain predictors, and predictive "what-if" progression simulation, the framework transforms static population data into longitudinal, interpretable representations of individual health trajectories. The proof-of-concept application to diabetes demonstrates that public health data can support robust and explainable DT models for exploratory risk analysis and hypothesis generation, without implying causal intervention effects or direct clinical decision support.
24 Apr 2026
Read appraisal →European journal of preventive cardiology
Aerobic exercise and cardiovascular outcomes in patients with diabetes undergoing percutaneous coronary intervention: a nationwide population-based study
AIMS: We investigated the impact of aerobic exercise on clinical outcomes in patients with diabetes undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: We analyzed a nationwide prospective population database from the Korean National Health Insurance System. We included 8225 patients with diabetes who had undergone PCI and documented their aerobic exercise habits before and after the procedure (mean interval: 2.0 years). The patients were categorized into four groups: persistent non-exercisers, new exercisers, exercise discontinuers, and exercise maintainers. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction, revascularization, and heart failure. We assessed the risk of clinical events using inverse probability-weighted Cox proportional hazards models. During a mean follow-up of 4.9 years, exercise maintainers, discontinuers, and new exercisers were associated with a significantly lower risk of MACE compared to non-exercisers. The lowest risk was observed in exercise maintainers (maintainers: aHR, 0.78; 95% CI: 0.71-0.86; discontinuers: aHR, 0.88; 95% CI: 0.79-0.98; new exercisers: aHR, 0.89; 95% CI: 0.80-1.00). A J-curve relationship between the amount of aerobic exercise and adverse clinical outcomes was observed, with the lowest risk identified at 1000-1499 MET-min/week. Benefits diminished with exercise intensity ≥1500 MET-min/week. CONCLUSION: Aerobic exercise maintenance after PCI was associated with a reduced risk of cardiovascular events in patients with diabetes, with a moderate amount of exercise providing maximal benefit. Therefore, aerobic exercise is advisable for patients with diabetes undergoing PCI, and the optimal exercise dosage warrants further research. LAY SUMMARY: This large-scale prospective population study, based on the Korean National Health Insurance System, demonstrated that maintaining aerobic exercise in patients with diabetes undergoing percutaneous coronary intervention is significantly associated with a lower risk of cardiovascular events.A J-curve relationship was observed between the amount of aerobic exercise and clinical outcomes, with the lowest risk observed at 1000-1499 MET-min/week for both new exercisers and the entire study population.However, exercising beyond 1500 MET-min/week offers diminishing returns, highlighting the need for balanced exercise intensity.
24 Apr 2026
Read appraisal →ACS applied materials & interfaces
Flexible, Scalable SERS Substrate with High Sensitivity and Stability for On-Site Detection and Wearable Applications
A key challenge in the commercialization of surface-enhanced Raman scattering (SERS) technology is the scalable and controllable preparation of substrates that simultaneously achieve high sensitivity, uniform signal distribution, excellent reproducibility, and long-term stability. In this study, we report a flexible SERS substrate based on a porous, high-surface-energy nanofilm, designed to serve as a spatially confined template for the uniform growth of silver nanoparticles (AgNPs). This substrate exhibits outstanding SERS performance with an enhancement factor (EF) of 2.05 × 1010 and a detection limit (DL) as low as 1.74 × 10-15 M for rhodamine 6G (R6G). The preparation process is mild, highly reproducible (RSD = 8.53% over 60 consecutive batches), and scalable to 25 cm2 areas. Moreover, the substrate maintains its SERS activity for over three months within a vacuum bag at room temperature. Owing to its excellent adhesion and good flexibility, the substrate can adhere effectively to complex surfaces. The substrate was successfully applied to sensitive in situ detection of trace thiram residues on grape surfaces, achieving a detection limit (DL) of 8.51 × 10-10 g cm-2. Additionally, a wearable sensor was developed based on the substrate and used for the noninvasive monitoring of uric acid levels in human sweat, with a DL of 2.95 × 10-7 M. This work provides a practical strategy for constructing high-performance, scalable, and flexible SERS substrates, advancing their potential for real-time, on-site analysis.
23 Apr 2026
Read appraisal →European journal of preventive cardiology
Comparison of patient characteristics and health outcomes between self-selected centre-based cardiac rehabilitation and hybrid cardiac telerehabilitation: a prospective cohort study
AIMS: Data on self-selected modes of delivery of cardiac rehabilitation (CR) are limited. This study compared centre-based CR (cbCR) with hybrid cardiac telerehabilitation (hCTR) in terms of patient characteristics, change in physical and mental functioning, and achievement of guideline-directed treatment targets. METHODS AND RESULTS: From May 2022 to December 2023, consecutive patients with cardiovascular diseases were enrolled at a tertiary centre into a 3 month cbCR or hCTR programme based on shared decision-making. Changes in exercise capacity, anxiety, depression, and health-related quality of life (hrQoL) scores from admission to the discharge visit were compared between CR modalities. The achievement of two-step blood pressure and LDL-cholesterol (LDL-C) goals, as well as the HbA1c goal in patients with diabetes at the discharge visit, was compared between CR modalities. Out of 1292 patients screened, 406 (21% females, age 60.4 ± 12.7 years) were eligible and completed the study. Of those, 72% chose cbCR and 28% chose hCTR. Patients in hCTR were 3 years younger and exhibited higher baseline peak VO2 (91 vs. 80% of predicted), better hrQoL, and lower depression and anxiety scores. No significant differences were found in improvements in physical or mental functioning or in meeting blood pressure and HbA1c targets between the two groups. A smaller proportion of hCTR participants achieved the LDL-C Step I target (56 vs. 69% in cbCR). CONCLUSION: Overall, hCTR attracted slightly younger patients with better baseline health, but both modalities showed similar effects on most health outcomes. Centre-based cardiac rehabilitation was associated with tighter lipid control, which could be related to more intense counselling or patient preference. Outpatient cardiovascular rehabilitation was equally effective when performed with thrice weekly supervised exercise training sessions or partly performed at home while monitored with fitness trackers and a biosensor vest. Patients who self-select digitally monitored home training were slightly younger, fitter, and had better quality of life with lower levels of anxiety and depression. Blood lipid control, weight loss, and smoking cessation therapies need to be enhanced by tighter control and more intensive medical therapy particularly in patients choosing to perform part of the exercise sessions at home.
23 Apr 2026
Read appraisal →PloS one
A hybrid CNN-XLSTM-GRU deep learning model with autoencoder-based feature selection for hypothyroidism diagnosis.
Hypothyroidism, caused by reduced thyroid-hormone production, is often difficult to diagnose because its symptoms are non-specific and overlap with other disorders. We developed FusionNet-CXG, a hybrid deep-learning model that couples CNN, eXtended LSTM, and GRU components for hypothyroidism prediction. Experiments were performed on a public dataset (3,772 records; 30 features). Class imbalance was mitigated using SMOTE-NC, and performance was estimated using 10 repetitions of 5-fold stratified cross-validation, yielding 50 fold-level evaluations to obtain stable results. Across folds, FusionNet-CXG achieved 0.9394 mean accuracy, F1 = 0.906, and AUC-ROC = 0.94, and it exceeded CNN+LSTM and CNN + BiLSTM baselines under the same protocol. The results indicate that combining local feature extraction with recurrent modelling is effective for this task. To support interpretability, SHAP was used to quantify feature influence on the predictions. Future work will focus on external validation using more diverse real-world cohorts and incorporating temporal clinical data to improve clinical relevance.
23 Apr 2026
Read appraisal →Journal of Korean medical science
Association Between Changes in Socioeconomic Status Before and After Human Immunodeficiency Virus Infection Diagnosis and Mortality Rates in Korea
BACKGROUND: This study investigated changes in medical insurance status as a surrogate marker of socioeconomic status after human immunodeficiency virus (HIV) infection, and their association with mortality among people living with HIV in Korea. METHODS: This study included 13,112 individuals newly diagnosed with HIV between 2004 and 2018, identified from the claims data of the National Health Insurance System-National Health Information Database. Participants' medical insurance status was categorized into National Health Insurance (NHI) and medical aid (MA). Using the Cox proportional hazards model, the association between mortality and changes in medical insurance status before and after HIV infection diagnosis was assessed using hazard ratios (HRs) and confidence intervals (CIs). RESULTS: The insurance coverage rates before HIV diagnosis were 95.1% and 4.9% for NHI and MA recipients, respectively. After diagnosis, the insurance coverage rates were 13.4% and 86.6% for MA and NHI recipients, respectively, demonstrating a threefold increase in the proportion of MA recipients. The conversion rate from NHI to MA was highest in the 35-44 and 45-54-year age groups at HIV infection diagnosis (32.9% and 29.4%, respectively). Compared with NHI recipients, the HR was significantly higher among individuals that transitioned from NHI to MA (HR, 1.66; 95% CI, 1.39-1.97) and individuals that remained on MA (HR, 1.74; 95% CI, 1.40-2.18), suggesting a higher mortality rate in these groups. CONCLUSION: In Korea, where highly active antiretroviral therapy is essentially free of charge, a significant association was observed between a decline in medical insurance status following HIV diagnosis and increased mortality.
23 Apr 2026
Read appraisal →JMIR formative research
Effects of a Modified Exposure Claim for an e-Cigarette on Claim Comprehension, Behavioral Intentions, and Risk Perceptions Among US Adult Tobacco Users and Nonusers: Randomized Experimental Study
BACKGROUND: Effective communication about the relative risks of cigarettes and e-cigarettes can help increase switching away from cigarettes while minimizing unintended use. OBJECTIVE: This study examined comprehension of a proposed modified exposure claim (MEC) about an e-cigarette (IQOS VEEV, the study product [SP]) and the effects of claim exposure on SP use intentions and risk perceptions among adult tobacco users and nonusers. METHODS: Adult smokers with no intention to quit smoking (S-NIQ, n=606), adult smokers with an intention to quit smoking (S-IQ, n=600), adult e-cigarette users (ECU, n=630), adult former smokers (FS, n=619), adult tobacco and nicotine products (TNP) never-users aged 18-24 years (n=648), and adult TNP never-users aged 25 years and older (n=749; total N=3852) participated in a randomized between-groups online experimental study. Participants viewed a marketing brochure for the SP with (test condition) or without (control condition) an embedded MEC. Outcome measures included claim comprehension, intention to use the SP regularly, and perceived health risk to self from using the SP or smoking cigarettes. RESULTS: Most participants were female (n=2110, 54.8%), had a mean age of 40.2 (SD 14.93) years, and were equally split across the 4 US regions. S-IQ and S-NIQ were long-term, frequent cigarette smokers, while 91.4% (566/619) of FS were long-term quitters. ECU on average used e-cigarettes ≥15.2 times per day, and the majority of them (552/630, 87.6%) had started using e-cigarettes more than 12 months before. Most participants correctly understood the key elements of the claim: the SP produces lower levels of harmful chemicals compared to cigarettes (1818/1926, 94.4%), and switching completely from cigarettes to the SP reduces exposure to harmful chemicals (1832/1926, 95.1%). In both conditions, positive intention to use the SP was high among ECU (control: 238/314, 75.8% vs test: 249/315, 79%; P=.33), moderate among S-IQ (control: 127/299, 42.5%; test: 166/299, 55.5%; P<.001) and S-NIQ (control: 140/299, 46.8%; test: 166/307, 54.1%; P=.07), low among FS (control: 28/306, 9.2%; test: 33/312, 10.6%; P=.55), and very low among adult TNP never-users aged 18-24 years (control: 3/330, 0.9%; test: 8/318, 2.5%; P=.11), and adult TNP never-users aged 25 years and older (control: 5/373, 1.3% vs test: 12/375, 3.2%; P=.09). All groups understood that the SP posed a lower health risk compared to cigarettes. In all groups, claim exposure was associated with significantly lower risk perception of the SP relative to cigarettes (all comparisons, P<.001). CONCLUSIONS: The tested MEC has the potential to benefit public health by simultaneously increasing already high levels of SP use intention and reducing SP risk perceptions relative to cigarettes among adult tobacco users while generating low levels of use intention among tobacco nonusers.
23 Apr 2026
Read appraisal →Journal of rehabilitation medicine
Effect of inspiratory muscle training on inspiratory muscle strength in adults with post-COVID-19 condition and inspiratory muscle weakness: a randomized controlled trial
OBJECTIVE: Evaluate the effect of inspiratory muscle training in adults with post-COVID-19 condition (PCC) and inspiratory muscle weakness. DESIGN: Randomized controlled trial. SUBJECTS/PATIENTS: Adults with PCC and inspiratory muscle weakness. METHODS: Participants were randomized to inspiratory muscle training twice daily plus individualized exercise twice weekly or exercise alone, with weekly follow-ups over 8 weeks. PRIMARY OUTCOME: inspiratory muscle strength (Maximal Inspiratory Pressure). SECONDARY OUTCOMES: expiratory muscle strength (Maximal Expiratory Pressure); functional capacity (Six‑Minute Walk Test; One‑Minute Sit‑to‑Stand); lung function (spirometry); dyspnoea (mMRC); respiratory symptoms (chest tightness, impaired deep breathing, breathing‑related pain); cough frequency (CAAT cough item); fatigue (Fatigue Severity Scale); physical activity (Frändin-Grimby Activity Scale); activity limitations (Patient‑Specific Functional Scale); and health-related quality of life (EQ‑5D‑5L). Intention-to-treat analyses used imputed missing data. Estimated sample size: 90. RESULTS: Forty-four participants were included (median age 47; 82% women; n = 22/group). Between‑group differences favoured the intervention for inspiratory muscle strength (mean difference: 18%; 95% CI: 5-30; OR for clinically meaningful improvement: 7.08, 95% CI: 1.31-38.32) and cough frequency. No other between-group differences were observed. CONCLUSION: Inspiratory muscle training may improve inspiratory muscle strength and reduce cough frequency, but limited sample size and underrepresentation of the most severely affected warrant cautious interpretation.
23 Apr 2026
Read appraisal →PloS one
An AI-based chatbot to support health-related social needs among pediatric primary care population: Protocol for a pilot randomized controlled trial
Unmet health-related social needs (HRSNs) are major drivers of poor health outcomes in early childhood. Children with unmet HRSNs are at greater risk for developmental delays, caregiver stress, and increased healthcare utilization, yet current screening approaches in pediatric primary care are resource-intensive and inconsistently implemented. AI-powered chatbots (conversational agents or virtual assistants) may offer a private, secure, scalable, and cost-effective alternative for identifying unmet needs and connecting families to services. This protocol describes a pilot randomized controlled trial designed to evaluate the feasibility, acceptability, and usability of DAPHNE, an AI-driven chatbot developed to facilitate the identification of unmet HRSNs and provide personalized community resource referrals. One hundred caregivers of children under two years of age will be recruited from Nationwide Children's Hospital pediatric primary care clinics and randomized to either the standard care (control) group or DAPHNE+ Standard care (intervention) group (n = 50 each arm). Caregivers will complete surveys at baseline, 1 month, 3 months, and 6 months post-intervention (depending on the measure). For the intervention group, participants will receive weekly chatbot prompts and on-demand access throughout the 6-month study period. Primary outcomes include study feasibility (recruitment, retention, and survey completion across both arms), acceptability (caregiver-reported ratings in both arms and intervention-specific ratings), and usability of the DAPHNE chatbot (System Usability Scale among intervention participants). Secondary outcomes includes caregiver-reported outcome measures (caregiver stress, self-efficacy, satisfaction with resource access, quality of life), and electronic health record-derived measures (including documentation of HRSN screening and referrals, adherence to well-child visits, missed appointments, emergency department utilization, and estimated healthcare costs). In addition, ten primary care providers will also participate to assess workflow integration and report on current HRSN practices. Mixed-methods analyses will integrate survey data, chatbot engagement metrics, and qualitative interviews to refine both the intervention and the study protocol. The results of this study will inform the design of a future multi-site trial to evaluate the efficacy and implementation of DAPHNE for addressing HRSNs in pediatric primary care. Trial registration: NCT07168382.
23 Apr 2026
Read appraisal →JMIR research protocols
WhatsApp-Led mHealth Intervention for Hypertension Management Among Adults Aged 40 to 59 Years in Kerala, India: Protocol for a Mixed Methods Study
BACKGROUND: Medication adherence and lifestyle modification remain key in the management of hypertension. Leveraging mobile technologies to improve patient adherence has been found to be effective in chronic disease management. Given the high mobile penetration and the opportunities it provides for encouraging lifestyle modification, an app such as WhatsApp, which is a free-to-use and real-time messaging platform, could facilitate patient-clinician interactions. We present a protocol for a WhatsApp-led mobile health (mHealth) intervention to improve adherence to medication and healthy lifestyles among adults aged 40 to 59 years in Kerala, India. OBJECTIVE: The study aims to assess the impact of the WhatsApp-led mHealth strategy on blood pressure measures and adherence to medication and lifestyle modification. The study also focuses on exploring participants' views on feasibility, facilitators, and challenges, as well as their intention to use this WhatsApp-led mHealth strategy. METHODS: The study will follow a multiphase mixed methods (sequential explanatory) design with an initial quantitative phase (quasi-experimental study design) followed by a qualitative phase (phenomenological approach). Multistage cluster sampling will be adopted. Using a survey checklist and blood pressure measurements, community-dwelling adults aged 40 to 59 years will be screened for hypertension. Approximately 120 participants with hypertension will be assigned each to the intervention and control arms. All the participants will be advised to follow routine hypertension care from health care providers. Additionally, participants in the intervention arm will receive regular health messages and reminders over WhatsApp. A baseline survey will be conducted at enrollment, and a follow-up survey will be conducted after 3 months at the end of the intervention. The qualitative phase will involve follow-up interviews. Participants will be selected through quota sampling from those with the lowest and highest adherence to medication and lifestyle modification after receiving the intervention. Statistical analysis for survey data and thematic analysis for qualitative data will be conducted. RESULTS: The study received ethics approval (IHEC/CUK/2024/04) from the Institutional Human Ethics Committee of the Central University of Kerala. All 240 participants were recruited by July 2025. The study completed data collection in August 2025 and is expected to finish data analysis by April 2026. The study results are expected to be submitted for publication in July 2026. CONCLUSIONS: The study will be a potential strategy to address nonadherence to treatment and lifestyle regimens, which is a critical bottleneck to controlling hypertension and preventing complications. The study could be proof for a WhatsApp-led mHealth strategy that can be integrated into hypertension management at the community level, especially for improving hypertension awareness and reminders for behavior change.
22 Apr 2026
Read appraisal →JMIR infodemiology
Cross-Sectional Evaluation of Medical Disinformation Safeguards in Consumer-Facing Large Language Model Platforms
This cross-sectional evaluation of six consumer-facing large language model platforms found significant heterogeneity in safeguard performance against the generation of health disinformation, with Claude and ChatGPT demonstrating complete resistance across all prompt types, while Copilot, Meta AI, Grok, and Gemini exhibited substantial vulnerabilities.
22 Apr 2026
Read appraisal →The aging male : the official journal of the International Society for the Study of the Aging Male
The effect of dutasteride on storage symptoms in men with lower urinary tract symptoms: a REDUCE trial analysis
BACKGROUND: Dutasteride is used to treat voiding symptoms; its impact on storage symptoms is unclear. METHODS: We reviewed 8122 men in the placebo and dutasteride arms from the REDUCE trial. Lower urinary tract symptoms outcomes were measured with international prostate symptom score and subscores. RESULTS: At 2-year follow-up, dutasteride significantly reduced the total International Prostate Symptom Score and voiding subscore versus placebo (both p < 0.001), but not storage symptoms (p = 0.09) or nocturia (p = 0.2). By 4 years, improvements in the total score and voiding subscores remained, but now extended to storage symptoms (p < 0.001) and nocturia (p = 0.003), though the impact on storage symptoms was modest (0.62 points improvement). CONCLUSION: While dutasteride reduces storage symptoms, it takes several years, and the overall effect is modest and unlikely to be clinically meaningful. Timely, comprehensive lower urinary tract symptoms management may require additional therapy.
22 Apr 2026
Read appraisal →PloS one
Global folate deficiency among adolescent girls: A systematic review and meta-analysis
INTRODUCTION: Adolescents have higher nutrient requirements than adults, as this stage accounts for approximately 40% of total adult weight gain, 45% of skeletal mass and about 15% of adult height. Adequate micronutrient intake is particularly essential for adolescent girls to support growth, reproductive health, and cognitive development. Adolescent folate deficiency disrupts hematopoiesis, causing megaloblastic anemia, and hinders growth, cognition, and immune function and becoming a major public health concern. OBJECTIVE: This global systematic review and meta-analysis aims to address the gap in comprehensive evidence on the prevalence of adolescent folate deficiency. METHODS: This systematic review was conducted and reported according to PRISMA guidelines. We conducted a systematic literature search in PubMed, HINARI, Science Direct, DOAJ, Google, and Google Scholar for studies reporting the prevalence of folate deficiency among adolescent girls up to August 2025. Study quality was assessed using the Newcastle-Ottawa Scale, and evidence certainty was evaluated using GRADE. Pooled prevalence estimates with 95% confidence intervals were calculated using a random-effects model (DerSimonian-Laird method). Heterogeneity was assessed with Cochrane Q and I² statistics. Publication bias was evaluated through visual inspection of funnel plots and Egger's regression test, and adjusted estimates were calculated using the trim-and-fill method. Meta-regression analyses were conducted to explore potential sources of heterogeneity. Sensitivity analyses were performed to assess the robustness of pooled estimates. RESULTS: The search strategy identified 1,498 records, of which 26 studies met the eligibility criteria and were included in this systematic review and meta-analysis. The pooled global prevalence of folate deficiency among adolescent girls was 26.9%(95% CI: 20.5-33.2), with substantial heterogeneity observed between studies (I² = 99.99%, p < 0.001). On average across included studies, approximately one-quarter of adolescent girls were classified as folate deficient, though the true prevalence varied markedly between settings.. The pooled prevalence of folate deficiency among adolescent girls varied across regions, with the highest rate observed in Africa at 35.5%. CONCLUSION: These findings revealed folate deficiency as a substantial global public health concern among adolescent girls with a disproportionately high burden in low-resource settings. Region-specific strategies are urgently needed to prevent folate deficiency among adolescent girls, particularly in low-resource settings. Implementing targeted nutritional interventions and public health policies is essential to reduce its associated health consequences in this vulnerable population.
22 Apr 2026
Read appraisal →European journal of pediatrics
Different doses of vitamin A supplementation as adjuvant treatment for pneumonia in children: a network meta-analysis of randomized controlled trials
UNLABELLED: While previous meta-analyses have established a link between vitamin A supplementation and outcomes in children with pneumonia, the efficacy and safety of different dosing regimens remain unclear. Existing evidence is predominantly based on single-dose trials, creating a critical knowledge gap. We systematically searched PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang and VIP databases from their inception to December 2025. Study searches were independently carried out in December 2025 by two reviewers. Two researchers used the Cochrane risk of bias tool to independently assess the quality of the included studies. Data analysis was conducted through the "netmeta" package in R software (version 4.3.3). Twenty-five trials involving 3116 patients were included. Network meta-analysis revealed that medium-dose vitamin A supplementation was most effective in reducing the duration of fever and cough. Low-to-medium doses were consistently associated with better clinical outcomes than high-dose regimens. However, evidence regarding safety outcomes remained limited and inconclusive. CONCLUSION: Low-to-medium dose vitamin A supplementation appears superior to high-dose regimens for alleviating clinical symptoms in children with pneumonia. However, the evidence is limited by high heterogeneity, indirect comparisons between dose groups, and poor reporting of adverse events. Future trials should prioritize direct dose-comparisons and rigorous safety monitoring to refine dosing guidelines. WHAT IS KNOWN: • Pneumonia poses a significant threat to the health and lives of children. Vitamin A supplementation plays an adjuvant role in the treatment of pneumonia in children. • There are currently divergent conclusions in the research regarding the optimal dosage of vitamin A, particularly with regard to the safety of high-dose supplementation and the effectiveness of low-dose supplementation. WHAT IS NEW: • This study revealed that medium-to-low-dose vitamin A supplementation appears to be more effective than high-dose therapy in alleviating the primary symptoms of childhood pneumonia. • This study also suggests that children in developed regions have higher baseline serum retinol levels, which may diminish the marginal benefits of high-dose supplementation and may even predispose them to its immunosuppressive effects.
22 Apr 2026
Read appraisal →Journal of neurology
The association of night shift work with the risk of acute ischemic cerebrovascular syndrome: a longitudinal study of 204,261 UK Biobank participants
BACKGROUND: Shift work is highly prevalent globally, yet evidence linking it to ischemic cerebrovascular disease remains inconsistent. Existing studies are limited by unsystematic quantification of night shift exposure and outcome definitions failing to capture the clinical continuum of ischemic events. We performed a large prospective cohort study using refined shift pattern classification and acute ischemic cerebrovascular syndrome (AICS) as the primary end point to enable a robust evaluation of the association between shift patterns and ischemic cerebrovascular disease. METHODS: 204,261 participants with employment information from the UK Biobank were included. Cox proportional hazards regression was used to assess associations between current shift work and AICS risk, with cross-classification by shift status and job duration. We further quantified average lifetime night shift frequency and cumulative duration among participants with complete occupational histories. Transient ischemic attack (TIA) and ischemic stroke (IS) were analyzed separately to identify the main driver of AICS and potential heterogeneity. RESULTS: During a median follow-up exceeding 14 years, irregular shift work was significantly associated with elevated AICS risk (HR 1.118, 95% CI 1.019-1.227, P = 0.019), while always night shift work was not (HR 0.904, 95% CI 0.707-1.157, P = 0.423). AICS risk was driven by irregular shift patterns rather than duration. Lifetime night shift frequency and duration showed significant dose-response relationships with AICS. CONCLUSIONS: Irregular shift work increases AICS risk relative to non-shift work, and lifetime night shift exposure exhibits a clear dose-response effect. IS constitutes the primary driver of the composite AICS end point.
20 Apr 2026
Read appraisal →Blood pressure
Acupuncture for primary hypertension: a systematic review and meta-analysis of randomised controlled trials
OBJECTIVE: This systematic review and meta-analysis evaluated the efficacy and safety of acupuncture for primary hypertension, based on randomised controlled trials (RCTs) published between 2015 and 2024. METHODS: We searched seven major databases for RCTs comparing acupuncture to control interventions. The primary outcomes were changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Meta-analyses utilised random-effects models, and the Cochrane Risk of Bias tool assessed study quality. RESULTS: Seven RCTs (n = 812) were included. Acupuncture was associated with lower SBP [mean differences (MD) = -6.73 mmHg, 95% confidence interval (CI): -8.84 to -4.62] and DBP (MD = -6.59 mmHg, 95% CI: -9.42 to -3.76). Heterogeneity was substantial for SBP (I2 = 73.3%) and considerable for DBP (I2 = 90.9%). Notably, the SBP analysis included seven studies, whereas the DBP analysis included six studies, and the similar absolute pooled reductions should be interpreted cautiously, given the small and not fully overlapping study sets. Exploratory subgroup analyses suggested blood pressure reductions across several acupuncture modalities, though each subgroup contained very few studies. Adverse-event reporting was limited and inconsistent across studies. Formal tests for publication bias were underpowered given the small number of included studies. CONCLUSIONS: Acupuncture may have blood pressure-lowering effects in patients with primary hypertension, but the evidence is limited by substantial heterogeneity, a small number of studies and considerable variation in intervention type and exposure. Larger, well-designed, multi-centre RCTs with standardised protocols and longer follow-up are needed to confirm these findings and establish optimal treatment parameters. High blood pressure (hypertension) is a major health concern worldwide. Acupuncture, a component of traditional Chinese medicine, has been used to manage blood pressure, but evidence of its effectiveness remains limited. This review examined seven recent randomised controlled trials involving 812 participants to assess whether acupuncture reduces blood pressure in people with primary hypertension. The findings suggest that acupuncture may reduce both systolic and diastolic blood pressure; however, the included studies were few and varied considerably in the type of acupuncture used, the number of treatment sessions (ranging from a single session to 60 sessions over 12 weeks) and the populations studied. Reported side effects were minor, such as temporary pain at the needle site, though safety reporting was incomplete. Therefore, while the results are encouraging, they are not definitive. Further large-scale, rigorously designed trials are needed before firm conclusions can be drawn about the role of acupuncture in hypertension management.
20 Apr 2026
Read appraisal →Journal of medical Internet research
Facility-Level Associations Between Use of a Digital Health Platform for Voluntary Counseling and Testing and HIV Testing Outcomes in the Urban Primary Health Care Centers of Guangzhou, China: Cross-Sectional Study
BACKGROUND: WellTest, a digital health platform designed to facilitate HIV voluntary counseling and testing (VCT) services, has been widely implemented in Guangzhou, China. However, the extent of its use by primary health care centers (PHCs) and the facility-level associations between WellTest use and HIV testing outcomes remain unclear. OBJECTIVE: This study aimed to assess the use of WellTest at the facility level across PHCs in urban Guangzhou, China, and to explore the associations between WellTest use and HIV testing outcomes. METHODS: We obtained data on VCT services visits from the National HIV/AIDS Prevention and Control Information System and the WellTest platform between January 1 and December 31, 2022. Two facility-level HIV testing outcomes, the HIV testing volume and HIV positivity rate, were calculated for each PHC. A structured questionnaire collected data on the PHCs' characteristics. Multilevel negative binomial regression and zero-inflated gamma models were used to examine associations between WellTest use and 2 HIV testing outcomes at the facility level. RESULTS: A total of 81 PHCs across 5 urban districts in Guangzhou were included. WellTest was used for 7997 active consultations and 7969 HIV tests that resulted in 157 newly diagnosed HIV cases, for an overall positivity rate of 2.0%, during 2022. The median share of clients booking via WellTest was 71% (IQR 34%-98%), and 81% (66/81) of PHCs offered online slots on all service days without mandates. PHCs that actively confirmed appointments had significantly lower HIV testing volumes compared with those that took no actions after clients scheduled appointments (incidence rate ratio 0.75, 95% CI 0.58-0.97; P=.03) but exhibited higher HIV positivity rates (β=.39, 95% CI 0.02-0.76; P=.04). Additionally, PHCs where ≥50% of clients used WellTest to schedule appointments showed higher HIV positivity rates than those with lower uptake (β=1.11; 95% CI 0.82-1.40; P<.001). CONCLUSIONS: WellTest showed substantial use among VCT clients and providers in urban Guangzhou PHCs, with greater use of digital appointments and counselor follow-up linked to increased HIV positivity rates. Strategies to optimize institutional adoption may help address stigma-related barriers, strengthen engagement in HIV testing, and support HIV case finding in primary health care settings.
20 Apr 2026
Read appraisal →Medicine
Drug-associated insomnia: A pharmacovigilance study based on FDA adverse event reporting system.
Insomnia has become an increasingly serious public health issue with complex causes, among which medications act as a significant factor. This study aims to systematically detect and evaluate drug adverse event signals associated with insomnia risk using the Food and Drug Administration Adverse Event Reporting System (FAERS) database. The analysis utilized data from the FAERS database covering January 2004 to December 2024. Disproportionality analysis was conducted using 4 algorithms: reporting odds ratio, proportional reporting ratio, information component (IC), and empirical Bayes geometric mean. Potential risk signals were deemed significant only when all 4 algorithms simultaneously met their thresholds. Subgroup analyses were further performed, stratified by age and sex, to assess the robustness of signals across different populations. From 2004 to 2024, there were 179,697 adverse event reports of insomnia in FAERS in which one or more medications were designated as the primary suspect. The top 30 medications with the strongest signal strength were predominantly nervous system medicines (18 types, 60%), followed by respiratory system medicines (3 types, 10%), and genitourinary system and sex hormones (3 types, 10%). The top 3 medications with the highest reporting frequency were mefloquine, viloxazine, and flibanserin. Subgroup analyses revealed distinct drug signal profiles across age groups and genders, with pediatric cases dominated by nervous system and anti-infective agents, adults and the elderly showing additional endocrine or hormonal signals, and sex specific signals such as finasteride in males and flibanserin in females. This pharmacovigilance study identifies insomnia risk signals across multiple drug classes, underscoring the need for clinical vigilance regarding drug-related sleep disturbances. Further prospective research is required to confirm these associations.
20 Apr 2026
Read appraisal →BMJ open respiratory research
Comparing paper Letters in addition to Emailed Audit and feedback in Refining Asthma treatment to Improve clinical and environmental Results in primary care through a cluster randomised controlled trial: the CLEAR AIR study
BACKGROUND: Suboptimal use of preventer inhalers and salbutamol reliever overprescribing are associated with preventable asthma deaths and are a major source of primary care carbon emissions. Audit and feedback produces modest behaviour change by assessing clinical performance and delivering feedback to encourage improvement. Although feedback is increasingly delivered digitally, clinicians may respond more to additional printed feedback reports. We evaluated whether combined digital and paper feedback was more effective than digital-only feedback in promoting safer and greener asthma prescribing at the practice level. METHODS: In this parallel, cluster randomised controlled trial, all 273 primary care practices in West Yorkshire were assigned within their primary care network clusters by stratified, permuted block randomisation to receive seven bimonthly reports on asthma prescribing either in 'digital and paper' (intervention) or 'digital-only' (control) formats. The primary outcome was the proportion of preventer inhalers prescribed in pressurised metred-dose devices due to their high carbon footprint. Intervention group allocation was concealed. The intention-to-treat population was analysed and adjusted for both potential confounders and preintervention achievement. RESULTS: Final analysis assessed 270 practices in 26 clusters per arm due to practice mergers within the control group. There was no significant difference between the intervention groups based on change in the primary outcome (intervention-0.15%; control-0.19%; risk ratio-1.00; 95% CI 0.98 to 1.03) nor any secondary outcome. Analysis of both interventions combined showed a background trend of mixed improvement following feedback. CONCLUSIONS: There was no evidence that combined paper and digital feedback was more effective than digital-only feedback, despite the background of mixed improvements following both interventions. Challenges remain to understanding the barriers to influencing the prescribing of preventer inhalers and transitioning inhaler devices towards low-carbon 'green' alternatives; however, this study demonstrated the value of an efficient 'real-world' trial embedded within an existing quality improvement initiative. TRIAL REGISTRATION NUMBER: NCT05761873.
20 Apr 2026
Read appraisal →PloS one
Risk prediction for cardiovascular related diseases using PRS and EHR in the Framingham Heart Study
Cardiovascular disease is a leading cause of mortality and rising healthcare costs worldwide. Fortunately, the disease is preventable, and addressing risk factors can significantly reduce its effects. Over the past decade, risk prediction models have advanced significantly, with polygenic risk scoring analysis, which is often used in combination with clinical health information for prediction. However, most previous cardiovascular disease prediction studies based on polygenic risk scores have focused on a single specific disease or event, such as cardiac events. Given the complex nature of the cardiovascular disease, which involves a combination of genetic and environmental factors, a comprehensive analysis of the disease prediction results is essential. In this study, we investigate the genetic and environmental factors contributing to cardiovascular disease by utilizing data from the Framingham Heart Study, a leading cardiovascular cohort. We compared the prediction performance of different methods across various scenarios and assessed performance using various evaluation metrics to identify the best-fitting model for six cardiovascular related diseases. We also analyzed the feature importance of genetic and clinical variables, noting that different variables had varying effects on each disease. Our findings demonstrated the performance of prediction algorithms in forecasting cardiovascular disease by utilizing genetic and clinical factors, as well as highlighting the importance of each feature in the disease prediction. While models relying solely on polygenic risk score showed relatively low prediction performance for some diseases, integrating genetic information with clinical data improved prediction performance in most cases. For certain diseases, particularly those known to be heritable, polygenic risk scores demonstrated predictive ability, suggesting that they may serve as standalone predictive tools. We believe our study reveals the value of combining polygenic risk scores with clinical variables and expect that our thorough analysis can inform study designs tailored to specific diseases and research objectives.
20 Apr 2026
Read appraisal →Global health action
Lifestyle interventions to prevent gestational and type 2 diabetes among migrant women from low- and middle-income countries: a systematic review.
Migrant women from low- and middle-income countries (LMICs) living in high-income settings experience disproportionately high risk of gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM). This review aimed to identify and synthesise culturally adapted lifestyle interventions for preventing or managing GDM and T2DM among migrant women from LMICs, focusing on intervention components, cultural adaptation strategies, and behavioural and metabolic outcomes. Five databases (PubMed, Embase, Scopus, CINAHL, Cochrane Central) were searched using Preferred Reporting Items for Systematic reviews and Meta-Analysis 2020 guidelines. Eligible studies included experimental designs involving lifestyle interventions delivered to migrant women from LMICs in high-income countries, reporting outcomes related to GDM or T2DM targeting behaviour change. Data were synthesised narratively; study quality was appraised using RoB2 for RCTs and a structured narrative approach for non-randomised designs. Certainty of evidence was evaluated using GRADE. Eight studies met the inclusion criteria. Sample sizes ranged from 28 to 641 participants. Intervention duration varied from 6 weeks to 12 months. Most interventions incorporated atleast one culturally tailored component, such as bilingual delivery, culturally adapted dietary education, or community-based engagement. Improvements were reported across dietary behaviours, physical activity, glycaemic measures, or diabetes-related knowledge; however, effect sizes were modest and inconsistent. Interventions combining dietary modification, physical activity, and culturally adapted delivery demonstrated greater improvements than exercise-only or digital-only programmes. Overall certainty of evidence ranged from low to moderate. Culturally adapted, multi-component lifestyle interventions show promise for improving behavioural and metabolic outcomes among migrant women from LMICs; however, the evidence base remains limited. Main findings: Culturally adapted, multi-component lifestyle interventions show modest but inconsistent improvements in behavioural and metabolic outcomes among migrant women from low- and middle-income countries with overall low-to-moderate certainty of evidence.Added knowledge: This review highlights cultural adaptation as a key feature of intervention effectiveness and identifies important evidence gaps, including limited high-quality studies and challenges in comparing heterogeneous interventions.Global health impact for policy and action: Policies should prioritise scalable, culturally responsive interventions – such as bilingual and community-based approaches – to reduce diabetes disparities and improve maternal health outcomes in migrant populations.
19 Apr 2026
Read appraisal →PloS one
Treatment sequence patterns of urate-lowering therapy in Korean patients with gout: A common data model-based study
BACKGROUND: A treat-to-target strategy involving treatment modification improves outcomes in gout, but evidence remains limited regarding the optimal approach when initial urate-lowering therapy (ULT) fails. This study aimed to investigate real-world ULT sequence patterns and evaluate treatment retention based on the initial agent, modification type, and comorbidities. METHOD: We analyzed electronic health record data collected from 2010 to 2022 from the common data model databases of two hospitals. Adults aged 18 years or older diagnosed with gout who initiated ULT and were followed for at least 2 years were included. Outcomes included the frequency and sequence of ULT prescriptions. Treatment modification, defined as switching to another ULT or adding an additional agent, was considered the end of retention for the previous regimen. Subgroup analyses were performed based on comorbidity. RESULTS: Among 2220 patients, febuxostat was the most common first-line agent (51.4%), with 90.9% maintaining therapy. Among those who modified febuxostat therapy, switchers and add-on users continued treatment similarly (91.5% vs. 86.8%, P = 0.33). Of allopurinol initiators, 55.8% changed therapy, mainly switching to febuxostat or benzbromarone rather than adding another agent (51.4% vs. 4.1%, P < 0.001), with similar retention rates (91.5% vs. 86.8%, P = 0.33). Among benzbromarone initiators, 57.2% changed therapy (switchers, 56.7%; add-on users, 0.5%; P < 0.001), and retention rates were 90.5% and 100%, respectively (P = 1.00). Chronic kidney disease was associated with low variability in ULT sequence. CONCLUSIONS: ULT demonstrated durable retention when used as first- or second-line treatment, with switching being more common than add-on therapy and maintaining similar retention rates.
19 Apr 2026
Read appraisal →Scientific reports
A hybrid dual-stream CNN framework with dynamic data augmentation and improved Manta Ray Foraging Optimization for robust glaucoma detection.
A progressive neurological condition, glaucoma is one of the main causes of irreversible blindness in the globe. Early detection is crucial to preventing irreversible vision loss however conventional diagnostic methods are often time-consuming, and heavily reliant on clinical expertise. This study presents an innovative deep learning framework designed to automate glaucoma detection while addressing key challenges such as data imbalance, image quality inconsistencies, and the need for accurate feature extraction. The proposed framework begins with a dedicated preprocessing pipeline that enhances image clarity, and isolates clinically relevant regions of interest. To handle class imbalance, a novel hybrid data augmentation strategy is introduced, combining geometric transformations with adaptive Gaussian noise injection that adjusts intensity according to image characteristics, thereby simulating realistic clinical variability. At its core, the framework leverages a dual-stream CNN architecture that integrates DenseNet121 for structural feature extraction and ResNet50 for texture representation. A lightweight channel-wise attention mechanism is then introduced to selectively emphasize clinically significant channels while suppressing redundant features, thereby balancing efficiency and interpretability. To optimize model performance while reducing computational overhead, an Improved Manta Ray Foraging Optimization (IMRFO) algorithm is employed. IMRFO enhances the standard MRFO with Partial Centroid Opposition-Based Learning (PCOBL) to dynamically fine-tune hyperparameters, including augmentation settings and transfer learning configurations. Experimental validation was conducted on four public benchmark datasets, ACRIMA, Drishti-Gs, ORIGA, and RIM-ONE-DL, demonstrating the framework's superior performance across all evaluation metrics. The model achieved 100.00% accuracy, precision, recall, and AUC on both ACRIMA and Drishti-Gs, with losses of 0.003 and 0.001, respectively. On ORIGA, it reached 99.70% accuracy, 99.80% precision, 99.30% recall, and 99.50% AUC (loss = 0.01). On RIM-ONE-DL, the model scored 99.90% accuracy, 99.70% precision, 99.50% recall, and 99.70% AUC (loss = 0.006). These findings confirm the framework's robustness and clinical applicability for effective glaucoma screening.
19 Apr 2026
Read appraisal →Journal of medical Internet research
Effectiveness of mHealth Interventions for Improving eHealth Literacy Among Patients With Chronic Diseases: Meta-Analysis and Systematic Review
BACKGROUND: With the widespread use of the internet and mobile devices, eHealth literacy promotion is critical for medical equity. Mobile health (mHealth) serves as a pivotal tool for enhancing eHealth literacy by providing accessible, interactive platforms for health information engagement. However, the evidence regarding the effectiveness of mHealth interventions on eHealth literacy among patients with chronic diseases remains inconclusive. OBJECTIVE: This study aimed to evaluate the effectiveness of mHealth interventions on eHealth literacy among patients with chronic diseases based on randomized controlled trials (RCTs) and summarize supportive evidence from quasi-experimental and qualitative studies. METHODS: A comprehensive search strategy was developed, and 8 electronic databases were systematically searched for studies published up to February 12, 2026. Patients with chronic diseases were included based on predefined inclusion criteria. The Cochrane risk of bias 2 tool for RCTs and the ROBINS-I tool for quasi-experimental studies were used to assess the risk of bias. Given the anticipated substantial heterogeneity among the studies included, we used a random-effects model based on the Hartung-Knapp-Sidik-Jonkman method to pool effect sizes. A narrative and quantitative synthesis of the findings was provided where appropriate. RESULTS: A total of 15 studies were included in this review, including 6 RCTs, 5 quasi-experimental studies, and 4 qualitative studies, involving a total of 2884 patients with chronic diseases. Meta-analyses of RCTs suggested that mHealth interventions could improve eHealth literacy, with a pooled mean effect size of standardized mean difference (SMD)=1. 19 (95% CI 0.14-2.23; P=.03; I²=97.75%; PI [prediction interval]=-2.68 to 5.05). Subgroup analyses by intervention targets showed that interventions on targets with specific disease produced larger mean effects (SMD=1.61; 95% CI 0.16-3.06; PI=-5.40 to 8.63), while interventions targeting the population with general chronic diseases produced smaller effects (SMD=0.36; 95% CI 0-0. 73; PI=-0. 21 to 0. 94). Analysis by intervention duration subgroup showed that the combined effect of studies with intervention duration <3 months was statistically significant (SMD=0.61; 95% CI 0.09-1.13; I²=88.04%; PI=-5.72 to 6.95); while the combined effect of studies with intervention duration ≥3 months was not statistically significant. Taking into account bias and the risk of GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), the certainty of RCT evidence was moderate, and the certainty of quasi-experimental evidence was low. CONCLUSIONS: mHealth interventions could improve eHealth literacy among patients with chronic diseases on average. By using prediction intervals, this study reveals that the effectiveness of mHealth interventions is highly context-dependent and closely linked to implementation factors. Advancing beyond prior work, this study centers on eHealth literacy as a core outcome and integrates multiple types of evidence. Meanwhile, this finding emphasizes the need for evidence-based intervention programs and more rigorous implementation of intervention designs in future research.
19 Apr 2026
Read appraisal →Pharmaceutical biology
Valeriana species and insomnia: multi-organ mechanisms and translational perspectives.
CONTEXT: Insomnia is a common sleep disorder that substantially impairs quality of life. Conventional treatments, including cognitive behavioral therapy and pharmacological agents, are often limited by side effects and insufficient long-term safety data. Valeriana species, such as Valeriana officinalis L. and Valeriana jatamansi Jones, have been traditionally used for their sedative and neuroprotective properties. OBJECTIVE: This review evaluates the therapeutic potential of Valeriana species for insomnia, emphasizing their pharmacological mechanisms, multi-organ effects, and evidence from preclinical and clinical studies. METHODS: A systematic literature search was performed in databases including PubMed and Web of Science. Studies addressing Valeriana-induced sleep regulation, neurotransmitter modulation, oxidative stress reduction, and neural, hepatic, and gastrointestinal interactions were included to assess efficacy and safety. RESULTS: Valeriana species modulate neurotransmission, mitigate oxidative stress, and influence hepatic and gastrointestinal functions. Preclinical studies support their sedative and neuroprotective effects, while clinical outcomes vary with formulation, dosage, and individual response. Overall, safety profiles are favorable, though inconsistencies remain. CONCLUSION: Valeriana species represent a promising multi-target strategy for insomnia, integrating neural and peripheral pathways. Future research should clarify the mechanisms underlying multi-organ effects, optimize formulations, and conduct rigorous clinical trials to establish standardized, effective, and safe interventions.
19 Apr 2026
Read appraisal →Scientific reports
Food preferences and mortality risk in the prospective cohort of UK Biobank participants.
Food preferences may serve as less biased proxies for self-reported food intake in predicting health outcomes but have not yet been linked to mortality risk. We included 177,148 UK Biobank participants who completed a food preference questionnaire (FPQ), with a mean follow-up of 3.4 years (607,779 person-years; 3355 deaths). High versus low preference for 140 food items was tested using Cox regression with Holm adjustment. Sensitivity analyses excluded participants with key health conditions, additional supplement use, or short follow-up, added BMI and physical activity as covariates, and redefined preference groups. Higher preference for asparagus (hazard ratio (95% confidence interval)): 0.69 (0.62, 0.77)), aubergine (0.79 (0.72, 0.87)), black pepper (0.72 (0.64, 0.81)), broccoli (0.69 (0.61, 0.79)), butternut squash (0.75 (0.68, 0.83)), and extra virgin olive oil (0.67 (0.58, 0.78)) was linked to lower all-cause mortality, whereas higher preference for regular fizzy drinks (1.38 (1.24, 1.54)) was linked to higher mortality across all analyses. Specific food preferences are associated with all-cause mortality risk. FPQs may, therefore, complement conventional dietary assessments. Further studies should examine their associations with metabolic and cardiovascular outcomes.
19 Apr 2026
Read appraisal →Open heart
Non-invasive endotyping improves treatment satisfaction and prescribing appropriateness in patients with angina and no obstructive coronary artery disease.
BACKGROUND: Patients with angina and no obstructive coronary artery disease (ANOCA) frequently receive empirical antianginal therapy that fails to target underlying pathophysiological mechanisms. Whether stress perfusion cardiac magnetic resonance (CMR)-guided endotyping and stratified medical therapy improves treatment satisfaction and appropriate medication prescribing in this population is uncertain. METHODS: In the Coronary Microvascular Angina CMR Imaging Trial, 250 patients with suspected ANOCA, who had undergone invasive coronary angiography demonstrating no obstructive disease, were enrolled and underwent stress perfusion CMR with quantification of myocardial blood flow. Participants were randomised 1:1 to CMR-guided management (intervention) or angiography-guided management (control). Treatment satisfaction was assessed using the validated Treatment Satisfaction Questionnaire for Medication (TSQM-9) at baseline, 6 months and 12 months. Medication prescriptions were documented at these time points. RESULTS: Stress CMR imaging led to diagnostic reclassification in 53.0% of patients, with microvascular angina diagnosed in 51.0%. At 12 months, global treatment satisfaction was significantly higher in the intervention group compared with controls (adjusted difference, 19.30 units (95% CI 13.89 to 24.71); p<0.001), with consistent improvements across the effectiveness and convenience domains. CMR-guided management was associated with more appropriate prescribing, including higher use of preventive therapies (85.5% vs 67.5%; p=0.001), and more targeted antianginal prescribing, including calcium channel blockers (43.5% vs 27.0%; p=0.008) and long-acting nitrates (56.5% vs 32.5%; p<0.001). CONCLUSIONS: In patients with ANOCA, non-invasive CMR-guided endotyping substantially improves treatment satisfaction and enables more appropriate, mechanism-targeted pharmacotherapy compared with angiography-guided care. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID NCT04805814.
19 Apr 2026
Read appraisal →BMJ open
Patients' experiences of the path to sarcoma diagnosis: a qualitative systematic review and thematic synthesis
OBJECTIVE: To explore existing qualitative research on patients' experiences from the onset of symptoms to the diagnosis of sarcoma, with the purpose of identifying patient-perceived barriers at both patient and healthcare system levels and to highlight opportunities for improvement. DESIGN: Systematic review of qualitative studies using thematic synthesis. METHODS: We systematically searched Medline [Ovid], Embase [Ovid], PsycINFO [EBSCOhost] and CINAHL [EBSCOhost] from database inception to 11 April 2025 for qualitative studies reporting sarcoma patients' experiences during their diagnostic trajectory. The final search was conducted on 11 April 2025. All articles were screened against predefined inclusion and exclusion criteria and methodological quality was appraised using the Critical Appraisal Skills Programme qualitative checklist. Six studies conducted in Australia, the Netherlands and the UK were included. Data were analysed using a thematic synthesis approach guided by Thomas and Harden (2008). Confidence in the synthesised findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation - Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERqual) approach. RESULTS: Four overarching themes emerged: patients' experience and interpretation of symptoms, diagnostic pathways, healthcare system factors, and reflections and recommendations. Key contributors to delayed diagnosis were symptom normalisation, misattribution by both patients and healthcare professionals, limited continuity of care and communication challenges. These findings were consistent across multiple countries, indicating relevance and validity in many settings. Patients emphasised the importance of disease awareness, persistence of patients and coordinated care. CONCLUSIONS: Diagnostic delays in sarcoma are influenced by both patient and healthcare systemic factors. Addressing these factors requires increased disease awareness among healthcare professionals and the public, improved coordination within the healthcare system, and targeted research to guide future interventions. This review provides cross-country insights into barriers to early sarcoma diagnosis, informing future priorities in clinical practice and research. PROSPERO REGISTRATION NUMBER: CRD420251030726.
