Background: Surgical procedures and their potential complications place substantial strain on patients, clinicians, and #Health care systems. These strains are driven by the anticipated morbidity and mortality, so that there is resource-intensive postoperative inpatient management. Given the concentration of surgical services within hospital settings, current standard levels of care have limitations such as communication gaps, time lapses before evaluation, and investment of resources, which limit accessibility and generate disparities in delivery of care. However, recent advances in #Digital #Health, including #Telemedicine platforms, #Mobile #Health (#mHealth), and #Wearable technologies, present an opportunity to decentralize and extend perioperative care into community settings. This review explored how established #mHealth technologies are being integrated into the perioperative pathway and their impact on surgical care delivery and outcomes. It also highlights possible emerging models of remote physician and patient interaction where benefits seem to be outweighing the risks. Objective: The aim of this narrative review was to present collected evidence for the use of established #mHealth technologies in the surgical pathway of patients and highlight their readiness and potential in models of standard care. Methods: A comprehensive literature search was conducted across MEDLINE (via PubMed), Web of Science, and Scopus databases between October 2022 and May 2024. Additional sources were identified through reference list screening of relevant systematic reviews. Data were extracted and analyzed based on surgical specialty, type of #mHealth intervention, cost-effectiveness, and ethical considerations. Findings were summarized in tables to illustrate key trends and variations across studies. The extracted data were tabulated and described qualitatively to highlight similarities, differences, and possible emerging trends across the studies. Results: A total of 28 articles published between 2008 and 2022 were included for qualitative analysis, with most (n=21, 75%) originating from the United States, Germany, and the United Kingdom. The study designs were predominantly randomized controlled trials (n=9, 32%) and observational studies (n=8, 29%). Collectively, these studies involved 6344 patients undergoing #mHealth-based perioperative interventions primarily in general surgery, orthopedics, and oncology. Interventions frequently used smartphones (n=10, 36%) and #Wearable devices, often in combination with other tracking and measuring systems. Applications included wound monitoring, postoperative follow-up, and patient education. Data collection was multimodal and typically conducted daily, yet only 36% (10/28) of the articles reported defined follow-up periods. Cost-effectiveness was rarely assessed, with only 4% (1/28) of the articles reporting per-patient savings. Overall, 64% (18/28) of the articles were rated as low quality due to methodological limitations. Conclusions: #mHealth- and #Telehealth-based interventions show promise in enhancing aspects of perioperative care by enabling remote monitoring, patient engagement, and improved care continuity. Future research should focus on scalable implementation, true cost-effectiveness analysis, equitable access, and integration into clinical workflows to ensure broad applicability in current models of care.

Background: Globally, the number of illegal drug users is rising, posing mental and physical health challenges and increasing societal burdens. Despite a significant need for treatment, only about 10% of these individuals receive it worldwide, often with poor adherence. Traditional treatments, while effective, suffer from high dropout rates due to limitations. The COVID-19 pandemic has spurred the growth of digital interventions like apps and online platforms, offering flexibility and cost-effectiveness that better meet patient needs and improve engagement. However, addressing the persistently high dropout rates in these online treatments is crucial and necessitates further research. Objective: This study aimed to estimate dropout rates among adults with illicit drug use participating in digital psychosocial intervention trials, and to identify factors associated with attrition. Methods: We conducted a systematic search of five major databases for English-language randomized trials published up to January 27, 2025. A total of 40 studies (80 arms; 9,563 participants) reporting 46 dropout rate estimates were included. A random-effects model was used to calculate pooled dropout rates, with meta-regression and subgroup analyses exploring potential moderators. The study was registered on PROSPERO (CRD42024534389). Results: At post-test, the pooled dropout rate in the intervention group across 17 studies was 22.4% (95% CI: 12.4%–37.2%). Dropout was significantly associated with education level, employment status, baseline clinical diagnosis, intervention frequency, and initial medication use. During the longest follow-up (29 studies), the dropout rate was 27.9% (95% CI: 18.8%–39.3%), with marital status, recruitment source, medication frequency, and intervention modality as significant predictors. Control group dropout rates were 25.9% and 28.3%, both higher than those in the intervention group. Conclusions: This meta-analysis revealed substantial dropout among adults with illicit drug use receiving digital psychosocial interventions. Targeted modifications to intervention design may improve engagement and long-term retention. Clinical Trial: The study was registered on PROSPERO (CRD42024534389).