18 Apr 2026
Read appraisal →JMIR medical informatics
Quality of Clinical Notes Created by Ambient Listening Generative AI: Pragmatic Prospective Pilot Study
BACKGROUND: Physicians routinely document specifics of patient encounters in clinic visit notes, a critical but potentially time-consuming task. Ambient listening artificial intelligence (AI) technology is being integrated into clinical workflows to reduce documentation burden by creating draft visit notes. While this technology is promising, it is not perfect, and the potential for patient harm needs to be understood and mitigated. We developed and piloted an efficient, standardized approach to evaluating AI-generated notes for safety concerns in ambulatory care visits. OBJECTIVE: The objective of this quality improvement project was to develop and pilot an efficient, standardized, and scalable approach to evaluating AI-generated notes for safety concerns in ambulatory care visits. METHODS: During a 2-month pilot (July to August 2024), 31 physicians across multiple specialties used an ambient listening AI scribe to assist with the creation of 7545 clinic notes. A novel survey instrument was developed to assess note quality, focusing on 4 error types: accidental inclusions, accidental omissions, hallucinations, and bias. Physicians evaluated 356 (4.7%) AI-generated notes. Where an error was present, physicians rated its severity based on its potential to cause patient harm if it was not corrected, on a 0 to 5 scale. Additionally, a vendor-reported metric on the percentage of note content edited by physicians was analyzed. RESULTS: Of the 356 evaluated notes, accidental omissions were the most frequent error (n=64, 18%), followed by hallucinations (n=41, 11.5%), and accidental inclusions (n=33, 9.3%). Bias was rare (n=4, 1.1%). Most (119/142, 83.8%) errors were rated as mild to moderate (severity 1-3), with only 19 (5.3%) notes containing errors rated as posing serious or imminent risk (severity 4-5). Editing metrics across all AI-created notes showed a median of 9.0% (IQR 2.5%-21.9%) of AI-generated words were changed, with 14.9% (143/960) of notes left entirely unedited. Physician editing practices varied widely, with average percentages of AI-generated words changed ranging from 1.9% to 69.3% (median 9.0%, IQR 2.5%-21.9%). CONCLUSIONS: AI-generated clinical notes were generally of high quality, with 94.7% (337/356) free from significant errors. However, because a small number contained errors that carried the risk of serious harm if not corrected, careful clinician review of notes remains imperative. Prior to deploying an AI scribe, organizations should pilot the technology and include an efficient review process to understand the nature and type of errors common at their organization. This pilot provides a scalable model for other health systems seeking to implement AI scribe technology responsibly.
18 Apr 2026
Read appraisal →JMIR aging
Leveraging Digital Health Technologies to Assess Older Adults' Frailty and Nutritional Status: Two Cross-Sectional Studies
BACKGROUND: With the rising prevalence of aging worldwide, there is a necessity for reliable and frequent assessments of older individuals' health status to manage and potentially prevent age-related complications. Digital health technologies (DHTs), such as wearable devices, provide an opportunity to gather objective, continuous, and unobtrusive measurements, enabling effective health management in everyday life. OBJECTIVE: We aimed to evaluate the relationship between digital endpoints and frailty, nutritional status, and patient-reported outcomes (PROs) in older individuals, as well as quantified their compliance and comfort with DHTs. METHODS: In two cross-sectional studies, namely the Geriatric Anorexia Studies 1 and 2, including three in-clinic visits and 2-3 weeks of at-home monitoring, 94 participants (mean age 72.98 years, SD 6.28 years) were stratified based on their frailty status (n=39, 41%, nonfrail; n=45, 48%, prefrail; and n=10, 11%, frail) and nutritional status (n=70, 74%, with normal nutrition and n=24, 26%, at risk for malnutrition), as assessed in a clinical setting using the Fried Frailty Score and the Simplified Nutritional Appetite Questionnaire, respectively. We remotely monitored older adults using different DHTs. At home, participants were monitored with a wrist accelerometer for physical activity, continuous glucose monitoring (CGM) for glucose concentration, a digital body scale for weight and body composition, and a digital nutritional scale for meal tracking. Compliance with devices was assessed via wear time and correct at-home usage, while comfort was evaluated using questionnaires. The association between digital endpoints and frailty/nutritional status was investigated via linear regression, followed by ANOVA, and the relationship between digital endpoints collected at home and PROs was evaluated via Spearman's ρ. Weight and body composition were also assessed during in-clinic visits with a research-grade scale, used to validate the at-home digital body scale measurements, via the intraclass correlation coefficient, Pearson's R, and Bland-Altman plots with mean bias. RESULTS: Physical activity digital endpoints collected at home were significantly different across frailty and nutritional groups and significantly correlated with self-reported appetite, fatigue, and physical function (eg, for mean daily activity in the maximum 60 minutes of activity, ρ=0.28, -0.23, and 0.47, respectively). More than 80% of participants reported that all devices were mostly to very acceptable to wear/use: 95% (88/93) for the body scale, 86% (43/50) for CGM, 80% (40/50) for the nutrition scale, and 91% (84/93) for the wrist accelerometer. Compliance ranged from 60% of monitoring days for the digital nutrition scale to 90% for the wrist accelerometer. CONCLUSIONS: Physical activity digital endpoints show clear prognostic significance for frailty and malnutrition in older individuals and reflect self-reported measures. DHTs can be reliably deployed at home for older individuals to measure their physical activity, weight and body composition, glucose concentration, and meal intakes, thus enabling patient-centric, data-centric clinical trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT04858932; https://clinicaltrials.gov/study/NCT04858932; ClinicalTrials.gov NCT05211973; https://clinicaltrials.gov/study/NCT05211973.
18 Apr 2026
Read appraisal →PloS one
EAC-Agent: A deep learning framework for multimodal emotion-aware conversational agent with contextual response generation
Conversational agents, commonly referred to as chatbots, have become an integral part of various important applications, such as customer support and virtual assistants in enterprise-level solutions. Despite their widespread use, current solutions predominantly rely on a single modality input, primarily text, which limits their ability to fully understand the correct emotions of users and respond accordingly. The increasing demand for multimodal inputs in conversation such as text, audio, and videos, highlights the need for a more comprehensive approach. Existing conversational agents face significant challenges in generating emotionally aware responses, as they lack the ability to effectively handle emotion embeddings, leading to limitations in emotional accuracy and contextual appropriateness. Focusing on these challenges, this research work leads to a novel multimodal approach which incorporates features from text, audio, and visual. The EAC-Agent proposed a sequence-to-sequence model with transformer, along with pre-trained embeddings such as GloVe. The self and cross-modal attention on text, audio and visual is used to generate a more emotionally intelligent response. EAC-Agent is validated through comparison with existing techniques on two benchmark datasets. The obtained results demonstrate superior performance in emotion classification and response generation. The proposed model achieves an accuracy of 76.27% on IEMOCAP and 67.57% on MELD for emotion recognition from multimodal user inputs. In addition, the emotion-aware response generation module shows clear improvements, with perplexity values of 39.01 and 42.30, BLEU scores of 0.31 and 0.30, and ROUGE-L scores of 0.45 and 0.44 on IEMOCAP and MELD, respectively. EAC-Agent demonstrates clear superiority over existing models and holds great promise for applications in customer service, healthcare, and other areas requiring empathetic and contextually appropriate interactions.
18 Apr 2026
Read appraisal →Journal of the International Society of Sports Nutrition
Effects of eight weeks of eicosapentaenoic acid and medium-chain triacylglycerol structured lipid intake on EPA/AA ratio and muscle performance in young men
BACKGROUND: Structured triglycerides (STGs), in which eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are esterified with medium-chain triglycerides (MCTs), have demonstrated greater bioavailability and potential benefits in improving endurance and reducing post-exercise strength loss compared with physical mixtures (PMs) of EPA and MCTs. However, it remains unclear whether STGs have superior effects on blood EPA levels and muscular endurance and fatigue. This study compared the effects of 8-week STG and PM intake on blood EPA levels, muscular endurance, and fatigue following resistance exercise. METHODS: Twenty-eight healthy young men were randomly assigned to an STG group (n = 15) or a PM group (n = 13) in a double-blind, parallel-group, active comparator trial. Participants consumed 4,560 mg/day of the test oil (600 mg EPA, 260 mg DHA) for 8 weeks. After the intervention, the participants performed four sets of leg extensions to exhaustion at 40% of their body weight. Muscular endurance was assessed by the number of repetitions, and fatigue was evaluated by changes in maximal voluntary contraction, range of motion, thigh circumference, muscle thickness, echo intensity, and jump performance. RESULTS: The STG group showed a significantly greater increase in the serum EPA/arachidonic acid (AA) ratio compared with the PM group. However, no significant differences were found between groups in repetition counts or fatigue-related measures. CONCLUSION: Eight weeks of STG supplementation improved the blood EPA/AA ratio more than a PM, but did not yield superior effects on muscle endurance or fatigue.
18 Apr 2026
Read appraisal →JMIR human factors
Interactive, Personalized Patient Decision Aid for COVID-19 Vaccination in Canada: User-Centered Design Approach
BACKGROUND: The COVID-19 pandemic highlighted the need for practical digital health tools to support informed decision-making amid rapidly evolving evidence and widespread misinformation. OBJECTIVE: We iteratively developed and refined VaxDA-C19, a bilingual (English and French) web-based patient decision aid designed to support informed decision-making in Canada about COVID-19 vaccination. VaxDA-C19 integrates interactive and personalized features aimed to enhance vaccine confidence, reduce cognitive overload, and respond to diverse informational needs. METHODS: VaxDA-C19 was developed using an iterative, user-centered design approach. Throughout the development process, we involved a citizen panel, health care professionals, user experience designers, and scientific experts to guide refinements. We also conducted usability testing sessions with adults in Canada, using semistructured interviews, comparative testing, and think-aloud protocols with thematic analysis. We ultimately conducted 4 design cycles in total with adults in Canada (users) and expert reviewers (experts). Cycle 1 involved 9 people (9 users), cycle 2 involved 22 people (22 users), cycle 3 involved 9 people (3 users and 6 experts), and cycle 4 involved 9 people (9 experts). RESULTS: In cycle 1, user feedback guided design decisions about how to present quantitative information and technical vaccine descriptions more simply. In cycle 2, while most users (9/11, 82%) favored in-depth explanations of vaccine development, a few raised concerns about content that could be perceived as politically charged. Cycle 3 identified usability improvements, including more explicit navigation controls, simplified medical terminology, and optimized interactive components (avatars and sliders). Expert reviews in cycle 4 refined linguistic consistency, mobile responsiveness, content transparency, and scientific accuracy, emphasizing explicit instructional guidance and bilingual accessibility. CONCLUSIONS: Our iterative process produced a personalized, bilingual digital decision aid to support evidence-informed, values-congruent decisions about COVID-19 vaccination. A randomized controlled trial will further evaluate VaxDA-C19's impact on vaccination intentions, knowledge retention, emotional responses, decisional conflict, and decisional regret. If it proves effective, the patient decision aid may also be used as a platform to support other vaccine decisions, namely, influenza, measles, shingles, pertussis, and potentially other emerging infectious diseases.
18 Apr 2026
Read appraisal →Medicine
Effectiveness of cognitive behavioral therapy for depression in patients with multiple sclerosis: A systematic review and meta-analysis
BACKGROUND: The efficacy and methodologies of cognitive behavioral therapy (CBT) for treating depression in multiple sclerosis (MS) require further comprehensive research. METHODS: Two researchers conducted independent literature searches across 5 databases, utilizing the keywords "multiple sclerosis," "cognitive behavioral therapy," and "depression," without any restrictions on publication year. The Cochrane Risk of Bias Tool 2.0 was utilized to assess the included studies. Statistical analyses were conducted using standardized mean difference as the effect size with Stata 17.0 software. RESULTS: This meta-analysis included 22 studies. The results indicate that, regardless of whether delivered face-to-face, online, or via telephone, both individual and group CBT effectively alleviate depression in patients with MS. Significant improvements in depressive symptoms were observed starting from the second month of intervention and persisted for up to 6 months post-intervention. CONCLUSION: Patients with MS can flexibly choose the delivery modality of CBT based on their individual circumstances while engaging in treatment for around 2 months. They are encouraged to reengage in CBT within 6 months post-intervention to ensure the continuity and stability of depression treatment outcomes. Healthcare providers can offer various CBT delivery modalities based on the individual preferences and circumstances of patients with MS, while developing corresponding plans to enhance the effectiveness of depression management.
18 Apr 2026
Read appraisal →Medicine
Efficacy of floating needles in the treatment of postpartum urinary incontinence and pain: A systematic review and meta-analysis
BACKGROUND: Postpartum pain and urinary incontinence (UI) are the most common postpartum sequelae, which can lead to postpartum anxiety and depression when severe, and seriously affect the quality of life of postpartum mothers. Floating needle (FN) is one of the Chinese medical treatments of the latest in recent years, and studies have shown that FN for postpartum pain and stress urinary incontinence has a positive effect; this study aimed to comprehensively and critically evaluate the available evidence on the effectiveness of FN in managing postpartum pain and UI, and provide the first evidence-based medical evidence for FN intervention for postpartum sequela. METHODS: Computerized retrieval of Chinese databases (CNKI, Wanfang, VIP, and CBM) and English databases (PubMed, Embase, Web of Science, and Cochrane Library) for randomized controlled trials on FN therapy for postpartum pain and UI was conducted up to December 20, 2023. Search terms included "floating needle," "urinary incontinence," and "labor pain." Data extraction and quality assessment were performed on eligible studies. Meta-analysis was conducted using RevMan 5.4, with mean differences (MDs) for continuous outcomes and risk ratios for dichotomous endpoints. RESULTS: A total of 1194 women were included in 8 articles in both Chinese and English, all of which were conducted in China; 6 of the articles were included in the meta-analysis. The FN is more effective in treating postpartum incontinence and pain than the control group (risk ratio = 1.33, 95% confidence interval [CI] = 1.18-1.5, P < .001), and significantly reduced the International Consultation on Incontinence Questionnaire-Short Form score (MD = 1.56, 95% CI = 0.78-2.35, P < .001); FN therapy can significantly reduce the amount of urine leakage in postpartum patients (MD = 1.79, 95% CI = 1.09-2.49, P < .001). CONCLUSION: Our results suggest that FN therapy could be encouraged as one of the routine treatments for postpartum sequelae.
18 Apr 2026
Read appraisal →BMJ open
Comparison of the effects of eHealth-delivered sedentary breaks versus physical activity promotion interventions on sedentary time: protocol for a systematic review and meta-analysis
INTRODUCTION: Prolonged sedentary behaviour (SB) is an independent risk factor for adverse health outcomes, with current WHO guidelines emphasising both increased physical activity (PA) and reduced sitting time. While electronic health (eHealth) interventions offer scalable solutions, the comparative effectiveness of two dominant strategies: sedentary break interventions (frequent interruptions of sitting) versus PA promotion (structured activity sessions) remains unclear. This systematic review and meta-analysis protocol aims to compare the effectiveness of interventions targeting breaks in SB versus increased PA in reducing sedentary time through meta-analysis of randomised controlled trials (RCTs) comparing either intervention to a control condition, while exploring key moderating factors including participant characteristics, intervention type, duration, eHealth delivery mode, theoretical basis, use of behaviour change techniques (BCTs), PA intensity and SB frequency. METHODS AND ANALYSIS: This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. A comprehensive search will be conducted in PubMed, Embase, Web of Science and the Cochrane Library from inception to 31 July 2025, with language restrictions limited to English and Chinese publications. RCTs comparing eHealth-delivered interventions promoting sedentary breaks with those increasing PA in adults will be included. The primary outcome is sedentary time (objectively measured or self-reported), and secondary outcomes include health outcomes such as cardiometabolic markers, fatigue and well-being. Two reviewers (SC and XN) will independently screen studies, extract data and assess risk of bias using validated tools. Meta-analyses will be performed if sufficient homogeneous data are available, comparing changes in sedentary time. Subgroup analyses will explore effects by participant characteristics including gender (male vs female), age groups (<60 vs ≥60 years), intervention type (sedentary breaks vs PA), duration (short-term ≤3 months vs medium-term >3 to <6 months vs long-term ≥6 months), eHealth platform/delivery mode (eg, smartphone apps vs websites vs wearable device prompts vs text messages), theoretical basis (eg, theory-driven interventions vs non-theoretical interventions), use of BCTs (eg, interventions incorporating BCTs vs interventions without BCTs), SB break frequency (eg, every 30 min vs every 60 min) and PA promotion intensity (eg, light vs moderate vs vigorous). A narrative synthesis will be conducted for studies unsuitable for quantitative analysis. ETHICS AND DISSEMINATION: Ethical approval is not required as this study involves secondary analysis of published data. Findings will be disseminated through peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER: CRD420251042994.
18 Apr 2026
Read appraisal →Journal of global health
National, regional and provincial prevalence of peripheral artery disease in Chinese adults in 2023: an updated systematic review and modelling study
BACKGROUND: Peripheral artery disease (PAD), a common atherosclerotic condition characterised by the narrowing or obstruction of peripheral arteries, has become a substantial public health concern in China. However, its prevalence across the country at the provincial level has never been quantified. Through an updated systematic review and modelling study, we aimed to estimate the national, regional, and provincial prevalence of PAD among Chinese individuals aged 30-89 years in 2023. METHODS: We conducted an updated literature search in PubMed, Embase, MEDLINE, the China National Knowledge Infrastructure, Wanfang, and the Chinese Science and Technology Journal Database to identify studies published between 4 March 2017 and 12 August 2024 reporting on the prevalence of PAD in the general Chinese population. We also identified and included studies from previous systematic reviews. We then used a multilevel mixed-effects meta-regression model to generate the age- and sex-specific prevalence estimates of PAD among individuals aged 30-89 years at the national level. We calculated pooled odds ratios (ORs) for factors associated with PAD using a random-effects meta-analysis and incorporated them into an 'associated factor-based model' to estimate regional and provincial prevalence. RESULTS: We included 54 articles from all searches. Model-based estimates indicated that the overall prevalence of PAD among Chinese adults aged 30-89 years in 2023 was 5.47% (95% confidence interval (CI) = 4.64-6.44), equivalent to 49.90 million (95% CI = 42.32-58.73) affected individuals. Prevalence increased progressively with age, ranging from 4.23% (95% CI = 3.58-5.00) among individuals aged 30-34 years to 18.37% (95% CI = 15.90-21.13) among those aged 85-89 years. The overall prevalence was higher in females (6.19%; 95% CI = 5.25-7.27) than males (4.76%; 95% CI = 4.03-5.61). Regionally, Northeast China had the highest prevalence of PAD at 5.87% (95% CI = 4.98-6.91), while Central China had the lowest at 5.26% (95% CI = 4.46-6.19). At the provincial level, the prevalence of PAD was the highest in Beijing (6.40%; 95% CI = 5.43-7.53) and lowest in Tibet (4.35%; 95% CI = 3.68-5.12). Female sex, current smoking, hypertension, diabetes, coronary heart disease, and stroke were identified as factors significantly associated with PAD. CONCLUSIONS: We found that PAD is prevalent in China, with pronounced age-related trends, sex differences, and regional disparities. These findings could inform targeted public health initiatives and appropriate resource allocation. REGISTRATION: PROSPERO: CRD420251118923.
18 Apr 2026
Read appraisal →Thorax
Multidisciplinary, non-pharmacological breathlessness intervention service for patients with moderately severe to severe COPD: a randomised controlled trial
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an often-progressive respiratory disease associated with disabling breathlessness. Breathlessness intervention services (BIS), which coach patients to self-manage breathlessness using non-pharmacological strategies, are effective in a variety of populations, including those with cancer and serious respiratory disease. This study aimed to compare the impact of the Westmead Breathlessness Service in people with moderate to severe COPD. METHODS: We analysed 113 participants randomised (1:1) with moderate/severe COPD (forced expiratory volume in 1 s (FEV1)/forced vital capacity <0.70 and FEV1 ≤60% predicted) and disabling breathlessness (modified Medical Research Council (mMRC) Breathlessness Score ≥2) to either an 8-week intervention involving breathing techniques, handheld fan use, exercise, energy conservation, dietetic advice (n=54) or 8-week wait-list control group (n=59). The primary outcome was change in Chronic Respiratory Questionnaire (CRQ) Mastery of breathlessness subscale. Secondary outcomes included change in other CRQ subscales (Fatigue, Emotion and Dyspnoea), exertional breathlessness intensity/unpleasantness (0-10 Numerical Rating Scale Score), anxiety and depression. Difference in change over 8 weeks between groups was compared using ANCOVA; p<0.05 statistically significant. FINDINGS: Participants were aged 70.9 (±8.5) years, 50% female, mean FEV1 =0.8 L (±0.3 L; 34% predicted), mMRC Breathlessness Score 3 (IQR 3-4). CRQ-Mastery improved following intervention compared with control (between-group difference 0.5 units; 95% CI 0.2 to 0.8; p=0.0262) using modified intention-to-treat analysis. Better CRQ-Dyspnoea and CRQ-Fatigue were seen in the intervention group (between-group difference-CRQ-Dyspnoea 0.4 units; CI 0.1 to 0.7; p=0.005, and CRQ-Fatigue 0.4 units; CI 0.1 to 0.7; p=0.014). Exertional breathlessness intensity (difference -0.8 units; CI -1.4 to -0.2; p=0.013) and breathlessness unpleasantness (difference -1.2 units; CI -1.7 to -0.6; p=0.001) also improved. INTERPRETATION: An 8-week BIS improved CRQ-Mastery, Dyspnoea and Fatigue, exertional breathlessness intensity and unpleasantness in people with severe COPD.
17 Apr 2026
Read appraisal →Journal of neurointerventional surgery
Transverse venous sinus stenting versus cerebrospinal fluid shunting in idiopathic intracranial hypertension: a multi-institutional and multinational database study
BACKGROUND: Cerebrospinal fluid (CSF) shunting and transverse venous sinus (TVS) stenting are promising treatment choices for idiopathic intracranial hypertension (IIH), addressing different aspects of IIH pathophysiology. However, large-scale comparative data remain limited. METHODS: We performed a multinational, multi-institutional, retrospective propensity score-matched analysis using the TriNetX platform. Adult patients diagnosed with IIH who underwent either TVS stenting or CSF shunting were included. The primary outcome was treatment failure, defined as the need for subsequent procedures (repeat TVS stenting, CSF shunt, or optic nerve fenestration). Secondary outcomes included residual symptoms (headache, visual disturbances, dizziness, and pulsatile tinnitus), ongoing use of IIH-related medications (furosemide, acetazolamide, and topiramate), and healthcare utilization, assessed through unplanned hospital readmissions and emergency department (ED) visits at 1 year follow-up. RESULTS: Of 134 530 IIH patients identified, 1362 underwent TVS stenting and 5278 underwent CSF shunting. After propensity score matching, patients who received TVS stenting had significantly lower odds of repeat interventions (9.6% vs 38.6%; OR 0.169, 95% CI 0.136 to 0.212, P<0.001). They also had significantly lower odds of residual headache, visual disturbances, and papilledema. However, stenting was associated with higher odds of persistent pulsatile tinnitus (6.7% vs 2.2%; OR 3.183, P<0.001). TVS stenting was associated with lower odds of unplanned inpatient readmissions (24.1% vs 40.5%; OR 0.466, P<0.001) and ED visits (22.0% vs 34.0%; OR 0.548, P<0.001). CONCLUSION: Both TVS stenting and CSF shunting resulted in symptomatic improvement and reduced medication use in patients with IIH. However, stenting was associated with significantly lower treatment failure rates, fewer residual papilledema, headaches and visual symptoms, and reduced healthcare utilization. Persistent pulsatile tinnitus was more common following stenting.
17 Apr 2026
Read appraisal →JMIR formative research
A Survey of Primary Care Clinician Experiences With Electronic Health Record-Based Clinical Decision Support to Improve HIV Pre-Exposure Prophylaxis Prescribing
A survey of primary care clinicians suggests that a clinical decision support tool to support sexual risk assessment and prescribing of HIV pre-exposure prophylaxis was appropriate and useful for identifying at-risk patients, but uptake was hindered by workflow and usability barriers, which underscores the importance of postimplementation clinician feedback to improve the use of clinical decision support tools.
17 Apr 2026
Read appraisal →Journal of global health
The impact of disasters on maternal mental health: a systematic review
BACKGROUND: The vulnerability of maternal mental health is increasing with the frequent increase in natural and man-made disasters, yet evidence remains fragmented. We aimed to synthesise quantitative evidence on the impact of disaster exposure on maternal mental health and related pregnancy outcomes. METHODS: We systematically searched 12 electronic databases, nine sub-databases, and additional web sources for the studies published between 1995 and 2025. We included studies that assessed the impact of disaster exposure during pregnancy and provided quantitative outcomes for depression, anxiety, stress, posttraumatic stress disorder (PTSD), or adverse pregnancy outcomes. RESULTS: Of 18 604 studies, 24 studies met the inclusion criteria. Natural disasters were the highest group (n = 16), including earthquakes (n = 8), floods/cyclone/hurricane (n = 7), and wildfire (n = 1), followed by man-made disaster (n = 7), including conflict/war/terrorism (n = 5), nuclear disaster (n = 1), plane crash (n = 1), and war (n = 1), and one hybrid disaster. Disaster showed a consistent increase in the risk of depression, anxiety, stress, and PTSD among pregnant women, with effects persisting up to six years post-disaster event. Across studies, disaster exposure increased maternal mental health problems by approximately 30% to over 200%, and PTSD odds increased seven to 10-fold among highly exposed pregnant women. Three studies reported that both depression and PTSD during pregnancy were associated with adverse pregnancy or early child outcomes, suggesting potential intergenerational effects. CONCLUSIONS: Disasters exert enduring and profound impacts on maternal mental health, with consequences cascading across both mother and child. Urgent, cost-effective and disaster-informed policies are needed to mitigate such long-term impacts. REGISTRATION: PROSPERO: CRD42023445559.
17 Apr 2026
Read appraisal →The Cochrane database of systematic reviews
Amyloid-beta-targeting monoclonal antibodies for people with mild cognitive impairment or mild dementia due to Alzheimer's disease
RATIONALE: Alzheimer's disease is a neurodegenerative disorder and the most common cause of dementia. Aggregated amyloid-beta protein deposits are implicated in its pathogenesis. Amyloid-beta-targeting monoclonal antibodies (sometimes represented as Aβ-mAbs) are potentially disease-modifying for Alzheimer's disease: through the clearance of amyloid in the brain, they may slow cognitive and functional decline. OBJECTIVES: To assess the clinical benefits and harms of amyloid-beta-targeting monoclonal antibodies aducanumab, bapineuzumab, crenezumab, donanemab, gantenerumab, lecanemab, ponezumab, remternetug, and solanezumab in people with mild cognitive impairment or mild dementia due to Alzheimer's disease. SEARCH METHODS: We searched CENTRAL, MEDLINE (PubMed), Embase, and two clinical trials registries (Clinicaltrials.gov and WHO International Clinical Trials Registry Platform), and we undertook reference checking and citation research. The most recent search date was 7 August 2025. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs) that lasted at least 12 months and compared amyloid-beta-targeting monoclonal antibodies with placebo or no treatment in people with mild cognitive impairment or mild dementia due to Alzheimer's disease. We included both parallel-group and cluster designs. OUTCOMES: Our outcomes of critical importance were: cognitive function; dementia severity; functional ability; any amyloid-related imaging abnormality (ARIA), which includes oedema (E) and haemorrhage (H); any symptomatic ARIA E and H; symptomatic brain haemorrhage; serious adverse events; and any-cause mortality. We analysed data at 12, 18, 24, and over 24 months of treatment. RISK OF BIAS: We used the Cochrane risk of bias tool RoB 2 to assess the risk of bias in outcomes of critical importance. SYNTHESIS METHODS: We meta-analysed results for each outcome within each comparison using the inverse variance method and the random-effects model. We used GRADE to assess the certainty of evidence for each outcome as very low, low, moderate, or high. INCLUDED STUDIES: Overall, we included 17 studies with 20,342 participants. The mean age of participants in the studies ranged from 70 to 74 years. Seven studies enroled only participants with mild dementia, and one study enroled only participants with mild cognitive impairment. The remaining studies included a mixed population. The mean duration of participants' cognitive impairment ranged from 17 to 52 months. The 17 studies assessed seven different amyloid-beta-targeting monoclonal antibodies: aducanumab (n = 3), bapineuzumab (n = 4), crenezumab (n = 2), donanemab (n = 1), gantenerumab (n = 4), lecanemab (n = 1), and solanezumab (n = 2). All used placebo as a comparison. Eleven studies lasted 18 months, four lasted 24 months, and two lasted more than 24 months. All studies were funded by the pharmaceutical industry. SYNTHESIS OF RESULTS: Below, we report the results of the studies at 18 months. Cognitive function Compared to placebo, amyloid-beta-targeting monoclonal antibodies probably result in little to no difference in cognitive function as measured by the ADAS-Cog (Alzheimer's Disease Assessment Scale-Cognitive) scale (standardised mean difference (SMD) -0.11, 95% confidence interval (CI) -0.16 to -0.06; 13 studies, 9895 participants; moderate certainty). Dementia severity Amyloid-beta-targeting monoclonal antibodies may result in little to no difference in dementia severity as measured by the CDR-SB (Clincal Dementia Rating Sum of Boxes) scale (SMD -0.12, 95% CI -0.24 to -0.00; 9 studies, 8053 participants; low certainty). Functional ability Amyloid-beta-targeting monoclonal antibodies probably result in little to no difference in functional ability as measured on the ADCS-ADL (Alzheimer's Disease Cooperative Study - Activities of Daily Living) scale (SMD 0.09, 95% CI 0.03 to 0.16; 3 studies, 3478 participants; moderate certainty) and may result in a small increase in functional ability if measured with the ADCS-iADL (Alzheimer's Disease Cooperative Study-Instrumental Activities of Daily Living) scale (SMD 0.21, 95% CI 0.10 to 0.32; 1 study, 1252 participants; low certainty) or ADCS-ADL-MCI (Alzheimer's Disease Cooperative Study - Activities of Daily Living for Mild Cognitive Impairment) scale (SMD 0.23, 95% CI 0.12 to 0.33; 4 studies, 2802 participants; low certainty). Adverse events Amyloid-beta-targeting monoclonal antibodies probably result in a small increase in the occurrence of any ARIA E (ARD (absolute risk difference) 107 more per 1000, 95% CI 77 more to 148 more; 11 studies, 13,595 participants; moderate certainty) and probably little to no difference in symptomatic ARIA E (ARD 29 more per 1000, 95% CI 22 more to 38 more; 2 studies, 3522 participants; moderate certainty) or symptomatic ARIA H (ARD 4 more per 1000, 95% CI 1 fewer to 31 more; 1 study, 1795 participants; moderate certainty). Three studies assessing any ARIA H showed heterogeneous results (I2 = 81%), which prevented pooled analysis. At 18 months, amyloid-beta-targeting monoclonal antibodies do not increase serious adverse events (ARD 6 more events per 1000, 95% CI 10 fewer to 26 more; 9 studies, 11,904 participants; high certainty) or overall mortality (ARD 2 more events per 1000, 95% CI 3 fewer to 11 more; 7 studies, 9733 participants; high certainty). We judged the overall risk of bias as low for the outcomes of serious adverse events and mortality. We had some concerns about the overall risk of bias for efficacy outcomes, mainly due to the risk of functional unblinding (i.e. participants and investigators correctly guessing whether a participant is receiving the active drug or placebo because of noticeable side effects). AUTHORS' CONCLUSIONS: The effect of amyloid-beta-targeting monoclonal antibodies on cognitive function and dementia severity at 18 months in people with mild cognitive impairment or mild dementia due to Alzheimer's disease is trivial, while on functional ability, it is small at best. Amyloid-beta-targeting monoclonal antibodies increase the risk of amyloid-related imaging abnormalities. Both desirable outcomes and adverse events were inconsistently reported in the studies included in the review. Successful removal of amyloid from the brain does not seem to be associated with clinically meaningful effects in people with mild cognitive impairment or mild dementia due to Alzheimer's disease. Future research on disease-modifying treatments for Alzheimer's disease should focus on other mechanisms of action. FUNDING: This Cochrane review was funded in part by the Drug and Medical Devices Governance Area, Regione Emilia-Romagna, Bologna, Italy. The publication of this article was supported by "Ricerca Corrente" funding from the Italian Ministry of Health. REGISTRATION: Protocol (2025): PROSPERO registration number CRD420251114325.
17 Apr 2026
Read appraisal →BMJ open
Trends and characteristics of syphilis incidence in Japan: a nationwide claims-based analysis of working-age populations and their dependents, 2016-2023
OBJECTIVES: To examine trends and demographic characteristics of syphilis incidence in Japan using a large nationwide claims database with family linkage, with particular focus on differences by sex, age, HIV status and family relationships. DESIGN: Retrospective cohort study. SETTING: JMDC claims database (JMDC Inc, Tokyo, Japan), a nationwide administrative claims database in Japan, using data from 2016 to 2023. PARTICIPANTS: Individuals aged 16-59 years enrolled in the JMDC database, including employees of medium-to-large companies and their dependents (n=12.5 million). OUTCOME MEASURES: Syphilis cases were defined by International Classification of Diseases, 10th Revision (ICD-10) codes (A50-A53) with concurrent treatment with relevant antibiotics. We determined syphilis incidence rates per 100 000 person-years, stratified by sex, age, HIV status and family relationships. We also investigated within-couple concordance patterns and reinfection rates. RESULTS: Among 16.4 million individuals, 9357 syphilis infections were identified among 8881 individuals. Incidence increased markedly during the pandemic, reaching 48.2 (men) and 12.9 (women) per 100 000 person-years in 2023. Men showed consistently high incidence in their 20s-50s, whereas female incidence peaked in the 10s-20s. Among 2 294 184 married couples, dependent women (ie, housewives) showed comparably high incidence to age-matched men (10-20 per 100 000 person-years). In 1286 couples with at least one syphilis case, 12.4% of wives in their 20s were also diagnosed, compared with 2%-3% in older groups. In 20s couples, the proportion of syphilis among wives only and husbands only was similar. Subgroup analysis revealed notably high incidence among unmarried female dependent youths (2022: 66.7 per 100 000 person-years). Individuals living with HIV had substantially elevated incidence (3000-15 000 per 100 000 person-years) and reinfection rates. CONCLUSIONS: Using a large claims database with family linkage, we found that while male syphilis incidence remained dominant, high rates were also observed among dependent women and youths. These findings suggest that syphilis risk may extend beyond traditionally recognised high-risk populations and emphasise the need for targeted screening and preventive strategies in broader demographic groups.
17 Apr 2026
Read appraisal →BMJ open
mHealth-based Healthy Lifestyle Promotion (MYLIFE) for metabolic syndrome risk reduction in Chinese employed adults: protocol for a cluster-randomised controlled trial
INTRODUCTION: Metabolic syndrome (MetS) poses a significant public health challenge among employed adults. Lifestyle modifications have been shown to be effective in preventing the onset and progression of MetS in employed adults, and the widespread adoption of mobile and wearable technologies introduces an appealing approach to mHealth lifestyle interventions. When widely implementing smartphone-based interventions for employed adults, enhancing equitable access and promoting wearable device use for those with MetS is a more cost-effective way to reduce health disparities, particularly in resource-limited settings. However, relevant evidence is currently lacking. OBJECTIVE: This study aims to design an mHealth-based Healthy Lifestyle Promotion (MYLIFE) trial, a three-arm randomised controlled trial (RCT), to evaluate the effectiveness of a smartphone-based lifestyle intervention and a combined smartphone-based lifestyle intervention with intensive intervention for MetS individuals using wearable devices, in reducing MetS risk among employed adults. METHODS AND ANALYSIS: This is a three-arm, parallel, single-blind, cluster RCT with a 12-week intervention and a total follow-up of 1 year. The trial will recruit 120 workplaces from the Chinese Cohort of Working Adults in a 1:1:1 ratio to either a control group or one of two intervention groups. Within these workplaces, a total of at least 348 eligible participants will be enrolled. The regular mHealth group will receive smartphone-based intervention. The intensive mHealth group will receive smartphone-based intervention for all participants, and an additional wearable device-intensive intervention for those with MetS. The primary outcome is the Chinese MetS Z score at 12 weeks. Secondary outcomes include MetS Z score, prevalence of MetS, specific MetS components, questionnaire-based indicators, and clinical outcomes at 12 weeks and 1 years. The main analysis will follow the intention-to-treat principle, using mixed-effects models to assess between-group differences in outcomes. ETHICS AND DISSEMINATION: The protocol has been approved by the Ethics Committee of the West China School of Public Health and the West China Fourth Hospital, Sichuan University (Gwll2025024). The findings will be published in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER: ChiCTR2500101904.
17 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Beyond breast cancer: mapping unmet needs and advancing an evidence-based framework of survivorship care
PURPOSE: The growing population of breast cancer survivors (BCS) underscores the need to address ongoing challenges that persist beyond active treatment. This scoping review aimed to systematically map the unmet needs of BCS and inform the development of an evidence-based survivorship care framework. METHODS: A systematic search of databases identified 13,401 studies, of which 170 met the inclusion criteria. Data were analyzed using qualitative content analysis and descriptive statistics to categorize unmet needs across studies. RESULTS: Six major categories of unmet needs were identified: physical symptom burden, psychosocial/emotional needs, informational needs, healthcare support needs, relational/sexual needs, and financial/occupational needs. Physical symptoms (33.5% of studies) and psychosocial/emotional concerns (32.4%) were most frequently reported. Based on these domains, a three-phase conceptual framework was developed: (1) universal needs screening, (2) targeted, multidisciplinary interventions tailored to individual survivors, and (3) ongoing evaluation through patient-reported outcomes to optimize care. CONCLUSIONS: Unmet needs among BCS are widespread and multifaceted, particularly regarding chronic physical symptoms and persistent psychosocial distress. Existing care frameworks are fragmented and insufficient. The proposed three-phase framework provides a structured approach to delivering proactive, patient-centred survivorship care. IMPLICATIONS FOR CANCER SURVIVORS: Implementing this framework can improve identification and management of unmet needs, enhance quality of life, support long-term physical and emotional recovery, and foster resilience throughout survivorship.
17 Apr 2026
Read appraisal →JMIR formative research
Fact-Checking Large Language Model Responses to a Health Care Prompt: Comparative Study
BACKGROUND: Large language models use machine learning to produce natural language. These models have a range of potential applications in health care, such as patient education and diagnosis. However, evaluations of large language models in health care are still scarce. OBJECTIVE: This study aimed to (1) evaluate the accuracy and efficiency of automated fact-checking by 2 large language models and (2) illustrate a process through which a large language model might support a patient in redrafting a prompt to include key information needed for patient safety. METHODS: A parallel comparison of 2 large language models and 3 human experts was conducted. A clinical scenario was devised in which a woman aged 23 years questions the safety of retinoid treatment for acne by sending prompts to 2 large language models (GPT-4o and OpenBioLLM-70B). GPT-4o and OpenBioLLM-70B were asked to suggest improvements to the patient's initial prompt to elicit key information for clinical decision-making. After the patient sent the revised prompt to the large language models, the models were then asked to fact-check the final response. To test the generalizability of automated fact-checking, a set of 20 clinical statements on disparate topics, mostly related to drug indications, contraindications, and side effects, was developed. The large language models also fact-checked these 20 medical statements. The results were compared against the evaluations of 3 clinical experts. The outcome measures were as follows: (1) percentage of accuracy of automated fact-checking, (2) time to complete fact-checking, and (3) a binary outcome for prompt redrafting (advising the patient to revise her prompt by naming her acne medication to address safety concerns). RESULTS: For the scenario of a patient with acne, GPT-4o and OpenBioLLM-70B both had 86% agreement with the clinical experts' fact-checking. The large language models did not consistently convey the urgency of discontinuing isotretinoin treatment when pregnancy is suspected. In addition, the models did not adequately convey the importance of folic acid supplementation during pregnancy. For the set of 20 medical claims, GPT-4o fact-checking had 100% agreement with that of human experts, whereas OpenBioLLM-70B had 95% agreement. OpenBioLLM-70B diverged from human experts and GPT-4o on 1 question related to pediatric use of antihistamines. The expert fact-checks took a mean time of 18 (SD 3.74) minutes, GPT-4o took 42 seconds, and OpenBioLLM-70B took 33 minutes. The GPT-4o responses for the acne scenario had some inconsistencies but zero fabrication and no obvious omissions. In contrast, OpenBioLLM-70B omitted 1 key information item needed for patient safety. CONCLUSIONS: GPT-4o can interact with patients to improve the quality and comprehensiveness of the information contained in health-related prompts. GPT-4o and OpenBioLLM-70B can conduct efficient fact-checking that is close to the level of accuracy of human experts. Human experts need to perform additional checks for accuracy and safety.
17 Apr 2026
Read appraisal →Infection and immunity
Maternal influences on oral microbiome development and implications for early childhood health: a systematic review
A deeper understanding of how maternal-infant interactions shape the establishment and diversification of the oral microbiome could have significant clinical applications; however, relatively few studies emphasize early maternal-infant microbial connections. This systematic review provides a longitudinal analysis of oral microbiome development from birth to five years, focusing on the relationship between maternal and infant microbiomes. We conducted a systematic search (June 2025) using keywords "mother," "children," "oral microbiome," and "longitudinal" across PubMed, Cochrane Library, and Embase. Twelve studies fulfilled the inclusion criteria: longitudinal design, healthy mother-child dyads, saliva sample collection, and relevant age range. We excluded review articles, non-English publications, and studies with overlapping data. Results were synthesized by developmental stage and topic. Overall, current literature agrees that the mother is an important source of exposure for initial colonization of the newborn's oral microbiome. Several studies indicated that the oral microbiome at birth is diverse and unspecialized, composed mostly of maternally derived strains. Rapid selection occurs over the first few weeks, as the relative abundances of typical oral bacterial species increase. Throughout the first year, increases in diversity strengthen the resemblance between infant and maternal microbiomes. The microbiome appears to stabilize around 3-5 years. In conclusion, maternal-infant connections play a significant role in influencing oral microbiome development during the first 5 years of life. This review highlights the need for future studies to incorporate larger, longitudinal designs with metadata and advanced tools to clarify the roles of delivery mode, tooth eruption, and parental lifestyle habits in shaping early oral microbiome development.
17 Apr 2026
Read appraisal →Emerging microbes & infections
Cross-protection against highly pathogenic avian influenza H5N1 virus from seasonal influenza vaccines: a systematic review and meta-analysis of ferret studies
The recent surge in spillover events of highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b to humans and mammals in North America has raised urgent pandemic concerns. Human H5N1 vaccines are unavailable in most countries. We synthesized data from ferret challenge trials to evaluate whether widely available seasonal influenza vaccines confer cross-protection against lethal H5N1 infection. We systematically searched PubMed, Embase, and Web of Science for ferret studies of lethal H5N1 challenge published up to 5 July 2025 (PROSPERO #CRD42024520346). Random-effects meta-analyses were conducted to compare vaccine efficacy (VE) of seasonal influenza vaccines and H5N1 vaccines against H5N1-related mortality. Seroprotection was defined as a neutralizing antibody titre of ≥1:40. We identified 35 studies (157 trials). Seasonal influenza vaccines without N1 did not confer significant cross-protection (five trials; VE 14.8%, 95% CI -3.6 to 30.0). In contrast, VE was 73% for N1-containing seasonal influenza vaccines (19 trials; 95% CI 54-84) and 77% for H5N1 vaccines overall (133 trials; 95% CI 72-82) (p = 0.52). The VE of N1-containing seasonal influenza vaccines was modestly lower than that of H5N1 vaccines with seroprotection (88%; 66 trials; 95% CI 84-91; p = 0.009), but comparable to H5N1 vaccines that did not achieve seroprotection (63%; 67 trials; 95% CI 52-71; p = 0.29). The VE of seasonal influenza vaccines against H5N1 was robust across sensitivity analyses, with no evidence of publication bias (p = 0.99). Seasonal influenza vaccines significantly reduce H5N1-associated mortality in ferret trials, suggesting the cross-protection potential of currently available vaccines. Human studies are warranted.
16 Apr 2026
Read appraisal →JMIR mental health
Determinants of Digital Health Literacy Among Patients With Serious Mental Illness: Cross-Sectional Survey
BACKGROUND: Individuals with serious mental illness increasingly use digital devices and the internet to access health information and services but often face challenges when navigating digital tools, which may limit the benefits they receive from online health resources and digital health care services. OBJECTIVE: The objective of our study was to assess digital health literacy among individuals with serious mental illness and identify factors influencing this literacy. METHODS: Participants were recruited, using convenience sampling, from 2 psychiatric clinics, 1 day-care center, and 4 halfway houses in Taipei, Taiwan, between May 2024 and February 2025. Self-reported data were collected using a survey that incorporated the eHealth Literacy Scale, the Attitudes Toward Computer/Internet Questionnaire, and the Mobile Device Proficiency Questionnaire. Generalized linear modeling was applied to identify factors associated with digital health literacy. RESULTS: Among 255 participants included in the analysis, 83.5% (n=213) reported owning at least 1 digital device. Digital health literacy was significantly lower among individuals who reported greater perceived difficulty in using digital tools (B=-1.533, 95% CI -2.350 to -0.717; P<.001) and higher distrust in online information (B=-0.986, 95% CI -1.916 to -0.056; P=.04). By contrast, greater mobile device proficiency (B=0.144, 95% CI 0.008-0.281; P=.04) and self-efficacy (B=1.777, 95% CI 0.376-3.177; P=.01) were positively associated with digital health literacy. CONCLUSIONS: Despite widespread device ownership, digital health literacy was varied and generally suboptimal among patients with serious mental illness. Perceived difficulty and distrust emerged as major barriers; proficiency and self-efficacy facilitated higher literacy. These findings highlight the need for mental health professionals to integrate tailored digital skills training, confidence-building strategies, and ongoing support into digital health interventions for individuals with serious mental illnesses.
16 Apr 2026
Read appraisal →European journal of trauma and emergency surgery : official publication of the European Trauma Society
Comparison of CATCH, PECARN and CHALICE rules in children with minor head trauma
PURPOSE: The aim of this study is to prospectively compare the diagnostic performance of the PECARN, CATCH, and CHALICE clinical decision rules in pediatric patients presenting with minor head trauma, within a rural secondary-level emergency department characterized by limited resources, high patient volume, and restricted access to specialist physicians. METHODS: The study was designed as a prospective observational study. The PECARN, CATCH, and CHALICE clinical decision rules were applied to the patients included in the study, and the data were recorded. The data included in the study were statistically analyzed using the SPSS (Statistical Package for Social Sciences; SPSS Inc., Chicago, IL) 27 program. A value of p < 0.05 was considered statistically significant. RESULTS: A total of 1,032 patients were included in the study. The PECARN did not miss any of the 15 patients with pathological brain CT and had 100% sensitivity and 52.1% specificity. CATCH failed to detect pathological brain CT in 1 patient and had 93.3% sensitivity and 53.3% specificity. CHALICE failed to detect pathological brain CT in 2 patients, with 86.7% sensitivity and 87.8% specificity. Overall, PECARN was more successful in detecting pathological brain CT, but it also had a high false-positive brain CT rate. CONCLUSION: PECARN criteria are more sensitive than other criteria in predicting brain CT pathology, but they lead to a large number of brain CT scans. While the CHALICE criteria are beneficial in reducing unnecessary brain CT scans, they may miss positive cases.
16 Apr 2026
Read appraisal →PloS one
Ultra-processed food consumption and the risk of overweight and obesity in adolescents: A systematic review and meta-analysis
INTRODUCTION: Overweight and obesity during early life increase the risk of premature morbidity and mortality. Adolescent obesity raises the likelihood of developing cardiovascular risk factors, including prediabetes, type 2 diabetes, dyslipidemia, hypertension, liver disease, and metabolic syndrome. Sedentary lifestyles and unhealthy diets are major contributors, with one of the fastest-growing unhealthy eating patterns being the consumption of ultra-processed foods (UPFs). No systematic review and meta-analysis has specifically examined the association between UPF consumption and overweight/obesity in adolescents. OBJECTIVE: To systematically review and conduct a meta-analysis of available evidence on the association between UPF consumption and overweight or obesity among adolescents. METHODS: We searched PubMed, ScienceDirect, HINARI, Google, and Google Scholar for primary studies reporting UPF consumption and overweight/obesity outcomes in adolescents, without restrictions on language or study period. Study quality was assessed using the Newcastle-Ottawa Scale. Heterogeneity was evaluated using Cochrane's Q test and the I² statistic. Publication bias and small-study effects were assessed using Egger's regression test (p < 0.05). A random-effects model estimated pooled associations. RESULTS: Twenty-three studies involving 155,000 adolescents were included. Adolescents with higher UPF consumption had 63% greater odds of overweight or obesity compared with those with lower intake (OR = 1.63; 95% CI: 1.36-1.95). CONCLUSION: High UPF consumption is associated with an increased risk of overweight and obesity among adolescents. Public health strategies targeting reduced UPF intake and promotion of healthier diets should be prioritized to prevent adolescent overweight/obesity and associated health risks.
16 Apr 2026
Read appraisal →The New England journal of medicine
Asundexian for Secondary Stroke Prevention
BACKGROUND: Patients with noncardioembolic ischemic stroke or transient ischemic attack (TIA) are at risk for recurrent stroke. Low factor XI levels are associated with a reduced risk of ischemic stroke. Asundexian inhibits activated factor XI. Whether the addition of asundexian to antiplatelet therapy would be superior to antiplatelet therapy alone for the secondary prevention of ischemic stroke is unclear. METHODS: In this phase 3, double-blind trial, we randomly assigned patients within 72 hours after the onset of a noncardioembolic ischemic stroke or high-risk TIA to receive asundexian (50 mg once daily) or placebo, in addition to planned dual or single antiplatelet therapy. Patients had at least one of the following: a nonlacunar infarct on imaging, a history of atherosclerosis, or evidence of atherosclerotic plaque at any location on cerebrovascular imaging. The primary efficacy outcome was ischemic stroke. The composite of death from cardiovascular causes, myocardial infarction, or stroke was a key secondary outcome. The primary safety outcome was major bleeding. RESULTS: Among 12,327 patients who underwent randomization (6162 to the asundexian group and 6165 to the placebo group), the incidence of ischemic stroke was lower in the asundexian group than in the placebo group (6.2% vs. 8.4%; cause-specific hazard ratio, 0.74; 95% confidence interval [CI], 0.65 to 0.84; P<0.001). The incidence of the composite of death from cardiovascular causes, myocardial infarction, or stroke was lower in the asundexian group than in the placebo group. The incidence of major bleeding was similar in the asundexian group and the placebo group (1.9% and 1.7%, respectively; cause-specific hazard ratio, 1.10; 95% CI, 0.85 to 1.44). The incidence of adverse events was 69.3% in the asundexian group and 70.1% in the placebo group; the incidence of serious adverse events was 19.2% and 19.5%, respectively. CONCLUSIONS: Among patients with noncardioembolic ischemic stroke or high-risk TIA treated with antiplatelet therapy, asundexian at a daily dose of 50 mg resulted in lower risks of ischemic stroke and major cardiovascular events than placebo, without a higher risk of major bleeding. (Funded by Bayer; OCEANIC-STROKE ClinicalTrials.gov number, NCT05686070.).
16 Apr 2026
Read appraisal →Journal of the American College of Cardiology
Risk-Guided Atrial Fibrillation Screening With Artificial Intelligence-Enabled Electrocardiogram Models: A VITAL-AF Trial Analysis
BACKGROUND: Screening for atrial fibrillation (AF) may lead to earlier detection and initiation of preventive measures. Current AF screening approaches using a guideline age-based threshold of ≥65 years have shown limited yield. OBJECTIVES: In an AF screening trial, we assessed whether the screening effect was larger among individuals at elevated AF risk using validated clinical and electrocardiogram (ECG)-based artificial intelligence (AI) risk models. METHODS: VITAL-AF was a cluster-randomized trial of patients aged ≥65 years treated at 1 of 16 primary care practices affiliated with Massachusetts General Hospital. Patients randomized to a screening practice were screened using a single-lead ECG. Among VITAL-AF participants without prevalent AF with at least one 12-lead ECG within 3 years before enrollment, we estimated AF risk using 3 validated models derived outside of VITAL-AF: the Cohorts of Heart and Aging Research in Genomic Epidemiology-AF (CHARGE-AF) clinical score, an AI-based model using a 12-lead ECG alone (ECG-AI), and a model combining ECG-AI and CHARGE-AF (CH-AI). Two-year incident AF discrimination was assessed by the time-dependent area under the receiver-operating characteristic curve (AUROC) and average precision. AF screening effect was defined as the difference in 2-year incident AF diagnosis rate (per 100 person-years) in screening vs control across AF risk deciles. RESULTS: Of 30,630 VITAL-AF participants without prevalent AF, 16,937 had pretrial ECG and clinical data. Each score discriminated 2-year AF risk according to AUROC (CHARGE-AF: 0.711 [95% CI: 0.671-0.749]; ECG-AI: 0.784 [95% CI: 0.743-0.819]; CH-AI: 0.788 [95% CI: 0.754-0.824]) and average precision (0.0952 [95% CI: 0.0836-0.112]; 0.132 [95% CI: 0.113-0.157]; 0.133 [95% CI: 0.117-0.159]). An AF screening effect was observed in the top decile of CH-AI (AF diagnosis rate in screening 10.07/100 person-years [95% 8.28-11.87] vs 7.76 [95% 6.30-9.21] in control, P < 0.05), corresponding to a difference in AF diagnosis rate of 2.32/100 person-years (95% CI: 0.01-4.63) and number-needed-to-screen of 43 per year. CONCLUSIONS: Use of ECG-based AI and clinical factors identified individuals at particularly high risk for AF who may benefit from screening. Findings suggest a trade-off between increasing AF screening efficiency and decreasing population coverage (ie, restriction of the screening pool). Future studies are needed to determine whether a risk-based approach is optimal or whether consideration of additional clinical- and systems-level factors (eg, access, health care system engagement) can further refine AF screening strategies. (Screening for Atrial Fibrillation Among Older Patients in Primary Care Clinics [VITAL-AF]; NCT03515057).