Background: Disaster medicine education increasingly emphasizes situational awareness and a proactive disaster mindset as crucial competencies for effective response. Situational awareness involves comprehending the disaster environment to make informed decisions under pressure, while a disaster mindset encompasses psychological resilience and effective functioning amidst chaos. Integrating technologies into simulation training allows experiential learning that bridges theoretical knowledge with practical application. Objective: This study aims to investigate the current status of teaching these concepts and the use of technology in fostering SA and a DMS, both individually and collectively, as well as locally, regionally, and transnationally, by reviewing the existing literature. Methods: This paper explores the integration of technology into disaster medicine education through a scoping review of scientific studies and publications, supplemented by a Google search for gray literature and official publications from relevant organizations. Results: Simulation training using virtual and augmented reality immerses learners in realistic disaster scenarios, enhancing situational awareness and stress management. Data analytics and GIS (Geographical Information System) mapping provide real-time information for better decision-making, while communication technologies like social media analysis tools offer insights into evolving disaster landscapes. Integrating these technologies into education bridges the gap between theory and practice, ensuring students are well-prepared for emergencies through experiential learning that fosters cognitive understanding and psychological preparedness. Conclusions: Simulation training using virtual and augmented reality enhances situational awareness and stress management, bridging the gap between theory and practice through experiential learning. The findings from this review highlight current pedagogical approaches and technological applications, identifying gaps and future directions for enhancing disaster medicine education.

Background: Providing integrated care is essential in pediatric #Rehabilitation, as children with disabilities often navigate complex, long-term pathways involving multiple professionals across health, education, and community services. Strengthening communication and partnership among children, families, and professionals is key to supporting meaningful participation in daily life. Shared #Digital health portals offer a promising solution to support integrated care, yet their potential remains underexplored in this context. Objective: This #Study explores the perspectives of multidisciplinary professionals involved in pediatric #Rehabilitation on shared patient portals designed to support integrated care for children with disabilities. Methods: An interpretive descriptive qualitative #Study grounded in a constructivist epistemological position was conducted. Data were collected through semistructured online interviews with professionals purposively recruited using maximum variation sampling. All were involved in the #Rehabilitation pathways of children with motor, cognitive, or mental disabilities in France. Interview verbatim transcripts were analyzed using NVivo (version 14, Lumivero) by an interdisciplinary team of researchers, including parents and clinicians, using a thematic analysis approach. Theoretical saturation was reached. Results: A total of 32 professionals, including clinicians, educators, social workers, and coaches working in hospitals, #Rehabilitation centers, outpatient clinics, or private practices, integrated health and social services, schools, nurseries, leisure associations, and social services, participated in this #Study. Four themes captured professionals’ ambivalent perspectives on portals, addressing their perceived contributions to integrated care, anticipated barriers, practical strategies for implementation, and expectations regarding features: (1) ensuring continuity across health, education, and recreation services: navigating transparency, confidentiality, and inclusion; (2) enhancing family partnership while preserving professional autonomy and navigating engagement diversity; (3) involving children in patient portals: from children’s empowerment to professionals’ ethical responsibility; and (4) the contrast between concerns about additional workload and beliefs regarding efficiency. Participants suggested features such as shared calendars, secure messaging, and tools to share videos, #Rehabilitation goals, and track progress, alongside practical strategies to support real-world adoption. Conclusions: This #Study highlights the perceived potential of shared patient portals to strengthen partnerships and fruitful collaboration among children, families, and professionals involved in the pediatric #Rehabilitation pathways, including education and recreation providers. Professionals proposed concrete features to support integrated care, informing the development of tools likely to improve the quality of #Rehabilitation services. Future studies should explore the perspectives of children, families, and decision makers to support effective implementation and evaluate the real-world impact. Clinical Trial: ClinicalTrials.gov NCT06570148; https://clinicaltrials.gov/#Study/NCT06570148

Background: The social determinants of health are “the conditions in which people are born, grow, live, work and age,” such as housing, employment, and race. Canadian primary health care organizations are increasingly looking for ways to systematically and routinely collect demographic and social needs data from patients to increase appropriate and responsive care by attending to the social determinants of health. The SPARK (screening for poverty and related determinants to improve knowledge of and links to local resources) tool is a standardized tool for use in primary health care settings that was developed, pilot-tested, refined, and validated in primary health care clinics across Canada. General Practitioners at the Deep End is a network of primary health care general practitioners working in the 100 most socioeconomically deprived areas in Scotland with the goal of connecting practitioners and advocating for better training, policies, and resources. Primary Health Care at the Deep End Canada or Soins primaires en milieux défavorisés Canada (Deep End Canada) was launched in June 2024 to offer guidance and resources to the growing number of primary health care teams interested in collecting and using demographic and social needs data. Objective: Our primary objective is to spread the sustainable implementation of the SPARK tool to systematically and routinely collect and use demographic and social needs data to respond to the social determinants of health in 20 to 25 primary health care organizations across Canada through the creation of Deep End Canada. Methods: Deep End Canada is a network of primary health care teams, including health professionals, #Researchers, and patient partners, working in areas with high rates of poverty. This project will use a multimethod developmental evaluation approach guided by the reach, effectiveness, adoption, implementation, and maintenance framework. Web-based surveys will capture the reach and adoption of demographic and social needs data collection, and network activities will be evaluated using qualitative analysis of focus groups, interviews, and meetings. Results: The #Study was funded in February 2022. Recruitment to the network commenced in June 2024 and included 10 organizations as of submission of the manuscript. Web-based survey data collection commenced in September 2024. Implementation of the network will be assessed from June 2024 to December 2025, with expected findings available in June 2026 and published in the fall of 2026. Conclusions: Efforts to systematically and routinely collect and use demographic and social needs data and address structural issues in Canadian primary health care have grown significantly in the last 10 years. This increased commitment involves using data to develop evidence-based interventions that can reduce health inequities and address local community needs at the individual, organizational, and policy levels. This #Study will demonstrate how the Deep End Canada network contributes to achieving those aims by fostering collaboration among practitioners to promote health equity and tackle the structural and social determinants of health.

Background: The United Nations considers #Children a crucial national asset and makes their welfare a top priority. However, infant mortality remains a persistent challenge, notably in Arab nations. Bahrain, Kuwait, and Oman, despite sharing similar income brackets and healthcare systems, differ in health policies, demographics, and maternal-#Child resource allocation. These countries also faced sharp fiscal deficits during the 2020 #covid19 crisis. Compared to wealthier nearby nations like the United Arab Emirates, their lower gross domestic product further complicates efforts to reduce the Infant Mortality Rate (IMR) and sustain effective, equitable #Child health strategies. Objective: This study aims to identify factors contributing to the IMR in Bahrain, Kuwait, and Oman by establishing an interpretative framework to examine the influence of sociodemographic, macroeconomic, health status and resource, and environmental factors. Methods: A longitudinal study collected annual time-series data (1990-2022) for Bahrain, Kuwait, and Oman from international open sources. To counterbalance the time-series effects on both IMR and explanatory factors, a generalized least squares (GLS) model based on the Cochrane-Orcutt procedure with a first-order autoregressive model was used. Results: GLS shows that the total fertility rate has a strong effect on IMR among the three countries (Oman: β=1.138, P

We outlined the characteristics and health status of individuals using a mobile health app, based on a real-world user database.

Background: Platinum salts are widely used for the treatment of #Cancers, including head and neck #Cancers. Despite their efficacy, platinum salts can induce neurosensory disorders such as ototoxicity, tinnitus, and decreased hearing acuity. Those side effects can have a major impact on the quality of life of patients and are not often considered after treatment. Objective: The #Study aims to compare the quality of life of patients with hearing aids in the case of ototoxicity due to platinum salt-based chemotherapy, according to two treatments: standard management without equipment versus standard management with equipment. Methods: PROTOTOX is an open pilot prospective monocentric and randomized #Study executed through collaboration of the Institut de Cancérologie de Lorraine (non-profit comprehensive #Cancer institute). 52 patients with head and neck #Cancer undergoing platinum-based chemotherapy and presenting with hypoacusis will be included and followed by an ear, nose and throat specialist. Audiometric testing will be performed, and eligible participants who consent will be randomized to either receive or not receive hearing aids (group 1 and 2). The primary endpoint of this #Study is to compare the quality of life of the patients undergoing platinum-based chemotherapy presenting with hypoacusis according to two ways of care: standard care without hearing aid versus standard care with hearing aid. Secondary outcomes are the evaluation of the hearing and the tinnitus, the evaluation of the patients’ satisfaction at the end of the #Study, and the evaluation of the patients’ adherence to hearing aid in case of ototoxicity due to platinum-based chemotherapy. Results: The #Study #Protocol has been opened and is actively recruiting participants. Conclusions: PROTOTOX #Study aims at demonstrating that the huge impact of platinum-based chemotherapy on hearing abilities must be managed to maintain the patients’ quality of life. Hearing aid is the solution experimented here. Clinical Trial: ClinicalTrials.gov NCT05936034; https://clinicaltrials.gov/#Study/NCT05936034.