16 Apr 2026
Read appraisal →Journal of the International Society of Sports Nutrition
Effects of race distance and probiotics intervention on kidney, muscle, and gut injury and inflammation biomarker responses during running.
INTRODUCTION: Prolonged intense physical activity, such as long-distance running, may lead to systemic inflammation and cause organ injury, particularly to the kidneys. This study aimed to assess the impact of trail race running on kidney and muscle injury and gut inflammation biomarkers, and the potential mitigating effects of Lactiplantibacillus plantarum 299v (Lp299v) supplementation. METHODS: This randomized, double-blind, placebo-controlled study included 34 participants who completed 42 races, ranging from 20 to 164 km. Participants were divided into two groups, receiving either 40 bn CFU Lp299v or a placebo for 4 weeks before the race. Urine and fecal samples were collected pre- and post-race (immediately after, morning after and 24 h after the race) to measure biomarkers of muscle and kidney injury, and gut inflammation. Principal component analysis was used to create a single tubular kidney injury biomarker component variable (TKIBC1) positively associated with five separate tubular kidney injury biomarkers (MCP-1, KIM-1, GST-π, clusterin, and calbindin) at the three post-race time points. RESULTS: Running led to increased tubular and glomerular kidney injury markers, increased levels of fecal calprotectin, and, in some cases, elevated urine myoglobin levels. These effects were more pronounced in races ≥107 km (ultradistance). While Lp299v supplementation did not significantly influence TKIBC1, it was associated with a protective effect against gut inflammation. CONCLUSION: These findings suggest that prolonged intense exercise induces kidney and muscle injury as well as gut inflammation, with more severe effects observed in ultra-distance running. Lp299v may have some protective effects, particularly against gut inflammation, but further studies are needed to confirm these findings and explore the underlying mechanisms linking gut health and kidney injury during extreme physical exertion.
16 Apr 2026
Read appraisal →Physiological measurement
Towards real-time sleep stage classification: a deep learning approach leveraging PPG and ECG
Objective.This work aims to enable adaptive consumer sleep technologies (CSTs) for sleep intervention by developing a deep learning model for sleep stage classification using wearable sensor data.Approach.We propose an end-to-end deep learning approach leveraging Photoplethysmography (PPG) signals, commonly available in CSTs. Model performance is improved by pretraining with electrocardiography (ECG) from the large-scale multi-ethnic study of atherosclerosis dataset datasets. Training and evaluation are conducted with the Dataset for Real-time sleep stage EstimAtion using Multisensor wearable Technology and an additional dataset comprising of 13 participants (aged 22-71 years) without prior known sleep disorders. The dataset contains combined synchronized polysomnography (PSG) and Empatica E4 wearable data, annotated with American Academy of Sleep Medicine (AASM) sleep stages.Main results.The proposed method demonstrates sleep stage classification from minimally processed PPG signals for real-time intervention. While ECG-trained models are not directly transferable to PPG, fine-tuning significantly improves performance, achieving up to a 29% increase in multi-stage classification accuracy.Conclusion.Pretraining with ECG and fine-tuning with PPG increases sleep stage classification for end-to-end deep learning models, exceeding previous efforts particularly in 3-stage sleep classification.Significance.This work contributes to sleep health by developing a sleep stage classification model for minimally processed PPG sensor data and takes a step further towards making adaptive CSTs feasible for use with wearable sensors.
16 Apr 2026
Read appraisal →Human fertility (Cambridge, England)
The global evaluation of the effects of antioxidants on seminal outcomes in infertile men: a systematic review and meta-analysis
The aim of the current review is to summarise information from publications on the impact of antioxidants on seminal outcomes in infertile men. A systematic search was performed in the five valid databases (Scopus, PubMed, Medline, Embase, and Web of Science) utilizing two sets of keywords up to September 2025, according to the PRISMA approach. Of the 11749 papers identified, 101 papers were included in this review, for a total of 11889 infertile men. Sperm concentration, normal sperm morphology, progressive sperm motility, and total sperm motility, were considerably higher in experimental groups compared with control groups. Both sperm concentration (106 mL-1) and total motility (%) were higher in experimental groups compared to control groups with an overall pooled standardised mean difference (SMD) of 2.33 (95% CI: 1.73, 2.94) for sperm concentration and SMD of 1.62 (95% CI: 1.20, 2.04) for total motility (%). Subgroup analysis demonstrated that duration of treatments of more than 6 months were more effective than those of less than 3 months. Based on the findings of this review, no definitive recommendation can be made regarding the use of antioxidants as a therapy for male infertility, and further research is necessary.
16 Apr 2026
Read appraisal →Spine
Predictors for Unsuccessful Outcome of Lumbar Spinal Stenosis Surgery: A Secondary Analysis of the 2 Randomized NORDSTEN Trials
STUDY DESIGN: Observational cohort study. OBJECTIVE: To evaluate potential predictors of unsuccessful outcomes after surgery in patients with lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA: LSS is a common cause of disability in adults and the leading indication for spine surgery in Norway. Despite advances in surgical techniques, nearly one-third of patients report either minor or no improvement or worsening of symptoms after surgery. Identifying predictors of unsuccessful outcomes is essential for improving patient selection and shared decision-making. MATERIALS AND METHODS: This secondary analysis used data from the 2 NORwegian Degenerative spondylolisthesis and spinal STENosis (NORDSTEN) randomized trials, which included 704 surgically treated patients with LSS, with (n=267) or without (n=437) degenerative spondylolisthesis. The Oswestry Disability Index (ODI) was the primary outcome measure. A reduction in ODI score of <30% from baseline to 2 years postoperatively was defined as an unsuccessful outcome. Multivariable logistic regression analysis was used to evaluate whether carefully selected baseline variables were associated with an unsuccessful outcome at 2-year follow-up. RESULTS: Longer duration of radiating pain (>12 mo; OR: 2.58, 95% CI: 1.54-4.29), psychological distress (HSCL-25 ≥1.75; OR: 1.60, 95% CI: 1.01-2.53), and advanced disc degeneration (Pfirrmann grades 4-5; OR: 1.98, 95% CI: 1.26-3.12) were independently associated with an unsuccessful outcome. Commonly discussed factors such as age, BMI, smoking, ASA grade, and predominant back pain did not reach statistical significance for association with the outcome. CONCLUSION: Among patients undergoing surgery for LSS, longer symptom duration, psychological distress, and advanced disc degeneration were associated with a higher risk of unsuccessful postoperative outcomes.
16 Apr 2026
Read appraisal →Spectrochimica acta. Part A, Molecular and biomolecular spectroscopy
SERS-based deep learning approach for early detection of gestational diabetes mellitus
Early and precise diagnosis of gestational diabetes mellitus (GDM) is crucial for improving maternal and neonatal outcomes and reducing the risk of adverse pregnancy events. However, current clinical screening methods for GDM still exhibit limitations in detection speed, sensitivity and convenience, making it difficult to meet the clinical demand for rapid early-pregnancy screening. To address this, we propose a novel strategy for early GDM diagnosis based on surface-enhanced Raman spectroscopy (SERS) combined with deep learning, aiming to achieve rapid and accurate early screening. Characteristic SERS spectra of serum were obtained using a substrate based on silver nanoparticles (Ag NPs). A fused PCA-CNN model integrating principal component analysis (PCA) for dimensionality reduction and a one-dimensional convolutional neural network (1D-CNN) for feature learning was developed. The PCA-CNN model effectively extracts potential biomarker features from serum SERS spectra, achieving a diagnostic accuracy of 93.7%, with sensitivity and specificity of 0.95 and 0.93, respectively. Moreover, the entire detection process can be completed within 30 min, requires about 2.5 μL of serum per sample, and involves minimal preprocessing, highlighting both efficiency and practicality. This study provides a novel method for early GDM screening that combines high diagnostic performance with clinical applicability, offering promising technical support for early intervention and clinical management of GDM.
16 Apr 2026
Read appraisal →Journal of affective disorders
Who engages? Machine learning insights into digital mindfulness-based intervention for generalized anxiety disorder.
BACKGROUND: Although mindfulness ecological momentary interventions (MEMI) appear effective in alleviating worry symptoms, treatment engagement remains suboptimal. Determining baseline variables of MEMI over self-monitoring placebo (SM) can inform tailored interventions for individuals with generalized anxiety disorder (GAD). METHOD: Machine meta-learning methods (ML) were applied to predict two-week engagement (log-transformed number of prompts completed) among individuals randomized to MEMI or SM (N = 110). Sixteen baseline variables comprised the predictor set: clinical, demographic, process, and executive functioning (EF) factors. Random forest using a five-fold nested cross-validation approach mitigated overfitting. X-learner meta-algorithms estimated conditional average treatment engagement (CATE). Shapley additive explanations evaluated relative importance. RESULTS: The 16-predictor model displayed strong predictive performance (R-squared [R2] = 82.7%; root mean squared error [RMSE] = 0.780; mean absolute error [MAE] = 0.512). The top-10 predictor model also yielded good predictive performance (R2 = 82.1%; RMSE = 0.547; MAE = 0.307). As predicted by the CATE analysiscate, participants had the highest treatment engagement when assigned to MEMI instead of SM (d = 1.447, p < .001). The following baseline variables predicted more engagement with MEMI over SM: lower GAD severity, inhibition response time (RT), and EF errors, higher attentional control, empathy, and verbal fluency (capitalization theory); lower mindfulness, and treatment expectancy, poorer working memory, and higher set-shifting RT (compensation model). LIMITATIONS: The small sample size, single engagement metric, and brief duration might constrain generalizability. DISCUSSION: Integrating robust ML approaches could optimally identify prescriptive predictors of engagement to brief digital mental health interventions to inform targeted treatments. TRIAL REGISTRATION: ClinicalTrials.gov ID (NCT04846777).
16 Apr 2026
Read appraisal →Open heart
Chronotype-aligned exercise timing in middle-aged adults at cardiometabolic risk: a randomised controlled trial
OBJECTIVE: To investigate whether aligning exercise timing with chronotype enhances cardiometabolic and sleep-related benefits in sedentary adults with cardiovascular risk factors. METHODS: In this 12-week randomised controlled trial conducted in Lahore, Pakistan (January-June 2025), 150 sedentary adults (aged 40-60) with at least one cardiovascular risk factor were recruited and categorised as morning-type or evening-type using the Morningness-Eveningness Questionnaire and validated by 48 hour core body temperature monitoring. Participants were randomised into a chronotype-aligned exercise (CAE) group exercising at their preferred time, or a chronotype-misaligned exercise (CME) group exercising at their non-preferred time. Moderate-intensity aerobic training (5 sessions/week, 40 min/session) was supervised. Primary outcomes included systolic and diastolic blood pressure (BP) and heart rate variability (RMSSD); secondary outcomes included peak oxygen consumption (VO₂ peak), low density lipoprotein (LDL), fasting glucose and sleep quality (PSQI), assessed pre- and post-intervention. RESULTS: Of 150 randomised participants, 134 completed the study (CAE: n=64; CME: n=70). CAE led to significantly greater improvements in systolic BP (-10.8 vs -5.5 mm Hg, p=0.002), diastolic BP, RMSSD, VO₂ peak, LDL, fasting glucose and PSQI scores compared with CME. Repeated measures analysis of variance (ANOVA) revealed significant group×time interactions across all outcomes (eg, systolic BP: η²=0.095, p=0.005). The reduction in systolic BP in the CAE group was substantial and significantly greater than in the CME group. CONCLUSION: Aligning exercise timing with individual chronotype significantly enhances cardiometabolic and sleep-related outcomes in at-risk adults. Chronotype-based exercise prescriptions may offer a cost-effective, personalised approach to improving cardiovascular health.
16 Apr 2026
Read appraisal →Journal of affective disorders
Comorbid clinical and biomarker outcomes in patients with obsessive-compulsive disorder: An umbrella review and evidence map
BACKGROUND: Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition with diverse comorbidities, yet outcome research remains limited. Thus, we aimed to systematically review existing meta-analyses of OCD-associated comorbid outcomes and assess the strength of evidence. METHODS: We conducted an umbrella review of meta-analyses, searching PubMed/MEDLINE, Embase, CINAHL, and Google Scholar up to July 7, 2025. Although we intended to include all studies related to OCD-associated comorbid outcomes, only observational studies were available. Effect sizes were recalculated using random-effects models, and all estimates were converted to equivalent standardized mean differences (eSMD) with 95 % confidence intervals (CIs). The methodological quality of the included reviews was assessed using the AMSTAR 2 tool, and the class of evidence (CE) for each association was graded according to predefined criteria (Class I-IV). RESULTS: We identified 17 meta-analyses that included 373 primary studies, covering 52 outcomes in 156,161 participants across 40 countries. Patients with OCD were associated with autistic traits outcomes, including restricted and repetitive behaviors (eSMD, 1.66 [95 % CI, 1.25-2.07]; CE = IV), and total autism-spectrum quotient score (1.40 [1.06-1.81]; CE = IV). OCD also showed associations of varying strength with several other outcomes, including suicidal attempt (0.64 [0.47-0.81]; CE = II) and toxoplasmosis infection (0.37 [0.15-0.59]; CE = III). Furthermore, quality of life was decreased across multiple domains in individuals with OCD (emotional, -1.47 [-1.96 to -0.98]; CE = II; global, -0.79 [-1.02 to -0.55]; CE = II; work/social, -1.21 [-1.72 to -0.69]; CE = III). CONCLUSION: Our study highlights the comprehensive impact of OCD, indicating associations with autism, suicidality, social-cognitive deficits, impaired quality of life, and neurobiological markers. STUDY REGISTRATION: PROSPERO CRD420251124380.
16 Apr 2026
Read appraisal →Journal of affective disorders
The effects of Omega-3 supplementation on stress, anxiety, depression, sleep quality, and everyday memory in individuals with psychological distress: A randomized, double-blind, placebo-controlled trial
BACKGROUND/OBJECTIVES: Psychological stress, anxiety, depression, memory impairment, and poor sleep quality are prevalent issues that affect individuals' quality of life and overall health. Omega-3 polyunsaturated fatty acids (PUFAs) have been suggested to have mood-regulating effects. However, there is lack of data on the effect of omega-3 supplementation on depression, stress, anxiety, everyday memory, and sleep quality on Saudi population. Therefore, this study aimed to evaluate the impact of omega-3 supplementation on stress, anxiety, depression, everyday memory, and sleep quality in individuals with severe psychological distress. METHODS: A randomized, double-blind, placebo-controlled trial was conducted involving 64 participants with high levels of stress, anxiety, depression, memory issues and with poor quality of sleep with 32 allocated to the intervention group and 32 to the control group. The participants received either omega-3 supplementation (500 mg EPA + 250 mg DHA) or a placebo daily for three months. Pre- and post-intervention assessments were conducted using validated scales, including the Perceived Stress Scale (PSS), Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Everyday Memory Questionnaire (EMQ). RESULTS: Significant improvements were observed in the intervention group regarding stress, anxiety, depression, sleep quality, and memory outcomes (p < 0.001 for PSS, GAD-7, PHQ-9, PSQI, and EMQ). Between-group comparisons showed statistically significant reductions in post-intervention scores for the intervention group versus the control group. Regression analysis revealed strong predictive relationships between pre- and post-scores, particularly for stress and depression. CONCLUSIONS: Omega-3 supplementation resulted in notable psychological and cognitive improvements, suggesting its potential as a safe and effective adjunct for managing stress, mood disorders, and sleep disturbances among participants with psychological distress. Further research should explore how individual responses are influenced by baseline inflammation and omega-3 status. CLINICALTRIALS: gov: NCT07157241.
16 Apr 2026
Read appraisal →Journal of affective disorders
Association of social isolation and loneliness with cancer prognosis: an analysis of the UK Biobank
BACKGROUND: Evidence is scarce for the association between social isolation and loneliness and prognosis of any cancer or other common cancer types. METHODS: To address this gap, we performed a cohort study from 2006 to 2022 using data from the UK Biobank (UKB). Social isolation and loneliness were identified based on the questionnaire of the UKB. Cases of death were obtained from the death registry, where both primary and contributory causes were recorded using ICD-10 codes. The Cox proportional hazard models were used to estimate hazard ratios (HRs) and associated 95% confidence intervals (CIs) of death in relation to social isolation and loneliness among patients with cancer. RESULTS: Among cancer patients studied, 6206 (9.6%) were socially isolated and 3130 (4.8%) reported loneliness. Over a median follow-up of 6.7 years, there were 2378 deaths (38.3%) among exposed patients and 16,566 deaths (29.1%) among unexposed patients. Social isolation was associated with poorer cancer prognosis overall (HR 1.21, 95% CI 1.16-1.26, P < 0.001), while loneliness correlated with a similar risk (HR 1.18, 95% CI 1.11-1.25, P < 0.001). Social isolation specifically impacted survival in colon, melanoma, breast, prostate, kidney, and bladder cancers, as well as myeloproliferative neoplasms. Loneliness was linked to poorer outcomes in breast, prostate, and bladder cancers. CONCLUSIONS: Our findings suggested that social support for these vulnerable patients might have the potential to improve prognosis.
15 Apr 2026
Read appraisal →Journal of affective disorders
Adverse psychosocial work exposures and 2-year incident prescription of psychotropic medications: a prospective French study using the national healthcare reimbursement database
OBJECTIVE: Despite the abundant literature on the associations between psychosocial work exposures and mental health outcomes, prospective studies using medico-administrative data are lacking. The objective was to study the associations between various psychosocial work exposures and incident prescription of psychotropic medications. METHODS: The study relied on three waves (2010, 2012, 2014) of the French ESPS survey (Health, Health Care and Insurance Survey) (baseline data), linked to the national database of healthcare reimbursements (follow-up data). Each survey wave was conducted among a randomly selected national sample of people aged 18+. The study included a total of 8689 observations among 7695 workers without psychotropic medication prescription within the 6 months preceding survey wave. Ten psychosocial work exposures (quantitative demands, tensions with the public, freedom, possibilities for learning new things, colleague support, recognition, salary satisfaction, job insecurity, temporary contract, and redundancy plan) were assessed at each survey wave. Covariates included gender, age, marital status, employee/self-employed worker, private/public sector, occupation, and full/part-time work. The outcome was psychotropic medication prescription within the 2 years following survey wave. Mixed effects Cox regression modelling was used. RESULTS: Seven of the ten psychosocial work exposures were associated with incident psychotropic medication prescription. Associations were observed more with incident prescription of antidepressants and anxiolytics than with hypnotics/sedatives. The number of psychosocial work exposures increased the risk linearly, except for hypnotics/sedatives. No gender interaction was found for any of these associations. CONCLUSION: The findings may support that poor psychosocial working conditions increase the risk of subsequent psychotropic medication prescription.
15 Apr 2026
Read appraisal →ChemMedChem
Structure- and Ligand-Based Discovery of Novel 3-Chymotrypsin-Like Protease Nonpeptidomimetic Hits
The SARS-CoV-2 3-chymotrypsin-like (3CLpro) protease is a key target for the development of COVID-19 therapeutics. While ensitrelvir and nirmatrelvir are approved drugs for treatment, the continuous research and development for new antiviral drugs is necessary to combat the emergence of variants and other related viruses. This study employed structure- and ligand-based computer-assisted approaches to identify new 3CLpro nonpeptidomimetic inhibitors. Using data from COVID Moonshot, NCATS, and the literature, computational methods such as shape-based, ensemble docking, and machine learning (ML) techniques were developed, achieving robust validation metrics: AUC = 87%, EF = 7, BEDROC = 60% for shape-based; AUC = 87%, EF = 7.03, BEDROC = 62% for ensemble docking, and ACC = 81%, MCC = 62% for ML models, combing Random forest + ECFP4 fingerprint. These models were utilized in virtual screening (VS) campaigns using the H3D and ChemBridge libraries, from which six promising hits with IC50 values ≤80 µM were identified, including LabMol-499 with an IC50 of 13.71 µM and a Ki of 21.74 µM. Moreover, we found that LabMol-499 acts as a noncompetitive, reversible inhibitor of 3CLpro. These findings provide a foundation for hit-to-lead optimization of new nonpeptidomimetic 3CLpro inhibitors.
15 Apr 2026
Read appraisal →Food & function
The effect of anthocyanins through diet and supplementation on cognitive function in older adults: a multi-centre randomised controlled clinical trial
Anthocyanins, a flavonoid subclass present in certain blue, purple and red fruits and vegetables, have potential neuroprotective properties due to their anti-inflammatory, antioxidant, and signalling effects. Clinical and epidemiological studies of anthocyanins provide promising evidence for attenuation of memory loss and improved cognitive function. We investigated the effects of anthocyanins, provided through diet or supplementation, on cognitive function and related parameters. A multi-centre, 24-week randomised, parallel 3-arm clinical trial was conducted in participants aged 60-85 years with self-reported memory complaints and scoring ≤13 on the Memory Index Score within the Telephone Montreal Cognitive Assessment (T-MoCA). Participants were randomised to high anthocyanin diet, freeze-dried product derived from blackcurrants (250 mg anthocyanins per day), or control (placebo). The primary outcome was auditory episodic memory functioning. Secondary outcomes were additional cognitive functions, subjective memory complaints and self-reported depression symptoms, blood pressure, inflammatory biomarkers, lipid profile, vascular and microvascular endothelial function tests. Mixed linear modelling evaluated changes over time using both intention-to-treat and completer analyses. Of 110 participants enrolled (mean age 69.2 years SD 6.7; 36 males, 74 females), 94 completed the study. There was no treatment × time effect on any primary or secondary outcomes. We postulate that the potential anti-inflammatory, antioxidant, and signalling effects of anthocyanins were insufficient to significantly modulate any outcomes due to participants' overall good health and lack of relevant cognitive decline. We recommend future interventional studies focus on subjects with diagnosed cognitive impairment, such as MCI and dementia, and those with more severe comorbidities, particularly chronic inflammatory conditions. Trial Sponsor: National Health and Medical Research Centre (NHMRC) Dementia Collaborative Research Centre.
15 Apr 2026
Read appraisal →Food & function
Metabolic and inflammatory effects of oleuropein and olive leaf extract: a systematic review and meta-analysis
Background: Olive leaves, a by-product of olive oil production, are rich in oleuropein, a phenolic compound with antioxidant and anti-inflammatory properties. This systematic review and meta-analysis evaluated the effects of olive leaf extract (OLE) and oleuropein on glucose metabolism, lipid profile, and inflammatory markers in randomized clinical trials (RCTs). Methods: The review was registered in PROSPERO (CRD42022375615) and followed PRISMA guidelines. PubMed, Scopus, and Web of Science were searched up to January 2026 without restrictions. Eligible studies were RCTs in adults comparing OLE or oleuropein with placebo or control. Study selection, data extraction, and risk of bias (RoB 2) assessment were performed independently by two reviewers; certainty of evidence was assessed with GRADE. Meta-analyses were conducted when at least two trials reported suitable data. Results: Eleven RCTs were included (4 short-term and 7 continuous-intake trials). Short-term crossover studies showed heterogeneous effects on postprandial glycemia and insulin responses, precluding meta-analysis. In continuous-intake, parallel-design RCTs, pooled analyses demonstrated no statistically or clinically significant effects on glycemic or lipid outcomes. Evidence regarding inflammatory markers was scarce and of low certainty. Conclusion: The current evidence does not support clinical recommendations for OLE supplementation aimed at health benefits. Data from methodologically consistent and robust trials indicate no statistically significant metabolic or inflammatory effects under usual human consumption patterns, whereas evidence from other study designs remains inconclusive. Further high-quality RCTs are required to clarify potential metabolic benefits.
15 Apr 2026
Read appraisal →Food & function
Regular black tea kombucha consumption is associated with improved insulin resistance and increased ADIPOQ expression in adults with obesity: a pre-post clinical trial
Kombucha is a fermented beverage obtained by a Symbiotic Culture of Bacteria and Yeast (SCOBY). Although in vitro and animal studies suggest that kombucha has anti-inflammatory and anti-obesogenic properties, no clinical trials have confirmed that. In this pre-post clinical intervention study, we aimed to evaluate whether regular black tea kombucha consumption would impact metabolic, inflammatory, and oxidative stress markers; body weight and composition; and obesity-associated genes in individuals with and without obesity. This study follows the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) guidelines. Individuals with normal weight (Group 1; n = 20) and with obesity (Group 2; n = 16) received 200 mL of black tea kombucha for 8 consecutive weeks. Blood and subcutaneous adipose tissue (SAT) were collected at the baseline (T0) and after 8 weeks of intervention (T8). Most inflammatory (hs-CRP, IFN-γ, TNF-α, and IL-4, IL-6, IL-8, IL-10, and IL-12p70) and oxidative stress markers (FRAP, MDA, and NO) showed significant changes over time following the intervention. However, interaction analyses revealed that responses to kombucha consumption differed between groups for only a limited number of variables: body weight, conicity index, HOMA-IR, and hs-CRP. An upregulation of the gene ADIPOQ in the SAT (p = 0.0481) was also observed, alongside a positive correlation between the BMI and PPARγ (r = 0.58; p = 0.030), and between HOMA-IR and both NFκB (r = 0.73; p = 0.002) and SREBF1 (r = 0.66; p = 0.010). In conclusion, metabolic and inflammatory pathways may respond differently to kombucha consumption depending on the obesity status. The results are mainly attributed to the high number and diversity of phenolic compounds identified in the black tea kombucha, which confer a high antioxidant capacity to the beverage.
15 Apr 2026
Read appraisal →JAMA
A Decision-Support System to Personalize Antidepressant Treatment in Major Depressive Disorder: A Randomized Clinical Trial
IMPORTANCE: Antidepressants for moderate to severe major depressive disorder may be discontinued prematurely because the prescribed antidepressant is not always the most appropriate medication for an individual. Guidelines have recommended more precise targeting of antidepressant treatment. OBJECTIVE: To evaluate the efficacy of a web-based tool to personalize antidepressant treatment. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, randomized clinical trial included persons between the ages of 18 and 74 years with major depressive disorder. The trial was conducted at 47 sites in 3 countries (Brazil, Canada, and the UK). The first participant was screened on November 29, 2022, and the last follow-up visit occurred on January 15, 2025. INTERVENTION: A total of 540 participants were randomized (1:1) to an evidence-based clinical decision-support system (PETRUSHKA tool; n = 271) or usual care (n = 269). MAIN OUTCOMES AND MEASURES: The primary outcome was treatment discontinuation due to any cause at 8 weeks. The secondary outcomes included treatment discontinuation up to 24 weeks due to adverse events and changes in depressive symptoms (measured with the 9-item Patient Health Questionnaire [PHQ-9]; range, 0-27; higher scores indicate more severe depression) and anxiety symptoms (measured with the 7-item Generalized Anxiety Disorder [GAD-7] questionnaire; range, 0-21; higher scores indicate more severe symptoms). RESULTS: Of the 520 eligible participants, 493 were included in the primary analysis (median age, 35 [IQR, 25 to 48] years; 58% female; PHQ-9 mean score, 16.6 [SD, 5.1]; GAD-7 mean score, 11.5 [SD, 4.1]). At 8 weeks, 41 of 241 participants (17%) in the PETRUSHKA group discontinued the prescribed antidepressant due to any cause vs 69 of 252 (27%) in the usual care group (adjusted relative risk, 0.62 [95% CI, 0.44 to 0.88]; P = .007). At 8 weeks, 22 of 241 participants (9%) in the PETRUSHKA group discontinued the prescribed antidepressant due to adverse events vs 39 of 252 (16%) in the usual care group (adjusted relative risk, 0.59 [95% CI, 0.36 to 0.97]; P = .04). For the assessment of depressive symptoms at 24 weeks, the mean PHQ-9 score was 7.1 (SD, 5.4) in the PETRUSHKA group vs 9.2 (SD, 6.5) in the usual care group (n = 129 in each group; adjusted between-group mean difference, -1.92 [95% CI, -3.06 to -0.78]; P < .001). For the assessment of anxiety symptoms at 24 weeks, the mean GAD-7 score was 4.6 (SD, 4.1) in the PETRUSHKA group (n = 133) vs 5.8 (SD, 4.9) in the usual care group (n = 126) (adjusted between-group mean difference, -1.39 [95% CI, -2.26 to -0.52]; P = .002). CONCLUSIONS AND RELEVANCE: Compared with usual care, use of the PETRUSHKA tool increased the number of patients still taking their antidepressant at 8 weeks and improved depressive and anxiety symptoms at 24 weeks. However, lack of a double-blind design and the large amount of missing data limit the validity of these results. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05608330.
15 Apr 2026
Read appraisal →Current pain and headache reports
Stellate Ganglion Block in the Treatment of Long COVID: A Systematic Review
OBJECTIVES: This review evaluates stellate ganglion block as a treatment for long COVID, seeking to evaluate the treatment's efficacy by various symptoms and the limitations of the current literature. STUDY DESIGN: Systematic Review. SETTING: Ambulatory or Outpatient Setting. METHODS, SUBJECTS: A systematic review of the current literature regarding use of stellate ganglion block in patients with long COVID was conducted. 2 databases were searched on August 28th, 2025. Search terms were "long COVID" and "stellate ganglion block", yielding 45 results. Studies examining patient outcomes after stellate ganglion block were included. Case reports, case series, basic science studies and previous reviews were excluded. Seven studies met inclusion criteria. RESULTS: Patients received a single stellate ganglion block in some studies and multiple stellate ganglion blocks in others. All studies reported symptomatic improvement without control groups. Response rates ranged from 55.8% to 100%. The most robust improvements (> 80% patients reporting relief) were seen in cough, dyspnea, headache, joint pain, pain interference/intensity, pins/needles, subjective relief. CONCLUSION: Stellate ganglion block is a promising treatment that appears to generate substantive benefit for many of the symptoms seen in long COVID. However, the current literature has small, uncontrolled studies with heterogenous study designs and follow-up periods. Standardized research with larger sample sizes, control groups, and longer-term follow up is necessary to elucidate the degree of benefit. IRB approval and clinical trial registration not required.
15 Apr 2026
Read appraisal →JMIR aging
Web-Based Personalized Machine Learning Recommendations to Enhance Shared Decision-Making in Prostate-Specific Antigen Screening: Randomized Controlled Trial
BACKGROUND: Prostate‑specific antigen (PSA) screening involves complex trade‑offs between early detection and the risks of overdiagnosis. For older adults (aged ≥50 years), shared decision‑making (SDM) is often hindered by limited health literacy, sensory or cognitive impairments, and multimorbidity, which complicate risk comprehension. Traditional decision aids provide foundational knowledge but are often nonpersonalized. Machine learning (ML) may offer individualized recommendations, yet the psychological and behavioral effects of ML‑assisted SDM in geriatric populations remain poorly characterized. OBJECTIVE: This study aimed to develop and evaluate a web‑based, ML‑driven decision aid integrated into an SDM workflow to provide personalized PSA screening recommendations and to assess its effects on decisional conflict (primary outcome), state anxiety, and decision satisfaction among middle‑aged and older men. METHODS: The study followed a 2‑stage design. First, a model establishment group (n=507) was used to train and evaluate 6 ML algorithms based on clinical and values‑clarification data. A random forest model was selected for its superior performance (mean area under the curve 0.933, SD 0.350; 95% CI 0.902-0.963). Second, a randomized controlled trial was conducted with 367 participants (mean age 64.34, SD 10.30 years) randomly assigned 1:1 to the ML suggestion group (MLSG; n=185) or the control group (CG; n=182). Both groups received video‑based education, counseling, and values clarification; only the MLSG received an ML‑generated "second opinion" recommendation. Primary and secondary outcomes were assessed using the Decisional Conflict Scale (DCS), Spielberger State‑Trait Anxiety Inventory (STAI), and Satisfaction with Decision scale. RESULTS: In the randomized controlled trial (n=367), the MLSG reported significantly lower decisional conflict than the CG (total DCS score: mean difference [MD] -3.77, 95% CI -5.55 to -1.99; Cohen d=-0.44; P<.001). The MLSG reported greater perceived support (DCS7: adjusted P=.03), more adequate advice (DCS9: adjusted P<.001), and higher decision confidence (DCS10: adjusted P=.03; DCS11: adjusted P<.001). Regarding psychological well‑being, although total anxiety scores did not differ, the MLSG reported reduced worry (STAI item 6: MD -0.98, 95% CI -1.20 to -0.76; d=-0.89; adjusted P<.001) and increased calmness (STAI item 1: MD 0.30, 95% CI 0.06-0.54; d=0.25; adjusted P=.01). Decision satisfaction was higher in the MLSG across all items (total Satisfaction with Decision score: MD -7.38, 95% CI -8.54 to -6.18; P<.001). Behavioral choices were strongly influenced by the ML recommendation: participants in the MLSG who received an "accept" recommendation were more likely to select "accept" (34/67, 50.7%) than those in the CG (44/182, 24.2%; P<.001). When the system suggested "not now," only 17.8% (21/118) chose "accept," which was lower than in the CG. CONCLUSIONS: Integrating personalized ML recommendations into SDM workflows provides emotional scaffolding for older men, reducing decisional distress and enhancing confidence without undermining autonomy. By addressing geriatric‑specific vulnerabilities through a facilitated digital interface, this ML‑driven approach complements traditional clinical consultations. These findings support the scalable integration of artificial intelligence-assisted decision support to foster patient‑centered care in aging populations.
15 Apr 2026
Read appraisal →Nature communications
A group 1 hemagglutinin stem vaccine elicits broad humoral responses against influenza in phase 1/2a study
Vaccines targeting the conserved stem region of influenza hemagglutinin (HA) may induce broad immunity and reduce reliance on strain-matched seasonal formulations. This Phase 1/2a study evaluates safety and immunogenicity of a universal influenza vaccine component comprising a soluble trimeric stabilized group 1 HA-stem protein (INFLUENZA G1 mHA). Healthy adults aged 18-to-45 received one or two doses at 45 µg or 135 µg, with or without Al(OH)₃. Primary endpoints were safety and reactogenicity. All regimens were well-tolerated with no vaccine-related serious adverse events. Secondary and exploratory endpoints included binding, neutralizing, and ADCC responses compared to a matched quadrivalent seasonal influenza vaccine cohort. A single dose induced robust binding antibody responses to H5 HA and homologous stem HA, with 6.5-16.4-fold increases at Day 29 versus baseline, exceeding responses elicited by the seasonal influenza vaccine. Additionally, we demonstrate broader binding to a panel of group 1 HAs, with responses maintained for at least one year. Neutralizing antibody and ADCC responses at Day 29 showed 7.9-15-fold and 4.9-8.6-fold increases, respectively. Importantly, serum from vaccinated participants protect mice against lethal heterologous H5N1 challenge. This study provides proof of concept that the HA stem vaccine elicits broad and durable influenza A group 1-directed immunity. This trial is registered with ClinicalTrials.gov (NCT05901636).
15 Apr 2026
Read appraisal →BMJ open
Regional disparities in insurance-covered cognitive behavioural therapy in Japan: a nationwide cross-sectional study using National Database Open Data, 2015-2023
OBJECTIVES: Cognitive behavioural therapy (CBT) is recommended as a first-line treatment for depression and anxiety disorders, but its utilisation under Japan's national health insurance remains poorly understood. This study aimed to describe CBT utilisation patterns, quantify regional disparities across prefectures and analyse temporal trends from fiscal year (FY)2015 to FY2023. DESIGN: This was a nationwide repeated cross-sectional study. SETTING: Japan's National Database of Health Insurance Claims and Specific Health Checkups Open Data (NDB Open Data), FY2015-2023. PARTICIPANTS: All patients who received insurance-covered CBT in FY2023, with a longitudinal comparison across FY2015-2023. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were annual CBT claims and patient counts. The secondary outcomes included prefecture-level distribution, population-adjusted utilisation rates per 100 000 population, distribution by sex and age, monthly trends and temporal changes over 9 years. Regional variation in physician-delivered CBT was assessed using the coefficient of variation (CV) and extremal quotient (EQ). RESULTS: In FY2023, the total CBT claims numbered 38 045 with 8299 patients, representing only 0.14% of an estimated 6.03 million psychiatric patients. Physician-delivered CBT accounted for 99.6% (37 886 claims), whereas nurse-delivered CBT introduced in 2016 remained at 0.4% (159 claims). 13 of the 47 prefectures (27.7%) had zero or fewer than 10 claims. The population-adjusted physician-delivered CBT claims ranged from 370.96 per 100 000 in Okayama to 0.99 per 100 000 in Kumamoto, yielding an EQ of 375-fold. The CV among the 34 prefectures with measurable physician-delivered CBT was 174.8%. Despite indication expansions in 2016 and 2018, claims decreased by 9.9% from 42 216 in FY2015 to 38 045 in FY2023. CONCLUSIONS: Insurance-covered CBT in Japan remains severely underused, with significant regional disparities. Incremental policy measures, including indication expansions and nurse-delivered CBT, have failed to improve access. Fundamental system reforms, potentially including dedicated psychological therapy services, are needed to ensure equitable access to evidence-based psychological treatments.
15 Apr 2026
Read appraisal →European journal of pediatrics
Multi-directional phototherapy vs. unidirectional phototherapy from below for severe neonatal jaundice: a randomized pilot trial in home phototherapy
UNLABELLED: Severe neonatal jaundice is a common problem, carrying a risk of neurologic toxicity. Phototherapy has become the standard treatment for jaundiced infants, eliminating the need for exchange transfusion and the risk of neurotoxicity. We hypothesized that treatment with multi-directional phototherapy would be more rapid than with single-direction, high-intensity treatment from below (unidirectional) in the home setting. We performed a prospective, randomized, pilot trial comparing high-intensity multi-directional phototherapy to high-intensity unidirectional treatment in the home setting. Treatment time was determined from device timers. Serum bilirubin levels were obtained daily and as ordered by the pediatrician, serving as a basis for estimating the bilirubin reduction rates. Eight infants were treated with multi-directional phototherapy; nine were treated with unidirectional phototherapy. Multi-directional treatment was more rapid with treatment time of 15.1 ± 6.4 h vs. 25.1 ± 11.8 h; p = 0.05. The estimated rate of bilirubin reduction was more rapid with multi-directional phototherapy 0.40 ± 0.21 vs. 0.14 ± 0.10 mg/dL/h; p < 0.02. CONCLUSION: Multi-directional phototherapy was more rapid than treatment with unidirectional phototherapy in the home setting. TRIAL REGISTRATION: ISRCTN88608924 29 January 2026, retrospectively registered. WHAT IS KNOWN: •Home phototherapy for hyperbilirubinemia is safe and effective. •Treatment times with fiberoptic and wearable devices in the home setting can be lengthy and complicated by overheating and readmission. WHAT IS NEW: •Home phototherapy with multidirectional illumination is more effective than unidirectional undersurface phototherapy. •Multidirectional home phototherapy can lower bilirubin levels at a rate comparable to hospital devices.
15 Apr 2026
Read appraisal →BMJ health & care informatics
Supporting street medicine through medical informatics: a manifesto on research needs
Homeless individuals face major barriers in accessing regular healthcare, leading to the development of street medicine as a distinct humanitarian field. To enhance continuity and quality of care, consistent documentation is crucial. However, electronic health records are rarely used in European street medicine. An interdisciplinary European workshop identified four key research fields for medical informatics in street medicine: (1) Research ethics: The creation of ethical guidelines that promote co-creation and active communication with patients. (2) System development: Designing a secure, anonymous and European Health Data Space-compliant personal Electronic Health and Social Record (pEHSR), establishing standardised health and social care datasets, and implementing dynamic consent management methods. (3) Education and training: Developing targeted programmes to improve digital and health literacy among street medicine clients and training professionals in the effective use of the pEHSR system. (4) Management and evaluation: Creating management structures and evaluation frameworks suited to the unique challenges of street medicine.This manifesto calls for internationally coordinated scientific efforts to build effective, integrated digital health solutions for vulnerable populations. It encourages researchers and practitioners from medical informatics and related fields to engage with these priorities and support innovation that advances equitable healthcare access.
15 Apr 2026
Read appraisal →Tobacco control
Cigarette filter ventilation, product appeal and regulatory options: a review of the influence of ventilation on consumers' sensory and risk perceptions
OBJECTIVE: Cigarette filter ventilation may enhance product appeal, support initiation and sustained smoking, and increase smoking prevalence. We reviewed recent evidence on how filter ventilation affects consumers' perceptions of product appeal and considered product use preferences to inform regulatory options. DATA SOURCES: PubMed, Embase and PsycINFO databases were searched up to December 2023. Systematic search strategies used terms based on cigarette filter ventilation, and multiple constructs comprising product appeal and user perceptions. STUDY SELECTION: Two reviewers screened all 917 retrieved titles and abstracts independently and applied a consensus strategy to identify 16 articles that met eligibility criteria. DATA EXTRACTION: Extracted data focused on study design, dependent variables or outcomes, and major conclusions. DATA SYNTHESIS: While remaining popular, awareness and risk perception of ventilated cigarettes is generally low. Cigarettes with filter ventilation are perceived as smoother and less irritating than non-ventilated cigarettes. These modified sensory experiences shape perceptions of reduced health risks. Pack text descriptors and colours convey further information to consumers about smoothness, supporting lowered risk perceptions. CONCLUSIONS: Filter ventilation and its associated marketing continue to influence consumers' perceptions of smoothness creating misperceptions about health risks. Standardised ('plain') packaging regulations are recommended to restrict communication of ventilation themes as well as evidence-based health communications to correct consumer misperceptions about smoothness and health risks. Since filter ventilation has no benefits for public health, policy makers could consider banning filter ventilation or even disallowing filters.
15 Apr 2026
Read appraisal →Tobacco control
Nitrosamine and nicotine exposure after switching from filtered to unfiltered cigarette smoking: a cross-over clinical trial
BACKGROUND: The cellulose acetate filter is a plastic attachment on nearly all commercial cigarettes sold worldwide. It is the main component of discarded cigarette butts, and the most prevalent waste item collected during urban and beach cleanups. This waste leaches toxic chemicals, including nicotine, metals and tobacco-specific nitrosamines and contributes to environmental microplastic pollution. There is growing international interest in reducing plastic waste from single-use, non-essential products such as cellulose acetate cigarette filters. Public health and environmental advocates recommend a ban on the sale of filtered cigarettes to reduce environmental pollution caused by discarded cigarette butts and to discourage cigarette smoking. RESEARCH QUESTION: What potential health and behavioural implications might arise among people who smoke if filtered cigarettes are removed from the market. METHODS: We conducted a cross-over, randomised clinical trial of 29 people who smoke to evaluate changes in biomarkers for nicotine and tobacco-specific nitrosamine exposure when switching between filtered and unfiltered cigarette smoking. RESULTS: Although unfiltered smoking showed a higher trend in the geometric means of 4-[(methylnitrosamino])-1-[3-pyridyl]-1-butanol (NNAL) compared with filtered cigarettes, regression models for urinary cotinine and NNAL showed no significant differences when switching between filtered and unfiltered cigarettes. CONCLUSION: This proof-of-principle study suggests there is no increased risk to people who smoke when switching to unfiltered cigarette smoking. Although larger studies might provide more evidence regarding unfiltered cigarette smoking, banning the sale of filtered cigarettes may be an important policy intervention to both reduce hazardous tobacco waste and discourage smoking.
15 Apr 2026
Read appraisal →BMJ sexual & reproductive health
Nurse and midwife interventions to improve access to contraception and abortion in primary care: a systematic review
OBJECTIVES: Amid the unmet need for contraception and safe abortion care globally, harnessing the capabilities of primary care nurses and midwives is vital for facilitating equitable access to these critical healthcare services. We aimed to evaluate the impact of interventions delivered by primary care nurses and/or midwives on facilitating access to contraception and abortion care. STUDY DESIGN: We conducted a systematic review in accordance with PRISMA guidelines and searched five electronic databases in September 2023. A narrative synthesis was conducted with analysis informed by the Levesque et al framework for access to healthcare. RESULTS: Twenty-three articles met the inclusion criteria; 20 related to contraception and three to abortion care. Access to contraception and abortion care was predominantly focused on addressing consumer-related factors such as perception of healthcare needs and support to engage with services. Findings suggested home visiting, telehealth and reproductive counselling interventions by primary care nurses and midwives can be effective at increasing women's access to contraception. There was some evidence these clinicians could be acceptable providers of medical abortion; however, there were no articles on procedural abortion. CONCLUSIONS: Primary care nurses and midwives have the potential to improve women's access to contraception care, particularly through the use of home visiting or telehealth strategies. However, evidence on how nurses and midwives can support access to abortion care is scarce and more research is needed, particularly for procedural abortion. Further research should also target under-studied access factors, including the acceptability of nurses and midwives providing contraception and abortion care and consumers' ability to reach and pay for this healthcare.
15 Apr 2026
Read appraisal →BMJ open
Challenging history taking encounters: a systematic review, meta-analysis and phenomenological framework
OBJECTIVES: All physicians will experience challenging history taking encounters, where communication is impaired and negatively impacts the diagnostic process. The aims of this systematic review were to (1) undertake a meta-analysis of the frequency of challenging encounters; (2) collate adverse outcomes of challenging encounters; (3) identify underlying causes of challenging encounters; (4) identify strategies to deal with different challenges; and (5) align these strategies with our published phenomenological framework of history taking challenges. DESIGN: This was a systematic review and meta-analysis of prevalence data adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses and the Meta-analyses of Observational Studies in Epidemiology guidelines. DATA SOURCES: A literature search in MEDLINE, Embase and Cochrane databases was performed on 12 July 2020, and updated on 4 August 2025, focusing on challenging history taking encounters in any clinical setting. ELIGIBILITY CRITERIA: Articles reporting on the frequency, adverse outcomes, causative factors or strategies used to address challenges in the history taking process in any clinical area of medicine. DATA EXTRACTION AND SYNTHESIS: Factors associated with challenging history encounters (causative or consequential) were categorised using inductive coding and referenced to a phenomenological framework. Meta-analysis was used to estimate the prevalence of history taking encounters using a restricted maximum likelihood model with τ 2 and I 2 as tests for heterogeneity and funnel plot with Egger's test for publication bias. RESULTS: 73 articles were included in the analysis. The overall prevalence of challenging history taking encounters was 19.5% (95% CI 14.2% to 24.7%). Adverse outcomes of patient dissatisfaction (level 1 evidence) and diagnostic uncertainty (level 3 evidence) were identified. Factors associated with (n=22) and strategies to mitigate challenging encounters (n=13) were categorised. Correlation of factors and strategies with a phenomenological approach created a framework to assist novice history takers in approaching such circumstances. CONCLUSIONS: Challenging history taking encounters are common. Little is known of the relative importance of factors associated with challenging history taking encounters or the impact of suggested strategies. Many of the suggested strategies to facilitate meaningful communication in these situations involve a departure from standard history taking. More research is required to better define the nature of challenges encountered in history taking with a view to develop better educational models for trainee physicians.
15 Apr 2026
Read appraisal →PloS one
Use of administrative data for evaluating trends in medically-attended Lyme disease, Manitoba, Canada, 2010-2021
While Lyme disease (LD) is the most common tick-borne disease reported to public health surveillance in North America and is increasingly recognized as a public health threat in Canada, it's incidence may be underreported. Our study aims to estimate medically-attended LD incidence in Manitoba, Canada, using administrative health data. We identified medically-attended LD cases in Manitoba from 2010 - 2021 in a claims database (Manitoba Population Research Data Repository), which contains the health records of >95% of the residents of Manitoba, using diagnostic codes, antibiotic dispensations, and laboratory results. The incidence of claims-based LD cases ranged from 8.4 to 28.5 per 100,000 population per year, 5.1 to 11.0 times higher than the incidence of surveillance-reported LD cases. The incidence of claims-based LD cases was particularly higher than the incidence of surveillance-reported LD cases in females and health regions with a low surveillance-reported incidence. Our study suggests that medically attended LD is more common than reported in surveillance. Further study is required to identify barriers to reporting. Interventions are needed to reduce the substantial burden of LD in Manitoba.
15 Apr 2026
Read appraisal →Journal of medical Internet research
Digital Monitoring of Pre-Exposure Prophylaxis Users Through Electronic Patient-Reported Outcome Measures and Electronic Patient-Reported Experience Measures: Multicenter Prospective Study on Feasibility, Safety, and Predictive Modeling of Digital Engagement
BACKGROUND: Digital health tools integrating electronic patient-reported outcome and experience measures (ePROMs/ePREMs) enable longitudinal monitoring of health-related quality of life (HRQoL), psychological well-being, and treatment satisfaction in pre-exposure prophylaxis (PrEP) users. However, determinants of sustained engagement with digital follow-up platforms remain insufficiently characterized. OBJECTIVE: To describe the feasibility of the Naveta-Phemium digital platform for longitudinal monitoring of safety, HRQoL, and treatment satisfaction among PrEP users, and to develop and internally validate a machine learning framework to characterize and predict engagement with digital follow-up. METHODS: A prospective observational study was conducted using the Naveta digital follow-up platform. HIV-negative adults at high risk of HIV infection received tenofovir disoproxil fumarate (245 mg) plus emtricitabine (200 mg). Clinical safety, HRQoL, and satisfaction were assessed using laboratory parameters and validated ePROMs/ePREMs (Hospital Anxiety and Depression Scale, Patient-Reported Outcome Measurement Information System Profile-29, Treatment Satisfaction Questionnaire for Medication, and Person-Centered Coordinated Care Experience Questionnaire). Engagement was defined at the questionnaire level and analyzed using the ALGOPROMIA-Classification framework with repeated stratified cross-validation. Model explainability was assessed using permutation-based Shapley Additive Explanations. RESULTS: A total of 81 participants contributed repeated questionnaire-level observations (mean PrEP duration 689 d). PrEP was well tolerated, with no moderate or severe adverse events; mild transient symptoms were mainly gastrointestinal (31/45, 68.9%) and neurological (26/45, 57.8%). Renal function remained stable (creatinine: 0.86 [SD 0.13] mg/dL; estimated glomerular filtration rate: P=.498). Psychological well-being and HRQoL remained stable (Hospital Anxiety and Depression Scale<7; Patient-Reported Outcome Measurement Information System Profile-29 near population norms). Treatment satisfaction was consistently high (Treatment Satisfaction Questionnaire for Medication≈85-87), and satisfaction with the NAVETA telemedicine model remained stable (8/10). Engagement showed clear sociodemographic and behavioral gradients. Ensemble-based machine learning models achieved good discrimination in predicting engagement (area under the curve≈0.82) across ≈12,300 questionnaire-level observations. Random forest was retained for robustness and consistency. Shapley Additive Explanations analysis highlighted lifestyle-related variables as the most influential predictors, with heterogeneous individual-level effects. CONCLUSIONS: Naveta enabled feasible telemedicine-based PrEP follow-up with preserved HRQoL, high satisfaction, and stable safety. Combining longitudinal ePROMs/ePREMs with explainable machine learning allowed detailed characterization of digital engagement, supporting digitally supported PrEP care optimization and informing future comparative and cost-effectiveness studies.
15 Apr 2026
Read appraisal →JMIR medical education
Developing and Validating a Coding Scheme for Clinical Reasoning in History Taking Using Generative AI-Based Virtual Patients: Systematic Text Condensation Approach
BACKGROUND: Effective history taking helps clinicians identify key symptoms and form accurate hypotheses. Generative artificial intelligence (GenAI)-based virtual patients (VPs) are increasingly used to simulate and practice history taking. However, there is currently no straightforward approach to effectively identify students' clinical reasoning activities during these interactions, which limits the ability to provide instructional feedback. OBJECTIVE: This study aims to develop and validate a coding scheme to identify medical students' history-taking behaviors during interactions with GenAI-based VPs. METHODS: Second-year medical students (N=210) participated in 5 history-taking cases with GenAI-based VPs, yielding 1030 dialogues. Researchers applied the systematic text condensation method to these dialogue data from cases 1 to 4 to inductively develop a coding scheme and validate coding consistency. Subsequently, the dialogue data from case 5 were used to assess the correlation between the students' history-taking behaviors and their academic performance, including diagnostic accuracy, history-taking checklist scores, clinical knowledge test scores, and postencounter form scores. RESULTS: A coding scheme comprising 12 behaviors across 3 dimensions-clinical reasoning behaviors, information gathering behaviors, and social interaction behaviors-was developed with high interrater reliability (κ≥0.85). The correlation analysis revealed that key clinical reasoning behaviors, such as summarizing and integrating and logical organization, showed significant positive correlations with multiple performance metrics, underscoring their importance in fostering clinical competence. In contrast, information gathering behaviors such as specifying symptoms and routine question were associated with clinical knowledge and thoroughness of history taking but were less predictive of diagnostic accuracy. CONCLUSIONS: This study developed a reliable, theory-informed coding scheme that can identify students' questioning behaviors during history taking with GenAI-based VPs. The scheme effectively captures higher-order cognitive strategies and provides valuable insights into the development of clinical reasoning in medical students. This approach offers a scalable and efficient way to integrate real-time feedback into future medical education, fostering personalized learning and advancing competency-based assessments in clinical training.
14 Apr 2026
Read appraisal →JMIR formative research
Comparing Large Language Models and Traditional Machine Translation Tools for Translating Medical Consultation Summaries: Quantitative Pilot Feasibility Study
BACKGROUND: Translation of medical consultation summaries is essential for equitable health care communication in culturally and linguistically diverse populations. While machine translation (MT) tools and large language models (LLMs) are widely accessible, their feasibility and safety for health care contexts remain underexplored. OBJECTIVE: This pilot study investigates the feasibility and limitations of using LLMs and traditional MT tools to translate medical consultation summaries from English into the most common languages other than English spoken in Australia-Arabic, Chinese (simplified written form), and Vietnamese. METHODS: Two simulated summaries-a simple patient-facing summary and a complex clinician-oriented interprofessional letter-were translated using 3 LLMs (GPT-4o, Llama-3.1, and Gemma-2) and 3 MT tools (Google Translate, Microsoft Bing Translator, and DeepL). Translations were benchmarked against professional third-party interpreter translations using Bilingual Evaluation Understudy, Character-level F-score, and Metric for Evaluation of Translation with Explicit Ordering metrics. RESULTS: The translation performance varied across languages, tools, and summary complexity when assessed using automatic evaluation metrics. Traditional MT tools outperformed LLMs on surface-level metrics, while LLMs showed relative strengths in semantic similarity for Vietnamese and Chinese. Arabic translations improved with complex input, suggesting morphological advantages. The metric-based evaluation highlighted feasibility but also risks, particularly in Chinese clinical contexts. CONCLUSIONS: This pilot study provides formative evidence of opportunities and limitations in applying artificial intelligence translation for health care communication. Findings underscore the importance of human oversight; domain-specific evaluation metrics; and further formative and clinical research to guide the safe, equitable use of artificial intelligence translation tools.
14 Apr 2026
Read appraisal →Journal of medical Internet research
Using Group Chats to Drive Behavior Change in Digital Health Interventions: Scoping Review and Realist Synthesis
BACKGROUND: Group chats on platforms such as WhatsApp (Meta Platforms, Inc), WeChat (Tencent Holdings Limited), and Telegram (Telegram FZ-LLC) are central to everyday communication in many settings, including across low- and middle-income countries and among groups often overlooked by one-to-one or app-based digital health tools. Yet their roles and underlying mechanisms as intentionally designed health interventions have not been comprehensively examined. OBJECTIVE: This scoping review with realist synthesis aimed to map the characteristics and reported outcomes of group chat-based health interventions and contextual conditions shaping their outcomes. It mapped intervention characteristics and identified context-mechanism-outcome (CMO) configurations driving behavior change. METHODS: We included empirical studies in which group chats were the primary digital component of the health intervention. Searches of PubMed, Embase, MEDLINE, Web of Science, and Scopus (2005-2026) and reference screening identified eligible studies. Data were extracted on study characteristics, health domains, settings, participants, platform, intervention features, and outcome domains. For the realist synthesis, CMO configurations were analyzed using reflexive thematic analysis informed by social cognitive theory and synthesized into a final program theory. RESULTS: Eighty-one studies were included. Publications increased sharply after 2020, with evidence clustering in mental health (25/81, 30.9%) and maternal and child health (20/81, 24.7%). Most studies enrolled adult participants, including pregnant or postpartum women, caregivers, and people managing chronic conditions. WhatsApp (38/81, 46.9%) and WeChat (21/81, 25.9%) were the most frequently studied platforms. Interventions were commonly delivered in clinical or community settings and typically involved mixed membership groups that included health professionals alongside participants (68/81, 84.0%). The realist synthesis identified 12 recurring CMO configurations across 5 domains: capability and actionability, confidence and motivation, modeling and norms, safe and supportive environment and access, and self-regulation and maintenance. These mechanisms were activated or suppressed by facilitation quality, group composition, cultural alignment, technological access, and social norms. The final program theory depicts group chats as dynamic systems where access, facilitation, and group structure shape how the domains amplify or dampen one another, explaining shifts from low engagement to high trust spaces sustaining behavior change. CONCLUSIONS: This review integrates descriptive mapping of interventions with realist program theory to explain how context and facilitation activate mechanisms of change, unlike prior reviews that have focused narrowly on effectiveness of digital modalities. This dual approach provides a practical, mechanism-focused basis for designing and scaling group chat interventions in practice, particularly given their potential as a low-cost, high-reach strategy embeddable within broader digital health programs. Realizing this potential depends on treating group chats as purposefully designed social environments, with deliberate attention to facilitation quality, equity-oriented access, and alignment between group structure, norms, and communication practices.
14 Apr 2026
Read appraisal →Neurology
Type 1 Diabetes and Incident Dementia: An Analysis in the All of Us Cohort
BACKGROUND AND OBJECTIVES: Although diabetes mellitus (DM) is a well-established determinant of dementia risk, most studies have evaluated type 2 DM (T2DM) or any DM. The influence of type 1 DM (T1DM) on dementia risk remains unclear. We evaluated associations of T1DM and T2DM, separately, with incident dementia using linked electronic health records (EHRs). METHODS: This prospective cohort study used previously collected survey and EHR data from the All of Us (AoU) cohort, a convenience sample of US adults. Eligible participants were 50 years or older and completed baseline surveys. Enrollment began in 2017, with data available through October 2023, along with records before enrollment. Mean follow-up from baseline was 2.4 years. We developed an algorithm to distinguish DM type based on count of T1DM encounters. This algorithm was validated against 2 reference measures: self-reported diabetes type and C-peptide values. Using AoU data, we classified participants as having no DM, T1DM, or T2DM. We ascertained incident dementia using ICD-9, ICD-10, and Systematized Nomenclature of Medicine codes in participants' EHRs. We estimated hazard ratios (HRs) and 95% CIs for the association of diabetes type with incident dementia using Cox proportional hazards models. RESULTS: Among 283,772 participants (mean [SD] age 64.62 [8.96] years; 56.7% women), 60.3% identified as non-Hispanic White and 13.3% as Hispanic/Latino. Optimal DM classification algorithm cutoffs varied by reference standard: self-reported diabetes: ≥1 T1DM EHR encounter (sensitivity: 0.59; specificity: 0.90) and C-peptide: ≥3 T1DM EHR encounters (sensitivity: 0.76; specificity: 0.79). Defining T1DM as having ≥1 T1DM encounter, 5,442 participants had T1DM. Compared with those without DM, participants with T1DM had higher dementia incidence (sociodemographic-adjusted HR 2.82; 95% CI 2.28-3.48) and those with T2DM also had elevated risk (sociodemographic-adjusted HR 2.08; 95% CI 2.87-2.31). Results were similar across sex, race, and ethnicity strata. DISCUSSION: In AoU, DM was associated with elevated dementia risk, with the highest risk among those with T1DM. These findings highlight the need to better understand mechanisms tying T1DM to dementia.
14 Apr 2026
Read appraisal →Blood advances
How to determine the optimal duration of anticoagulation for VTE: an evidence-based decision-analytical approach
When advising patients on the optimal duration of anticoagulation for venous thromboembolism (VTE), current management often relies on the intuition of treating physicians and guideline panels, an approach that remains opaque to outside observers. We present a decision-analytical framework adopted in our practice. This approach formalizes the intuition of physicians and guideline panels, providing an explicit and transparent integration of the best available evidence on benefits and harms. It also incorporates a systematic method for eliciting patient values and preferences to determine the optimal duration of anticoagulation. To demonstrate the practical utility of the decision-analytical approach, we apply it to 3 clinical scenarios: unprovoked VTE, VTE related to long-haul travel, and portal vein thrombosis in cirrhosis. By transparently synthesizing evidence and patient values, this method supports individualized, evidence-based, patient-centered recommendations for the duration of anticoagulation, and it is applicable to solving similar clinical problems in hematology and medicine.
14 Apr 2026
Read appraisal →Blood advances
MPN-FIT: a randomized controlled pilot trial of supervised exercise in myeloproliferative neoplasms
Myeloproliferative neoplasms (MPN) are associated with a high symptom burden and impaired quality of life (QoL), often unaided by available treatments. Physical activity has demonstrated benefits in other cancers; however, its potential has yet to be explored in MPN. This randomized controlled trial aimed to evaluate the feasibility, acceptability, and efficacy of a supervised exercise program for patients with MPN based on longitudinal assessment of symptom burden, QoL, and clinical/inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, ferritin, lactate dehydrogenase [LDH], and serum cytokines). Patients with MPN (n = 55) were randomized 3:2 to a 12-week home-based exercise intervention (flexibility/resistance/aerobics) supervised by a kinesiologist vs waitlist control. Measures included patient-reported outcome questionnaires, peripheral blood sampling, and postintervention interviews with participants. Forty-seven patients completed the trial (FIT group, n = 26; control group, n = 21). Median age was 66 years (range, 27-86), and 60% were female. All feasibility benchmarks were met, with 88% of participants satisfied and 92% with intent to continue an exercise program on a regular basis. A significant reduction in LDH was observed in FIT patients compared with controls (-14.5 U/L vs +4.0 U/L; P = .03). Patients interviewed described positive effects of the intervention on symptoms and would unanimously recommend the program to others with MPN. In this pilot study, supervised exercise was feasible, acceptable, and showed potential benefits on inflammatory/disease markers.
14 Apr 2026
Read appraisal →Lancet (London, England)
Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention: 10-year follow-up of the HOST-EXAM trial
BACKGROUND: The long-term clinical outcomes of clopidogrel monotherapy versus aspirin monotherapy after percutaneous coronary intervention (PCI) remain uncertain. We conducted a 10-year follow-up of the HOST-EXAM trial to assess the very long-term effects of clopidogrel versus aspirin monotherapy in this setting. METHODS: In HOST-EXAM, patients who had completed dual antiplatelet therapy without clinical events for 6-18 months after PCI were randomly assigned to receive clopidogrel 75 mg once daily or aspirin 100 mg once daily. This study is an investigator-initiated 10-year extended follow-up of the HOST-EXAM trial. The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and Bleeding Academic Research Consortium type ≥3 bleeding. The primary analysis was done in the intention-to-treat population. The study is registered with ClinicalTrials.gov (NCT02044250) and is complete. FINDINGS: From March 26, 2014, to May 29, 2018, 5530 patients were enrolled and 5438 were randomly assigned to the aspirin group (n=2728) or the clopidogrel group (n=2710). Clinical follow-up status was ascertained on May 1, 2025, resulting in a median follow-up duration of 10·5 years (IQR 9·4-11·4) after PCI and a completion rate of 92·8%. Clopidogrel was associated with a lower rate of the primary composite endpoint than aspirin (Kaplan-Meier estimate 25·4% for the clopidogrel group vs 28·5% for the aspirin group; hazard ratio 0·86 [95% CI 0·77-0·96]; log-rank p=0·0050). Clopidogrel was also associated with a lower rate of the thrombotic endpoint (17·3% vs 20·0%; log-rank p=0·0024) and bleeding endpoint (9·1% vs 10·8%; log-rank p=0·020). All-cause mortality was similar between groups. INTERPRETATION: During 10 years of follow-up, clopidogrel monotherapy, compared with aspirin monotherapy, was associated with lower rates of the primary composite, ischaemic, and bleeding outcomes, but not all-cause mortality after PCI. These findings support consideration of clopidogrel as an alternative to aspirin for long-term antiplatelet monotherapy during the chronic maintenance phase after PCI. FUNDING: Ministry of Health & Welfare, South Korea.
14 Apr 2026
Read appraisal →Epidemiology and psychiatric sciences
Cross-cultural validity of the generalized anxiety disorder 7-item scale (GAD-7): a systematic review and standardized assessment
AIMS: The Generalized Anxiety Disorder 7-Item Scale (GAD-7) is a brief self-reported measure for screening for anxiety symptoms. However, the evidence about its cross-cultural validity is fragmentary and usually focused on specific settings. Therefore, we aimed to critically review and synthesize the existing evidence about the cross-cultural validity of the GAD-7. METHODS: We conducted a systematic review of studies assessing the cross-cultural validity of the GAD-7 in following the PRISMA guidelines. Additionally, the quality of the studies was assessed following the COSMIN guidelines, and the quality of the evidence was assessed with the GRADE. Data were synthesized narratively. RESULTS: Out of 1,965 unique records, 9 unique studies were deemed eligible for the COSMIN appraisal and the narrative synthesis (total sample: 11,894, 53.7% females and 20 different cultural groups). Most studies (7) had adequate quality and showed evidenced of the unitary structure of the GAD-7 across cultural groups. In 4 studies also assessing possible cultural bias, the effect on the general score was deemed negligible. CONCLUSIONS: The evidence about the cross-cultural validity of the GAD-7 is very limited. Although more research is needed, the evidence available shows that the GAD-7 could be a cross-culturally valid tool for the assessment of anxiety symptoms in clinical contexts and epidemiological studies. Until new high-quality evidence will be available, these results would constitute a key first step for supporting the use of the GAD-7 in multi-cultural clinical settings and to inform clinical, public health and global health decision making in relation to anxiety.
14 Apr 2026
Read appraisal →Cardiovascular toxicology
A Real-World Disproportionality Analysis of Drug-Induced Heart Failure: Integrating FAERS Database and AHA Statement
Heart failure (HF), the advanced stage of diverse cardiac conditions, poses a significant public health challenge. This study analyzes adverse event (AE) signals associated with HF within the FDA Adverse Event Reporting System (FAERS) database, offering critical insights to guide rational medication use in clinical settings. Adverse event reports (AERs) associated with HF in the FAERS database, spanning from the first quarter of 2004 to the fourth quarter of 2024, were analyzed. The potential HF risk of drugs was assessed using the disproportionality analysis, with findings juxtaposed against the American Heart Association (AHA) drug list. Drug-induced HF cases showed equivalent distribution between male and female, and high rates of rehospitalization and mortality. Prominent hypoglycemic drugs associated with HF included rosiglitazone, pioglitazone, and saxagliptin. Combination therapies, such as metformin/saxagliptin and metformin/rosiglitazone, also demonstrated elevated risks. In the context of pulmonary hypertension, drugs like macitentan, selexipag, and epoprostenol were particularly notable. Analysis against the AHA drug list confirmed stronger signal strength and frequency among Class A drugs, validating our results. Furthermore, drugs not flagged as positively signaling in the AHA registry, such as amiodarone, aliskiren, and testosterone, merit closer scrutiny due to their potential for adverse reactions. Our analysis of the FAERS database has identified medications associated with potential HF risks, providing valuable evidence to inform clinical decision-making and promote the safe use of medications.
13 Apr 2026
Read appraisal →Journal of medical Internet research
Large Language Model-Based Analysis of Statin Therapy Discussions and Sentiment on Social Media: Cross-Sectional Observational Study
BACKGROUND: Statin therapy, despite proven cardiovascular benefits, remains underused. Social media platforms may capture patient perspectives that are less visible in clinical encounters. OBJECTIVE: This study aimed to characterize themes, sentiment, and decision-making factors related to statin therapy through large language model (LLM)-based analysis of Reddit discussions. METHODS: This cross-sectional observational study analyzed English-language Reddit posts and comments mentioning statins from January 2022 to May 2025, identified via keyword-based Reddit application programming interface searches (≤1000 posts per keyword). A total of 5328 retrieved discussions (n=1661, 31.2% posts and n=3667, 68.8% keyword-containing comments) from public subreddits were included. Themes, sentiments (positive, neutral, or negative), guideline-informed clinical relevance, information-seeking behavior, adverse effect mentions, decision factors, and adherence-related content were extracted using an LLM-based pipeline. RESULTS: Among 5328 discussions, prominent topics included adverse effects (n=1697, 31.9%), decision-making references related to laboratory results and physician advice (n=2767, 51.9% and n=2034, 38.2%, respectively), and alternative approaches (n=2485, 46.6%). Overall sentiment was neutral in 34% (n=1812) of discussions, negative in 30.9% (n=1646), and positive in 16.9% (n=900); the remainder were mixed or unclear. Statin-directed sentiment was neutral in 44.1% (n=2350) of discussions, negative in 25.2% (n=1343), and positive in 12.5% (n=666); the remainder did not express statin-directed sentiment. High clinical relevance was identified in 12.6% (n=672) of discussions. Adherence-related issues were mentioned in 29.8% (n=1587) of discussions. Among adverse effect mentions, muscle pain (n=129, 7.6%) and fatigue (n=110, 6.5%) were common. CONCLUSIONS: LLM-enabled analysis of Reddit discourse highlights substantial negative sentiment, adherence-related concerns, and adverse effect narratives surrounding statin therapy. These findings suggest opportunities for patient-centered communication and shared decision-making strategies that address symptom attribution, uncertainty, and information needs in digital information environments.
12 Apr 2026
Read appraisal →Australian journal of primary health
National and international guidelines for preconception care and comparison with Australian guidelines: a systematic review
BACKGROUND: Guidelines for preconception care are resources that are systematically arranged based on evidence and local contexts to enhance the delivery of high-quality and consistent healthcare. The Royal Australian College of General Practitioners Guidelines (RACGP) for preventive activities in general practice (the Red Book) contains specific components of preconception care items, yet this guideline primarily focuses on general preventive healthcare and may not include a comprehensive list of preconception items based on more recent evidence. This review aimed to compare the recent RACGP guidelines (the 2024 Red Book) with national and international guidelines for preconception care. METHODS: Electronic databases, including PubMed, Embase, Web of Science, CINAHL, and Scopus, were systematically searched following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We also searched clinical guideline registries on professional organisations' websites. Searches were conducted from May to June 2024 and in July 2025. RESULTS: We identified seven other national and international guidelines that recommended what should be done as part of preconception health in clinical practice. Preconception care elements that were not included in the current RACGP guidelines that have evidence of effectiveness were the inclusion of men in preconception care, screening for intimate partners and domestic violence, screening for chlamydia and gonorrhoea infections, and screening for female genital mutilation as part of preconception care. CONCLUSIONS: This review identified four preconception care elements that may potentially improve the implementation of preconception care in Australian practice. This work informs the next steps towards developing a comprehensive preconception medical record tool for use in general practice.
12 Apr 2026
Read appraisal →Vaccine
Adenovirus type 5 vector-based COVID-19 vaccine does not increase the likelihood of HIV infection
BACKGROUND: There is a concern about the potential increased risk of acquiring HIV infection after vaccination with adenovirus type 5 (Ad5) vector-based vaccines. We aimed to investigate whether Ad5-nCoV increases the risk of HIV infection. METHODS: Between September 2020 and March 2021, a Phase 3 clinical trial was executed to evaluate the efficacy of Ad5-nCoV. This trial, employing a double-blind, randomized, and placebo-controlled design, enrolled 44,247 participants from 66 clinical sites spanning Argentina, Chile, Mexico, Russia, and Pakistan. Participants were allocated randomly in a 1:1 ratio to receive either Ad5-nCoV or a placebo, and their HIV-negative status was assessed by self-report and confirmed by HIV testing on a baseline blood sample at the end of the study. Consequently, individuals initially administered a placebo received one dose of Ad5-nCoV, while those initially given Ad5-nCoV finally received two doses, with an interval of approximately 6-10 months between administrations. The trial design and primary outcomes have been previously reported. This analysis involves a comprehensive assessment of the associations between pre-existing Ad5 neutralizing antibodies, HIV prevalence and incidence before and after vaccination while accounting for demographic variables. RESULTS: A total of 43,780 participants who had valid HIV baseline testing results were included in this study. Prior to vaccination, there was no discernible difference in HIV prevalence between the placebo group (0·39% of 21,877 participants) and the Ad5-nCoV group (0·38% of 21,893 participants). This similarity persisted when the data were stratified by country, gender, age, and race. Paired analyses assessing HIV incidence were conducted on participants who tested negative for HIV before vaccination, with data collected over a 6-month period post-vaccination. The results revealed notable similarity in HIV incidence across all groups: 0·29% for Group A (Ad5-nCoV group), 0·21% for Group B (Placebo group), 0·27% for group A + D (Ad5-nCoV group and 1 × Placebo+1 × Ad5-nCoV group), 0·1% for Group C (2 × Ad5-nCoV group), and 0·25% for Group A + C + D (participants who received at least one dose of Ad5-nCoV). Testing approximately 100 randomly chosen participants in each country revealed a similar distribution of pre-existing Ad5 neutralizing antibodies (Nab), with the ratio above a titer of 200 ranged from 65·42% to 67·71%. Notably, the heightened presence of pre-existing Ad5 Nab did not result in an increased risk of HIV infection. CONCLUSION: The Ad5-nCoV did not increase the short-term risk of HIV infection in this large and diverse sample of the general population, regardless of the presence of pre-existing Ad5 Nab providing valuable insights into the safety of Ad5 vector-based vaccines. CLINICALTRIALS: gov, NCT04526990.
12 Apr 2026
Read appraisal →BMJ open respiratory research
Parasternal electromyography in participants with mild or moderate chronic obstructive pulmonary disease in primary care: cohort study to assess technical and clinical application
BACKGROUND: Neural respiratory drive (NRD) measurement, reflecting the balance between respiratory muscle load and capacity, is quantified using surface parasternal electromyography (EMGpara). EMGpara tracks recovery from severe exacerbations of chronic obstructive pulmonary disease (COPD). Among stable COPD participants, we hypothesised the existence of a relationship between NRD, breathlessness and airway obstruction. STUDY AIMS: (1) assessing the feasibility of measuring EMGpara in COPD participants with forced expiratory volume in 1 s (FEV1) ≥50% predicted in primary care; (2) investigating relationships between NRD measures, self-reported breathlessness, airflow obstruction severity and health-related quality of life (HRQoL). METHODS: Participants with stable mild/moderate COPD, using inhaled corticosteroid (ICS) therapy, were recruited from 20 general practices. Participants were randomly allocated to continue using ICS (maintenance group) or to withdraw ICS (withdrawal group) over 6 weeks. EMGpara, spirometry, self-reported breathlessness (modified Borg dyspnoea scale), COPD Assessment Test and Chronic Respiratory Disease Questionnaire Self-Administered Standardised were measured at baseline, 3- and 6-month follow-up. Bland-Altman plots examined agreement between serial measurements. RESULTS: Forty COPD participants were recruited: age 70±9.2 years; body mass index 26±5.3 kg/m2; FEV1 1.74±0.54 L; and FEV1% pred 69.6±14.0%. High-quality EMGpara data were obtained from 35 participants at baseline and 31 participants on three occasions. High intra-rater and inter-rater agreement for EMGpara (intraclass correlation coefficient >0.9) and moderate correlation between EMGpara and FEV1% predicted (r=-0.42; p=0.01) were recorded. No correlation was observed between resting EMGpara and breathlessness or HRQoL measures across the three time points. CONCLUSIONS: EMGpara measurement is feasible in primary care. In this group of COPD patients, lung function was stable across the three time points and EMGpara was associated with the degree of airflow obstruction. In the resting stable state in mild/moderate disease, there was no association between EMGpara and participant-reported outcomes. Further work should investigate the utility of EMGpara in mild/moderate COPD participants during acute exacerbation and recovery.
12 Apr 2026
Read appraisal →Scientific reports
Effect of glucose on medium chain triglyceride induced ketosis in healthy adults in a randomized, double-blind, controlled study
Although medium-chain triglycerides (MCT) stimulate and carbohydrates inhibit ketone body synthesis, their quantitative interaction in humans is not well defined. This randomised, controlled, double-blind crossover study investigated how increasing glucose doses affects C8-MCT-induced ketone body synthesis after overnight fasting. Eleven healthy young woman (22.5 ± 1.9 years) received a constant dose of tricaprylin (99% C8; 0.2 g/kg bodyweight) combined with increasing glucose doses (0.2-0.6 g/kg bodyweight). In additional interventions, both C8-MCT and glucose were increased in parallel. Plasma β-hydroxybutyrate (βHB), glucose, and insulin were measured for up to 300 min post-dose. Indirect calorimetry in a subset and side effects were monitored. C8-MCT significantly increased βHB concentrations at low and medium glucose doses compared with control, but not at highest glucose dose. When both substrates were increased equally (1:1 ratio), ketone body synthesis increased. βHB was negative correlated with increasing glucose dosing at constant C8-MCT dosing, while parallel increases in both substrates showed a positive moderate correlation between βHB and C8-MCT doses. No dose-dependent side effects occurred. Overall, ketone body synthesis declines with rising glucose intake. It remains unclear whether a C8-MCT: glucose ratio of 1:3 represents a metabolic cut-off or whether glucose intake becomes excessive due to linear effects.Trial registration This study was prospectively registered in the German Clinical Trials Register (DRKS ID DRKS00035373 https//www.bfarm.de/EN/BfArM/Tasks/GermanClinicalTrialsRegister/_node.html ).
12 Apr 2026
Read appraisal →BMJ paediatrics open
Which healthcare services did children and adolescents use before presentation at specialised outpatient clinics for post-COVID-19 condition? Descriptive findings from the Post-COVID Kids Bavaria study.
OBJECTIVE: Measuring the utilisation of healthcare services in children and adolescents with symptoms suggesting post-COVID-19 condition (PCC) until their presentation at specialised outpatient clinics (SOC). METHODS: 117 patients (aged 4-17 years) with symptoms suggesting PCC were recruited for study participation in SOCs of the comprehensive care network 'Post-COVID Kids Bavaria' for children and adolescents with PCC in Bavaria, Germany. Information on healthcare utilisation from their initial SARS-CoV-2 infection until presentation at an SOC was collected via telephone interviews with parents. RESULTS: Participants had a median of 6.5 physician contacts (Q1-Q3: 3.8-11.5), mainly in person (99.1%, n=116) and rarely used telemedicine (21.4%, n=25). Contacts were mainly with paediatricians (72.6%, n=85), followed by general practitioners (46.2%, n=50). Non-pharmacological measures were used by 56 participants (47.9 %), with therapies by Heilpraktiker and osteopaths being used most commonly (30.8%, n=36). 76 participants (65.0%) were prescribed medications, and 71 (60.7%) used non-prescribed medications or supplements. CONCLUSIONS: Children and adolescents with PCC symptoms frequently consult healthcare services, often self-initiated measures provided by Heilpraktiker and osteopaths, until their presentation at an SOC. This may be due to unclear care pathways. Paediatricians and general practitioners are key providers, making their expertise and strong connections with SOCs essential for early diagnosis and appropriate treatment.
12 Apr 2026
Read appraisal →PloS one
The effectiveness of dry needling at myofascial trigger points for knee disorders: A quantitative synthesis of randomized controlled trials
PURPOSE: Dry needling (DN) targeting myofascial trigger points (MTrPs) has been proposed as a treatment for knee disorders, including knee osteoarthritis (KOA) and patellofemoral pain syndrome (PFPS). This meta-analysis evaluated the effectiveness of DN in improving pain and function in patients with knee disorders. METHODS: This meta-analysis was conducted in accordance with PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420261294603). Systematic searches were performed in PubMed, Embase, Web of Science, Cochrane CENTRAL, CNKI, Wanfang, and VIP databases from inception to December 2025 for randomized controlled trials (RCTs) comparing DN targeting MTrPs with sham DN, no intervention, or other active treatments for knee disorders. Primary outcomes were pain intensity measured by the Visual Analog Scale (VAS) and Numeric Pain Rating Scale (NPRS). Secondary outcomes included functional status assessed by the WOMAC functional subscale and the Kujala Patellofemoral Score. Weighted mean differences (WMDs) were calculated using random-effects models. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, and certainty of evidence was evaluated using the GRADE framework. RESULTS: Twenty RCTs (n = 1,234; mean age range: 22-69 years) met the inclusion criteria. Compared with controls, DN significantly reduced knee pain across all pain measures: NPRS (WMD = -1.00, 95% CI: -1.25 to -0.76; I² = 0.0%), VAS (WMD = -1.19, 95% CI: -1.73 to -0.66; I² = 80.4%), and WOMAC Pain subscale (WMD = -1.76, 95% CI: -2.57 to -0.95; I² = 67.6%), with an overall pooled pain reduction of WMD = -1.25 (95% CI: -1.58 to -0.92; I² = 74.7%). DN also significantly improved knee function as measured by the WOMAC functional subscale (WMD = -6.59, 95% CI: -8.88 to -4.29; I² = 61.6%) and the Kujala Patellofemoral Score (WMD = 6.39, 95% CI: 4.64 to 8.14; I² = 30.1%). Pre-specified sensitivity analyses using standardized mean differences confirmed the robustness of these findings. The overall risk of bias was moderate, with concerns primarily related to inadequate blinding of participants and outcome assessors. The GRADE certainty of evidence was rated as moderate for all primary outcomes. CONCLUSION: DN targeting MTrPs provides significant short-term pain relief and functional improvement in KOA and PFPS, with pain reductions approaching clinically important thresholds. However, substantial heterogeneity, blinding limitations, and short follow-up necessitate cautious interpretation, and high-quality long-term RCTs are needed.
12 Apr 2026
Read appraisal →Global public health
Seroprevalence of hepatitis C virus among refugees, asylum seekers, and internally displaced populations within Africa: A systematic review and meta-analysis
Hepatitis C virus (HCV), an often overlooked public health concern, is highly prevalent among marginalized groups. Refugees, asylum seekers, and internally displaced people (RASIDP) constitute an underserved population in healthcare. Given that displacement rates are increasing and that HCV is endemic to many African countries, we aimed to determine the prevalence of HCV among RASIDP communities in Africa. Studies investigating HCV prevalence within RASIDP communities across Africa were identified via the following database searches: Ovid MEDLINE, EMBASE, Web of Science, APA PsycINFO, and the WHO Africa Index Medicus. Seroprevalence estimates were meta-analysed using a random-effects model, with data stratified by participant region, age, and gender. Across 9 studies, we estimated a pooled HCV seroprevalence of 3.63% (95% CI: 0.54, 9.16) among RASIDP in Africa. Seroprevalence varied by region of origin and age, with those from Northern Africa and those aged > 40 years having the highest seroprevalence, at 10.03% (95% CI:9.03, 11.13) and 5.70% (95% CI: 0.81, 14.21), respectively. RASIDP communities represent a marginalised and vulnerable population that often faces significant barriers to accessing healthcare. Our findings show that HCV seroprevalence within these communities varies by region and age, thus suggesting a need for targeted screening approaches.
12 Apr 2026
Read appraisal →Nature communications
Exposome-wide patterns predict brain health in aging
Promoting brain health is vital for well-being and reducing healthcare burdens. Brain health as measured with the Brain Age Gap (BAG) - the difference between chronological and predicted brain age- relates to many factors. However, a holistic view, integrating the range of factors an individual brain is exposed to, is missing for understanding how the exposome shapes brain health. After computing BAG as an indicator of grey matter (GM) health, we predicted it using machine learning based on 261 exposome variables (spanning biomedical, environmental, lifestyle, socio-affective, and early life domains) in UK Biobank participants. Exposome data can predict GM health with factors pertaining to cardiovascular and bone health, along with alcohol and smoking, nutrition and diabetes showing greater contribution to the prediction. In such domains, life period and duration of exposure appeared crucial. These findings call for early prevention in cardiovascular and metabolic health to promote life-long brain health.
12 Apr 2026
Read appraisal →Heart (British Cardiac Society)
Subclinical atherosclerosis in women after pre-eclampsia: a systematic review and meta-analysis
BACKGROUND: Women with pre-eclampsia are at increased risk of later-life cardiovascular disease (CVD). Despite suggestions that women affected by pre-eclampsia should undergo routine CVD screening, uniform recommendations are lacking. Subclinical atherosclerosis provides a window of opportunity to identify and treat those at risk of CVD. Coronary artery calcium scoring (CAC), carotid intima-media thickness (CIMT) and ankle brachial index (ABI) are effective methods of detecting subclinical atherosclerosis. This systematic review sought to explore associations between timing of measurement and presence of subclinical atherosclerosis in women with a history of pre-eclampsia. METHODS: We searched the MEDLINE, EMBASE and CINAHL databases for all studies which reported subclinical atherosclerosis in women with a history of pre-eclampsia. Common and random effects models were used to examine the associations between pre-eclampsia and subclinical atherosclerosis. RESULTS: 35 case-control studies comprising 20 235 women were included in the final analysis. 3376 had a history of pre-eclampsia. Among the 26 studies assessing CIMT, pre-eclampsia was associated with increased CIMT (standardised mean difference 0.63 (95% CI 0.32, 0.93)). This difference was present during pregnancy (0.65 (95% CI 0.33, 0.98)) and persisted for 12 months post partum (0.84 (95% CI 0.20, 1.47)) and beyond (0.50 (95% CI 0.01, 0.99)). Pooled analysis of the eight CAC studies also demonstrated that the odds of having subclinical atherosclerosis were 1.57 (95% CI 1.39, 1.77) times higher in women with a history of pre-eclampsia. CONCLUSIONS: Among women with a history of pre-eclampsia, subclinical atherosclerosis can be seen during pregnancy and persists long term. Our review supports the importance of early follow-up in patients who have had pre-eclampsia.
12 Apr 2026
Read appraisal →Vaccine
Increasing HPV vaccine uptake using a "start at 9" strategy: A pilot program
BACKGROUND: Human papillomavirus (HPV) vaccine completion rates by 13 years remain suboptimal. Earlier HPV vaccination may result in improved timely completion rates. We aim to describe the impact of recommending HPV vaccine at 9 years of age on vaccine completion rates. METHODS: We implemented a multi-level program (including policy development, provider and office personnel education, electronic health record changes, and use of vaccine promotional items) to facilitate routine HPV vaccine recommendation at 9 years at 2 pediatric practices. Monthly chart reviews were performed 6 months before through 18 months after program implementation. Outcome measures included rates of HPV vaccination and documentation of HPV vaccine during the visit. Quarterly data (age, HPV vaccination status, gender, race, ethnicity, insurance, and primary care provider type) were obtained from the electronic health records of 9-12-year-olds served by the practice from baseline through 18 months after program implementation. RESULTS: Following program implementation, the median percentage of HPV vaccine uptake among 9-10-year-olds increased from 8% to 41% at the urban practice and from 3% to 23% at the suburban practice. Similarly, HPV vaccine completion rates among 9-12 year olds increased from 9% to 14%, p < 0.001 and from 6% to 16%, p < 0.001, respectively. Documentation of provider vaccine recommendation strongly correlated with HPV vaccination. CONCLUSION: Implementation of a multi-level program to routinely recommend the HPV vaccine at 9 years of age is feasible and effective in increasing in HPV vaccine completion by 13 years of age.
12 Apr 2026
Read appraisal →Vaccine
Impact of pharmacy-based interventions on vaccination coverage among vulnerable and underserved populations: a systematic review and meta-analysis
BACKGROUND: Vaccination coverage remains suboptimal among vulnerable and underserved adult populations. We investigated the effectiveness of pharmacy-based interventions in improving vaccine uptake in high-risk groups and the most effective strategies. METHODS: A systematic search (PubMed/MEDLINE, Embase, Scopus; 26 July 2025) identified experimental and observational studies evaluating pharmacy-led vaccination interventions targeting adults ≥65 years or individuals aged 18-64 years with chronic conditions or limited healthcare access. The primary outcome was vaccination coverage. Odds ratios (ORs) were pooled using fixed- and random-effects models. Sensitivity analyses were conducted by intervention type and setting. Risk of bias was assessed using ROBINS-I, RoB 2, and NOS tools. RESULTS: A total of 35 studies were included, encompassing over 1.3 million participants. In pre-post comparisons, pharmacy-based interventions nearly doubled vaccination uptake (random-effects OR = 1.88; 95% CI: 1.68-2.12). In case-control analyses, individuals exposed to pharmacist interventions were almost five times more likely to be vaccinated (random-effects OR = 4.87; 95% CI: 2.23-10.64). Multicomponent strategies and direct vaccine administration by pharmacists produced the most consistent improvements. CONCLUSIONS: Pharmacist-led vaccination interventions significantly increase vaccine uptake among vulnerable adults. The most effective approaches involved pharmacists included eligibility assessment, counselling, administration, and documentation, integrated within routine care workflows.
11 Apr 2026
Read appraisal →PloS one
Inconsistent condom use and its associated factors among female sex workers in African countries: Systematic review and meta-analysis
BACKGROUND: Inconsistent condom use represents the most proximal behavioral risk factor for acquisition and transmission of sexually transmitted infections, including human immunodeficiency virus. However, certain situations hinder female sex workers from practicing consistent condom use. This study aimed to assess the pooled estimate of inconsistent condom use among female sex workers and identify factors associated with it. METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 2020 reporting checklist. Electronic databases (PubMed, Cochrane Library, Epistemonikos, Hinari, and Science Direct), Google Scholar, and other university repositories were searched until March 20, 2024, based on the eligibility criteria. Three independent reviewers screened the titles, abstracts, and full texts. Two independent reviewers extracted the data. The Joanna Briggs Institute quality appraisal checklist was used. The Higgin's I² test was used to quantify heterogeneity. Pooled analysis was conducted using a random-effects model. Sensitivity and subgroup analyses were done. Publication bias was assessed using Egger's regression test and funnel plot. The pooled prevalence and statistical association were declared at a p-value < 0.05 with the 95% CI. RESULTS: A total of 24 studies involving 23,496 female sex workers with a median age of 27.3 years were included. The overall pooled prevalence of inconsistent condom use among FSW in Africa was estimated at 46.73% (95% CI: 37.60, 55.86), I² = 99.59%, and p = 0.00. Condom availability (AOR = 0.68; 95% CI: 0.50, 0.92), depression (AOR = 1.51; 95% CI: 1.00, 2.30), no education (AOR = 1.87; 95% CI: 1.19, 2.93), two or more nonpaying clients (AOR = 2.90; 95% CI: 1.51, 5.54), having >9 current client number (AOR = 0.46; 95% CI: 0.29, 0.74), violence (AOR = 1.74; 95% CI: 1.33, 2.27), and police harassment (AOR = 2.28; 95% CI: 1.03, 5.05) were significant factors. CONCLUSION AND RECOMMENDATION: Inconsistent condom use was high in Africa. Factors including availability of condoms, depression, and education, having two or more nonpaying clients, client numbers, violence, and police harassment were significant factors. Strategies like improving peer education, providing mental health support, empowering women, and improving female sex workers educational status, ensuring condom availability, and strengthening supply for easily accessible condoms can decrease inconsistent condom use and protect FSWs from STI including HIV.
11 Apr 2026
Read appraisal →PloS one
Association between hypertension and impaired lung function among adults: A systematic review and meta-analysis
BACKGROUND: Impaired lung function and hypertension are both significant global public health concerns, and their potential association has recently drawn considerable interest. This systematic review and meta-analysis aims to investigate the association between impaired lung function and hypertension, and vice versa. METHODS: We searched CINAHL (EBSCOhost), MEDLINE (PubMed), Scopus and Web of Science up to 22nd July 2025 for observational studies involving adults (≥ 18 years) reporting hypertension and impaired lung function. Grey literature was also searched, and data extraction was verified independently. The review was registered with PROSPERO (CRD42023427631). Random effects models estimated pooled ORs with 95% CIs. Subgroup analysis and meta-regression were performed to identify potential sources of heterogeneity. Quality assessment was conducted using Newcastle-Ottawa Scale and JBI checklist and publication bias were appraised. RESULTS: This systematic review included 28 articles, of which 26 articles were selected for the meta-analysis. Of these, 17 studies (n = 134823) examined impaired lung function as the exposure, while 9 studies (n = 12522) investigated hypertension as the exposure. Our findings revealed that the pooled unadjusted effect of lung function impairment on hypertension was 1.70 (95% CI: [1.53-1.88]), while the pooled adjusted effect was lower at 1.40 (95% CI: [1.31-1.49]). In contrast, the pooled unadjusted effect of hypertension on lung impairment was 3.00 (95% CI: [1.86-4.82]), but the pooled adjusted effect decreased to 1.94 (95% CI: [1.51-2.50]). The findings indicate that obstructive, restrictive and mixed lung function impairments are significantly associated with hypertension. Restrictive lung impairment consistently shows a stronger association with hypertension compared to obstructive impairment when impaired lung function is the exposure. CONCLUSION: This study concludes that there is a significant positive association between impaired lung function and hypertension in both directions, with stronger temporal evidence suggesting that impaired lung function may precede hypertension, while the reverse causal direction lacks such evidence.
11 Apr 2026
Read appraisal →Open heart
Effect of a mobile health intervention optimised with artificial intelligence on blood pressure and other cardiovascular risk factors in adults with high blood pressure: rationale and design of My Intelligent Cardiac Assistant (MICArdiac) randomised controlled trial
INTRODUCTION: Control of blood pressure (BP) continues to be a challenge globally. Clinical trials have shown home BP monitoring and text-message interventions to lower BP. Integrating these to personalise supportive messaging in response to changing BP and activity through leveraging artificial intelligence (AI) could improve BP control. The aim of this trial is to examine the impact on BP, compared with a text-message only programme, of the My Intelligent Cardiac Assistant (MICArdiac) programme. MICArdiac is a 6-month programme comprising tracking of BP, physical activity and heart rate informing a content stream of AI-driven personalised messages to encourage BP self-management, as-necessary medical review to up-titrate medicines and cardiovascular preventative behavioural change. METHODS AND ANALYSIS: MICArdiac is a prospective randomised open-blinded endpoint randomised controlled trial with 1:1 (intervention:control) allocation and active control. Individuals aged 35 years old or above with high BP are randomised to the MICArdiac programme or to a text-message cardiovascular education programme. Recruitment started in primary care and hospital clinics in Western Sydney and moved to decentralised direct-to-community recruitment in the Australian Capital Territory, New South Wales and Victoria. Randomisation and allocation concealment occur via a secure web-based system. The primary outcome is mean daytime systolic BP measured by 24-hour Ambulatory Blood Pressure Monitoring at 6 months. Primary analysis will follow intention-to-treat principles; data analysts will be blinded. Process evaluation will be conducted. ETHICS AND DISSEMINATION: Ethics approval was obtained from Western Sydney Local Health District Human Ethics Research Committee (2021/ETH11379). TRIAL REGISTRATION NUMBER: ACTRN12622000091707.
11 Apr 2026
Read appraisal →JMIR aging
Facilitators and Barriers to Digital Self-Management in Older Adults With Depression: COM-B and Theoretical Domain Framework Qualitative Study
BACKGROUND: Depression in older adults presents unique challenges in self-management. Digital tools, such as mobile health (mHealth) apps, have the potential to support this population. This study explored the facilitators and barriers to digital self-management in older adults with depression to inform the design of effective mHealth apps. OBJECTIVE: This study aims to explore the facilitators and barriers to digital self-management in older patients with depression with the aim of informing the design and development of mHealth apps for older adults. METHODS: A purposive sampling method was used to recruit 25 older patients with depression from July to September 2024. Semistructured interviews were conducted to capture real-life experiences. Directed content analysis ensured objective and accurate data interpretation, and the Capability, Opportunity, Motivation, and Behavior (COM-B) model and the Theoretical Domains Framework were applied to identify facilitators and barriers related to behavior. RESULTS: Six themes were identified based on the COM-B model and the Theoretical Domains Framework: perception of illness and accumulation of personal experience; dual challenges of cognitive abilities and physical limitations; integration of digital technologies and acceptance differences; social influences and access to and utilization of support resources; environmental constraints and accommodations; and intertwined influences of beliefs, emotions, and motivation. A total of 13 barriers and 11 facilitators were identified. CONCLUSIONS: Digital self-management in older adults with depression is complex and influenced by multiple interrelated factors. Effective mHealth apps must integrate the cognitive, emotional, and social contexts of patients to provide user-friendly, personalized solutions.
11 Apr 2026
Read appraisal →JMIR aging
Global, Regional, and National Burden of Falls Among Older Adults Aged 65 Years and Above: Secondary Data Analysis of the Global Burden of Disease Study 2021
BACKGROUND: Falls are a leading cause of injury, disability, and death among older adults, posing significant public health challenges. However, comprehensive global analyses of fall-related burdens in older populations remain scarce. OBJECTIVE: This study aimed to explore the patterns and distribution of the global, regional, and national burden of falls among adults aged 65 years and older. METHODS: Data from the Global Burden of Disease study 2021 were used to assess the overall, disability, and mortality burden of falls among adults aged 65 years and older. Age-standardized rates of disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost were calculated to compare burdens across countries. Health inequalities were evaluated via the slope index of inequality and the concentration index. Frontier analysis identified optimal burden levels by sociodemographic index (SDI). Bayesian age-period-cohort models projected trends up to 2050. RESULTS: DALY age-standardized rates showed a U-shaped distribution across SDI regions: lower-SDI countries faced higher mortality burdens, while higher-SDI countries had elevated disability burdens. Despite an increase in absolute overall burden inequality from 1990 to 2021, absolute inequalities in YLDs and years of life lost declined, with DALYs and YLDs exhibiting relatively more balanced distributions. Frontier analysis pinpointed countries with the greatest burden reduction potential. Projections suggest decreasing overall and mortality burdens by 2050 but rising disability burdens. CONCLUSIONS: Higher- and lower-SDI countries face distinct fall-related challenges. Reducing cross-national health inequalities and closing gaps between the observed burden and the optimal burden level achievable at a similar SDI level are critical. Despite projected declines in the overall burden (DALYs), the rising disability burden (YLDs) could present evolving challenges, potentially underscoring the importance of proactive preparedness.
11 Apr 2026
Read appraisal →PloS one
Exploring barriers and enablers to diabetes self-care practice in Ethiopia, 2025: A qualitative systematic review
INTRODUCTION: Diabetes mellitus is a growing public health concern in Ethiopia, with increasing prevalence and a high proportion of undiagnosed cases. Effective self-care is crucial for managing diabetes; however, many patients face challenges ranging from personal beliefs to systemic and sociocultural constraints. Although multiple qualitative studies have explored these challenges, a synthesized, context-specific understanding that incorporates broader social and health system factors remains limited. This review aimed to synthesize qualitative evidence on barriers and facilitators of diabetes self-care practice in Ethiopia. METHODS: A qualitative systematic review was conducted in accordance with PRISMA 2020 and PRISMA-QS guidelines. A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, Web of Science, and Google Scholar was performed using relevant keywords and Medical Subject Headings. Eligible studies included primary qualitative and mixed-methods studies with extractable qualitative findings that explored diabetes self-care barriers and facilitators among patients, caregivers, or healthcare providers in Ethiopia. Purely quantitative studies, reviews, editorials, and studies conducted outside Ethiopia were excluded. Thematic synthesis was employed to integrate findings, and the GRADE-CERQual approach was used to assess confidence in the review findings. RESULTS: Eleven studies were included, comprising qualitative and mixed-methods designs conducted across diverse urban and semi-urban healthcare settings in Ethiopia. Study participants included adults with type 1 and type 2 diabetes, as well as healthcare professionals and caregivers. Six major barriers to diabetes self-care were identified: health system limitations, individual-level challenges, socioeconomic constraints, behavioral and lifestyle factors, cultural and social norms, and lack of social support. Key facilitators included strong family and social support, health education and counseling, patient motivation and skills, culturally aligned practices, and signs of health system readiness. CONCLUSION AND RECOMMENDATION: Diabetes self-care in Ethiopia is shaped by interconnected individual, cultural, and systemic factors. While substantial barriers persist, important enablers, particularly family involvement and supportive healthcare interactions, offer opportunities for improvement. Interventions should be culturally sensitive, community-centered, and supported by strengthened health systems. Policy efforts should prioritize integration of diabetes care into primary healthcare services, capacity building of healthcare providers, and incorporation of patients' lived experiences into care planning. Prospero registration number CRD420251033692.
11 Apr 2026
Read appraisal →Journal of medical Internet research
Digital Discourse, Secondary Victimization, and Psychological Harm: Mixed-Methods Analysis of System Justification in the #MeToo Movement
BACKGROUND: The #MeToo movement, initiated in 2006 and amplified on social media in 2017, mobilized women worldwide to share experiences of sexual harassment and assault online. While the movement increased awareness, it also revealed deep social divisions in digital spaces. Supportive discussions promoted solidarity and healing, whereas antagonistic responses reinforced backlash and secondary victimization. In India, the Indian Entertainment Industry (IEI) became a focal point where survivors' disclosures highlighted structural gender inequalities. These polarized reactions function as digital-health signals, reflecting stigma, psychosocial distress, and conditions that shape women's safety and mental well-being. Examining these narratives as indicators of public health risk helps identify patterns of structural inequity and secondary mental health burdens among survivors. OBJECTIVE: This study examined online discourse surrounding #MeToo to identify forms of system-justifying narratives on social media and to assess how #MeTooIndia exposed institutional inequities within the IEI. METHODS: This mixed-methods study comprised 2 components. In study 1, natural language processing was applied to analyze global #MeToo Twitter (subsequently rebranded X) discourse. From an initial corpus of 350,000 tweets, 205,082 were preprocessed, and sentiment and stance detection analysis identified 18,416 tweets expressing negative attitudes toward the movement. Latent Dirichlet allocation topic modeling extracted 22 topics, 12 of which aligned with system-justification categories, revealing distinct lexical and semantic patterns related to gender, institutional, and power dynamics. Two trained coders manually annotated a subsample to ensure conceptual clarity and interrater reliability. Study 2 involved qualitative, semistructured interviews with 20 academic experts in film, gender, and media studies to gather opinions on how #MeTooIndia influenced institutional discourse in the IEI and how these dynamics translate into digital and mental health risks. RESULTS: Analysis of #MeToo Twitter discourse in study 1 identified 4 primary forms of system justification: by gender, by the institutional system, by backlash, and by victim-blaming. Gender and institutional system justifications were the most prevalent. Study 2 reinforced these findings, revealing how experts perceived #MeTooIndia as both empowering and constrained by entrenched institutional and cultural barriers. Together, our findings highlight the dual function of social media in promoting collective advocacy while reproducing conditions linked to gender-based violence, psychological stress, and reduced help-seeking-key digital and mental health concerns. CONCLUSIONS: This mixed-methods study reveals that digital discourse surrounding #MeToo often sustains existing gender and institutional hierarchies rather than dismantling them. Across Twitter data and expert interviews, gender and institutional system justifications emerged as dominant narratives, highlighting how online spaces can reinforce structural inequities while appearing progressive. Although #MeToo amplified visibility and awareness, its potential for lasting institutional change remains limited. These findings underscore the need for trauma-informed digital governance, public health recognition of online hostility as a psychosocial risk, and frameworks that situate digital activism to institutional reforms that support safety and mental well-being.