Date Submitted: Oct 10, 2025. Open Peer Review Period: Oct 10, 2025 - Dec 5, 2025.

Background: Frozen shoulder is a shoulder ailment that denotes dysfunction in the arm characterised by limited range of motion accompanied by pain. The prevalence of adhesive capsulitis is 3-5% in the general population and up to 20% in those with #Diabetes. Physiotherapy, analgesics, corticosteroids, and surgical capsulotomy are common forms of treatment. Administering oil through the nasal route (or Nasya karma) is mentioned in Ayurvedic Scriptures for managing the above neck and clavicle disorders. Thermal microcautery (or Agnikarma) is a parasurgical procedure for treating related pathologies of bodily humor (Vata and Kapha). This #Study will aim to compare the efficacy of Honey Thermal micro cautery versus Standard Physiotherapy versus cordifolia oil via nasal administration in the treatment of frozen shoulder to determine which provided the most relief. Objective: The primary aim is to evaluate the efficacy of Honey Thermal Micro Cautery, Standard Physiotherapy, and Sida Cordifolia Oil via Nasal Administration on VAS, R.O.M., and S.P.A.D.I., Mc Gill Pain Questionnaire and to compare these interventions. The secondary objective is to assess sustained relief in all three groups. Methods: We will enrol 60 patients, 20 in each group, for this single-blind accessor control #Study. Group A will receive Ayurvedic treatment, that is, Thermal micro cautery using honey for two days (1st and 7th ) and placebo capsules (twice per day) for seven days, and Group B will receive Standard Physiotherapy and placebo capsules (twice per day) for seven days; Group C will be given Sida cordifolia oil via nasal administration with eight drops in each nostril and placebo capsules (twice per day) for seven days. Evaluation Parameters: Pain (Visual Analog Scale - VAS), Range of Motion (R.O.M.) measured with a goniometer, Shoulder Pain and Disability Index (S.P.A.D.I.), Mc Gill Pain Questionnaire. On 18/09/2023, approval was received from the Institutional Ethics Committee Mahatma Gandhi Ayurved College, Hospital and #Research Centre, Salod(H), with Ref. No. MGACHRC/IEC/Sep-2023/740 C.T.R.I. registration No, C.T.R.I./2023/11/059594 Results: The results will be subjected to statistical analysis using appropriate methods like ANOVA test. If ANOVA shows significance, post hoc tests (e.g. Tukey’s HSD) will identify group differences, with p

Background: Background: Exercise is an important aspect of #diabetes self-management. Patients with type 1 #diabetes frequently struggle with exercise-induced hyperglycemia and hypoglycemia, decreasing their willingness to exercise. Objective: Objective: We aim to build accurate and easy-to-deploy models to forecast exercise-induced glycemic events in real-world settings. Methods: Methods: We analyzed free-living data from the Type 1 #diabetes Exercise Initiative (T1DEXI) study, where adults with type 1 #diabetes wore a continuous glucose monitor (CGM) while performing video-guided exercises (30-minute exercises at least 6 times over 4 weeks), along with concurrent detailed phenotyping of their insulin program and diet. We built models to predict glycemic events (blood glucose ≤ 54 mg/dL, ≤ 70 mg/dL, ≥ 200 mg/dL, and ≥ 250 mg/dL) during and 1-hour post-exercise with variables from four data modalities: demographic and clinical; CGM; carbohydrate intake and insulin administration; and exercise type, duration and intensity. Results: Results: Models incorporating information from all four data modalities showed excellent predictive performance with AUCs > 0.880 for all glycemic events. Models built with CGM data alone have statistically indistinguishable performance compared to models using all data modalities. These models also showed outstanding calibration (Brier score ≤ 0.08) and resilience to noisy input. Conclusions: Conclusion: We successfully constructed models to forecast exercise-induced glycemic events using only automatically captured CGM data as input, incurring minimal user burden. These models showed excellent predictive performance, calibration, and robustness, enabling model translation into a decision support tool that is easy to deploy and maintain.