11 Apr 2026
Read appraisal →JMIR human factors
Evaluation of Wellby, a Cocreated Mobile App and Wearable to Support Stress Management and Overall Well-Being: Mixed Methods Acceptability and Usability Study
BACKGROUND: Digital well-being support tools can offer adolescents tailored interventions embedded in their digital environments. However, there is a lack of high-quality, evidence-based digital interventions specifically designed for young people's well-being needs. Wellby is a mobile app and wearable device cocreated with Irish secondary school students to support stress management and overall well-being. OBJECTIVE: This study aimed to evaluate the acceptability and usability of the Wellby system using the technology acceptance model, focusing on ease of use, perceived usefulness, and behavioral intention among Irish secondary school students. METHODS: A mixed methods acceptability and usability study was conducted with Irish secondary school students (n=43) across 3 schools: 2 mainstream secondary schools and 1 Youthreach center for early school leavers. Students accessed the Wellby mobile app for 8 weeks and received the custom wearable device for the final 4 weeks (April-May 2024). Wellby included mood tracking, to-do lists, educational resources, text-based health coaching, and heart rate variability biofeedback with guided breathing exercises. Acceptability and usability were evaluated using the user version of the Mobile App Rating Scale (uMARS), structured focus groups, and app engagement analytics. Secondary measures included baseline well-being questionnaires (Perceived Stress Scale, Pittsburgh Sleep Quality Index, and EPOCH Measure of Adolescent Well-Being). RESULTS: Among survey respondents (n=29), uMARS subscale scores were high: information quality (mean 4.2/5.0), functionality (4.1/5.0), and aesthetics (4.1/5.0). The perceived impact subscale showed the highest scores for well-being awareness (3.8/5.0) and help-seeking intention (3.9/5.0). Of survey respondents who participated in prior co-design sessions, 88% (21/24) and 83% (20/24) felt the wearable and app, respectively, aligned with their co-design feedback. App engagement more than doubled following the introduction of the wearable and revealed that the wearable tab was most accessed (643/1688, 38% of interactions), followed by the home (430/1688, 25%), resources (338/1688, 20%), and coaching (277/1688, 16%) tabs. Focus group feedback highlighted the mood tracker as the most valued feature and identified technical improvements, including better battery life, enhanced Bluetooth connectivity, and more personalization options. CONCLUSIONS: This study demonstrates that cocreated digital well-being tools can achieve high acceptability and usability with Irish secondary school students. Applying the technology acceptance model effectively captured student experience through mixed methods feedback. Students particularly valued self-tracking and personalization features over coaching or educational features. These findings highlight the importance of aligning digital technologies with adolescents' needs and preferences, such as features that encourage increased autonomy and identity formation. Future iterations of Wellby should address the technical limitations while continuing the involvement of students to adapt to their developmental needs and maintain high acceptability.
11 Apr 2026
Read appraisal →Journal of epidemiology and community health
Utilisation of in-person and telehealth care among US adults with loneliness and social isolation
BACKGROUND: Telehealth has become a critical tool for improving access to care among populations facing physical barriers to in-person care. However, its potential role in delivering care to adults with social barriers remains underexplored. We examined whether adults with loneliness or social isolation are more likely to use telehealth care versus in-person care compared to adults without loneliness or social isolation. METHODS: This cross-sectional study analysed data for US adults in the 2021 Medical Expenditure Panel Survey. Loneliness and social isolation were measured using the UCLA Loneliness Scale and the Berkman-Syme Social Network Index. Three indicators of healthcare utilisation were used as outcomes: in-person care only, telehealth care only and a combination of both. RESULTS: Among adults experiencing loneliness and social isolation, the likelihood of using only in-person care was lower by 4.1 (95% CI -6.1 to -2.1) and 2.8 (95% CI -5 to -0.6) percentage points. In contrast, the likelihood of using only telehealth care was higher by 2.6 (1.1-4.2) and 5.4 (3.9-6.9). The likelihood of using both in-person and telehealth care was also higher by 2.3 (0.7-3.9) and 5.2 (3.7-6.7), but telehealth was used more frequently than in-person care. Furthermore, telehealth utilisation for mental health services was higher among adults experiencing loneliness or social isolation. CONCLUSION: Compared with adults who are not lonely or socially isolated, adults experiencing loneliness and social isolation are more likely to use telehealth and less likely to use in-person care. Telehealth may serve as a viable alternative for individuals facing social challenges in accessing in-person services.
11 Apr 2026
Read appraisal →Scientific data
Continuous observation of Parkinsonian symptoms using symptom diaries & wearable accelerometry
Treatment adjustments in Parkinson's Disease (PD) are often based on clinical evaluations at single time points which are insufficient to adequately assess real-life motor fluctuations. Patient-written symptom diaries on the other hand are highly subjective and require well-educated and adherent patients to provide reliable results. Wearable accelerometry might provide a reliable, objective, and continuous diagnostic method to assess PD motor symptoms & fluctuations. However, large datasets of simultaneous sensor data and symptom diaries are needed for such method development and validation. We here provide a well-described, open-science dataset of simultaneous, bilateral, wrist-worn accelerometry and symptom diary data from 66 participants (41 male, 25 female) with PD. On average, participants provided data for 6.0 consecutive days resulting in a total of 393.8 days for the dataset as a whole. Symptom diaries include data on kinetic state, tremor, freezing of gait, falls, and PD-related medication intake. Further demographic information is also provided. This dataset will support the development and validation of accelerometry-based approaches to assessing motor symptoms and fluctuations in PD.
11 Apr 2026
Read appraisal →Open heart
Sex differences in risk factor control and medication adherence post-ACS: insights from the TEXTMEDS randomised clinical trial
INTRODUCTION: Poor adherence to risk factor control and life-saving medications is a key factor affecting long-term patient prognosis. Evidence indicates that sex plays a significant role in the uptake of both pharmacological and non-pharmacological interventions, ultimately influencing long-term outcomes. This study aimed to quantify sex differences in risk factor management and medication adherence following acute coronary syndrome (ACS). METHODS: This is a secondary analysis of the TEXTMEDS randomised clinical trial - a single-blind, multicentre randomised controlled trial of patients post-ACS. We compared sex differences in achieving clinical and lifestyle targets for secondary prevention, namely blood pressure control (<140/90 mm Hg), low-density lipoprotein cholesterol (LDL-C) (<1.8 mmol/L), healthy body mass index (BMI) (<25 kg/m²), regular physical activity (Global Physical Activity Questionnaire score ≥600), smoking status and adherence to cardioprotective medications (aspirin, beta blockers, ACE/angiotensin receptor blockers, statins, antiplatelets), using adjusted logistic regression models. Medication adherence was defined as taking ≥80% of prescribed doses in the month prior to follow-up, across all five drug classes, unless contraindicated. RESULTS: Of 1379 patients (mean age 58.5±10.7 years; 1095 (79.4%) male), females were less likely than men to achieve LDL-C targets (adjusted OR (aOR): 0.61, 95% CI 0.45 to 0.82) and engage in regular physical activity (aOR: 0.61, CI 0.47 to 0.80), but more likely to achieve a healthy BMI (aOR: 1.47, CI 1.04 to 2.06). Female patients are less likely to adhere to their medication compared with male counterparts (aOR: 0.68, CI 0.50 to 0.92). However, this association weakened and lost statistical significance after further adjustment for socio-economic factors (aOR: 0.71, CI 0.50 to 1.03). There were no significant interactions between sociodemographic or clinical factors and sex in relation to overall medication adherence (P-interactions >0.05). CONCLUSION: This study reveals that female patients are less likely to achieve LDL-C targets and engage in physical activity but more likely to maintain a healthy BMI. Although females showed lower medication adherence, this association weakened after adjusting for socio-economic factors. These findings highlight the importance of sex-sensitive strategies focusing on risk factor control and medication adherence for improving cardiovascular health outcomes. TRIAL REGISTRATION NUMBER: ACTRN12613000793718.
11 Apr 2026
Read appraisal →Cell host & microbe
VIBRANT: A phase 1 randomized trial of multi-strain vaginal L. crispatus live biotherapeutic products in people with bacterial vaginosis
Bacterial vaginosis (BV) is characterized by high microbial diversity. High recurrence rates following antibiotics may stem from poor recolonization by protective Lactobacillus species. This phase 1 randomized trial in the United States and South Africa evaluated two vaginally delivered live biotherapeutic products (LBPs) containing multiple Lactobacillus crispatus strains. After metronidazole treatment for BV, participants received either a placebo or 3 or 7 days of active LBPs. LBP strains were detected by metagenomics in 66.1% (47/71) of participants in the active arms in the first 5 weeks. Among those, nearly half (49%, 23/47) remained colonized at 12 weeks despite the short initial treatment course. Participants were most often colonized by one of three component strains, with no geographic differences in strain colonization observed. LBPs were safe, acceptable, and well tolerated, with no serious adverse events (AEs) reported. These results provide a foundation for the development of transformational interventions aimed at optimizing the vaginal microbiome.
11 Apr 2026
Read appraisal →Cell host & microbe
Vaginal microbiota impacts of a Lactobacillus crispatus live biotherapeutic and predictors of colonization in randomized controlled trial
Bacterial vaginosis (BV) affects >25% of women worldwide and often recurs after standard-of-care metronidazole (MTZ) treatment. LACTIN-V, a live biotherapeutic product (LBP) containing Lactobacillus crispatus strain CTV-05, significantly reduced recurrent BV in a phase 2b clinical trial, but efficacy was incomplete. Here, we characterize microbiota and immune effects using multi-omics and define correlates of treatment success. By week 12, an L. crispatus-dominant microbiota was achieved in 30% of LBP recipients compared with 9% of placebo recipients (benefit ratio: 3.31; p < 0.005). This is primarily due to CTV-05, but native L. crispatus strains are also present and increase over time. Inflammatory cytokines decrease in both arms after MTZ but return to baseline in placebo recipients. Successful L. crispatus colonization is associated with pre-MTZ microbiota, baseline inflammatory profiles, post-MTZ bacterial load, and clinical and behavioral variables. These findings elucidate LBP microbiota effects and identify predictors of treatment success, informing improved intervention strategies to advance women's health.
11 Apr 2026
Read appraisal →PloS one
Prevalence and determinants of inadequately controlled diabetes in Qatar's public primary care settings: A cross-sectional study
BACKGROUND: The prevalence of type 2 diabetes mellitus (T2DM) is rapidly increasing worldwide, causing serious morbidity and mortality. Proper management and control of T2DM are essential in slowing and reducing complications. Measuring the adequacy of diabetic control, therefore is one of the ways of evaluating the success of health care system and the individuals in addressing disease morbidity and mortality. This study was proposed to assess the extent of uncontrolled T2DM in ambulatory adults managed in the public primary care settings of Qatar over five years. In addition, it aimed to predict the risk of uncontrolled disease based on age, sex, nationality and comorbidity. METHODS: A cross sectional review of Electronic Health Records of 84,512 adult individuals with T2DM having at least one HbA1c blood test result per year during the 5 years study period (1st January 2018, to 31st December 2022) was analyzed. The term "inadequately controlled" T2DM was used to define an individual with HbA1c measurements of 7% or higher. RESULTS: The yearly prevalence of inadequately controlled T2DM remained stable at a high rate (53%) during the last three years of observations. Aging increases the probability of having inadequately controlled T2DM, but this was attributed to comorbidities. Adjusting for those comorbidities will show that younger ages are the ones at higher risk of being uncontrolled. Additionally, the study reported that hypertension and dyslipidemia are the most frequently prevalent comorbidities, nevertheless retinopathy, although less frequent, was the most important predictor for inadequately controlled T2DM. CONCLUSIONS: The study highlights the significant healthcare challenge posed by T2DM in Qatar due to its high prevalence and associated complications. Males, South Asian ethnic background and Qatari locals have the highest probability of being inadequately controlled. Overall, the study emphasizes the need for targeted interventions to address the challenges of controlling diabetes, particularly among high-risk groups identified in the study.
10 Apr 2026
Read appraisal →JMIR mHealth and uHealth
Trust and Use of Recommendations for Health Apps Among European Residents: Cross-Sectional Survey
BACKGROUND: There is growing recognition of the role of health apps in addressing health care system challenges, yet app quality and evidence vary widely, and consumers have little decision support at the point of download. OBJECTIVE: This study aimed to explore which sources of recommendations European residents use and trust when choosing health apps and whether residents support government review and rating of health apps. METHODS: We conducted a cross-sectional online survey (December 7, 2022, to February 16, 2023) in 26 languages targeting residents of the European Economic Area, the United Kingdom, and Ukraine. The survey contained 11 questions covering demographics, types of apps used, sources of advice used and trusted, and views on government review and rating. We included only fully completed responses (N=1228). Descriptive statistics are presented as counts and percentages. For subgroup analyses, we dichotomized trust responses ("I trust" vs other responses) and tested associations with gender (Fisher exact test), age group, and education level (chi-square test); an adjusted significance threshold was applied (P<.004) to account for multiple testing. We followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines for reporting online surveys and STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) recommendations for observational studies. RESULTS: A total of 1228 respondents from 33 countries completed the survey; 1110 (90.4%) reported using one or more health apps. COVID-19 apps (763/1228, 62.1%) and activity apps (737/1228, 60.0%) were the most frequently used, whereas disease management (86/1228, 7.0%), diagnostic (77/1228, 6.3%), and treatment apps (70/1228, 5.7%) were the least used. Sources used to choose apps included family and friends (434/1228, 35.3%), health professionals (412/1228, 33.6%), and government or health authorities (358/1228, 29.2%). The most trusted sources were health professionals (987/1228, 80.4%), pharmacists (750/1228, 61.1%), and government or health authorities (736/1228, 59.9%). No statistically significant differences in trust by gender were observed (all P>.0038). Some differences by age and education were observed for select sources (eg, government or health authorities: χ21=8.546; P=.003; family and friends: χ2=19.133; P<.001). Overall, 1060 (86.3%) of 1228 respondents supported government review and rating of health apps (either directly or by commissioning another organization). CONCLUSIONS: In this large multilingual European survey, most respondents reported experience with health apps and placed greatest trust in health professionals, pharmacists, and government or health authorities, yet professional recommendations were used less often than informal sources. There is clear public support for government-led review and rating schemes to guide consumer choice. Efforts to make trustworthy, easy-to-find information available at the point of download and to support health care professionals in recommending high-quality apps could help bridge the gap between trusted and used sources.
10 Apr 2026
Read appraisal →Acta orthopaedica
Effect of an in-consult patient decision aid on decisional quality and involvement for patients with severe hip or knee osteoarthritis: a multicenter, cluster randomized controlled trial
BACKGROUND AND PURPOSE: Shared decision-making (SDM) is important in managing patients with severe hip and knee osteoarthritis, where treatment decisions often depend on patient preferences and values. We aimed to evaluate the effectiveness of an in-consult patient decision aid in improving decision quality and patient involvement compared with usual care. METHODS: In a cluster-randomized controlled trial, surgeons from 2 Danish orthopedic departments were randomized to use in-consult patient decision aids or provide usual care. The primary outcome was decision quality assessed using the Hip/Knee OA Decision Quality Instrument (HK-DQI). Patients who were well informed and received their preferred treatment received an Informed Patient-Centered (IPC) score of 1, indicating good decisional quality; all others scored 0. Secondary outcomes included patient-experienced engagement and involvement in decision-making, assessed using CollaboRATE and the decision-process domain of the Hip/Knee OA Decision Quality Instrument and consultation duration. Relative risks (RR) and mean differences (MD) with 95% confidence intervals (CIs) were estimated using multilevel regression models. RESULTS: 20 surgeons were randomized to either use in-consult patient decision aids (n = 10) or provide usual care (n = 10). Of the 1,038 patients screened for severe hip or knee osteoarthritis, 581 were included in the study. Decision quality was similar between groups, with a score of 43 (36-51) in the intervention group and 44 (37-52) in the usual care group (RR 0.9, CI 0.7-1.2; P = 0.8), likewise, patient-experienced engagement assessed with CollaboRATE (RR 1.1, CI 0.8-1.4; P = 0.6). Consultations were longer in the intervention group, with a mean difference of 3.9 minutes (CI 0.1-7.7; P = 0.04). CONCLUSION: Decision quality and patient-reported engagement were similar between groups, while consultation time was longer with in-consult patient decision aids use. In the absence of prespecified minimal important differences, the clinical relevance of these findings remains uncertain.
10 Apr 2026
Read appraisal →JMIR mHealth and uHealth
Effectiveness of mHealth-Based Nutritional Interventions on Iron Status of Pregnant Women: Systematic Review of Randomized Controlled Trials
BACKGROUND: Anemia is a global health concern. It is disproportionately prevalent among pregnant women in low-resource regions, where iron deficiency is the leading cause. Given the multifactorial nature of anemia, a range of nutritional interventions is recommended. However, effective implementation is often hindered by limited health care access, poor adherence to supplementation, and gaps in nutrition knowledge and counseling. To address these challenges and optimize hemoglobin (Hb) levels among pregnant women, mobile health (mHealth)-based nutritional interventions offer a promising alternative. OBJECTIVE: The aim of the study is to review available evidence on the effectiveness of mHealth-based nutritional interventions on iron status (Hb and/or serum ferritin concentration) among pregnant women. METHODS: Searches were conducted in Embase, CINAHL, Cochrane Library, PubMed, Web of Science, and Scopus, and supplemented by snowballing to identify additional relevant studies from citation lists. The key search strings comprised 4 concepts: "mobile health," "nutritional intervention," "Hb, anemia or iron deficiency anemia," and "pregnant women." Predefined inclusion and exclusion criteria were applied during screening. The methodological quality of included studies was assessed using the Risk of Bias 2 tool. The primary end point was the change in mean Hb concentration or serum ferritin level. Effect sizes (ESs) were calculated as standardized mean differences, including Cohen d and Hedges g. RESULTS: Of the 14,284 studies identified, only 11 randomized controlled trials were included. These studies used various modes of delivery, including mobile phone calls (n=1), SMS text messaging (n=3), and mobile apps (n=4), with some using more than 2 modes (n=3). The effect of mHealth-based nutritional interventions on iron status varied significantly. In total, 4 studies demonstrated a large ES (>0.8), with 3 relying on WhatsApp Messenger as an mHealth delivery mode. Approximately 82% (9/11) of the included studies reported a positive effect (P values ranging from <.001 to .047) of the intervention on Hb level, whereas 2 studies reported no statistically significant association (P=.33 and P=.35, respectively). Notably, interventions with the largest ES achieved clinically significant improvements in Hb concentration, with within- and between-group differences exceeding 1 g/dL. However, including behavioral change theories and nutrition-sensitive components was not consistently associated with larger ESs. Due to high heterogeneity (I2>95%), attributed to variations in mHealth delivery modes, functions, and interactive features across the included studies, meta-analysis could not be performed. CONCLUSIONS: This review demonstrates that mHealth-supported nutritional interventions effectively optimize Hb concentration in pregnant women. While SMS text messaging was less effective in improving Hb concentration, combining it with another mHealth delivery mode, such as phone calls, improved intervention effectiveness. However, the variability in mHealth delivery modes, functions, and interactive features underscores the need for tailored strategies that account for context-specific challenges, digital literacy, and access to technology to enhance effectiveness.
10 Apr 2026
Read appraisal →JMIR mental health
Predicting Momentary Suicidal Ideation From Smartphone Screenshots Using Vision-Language Models: Prospective Machine Learning Study
BACKGROUND: Passive smartphone sensing shows promise for suicide prevention, but behavioral metadata (GPS, screen time, and accelerometry) often lacks the contextual information needed to detect acute psychological distress. Analyzing what people actually see, read, and type on their phones-rather than just usage patterns-may provide more proximal signals of risk. OBJECTIVE: This study aimed to test whether vision-language models (VLMs) applied to passively captured smartphone screenshots can predict momentary suicidal ideation (SI). METHODS: Seventy-nine adults with past month suicidal thoughts or behaviors completed ecological momentary assessments (EMA) over 28 days while screenshots were captured every 5 seconds during active phone use. We fine-tuned open-source VLMs (Qwen2.5-VL [Alibaba Cloud], LFM2-VL [Liquid AI]), and text-only models (Qwen3 [Alibaba Cloud]) to predict SI from screenshots captured in the 2 hours preceding each EMA. We evaluated performance with temporal and subject holdouts. RESULTS: The analytic sample comprised 2.5 million screenshots from 70 participants. Temporal holdout models achieved strong discrimination at the EMA level (AUC=0.83; AUPRC=0.77), with image-based models outperforming text-only models (AUC=0.83 vs 0.79; 95% CI 0.003-0.07). Subject holdout generalization was near chance (AUC≈0.50), though a simple lexical screening method retained modest discrimination (AUC=0.62). Smaller models performed comparably to larger models, supporting feasible on-device deployment. CONCLUSIONS: Screen content predicts short-term SI with clinically meaningful accuracy when models are personalized but does not generalize across individuals. These findings support a 2-stage clinical architecture, coarse lexical screening for new patients, with personalized VLM-based monitoring after a calibration period. On-device inference may enable privacy-preserving deployment.
10 Apr 2026
Read appraisal →Journal of medical Internet research
Preferences for Personalized Text Message Appointment Reminders Among Outpatients in a Universal Health System: Cross-Sectional Study
BACKGROUND: SMS text messaging reminders are widely used to reduce missed outpatient appointments; however, evidence remains limited regarding which types of reminder content patients prefer, particularly within East Asian universal health systems. In Taiwan, minimal financial barriers to care and unrestricted access to secondary and tertiary hospitals contribute to high outpatient visit volumes and persistent no-show rates. These contextual features underscore the need for behaviorally informed and demographically tailored reminder strategies rather than uniform messaging approaches. OBJECTIVE: This study aimed to examine patient preferences for 6 theory-guided SMS appointment reminder types and to identify the predictors of reminder preference related to demographic characteristics and health care utilization, with the goal of informing personalized reminder design for a forthcoming randomized controlled trial. METHODS: We conducted a cross-sectional online survey among adults in Taiwan with prior outpatient experience. Six SMS reminder prototypes were developed based on behavioral communication principles and validated by a multidisciplinary expert panel using item-level content validity indices. Participants selected their preferred SMS reminder type and reported sociodemographic characteristics and recent health care utilization. Bivariate associations were examined using chi-square tests and one-way ANOVA, with Benjamini-Hochberg false discovery rate correction applied to control for multiple testing. To identify independent predictors of SMS reminder preference while adjusting for potential confounding, we fitted a multinomial logistic regression model with all covariates entered simultaneously. RESULTS: A total of 1095 respondents completed the survey. General reminders and messages referencing prior missed appointments were most frequently preferred, whereas empathy-based or relationally framed messages were selected less often. In false discovery rate-adjusted univariate analyses, both age and sex were associated with SMS reminder preference. However, in the fully adjusted multinomial logistic regression model, age emerged as the only statistically significant independent predictor. Participants younger than 50 years were significantly more likely to prefer alternative reminder message types compared with the general reminder (adjusted odds ratio 1.64, 95% CI 1.18-2.28; P=.003). Sex did not retain statistical significance after multivariable adjustment. Other sociodemographic characteristics and health care utilization variables, including education level, employment status, residential region, outpatient visit frequency, and recent missed appointments history, were not independently associated with reminder preference. CONCLUSIONS: Preferences for outpatient SMS reminder content vary systematically, with age representing the most robust independent predictor. Across the sample, concise and behavior-focused reminders were preferred over empathy-oriented or relational formats. These findings support age-informed tailoring of SMS reminder content and provide content-validated SMS prototypes for use in subsequent interventional research. The results offer formative evidence to guide the design of randomized trials aimed at reducing outpatient no-shows and improving the efficiency of ambulatory care delivery in Taiwan's universal health care system.
10 Apr 2026
Read appraisal →PloS one
MaxGRNet: A multi-axis vision transformer with improved generalization for eye disease classification using explainable AI with insertion-deletion operations on fundus images
Eye diseases, including diabetic retinopathy (DR), glaucoma, and cataracts, represent a major global health concern and can lead to severe visual impairment or blindness if not identified in a timely manner. This study proposes a novel eye disease classification framework based on a multi-axis vision transformer (MaxViT) applied to color fundus images with Explainable Artificial Intelligence (XAI) techniques to enhance model transparency. The proposed architecture integrates transformer-based attention mechanisms with Global Response Normalization (GRN)-based multi-layer perceptron (MLP) layers to capture complex spatial and contextual relationships within fundus images effectively. The model was evaluated on a publicly available eye disease classification dataset using a five-fold cross-validation strategy to assess its robustness and generalization. The experimental results show that the proposed approach consistently outperforms conventional Convolutional Neural Networks (CNNs) and Vision Transformer (ViT) variants, including ResNet50, Swin-T, MaxViT-T, and ViT-B16. The model achieved a macro-averaged test accuracy, precision, and recall values of 96.75%, 96.70%, and 96.80%, respectively, with paired statistical t-tests confirming that these improvements were statistically significant. Rigorous preprocessing techniques were employed to improve data consistency, and XAI-based visual explanations provided insights into the model's decision-making process, supporting interpretability in ophthalmic image analysis. Overall, the proposed MaxViT-based framework is robust and computationally feasible for research-oriented evaluation approaches for automated fundus image classification, highlighting the potential of advanced transformer architectures for future decision-support and research-oriented ophthalmic applications.
10 Apr 2026
Read appraisal →JMIR formative research
A Gamified Pain Management Intervention for Adults With Chronic Pain in Mainland China: Single-Arm Pre-Post Pilot Study With Machine Learning Predictive Modeling
BACKGROUND: The widespread prevalence of chronic pain (CP) significantly impacts daily functioning worldwide. In mainland China, maintaining engagement in biopsychosocial interventions remains challenging. Gamification, designed based on self-determination theory, can enhance motivation, while machine learning (ML) algorithms can assist clinicians in dynamically optimizing pain management. OBJECTIVE: This study aimed to (1) evaluate the preliminary effectiveness of a gamified pain management (GPM) program on CP and psychological outcomes and (2) identify key factors of significant pain improvements through the application of ML to guide intervention adjustments. METHODS: A single-arm, pre-post study was conducted with 16 participants with CP in mainland China, recruited via social media using convenience sampling. Participants engaged in a 10-week web-based GPM intervention consisting of education, physical activities, and gamified elements, including points, avatars, and feedback. Primary outcomes were pain intensity and interference measured by the Brief Pain Inventory. Secondary outcomes included anxiety, depression, and quality of life. Analysis included paired t tests, and ML models were trained to predict clinically meaningful pain reductions. Shapley additive explanations, least absolute shrinkage and selection operator regression, association rule mining, and Kaplan-Meier survival analysis were used to identify key predictors and optimal sessions and intervention durations across subgroups. RESULTS: A total of 16 participants were engaged, with a mean age of 27.63 (SD 9.584) years. Results from paired t tests reported significant improvements in pain intensity (decreased by 27.3%, 95% CI 1.061 to 3.064; P=.001), pain interference (decreased by 27.3%, 95% CI 8.159-17.216; P<.001), and psychological distress, including anxiety (t15=3.538, 95% CI 0.969 to 3.906; P=.003) and depression (t15=4.559, 95% CI 2.230 to 6.145; P<.001). The gradient boosting model demonstrated the highest predictive accuracy (area under the curve=0.89 and accuracy=0.82). Least absolute shrinkage and selection operator regression identified session 3 (β=-0.45, 95% CI -0.68 to -0.22; P<.001) and session 5 (β=-0.32, 95% CI -0.59 to -0.05; P=.02) as most predictive of clinical success, while association rule mining revealed effective session combinations for different patient subgroups. Time-to-event analyses indicated that individuals with low back pain and higher baseline severity required longer intervention durations for improvement (5 wk; P=.03). CONCLUSIONS: This pilot study presents an innovative method that combines ML with dynamic engagement data from a GPM program during interventions, rather than relying on static baseline data in prior studies. The results show preliminary efficacy and identify specific optimal session combinations and personalized treatment durations for different pain subgroups. These exploratory findings contribute to the field by providing a data-driven method for adaptive, personalized digital health interventions that move beyond one-size-fits-all strategies, potentially enabling clinicians to modify content and dosage to improve engagement and outcomes if validated in larger sample trials.
10 Apr 2026
Read appraisal →European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
Memantine as a pain management strategy post-total knee arthroplasty: a randomized controlled trial
INTRODUCTION: Total knee arthroplasty (TKA) provides significant pain relief and improved function for patients with knee osteoarthritis. Despite its effectiveness, postoperative pain remains a major challenge. Effective management of this acute postoperative pain is critical for enhancing recovery. The study investigates the effectiveness of memantine in reducing postoperative pain in patients undergoing TKA. METHODS: This double-blind, randomized controlled trial aimed to evaluate the efficacy of memantine for managing postoperative pain after TKA. Conducted from April to September 2022, eligible participants over 18 years with ASA grades I or II were recruited. Exclusions included patients with substance abuse histories, chronic opioid use, significant comorbidities, or contraindications to memantine. Participants were randomly assigned to receive either memantine (20 mg daily preoperatively for three days and 10 mg daily postoperatively for two weeks) or a placebo. Both groups received standard analgesics during hospitalization and upon discharge. Pain levels were assessed using Visual Analog Scale (VAS) scores and Short-Form McGill Pain Questionnaire (SF-MPQ) at various time points. Secondary outcomes measured included opioid usage and nocturnal awakening. RESULTS: Memantine did not significantly lower pain levels compared to placebo, as measured by VAS (mean difference: 0.138, CI 95%: - 0.468-1.103, P = 0.418) and SF-MPQ (mean difference: 1.962, CI 95%: - 1.013-4.936, P = 0.190). Patients receiving memantine needed opioid analgesia (2.85 ± 0.67 times) significantly (P < 0.001) less frequently than the Placebo patients (4.14 ± 1.06 times). Nocturnal awakening did not differ significantly between the two groups (Memantine: 3.59 ± 2.15, Placebo: 2.33 ± 2.12, P = 0.067). CONCLUSION: The comparison of pain levels between oral memantine and placebo indicates that memantine does not significantly reduce pain in patients undergoing TKA. However, it significantly lowers the need for opioids postoperatively.
10 Apr 2026
Read appraisal →European respiratory review : an official journal of the European Respiratory Society
Prevalence of respiratory viruses in stable and acute asthma: a systematic review and meta-analysis
BACKGROUND: Respiratory viruses, frequently detected in asthma, are associated with worse outcomes. This meta-analysis systematically quantifies the prevalence of respiratory viruses in stable and acute asthma, across children and adults, and explores factors associated with increased viral burden through meta-regression. METHODS: This prospectively registered meta-analysis (PROSPERO-CRD42023375108) included studies employing molecular techniques to assess respiratory virus prevalence in asthma. Three databases were searched in August 2024. Risk of bias and certainty of evidence were assessed. We performed random-effects meta-analysis of proportions. RESULTS: We included 111 eligible studies. Moderate-certainty evidence indicated a pooled prevalence of any respiratory virus of 33.9% (95% confidence interval 24.8-43.7%) in children and 23.0% (12.9-35.0%) in adults with stable asthma. In acute asthma, prevalence increased to 58.8% (52.5-65.0%) in children and 49.9% (41.2-58.5%) in adults (moderate certainty). Rhinovirus was the most frequently identified virus, especially in acute asthma (45.0% in children versus 21.2% in adults). Respiratory syncytial virus and bocavirus were more common in younger children, while coronavirus and influenza were more frequently detected in adults; respiratory syncytial virus peaked in older adults too. A higher prevalence of influenza virus B and adenovirus in children, and of influenza virus A and parainfluenza 2 in adults with severe versus non-severe acute asthma suggests a potential association with more severe acute attacks. CONCLUSION: Respiratory viruses are common in both stable and acute asthma. This suggests that the diagnostic value of a positive viral test during acute episodes may be limited and could benefit from complementary biomarkers to improve interpretation.
10 Apr 2026
Read appraisal →The New England journal of medicine
Multifaceted Strategies for Hypertension Control in Low-Income Patients
BACKGROUND: Uncontrolled hypertension disproportionately affects populations that have substantial health disparities. Data regarding the effectiveness and implementation of multifaceted, team-based strategies for hypertension control among low-income patients are lacking. METHODS: We randomly assigned federally qualified health center clinics in Louisiana and Mississippi to use either a multifaceted implementation strategy (intervention group) or enhanced usual care (control group) for hypertension control. The intervention included team-based care, protocol-based intensive blood-pressure management, blood-pressure audit and feedback, health coaching on lifestyle changes and medication adherence, and home blood-pressure monitoring. Enhanced usual care involved educating physicians about clinical guidelines for hypertension. The primary effectiveness outcome was the mean change in systolic blood pressure from baseline to 18 months. The primary implementation outcome was the adherence summary score (on a scale of 0 to 4, with higher scores indicating better adherence to blood-pressure management). RESULTS: A total of 36 clinics underwent randomization. Among these clinics, we enrolled 1272 patients with uncontrolled hypertension who were 40 years of age or older; 642 were in the intervention group and 630 were in the control group. The mean age of the patients was 58.8 years, 56.7% were women, 63.4% were Black, 75.9% were unemployed, and 73.4% had a family income of less than $25,000 per year. At 18 months, the mean change from baseline in the systolic blood pressure was -15.5 mm Hg (95% confidence interval [CI], -17.4 to -13.6) in the intervention group and -9.1 mm Hg (95% CI, -11.0 to -7.2) in the control group (between-group difference, -6.4 mm Hg; 95% CI, -9.0 to -3.8; P<0.001). The mean adherence summary score over the 18-month follow-up period was 2.8 (95% CI, 2.7 to 2.9) in the intervention group and 2.1 (95% CI, 2.0 to 2.2) in the control group (between-group difference, 0.7 points; 95% CI, 0.6 to 0.8; P<0.001). Serious adverse events occurred in 20.9% of the patients in the intervention group and in 21.7% of those in the control group. CONCLUSIONS: Among low-income patients with hypertension, a multifaceted, team-based implementation strategy resulted in a significantly greater reduction in systolic blood pressure than enhanced usual care. (Funded by the National Heart, Lung, and Blood Institute and others; IMPACTS-BP ClinicalTrials.gov number, NCT03483662.).
9 Apr 2026
Read appraisal →Cell metabolism
Blood-flow restriction resistance training improves skeletal muscle mitochondrial capacity and cardiovascular risk factors in type 2 diabetes.
Impaired muscle strength and mitochondrial functionality are hallmarks of type 2 diabetes (T2D). Conventional combined resistance/endurance exercise training has limited efficacy to simultaneously improve muscle function and metabolism. We examined whether low-load blood-flow restriction training (BFRT) increases both muscle strength and mitochondrial oxidative capacity in T2D. Over 12 weeks, BFRT and conventional resistance training (CREST) similarly improved muscle strength despite lower workload in BFRT. Uniquely, BFRT enhanced muscle and adipose tissue oxidative capacity and increased muscle mitochondrial content. Transcriptomic profiling revealed more pronounced changes, particularly in angiogenesis-linked pathways, upon BFRT. BFRT also preferentially led to reductions in visceral adipose tissue volume and waist circumference, whereas CREST more effectively decreased subcutaneous adipose tissue volume. Both interventions lowered resting heart rate and diastolic blood pressure. These findings position BFRT as a promising low-load exercising strategy to simultaneously improve mitochondrial oxidative capacity, muscle strength, and body composition in individuals with T2D.
9 Apr 2026
Read appraisal →JMIR mHealth and uHealth
Promoting Self-Regulated Social Media Use on Smartphones With a Mobile Intervention App (Wellspent): Randomized Controlled Trial
BACKGROUND: Problematic social media use has been linked to reduced well-being and impulse control difficulties. While digital self-control apps show potential for reducing general app usage, they often lack customization, leading to limited effectiveness and increased user resistance. Their impact on problematic social media use remains uncertain. OBJECTIVE: This study evaluates the effectiveness of the Wellspent app, a customizable mobile intervention app designed to promote self-regulated social media use by targeting user-defined problematic app use and offering tailored behavioral nudges. METHODS: In a 3-week randomized controlled trial, 70 iPhone users (mean age 26.2, SD 5.6 years; 47/70, 67% female), regularly using at least 1 social media app, were randomly assigned to an intervention (n=35) or control group (n=35). The intervention group received personalized full-screen reminders with the option to quit or continue social media app use whenever an app session exceeded a self-defined time limit. Participants completed weekly online surveys measuring problematic social media use, problematic smartphone use, self-efficacy, and daily screen time on their most problematic app. Linear mixed models tested intervention effects. RESULTS: While no significant reduction in problematic social media use or increase in self-efficacy was observed, the intervention group showed a significant reduction in daily screen time on their most problematic app by approximately 29 minutes (estimate=-29.35, SE 6.84, 95% CI -42.79 to -15.99; P<.001), and a significant decrease in perceived problematic smartphone use (estimate=-0.46, SE 0.18, 95% CI -0.80 to -0.11; P=.01). CONCLUSIONS: The Wellspent app demonstrated short-term efficacy in reducing problematic smartphone use. By allowing users to tailor interventions to their personal goals, the app shows promise as a self-directed tool to support healthier digital habits. Further research should explore long-term effects and feature-specific impacts.
9 Apr 2026
Read appraisal →The New England journal of medicine
Immunogenicity and Safety of vYF, a Yellow Fever Vaccine - A Phase 2 Trial
BACKGROUND: A next-generation, live-attenuated yellow fever vaccine, vYF, was developed in Vero cells to improve vaccine supply and availability. The safety of and immune response to vYF as compared with those of the licensed yellow fever vaccine, YF-VAX, are unclear. METHODS: In this year 1 interim analysis of a phase 2, observer-blinded, randomized, active-controlled trial, we randomly assigned healthy adults 18 to 60 years of age in a 2:1 ratio to receive vYF or YF-VAX as a single vaccine injection on day 1. Neutralizing antibody titers were measured on day 29, month 6, and year 1. The primary analysis focused on the per-protocol population, which included participants with no history of yellow fever infection or vaccination and with no protocol deviations. Noninferiority would be shown if the lower limit of the two-sided 95% confidence interval of the between-group difference in the percentage of participants with seroconversion was greater than -5 percentage points on day 29. RESULTS: A total of 568 participants were enrolled: 382 in the vYF group and 186 in the YF-VAX group; 329 and 156 participants, respectively, were included in the per-protocol population for the noninferiority analysis. Seroconversion by day 29 occurred in 99.7% of participants receiving vYF and 99.4% of those receiving YF-VAX (difference, 0.3 percentage points; 95% confidence interval, -1.2 to 3.2, which met the criterion for noninferiority). Neutralizing antibody geometric mean titers were similar in the two vaccine groups, peaking on day 29 (in the vYF group, 1:2654 among participants with no history of yellow fever infection or vaccination and 1:1312 among participants with a history of yellow fever infection or vaccination; in the YF-VAX group, 1:3147 and 1:1079, respectively), then decreasing through 1 year after vaccination (in the vYF group, 1:401 among participants with no history of yellow fever infection or vaccination and 1:490 among participants with a history of yellow fever infection or vaccination; in the YF-VAX group, 1:548 and 1:646, respectively). No major safety concerns were identified. The safety profiles were similar in the two vaccine groups: solicited adverse events were reported by 208 of 367 participants (56.7%) in the vYF group and 113 of 185 participants (61.1%) in the YF-VAX group, and unsolicited adverse events were reported by 99 of 379 participants (26.1%) and 39 of 186 participants (21.0%), respectively. CONCLUSIONS: In this trial, vYF had immunogenicity and safety profiles similar to those of YF-VAX. (Funded by Sanofi; ClinicalTrials.gov number, NCT04942210.).
9 Apr 2026
Read appraisal →Sexual health
E-screening for sexually transmissible infections and blood-borne viruses in New South Wales, Australia: a cost analysis.
BACKGROUND: MyCheck is an e-testing pathway, first implemented at Sydney Sexual Health Centre, which enhances access to STI/HIV testing via telehealth and off-site sample collection; thus, reducing clinic visits. This study evaluates MyCheck's direct and indirect costs versus standard in-person screening (Xpress). METHODS: A 12-month bottom-up cost analysis from a societal perspective compared MyCheck and Xpress. Direct medical (health system), direct non-medical (patient travel) and indirect non-medical (productivity) costs were calculated using retrospective Sydney Sexual Health Centre data. Costs included pathology, staff time, overheads, consumables, patient travel and forgone productivity. Statewide scale-up costs were estimated, with sensitivity analyses adjusting for inflation, minimum wage and an increase in the proportion of MyCheck users with productivity loss. RESULTS: From January to July 2023, Sydney Sexual Health Centre conducted 2548 screening episodes (45% MyCheck, 55% Xpress), with MyCheck attracting more men who have sex with men/transgender and gender diverse patients. MyCheck's shorter appointments (median 5 min vs Xpress's 15 min) led to lower staff costs (A$5 vs A$16). MyCheck had higher overall health system cost (A$127/patient) compared with Xpress (A$91/patient), mostly due to pathology costs. However, considering patient travel cost and productivity loss for Xpress, MyCheck's societal cost (A$137) was lower than Xpress (A$146), yielding A$104,260 annual savings. Statewide scale-up provides significant societal savings (A$419,077/year). CONCLUSION: This analysis of MyCheck's direct and indirect costs compared with traditional in-person screening demonstrates significant societal savings, despite higher direct pathology costs. It underscores the importance of a broader societal perspective in cost analyses. Lowering private pathology costs could further enhance MyCheck's cost-effectiveness. MyCheck, an innovative e-screening pathway, reduces barriers for STI/blood-borne virus screening by improving patient convenience and reduced opportunity costs. Despite higher direct pathology costs, its societal cost savings support statewide scale-up for improved screening accessibility.
9 Apr 2026
Read appraisal →PloS one
The Relationships between physical activity, sedentary behaviour, sleep, and dementia: A systematic review and meta-analysis of cohort studies
OBJECTIVE: This study aimed to summarize the observational evidence from prospective cohort studies examining the associations of regular physical activity, sedentary behaviour, and sleep duration with incident dementia among community-dwelling adults aged 35 years and older. METHODS: Systematic literature searches (1946 to August 2025) of CINAHL, EMBASE, MEDLINE, PSYCINFO, and SPORTDISCUS were performed. Eligible studies included community-dwelling adults aged 35 + years with at least one year of follow-up and valid measures of movement behaviours and dementia outcomes. Studies were excluded if they included participants with baseline dementia, lacked risk estimates for all-cause dementia. Grey literature was excluded. Random effects meta-analysis generated pooled risk ratio (RR) and 95% confidence intervals (CI). Primary exposures were defined using national thresholds for physical activity, sedentary time, and sleep duration. Subgroup analyses were performed by age and follow-up duration. RESULTS: Forty-nine studies with physical activity (n = 2,855,529), 17 studies on sleep duration (n = 1,344,170), and three studies on sedentary duration (n = 295,809) were included. Regular physical activity significantly reduced the risk of incident dementia (pooled RR = 0.75, 95% CI = 0.68 to 0.82), though heterogeneity was substantial and partially explained by subgroup analyses. Prolonged sedentary behaviour (8 + hours/day sitting) increased dementia risk (RR = 1.27, 95% CI = 1.17 to 1.39) with low heterogeneity. Moreover, both short (<7 hours; RR = 1.18, 95% CI = 1.09 to 1.28) and long (>8 hours; RR = 1.28, 95% CI = 1.15 to 1.43) sleep were linked to higher dementia risk compared with 7-8 hours. Heterogeneity was moderate to substantial. CONCLUSION: Regular physical activity, less sedentary time and appropriate nightly sleep (7-8 h) may be associated with reduced risk of dementia and are potentially modifiable factors in the prevention or delay of dementia. Future studies with middle-aged adults and longer-term follow-up including changes in movement behaviours over time are needed to better understand the relationship between physical activity, sedentary behaviour, and sleep for dementia risk. PROSPERO REGISTRATION: CRD42021272054.
9 Apr 2026
Read appraisal →PloS one
Dizziness in the emergency department and risk of stroke: A systematic review and meta-analysis
BACKGROUND: Dizziness is a frequent emergency department (ED) presentation, and a subset of patients, especially those with isolated dizziness without focal neurological deficits, have stroke but are prone to misdiagnosis and adverse outcomes. Reported stroke prevalence in ED dizziness cohorts is highly heterogeneous, and comprehensive assessments of isolated dizziness remain limited. METHODS: Following PRISMA guidelines, we systematically searched PubMed, Web of Science, Embase, and the Cochrane Library for relevant studies. We included cross-sectional studies reporting stroke prevalence among all ED patients with dizziness or isolated dizziness. A random-effects model was used for meta-analysis to calculate pooled prevalence. Subgroup analyses and Egger's test were employed to explore heterogeneity and publication bias. The diagnostic accuracy of bedside diagnostic tools was also systematically reviewed. RESULTS: Twenty-nine studies involving 161,013 ED patients presenting with dizziness were included. The pooled stroke prevalence among all ED dizziness patients (n = 158,583) was 5.5% (95% CI: 4.1-7.1). Among patients with isolated dizziness (n = 2,559), the pooled prevalence was 13.9% (95% CI: 8.2-20.9), substantially higher than in the overall dizziness cohort. Subgroup analyses indicated diagnostic methods and hospital level as major contributors to heterogeneity. Summary analysis of bedside diagnostic tools showed that HINTS and STANDING examinations have high diagnostic accuracy overall, while the TriAGe+ score can be applied flexibly for screening or confirmation based on different cut-off points. CONCLUSIONS: ED patients with dizziness carry a meaningful, setting-dependent stroke risk. Standardized bedside exams (HINTS, STANDING) improve early triage, and selectively deploying neuroimaging helps prevent missed strokes when risk is high.
9 Apr 2026
Read appraisal →The New England journal of medicine
Intensive LDL Cholesterol Targeting in Atherosclerotic Cardiovascular Disease
BACKGROUND: Despite guideline recommendations, evidence from randomized trials evaluating the appropriate low-density lipoprotein (LDL) cholesterol target for secondary prevention in patients with atherosclerotic cardiovascular disease remains limited. METHODS: In this open-label superiority trial conducted in South Korea, we randomly assigned patients with atherosclerotic cardiovascular disease in a 1:1 ratio to a target LDL cholesterol level of less than 55 mg per deciliter (1.4 mmol per liter) (intensive-targeting group) or less than 70 mg per deciliter (1.8 mmol per liter) (conventional-targeting group). The primary end point was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, any revascularization, or hospitalization for unstable angina at 3 years. Safety was also assessed. RESULTS: Of 3048 patients who underwent randomization, 1526 were assigned to the intensive-targeting group and 1522 to the conventional-targeting group. The median follow-up was 3.0 years. The median LDL cholesterol level during the trial was 56 mg per deciliter (1.4 mmol per liter) in the intensive-targeting group and 66 mg per deciliter (1.7 mmol per liter) in the conventional-targeting group. A primary end-point event occurred in 100 patients (Kaplan-Meier estimate of cumulative incidence, 6.6%) in the intensive-targeting group and in 147 patients (Kaplan-Meier estimate of cumulative incidence, 9.7%) in the conventional-targeting group (hazard ratio, 0.67; 95% confidence interval, 0.52 to 0.86; P = 0.002). The incidence of prespecified safety end points was similar in the two trial groups, except for a lower incidence of creatinine elevation in the intensive-targeting group. CONCLUSIONS: Among patients with atherosclerotic cardiovascular disease, targeting an LDL cholesterol level of less than 55 mg per deciliter resulted in a lower risk of cardiovascular events at 3 years than targeting a level of less than 70 mg per deciliter. (Funded by the Cardiovascular Research Center and Yuhan; Ez-PAVE ClinicalTrials.gov number, NCT04626973.).
9 Apr 2026
Read appraisal →JMIR cancer
Acceptance, Perceived Usefulness, and Data Sharing in Mobile Health Apps Among Patients With Breast Cancer: Cross-Sectional Survey Study
BACKGROUND: Mobile health (mHealth) apps promise to enhance patient empowerment, enable real-time health monitoring, and support self-management. Patients with breast cancer stand to benefit particularly from these capabilities, given the demanding pre- and posttreatment procedures they face. However, the effective adoption of these tools is challenged by issues including accessibility, usability limitations, and privacy concerns. OBJECTIVE: This study aimed to investigate the current usage behavior and attitudes toward mHealth apps among patients with breast cancer in Germany, focusing on acceptance, usefulness, empowerment, and data-sharing. Specifically, we aimed to identify the incentives and barriers influencing use and the intention to use mHealth apps at the time of this writing to guide their further implementation and use. METHODS: A cross-sectional online survey was conducted between November 2023 and June 2024 using a structured questionnaire developed in German. Participants with a self-reported breast cancer diagnosis were recruited via university hospital channels, patient associations, and social media. Topics included technology and health app usage, perceived usefulness, personal empowerment, and attitudes toward data sharing. The survey comprised both closed- and open-ended questions to capture quantitative patterns and qualitative insights into participants' experiences and perspectives. RESULTS: We collected responses from 90 participants with breast cancer. Participants demonstrated high engagement with digital technology; 97% (87/90) reported daily smartphone use, and 70% (63/90) owned a smartwatch or fitness tracker. Approximately 67% (60/90) of respondents had used health apps in the past year, with many relying on general fitness and lifestyle apps to support their health management. Most participants (62/90, 69%) indicated that health apps contribute to a better understanding of their personal health. Health apps were generally perceived as useful, with users highlighting their ability to provide continuous support and timely, reliable health information (n=31). This, in turn, was seen as instrumental in promoting self-management and empowerment. Respondents also showed a conditional willingness to share personal health data for research, particularly when clear benefits for treatment advancements were evident (n=82). Nonetheless, concerns were raised regarding data privacy, app usability, the need for multiple apps to cover all necessary features, and the potential increase in fear of illness (cyberchondria). CONCLUSIONS: The findings underscore the potential of mHealth apps to empower patients with breast cancer by improving health literacy and supporting self-management. To maximize their impact, future digital health tools must align closely with patient needs by incorporating adaptive, interactive features and integrating seamlessly with clinical care. Addressing key barriers-particularly data privacy and usability issues-is essential for broader adoption. Longitudinal studies are warranted to evaluate the long-term effects of health app usage on patient empowerment, quality of life, and clinical outcomes.
9 Apr 2026
Read appraisal →Physiological measurement
Continuous blood pressure monitoring via hemodynamic parameter and pulse transit time derived from capacitive sensing pads
Objective.Continuous blood pressure (BP) monitoring is crucial for detecting nocturnal hypertension and acute hemodynamic changes. Conventional cuff-based methods disrupt sleep and miss transient BP fluctuations from sleep-related events or instability. Cuffless methods, such as pulse transit time (PTT), offer potential but often struggle to reliably track acute BP fluctuations due to complex and nonlinear hemodynamics.Approach.We developed a capacitive sensing pad system incorporating PTT with additional hemodynamic features for unobtrusive, continuous BP monitoring in supine subjects. The pad contains ultra-sensitive single-electrode capacitive (SEC) sensors made from carbon nanotube composites. In passive contact, SEC sensor on the back of the chest captures intrathoracic blood volume changes through deep tissue permittivity and ballistocardiography, while another under the leg detects arterial pulse-induced tissue vibrations. PTT is derived from the temporal delay between chest and leg signals. A neural network model incorporates PTT and intrathoracic blood volume features to improve BP estimation.Main results.In human trials (N= 30) with arm-cuff reference, the system showed strong correlation (r⩾ 0.94), with a mean error (ME) ⩽ 0.1 mmHg and standard deviation (SD) ⩽ 5.6 mmHg. In a subset (N= 8) with continuous finger-cuff reference, it maintained strong correlation (r⩾ 0.89), with a ME ⩽ 0.2 mmHg and SD ⩽ 7.8 mmHg.Significance.These results suggest the possibility of bed-based unobtrusive and continuous BP monitoring in the supine position.