 

Background: Stroke frequently leads to various functional impairments. Both virtual reality (VR) and mirror therapy (MT) have shown efficacy in stroke rehabilitation. In recent years, the combination of these two approaches has emerged as a potential treatment for stroke patients. Objective: This systematic review and meta-analysis aim to evaluate the efficacy of combined immersive and non-immersive VR with MT in stroke rehabilitation. Methods: Five electronic databases were systematically searched for relevant articles published up to Jan. 2025. Randomized controlled trials (RCTs) that investigated combination treatment of VR and MT for participants with stroke were included. A grey literature search was also conducted. The risk of bias and the certainty of the evidence were assessed using the Cochrane collaboration’s tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline, respectively. Results: A total of 475 participants from 14 RCTs were included, of which 7 were eligible for meta-analysis. Meta-analysis revealed significant improvements in upper extremity (UE) motor function and hand dexterity, as evidenced by Fugl-Meyer assessment of upper extremity (FMA-UE) (MD 3.50, 95% CI 1.47 to 5.53; P=0.0007), manual function test (MFT) (MD 2.15, 95% CI 1.22 to 3.09; P6 months or not) revealed significant differences in the FMA-UE outcome. However, the pooled FMA-UE improvement did not consistently exceed the established minimal clinically important difference (MCID; 4.25–7.25), indicating that while statistically significant, the clinical meaningfulness of the observed effect remains uncertain. Narrative evidence also suggested potential benefits for lower extremity function, dynamic balance, and quality of life, though these findings were not meta-analyzed and should be interpreted with caution. Conclusions: Moderate-quality evidence supports VR-MT as a promising nonpharmacological intervention to improve upper extremity function and hand dexterity in stroke rehabilitation. While the intervention demonstrates statistically significant effects, it does not reach the minimum clinically important difference for the FMA-UE outcome. Preliminary descriptive evidence indicates possible advantages for lower extremity function, balance, and quality of life. Clinical Trial: PROSPERO CRD42024572150

Background: Head and neck #Cancer (HNC) survivors face profound functional and quality-of-life deficits due to disease- and treatment-related sequelae, ranging from mild fatigue to debilitating dysphagia. #Wearable technology, by monitoring biometric data such as step counts or providing swallowing biofeedback, offer a unique method for tracking and monitoring negative effects of HNC. Objective: The aim of the present study is to explore the current applications of #Wearable technology in head and neck #Cancer. Methods: A scoping review was conducted following the PRIMSA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. A search strategy was built, and a literature search was performed across five databases. The initial search yielded 5256 studies, which underwent a two-phase screening process: title and abstract review followed by full-text review. Inclusion criteria included peer-reviewed, English-language articles published between January 2002 to April 2024 that utilized #Wearable technology in HNC care. After full-text review, nine studies met the inclusion criteria. Data was manually extracted and synthesized narratively. Results: The included studies examined three main types of #Wearable devices: radioactivity (2 studies), #PhysicalActivity (4 studies), and throat physiology monitors (3 studies). Radioactivity monitors detected residual radioactivity and thyroidal radioiodine uptake. They demonstrated potential to reduce radioactivity exposure risk and personalize radiation doses for thyroid #Cancer patients. #PhysicalActivity monitors tracked step counts, heart rate, and sleep habits. Low step counts were significantly associated with increased anxiety, radiation-related toxicity, hospital admission rates, and feeding tube placement. One study also linked poor sleep patterns to declines in quality of life. Throat physiology monitors measured pharyngeal EMG data as well as extrinsic laryngeal muscle movements. Throat sensors achieved high accuracy in classifying swallowing events and translating muscle movements into speech. While earliest in the development continuum, they are promising tools for swallowing and vocal rehabilitation therapy. Barriers to #Wearable adoption included #Wearable discomfort, technical difficulties and patient withdrawal due to treatment side-effects. As the definition of #Wearable adherence varied widely, we propose that future studies report #Wearable adherence as “percentage of prescribed wear time achieved” to facilitate cross-study comparisons Conclusions: #Wearable technology may enhance treatment monitoring, prognostication, and rehabilitation in head and neck oncology. Radioactivity and #PhysicalActivity monitors provide actionable insights for clinical decision-making, while throat physiology monitors offer innovative solutions for speech and swallowing therapy. However, challenges such as device adherence, data integration, and patient comfort must be addressed to realize their full potential. Future research should prioritize larger, longitudinal studies, standardized adherence metrics, and consider the integration of artificial intelligence (#AI) to refine predictive capabilities. By overcoming these barriers, #Wearable technology could transform survivorship care, improving functional outcomes and quality of life for HNC patients.