9 Apr 2026
Read appraisal →Brain : a journal of neurology
Leveraging machine learning to predict Parkinson's disease using pre-symptomatic proteomics data
In Parkinson's disease, non-motor symptoms precede the characteristic motor manifestations by up to 20 years. However, predicting the disease risk remains challenging. We applied machine learning to 2937 plasma proteins assayed in UK Biobank participants with Parkinson's disease to predict disease outcome up to 14 years before diagnosis. Of the 446 proteins found to be dysregulated in incident cases compared with controls, a subset of 23 predicted disease with an area under the curve (AUC) value of 0.78 in incident and 0.795 in prevalent cases. The utility of the identified proteomic signatures was validated in an independent cohort, based on 16 proteins shared across datasets, leading to a validation AUC of up to 0.76. Parkinson's disease-related pathways, including neuron death and amyloid-β clearance, were enriched up to 9 years before diagnosis. Furthermore, a co-expression network analysis revealed protein modules associated with disease risk and time-to-diagnosis. Our findings underscore the potential of applying machine learning to large-scale proteomics data from pre-symptomatic patients for early disease prediction.
9 Apr 2026
Read appraisal →European journal of psychotraumatology
Emotion regulation skills training as an adjunctive treatment to narrative exposure therapy for posttraumatic stress disorder (PTSD) in refugees: a pilot randomized controlled trial
Background: Responses to evidence-based interventions for posttraumatic stress disorder (PTSD) in refugees vary considerably. Emotion regulation difficulties are associated with greater PTSD severity in refugees and thus represent a potential treatment target.Objective: This study aimed to test the efficacy of Skills Training in Affective and Interpersonal Regulation for Refugees (STAIR-R) and Narrative Exposure Therapy (NET) or Supportive Problem-Solving (SPS) and NET. An exploratory aim was to examine relative efficacy in refugees with high and low levels of visa and family insecurity.Methods: Seventy-one participants were randomly assigned to STAIR-R (6 sessions) + NET (7 sessions) or SPS (6 sessions) +NET (7 sessions). Assessments occurred at baseline, post-treatment, and 3-month follow-up, with additional self-report at mid-treatment. The primary outcome was clinician-assessed PTSD symptom severity (CAPS-5) and secondary outcomes included self-reported PTSD symptoms, depression symptoms, emotion regulation difficulties, difficulties in relationships and environmental quality of life.Results: Intent-to-treat linear mixed models showed no significant between-group differences at mid-treatment, post-treatment, or follow-up. Both groups demonstrated significant improvements at 3-month follow-up in clinician-assessed (STAIR-R + NET, g = -1.41; SPS + NET, g = -1.54, p < .001) and self-reported (STAIR-R + NET, g = -0.49; SPS + NET, g = -0.44, p = .006) PTSD symptoms. Moderatorg analyses revealed that those with high insecurity (n = 16) obtained greater benefits in STAIR-R + NET from pre-treatment to follow-up on self-reported PTSD (g = 1.35), depression (g = 1.11), emotion regulation difficulties (g = 1.24), relationship difficulties (g = 1.12) and quality of life (g = -1.05).Conclusions: While there were no overall between group-differences, refugees in both conditions showed reduced PTSD symptoms. There is preliminary evidence that those with high insecurity showed a better response to STAIR-R + NET than SPS + NET across several clinical outcomes, although the small sample size necessitates replication of these. These findings highlight the potential importance of tailored intervention approaches for refugees living in different environmental circumstances. Emotion regulation difficulties represent a promising treatment target for refugees with PTSD.A randomized controlled trial comparing Skills Training in Affective and Interpersonal Regulation for Refugees + Narrative Exposure Therapy (STAIR-R + NET) to Supportive Problem Solving Training + Narrative Exposure Therapy (SPS + NET) revealed no significant differences at 3-month follow-up, with both groups improving on PTSD symptoms.Moderator analyses provided preliminary evidence that refugees living with high insecurity (i.e. insecure visa or separated from all family) showed greater improvements following STAIR-R + NET than SPS + NET.
9 Apr 2026
Read appraisal →European journal of psychotraumatology
Phase-based versus non-phase-based psychological interventions for complex PTSD: a systematic review and meta-analysis
Background: Since complex post-traumatic stress disorder (CPTSD) was incorporated to the International Classification of Diseases-11th revision (ICD-11), the construct has drawn increasing attention in clinical research due to its debilitating effects across multiple domains of functioning. However, whether stabilization (Phase 1) is necessary before exposure to traumatic memories (Phase 2) remains controversial.Objective: We examined whether phase-based interventions are more effective than non-phase-based interventions in reducing symptoms of CPTSD.Methods: On 17 June 2025, we searched the Cochrane Library, Embase, Medline, PTSDpubs, Scopus, and Web of Science as well as South Korean databases, including the Korean Citation Index, the Research Information Sharing Service, DataBase Periodical Information Academic (DBPia), and ScienceON. Randomized controlled trials of psychological interventions for individuals with clinically significant CPTSD symptoms or PTSD with at least two of the 'disturbances in self-organization' (DSO) symptom clusters were eligible. We used Hedges' g to pool effect sizes and performed subgroup analyses using Cochran's Q test. We assessed risk of bias using the Cochrane Risk-of-Bias Assessment 2 tool.Results: Across most outcomes, we observed no significant differences between phase- and non-phase-based interventions, between multi-phase and single-phase interventions, or between exposure and non-exposure interventions. However, multi-phase interventions had superior effects on PTSD, while phase-based, multi-phase, and exposure interventions showed greater improvements in DSO - affect regulation compared to their counterparts.Conclusions: This study was limited by the small number of available trials, single time-point, and heterogeneity in outcome measures, which constrained both the detection of subgroup differences and the precision of effect size estimates. Our findings provide empirical evidence for the current discourse, suggesting that non-phase-based and non-exposure-based interventions can be as effective as structured approaches in many contexts, while some outcomes may still benefit from phase-, multi-modular-, or exposure-based designs. This systematic review examined whether interventions that include a first phase of stabilization followed by a second phase of exposure to traumatic memories are more effective than other interventions.Across most outcomes, there were no clear differences between phase- and non-phase-based interventions, or between exposure and non-exposure interventions.For post-traumatic stress symptoms, interventions with more than one phase were more effective than those with a single-phase treatment. For difficulties with emotion regulation, multi-phase interventions that included stabilization before exposure showed greater benefits.
9 Apr 2026
Read appraisal →BMJ open
A double-blind, crossover, non-inferiority randomised controlled trial where primary care providers and patients compare human-generated and AI-generated digital health messages: the AI-CARE study protocol
INTRODUCTION: Primary care is facing multiple crises, including an increase in health misinformation. Digital health messaging by primary care providers has been shown to reach a diverse patient population. With the uptake of Generative Artificial Intelligence (GenAI) usage in healthcare, there is an important opportunity to rapidly create messages that are tailored to different populations and conditions. However, thoroughly assessing artificial intelligence (AI)-generated content is essential, as GenAI raises concerns regarding its accuracy, understandability, actionability and bias perpetuation. We aim to investigate whether digital health messages created by GenAI are evaluated as non-inferior compared with those created by human experts. METHODS AND ANALYSIS: The AI-CARE (AI to Create Accessible and Reliable patient Education materials) study is a double-blind, crossover, non-inferiority randomised controlled trial. Data collection began on 30 May 2025, and is expected to be completed at the end of May 2026. Over 12 months, 192 messages on 48 topics will be written: half by primary care and public health experts and half by a GenAI tool (OpenAI's ChatGPT). Review Panels composed of 24 primary care providers and 24 patients will evaluate these messages using an Evaluation Grid developed to assess the messages' quality of information, adaptation to the target audience, relevance and usefulness, and readiness to be shared with patients. Evaluations will be completed via online REDCap (Research Electronic Data Capture) surveys and the order in which the 192 messages appear will be randomised and will vary between individuals. Participants and analysts will be blinded to the generation source. The primary outcome will be the Clarity and Understandability score. ETHICS AND DISSEMINATION: The Research Ethics Boards of the Hôpital Montfort (24-25-11-038) and the University of Ottawa (S-12-24-11153) formally approved this study in December 2024. Reported data will be grouped and anonymised for dissemination in peer-reviewed scientific journals and conferences. TRIAL REGISTRATION NUMBER: NCT06997107.
9 Apr 2026
Read appraisal →JMIR mHealth and uHealth
Effectiveness of a Telecare-Based Intervention Program in Supporting Informal Caregivers of Community-Dwelling Older Adults in Reducing Stress Levels: Randomized Controlled Trial
BACKGROUND: Informal caregivers are essential in supporting community-dwelling older adults, especially as global populations age. However, caregiving responsibilities often result in high stress, depressive symptoms, and diminished quality of life. Traditional support services are fragmented, and many programs overlook caregivers' emotional and informational needs. Telecare-the remote delivery of health and social care via digital technologies-offers a promising approach to provide accessible, personalized, and timely support. OBJECTIVE: This study evaluated the effectiveness of a telecare-based intervention program, developed by a health-social partnership team, in improving psychological well-being and caregiving outcomes among informal caregivers of community-dwelling older adults. We hypothesized that caregivers in the intervention group would show greater improvements in stress, self-efficacy, depression, quality of life, and caregiving burden compared to those receiving usual care. METHODS: A single-blind randomized controlled trial was conducted from January to December 2023, with 75 informal caregivers providing care to older adults (aged ≥60 y) for at least 4 hours per week. Participants were randomized to an intervention group (n=38, 51%) or a control group (n=37, 49%). The 3-month intervention included (1) biweekly online nurse case management supported by a multidisciplinary health-social team, (2) personalized WhatsApp videos on caregiving skills, and (3) a password-protected caregiver website offering resources and peer discussion. The control group attended 6 in-person educational sessions at a community center. Outcomes such as stress, self-efficacy, depression, quality of life, and caregiving burden were measured at baseline and postintervention. RESULTS: Participants had a mean age of 65.5 (SD 9.617) years, and 81.3% (61/74) were female. Baseline characteristics were similar between groups. Compared to controls, the intervention group showed significantly higher self-efficacy (t=1.98; P=.04) and lower depression (t=-2.24; P=.03) at follow-up. Within-group improvements in the intervention group were also observed for stress, depression, self-efficacy, mental quality of life, and caregiving burden. No significant between-group differences were found for stress, quality of life, or caregiving burden. No significant within-group improvements were observed in the control group. CONCLUSIONS: This study provides novel evidence that a digitally delivered, nurse-led telecare program-integrating health and social services-can improve psychological outcomes among informal caregivers. These findings have practical implications for health systems seeking scalable, low-barrier solutions to support caregivers. Telecare models may be a valuable complement to traditional services, enhancing caregiver resilience and promoting aging in place while alleviating long-term strain on institutional care systems.
9 Apr 2026
Read appraisal →Blood pressure
Effects of whole-body vibration training on resting blood pressure in adults: a systematic review and meta-analysis of randomised controlled trials
OBJECTIVE: To investigate the effect of whole‑body vibration training (WBVT) on resting blood pressure (BP) in adults and its moderating factors through a meta‑analysis. METHODS: PubMed, Cochrane Library, Embase, and Web of Science were systematically searched up to 2 December 2025, with systolic BP (SBP) and diastolic BP (DBP) as the primary outcomes. Using Stata 17.0 software, effect sizes were pooled with a random‑effects model, and results were reported as weighted mean differences (WMDs) with 95% confidence intervals. RESULTS: This meta-analysis included 14 randomised controlled trials (RCTs) involving 490 adult participants. WBVT significantly reduced SBP (WMD = -6.57 mmHg, 95% CI [-8.84, -4.29]; p < 0.01) and DBP (WMD = -3.01 mmHg, 95% CI [-4.32, -1.71]; p < 0.01) in adults. Subgroup analyses showed greater BP reduction in individuals with higher baseline BP (SBP: -11.34 mmHg [95% CI: -13.45, -9.23]; p < 0.01; DBP: -6.15 mmHg [95% CI: -7.46, -4.83]; p < 0.01) and in those who were overweight or obese (SBP: -8.99 mmHg [95% CI: -11.18, -6.80]; p < 0.01; DBP: -3.98 mmHg [95% CI: -5.17, -2.78]; p < 0.01). Interventions using combined movement patterns also yielded more pronounced effects (SBP: -7.12 mmHg [95% CI: -9.73, -4.51]; p < 0.01; DBP: -3.30 mmHg [95% CI: -5.61, -0.79]; p < 0.01). CONCLUSION: WBVT significantly reduced resting BP in adults, particularly effective in those with higher baseline BP, overweight/obese, or using combined exercise protocols, but further high-quality RCTs are needed. This meta-analysis demonstrates that WBVT significantly reduces resting BP in adults, with an average reduction of 6.57 mmHg in SBP and 3.01 mmHg in DBP. Subgroup antihypertensialyses further revealed that the anve effect was more pronounced in individuals with elevated baseline BP (SBP ≥130 mmHg or DBP ≥80 mmHg) and in those who were overweight or obese (BMI ≥25 kg/m2). Additionally, training protocols incorporating compound movements, such as squats combined with heel raises, were superior to those using simple standing postures. These findings hold clear clinical significance. The magnitude of BP reduction achieved by WBVT, particularly the approximate 6.57 mmHg decrease in SBP, is expected to translate into a significant reduction in cardiovascular risk. Prior evidence indicates that for every 5 mmHg reduction in SBP, the risk of major cardiovascular events decreases by approximately 10%. Therefore, WBVT provides an effective, safe, and promising non-pharmacological adjunctive management strategy for adults, especially for higher-risk groups (e.g. individuals with hypertension or those who are overweight/obese) and for those who have difficulty engaging in traditional exercise.
9 Apr 2026
Read appraisal →Journal of the American Heart Association
Patient Care Pathways and Outcomes Following Newly Diagnosed Atrial Fibrillation
BACKGROUND: Care pathways for patients with atrial fibrillation (AF) are poorly understood and may influence the likelihood of guideline concordant oral anticoagulation or antiarrhythmic drug therapy and associated outcomes. METHODS: Adult patients in the Optum Clinformatics Database (2015-2023) with incident AF were identified. Care pathways, by treating clinician specialty (primary care, cardiology, electrophysiology) during each AF-related visit in the 1 year post diagnosis were examined. Cox regression models were used to assess associations between an electrophysiologist visit and AF-related treatments including antiarrhythmic drug therapy and oral anticoagulation and outcomes including AF-related hospitalizations, heart failure hospitalizations, and stroke. RESULTS: Of the 37 370 patients included, 7700 (20.6%) had a care pathway including an electrophysiologist visit. Older patients (70-79 and 80+ versus 18-49 years: hazard ratio [HR], 0.71 [95% CI, 0.64-0.78] and HR, 0.57 [95% CI, 0.51-0.63], respectively) and those with a higher CHA2DS2-VASc score (2-3 and ≥4 versus 0-1: HR, 0.79 [95% CI, 0.74-0.85] and HR, 0.76 [95% CI, 0.68-0.84], respectively) were less likely to have an electrophysiologist visit. Electrophysiologist visits were associated with a significant increase in rates of treatment with antiarrhythmic drug and oral anticoagulation. Patients aged ≥80 years with an electrophysiologist visit had significantly lower risks of stroke compared with those without an electrophysiologist visit (HR, 0.63 [95% CI, 0.42-0.95]). CONCLUSIONS: Certain demographic groups including older patients had lesser likelihood of electrophysiologist consultation, but guideline concordant care was more likely associated with electrophysiology care pathways. Electrophysiology care pathways were associated with improved outcomes especially among the groups with greatest stroke risk.
8 Apr 2026
Read appraisal →JBJS reviews
Treatment Outcomes for Distal Radius Fractures: A Meta-Analysis
BACKGROUND: Distal radius fractures (DRFs) are among the most prevalent in upper-extremity injuries, particularly in older adults and individuals with osteoporosis. The common treatment options include surgical interventions such as volar locking plate (VLP) fixation and percutaneous pinning, as well as conservative strategies like splinting and bracing. However, the comparative effectiveness of these modalities remains unclear. This study aims to compare the functional outcomes and complication rates associated with VLP, percutaneous pinning, bracing, and splinting in the treatment of DRFs. METHODS: A systematic search of PubMed, Google Scholar, and the Cochrane Library (September 2001-February 2025) identified randomized controlled trials, prospective cohort studies, and retrospective cohort studies comparing DRF treatments. Functional outcomes and complication rates (superficial infection, malunion, nonunion, delayed union) were analyzed. Data were analyzed using Review Manager Web with significance set at p ≤ 0.05. RESULTS: Twenty-seven studies involving 3,200 patients met inclusion criteria: VLP fixation (n = 896), percutaneous pinning (n = 666), splinting (n = 718), and bracing (n = 903). No significant differences were observed between VLP and splinting or between bracing and splinting for Disabilities of the Arm, Shoulder, and Hand (DASH); Patient-Rated Wrist Evaluation (PRWE); or grip strength. Compared with VLP, percutaneous pinning demonstrated better PRWE scores but a higher infection rate. Compared with bracing, percutaneous pinning showed significantly better DASH, PRWE, and grip strength outcomes, although with substantial heterogeneity. Compared with bracing, VLP fixation yielded significantly better DASH, PRWE, and grip strength outcomes and a lower malunion rate. CONCLUSION: All 4 treatments achieved acceptable outcomes, but with key trade-offs: Percutaneous Pinning had the best functional results but a higher infection risk. VLP provided better function and lower malunion rates than bracing. Splinting and bracing were effective conservative options, often yielding results similar to VLP, but were inferior in some specific measures. The findings suggest that a perfect anatomic repair is not always necessary for a good recovery. Ultimately, the choice of treatment must be individualized, weighing the functional benefits against the risks of complications, while considering patient health factors and preferences. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
8 Apr 2026
Read appraisal →JMIR research protocols
Enhancing Continuous Medication Safety Through e-Prescription and Clinical Decision Support Systems in Outpatient Practices and Pharmacies: Protocol for a Multiperspective Study (eRIKA Study)
BACKGROUND: Increased life expectancy is associated with increasing multimorbidity and polypharmacy, leading to a heightened risk of drug-drug interactions and adverse events, especially when multiple health care providers are involved. To address the urgent need for safer medication management in this population, tools such as medication plans (MP), electronic prescriptions (e-prescriptions), and clinical decision support systems (CDSS) offer valuable support. These instruments have the potential to enhance medication safety by providing physicians and pharmacists with a comprehensive overview of a patient's overall medication regimen and by assisting health care professionals in making informed prescribing decisions. OBJECTIVE: This study aims to improve medication therapy safety by combining e-prescriptions, the use of claims data, MPs, CDSS, and interprofessional communication. To comprehensively evaluate this complex intervention, a holistic multiphase study will be conducted, examining (1) the effectiveness of the intervention and (2) health-economic and (3) implementation-related aspects. METHODS: A multiphase study design is used. In the first phase, the intervention is implemented in selected outpatient practices (n=10) and pharmacies (n=10) in 2 regions in Germany as part of a cluster-randomized controlled trial to assess process-related outcomes. The primary outcome is the congruence between the MP and claims data. In phase 2, the intervention is scaled up in 3 regions and evaluated in a quasi-experimental study. The required sample size for the intervention group is 3528 patients, with a synthetic control group matched from existing claims data. The primary outcome is a combined end point of all-cause mortality and hospitalization within 3 months of an index prescription. Quantitative methods (descriptive, regression-based methods using claims data, calculation of the incremental cost-effectiveness ratio, and survey-based analyses of implementation-related aspects) and qualitative methods (interviews and focus groups to capture experiences of health care professionals and patients) are used. RESULTS: In phase 1, a total of 187 patients were recruited (74 in the intervention group and 113 in the control group) by June 2025. Phase 2 is currently ongoing, with data collection continuing through December 31, 2025. Final analyses are planned by March 2027. CONCLUSIONS: Medication safety in polypharmacy remains a critical challenge in Germany. This study provides multiperspective evidence supporting the nationwide implementation of the eRIKA (e-prescription as an element of interprofessional care pathways for continuous medication therapy management [eRezept als Element interprofessioneller Versorgungspfade für kontinuierliche AMTS]) intervention.
8 Apr 2026
Read appraisal →Archives of endocrinology and metabolism
Cushing's syndrome: a systematic review of psychiatric and cognitive symptoms in case studies
OBJECTIVE: Cushing's syndrome, characterized by chronic hypercortisolism, is associated with various health risks, including psychiatric symptoms and cognitive impairments. This systematic review of case studies aimed to map and categorize these symptoms. MATERIALS AND METHODS: We hypothesized that a broader range of psychiatric and cognitive manifestations would be observed beyond anxiety, depression, and memory impairment. The review followed PRISMA guidelines and was preregistered in PROSPERO (CRD42024433186). We conducted searches in PsycINFO, Embase, PubMed, and Scopus, identifying 273 potentially relevant studies. After screening, 66 studies were included, comprising 74 cases (81% female; mean age 35.7 years, range 13-81). RESULTS: revealed that 93% of cases presented psychiatric complaints, including depression (39.2%), psychosis/schizophrenic symptoms (35.1%), suicidal ideation/attempts (20.3%), anxiety (17.5%), panic attacks (2.7%), and post-traumatic stress disorder (1.4%). Cognitive complaints were reported in 32% of cases, primarily as general cognitive complaints (18.9%), memory impairment (9.5%), and attentional deficits (5.4%). An overlap of psychiatric and cognitive symptoms was observed in 26% of cases. CONCLUSION: This review underscores the clinical relevance of symptoms such as mania, psychosis, and suicidal behavior in Cushing's syndrome, which are often underreported. Individualized clinical assessment informed by these case studies is crucial for comprehensive management that extends beyond the typical focus on depression and memory. Moreover, greater awareness of the full spectrum of neuropsychiatric manifestations in hypercortisolism is needed.
8 Apr 2026
Read appraisal →Annals of medicine
Intervention components, training dose, and adherence in exercise-based prevention of hamstring strain injury in football: a systematic review and meta-analysis
OBJECTIVE: To quantify associations between exercise-based prevention programmes and hamstring strain injury (HSI) risk in football participants, and whether training dose and adherence modify effects. METHODS: Six databases were searched to 1 October 2025. Randomised and cluster-randomised trials comparing HSI prevention programmes with usual practice or warm-up in football participants were included. Random-effects meta-analysis pooled risk ratios (RRs); subgroup analyses and meta-regression assessed effect modification. RESULTS: Fifteen trials (n = 7,465) were analysed. Programmes reduced HSI risk (RR = 0.51, 95% CI 0.36-0.71), with I²=57% and a prediction interval crossing the null (0.18-1.40). Based on a control event rate of 7.8%, absolute risk reduction was 3.8% (38 fewer HSIs per 1000 participants; 95% CI 23-50 fewer). Effects were stronger for shorter interventions (1-6 months; RR = 0.43) than longer interventions (7-10 months; RR = 0.77; P for interaction=0.04), and for elite/semi-professional players (RR = 0.38) than amateur players (RR = 0.77; P for interaction = 0.02). Training frequency and weekly volume did not modify effects, whereas adherence did. High adherence (≥75%) was associated with lower HSI risk (RR = 0.36, 95% CI 0.28-0.48), whereas low adherence (<75%) showed no clear benefit (RR = 0.92, 95% CI 0.68-1.23; P for interaction <0.00001). Each 10% increase in adherence corresponded to an RR multiplier of 0.83 (approximately 17% lower RR). Certainty of evidence was low. CONCLUSION: Exercise-based programmes reduce HSI risk in football when implementation supports sustained adherence. Effects may be stronger in shorter interventions and elite populations, but evidence remains insufficient to differentiate programme types or components.
8 Apr 2026
Read appraisal →JMIR human factors
Use of Digital Peer Support for Employee Well-Being: Retrospective Analysis Across Five Large Employers
BACKGROUND: Anonymous, 24/7 digital peer support (DPS) offers a scalable solution to support employees' emotional well-being. Understanding sociobehavioral factors, such as timing of engagement and the impact of shared resources, can help employers and employee assistance programs (EAPs) integrate digital tools to better support workforce well-being. OBJECTIVE: This study examines (1) outcomes via overall sentiment changes among DPS users; (2) sociobehavioral differences between employees who accessed real-time, anonymous DPS during versus outside business hours; (3) differences in sentiment outcomes based on time of use; and (4) the impact of in-session resource sharing on sentiment improvement. METHODS: Using OpenAI's large language model (LLM) GPT-4o-mini with a few-shot learning approach, 24,818 anonymous chat conversations from 13,879 employees at 5 large employers were evaluated for subclinical sentiment variables, including loneliness, sadness, stress, anxiety, depression, despair, helplessness, and optimism. RESULTS: Distinct activity patterns were observed between employees during and outside business hours, with a median user age of 36 years. During business hours, employees reported higher baseline stress (Δ1.6%), whereas outside business hours, baseline depression (Δ1.7%) and loneliness (Δ1.2%) were higher. After DPS use, LLM-derived negative sentiment scores decreased (loneliness 46% reduced, sadness 45%, stress 46%, anxiety ~39%, depression ~40%, despair ~40%, and helplessness ~38%), and optimism increased (~77%). Outside business hours, users engaged more (~68% of all sessions), remained in sessions 19% longer, and discussed 13% more topics, whereas users during business hours reported greater improvements in depression (Δ2.3%), helplessness (Δ1.9%), and loneliness (Δ0.5%). Resource sharing was associated with greater improvements in loneliness (Δ2.9%), stress (Δ1.3%), anxiety (Δ1.9%), depression (Δ7.3%), despair (Δ3.0%), helplessness (Δ2.8%), and optimism (Δ8.8%), but not sadness. CONCLUSIONS: DPS complements employers' EAPs by addressing employee engagement gaps, reducing barriers to mental health care, and promoting emotional well-being among the workforce.
8 Apr 2026
Read appraisal →Journal of the American Heart Association
Predicting Recurrence and Outcomes After Stressor-Associated Atrial Fibrillation Using ECG-Based Deep Learning
BACKGROUND: Stressor-associated atrial fibrillation (AF) refers to new-onset AF that occurs with a reversible, acute stressor. Identifying individuals at highest risk for AF recurrence is essential to guide management. Although clinical factors have shown limited value, the utility of contemporary artificial intelligence (AI)-enabled models using the 12-lead ECG to estimate recurrence risk remains unknown. METHODS: We retrospectively analyzed consecutive primary care and cardiology patients with stressor-associated AF occurring during hospitalization. We quantified the cumulative incidence of recurrence accounting for death as a competing risk. We investigated the relationship between time-varying recurrence and a composite end point of AF-related adverse events (stroke, heart failure, all-cause death) using Cox models. We then developed and validated a penalized regression model to predict recurrence using clinical factors, stressor type, and AF risk estimates from a previously validated ECG-based AI model. RESULTS: We analyzed 3371 patients with stressor-associated AF (mean age, 69±12 years; 40% women). Over a median of 3.7 years (interquartile range, 1.8-7.2), the 10-year cumulative incidence of AF recurrence was 41% (95% CI, 39-44). AF recurrence was strongly associated with AF-related adverse events (hazard ratio, 2.24 [95% CI, 1.81-2.76]). A model incorporating clinical factors, stressor type, and ECG-based AI model AF risk estimates (clinical-AI) discriminated AF recurrence (area under the receiver operating characteristic curve, 0.768 [95% CI, 0.707-0.830]) favorably compared with clinical features (area under the receiver operating characteristic curve, 0.707 [95% CI, 0.642-0.772]; P<0.05). CONCLUSIONS: AF recurrence rates following stressor-associated AF are considerable and are associated with substantially higher risk of adverse cardiovascular events. Models incorporating ECG-based AI risk estimates may prioritize individuals for intensive monitoring and preventive interventions.
8 Apr 2026
Read appraisal →JMIR mHealth and uHealth
A Mobile App-Based Individualized Nonpharmacological Intervention for Behavioral and Psychological Symptoms in Dementia: Pilot Randomized Controlled Trial
BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are common and negatively impact both individuals with dementia and their families. Although nonpharmacological interventions are recommended as the first-line treatments, their use in community settings is limited by access and caregiver resources. Existing approaches are often not individualized and rely on institutional or clinician-led delivery. OBJECTIVE: We developed a caregiver-initiated and individualized multimodal mobile app. The app delivers tailored nonpharmacological interventions-such as music therapy, exercise, and reminiscence therapy-based on each user's preferences and functional abilities. This study aimed to evaluate the effectiveness of this mobile app-based intervention in reducing BPSD in community-dwelling persons living with dementia. METHODS: This study used a single-blinded randomized controlled trial design. Participants were recruited from an outpatient clinic of a tertiary hospital, a dementia care center, and 5 home care service centers. A total of 36 dyads participated, each comprising a community-dwelling person living with dementia aged 60 years or older and their primary family caregiver. The dyads were randomly allocated to either the intervention or control group. The intervention group received a caregiver-initiated, multimodal, mobile app-based individualized intervention for 4 weeks, whereas the control group continued with usual care. The primary outcomes were overall BPSD, agitated behavior, and depression. The secondary outcomes were nighttime sleep efficiency and caregiver competency in managing BPSD. Assessments were conducted at baseline, immediately after the intervention, and at a 2-week follow-up. RESULTS: Of the 36 randomized dyads, 33 were included in the final analysis. Although the intervention group showed greater reductions in overall BPSD, agitated behavior, and depression after the intervention, no significant group-by-time interaction effects were observed in the total sample. In the subgroup analysis of participants with clinically significant baseline BPSD, a statistically significant improvement in overall BPSD was found in favor of the intervention group (β=-12.885, 95% CI -24.530 to -1.240; P=.03). No significant effects were observed for either nighttime sleep efficiency or competence in the management of BPSD. CONCLUSIONS: A mobile app-based individualized intervention may offer a flexible, caregiver-initiated approach to managing BPSD in home-care settings. While overall effects were limited, exploratory subgroup findings provided meaningful insights, indicating potential benefits for those with higher baseline symptom severity. The results highlight the need for further research on adaptive personalization and optimized intervention delivery to enhance the clinical effectiveness of digital dementia care.
8 Apr 2026
Read appraisal →Journal of medical Internet research
Electrocardiogram-Based Mental Stress Detection Amid Everyday Activities Using Machine Learning: Model Development and Validation Study
BACKGROUND: Frequent, sustained stress is linked to poor health and requires monitoring for early intervention. Electrocardiograms (ECG) are promising biomarkers because they can be recorded noninvasively and continuously using wearable devices. However, tracking stress with ECG is challenging because daily activities elicit responses similar to mental stress (MS), and various mental stimuli that individuals encounter complicate the use of machine learning (ML) models trained on a limited set of stressors. OBJECTIVE: We (1) evaluated the ability of ML models to distinguish MS episodes from a composite "no-stress" background, including rest and low- to moderate-intensity activities; (2) assessed their generalizability to new stressors and participants; and (3) tested robustness to lower sampling rates and fewer features, to explore their suitability for lightweight wearables. METHODS: We used a comprehensive ECG dataset sampled at 1000 hertz from 127 participants who underwent various mental stressors and engaged in diverse physical activities. A 30-second window was used to extract 55 features from time, frequency, nonlinear, and morphological domains. We trained a logistic regression (LR) model and an extreme gradient boosting (XGBoost) model, splitting the data into 60/20/20 for training, validation, and testing. Shapley additive explanation values were computed to explain model predictions. Additional analyses included leave-one-stressor-out; downsampling to 500, 250, and 125 hertz; a time-window sensitivity analysis; and reducing the number of features to as few as 5. RESULTS: XGBoost achieved an area under the receiver operating characteristic curve (AUROC) of 0.741 (95% CI 0.701-0.783) and an area under the precision-recall curve (AUPRC) of 0.706 (95% CI 0.658-0.753), compared with 0.724 (95% CI 0.678-0.772) and 0.691 (95% CI 0.639-0.742) for LR. The mean performance difference between XGBoost and LR was 0.017 for AUROC (95% CI 0.001-0.032) and 0.015 for AUPRC (95% CI -0.001 to 0.037; clustered bootstrap analysis using 2000 participant-level resamples), suggesting that LR performs comparably to the nonlinear XGBoost model. Both models were robust to downsampling and feature reduction (10 features retained >93% of performance). Extending the analysis window to 60 seconds improved model performance across all sampling rates, highlighting a trade-off between rapid detection and overall performance. When evaluating discrimination from physical activity, models achieved acceptable specificity for light physical activity (XGBoost: 0.787; LR: 0.794) but poor specificity for moderate physical activity (XGBoost: 0.418; LR: 0.444). Both models generalized to most unseen stressors, although performance varied across stressors, with limited transfer to the social-evaluative stressor. Feature importance analysis revealed fuzzy entropy and frequency-based features as key predictors. CONCLUSIONS: ML models can detect MS with high sensitivity and remain robust to lower sampling rates and fewer features. Generalization to novel stressors was stressor-dependent. Importantly, our results highlight challenges in distinguishing stress-related cardiac responses from those caused by physical exertion, revealing critical limitations of single-sensor ECG approaches for MS detection.
8 Apr 2026
Read appraisal →Global public health
Link between housing and community factors and mental health and psychological well-being of refugee parents and children in high-income countries: A systematic review
Whilst forced migration is known to significantly increase the risk of mental health problems, the influence of post-migration factors for refugee children and parents in high-income countries remains understudied. However, systemic post-migration factors have the potential to be modified by policy and practice to improve outcomes. This systematic review identifies the housing and community factors examined in research and their link to the mental health and psychological well-being of refugee parents and children in high-income countries. Adhering to the PRISMA guidelines, we searched the databases of PubMed, PsycINFO and Embase for studies published in peer-reviewed journals until the 17th of October 2025. Of the 11,588 studies identified, 30 were eligible for inclusion in this review. Our findings particularly suggest favourable mental health outcomes among those living with their families/relatives or foster care as opposed to reception centres, as well as those with social support. Perceived discrimination consistently showed an association with negative mental health outcomes. The findings suggest a gap in the evidence base focusing on parents, education and school-related factors. We recommend that policy makers provide family-based living arrangements and improve access to spaces for social support. Future research in this field will benefit from further sub-group analyses.
8 Apr 2026
Read appraisal →Journal of the American Heart Association
Blood Pressure Parameters and Risk of Cognitive Decline and Dementia in Type 2 Diabetes: Results From the ADVANCE Trial
BACKGROUND: Blood pressure (BP) variability and cumulative BP load are significantly associated with cardiovascular disease risk beyond mean systolic BP, but less is known regarding their associations with cognitive decline/dementia and whether these associations differ by cognitive function at baseline or by sex. The aims of this study were to determine associations of different BP parameters with cognitive decline/dementia in patients with type 2 diabetes and explore differences by mild cognitive impairment at baseline and sex. METHODS: Using data from the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) study, BP parameters were calculated from an 18-month exposure window comprising measurements at 3, 4, 6, 12, and 18 months, after randomization. Logistic regression was used to estimate the odds ratio (OR) per SD higher and 95% CI for the associations of BP parameters with the composite outcome of cognitive decline (≥3 points from baseline on the Mini-Mental State Examination) or clinical diagnosis of dementia. RESULTS: Of the 11 140 ADVANCE participants, 9586 patients had 5 complete BP measurements within the 18-month exposure window. After a mean follow-up of 3.5 years, 1674 (17.5%) participants were diagnosed with cognitive decline and/or dementia. Overall, variability and baseline pulse pressure (PP), but not BP load, were associated with higher odds of cognitive decline/dementia (OR: variability in systolic BP, 1.11 [95% CI, 1.05-1.17]; diastolic BP, 1.11 [95% CI, 1.05-1.17]; PP, 1.05 [95% CI, 1.00-1.11]; mean arterial pressure, 1.13 [95% CI, 1.07-1.19]; and baseline PP, 1.19 [95% CI, 1.13-1.25]). There were no differences by mild cognitive impairment at baseline or sex. CONCLUSIONS: Higher BP variability and baseline PP, but not mean BP or BP load, were associated with higher odds of cognitive decline/dementia in patients with type 2 diabetes. BP variability and PP may be important therapeutic markers for the preservation of brain health. REGISTRATION: URL: https://clinicaltrials.gov; Unique Identifier: NCT00145925.
8 Apr 2026
Read appraisal →Journal of the American Heart Association
Impact of Atrial Fibrillation Pattern on Edoxaban Antithrombotic Therapy in Patients With Atrial Fibrillation and Stable Coronary Artery Disease: A Secondary Analysis of the EPIC-CAD Randomized Clinical Trial
BACKGROUND: Paroxysmal atrial fibrillation (AF) is associated with a risk of stroke or systemic embolism similar to nonparoxysmal (persistent or permanent) AF. However, whether the optimal antithrombotic strategy in patients with AF and stable coronary artery disease differs by AF pattern remains uncertain. METHODS: This prespecified substudy of the EPIC-CAD (Edoxaban Antithrombotic Therapy for Atrial Fibrillation and Stable Coronary Artery Disease) trial compared edoxaban monotherapy with dual antithrombotic therapy (edoxaban plus a single antiplatelet agent) in patients with AF and stable coronary artery disease. Stratified analyses were performed by AF pattern. The primary outcome was net adverse clinical events, defined as a composite of all-cause death, myocardial infarction, stroke, systemic embolism, unplanned urgent revascularization, major bleeding, or clinically relevant nonmajor bleeding within 12 months. RESULTS: Among 1040 patients, 575 (55.3%) had paroxysmal and 465 (44.7%) had nonparoxysmal AF. The 12-month primary outcome rate was similar between paroxysmal and nonparoxysmal AF (10.3% versus 12.2%; adjusted hazard ratio [HR], 1.15 [95% CI, 0.79-1.68]). Edoxaban monotherapy was associated with a significantly lower risk of the primary outcome than dual antithrombotic therapy in both paroxysmal AF (4.6% versus 16.2%; adjusted HR, 0.23 [95% CI, 0.12-0.42]) and nonparoxysmal AF (9.3% versus 15.0%; adjusted HR, 0.56 [95% CI, 0.32-0.87]). No significant interaction was observed between antithrombotic strategy and AF pattern (P for interaction=0.10). CONCLUSIONS: In patients with AF and stable coronary artery disease, edoxaban monotherapy significantly reduced net adverse clinical events at 12 months compared with dual antithrombotic therapy, irrespective of AF pattern. REGISTRATION: URL: https://www.ClinicalTrials.gov; Unique identifier: NCT03718559.
8 Apr 2026
Read appraisal →The Cochrane database of systematic reviews
Antibiotic treatment for low back pain, radicular pain, or both.
RATIONALE: Low back pain is the leading cause of disability worldwide. Research has associated Modic changes (signal changes in the vertebral endplate on magnetic resonance imaging (MRI)) with low back pain. Some hypothesise that Modic type 1 changes (oedema) may have an infective cause, and that antibiotics could serve as targeted treatment. OBJECTIVES: To assess the benefits and harms of antibiotic therapy, compared with placebo or another treatment, in people with low back pain, radicular pain, or both. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and two trials registries up to 26 August 2025, with no restrictions related to language or date of publication. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs) that assessed antibiotics versus placebo (primary comparison) or other treatments. We assessed the evidence separately for four populations of adults with low back pain, radicular pain, or both: those with 1) Modic type 1 changes and evidence of disc herniation, 2) other Modic changes and evidence of disc herniation, 3) any Modic changes but no evidence of disc herniation, and 4) evidence of disc herniation without any Modic changes. OUTCOMES: Critical outcomes were pain intensity and disability or function up to 12 to 14 weeks, and the number of participants with any adverse events and serious adverse events at the end of the trial period. RISK OF BIAS: Two review authors independently evaluated the risk of bias using the Cochrane risk of bias tool RoB 1. SYNTHESIS METHODS: Two review authors independently screened studies and extracted data. We synthesised results for each outcome using random-effects meta-analysis. Where this was not possible due to the nature of the data, we reported the results descriptively. We used GRADE to assess the certainty of evidence. The primary comparison was antibiotics versus placebo in people with low back pain, radicular pain, or both, and Modic type 1 changes with evidence of disc herniation (population 1) up to 12 to 14 weeks. INCLUDED STUDIES: We included three trials, conducted in Denmark, Belgium, and Norway, with a total of 402 participants (mean ages ranged from 44.7 years to 51.0 years). Two trials recruited people with chronic (> 6 months) moderate-to-severe low back pain (with or without radicular pain), Modic changes, and disc herniation. One trial included people with Modic type 1 changes only (population 1) and compared oral amoxicillin-clavulanate 500 mg/125 mg to placebo (for both treatments, 1 or 2 tablets 3 times daily for 100 days). The second trial included people with either Modic type 1 changes (population 1) or Modic type 2 changes (population 2) and compared oral amoxicillin 750 mg to placebo (for both treatments, 3 times daily for 100 days). Follow-up was 12 months in both trials. The third trial recruited people with lumbar radicular pain (with or without low back pain) and disc herniation. Modic changes was not an inclusion criterion (population 4). This trial evaluated minocycline 100 mg versus amitriptyline 25 mg versus placebo and followed participants for 14 days (treatment duration). There were no trials with population 3. SYNTHESIS OF RESULTS: All three trials were at low risk of selection, performance, and detection bias. We rated one trial at high risk of attrition bias and unclear risk of reporting and other bias. The overall certainty of evidence is low to very low, primarily due to imprecision and indirectness. In people with low back pain, Modic type 1 changes, and disc herniation, the antibiotic oral amoxicillin (with or without clavulanate) may improve pain slightly and may result in a small to moderate improvement in disability at 12 to 14 weeks compared with placebo (low-certainty evidence, downgraded for imprecision and indirectness). At this time point, the mean back pain score was 50.6/100 (where a lower score indicates less pain) in the amoxicillin group versus 59/100 in the placebo group (mean difference (MD) -8.42 points, 95% CI -16.18 to -0.67; I² = 35%; 2 trials, 255 participants), and the mean disability score was 45.2/100 (where a lower score indicates less disability) in the amoxicillin group versus 55.7/100 in the placebo group (MD -10.52 points, 95% CI -15.94 to -5.09; I² = 0%; 2 trials, 255 participants). We are unsure if amoxicillin (with or without clavulanate) results in more people reporting adverse events (very low-certainty evidence, downgraded for imprecision, inconsistency, and indirectness). Adverse events were reported in 76 of every 100 people taking amoxicillin compared with 49 of every 100 people taking placebo (risk ratio (RR) 1.79, 95% CI 0.54 to 5.94; I² = 96%; 2 trials, 262 participants). We are unsure if amoxicillin (with or without clavulanate) results in more people reporting serious adverse events (very low-certainty evidence, downgraded for imprecision and indirectness). Serious adverse events were reported in three of every 100 people taking amoxicillin (with or without clavulanate) compared with two of every 100 people taking placebo (RR 1.43, 95% CI 0.11 to 18.35; I² = 45%; 2 trials, 262 participants). We are unsure of the effects of amoxicillin compared to placebo in people with low back pain, Modic type 2 change, and disc herniation. Similarly, we are unsure of the effects of minocycline compared to placebo or amitriptyline in people with low back pain, disc herniation, and no Modic changes. AUTHORS' CONCLUSIONS: In people with low back pain, Modic type 1 changes, and evidence of disc herniation, the antibiotic amoxicillin (with or without clavulanate) may provide slight to small benefits in reducing back pain and small to moderate benefits in improving disability compared to placebo at 12 to 14 weeks. The evidence on the risk of adverse events, including serious adverse events, with amoxicillin (with or without clavulanate) is very uncertain. Further research is likely to change our confidence in the estimates. FUNDING: This review had no dedicated funding. REGISTRATION: Protocol (2021): DOI 10.1002/14651858.CD014221.
8 Apr 2026
Read appraisal →Psychological medicine
Joint effects of childhood adversity and genetic risk for psychosis on psychopathology in the UK Biobank
BACKGROUND: The individual effects of genetic factors and adverse childhood experiences (ACEs) on risk of psychosis, including schizophrenia (SCZ) and bipolar disorder (BIP), have been widely acknowledged, but their interaction effects on individual psychopathological symptoms remain unclear. METHODS: Based on data from 163,704 individuals in the UK Biobank, we investigated the joint effects of polygenic risk scores (PRSs) of SCZ and BIP and ACEs on psychopathology. ACEs status and 55 psychopathological symptoms from seven domains were measured retrospectively using an online mental health questionnaire in 2016. Recent genome-wide association studies for SCZ and BIP were combined with genotype data to generate PRSs. Logistic regression analyses were then conducted to explore univariate and joint main effects of PRSs and ACEs on psychopathological symptoms, as well as their additive and multiplicative interaction effects. RESULTS: The interaction mechanisms for PRSs and ACEs varied across symptom domains: additive interactions were observed on the depression (RERIBIP-ACEs = 0.20-0.25), anxiety (RERISCZ-ACEs = 0.20; RERIBIP-ACEs = 0.22-0.26), help-seeking (RERISCZ-ACEs = 0.24; RERIBIP-ACEs = 0.23), and cognition domains (RERISCZ-ACEs = -0.23 to -0.17), whereas multiplicative interactions were only detected on the psychotic (betaSCZ-ACEs = -0.543; betaBIP-ACEs = -0.181), mania (betaBIP-ACEs = -0.195), self-harm or suicide (betaSCZ-ACEs = -0.118), and cognitive domains (betaSCZ-ACEs = -0.204 to -0.157). CONCLUSIONS: The interplay mechanisms for genetic liability to SCZ and BIP and ACEs vary across symptom domains. This study reveals heterogeneity in gene-ACEs interaction mechanisms underlying psychosis and may provide personalized guidance for psychological care after ACEs.
8 Apr 2026
Read appraisal →Pulmonology
Low-dose theophylline in mild to moderate Chronic Obstructive Pulmonary Disease: A randomized clinical trial in China
BACKGROUND: Low-dose theophylline has anti-inflammatory effects, but its efficacy in mild to moderate COPD remains controversial. RESEARCH QUESTION: Is low dose theophylline effective and safe in patients with mild to moderate COPD? METHODS: In this prospective, parallel-group, randomised, double-blind, placebo-controlled trial across ten centres in China, subjects with mild to moderate COPD were randomized 2:1 to oral low-dose theophylline sustained-release tablets (100 mg twice daily) or matching placebo for 12 months. Primary endpoints were between-group differences in pre-bronchodilator FEV1 change from baseline to 12 months and annual exacerbation rate. FINDINGS: 734 subjects were randomized; 615 completed the study. Compared with placebo, low-dose theophylline significantly ameliorated FEV1 before bronchodilator use by 30 ml [95% CI, 3 to 57 ml] (p = 0.031) at month 12, with a between-group difference in mean change from baseline of 28 ml/year [95% CI, -2 to 58 ml/year] (p = 0.063). The annual exacerbation rate did not differ between groups (0.46 ± 0.03 vs 0.43 ± 0.04 per patient-year; RR, 1.07 [95% CI, 0.84 to 1.36]; p = 0.607). In addition, the incidence of adverse events was comparable between both groups. INTERPRETATION: In mild to moderate COPD, low-dose theophylline was well-tolerated but did not reduce exacerbation rates. A modest improvement in pre-bronchodilator FEV1 was observed, though its magnitude was limited. Larger trials are needed to further evaluate its potential to improve lung function in this population. What is already known on this topic:The efficacy of low-dose theophylline specifically in the mild to moderate COPD population remains unclear.What this study adds:Our study indicated that low-dose theophylline treatment alone was associated with a significant improvement in pre-bronchodilator FEV1 and demonstrated good tolerability in patients with mild to moderate COPD.How this study might affect research, practice or policy:What we found in this study presented promising opportunities for intervention with theophylline alone in patients with mild to moderate COPD.
8 Apr 2026
Read appraisal →Psychological medicine
Maternal communication and attachment following a group singing intervention for postnatal depression: findings from the SHAPER-PND trial
BACKGROUND: Postnatal depression (PND) can disrupt maternal communication during early interactions, affecting infant socioemotional development. Singing is a natural form of caregiver-infant communication and a promising intervention to enhance maternal well-being and bonding. However, its effects on observed communication and perceived attachment in clinical PND populations remain underexplored. METHODS: Within the Scaling-Up Health-Arts Programs: Postnatal Depression trial, 199 mothers with PND were randomized 2:1 to a 10-week group singing intervention (Breathe Melodies for Mums) or a non-singing community activity. One hundred participants (singing = 70; control = 30) completed video-recorded interactions at baseline, week 10, and week 36. Maternal speech was coded using the Parental Cognitive Attributions and Mentalization Scale (PCAMS) for mentalization, affective tone, and attentional focus. Perceived maternal attachment was assessed separately via self-report using the Maternal Postnatal Attachment Scale. RESULTS: At week 10, singing mothers showed greater improvement in communication with their infants than controls, with about 1.7-fold higher proportions of mentalizing comments (p = 0.01), 1.4-fold more infant-focused speech (p < 0.001), 2.4-fold less parent-focused speech (p < 0.001), and fivefold less negative speech (p < 0.001). These effects were maintained at week 36. Perceived attachment improved significantly across both groups (p < 0.001), but only singing mothers showed further gains from week 10 to week 36 (p = 0.02), indicating continued strengthening of attachment perceptions. CONCLUSIONS: Group singing enhanced maternal communication and perceived attachment in mothers with PND. Findings support community-based, arts-informed interventions as accessible approaches to strengthen early relational health and complement perinatal mental healthcare.
8 Apr 2026
Read appraisal →Psychological medicine
Sleep diary-derived parameters and sleep measures mediate the efficacy of transdiagnostic sleep and circadian intervention for depression.
The present study aimed to explore sleep diary-derived parameters and sleep measures as mediators of the effects of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TSC) on psychological outcomes. A secondary analysis of a two-arm randomized controlled trial of a group-based TSC for major depressive disorder was conducted. The participants included 152 adults (mean age = 34.0; 79.6% female) who were randomized into either the TSC or care-as-usual group. Mediation analysis indicated that reduction in insomnia symptom severity (standardized indirect effects: -0.06 to -0.17), sleep disturbance (-0.04 to -0.22), and sleep-related impairment (-0.04 to -0.17) was significantly mediated by sleep diary-derived sleep parameters. The treatment effects on depressive symptoms (standardized indirect effects: -0.05 to -0.10), anxiety symptoms (-0.04 to -0.07), fatigue (-0.05 to -0.09), functional impairment (-0.06 to -0.09), and quality of life (0.04 to 0.08) were sequentially mediated by sleep parameters and insomnia symptom severity. However, the severity of insomnia symptoms alone (magnitudes of standardized indirect effects: 0.09-0.17) but not sleep parameters alone (0.00-0.07) mediated the treatment effects on psychological outcomes, indicating that sleep parameters need to influence subjective sleep measures to sequentially affect psychological outcomes. These results underscore the critical roles of subjective sleep measures in clinical improvements within a sleep-targeted intervention.
8 Apr 2026
Read appraisal →JMIR human factors
Factors Influencing User Satisfaction in Accessing Health Data: Cross-Sectional Survey of United Kingdom Adults
BACKGROUND: While patient health records (PHRs) are becoming ubiquitous, nationwide evidence on the drivers of user satisfaction in the United Kingdom remains scarce. OBJECTIVE: This study aimed to quantify determinants of PHR user satisfaction in a nationally representative sample of United Kingdom adults and to contrast real-world experiences with hypothetical expectations among individuals without PHR exposure. METHODS: We conducted a cross-sectional online survey in March 2022 using stratified quota sampling (eg, age, sex, ethnicity) through the Prolific platform. Of 1001 respondents, 533 (53%) were female (mean age 41, SD13) years, 468 (47%) reported previous PHR use ("experienced" cohort), and 533 (53%) respondents did not ("hypothetical" cohort). Primary outcomes were five satisfaction items (5-point Likert), overall PHR evaluation (0-100), and stated/anticipated PHR functions. Two-sample t-tests with unequal variances examined between-group differences; multivariate analysis of variance (MANOVA) assessed demographic equivalence. Significance was set at P<.05. RESULTS: Respondents with PHR experience rated their record easy-to-use in 79% (370/468) of cases versus an anticipated 93% (498/533) among nonusers (P<.001). Experienced users rated appointment-scheduling time-saving at 68% (319/468) compared with 72% (387/533) of nonusers (P=.17). Mean overall evaluation scores were 71.0 (SD 19.5) versus 74.2 (SD 18.6) (t₉₉₇=2.25, P=.02). MANOVA confirmed demographic balance (Wilks Λ=.99, F₇,₉₉₃=1.48, P=.18). Preferred functions across cohorts were viewing personal health information (experience 81%, hypothetical 90%) and lab results (50% vs 76%). Users lacking experience consistently over-estimated future use of carer-related functions (eg, children's data: 36% vs 12%, P<.001). CONCLUSIONS: Adults in the United Kingdom value PHRs primarily for personal data access and scheduling convenience. Nonusers displayed optimistic expectations about carer-related features and breadth of functionality, indicating an information gap. Enhancing transparency about current capabilities and expanding features that facilitate caregiving could increase satisfaction and adoption.