Background: Offline reinforcement learning (RL) has been increasingly applied to clinical decision-making problems. However, due to the lack of a standardized pipeline, prior work often relied on strategies that may lead to over-fitted policies and inaccurate evaluations. Objective: In this work, we present a practical pipeline – PROP-RL – designed to improve robustness and minimize disruption to clinical workflow. We demonstrate its efficacy in the context of learning treatment policies for administering loop diuretics in hospitalized #patients. Methods: Our cohort included adult in#patients admitted to the emergency department at Michigan Medicine between 2015-2019 and required supplemental oxygen. We modeled the management of loop diuretics as an offline RL problem using a discrete state space based on features extracted from #ehrs, a binary action space corresponding to the daily use of loop diuretics, and a reward function based on in-hospital mortality. The policy was trained on data from 2015-2018 and evaluated on a held-out set of hospitalizations from 2019, in terms of estimated reduction in mortality compared to clinician behavior. Results: The final study cohort included 36,570 hospitalizations. The learned treatment policy was based on 60 states: the policy deferred to clinicians in 36 states, recommended the majority action in 22 states, and diverged significantly from clinician behavior in 2 of the states. Among the cases where the policy meaningfully diverged from the behavior policy, the learned policy significantly reduced the mortality rate from 3·80% to 2·22% by 1·58% (95% CI: 0·38, 2·73; p-value: 0·012). Conclusions: We applied our pipeline on the clinical problem of loop diuretic treatment, highlighting the importance of robust state representation and thoughtful policy selection and evaluation. Our work reveals areas of potential improvement in current clinical care for loop diuretics and serves as a blueprint for using offline RL for sequential treatment selection in clinical settings.

Background: The prevalence of stunting in Indonesia remains substantial at 21.5%, indicating that about one in five #Children under the age of five is affected, with the highest incidence observed among #Children aged 24 to 35 months. The cause-effect of stunting has known as a complex factor, including family, environmental, social and cultural factors, in stunting among #Children under five years. Yet, the latest update associated factors emphasizing on social and environmental factors are still limited. Objective: To analyse the latest evidence on the factors associated with stunting, with a particular focus on external and exposome factors, to provide actionable insights for reducing stunting in Indonesia. Methods: A secondary data analysis was conducted by extracting data from 2023 Indonesia Health Survey (Survey Kesehatan Indonesia- SKI 2023). This study analysed a total of 78,049 #Children under five years who had a complete response to all interest variables (sex, immunisation status, last months’ history of diarrhoea, place of residence, social benefit card ownership, household water sources, water quality, and geographical location). bivariate analysis using Pearson chi-square test was implemented with a p-value of

Background: The six-minute walk test (6MWT) measures exercise capacity in cardiorespiratory, neurological and musculoskeletal conditions. It consists in observing how far a patient can walk in 6 minutes and is usually performed in a corridor in a clinic. During the COVID 19 pandemic, as healthcare systems cancelled nonurgent outpatient appointments, many tests were done online. At the Oxford University Hospitals, cardiac patients were asked to use the open-source Timed Walk app top perform 6MWT in their community, as a substitute for the regular tests in clinic. Objective: (1) To assess participation and user acceptance of the Timed Walk app, (2) to assess the clinical usefulness of the app within the context of the pandemic, and (3) to validate and improve the algorithms that compute the walked distance from the sensors data collected by the phone. Methods: Consented cardiac patients were invited to perform a 6MWT, outdoor, using the app, at least once a month, and report the results at periodic telephone calls and visits. Any clinical decision taken based on the results of the app was registered. Patients were also sent a #usability and acceptance questionnaire and 10 of the respondents were selected for interviews. A group of 12 volunteers also provided sensors data collected by the app and a trundle wheel to measure reference distance for 10 tests, 5 of which were intentionally performed without following instructions to walk over straight paths. Results: the study run between 2021-09-29 and 2022-12-30. 55 participants consented (25 female, age: 44.80 ± 17.49) 1) Twenty-four patients performed one or more tests per month, average number of 6MWTs per month per patient was 1.14 ± 1.20. #usability was rated high on all dimensions; acceptance was high except intention to use the app beyond the study. Thematic analysis of the interviews provides useful insights on 3 themes: 2) 741 events were logged. 24% of 51 medical decisions involving 23% of 48 patients who performed at least 1 test, were influenced by the app-based 6MWT. Between 2018 and 2023 a cohort of 49 patients conducted 63 6MWT in the clinic (18 in 2021), whereas the same patients performed 605 tests using the app only in 2021. 3) Sensor data was sent for 107 tests, 52 not following instructions. Difference between reference distance and app distance was within minimal clinically significant difference for tests performed following instructions (limits of agreement: -27m, 34m). Anonymized data has been made publicly available. Conclusions: The use of the Timed Walk app for remote 6MWT allowed clinicians to obtain objective indications of the status of the patient during the pandemic. The distance estimated by the app is accurate when patients follow instructions. Motivation to use the app can vary depending on internal factors such as attitudes and health status, and external factors such as weather, fit into everyday life, how the data is used by clinicians and forgetfulness. Clinical Trial: ClinicalTrials.gov NCT05096819

Background: Bacterial vaginosis (BV) is the most common cause of vaginal discharge in people of childbearing age in the United States. More information about what patients do and do not like about the most common BV products and the extent to which they reduce BV symptoms is important for understanding patients’ health and the current treatment landscape for BV. Objective: Using data from online drug review forums, this study’s objectives were to (1) quantitatively characterize the patient voice via sentiments (positive to negative) and emotions about the three most common Food and Drug Administration (FDA)–approved treatments for BV—oral metronidazole (OM), vaginal metronidazole (VM), vaginal clindamycin (VC)—and (2) qualitatively summarize themes characterizing the patient-perceived impact of BV and BV products. Methods: Data for this mixed methods descriptive study came from 1645 users’ reviews of BV products posted on WebMD.com and Drugs.com. Reviewer attributes, reviewer-submitted star ratings, and sentiment analysis (SA) using word-emotion association were analyzed with descriptive statistics and bivariate associations. A traditional qualitative analysis using qualitative description was also performed. Results: Most reviewers were female (n=629, 99.4%), between the ages of 18 and 44 years, and reported using BV products for less than 1 month, though qualitative results suggested most reported recurrent BV infections. Quantitative results revealed reviewers’ preference for vaginal products. The mean star ratings for VC were significantly higher when compared to OM and VM. VC reviews had the highest proportion of positive emotion words compared to OM and VM. Qualitative results for VC supported the quantitative findings: favorable themes related to perceptions of value, effectiveness in alleviating symptoms, and minimal side effects. Additionally, despite some concerns related to the cost of VC, reviewers said they would use the medication again. Other qualitative findings supported BV medical education campaigns for patients and providers on BV treatment. Conclusions: Overall, people want a BV treatment that is easy to use, quickly alleviates symptoms, and has minimal side effects. Patients use product reviews to inform their decision-making about BV treatment, ask and seek answers to health-related questions, and share their experiences, presenting a unique opportunity for comprehensive patient education through clinical encounters or public health outreach efforts.