7 Apr 2026
Read appraisal →Proceedings of the National Academy of Sciences of the United States of America
AI-derived therapeutic development of a serotonin receptor-targeting drug for the treatment of opioid use disorder
The opioid epidemic has led to a devastating loss of life nationwide. Of those dependent on opioids, many individuals desire to quit or reduce use, but their efforts are often unsuccessful given the powerful reinforcing properties associated with opioid drugs, including fentanyl. Here, we developed a therapeutic drug based on an AI-based platform, which was rationally designed to identify markers of dysregulation from human drug user postmortem brain tissue. Two top candidate compounds, GATC-021 and GATC-1021, were synthesized and validated with in vitro screening for target specificity. Thereafter, the drug candidates were examined for their effectiveness in modulating opioid reinforcement and intake. GATC-1021 emerged as the most efficacious compound as it significantly decreased fentanyl intake in both male and female rats, without any notable side effects. GATC-1021 was further found to modulate gene expression patterns in addiction-relevant brain regions following fentanyl-induced alterations. These findings validate GATC's AI-based platform with its polypharmacy-focused drug development approach and further support the clinical potential of GATC-1021 as a promising therapeutic for those suffering from opioid use disorder.
7 Apr 2026
Read appraisal →Journal of medical Internet research
Supporting Access to Care Through Peripheral Devices and Patient-Generated Health Data: Qualitative Study
BACKGROUND: In 2016, the US Department of Veterans Affairs (VA) implemented a national initiative to distribute video-enabled tablets and peripheral devices, such as blood pressure monitors and weighing scales, to patients facing geographic, clinical, or socioeconomic challenges. Such patients could potentially benefit from health monitoring in conjunction with video-based care, as peripheral devices offer opportunities to enrich care received during a video visit and support tracking of health-related data collected outside of clinical care, or patient-generated health data. However, little is known about experiences with the devices and how they could support improved access to care. OBJECTIVE: We explored patients' experiences with VA-issued peripheral devices and their impact on video-based care and health monitoring outside of clinical visits. METHODS: We conducted in-depth semistructured interviews among patients who received VA-issued tablets and peripheral devices between 2023 and 2024. Purposive sampling was used to gather views based on gender, age, race or ethnicity, and rurality. Interviews were transcribed and analyzed using rapid qualitative analysis, guided by the Unified Theory of Acceptance and Use of Technology. RESULTS: Among 25 patients, most received a blood pressure monitor (21/25, 84%), a weight scale (14/25, 56%), and/or a pulse oximetry device (12/25, 48%). The majority reported using their peripheral devices (23/25, 92%) and tablets (19/25, 76%) to monitor their vital signs and attend video visits. Qualitative analysis yielded ten themes reflecting experiences and impacts of the devices, organized by the Unified Theory of Acceptance and Use of Technology constructs: "effort expectancy" consisted of (1) familiar and easy to use devices and (2) challenges of Bluetooth pairing and measurement; "performance expectancy" consisted of (3) integration with video visits, (4) health monitoring for peace of mind, (5) perceptions of improved vital signs and lifestyle behaviors, (6) removing obstacles to in-person care, and (7) desiring an overall picture of health; "social influence" consisted of (8) fostering care team connections and (9) promoting awareness of tablets and peripheral devices; and "facilitating conditions" consisted of (10) supportive help desk infrastructure. Overall, patients described using peripheral devices during virtual visits by syncing data to the tablet for real-time access by their care team. They also reported manually tracking and sharing patient-generated health data with their care team. Despite some challenges with Bluetooth pairing, patients found the devices easy to use and contributed to improved health and motivation. Devices also reduced logistical burdens of in-person visits, especially for those with limited mobility, visual impairments, mental health needs, or transportation barriers. CONCLUSIONS: Patients perceive that peripheral devices can enhance video-based care and support health care access and chronic disease management. Patients reported benefits to health, behavior, and communication with care teams. To maximize the impact, program enhancements should prioritize device interoperability, accessible training, and expanded outreach.
7 Apr 2026
Read appraisal →Circulation
Wearable-Derived Training Load and Coronary Atherosclerosis in Middle-Aged and Older Athletes and Physically Active Controls: A New Perspective From the Master@Heart Study
BACKGROUND: Middle-aged and older endurance athletes have increased prevalence of coronary artery disease (CAD) on coronary computed tomography angiography compared with healthy controls, despite similarly low cardiovascular risk. Previous studies relied on self-reported data to quantify training load (TL), which poorly correlates with objective wearable-derived TL and may bias outcomes. The effect of objective TL on CAD risk remains unknown. METHODS: In this observational, cross-sectional analysis of the Master@Heart study, 222 men (median age, 54 [49-59] years) were included: 77 lifelong athletes, 98 late-onset athletes, and 47 controls. TL was assessed using objective wearable-derived training duration and intensity (12 consecutive months), as well as self-reported training measures. Coronary computed tomography angiography-derived CAD prevalence was compared across TL quartiles (Q) using a global unadjusted chi-square test and logistic regression, adjusted for cardiovascular risk factors and years of endurance exercise, to estimate odds ratios between Q4 and Q1. In addition, adjusted logistic regression models were fitted with continuous TL, using smoothing splines to capture potential nonlinear associations. RESULTS: Across quartiles of objective Edwards training impulse (training duration × heart rate-weighted intensity), unadjusted global differences were observed for ≥1 plaque (P<0.001), coronary artery calcification (CAC)>0 (P=0.002), and CAC>100 (P=0.012). Q4 participants had significantly higher adjusted odds of ≥1 plaque (odds ratio, 5.85; 95% CI, 2.33-14.71), CAC>0 (odds ratio, 5.03; 95% CI, 2.04-12.35), and CAC>100 (odds ratio, 3.50; 95% CI, 1.22-10.00) versus Q1. Similar associations were found for objective training duration, whereas no clear associations were observed for relative time spent in high-intensity zones. In continuous analyses, Edwards training impulse and objective training duration showed significant positive associations with ≥1 plaque and CAC>100 (P<0.05), whereas self-reported training duration was only significantly associated with CAC>100 (P<0.05). Metabolic equivalent of task-minutes per week based on self-reported TL was not associated with CAD (P>0.05). CONCLUSIONS: High training duration (hours/week), particularly when combined with cumulative high-intensity TL (Edwards training impulse), was independently associated with increased prevalence of subclinical CAD in middle-aged and older athletes and physically active controls. Exercise intensity alone, in the absence of high duration, was not clearly linked to CAD. These findings underscore the potential of objectively measured TL for understanding associations with subclinical CAD in endurance athletes. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03711539.
7 Apr 2026
Read appraisal →International ophthalmology
Retinal image-based cardiovascular risk prediction using AI-CRS: a multi-modal deep learning framework
This study presents AI-CRS, an AI-driven deep learning framework for cardiovascular risk assessment using retinal images. By combining convolutional neural networks (CNNs), attention mechanisms, and vasculature segmentation, AI-CRS overcomes the limitations of traditional methods, such as reliance on handcrafted features and single-modality data. The model integrates multi-modal information, fusing vasculature segmentation maps with raw image data to capture subtle vascular changes indicative of cardiovascular diseases. Experimental validation demonstrates that AI-CRS outperforms conventional diagnostic techniques in cardiovascular risk stratification, achieving superior sensitivity, specificity, and accuracy. The model excels in detecting early-stage disease and subtle vascular anomalies, and it shows strong generalizability across diverse datasets, patient demographics, and varying image qualities. Beyond cardiovascular risk, AI-CRS also shows promise in assessing systemic health conditions like hypertension and diabetes, demonstrating the broader utility of retinal imaging in health monitoring. The attention-driven architecture enhances model interpretability, providing clinicians with visual explanations of disease-associated vascular patterns, which is essential for clinical adoption. AI-CRS offers a non-invasive, scalable solution that can be integrated into routine clinical practice, supporting early diagnosis, personalized care, and population-wide screening. Its automated analysis reduces the need for manual feature extraction and subjective interpretation, streamlining workflows and improving efficiency. Ultimately, AI-CRS represents a significant step toward precision medicine by enabling timely interventions, reducing healthcare costs, and improving patient outcomes through non-invasive digital biomarkers.
7 Apr 2026
Read appraisal →JMIR medical informatics
Automated ICD-10-Anchored Classification of Primary Care Text Data: Development and Evaluation of a Custom Multilabel Classifier
BACKGROUND: Electronic medical records are a vast and valuable source of information, useful for tasks such as estimating disease prevalence. However, in routine primary care, much of this information is in free-text format rather than in a structured form and, therefore, not readily amenable to analysis. Manual coding of this textual data is both time-consuming and resource-intensive, making it impractical for large datasets. Although powerful open-source language models offer new opportunities for automated coding, their use on short heterogeneous primary care notes, particularly in German-language settings, remains insufficiently studied. OBJECTIVE: By providing hands-on guidance for applied health researchers, this study aims to demonstrate the effective and accurate automatic classification of free-text notes using a language model fine-tuned for automated International Statistical Classification of Diseases, Tenth Revision (ICD-10) coding. METHODS: Building on the extensive Family Medicine Research Using Electronic Medical Records (FIRE) routine database from the Institute of Primary Care at the University Hospital Zurich and the University of Zurich, we trained a large language model-based multilabel classifier on a dataset of 38,728 free-text notes, which had been manually categorized into 47 classes using specific ICD-10 codes and code ranges or nondiagnostic/ad hoc labels (eg, "unclear diagnosis," "status post"). We stratified the labeled data into training (70%), validation (15%), and posttraining test (15%) sets, ensuring similar label distributions across these sets. Using the Transformers Python library, we trained the model over 10 epochs and evaluated it on the posttraining test dataset. RESULTS: Across 48 classes, the FIRE classifier achieved strong performance on the held-out posttraining set, with F1-scores of 0.85 (micro, overall across all predictions), 0.86 (macro, mean of per-class scores treating classes equally), and 0.84 (weighted, per-class scores weighted by class frequency). CONCLUSIONS: This study demonstrates steps for training open-source large language models and highlights the potential to streamline and scale the extraction of diagnostic information for practical applications. Our model can be robustly deployed, for example, for prescreening and labeling of free-text information, thus potentially reducing the burden of repetitive and error-prone manual handling.
7 Apr 2026
Read appraisal →PloS one
Identifying minimal risk factors for adolescent suicidal ideation and suicide attempts: A machine learning-optimized approach.
This study aimed to develop and validate a machine learning (ML) model to identify the minimal risk factors for adolescent suicidal behaviors, including suicidal ideation and suicide attempts. Data from the Korea Youth Risk Behavior Web-based Survey (2022-2023), including 90,813 adolescents aged 12-18 years, were analyzed. Using multidimensional risk factors spanning sociodemographic, physical and mental health, and behavioral domains, we applied a Random Forest model combined with recursive feature elimination to identify a minimal subset of risk factors (optimal features). Model performance for identifying suicidal ideation and predicting suicide attempts was evaluated via area under the curve (AUC), sensitivity, specificity, and accuracy metrics across the validation datasets. Sadness, loneliness, anxiety, and stress were identified as optimal features, achieving a high AUC, sensitivity, specificity, and accuracy in identifying suicidal ideation and predicting suicide attempts. Additional factors further improved the ML model's predictive performance for suicide attempts, achieving an AUC of 97.28%, sensitivity of 93.49%, specificity of 90.21%, accuracy of 91.85%, a PPV of 90.52%, and an NPV of 93.26%. This study demonstrated the efficacy of ML-driven approaches in identifying critical risk factors for adolescent suicidal behaviors. The findings highlight the potential of ML frameworks to transform suicide prevention strategies and improve mental health outcomes in adolescents.
7 Apr 2026
Read appraisal →Rheumatology international
The effect of structured hand massage on hand function and grip strength in rheumatoid arthritis patients: a randomized controlled pilot study
INTRODUCTION: This study aimed to assess the impact of a 10-session hand massage protocol on hand function, grip strength, pinch strength, pain threshold, and tactile sensory threshold in patients with early-stage, seropositive rheumatoid arthritis (RA) without radiographic damage or hand deformity. METHODS: This study was a randomized controlled clinical trial. Thirty female RA patients with a diagnosis time of less than two years, seropositive, with low disease activity/remission, and without active arthritis in their hands were included in the study. Participants were randomized 1:1 to intervention and control groups. The intervention group underwent 10 hand massage sessions over a two-week period, in addition to regular medical care. The control group received only regular medical care. All assessments were performed at baseline (T1) and at week 2 (T2). Outcome measures included hand grip strength, pinch strength, pain threshold (dolorimetry), tactile sensory threshold (Semmes-Weinstein monofilament test), Duruöz Hand Index (DHI), and patient global assessment (PGA). RESULTS: A total of 30 RA patients were included in the study (intervention group, n = 15; control group, n = 15). At baseline, no significant differences were observed between the groups in demographic, laboratory, or clinical characteristics (p > 0.05). In the intervention group, significant improvements in hand grip strength and pinch force were observed at T2 compared with baseline (p = 0.008 and p = 0.023, respectively). Median hand grip strength increased from 55 (40-75) to 65 (45-80) kg, and median pinch strength increased from 15 (6-18) to 16 (11-21) kg. No significant alterations were noted in these parameters within the control group (p > 0.05). In the control group, median hand grip strength was 45 (25-80) kg at baseline and 45 (20-80) kg at week 2, while median pinch strength was 14 (6-18) kg at baseline and 14 (5-19) kg at week 2. In the intervention group, significant reductions in DHI and PGA scores were recorded at the end of therapy (p = 0.005 and p = 0.001, respectively). No significant differences were noted in DHI and PGA levels in the control group (p > 0.05). Moreover, median PGA scores were significantly lower in the intervention group than in the control group at T2 (4 [2-5] vs. 5 [3-6]; p < 0.001). No significant changes were found in dolorimeter and touch sensory thresholds in either group (p > 0.05). CONCLUSION: Hand massage interventions for patients with RA enhance grip strength, hand function, and overall patient evaluations. No effect on pain or tactile thresholds was observed. Further studies with larger sample sizes and longer follow-up periods are required to corroborate these findings.
6 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
User experiences of digital health interventions among older adults with cancer: a systematic review of qualitative data
PURPOSE: The aim of this review was to synthesize and analyze the results of several qualitative studies to understand the perceptions of older adults with cancer using digital health interventions to manage cancer in a digital context. METHODS: Six databases were systematically queried to identify qualitative studies of digital health interventions in older cancer populations, published from the inception of the databases until December 10, 2024. Studies that met the inclusion and exclusion criteria were selected, and the quality of the literature was assessed according to established guidelines. The results were synthesized using a thematic synthesis approach. RESULTS: A total of 12 papers were included. Three analytic themes emerged, (1) positive experiences, (2) barriers to use, (3) user expectations. The first theme was with three descriptive themes, including "improved self-management," "safe and accessible support," and "better access to health information"; the second theme with three descriptive themes, including "inadequate content design," "technical difficulties," and negative user perceptions and behaviors"; the third theme with two descriptive themes: "enhanced functionality" and "optimized user experience." CONCLUSIONS: This study found that older adults with cancer recognize the benefits of digital health Interventions in improving their health. However, their experiences are influenced by various factors. Patients expressed diverse needs regarding the functionality, information support, and social support aspects of digital health interventions.
6 Apr 2026
Read appraisal →Journal of ethnopharmacology
Evaluation of the association of pseudoaldosteronism with licorice-containing herbal medicine using the Japanese adverse drug event report (JADER) database
ETHNOPHARMACOLOGICAL RELEVANCE: Herbal medicine in Japan is known as Kampo preparation, a traditional medicine that combines multiple medicinal herbs and is widely used in medical practice. Pseudoaldosteronism is an issue associated with herbal medicines that contain licorice. However, the relationship between licorice intake and pseudoaldosteronism is not fully understood and is debatable. AIM OF THE STUDY: This study evaluates the association between herbal medicine preparations containing licorice and pseudoaldosteronism using data from the Japanese Adverse Drug Reaction Reporting System (JADER) database. MATERIALS AND METHODS: The JADER database contained 961,171 reports published between April 2004 and December 2024. The association between herbal medicines and pseudoaldosteronism was evaluated using the pharmacovigilance index as the reporting odds ratio (ROR) and logistic regression models. RESULTS: There were 537 cases of pseudoaldosteronism (PT code: 10037113). The reporting ratio of pseudoaldosteronism was higher in the licorice-containing herbal medicines group than in the overall herbal medicines group. The RORs of the top 20 herbal medicines with the highest number of pseudoaldosteronism reports, all of which contained licorice, exceeded one, and a signal was detected. The risk of pseudoaldosteronism increased with increasing licorice intake. According to the receiver operating characteristic (ROC) curve for pseudoaldosteronism (area under the curve (AUC) = 0.71, sensitivity = 0.8493, 1-specificity = 0.5530), the cutoff value was 1.125 g/day. CONCLUSIONS: This study is the first to clarify the association between licorice intake from herbal medicines and pseudoaldosteronism using Japan's spontaneous adverse event-reporting database. These findings will be useful and informative for medical professionals considering treatments with herbal medicines.
6 Apr 2026
Read appraisal →European journal of cardiovascular nursing
Impact of home-based cardiac rehabilitation in people with heart failure with elevated depressive and anxiety symptoms: a secondary analysis of the REACH-HF randomized trials
AIMS: This study examined whether elevated baseline depression and anxiety moderated the effects of the REACH-HF home-based cardiac rehabilitation (CR) programme on patient outcomes in individuals with heart failure. METHODS AND RESULTS: Individual patient data from 263 patients with HF from the REACH-HF HFrEF and HFpEF trials were analysed. At baseline, 62 (24%) had elevated depression [Hospital Anxiety and Depression Scale (HADS) D > 7], and 86 (33%) had elevated anxiety (HADS-A > 7). Patients were randomized to home-based CR plus usual care or usual care alone. Outcomes at 6-12 months included depression and anxiety (HADS), health-related quality of life (HRQoL) [Minnesota Living with Heart Failure Questionnaire (MLHFQ), HeartQoL], and accelerometer-measured physical activity (PA). Linear regression models, adjusting for baseline values, stratification variables, and confounders, included interaction terms (baseline depression/anxiety ×intervention group) to assess moderation effects. Those with elevated depression showed greater benefits from CR effects in depressive symptoms and HRQoL, with significant interactions for HADS-D (P = 0.004), MLHFQ (P = 0.007), HeartQoL (P = 0.001). No effects were found for PA. In participants with elevated anxiety, significant interactions were observed for HADS-D (P = 0.024), HeartQoL physical (P = 0.04), inactivity (P = 0.02), and light PA (P = 0.04). No effects were found for anxiety symptoms or HRQoL measures. CONCLUSION: People with HF participating in REACH-HF with elevated depression and anxiety experienced greater improvements in their mental health and HRQoL than individuals without elevated symptoms. Diagnostic clinical interviews in future studies would allow for stronger conclusions regarding the impact of home-based CR on patients with confirmed depression or anxiety.
5 Apr 2026
Read appraisal →Chinese medical journal
Efficacy and safety of topical finasteride spray solution in the treatment of Chinese men with androgenetic alopecia: A phase III, multicenter, randomized, double-blind, placebo-controlled study
BACKGROUND: Topical finasteride is a novel treatment for men with androgenetic alopecia (AGA). This study aimed to evaluate the efficacy and safety of topical finasteride spray solution in Chinese men with AGA. METHODS: This randomized, double-blind, placebo-controlled, phase III trial enrolled 270 individuals with AGA from 16 sites across China between December 2021 and March 2023. The participants were randomized at a ratio of 2:1 to receive either topical finasteride or placebo treatment once daily for 24 weeks. The primary endpoint was the change from baseline in target area (0.903 cm 2 area) hair count at week 24. The secondary endpoints were change from baseline in target area hair count at week 12, target area terminal hair count at weeks 12 and 24, target area terminal hair width at week 24, and target area hair width at week 24; an improvement of vertex hair growth assessed by the investigator at week 24; and the patient-assessed scores on the Male Hair Growth Questionnaire at week 24. RESULTS: A total of 270 individuals were enrolled and randomized, and 251 completed the study (165 in topical finasteride group, 86 in placebo group). Compared with the placebo group, in the topical finasteride group, the change from baseline in target area hair count was significantly higher at week 24 ( P <0.05), although it was only numerically higher at week 12 ( P = 0.0688). Significant differences favoring topical finasteride over placebo were observed for change from baseline in target area terminal hair count at weeks 12 ( P <0.05) and 24 ( P <0.01). The improvement of vertex hair growth assessed by the investigator was significantly greater in the topical finasteride group vs. the placebo group at week 24 ( P <0.01). Topical finasteride was generally safe and well-tolerated. CONCLUSIONS: In Chinese men with AGA, topical finasteride spray solution increased hair growth and showed good safety and tolerability profile during a 24-week treatment period. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05135468.
5 Apr 2026
Read appraisal →European journal of cardiovascular nursing
Effect of exercise intensity and volume on mortality and hospitalization in patients with coronary artery disease: a systematic review and pairwise and exploratory network meta-analysis
AIMS: To ascertain the impact of varying exercise intensities and volumes on clinical outcomes of patients with coronary artery disease (CAD) via a systematic review and meta-analysis. METHODS AND RESULTS: This study included randomized controlled trials to evaluate the effects of different intensity levels and volumes of exercise training and control interventions on clinical outcomes in patients with CAD. Data from eight databases were screened, extracted, and assessed for quality by two independent reviewers. Included studies were categorized into subgroups based on exercise intensity and volume. A random-effects model was used to conduct a meta-analysis of different outcomes. To further explore the combined effects, an exploratory network meta-analysis was performed, combining exercise intensity and exercise volume. Exercise training reduces the risk of cardiovascular mortality, overall hospitalization and cardiovascular hospitalization. In subgroup analyses, both moderate-intensity and continuous training significantly reduce the risk of overall hospitalization. Furthermore, the network meta-analysis shows that moderate-intensity continuous training (MICT) significantly lowers the risk of overall hospitalization [(risk ratio (RR) = 0.66, 95% confidence interval (CI): 0.47-0.95), surface under the cumulative ranking curve (SUCRA) = 70.6%] and cardiovascular hospitalization (RR = 0.66, 95% CI: 0.44-0.99, SUCRA = 80.1%) compared with usual care. In contrast to usual care, vigorous-intensity continuous training (VICT) lowers the risk of cardiovascular hospitalization (RR = 0.35, 95% CI: 0.14-0.92, SUCRA = 94.1%). CONCLUSION: MICT significantly reduces the risk of overall hospitalization and cardiovascular hospitalization. Although the evidence is limited, VICT appears to reduce the risk of cardiovascular hospitalization. Consequently, it may become an effective exercise-based intervention for preventing such events. REGISTRATION: PROSPERO: CRD42024519198.
5 Apr 2026
Read appraisal →PloS one
Real-world safety of aliskiren in primary hypertension: A cross-database study
Hypertension is one of the main causes of cardiovascular diseases worldwide, affecting over one billion people. Although aliskiren offers a valuable option for inhibiting the renin-angiotensin system, its safety profile in the real world remains insufficiently explored, especially for rare or under-recognized adverse events (AEs), which have not been fully clarified. Therefore, leveraging large-scale post-marketing surveillance data is crucial for identifying rare AEs and guiding safer clinical practice. This study aims to elucidate pharmacovigilance signals associated with aliskiren (an antihypertensive drug) by systematically analyzing the characteristics of adverse events (AEs) from the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database and WHO-VigiAccess database, which provides a reliable scientific basis for clinical practice and regulatory decision-making. We conducted a retrospective quantitative analysis of aliskiren-related AE reports from the aforementioned two databases, employing the Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS) algorithms for signal detection. The results indicate that there were 5,596 and 5,549 aliskiren-related reports in the FAERS and WHO-VigiAccess databases, respectively. The median duration of these AEs during the observation period was 62 days, with an interquartile range (IQR) of 7-282 days. In both databases, signals for aliskiren were distributed across 28 System Organ Classes (SOCs), among which investigations, cardiac disorders, renal and urinary disorders, vascular disorders, and metabolism and nutrition disorders exhibited significant signals based on specific criteria applied across the four algorithms. A total of 607 preferred terms (PTs) with significant disproportionality signals were detected using the four algorithms, including potential AEs not previously well-documented, such as palpitations, myalgia, proteinuria, muscular weakness, pulmonary edema, and pollakiuria. This study not only confirms the known adverse reactions of aliskiren but also uncovers new potential risks, highlighting the importance of strengthening drug safety monitoring to enhance therapeutic efficacy and reduce the risk of adverse reactions. It provides valuable safety insights for physicians considering the use of aliskiren in the management of primary hypertension.
5 Apr 2026
Read appraisal →BMJ open respiratory research
Associations between respiratory diseases and lung cancer risk: a secondary analysis of the large-scale prospective UK biobank cohort
INTRODUCTION: Respiratory diseases are significant risk factors for lung cancer; however, the association between acute respiratory infections and lung cancer incidence requires further exploration. METHODS: We performed a secondary analysis of the prospective UK Biobank cohort, including participants aged 37-73 years recruited from 22 assessment centres across the UK between 2006 and 2010. Cox proportional hazards models estimated HRs for incident lung cancer according to respiratory disease status, which was defined based on linked hospital inpatient records. Mediation analysis explored potential biomarkers, and Mendelian randomisation assessed causal relationships. RESULTS: During a mean follow-up of 10.44 years (4 790 738 person-years), 2189 participants developed lung cancer. Among 107 007 individuals with respiratory diseases, 1322 cases occurred (incidence rate 27.6 per 10 000 person-years), compared with 867 cases among 351 876 participants without respiratory diseases (7.9 per 10 000 person-years). Overall, respiratory diseases were associated with increased lung cancer risk (HR 2.97, 95% CI 2.75 to 3.21). Acute respiratory infections, including acute nasopharyngitis (HR 3.41; 95% CI 1.83 to 6.34), influenza (HR 3.90; 95% CI 2.53 to 6.01), viral pneumonia (HR 9.86; 95% CI 6.55 to 14.85) and bacterial pneumonia (HR 6.28; 95% CI 4.40 to 8.96), showed strong associations with lung cancer incidence. In subtype analyses, squamous cell carcinoma exhibited the highest risk elevation (HR 3.65; 95% CI 3.06 to 4.36). Mediation analysis indicated that neutrophil counts partially mediated these associations (proportion mediated up to 8%). CONCLUSION: Acute respiratory infections were associated with higher lung cancer incidence, providing hypothesis-generating evidence that may inform future risk stratification research.
5 Apr 2026
Read appraisal →PloS one
Baseline associations between thoracic expansion, respiratory function, and pain in nonspecific low back pain: A cross-sectional analysis from the DIAFRAGMA trial
OBJECTIVE: To examine the associations of respiratory variables (chest and abdominal expansion, spirometry) with pain, lumbar mobility, and quality of life in nonspecific low back pain (NSLBP) using baseline data from the DIAFRAGMA trial. DESIGN: Cross-sectional study using baseline data from a randomized controlled trial. PARTICIPANTS: Fifty subjects (22 females [44%], 28 males [56%]; mean age 45.96 years; BMI 26.97 kg/m²) with NSLBP recruited between January and July 2024. Main measures: Axillary, sternal, and abdominal inspiratory expansion; spirometric parameters (FVC, FEV1); pain via pressure pain thresholds (PPT), Schober test, FFT; and quality of life via SF-12. METHODS: Pearson correlations assessed relationships between respiratory and clinical variables. Multiple linear regression adjusted for age, sex, and BMI. Significance was set at p < 0.05 with Bonferroni correction. RESULTS: Abdominal expansion correlated with FVC (r = 0.45; p < 0.001), FEV1 (r = 0.39; p = 0.003), PEF (r = 0.28; p = 0.03), axillary (r = 0.47; p < 0.001) and sternal expansion (r = 0.58; p < 0.001), PPT at L4 (r = 0.26; p = 0.04) and L5 (r = 0.29; p = 0.02), and SF-12 (r = 0.25; p = 0.04). BMI correlated negatively (r = -0.31; p = 0.02). In regression, abdominal expansion independently predicted pain after adjustment. CONCLUSIONS: Reduced thoracoabdominal expansion and spirometric performance are associated with greater pain and poorer quality of life in NSLBP, supporting the diaphragm's role in low back pain.
5 Apr 2026
Read appraisal →Cancer causes & control : CCC
A preference study for applying mHealth to improve the quality of cervical cancer screening management from a supply and demand perspective: a discrete choice experiment.
OBJECTIVES: This study aims to investigate the preferences of women of cervical cancer screening age regarding the use of mobile health (mHealth) technologies in Xinjiang. The purpose is to enhance adherence and acceptance of mHealth applications, thereby improving the quality of cervical cancer screening follow-up for women residing in rural areas of Xinjiang. METHODS: The attributes and levels were established based on a comprehensive literature review and qualitative interviews. The choice set questionnaire was developed using SAS 9.4 through D-efficiency analysis. The research site was identified using a multi-stage sampling method, and the survey was launched in December 2024. An Optimal Logit model was selected for preference analysis, utilizing Stata 17.0. RESULTS: A total of six attributes were identified through the literature review and subsequently combined with qualitative interviews. The mixed logit regression results indicated that, among the six attributes, five were statistically significant (P < 0.05): mHealth approach, frequency of receiving notifications, reminder content, screening notification time, missionary form, and mission strategy. The results demonstrated a preference for WeChat as the mHealth approach (β = 0.230, P < 0.001, 95%CI 1.214-1.500), not accepting receiving notifications everyday (β = - 0.144, P = 0.001, 95%CI 0.797-0.940), preferred reminders containing positive information (β = 0.159,P = 0.001,95%CI1.068-1.288), opted for screening notifications 1 month in advance (β = 0.208, P < 0.001, 95%CI 1.133-1.339), and preferred the image form of education for missionary form (β = 0.118, P < 0.001, 95%CI 1.102-1.322). CONCLUSION: A one-size-fits-all approach should be avoided in the design of mHealth solutions to effectively address the diverse needs of individuals with varying preferences, thereby promoting the adoption of mHealth and improving the feasibility of its application.
5 Apr 2026
Read appraisal →BMJ global health
Risk and protective factors of depression among caregivers of children with disabilities in rural Rwanda
BACKGROUND: Caregivers of children with disabilities are at increased risk of experiencing poor mental health due to the compound effects of financial and family stressors. This study aims to identify risk and protective factors for poor mental health, particularly depression, among caregivers of young children with disabilities. METHODS: This is a secondary data analysis, including a total of 1518 caregivers who were enrolled at baseline in a cluster randomised trial evaluating the effects of Sugira Muryango, a home-visiting parenting intervention, on early child development and violence prevention outcomes. A total of 309 primary caregivers were identified as having a child aged 12-36 months who screened positive for some form of developmental delay. Associations between key sociodemographic and household characteristics and depression outcomes were explored using multivariable linear regression models. RESULTS: Among the sample of caregivers of children with disabilities, 65% met the clinical cut-off for likely depression. Economic hardship (β=0.158, p<0.001), food insecurity (β=0.009, p<0.01) and caregiver illness (β=0.183, p<0.01) were significant risk factors for depression. In contrast, family unity (β=-0.013, p<0.001) was an important protective factor for depression among these caregivers. Among married/cohabiting caregivers, intimate partner violence (IPV) was associated with higher mean depression scores (β=0.306, p<0.001), though the inclusion of family unity in the full model (inclusive of risk and protective factors) attenuated the impact of IPV on depression. CONCLUSIONS: Programmes targeting children with disabilities should also address the mental health needs of parents. Mental health difficulties are common for caregivers living in poverty, especially those raising a child with a disability or developmental delay. Additionally, parenting programmes that reduce family violence and build family unity should be prioritised by policymakers interested in improving the mental health and well-being of families facing extreme poverty.
5 Apr 2026
Read appraisal →PloS one
Patterns and predictors of variability in patient-generated daily pain severity collected via a mobile health smartphone app.
Digital-health technologies support the collection of patient-generated health data that is frequent, longitudinal, and collected in participant's own environments. Such high-frequency data could detect patterns of variation in disease and associated symptoms, but characterizing, interpreting, and understanding the reasons for this variability remain open questions. Here, we examine 2070 people living with chronic pain to quantify daily variability in pain severity across seven-day periods and identify factors associated with that variability. Data were collected via a smartphone application from a population-based mobile-health study, Cloudy with a Chance of Pain. Summary statistics and distributions of pain changes on consecutive days were calculated within 13,052 complete weeks of data, which had been assigned to one of four clusters via a previously published k-mediods clustering algorithm: no/low pain, mild pain, moderate pain, and severe pain. Cumulative-probit models were used to identify associations between changes in pain severity and changes in exposure data. Across the four clusters, the no/low-pain cluster had the highest proportion of weeks with no within-week changes (59%) in pain severity compared to the other clusters (48-53%). When pain did change, it changed one unit (out of five) about 20% of the time, but larger changes of two to four units also occurred. Changes in pain severity were associated most strongly with changes in pain interference (i.e., how pain impacts daily activities) and were also associated with changes in fatigue, morning stiffness, mood, and participant well-being. Thus, this study showed that data collected frequently through digital-health technologies can be used to explore variability in symptoms and their associations with other variables. That pain severity was associated with changes in modifiable variables (e.g., fatigue, mood) suggests opportunities for different treatment and self-management regimes for different patient subtypes within the four clusters.
5 Apr 2026
Read appraisal →Annals of medicine
An explainable online frailty prediction model for community-dwelling older adults based on machine learning algorithms: a cross-sectional study based on retrospective health data
BACKGROUND: Frailty is a significant health concern associated with diminished physiological reserves and increased healthcare burdens. Currently, effective models for predicting frailty risk are lacking. This study utilizes machine learning-based models to early identify community-dwelling older adults, enhancing risk assessment accuracy and guiding targeted interventions to slow frailty progression. METHODS: A cross-sectional analysis of data from 1,156 older adults across 31 community health centers in Nanjing, conducted between January and October 2024, was performed. Independent predictors of frailty were identified using univariate analysis and the least absolute shrinkage and selection operator. The dataset was divided into 70% training and 30% testing subsets. Six machine learning (ML) models were developed and their performances compared. The SHapley Additive exPlanations (SHAP) method was applied to interpret the models, and a web-based risk calculator was created. RESULTS: Our dataset showed that 22.3% of older adults were frail. Significant predictors of frailty were identified as age, education, medicine, vegetable, cognitive status, number of diseases, hemoglobin, total cholesterol, and neutrophil-to-lymphocyte ratio. Among the six ML models, Categorical Boosting (CatBoost) exhibited the highest performance, attaining an AUROC of 0.886 in the training set and 0.831 in the testing set. CONCLUSIONS: The developed CatBoost model and web calculator can be employed by general practitioners to proactively identify high-risk community-dwelling older adults, thereby enabling timely interventions to mitigate the progression of frailty. The tool's simplicity and replicability effectively facilitate the promotion and management of frailty prevention within the community. An effective model was developed to predict frailty risk in community-dwelling older adults.The integration of biomarkers and self-reported data enhances frailty prediction and optimizes risk-based intervention strategies.The CatBoost model demonstrates superior predictive performance compared to other models.The web-based tool integrates a frailty prediction model for proactive risk management.
5 Apr 2026
Read appraisal →PloS one
Safety and efficacy of Vectored thermal pulsation, Intense pulsed light, and Eyelid Warm compress therapies (VIEW) for meibomian gland dysfunction: Study design and baseline characteristics of a randomized controlled trial
BACKGROUND: Meibomian gland dysfunction (MGD) is one of the most prevalent chronic eye diseases, characterized by meibomian gland obstruction and abnormal meibum secretion both in quantity and quality. OBJECTIVE: To assess the efficacy and safety of vectored thermal pulsation (VTP), intense pulsed light plus meibomian gland expression (IPL + MGX), and eyelid warm compress (EW). METHODS: This is a 3-arm, assessor-masked, randomized controlled trial. 360 symptomatic mild to moderate MGD subjects would be recruited and randomized into 3 intervention groups. Subjects from Group-A, Group-B, and Group-C would be treated with one-session VTP (at baseline), four-session IPL + MGX (at baseline, month-1, month-2, and month-3 visits), and twice-daily EW for 15 months, respectively. All subjects would be prescribed topical artificial tears (Hypromellose, 0.3% w/v) to be used as frequently as needed from wash-out (1 month before baseline) to endpoint (month-15 visit). Subjects would be assessed 9 times throughout a total of 16-month study period. Five self-administered questionnaires would be collected each time in random order. Masked observers would conduct examinations using slit-lamp biomicroscopy, LipiView® II, and Keratograph 5M machines. The eye with worse MGD would be selected and analyzed as the study eye. Tear film break-up time (TFBUT) at month-6 and month-15 visits are the primary outcomes. RESULTS: 374 subjects were enrolled and randomized into three groups, and 372 subjects (aged 54.4 ± 14.7 years) were finally analyzed. The mean of TFBUT time at baseline was 3.1 ± 1.7 seconds. CONCLUSION: This is the first head-to-head comparison of three physical treatments for mild to moderate MGD on their therapeutic efficacy, safety, longevity and compliance in a randomized controlled trial setting.
5 Apr 2026
Read appraisal →Journal of behavioral addictions
When rejection backfires: Social exclusion and economic decision-making in gamblers
BACKGROUND AND AIMS: Economic decision-making deviates from rational choice models and is influenced by social factors, particularly fairness considerations and belonging needs. Social exclusion and altruistic punishment are intended to promote behavioral conformity, yet paradoxically may exacerbate rather than correct targeted behaviors among individuals with addictions already experiencing chronic rejection. Several preliminary studies show that social exclusion increases money desirability in general populations, however, the interaction between acute social exclusion and economic decision-making among individuals with gambling disorders (PGs)-marked by aberrant financial decision-making-remains unexplored. METHODS: In a field study, 203 gamblers were recruited outside gambling venues and randomized to experience either social inclusion or exclusion via Cyberball, a virtual ball-tossing paradigm. Participants then completed an ultimatum game, making accept/reject decisions on fair and unfair monetary offers, followed by the Problem Gambling Severity Index. RESULTS: Social exclusion increased unfair offer acceptance among PGs but had no effect on low- and moderate-risk gamblers. PGs accepted more unfair offers following exclusion than inclusion. Gambling severity had no effect on unfair offers acceptance. Neither social exclusion nor gambling severity affected fair offer acceptance. DISCUSSION AND CONCLUSIONS: Social exclusion triggered utilitarian decision-making only among PGs. This selective effect suggests rejection compromises PGs' economic decision-making processes, shifting priorities toward immediate monetary gains over equitable outcomes. These findings reveal how social punishment creates self-reinforcing cycles where exclusion triggers the utilitarian mindset characterizing problematic gambling. Treatment and societal approaches relying on social consequences may inadvertently strengthen harmful patterns, highlighting the need for inclusion-based interventions.
5 Apr 2026
Read appraisal →BMJ open
Development and acceptability of a patient decision aid for people with degenerative cervical myelopathy: an international mixed-methods study
OBJECTIVES: To develop and user-test a patient decision aid for people diagnosed with degenerative cervical myelopathy and who are considering surgery. DESIGN: Mixed-methods study describing the development of a patient decision aid. SETTING: A draft decision aid was developed by a multidisciplinary steering group (including study authors with degenerative cervical myelopathy, health professionals and researchers) informed by the best available evidence, authorship consensus and existing patient decision aids. PARTICIPANTS: Patient-participants and health professional-participants who manage people with degenerative cervical myelopathy were recruited through social media and the steering group's research and practice network. Quantitative questionnaires were used to gather baseline data, descriptive feedback, refine the decision aid and assess its acceptability. Qualitative semi-structured interviews were conducted online to gather feedback on the decision aid and were analysed using reflexive thematic analysis. RESULTS: We conducted 32 interviews: 19 patient-participants and 13 health professional-participants who manage people with degenerative cervical myelopathy (neurosurgeons, neurologists, physiotherapists, orthopaedic surgeons, general practitioners, rehabilitation and pain specialists and consultant occupational physicians and chiropractors). Participants were from 10 countries (Australia, Canada, Cyprus, Germany, Ireland, New Zealand, Sweden, Switzerland, United Kingdom and USA). Most participants rated the decision aid's acceptability as good-to-excellent and agreed with most aspects of the decision aid (eg, defining degenerative cervical myelopathy, management recommendations, potential benefits and harms, questions to consider asking a health professional). CONCLUSION: Our patient decision aid was rated as an acceptable tool by both health professional-participants who treat degenerative cervical myelopathy and patient-participants with lived experience of degenerative cervical myelopathy. This decision aid can be used by clinicians and people with degenerative cervical myelopathy to help with shared decision making following a diagnosis of degenerative cervical myelopathy. A study testing the potential benefits of this decision aid in a clinical setting is recommended.
5 Apr 2026
Read appraisal →Open heart
Women's IschemiA TRial to Reduce Events In Non-ObstRuctive CAD (WARRIOR): a randomised controlled trial
IMPORTANCE: Women with angina due to suspected ischaemia referred for coronary angiography often have no obstructive coronary artery disease (ANOCA/INOCA). OBJECTIVE: To determine if intensive medical treatment (IMT) reduces major ischaemic events (major adverse cardiovascular event, MACE) among women with suspected ANOCA/INOCA. DESIGN: Randomised, prospective, blinded-outcomes evaluation. SETTING: 71 sites in the USA. PARTICIPANTS: 2476 women with suspected ANOCA/INOCA. INTERVENTIONS: IMT-high intensity statin, ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) and aspirin versus usual care (UC). MAIN OUTCOMES AND MEASURES: Primary: all cause death, myocardial infarction, stroke/transient ischaemic attack, hospitalisation for angina or heart failure (MACE). Secondary: components of the primary, quality of life and win ratio. RESULTS: Recruitment was lower than planned (n=2476), yielding an aged population (mean, 64 years) with well-controlled blood pressure and low-density lipoprotein cholesterol at baseline, and relatively high rates of statin and ACEI/ARB use. At 2.5 years, 421 events occurred (221 in IMT, 200 in UC) with no difference in the primary outcome (HR=1.13 (95% CI 0.94 to 1.37) for IMT vs UC, p=0.20) or secondary outcomes. Hospitalisations for angina were the dominant contributor to MACE. Sensitivity analysis of contamination provided an estimated HR for IMT versus UC of 0.74 95% CI (0.352 to 1.558), p=0.43. CONCLUSIONS AND RELEVANCE: Among women with suspected ANOCA/INOCA, outcomes were dominated by chest pain and IMT did not improve outcomes, although limited power precludes concluding that it may not be helpful. The findings support the need for more investigation in this population with high burden of angina hospitalisation, health resource consumption and poor quality of life. TRIAL REGISTRATION NUMBER: NCT03417388.
4 Apr 2026
Read appraisal →BMJ paediatrics open
Mapping the global prevalence and socioecological drivers of child sexual abuse: a systematic review and synthesis
INTRODUCTION: Child sexual abuse (CSA) is a widespread global health concern with lasting impacts. CSA is multifactorial and layered, and interventions to tackle CSA require an analysis of the key contributing factors. The main objective of this study was to explore global prevalence estimates of CSA and key contributing factors. METHODS: We systematically searched PubMed, Scopus and Web of Science for studies reporting lifetime prevalence of contact (eg, inappropriate touching or sexual acts) and non-contact (eg, exposure to sexual content or ill-intended conversations) CSA. Of 5493 articles screened, 332 met inclusion criteria. Prevalence data were stratified by population, region and abuse type. Risk factors were synthesised thematically using a socioecological framework. RESULTS: Median prevalence of reported non-contact CSA was 57.0% (range: 31.1%-80.0%). Contact CSA prevalence was higher among females (median: 14.9%, range: 2.2%-40.2%) than males (median: 6.0%, range: 0.6%-21.2%). Regional variations were notable, with sub-Saharan Africa reporting the highest contact CSA prevalence (median: 25.5%) and Latin America and the Caribbean the lowest (median: 8.5%). Vulnerable groups, including Indigenous children (median: 39.2%), orphans (37.9%) and the incarcerated (31.1%), faced higher risk. Risk factors spanned individual (shame, stigma), familial (poor supervision, dysfunction), institutional (lack of safeguards) and societal (weak legal frameworks, normalisation of abuse) levels. CONCLUSIONS: Prevalence of CSA was globally high, with 14 in 100 females reporting having experienced CSA. Multilevel interventions, particularly strengthening family supervision and institutional safeguarding, legal accountability and community awareness, are critical for the prevention of CSA.
4 Apr 2026
Read appraisal →Sexual medicine reviews
Internet-based cognitive behavioral therapy, web-based counseling, and online/digital psychoeducation for male sexual dysfunction: a systematic review
INTRODUCTION: Male sexual dysfunctionhas a substantial impact on psychological well-being and intimate partner relationships. The expanding availability of digital health services has enabled online interventions, such as internet-based cognitive behavioral therapy (ICBT), digital psychoeducation, and web-based counseling, to emerge as alternatives to conventional therapies. OBJECTIVE: To evaluate the effectiveness, feasibility, and acceptability of digital and online interventions for male sexual dysfunction, and to synthesize evidence from randomized, non-randomized, and observational studies on clinical outcomes and patterns of digital engagement. METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted across several databases using predefined keywords. Eligible studies included randomized controlled trials, experimental studies, and analytical observational studies published between 2007 and 2024. Extracted data comprised country, participant characteristics, type and duration of intervention, control conditions, outcome measures, and main findings. The primary outcome was improvement in erectile/sexual function using certain parameters, while secondary outcomes included relationship satisfaction, anxiety, and depression. RESULTS: Of 2482 records identified, and 21 met the inclusion criteria. Overall, web-based ICBT and psychoeducational interventions improved erectile function and sexual satisfaction compared with control conditions. Most interventions lasted 6-12 weeks and incorporated therapist feedback or automated systems. Remission rates for erectile dysfunction ranged from 20% to 30%; however, participant adherence was low (<60%). Several studies also reported reductions in performance anxiety and improvements in sexual confidence, with no serious adverse effects. CONCLUSION: Online interventions are promising approaches for managing male sexual dysfunction. Nevertheless, low adherence rates and heterogeneity in intervention formats remain major challenges. The findings also suggest heterogeneous benefits of digital interventions, alongside improved accessibility, reduced stigma, and increased engagement in help-seeking among men with sexual dysfunction. Future research should prioritize strategies to enhance adherence, integrate mobile health technologies, and assess long-term outcomes through large-scale clinical trials.
4 Apr 2026
Read appraisal →Journal of psychosomatic obstetrics and gynaecology
The effect of Snyder's hope theory-based psychological intervention on post-traumatic growth in chinese women experiencing perinatal loss: a randomised controlled trial
OBJECTIVE: To evaluate a Snyder's hope theory-based psychological intervention for promoting post-traumatic growth (PTG) in women after perinatal loss. METHODS: This single-blind randomised controlled trial enrolled 140 women (≥20 years) who had experienced perinatal loss. Participants were randomised to an intervention group (n = 70, four weekly hope-based sessions plus routine care) or a control group (n = 70, routine care only). The primary outcome was PTG, with secondary outcomes including grief, hope and post-traumatic stress symptoms. Assessments were conducted at baseline, post intervention and at 1-month follow-up. RESULTS: The intervention group demonstrated significantly greater improvements in PTG than the control group (post intervention: 69.4 ± 10.2 vs 58.3 ± 11.9; follow-up: 71.9 ± 9.6 vs 59.5 ± 11.0; both p < 0.001), with a large effect size (Cohen's d = 1.21). Significant benefits were also observed in grief reduction, hope enhancement and reductions in trauma-related symptoms (all p < 0.001). Regression analysis identified post-intervention hope as a robust predictor of PTG (β = 0.44, p < 0.001). CONCLUSIONS: Snyder's hope theory-based intervention effectively promoted PTG and improved psychological outcomes in women experiencing perinatal loss. This approach represents a promising therapeutic framework for supporting women through the complex process of moving from trauma to growth following perinatal loss.
4 Apr 2026
Read appraisal →JMIR mental health
AI Chatbots for Mental Health Self-Management: Lived Experience-Centered Qualitative Study
BACKGROUND: Large language models (LLMs) now enable chatbots to engage in sensitive mental health conversations, including depression self-management. Yet their rapid deployment often overlooks how well these tools align with the priorities of people with lived experiences, which can introduce harms such as inaccurate information, lack of empathy, or inadequate crisis support. OBJECTIVE: This study explores how people with lived experience of depression experience an LLM-based mental health chatbot in self-management contexts, and what perceived benefits, limitations, and concerns inform harm-mitigating design implications. METHODS: We developed a technology probe (a GPT-4o-based chatbot named Zenny) designed to simulate depression self-management scenarios grounded in prior research. We conducted interviews with 17 individuals with lived experiences of depression, who interacted with Zenny during the session. We applied qualitative content analysis to interview transcripts, notes, and chat logs using sensitizing concepts related to values and harms. RESULTS: We identified 3 themes shaping participants' evaluations: (1) informational accuracy and applicability, including concerns about incorrect or misleading information, vagueness, and fit with personal constraints; (2) emotional support vs need for human connection, including validation and a judgment-free space alongside perceived limits of machine empathy; and (3) a personalization-privacy dilemma, where participants wanted more tailored guidance while withholding sensitive information and using privacy-preserving tactics. CONCLUSIONS: People with lived experience of depression evaluated LLM-based mental health chatbots through intertwined priorities of actionable information, emotional validation with clear limits, and personalization that does not require unsafe data disclosure. These findings suggest concrete design strategies to mitigate harms and support LLM-based tools as complements to, rather than replacements for, human support and recovery.
4 Apr 2026
Read appraisal →The Cochrane database of systematic reviews
Pharmacotherapy for mild hypertension
RATIONALE: This is an update of a Cochrane review published in 2012 of initiation of antihypertensive monotherapy or step-up therapy in people with untreated mild hypertension (systolic blood pressure 140 to 159 mmHg or diastolic blood pressure 90 to 99 mmHg, or both) and no pre-existing cardiovascular disease. The original review demonstrated no difference in the incidence of all-cause mortality, total cardiovascular events (stroke, myocardial infarction, and congestive heart failure), stroke incidence, coronary heart disease, or withdrawal due to adverse effects (WDAEs). Evidence for antihypertensive pharmacotherapy in people with mild hypertension for primary prevention remains uncertain in the literature with conflicting studies. We therefore performed an update of the original Cochrane review to reassess whether initiation of antihypertensive pharmacotherapy compared to placebo or no treatment in people with untreated mild hypertension and no pre-existing cardiovascular disease reduces the risk of all-cause mortality, total cardiovascular events, stroke, coronary heart disease, or WDAEs. OBJECTIVES: To reassess the efficacy and risks of initiating antihypertensive pharmacotherapy in adults with untreated mild hypertension and no pre-existing cardiovascular disease. The primary objective was to reassess the risk of all-cause mortality and total cardiovascular events (defined as fatal and non-fatal strokes, myocardial infarction, and congestive heart failure). The secondary objectives were to reassess the risk of stroke (fatal and non-fatal), coronary heart disease (fatal and non-fatal myocardial infarction and sudden cardiac death), and WDAEs. SEARCH METHODS: We searched the Cochrane Hypertension Specialised Register, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform from inception to June 2024. ELIGIBILITY CRITERIA: We included randomized controlled trials (RCTs) of at least one-year duration comparing initiation on antihypertensive monotherapy or step-up therapy, or both, versus placebo or no treatment in participants with mild hypertension and no pre-existing cardiovascular disease. OUTCOMES: Our critical outcomes were all-cause mortality and total cardiovascular events. Important outcomes were stroke, coronary heart disease (fatal and non-fatal myocardial infarction and sudden cardiac death), and WDAEs. RISK OF BIAS: Two review authors assessed risk of bias independently and in duplicate using Cochrane's RoB 1 tool. SYNTHESIS METHODS: Two review authors performed title and abstract screening, full-text review, and data extraction independently and in duplicate. We calculated risk ratio (RR) along with 95% confidence interval (CI) for all-cause mortality, total cardiovascular events, stroke events, coronary heart disease events, and WDAEs with the Mantel-Haenszel test and a fixed-effect model. We assessed the certainty of the evidence using the GRADE approach. INCLUDED STUDIES: We included individual patient data from five trials involving a total of 9124 participants, of whom 4593 received antihypertensives and 4531 received placebo or no treatment. All five trials reported all-cause mortality; four trials reported total cardiovascular events and strokes; three trials reported coronary heart disease; and one trial reported WDAEs. SYNTHESIS OF RESULTS: There may be little to no reduction in all-cause mortality (RR 0.85, 95% CI 0.64 to 1.14; 5 trials, 9124 participants; low-certainty evidence), total cardiovascular events (RR 0.93, 95% CI 0.69 to 1.24; 4 trials, 7292 participants; low-certainty evidence), or coronary heart disease (RR 1.12, 95% CI 0.80 to 1.57; 3 trials, 7080 participants; low-certainty evidence). There may be a decreased risk of stroke (RR 0.41, 95% CI 0.20 to 0.84; 4 trials, 7292 participants; low-certainty evidence) and an increase in WDAEs (RR 4.80, 95% CI 4.14 to 5.57; 1 trial, 17,354 participants [aggregate trial-level data; individual patient data unavailable]; low-certainty evidence) with antihypertensives. We downgraded the certainty of evidence for all outcomes due to imprecision, indirectness, and risk of bias. AUTHORS' CONCLUSIONS: In people with untreated mild hypertension and no pre-existing cardiovascular disease, initiation of antihypertensive monotherapy or step-up therapy may not reduce all-cause mortality, total cardiovascular events, or coronary heart disease compared to those who received placebo or no treatment. There may be a reduction in stroke, but possibly also an increase in WDAEs. FUNDING: CIHR Grant to the Hypertension Review Group and British Columbia Ministry of Health Grant to the Therapeutics Initiative. REGISTRATION: Protocol (2007): doi.org/10.1002/14651858.CD006742. Original review (2012): doi.org/10.1002/14651858.CD006742.pub2.
4 Apr 2026
Read appraisal →Journal of medical Internet research
Effectiveness of the Components of a Digital Multiple Health Behavior Change Intervention Among Individuals Seeking Help Online (Coach): Factorial Randomized Trial
BACKGROUND: Extant digital multiple health behavior change interventions have shown promise in various populations; however, evidence for a broader approach among the general population is lacking. Moreover, existing interventions often contain several components but are typically assessed as a whole, meaning it remains unclear to what extent individual components contribute to intervention effects and how they may interact to influence health outcomes. OBJECTIVE: This study estimates the effects of 6 components of a digital health behavior change intervention on alcohol, diet, physical activity, and smoking outcomes among individuals searching for help online. METHODS: A double-blind randomized factorial trial design with 6 two-level factors was used. Adults from the general public in Sweden who were seeking help to change their behaviors were recruited through web searches and social media. Participants were eligible if they were 18 years or older and had at least one health behavior classified as unhealthy. Effects of 6 components were estimated: screening/feedback, goal-setting/planning, motivation, skills/know-how, mindfulness, and self-authored SMS text messages. Primary outcomes were weekly alcohol consumption and frequency of heavy episodic drinking, average daily fruit and vegetable consumption, weekly moderate-to-vigorous physical activity, and 4-week point-prevalence smoking. RESULTS: A total of 5419 individuals were randomized. Overall, the screening/feedback component was the most effective for changing health behaviors, along with goal-setting/planning and motivation to change. In particular, there was evidence that screening/feedback increased average daily portions of fruit and vegetables at 2 months (mean difference 0.17, compatibility interval [CoI] 0.09-0.25, probability of effect [POE] >99.9%) and at 4 months (mean difference 0.13, CoI 0.04-0.21, POE 99.9%) and reduced the frequency of heavy episodic drinking at 4 months (incidence rate ratio 0.91, CoI 0.81-1.03, POE 94.2%). Components also interacted to further improve health outcomes, most notably the combination of screening/feedback with motivation to change, which further increased fruit and vegetable consumption (2 months: mean difference 0.20, CoI 0.09-0.30, POE >99.9%; 4 months: mean difference 0.17, CoI 0.05-0.29, POE 99.8%). CONCLUSIONS: The results from this study contribute to the development of more effective interventions by providing novel insights into the effects of individual and pairwise components of complex digital health behavior change interventions. TRIAL REGISTRATION: ISRCTN Registry ISRCTN16420548; http://www.isrctn.com/ISRCTN16420548. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2022-061024.
4 Apr 2026
Read appraisal →Journal of medical Internet research
The Role of Digital Biomarkers in Physiological Signal-Based Depression Assessment: Systematic Review and Meta-Analysis
BACKGROUND: Digital biomarkers are increasingly being used to support depression assessment by providing objective, continuous, and real-time physiological and behavioral data. However, most existing studies have focused on individual biomarkers, such as sleep or cardiac parameters, while integrative evaluations that capture the multidimensional nature of depression remain limited. OBJECTIVE: This systematic review evaluated digital biomarkers for depression and synthesized evidence on differences between individuals with depression and controls. METHODS: Eligible studies included observational or interventional studies examining digital biomarkers for depression with validated outcome measures. We searched major international and Korean databases, including MEDLINE, PsycINFO, CINAHL, IEEE Xplore, Web of Science, Cochrane Library, KISS, RISS, KMbase, and KoreaMed, from inception to December 28, 2025. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Scottish Intercollegiate Guidelines Network checklist. Meta-analyses were conducted using random-effects models with the Hartung-Knapp-Sidik-Jonkman method, and other outcomes were narratively summarized. RESULTS: The search yielded 39,617 records, of which 132 studies involving 57,852 participants met the inclusion criteria. These studies encompassed various digital biomarkers, including sleep, physical activity, cardiac measures, smartphone-derived data, speech, GPS data, and circadian rhythms. A meta-analysis of 22 studies (6947 participants) revealed that individuals with depression had significantly longer sleep onset latency (5 studies; n=292; +4.75 min, 95% CI 2.46-7.04; P=.005; 95% prediction interval [PI] 0.01-10.27) and time in bed (3 studies; n=236; +31.81 min, 95% CI 18.22-45.39; P=.01; 95% PI 2.28-55.16). Physical activity counts were also significantly lower (5 studies; n=462; standardized mean difference -0.71, 95% CI -1.33 to -0.09; P=.03; 95% PI -2.18 to 0.71). Although individuals with depression showed a lower sleep efficiency, higher mean heart rate, and lower SD of normal-to-normal intervals, these differences were not statistically significant. Other digital markers yielded inconsistent results. Overall, these findings indicate that no single digital biomarker sufficiently captures depression-related changes. Instead, the results support the superiority of personalized, multimodal approaches. However, the generalizability of these findings is limited by the lack of standardized data collection protocols and high clinical heterogeneity across studies, as reflected in wide PIs. CONCLUSIONS: Certain digital biomarkers, particularly sleep onset latency and physical activity counts, showed consistent average differences between the depression and control groups. However, wide PIs indicate substantial variability across settings, suggesting that no single marker is sufficient for reliable detection. This study advances the field by providing a comprehensive meta-analysis of multidimensional digital biomarkers, establishing a quantitative foundation for objective depression screening and monitoring. These findings support the use of personalized, multimodal digital phenotyping approaches and highlight the need for standardized, clinically interpretable frameworks for real-world depression monitoring.
4 Apr 2026
Read appraisal →Quintessence international (Berlin, Germany : 1985)
The association between concurrent oral cancer and periodontal disease: a systematic review and meta-analysis
OBJECTIVE: Since emerging studies have reported a positive association on oral cancer and periodontal disease, the present study aimed to evaluate the odds ratio of having concurrent oral cancer in patients with periodontal disease. METHOD AND MATERIALS: A systematic review following the PRISMA guidelines was conducted with three electronic databases. The inclusion criteria were structured according to the PECOS framework: (P) Human subjects aged over 18; (E) Patients with periodontal disease; (C) Individuals without periodontal disease; (O) The odds of patients developing oral and/or head and neck cancers; (S) Case-control studies. After screening, 18 clinical studies from 13 different regions, comprising a total of 31,504 participants, were included. RESULTS: A meta-analysis was performed and revealed that the odds ratio for developing oral cancer in patients with periodontal disease, compared to those without, was 3.35 (95% CI 2.63-4.26; P .001). After adjusting for potential confounding factors, the adjusted odds ratio was found to be 2.32 (95% CI 1.71-3.15; P .001). Case definition also has an impact, with odds ratio of 2.02 if using missing teeth compared to odds ratio of 2.68 by using American Academy of Periodontology clinical periodontal parameters. CONCLUSION: Clinical considerations for this specific group of patients should draw new attention for a strategic interdisciplinary care.
4 Apr 2026
Read appraisal →The New England journal of medicine
Discontinuation of Beta-Blocker Therapy after Myocardial Infarction
BACKGROUND: The role of long-term beta-blocker therapy after a myocardial infarction in patients without left ventricular systolic dysfunction or heart failure is unclear in the era of contemporary coronary-artery reperfusion and secondary prevention interventions. METHODS: We conducted an open-label, randomized, noninferiority trial at 25 centers in South Korea. Patients whose condition remained stable after a myocardial infarction, who had a left ventricular ejection fraction of at least 40% and no heart failure, and who had received beta-blocker therapy for at least 1 year after the myocardial infarction were randomly assigned in a 1:1 ratio to discontinue or to continue beta-blocker therapy. The primary end point was a composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure. The prespecified noninferiority margin was an upper limit of the 95% confidence interval for the hazard ratio of 1.4. RESULTS: A total of 2540 patients underwent randomization; 1246 were assigned to beta-blocker discontinuation and 1294 to beta-blocker continuation. The mean age of the patients was 63.2 years, and 12.8% were women. At a median follow-up of 3.1 years (interquartile range, 2.5 to 3.5), a primary end-point event had occurred in 58 patients (4-year Kaplan-Meier estimate, 7.2%) in the discontinuation group and in 74 patients (4-year Kaplan-Meier estimate, 9.0%) in the continuation group (hazard ratio, 0.80; 95% confidence interval, 0.57 to 1.13; P = 0.001 for noninferiority). The incidence of serious adverse events was similar in the two groups. CONCLUSIONS: Among patients who received beta-blocker therapy beyond the first year after a myocardial infarction, discontinuation of beta-blocker therapy was noninferior to continuation with respect to a composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure. (Funded by Patient-Centered Clinical Research Coordinating Center in the Ministry of Health and Welfare, South Korea; SMART-DECISION ClinicalTrials.gov number, NCT04769362.).
4 Apr 2026
Read appraisal →Journal of diabetes investigation
A machine learning approach to predicting severe diabetes distress in adults with type 1 diabetes mellitus.
BACKGROUND: Diabetes distress is common in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to construct and validate prediction models for diabetes distress in adults with T1DM using continuous glucose monitoring (CGM) metrics. METHODS: The CGM metrics were collected from 259 adults with T1DM. Severe diabetes distress was defined as 40 points on the Problem Areas in Diabetes scale. Prediction models were developed based on ten machine learning algorithms: random forest (RF), support vector machine (SVM), Naive Bayes (NB), Neural Network (NN), k-nearest neighbor (k-NN), XGBoost (XGB), SGDClassifier (SGDC), XGB_limitet_depth (CGB_ld), L1LogisticRegression (L1), and LightGBM. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, precision, recall, and F1 score. RESULTS: Among the ten models, accuracy in the NN model was the highest (NN: 0.744, L1: 0.731, NB: 0.718, SVM: 0.692, SGDC: 0.654, RF: 0.628, k-NN: 0.628, LightGBM: 0.615, XGBoost: 0.564, and XGB_ld: 0.564). The NN model achieved the highest AUC of 0.728 (95% confidence interval: 0.608-0.845). CONCLUSIONS: This study developed a predictive model for severe diabetes distress using machine learning, incorporating both demographic and CGM metrics in adults with type 1 diabetes mellitus. The NN model demonstrated potential as a practical tool to assist clinicians in identifying individuals at risk of severe diabetes distress.
4 Apr 2026
Read appraisal →Respiratory medicine
A review of artificial intelligence-based research on chronic obstructive pulmonary disease.
In recent years, with the rapid development of artificial intelligence (AI), Chronic Obstructive Pulmonary Disease (COPD), one of the world's three major chronic diseases, has achieved remarkable progress in diagnosis, grading, and prognosis, which is of great significance for promoting the clinical transformation of respiratory diseases. To deeply explore the application of AI in the diagnosis and management of COPD, this paper reviews recent studies based on machine learning and deep learning, covering screening and diagnosis, disease grading and assessment, disease management and monitoring, and treatment. First, the technical basis of COPD-related research is analyzed from five perspectives: traditional research methods, supervised learning, unsupervised learning, semi-supervised learning, and reinforcement learning. Then, the commonly used datasets and model evaluation metrics are summarized. Finally, the application scenarios of AI in COPD research are elaborated, focusing on three aspects: early screening and diagnosis, disease monitoring and risk prediction, and disease classification and risk stratification. This paper summarizes the main research hotspots at home and abroad over the past five years with representative models, and analyzes and compares the advantages and limitations of each type of model in specific COPD tasks through comparative experiments. The study also outlines prospects for the future development of this field, aiming to provide theoretical references and insights for subsequent research.
4 Apr 2026
Read appraisal →JMIR research protocols
Development and Validation of Machine Learning Models for Predicting Early Cognitive Decline Using Home Sensor-Derived Behavioral Data: Sensors in-Home for Elder Wellbeing (SINEW) Cohort Study
BACKGROUND: As the global population continues to age, the prevalence of geriatric conditions, including dementia and frailty, is also increasing. Early identification of individuals at an elevated risk of these conditions, such as those presenting with mild cognitive impairment (MCI) or prefrailty, can provide a critical window for prompt intervention aimed at preventing or reversing disease progression. To promote such early identification, there is a burgeoning interest in the use of digital sensor technology and predictive modeling. OBJECTIVE: This study aimed to use a continuous, home-based monitoring sensor system for older adults to distinguish those exhibiting normal aging from those with MCI, early dementia, prefrailty, or frailty, and to predict their transition from normal aging to one of these conditions. METHODS: This longitudinal cohort study will recruit 200 community-dwelling adults aged ≥65 years with normal cognition or MCI at baseline. A multi-sensor system will be installed in participants' homes, including passive infrared motion sensors, door contact sensors, bed sensors, medication box sensors, wearable activity bands, and Bluetooth proximity beacons. These devices will continuously capture spatiotemporal activity patterns, mobility indicators, sleep behaviors, and medication-taking routines. Annual assessments will include standardized cognitive tests (eg, Montreal Cognitive Assessment, Mini-Mental State Examination, Rey Auditory-Verbal Learning Test, digit span, Color Trails Test, semantic fluency, Stroop), frailty measures (modified Fried phenotype, gait speed, grip strength), mental health scales, sleep quality, and psychosocial indicators. Sensor-derived features-such as gait variability, activity regularity, sleep fragmentation, and medication adherence patterns-will be integrated with clinical data to develop supervised machine learning models. Planned approaches include logistic regression, random forests, gradient boosting, and deep learning. Model performance will be evaluated using cross-validation and independent test sets. Primary metrics will include area under the receiver operating characteristic curve, sensitivity, specificity, precision, recall, and F1-score. Models will be benchmarked against gold-standard clinical diagnoses and validated using temporal subsets of the dataset. RESULTS: Enrollment for this study started in November 2019 and will continue until March 2030. As of June 2025, we have enrolled 138 participants. Full data analysis has yet to begin. CONCLUSIONS: We aim to develop a reliable and effective sensor system for in-home use that will facilitate the early detection of cognitive and physical decline. In so doing, it will add to our current understanding of digital biomarkers. It is common for older adults to seek clinical intervention only when their cognitive impairment has already reached an advanced stage. The implementation of readily deployable sensor systems within community settings presents us with opportunities for prompt intervention, which holds the potential for delaying or reversing disease progression and allowing for a greater number of functional and meaningful years.
4 Apr 2026
Read appraisal →BMJ open
Use of ambient AI scribe in physicians' clinical documentation: a protocol for a systematic review on effectiveness, efficiency, and satisfaction
INTRODUCTION: Clinical documentation is a significant driver of burnout among physicians. Ambient artificial intelligence (AI) scribes, which leverage generative large language models to automate the creation of clinical notes from patient-physician conversations, are rapidly emerging as a potential solution. While these tools promise to enhance efficiency and reduce administrative tasks, concerns about the quality, accuracy and potential biases persist. There is now a need for a systematic synthesis of evidence to evaluate the impact of these technologies in clinical practice. To assess the effects of ambient AI scribes on physicians' clinical documentation, the specific objectives are to: (1) evaluate the effectiveness of these tools on documentation, including accuracy and completeness; (2) synthesise evidence on the impact on physician efficiency after adoption, including time spent on documentation and (3) examine physicians' satisfaction with these tools, including physicians' perceived burden. METHODS AND ANALYSIS: A systematic review of quantitative or mixed-method studies as well as preprints will be conducted. We will perform a comprehensive search of four electronic databases (PubMed, IEEE Xplore, APA PsycInfo and Web of Science, along with medRix and ClinicalTrials.gov for preprints) for empirical studies published between January 2023 and March 2026. The review will synthesise studies comparing physicians' use of ambient AI scribes with traditional documentation approaches. Given the anticipated heterogeneity of the studies, a narrative synthesis will be employed to summarise the findings. Where common quantitative outcomes exist, effect sizes will be calculated using Hedges' g, mean differences or risk ratios/odds ratios as appropriate. The overall quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. ETHICS AND DISSEMINATION: As no patient data are involved in the data collection, no ethical approval is acquired. Results will be disseminated in a peer-reviewed, open-access journal, and presented at relevant academic conferences. PROSPERO REGISTRATION NUMBER: CRD420251149086.
4 Apr 2026
Read appraisal →Regional anesthesia and pain medicine
Deciphering risk factors for severe postherpetic neuralgia in patients with herpes zoster: an interpretable machine learning approach
INTRODUCTION: Postherpetic neuralgia (PHN) is a common complication of herpes zoster (HZ). This study aimed to use a large real-world electronic medical records database to determine the optimal machine learning model for predicting the progression to severe PHN and to identify the associated risk factors. METHODS: We analyzed the electronic medical records of 23,326 patients diagnosed with HZ from January 2010 to June 2020. PHN was defined as pain persisting for ≥90 days post-HZ, based on diagnostic and prescription codes. Five machine learning algorithms were compared with select the optimal predictive model and a subsequent risk factor analysis was conducted. RESULTS: Of the 23,326 patients reviewed, 8,878 met the eligibility criteria for the HZ cohort. Among these, 801 patients (9.0%) progressed to severe PHN. Among the various machine learning approaches, XGBoost-an approach that combines multiple decision trees to improve predictive accuracy-performed the best in predicting outcomes (F1 score, 0.351; accuracy, 0.900; area under the receiver operating characteristic curve, 0.787). Using this model, we revealed eight major risk factors: older age, female sex, history of shingles and cancer, use of immunosuppressants and antidepressants, intensive initial pain, and the neutrophil-to-lymphocyte ratio. When patients were categorized into low-risk and high-risk groups based on the predictive model, PHN was seven times more likely to occur in the high-risk group (p<0.001). CONCLUSIONS: Leveraging machine learning analysis, this study identifies an optimal model for predicting severe PHN and highlights key associated risk factors. This model will enable the establishment of more proactive treatments for high-risk patients, potentially mitigating the progression to severe PHN.
4 Apr 2026
Read appraisal →Advanced science (Weinheim, Baden-Wurttemberg, Germany)
A Wearable Brain-Computer Interface for Mitigating Car Sickness via Attention Shifting
Car sickness, an enormous vehicular travel challenge, affects a significant proportion of the population. Pharmacological interventions are limited by adverse side effects, and effective nonpharmacological alternatives remain to be identified. Here, we introduce a novel attention-shifting method based on a closed-loop, artificial intelligence (AI)-driven, wearable mindfulness brain-computer interface (BCI) to alleviate car sickness. As the user performs an attentional task, i.e., focusing on breathing as in mindfulness, with a wearable headband, the BCI collects and analyzes electroencephalography (EEG) data via a convolutional neural network to assess the user's mindfulness state and provide real-time audiovisual feedback. This approach might sustainedly shift the user's attention from physiological discomfort toward the BCI-based mindfulness practices, thereby mitigating car sickness symptoms. The efficacy of the proposed method was rigorously evaluated in two real-world experiments, namely, short and long car rides, with a large cohort of more than 100 participants susceptible to car sickness. Remarkably, over 83% of the participants rated the BCI-based attention shifting as effective, with significant reductions in car sickness severity, particularly in individuals with severe symptoms. Furthermore, EEG data analysis revealed a neurobiological signature of car sickness, which provided mechanistic insights into the efficacy of the BCI-based attention shifting for alleviating car sickness. This study proposes a wearable, nonpharmacological intervention for car sickness, validated in a relatively large-scale study involving over 100 participants in real-world car riding. These findings, derived from a between-cohort comparison, support the potential of this approach to improve the travel experience for car sickness sufferers and represent a novel practical application of BCI technology.
4 Apr 2026
Read appraisal →Patient education and counseling
Patient and clinician engagement with generative artificial intelligence (GenAI): A scoping review of implications for patient-centered communication
OBJECTIVE: To examine the influence of the emerging use of generative artificial intelligence (GenAI) within electronic health records and among the public on the patient-centeredness of communication in healthcare. METHOD: In this scoping review, we conducted a systematic search for peer-reviewed studies in PubMed and PsycInfo that empirically examined GenAI involvement in clinical communication. We then mapped study findings onto a well-established framework for patient-centered communication. RESULTS: Our search yielded 67 studies for analysis. Results suggest that integration of GenAI into healthcare communication has the potential to increase clinician efficiency in interacting with patients, to expand channels for patients to obtain information about their healthcare, and to enhance empathy in clinical communication. However, findings also indicate variability in the quality of information produced by GenAI, the potential for GenAI to recast the clinician as a technical supervisor rather than a humanistic care provider, and several issues of equity and privacy raised by engagement with GenAI. CONCLUSION: As GenAI becomes more prevalent in healthcare, rigorous examination of GenAI is needed to ensure that its development and implementation aids rather than hinders patient-centered communication. We conclude with an agenda for further research on GenAI grounded in the PCC framework underlying our review. PRACTICE IMPLICATIONS: Findings from this review highlight the current potential benefits and limitations of GenAI as a third party to clinical communication. Continued efforts toward developing and applying GenAI for effective healthcare communication should focus on protecting patients from potential drawbacks and maximizing nascent benefits for patient-centered communication.
4 Apr 2026
Read appraisal →Journal of advanced research
Machine learning ensemble meets clinical practice: developing a real-world risk prediction model for metabolic syndrome using super learner and scorecard approaches
INTRODUCTION: Metabolic syndrome (MetS) refers to a cluster of metabolic abnormalities that significantly increase the risk of developing cardiovascular diseases (CVDs). Traditional binary definitions of MetS fall short in capturing its severity spectrum, limiting personalized risk stratification. OBJECTIVES: We aimed to develop a super learner model and multilevel risk scorecard to improve MetS risk prediction and support early cardiovascular risk identification. METHODS: This study included a total of 460,256 health examination records from Zhejiang, China (2018-2023), with 344,925 used for model development and 115,331 used for external validation. A super learner model combining multiple machine learning algorithms was constructed to predict MetS risk. Key predictors identified through feature selection were used to develop a logistic regression-based MetS risk scorecard, stratifying individuals into five risk levels for practical and interpretable applications. RESULTS: The super learner model achieved area under the receiver operating characteristics (AUCs) of 0.816 (95 % confidence interval [CI]: 0.814-0.817) and 0.810 (95 % CI: 0.808-0.813) in the development and external validation cohorts, respectively. The risk scorecard, which incorporates ten predictors, demonstrated comparable performance, with AUCs of 0.793 (95 % CI: 0.791-0.794) and 0.788 (95 % CI: 0.785-0.791) in the respective cohorts. Based on the risk scorecard, individuals were stratified into five categories: very low, low, normal, high, and very high risk levels. CONCLUSION: The super learner model provides a highly accurate tool for MetS risk prediction, whereas the risk scorecard offers a practical and interpretable solution for clinical and personal use. These models enable precise risk assessment to guide prevention and improve outcomes.
4 Apr 2026
Read appraisal →Physiological reviews
An umbrella review of systematic reviews of the impact of wrist-worn wearables on health outcomes
We conducted an umbrella review to synthesize the evidence on the effectiveness of interventions incorporating wrist-worn wearables' feedback on diverse health outcomes including health promotion (i.e., health behaviors and disease risk perception) morbidity, mortality, functioning, and other health-related metrics in humans. We searched in MEDLINE, Web of Science, Embase, and Cochrane Library until March 18, 2025, for eligible systematic reviews. After screening 9,487 citations, we identified 39 systematic reviews, which included 98 original studies (1 observational study, 95 randomized controlled trials, and 1 pre-post study). The reviews primarily focused on adult populations, individuals with cardiometabolic conditions, and cancer survivors. The original interventional studies mainly included Fitbit (40.2%), Polar (12.4%), and ActiGraph (10.3%) devices. Over 80% of the clinical trials involved complex behavioral interventions with wearable-based feedback, and the control groups varied. Most systematic reviews were rated as low confidence, with common flaws including inadequate consideration for risk-of-bias and heterogeneity. Interventions incorporating wrist-worn activity trackers increased physical activity in diverse populations. The effect of interventions incorporating wrist-wearables' feedback on cardiometabolic risk markers, quality of life, depression/anxiety, and pain was limited and remained inconsistent. Our findings rely on existing systematic reviews, which may vary in quality, review methodologies, and comprehensiveness. There is also potential for missing more recent evidence not yet captured in these reviews. These limitations should be considered when interpreting our results. Acknowledging these caveats, wrist-worn wearables seem to increase physical activity and may have additional benefits that require further study.
4 Apr 2026
Read appraisal →GeroScience
Integrative machine learning approach to risk prediction for dementia and Alzheimer's disease
Dementia, particularly Alzheimer's disease (AD), presents a growing global health challenge characterized by cognitive decline, behavioral changes, and loss of independence. With increasing life expectancy, early diagnosis and improved clinical strategies are urgently needed. This study developed and evaluated machine learning (ML) models to predict AD risk using UK Biobank data, integrating health, genetic, and lifestyle factors. The cohort included 2878 AD cases and 72,366 controls. Among several algorithms, CatBoost performed best (ROC-AUC = 0.773), especially in females. Inputs included ICD-10 codes from 5 years pre-diagnosis, ApoE-ε4 genotype, and large collection of modifiable risk factors. Despite fewer cases, the risk predictive models for vascular dementia (VaD) outperformed the unique AD models. ApoE-ε4 was the most predictive genetic marker, while other common variants had limited utility. Key non-genetic predictors included comorbidities (e.g., diabetes, hypertension), education, physical activity, and diet. These findings highlight the value of integrating diverse data sources for dementia risk prediction and emphasize the role of sex-specific modeling and modifiable factors in early, personalized intervention strategies.
2 Apr 2026
Read appraisal →Ophthalmology
Special AAO Report: Recommendations on Screening for Hydroxychloroquine Retinopathy (2025 Revision)
BACKGROUND: The American Academy of Ophthalmology recommendations on screening for hydroxychloroquine (HCQ) retinopathy are now a decade old. This revision provides an update based on current knowledge. Major points and changes are as follows. NATURE OF TOXICITY: The retina typically remains clinically normal for many years on HCQ, but there is an unpredictable point at which signs of toxicity may develop. PATTERN OF TOXICITY: Most eyes of patients of European heritage have a parafoveal pattern of toxicity, whereas eyes of East Asian patients tend to present with pericentral toxicity, but there are many exceptions, and screening examinations should look for both patterns. DOSAGE: The recommended daily dosage remains unchanged at ≤5.0 mg/day/kg real weight. Keep under 400 mg/day for severely obese patients. RISK FACTORS: Beyond dose and duration, concurrent renal disease and tamoxifen use increase risk, as does initiation of HCQ therapy at an older age. CLINICAL TESTS: The primary screening tool should be OCT, along with wide-pattern fundus autofluorescence (FAF). Visual field (VF) and multifocal electroretinography (mfERG) are secondary confirmatory tests. Newer VF algorithms such as 24-2C can screen parafoveal and pericentral regions simultaneously. SCREENING: A baseline screening examination, including fundus, OCT, and FAF, is advised soon after HCQ is begun, not only to rule out preexisting conditions but also for comparison with later results. Annual screening with OCT and FAF is recommended while using HCQ, but may be deferred during the first 5 years if there are no significant risk factors. PROGRESSION: Mild retinopathy is unlikely to progress after discontinuation of HCQ, but severe retinopathy may continue to worsen for many years. IMPLICATIONS OF EARLY SIGNS OF TOXICITY: With earlier recognition comes greater need to communicate with patients and their medical providers regarding options to stop HCQ or continue with cautious monitoring. NEW TECHNOLOGY: There have been experimental advances in imaging and artificial intelligence analysis for HCQ screening, but none have been validated for general use or are widely available at this time. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
1 Apr 2026
Read appraisal →Ann Anat
Epiphyseal interfaces.
This work explores interconnected articular and growth plate osteochondral interfaces, via complementary anatomical, biomechanical and structural analyses that combine benchtop micro-computed tomography (microCT) and high-resolution synchrotron CT (sCT) imaging approaches. We show that bony sclerosis, well-documented in late-stage OA in humans, and the osteoarthritic STR/Ort mouse model, is preceded by the amplified regionalised expansion of articular calcified cartilage (ACC) where vulnerability load-induced failure is greatest. We further observed marked alterations in the number and size of resident osteocyte lacunae in pre-OA and OA regions in comparison to controls, which age healthily, underscoring the value of CT-based approaches for elucidating early OA-related changes. Notably, our findings imply that excessive ACC formation is an early consequence of disrupted endochondral ossification that precedes and potentially drives OA sclerosis, osteophytosis and indeed, articular cartilage lesions. By applying digital volume correlation (DVC) to sCT images of loaded murine knee joints under physiological conditions, we demonstrate that the joints from a healthy parental control strain of CBA mice efficiently dissipate compressive strain, whereas OA-prone STR/Ort exhibit high strain foci in the epiphyseal compartment prior to cartilage degeneration; suggesting that early strain accumulation may therefore promote early joint vulnerability and subsequently prime degenerative progression with age. Finally, we examined how the cartilaginous growth plate (GP), responsible for all longitudinal bone growth, contributes to mechanical epiphyseal stability for articulation. Analysis of mineralised trans-physeal GP structures (bridges), revealed their dynamic and sexually dimorphic character as well as their regulation by mechanical loading and osteotropic agents. DVC analyses of sCT-imaged murine knee joints subjected to identical physiologically oriented load, identified that regionally heterogeneous load-induced strain patterns in the GP are spatially synchronised to bridge location; a relationship substantiated by finite element simulation. Together, these findings establish intra-physeal GP bridges as regulatable and mechanically sensitive structures that coordinate the transfer of local GP strains, while enhancing epiphyseal stability by distributing compressive and shear strains to thereby permit cessation of longitudinal growth.
1 Apr 2026
Read appraisal →J Med Internet Res
Use of Health and Welfare Technology in Palliative Care: State-of-the-Art Review
BACKGROUND: As more individuals live longer with complex conditions, the need for effective palliative care (PC) grows. It has been stated that access to PC should be integrated early and delivered in a timely manner to patients with life-threatening illnesses. Health and welfare technologies (HWTs) offer tools to enhance care delivery, particularly in home and rural settings. Although there is a profound lack of evidence regarding the impact when used in PC, it is necessary to critically assess the current state of knowledge regarding impacts and consequences of technologies, ensuring that their integration considers broader implications for patients, caregivers, and health care systems in PC. OBJECTIVE: This review explores health and welfare technology used in PC, aiming to inform practice and improve care quality. METHODS: This state-of-the-art review included empirical studies describing the use of HWT in PC for adult patients. We used a thematic synthesis approach to compare studies and provide a synthesis of the key points. RESULTS: Based on the inclusion criteria, 94 studies were included. PC is both a clinical specialty and an overall approach to care that focuses on improving quality of life and relieving suffering for patients and families facing serious illness, based on needs and not prognosis. HWT shows potential to increase access and continuity of care, for symptom management to support patients to remain at home and prevent frequent emergency visits. It can have the potential to build and remain relationships between patients, their families, and the health care team, as well as for interprofessional collaboration and support. However, there are challenges to overcome that might affect the quality of care when using technology. CONCLUSIONS: HWT shows potential as a complement to usual PC. Our findings point toward the importance of caution in choosing when to use HWT in PC, and for which patients.
1 Mar 2026
Read appraisal →Cancer Cell
Precision treatment with artificial intelligence assisted subtyping enhances therapeutic efficacy in HR+/HER2- breast cancer: The LINUXtrial.
We report the results of LINUX (NCT05594095), a multicenter, randomized, controlled phase II platform trial aiming to identify effective precision treatments for hormone receptor-positive/human epidermal growth factor receptor 2-negative metastatic breast cancer after resistance to cyclin-dependent kinase 4/6 inhibitor. A total of 105 patients were categorized into four similarity network fusion (SNF) subtypes by artificial intelligence-assisted classification and randomly assigned to receive subtyping-based precision therapy (N = 70) or treatment of physician's choice (N = 35). Results demonstrate superior primary endpoint of objective response rates in the subtyping-based groups compared to controls: 10% versus 0% for SNF1, 65% versus 30% for SNF2, 40% versus 30% for SNF3, and 70% versus 20% for SNF4. Grade 3-4 treatment-related adverse events occurred in 37% of both groups. These findings highlight the clinical benefits of subtyping-based precision therapies, particularly for SNF2 and SNF4 subtypes, warranting further validation in phase III trials.
1 Feb 2026
Read appraisal →Clin Dermatol
Chancroid.
Chancroid, caused by Haemophilus ducreyi, is a sexually transmitted genital ulcerative condition associated with inguinal bubo formation. The relative prevalence of chancroid has dramatically declined based on surveillance findings in those few endemic settings where the appropriate diagnostic tools exist; however, laboratory-based diagnostics are lacking to assist clinical management and support etiological surveillance in most parts of the world. Recent yaws surveys within the Western Pacific region indicate that H ducreyi has re-emerged as a frequent cause of chronic skin ulceration. Although there have been no antimicrobial susceptibility studies for three decades, it is assumed that a cure remains possible with extended-spectrum cephalosporins, macrolides, or fluoroquinolones. HIV-1-infected patients require careful followups due to reports of treatment failure with single-dose regimens. Buboes may need additional treatment with either aspiration or excision and drainage.
1 Jan 2026
Read appraisal →Clin Dermatol
Gonorrhea.
Neisseria gonorrhoeae, a Gram-negative intracellular pathogen, causes gonorrhea. Although usually sexually transmissible, it can be acquired by direct inoculation. Untreated gonococcal infections have deleterious impacts, including adverse pregnancy outcomes, ectopic pregnancy, infertility, and even blindness. Extended-spectrum cephalosporins remain the mainstay of therapy, and gonococcal culture is essential to determine susceptibility to these agents. Antimicrobial resistance is a global public health concern, and a few new agents are in the pipeline. Gonorrhea control programs rely on health education, access to diagnostic testing (where possible), effective therapy, and partner notification. Introducing inexpensive, sensitive, and specific point-of-care tests will aid antimicrobial stewardship efforts in countries using the syndromic management approach. Targeted vaccination of higher-risk populations with cross-protective outer membrane vesicle-based meningococcal B vaccines might reduce N. gonorrhoeae transmission in the future. Doxycycline postexposure prophylaxis may further reduce gonococcal incidence in the short term; however, its long-term impact on the human resistome/microbiome remains unknown.
1 Jan 2026
Read appraisal →Ann Med
Advancements in artificial intelligence for atopic dermatitis: diagnosis, treatment, and patient management
Atopic dermatitis (AD) is a common and complex skin disease that significantly affects the quality of life of patients. The latest advances in artificial intelligence (AI) technology have introduced new methods for diagnosing, treating, and managing AD. AI has various innovative applications in the diagnosis and treatment of atopic dermatitis, with particular emphasis on its significant benefits in medical diagnosis, treatment monitoring, and patient care. AI algorithms, especially those that use deep learning techniques, demonstrate strong performance in recognizing skin images and effectively distinguishing different types of skin lesions, including common AD manifestations. In addition, artificial intelligence has also shown promise in creating personalized treatment plans, simplifying drug development processes, and managing clinical trials. Despite challenges in data privacy and model transparency, the potential of artificial intelligence in advancing AD care is enormous, bringing the future to precision medicine and improving patient outcomes. This manuscript provides a comprehensive review of the application of AI in the process of AD disease for the first time, aiming to play a key role in the advancement of AI in skin health care and further enhance the clinical diagnosis and treatment of AD.
1 Dec 2025
Read appraisal →Am J Obstet Gynecol
Can artificial intelligence improve the readability of patient education information in gynecology?
BACKGROUND: The American Medical Association recommends that patient information be written at a sixth-grade level to increase accessibility. However, most existing patient education materials exceed this threshold, posing challenges to patient comprehension. Artificial intelligence, particularly large language models, presents an opportunity to improve the readability of medical information. Despite the growing integration of artificial intelligence in healthcare, few studies have evaluated the effectiveness of large language models in generating or improving readability of existing patient education materials within gynecology. OBJECTIVE: To assess the readability and effectiveness of patient education materials generated by ChatGPT, Gemini, and CoPilot compared to American College of Obstetricians and Gynecologists and UpToDate.com. Additionally, to determine whether these large language models can successfully adjust the reading level to a sixth-grade standard. STUDY DESIGN: This cross-sectional study analyzed American College of Obstetricians and Gynecologists, UpToDate, and large language model-generated content, evaluating large language models for 2 tasks: 1) independent large language model-generated materials and 2) large language model-enhanced versions reducing existing patient information to sixth-grade level. All materials were assessed for basic textual analysis and readability using 8 readability formulas. Two board-certified obstetrician-gynecologists evaluated blinded patient education materials for accuracy, clarity, and comprehension. Analysis of variance was used to compare textual analysis and readability scores, with Tukey post-hoc tests identifying differences for both original and enhanced materials. An alpha threshold of P<.004 was used to account for multiple comparisons. RESULTS: Large language model-generated materials were significantly shorter (mean word count 407.9 vs 1132.0; P<.001) but had a higher proportion of difficult words (36.7% vs 27.4%; P<.001). American College of Obstetricians and Gynecologists and UpToDate materials averaged ninth-grade and 8.6-grade levels, respectively, while artificial intelligence-generated content reached a 10.6-grade level (P = .008). Although CoPilot and Gemini improved readability when prompted, no large language model successfully reached the sixth-grade benchmark, and ChatGPT increased reading difficulty. CONCLUSION: Large language models generated more concise patient education materials but often introduced more complex vocabulary, ultimately failing to meet recommended health literacy standards. Even when explicitly prompted, no large language model achieved the sixth-grade reading level required for optimal patient comprehension. Without proper oversight, artificial intelligence-generated patient education materials may create the illusion of simplicity while reducing true accessibility. Future efforts should focus on integrating health literacy safeguards into artificial intelligence models before clinical implementation.
1 Dec 2025
Read appraisal →JAMA
An AI-Powered Lifestyle Intervention vs Human Coaching in the Diabetes Prevention Program: A Randomized Clinical Trial
IMPORTANCE: Prediabetes is common, yet evidence-based lifestyle interventions are underutilized. OBJECTIVE: To determine whether referral to an exclusively artificial intelligence (AI)-led lifestyle intervention based on the Diabetes Prevention Program (DPP) is noninferior to referral to a human-led DPP in achieving recommended thresholds for weight loss, hemoglobin A1c (HbA1c) reduction, and weekly physical activity among adults with prediabetes and overweight or obesity. DESIGN, SETTING, AND PARTICIPANTS: This phase 3, parallel-group, pragmatic, noninferiority randomized clinical trial was conducted from October 11, 2021, to December 16, 2024 (last follow-up) at 2 US clinical sites in Baltimore, Maryland, and Reading, Pennsylvania. Adults 18 years or older with prediabetes and overweight or obesity were enrolled. INTERVENTIONS: Participants were randomized in a 1:1 ratio to receive either a referral to an AI-powered DPP lifestyle intervention delivered via a mobile app and Bluetooth-enabled digital scale or a referral to a human coach-led DPP lifestyle intervention delivered remotely. Both interventions were delivered independently of the study team over a 12-month period. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of maintaining an HbA1c less than 6.5% throughout the study and achievement of at least 5% weight loss, at least 4% weight loss plus at least 150 minutes of weekly physical activity (assessed with actigraphy), or an absolute reduction in HbA1c of at least 0.2 percentage points at 12 months. Noninferiority of referral to the AI-led DPP compared with referral to the human-led DPP was prespecified to be determined if the 1-sided 95% CI lower boundary of the risk difference did not cross -15%. RESULTS: A total of 368 participants were included (median [IQR] age, 58 [50-65] years; 71% were female, 27% were Black, 6% were Hispanic, and 61% were White; median [IQR] BMI, 32.3 [28.5-37.1]). After referral, 171 of 183 participants (93.4%) initiated the AI-led DPP and 153 of 185 (82.7%) initiated the human-led DPP. The primary outcome was achieved by 58 of 183 participants (31.7%) in the AI-led DPP group and 59 of 185 (31.9%) in the human-led DPP group (risk difference, -0.2% [1-sided 95% CI, -8.2%]), meeting the criterion for noninferiority. Findings were consistent across individual components of the composite end point and in sensitivity analyses. CONCLUSIONS AND RELEVANCE: Among adults with prediabetes and overweight or obesity, referral to a fully automated AI-led DPP was noninferior to referral to a human-led DPP in achieving a composite outcome based on weight reduction, physical activity, and HbA1c. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05056376.
1 Dec 2025
Read appraisal →BMC Geriatr
Smart aging: integrating AI into elderly healthcare
Artificial Intelligence (AI) is transforming geriatric healthcare by improving early disease detection, optimizing patient management, and enhancing clinical decision-making. AI-driven tools, including machine learning (ML) algorithms, predictive analytics, and assistive robotics, are increasingly utilized to address challenges associated with aging, such as frailty, multimorbidity, polypharmacy, and fall prevention. These technologies can facilitate personalized medicine, improve diagnostic accuracy, and support healthcare administration by streamlining workflows and resource allocation. Despite its promising applications, the integration of AI in geriatric care presents several challenges, including issues related to data privacy, algorithmic bias, ethical considerations, and the digital literacy of older adults. Ensuring the inclusivity of AI models by incorporating diverse and representative datasets is essential to avoid disparities in healthcare delivery. Additionally, the role of AI must be carefully regulated to complement, rather than replace, human clinical expertise. This paper provides a comprehensive overview of AI applications in geriatric medicine, discussing its benefits, limitations, and future directions. By leveraging AI responsibly, healthcare systems can improve patient outcomes, reduce hospital readmissions, and promote aging in place. However, addressing existing challenges through interdisciplinary collaboration, policy development, and continued research is crucial to fully realizing AI's potential in elderly care.
1 Dec 2025
Read appraisal →Ann Allergy Asthma Immunol
Current updates in the epidemiology and comorbidities of atopic dermatitis
Atopic dermatitis (AD) is a chronic, inflammatory skin disorder that affects individuals across the lifespan, with significant implications for both public health and individual well-being. This paper provides an overview of the epidemiology of AD, focusing on its prevalence, incidence, and risk factors across different populations and regions. We evaluate the growing global burden of AD, highlighting trends in both high-income and low- to middle-income countries, and the impact of socioeconomic, environmental, and genetic factors on disease manifestation. The review also explores the variations in disease severity, age of onset, and comorbidities such as asthma and allergic rhinitis. This paper emphasizes the need for more robust epidemiologic studies to further elucidate the complex interactions between genetic predisposition and environmental exposures in the development and progression of AD and explores the potential role of technology (eg, artificial intelligence) in helping to collect robust epidemiologic data. Understanding the epidemiology of AD is crucial for identifying high-risk groups, informing preventive strategies, and optimizing management approaches.
1 Nov 2025
Read appraisal →Int J Surg
Multi-omic profiling reveals age-specific blood biomarkers and aging-driven B cell remodeling in osteoarthritis
BACKGROUND: Osteoarthritis (OA) pathogenesis involves age-related immune dysregulation, yet non-invasive diagnostic tools and mechanistic insights remain limited. METHODS: We integrated transcriptomic profiling of four OA-affected joint tissues with machine learning to identify potential peripheral blood biomarkers. Weighted gene co-expression network analysis was employed to explore gene modules and pathways associated with OA. Single-cell RNA sequencing was performed on 217 983 joint cells to delineate B cell differentiation trajectories. Flow cytometry was used to validate age-associated B cell imbalances in peripheral blood. RESULTS: We identified five peripheral blood biomarkers: MAPK1, MAP3K8, ING1, LDLR, and NUP153 in distinguishing OA patients from controls (the area under the curve [AUC] = 0.966). Importantly, these markers exhibited age-specific expression profiles; ING1, NUP153, and MAP3K8 were elevated, while MAPK1 was reduced in elderly compared to younger OA patients. A refined predictive model based on these age-specific markers demonstrated superior performance specifically for elderly Knee OA (KOA, AUC: 0.8 vs. 0.7 for younger KOA). These biomarkers correlated with immune cell infiltration and inflammatory cytokines. In osteoarthritic joint tissues, B cells predominantly originated from subchondral bone and synovium. Single-cell analysis identified age-specific B cell differentiation patterns, with elderly KOA patients enriched in an activated B cell cluster (C1). Furthermore, B cells from elderly KOA patients showed altered energy metabolism and increased proportions in peripheral blood, and functionally promoted chondrocyte damage. CONCLUSION: Our findings establish a novel blood-based diagnostic framework for OA and uncover aging-driven B cell remodeling as a key contributor to elderly OA pathogenesis. These findings offer non-invasive diagnostics and immunomodulatory targets for age-specific OA therapy.
1 Nov 2025
Read appraisal →Nat Hum Behav
Machine learning-assisted optimization of dietary intervention against dementia risk
A healthy diet has been associated with a reduced risk of dementia. Here we devised a Machine learning-assisted Optimizing Dietary intERvention against demeNtia risk (MODERN) diet based on data from 185,012 UK Biobank participants, 1,987 of whom developed all-cause dementia over 10 years. We first identified 25 food groups associated with dementia in a food-wide association analysis. Second, we ranked their importance using machine learning and prioritized eight groups (for example, green leafy vegetables, berries and citrus fruits). Finally, we established and externally validated a MODERN score (0-7), which showed stronger associations with lower risk of dementia-related outcomes (hazard ratio comparing highest versus lowest tertiles: 0.64, 95% CI: 0.43-0.93) than the a priori-defined MIND diet (0.75, 0.61-0.92). Across 63 health-related outcomes, the MODERN diet showed particularly significant associations with mental/behavioural disorders. Multimodal neuroimaging, metabolomics, inflammation and proteomics analyses revealed potential pathways and further support the potential of MODERN diet for dementia prevention.
1 Nov 2025
Read appraisal →Cardiovasc Diabetol
Association of estimated glucose disposition rate with aging acceleration and mortality risk in individuals with cardiovascular-kidney-metabolic syndrome: evidence from two large national population-based studies
OBJECTIVE: This study investigated the relationship between estimated glucose disposal rate (eGDR), aging acceleration (AgeAccel), and mortality in adults diagnosed with cardiovascular-kidney-metabolic (CKM) stages 1 to 4. METHODS: The study utilized data from 4,826 adults with CKM syndrome stages 1 to 4, collected from the National Health and Nutrition Examination Survey (NHANES) conducted during the 2005-2010 survey cycles. The assessment of AgeAccel was performed using two complementary measures: phenotypic AgeAccel (PhenoAgeAccel) and biological AgeAccel (BioAgeAccel). Survey-weighted logistic regression and Cox proportional hazards models were used to assess the associations of eGDR with AgeAccel and mortality risk, respectively. To assess the prognostic value of eGDR for mortality risk, we implemented a suite of nine distinct machine learning models. Additionally, a nomogram was developed to enhance the clinical applicability of our findings. Furthermore, we performed causal mediation analysis to quantify the proportion of the total effect of eGDR on mortality that was mediated through AgeAccel. To ensure the robustness of the results, we replicated our primary analyses using data from the nationally representative China Health and Retirement Longitudinal Study (CHARLS) cohort. RESULTS: Our analysis included 4,826 NHANES participants, among whom we documented 831 all-cause mortality events and 208 cardiovascular disease (CVD)-specific deaths during follow-up. In multivariable-adjusted Cox regression models, each unit increase in eGDR was significantly associated with a 10% reduction in all-cause mortality risk (Hazard ratio [HR] = 0.90, 95% Confidence interval [CI] 0.86-0.93) and a 13% decrease in CVD mortality risk (HR = 0.87, 95% CI 0.81-0.93). Additionally, eGDR showed a negative association with AgeAccel, including both BioAgeAccel (odds ratio [OR] = 0.85, 95% CI 0.82-0.87) and PhenoAgeAccel (OR = 0.78, 95% CI 0.75-0.80). For predicting all-cause mortality from eGDR, the K-Nearest Neighbors (KNN) showed superior discrimination (Area Under the Curve [AUC]: 0.926), exceeding the performance of other machine learning algorithms in a comparative evaluation. Mediation analysis revealed that the protective effect of higher eGDR was partially explained by slower PhenoAgeAccel, with mediation effects accounting for 23.53% and 15.73% of the total impact on all-cause and CVD mortality, respectively. CONCLUSIONS: In the CKM population, lower eGDR levels may be associated with both AgeAccel and an increased risk of mortality, with AgeAccel potentially mediating the relationship between eGDR and mortality. These findings suggested that eGDR could serve as a potential predictor and intervention target for delaying aging and reducing mortality risk.
1 Oct 2025
Read appraisal →Nat Commun
Proteome atlas for mechanistic discovery and risk prediction of diabetic retinopathy
Proteomics offers an unprecedented opportunity to characterize and predict diabetic retinopathy (DR) with minimal invasiveness. Here we examine this in 10,873 individuals with (pre)diabetes from two ethnically distinct cohorts. By simultaneous profiling of ~3000 proteins, we identify 668 associations with mechanistically plausible directionality that constitute a comprehensive DR proteomic landscape with linkages to retinal tomographic structure and genetic predisposition, pointing to established and novel biological pathways conferring DR risk. Integrating DR proteomic profile markedly improves predictive performance beyond clinical and genetic predictors, with plexin B2, growth differentiation factor 15, and renin emerging as top proteins validated across cohorts and linked to retinal microvascular degeneration in Guangzhou Diabetic Eye Study (GDES) based on SS-OCTA. A parsimonious panel of these three proteins alone achieves comparable performance in predicting DR development and progression, while renin is confirmed as a causal promoter through genetic analyses. Our findings highlight the potential of large-scale proteomics in elucidating DR pathogenesis and advancing biomarker discovery, with broad implications for early detection and intervention.
1 Oct 2025
Read appraisal →Acad Pediatr
Caregiver and Pediatric Clinician Perspectives on Artificial Intelligence for Language Services
OBJECTIVE: Children and caregivers who use languages other than English (LOE) for pediatric health care experience inequities and poorer overall health. Advancement of large language models has raised questions about the future use of artificial intelligence (AI) for language access. This study explored the perspectives of caregivers who use LOE and pediatric clinicians on using AI to address unmet needs in health care translation and interpretation. METHODS: We conducted semistructured individual interviews with caregivers of pediatric patients who use LOE and pediatric clinicians about the use of AI language technologies in health care. A phone interpreter or fluent team member was used for LOE interviews. Recordings were transcribed, translated as needed, coded, and analyzed using inductive thematic analysis. RESULTS: Twenty caregivers using 11 different LOE and 22 clinicians participated. Themes were consistent across participants, though clinicians were more familiar with the concept of AI. Participants reported use of technologies (eg, Google Translate) for written communication and situations where verbal interpretation was perceived to be inadequate. They were concerned about AI accuracy, privacy, and loss of empathy, but hoped it could provide real-time document translation and more convenient verbal communication. Ease of use, validation, and equitable creation and access were critical for use. CONCLUSIONS: Caregivers and clinicians were open to using AI to fill gaps in translation and interpretation; however, robust validation of AI technology and complementary use with human interpreters and translators is needed. Future research, practice, and policy should focus on integrating AI while investing in human translation and interpretation.
1 Jan 2025
Read appraisal →