Background: Achieving equity in translational precision medicine requires the integration of genomic, clinical, and social determinants of health (SDoH) data to uncover disease mechanisms, personalize treatment, and reduce health disparities. Yet, existing bioinformatics tools are often hindered by fragmented data structures, steep technical barriers, and limited capacity to incorporate SDoH variables-challenges that disproportionately affect underserved populations. Objective: To address this, we developed AI-HOPE-PM (Artificial Intelligence agent for High-Optimization and Precision mEdicine in Population Metrics), a conversational AI platform that allows users to conduct multi-dimensional cancer analyses through natural language interaction. By unifying large-scale clinical, genomic, and SDoH data within a dynamic and accessible interface, AI-HOPE-PM lowers the barrier to integrative research and supports inclusive, hypothesis-driven investigation. Methods: AI-HOPE-PM leverages large language models (LLMs), structured natural language processing, retrieval-augmented generation (RAG), and an internal Python-based workflow engine to automate data ingestion, filtering, cohort stratification, and statistical analysis. The platform operates on harmonized datasets from TCGA, cBioPortal, and AACR GENIE, enriched with simulated SDoH variables such as financial strain, food insecurity, and healthcare access. Free-text queries (e.g., Compare survival outcomes in CRC patients with TP53 mutations and limited access to care) are parsed into executable scripts aligned with biomedical ontologies. The system performs survival modeling, odds ratio testing, and case-control comparisons, generating interpretable visualizations and narrative reports in real time. Benchmarking against platforms like cBioPortal and UCSC Xena demonstrated 92.5% query interpretation accuracy and efficient performance across both CPU and GPU cloud environments. Results: AI-HOPE-PM successfully translated diverse user queries into real-time, executable analyses across colorectal cancer (CRC) datasets, enabling integration of clinical, genomic, and SDoH data. In one case study, the platform identified significantly worse survival in FOLFOX-treated CRC patients with TP53 mutations experiencing financial strain (p = 0.0481). Another analysis revealed poorer progression-free survival in APC wild-type patients with good healthcare access (p = 0.0233). Additional findings highlighted the influence of social support (p = 0.0220), food insecurity (p = 0.0162), and health literacy on outcomes and treatment access. Odds ratio analyses revealed disparities in chemotherapy exposure (OR = 0.356 for food-insecure patients) and KRAS mutation prevalence by sex and literacy status. AI-HOPE-PM also surfaced racial and ethnic differences in progression-free survival, emphasizing the importance of SDoH integration in population-level cancer research. All analyses were completed in under one minute, significantly reducing manual workload and improving scalability. Conclusions: AI-HOPE-PM marks a significant leap forward in the field of precision oncology by uniting clinical, genomic, and SDoH data within a single, conversational AI framework. Instead of relying on traditional, code-heavy approaches, the platform enables users to perform complex, multi-layered analyses through simple natural language interactions. This functionality not only democratizes access to integrative cancer research but also enhances the ability to uncover disparities in outcomes linked to genetic, clinical, and social variables. By contextualizing molecular insights within real-world social environments, AI-HOPE-PM delivers a more comprehensive understanding of cancer biology and care inequities. Its high performance, interpretability, and scalability position it as a powerful tool for accelerating hypothesis generation, guiding biomarker discovery, and informing equity-driven treatment strategies. As a flexible and user-centered platform, AI-HOPE-PM lays the groundwork for a new paradigm in AI-assisted, health equity-focused translational research.

Background: US children’s diets are high in calories and are of poor nutritional quality, and a likely contributing factor is the consumption of food from restaurants. While children readily accept the sweet and salty foods that characterize restaurant children’s menus, #Research shows that their taste preferences are malleable, and regular exposure to healthier foods can promote their acceptance. Objective: We describe a cluster-#RCT #ClinicalTrial testing the effects of behavioral intervention strategies (choice architecture and repeated exposure) on ordering and dietary intake among children in restaurants and present baseline demographic data for the #Study cohort. Methods: Six locations of a regional quick-service restaurant chain were randomized to the intervention or control group in pairs based on income in surrounding census tracts. Families with children aged 4 to 8 years were recruited and asked to complete 8 visits to the #Study restaurant, including a baseline assessment completed at the time of enrollment, followed by 6 visits during a designated 2-month exposure period and a final posttest assessment. Intervention content provided to intervention group families after baseline assessments includes placemats promoting 2 healthier kids’ meals and the opportunity to redeem their kids’ meal “cone token” for a toy instead of a dessert (choice architecture strategies). In addition, participating families receive frequent diner cards, which can be used to earn a free kids’ meal after purchasing a promoted kids’ meal 6 times (repeated exposure strategy). Families in control restaurants receive generic versions of these materials (eg, frequent diner cards that can be redeemed for a free kids’ meal after purchasing any 6 kids’ meals). The primary outcome is the meal ordered for the child at a posttest restaurant visit following the exposure period (ie, whether or not a promoted meal was ordered). Additional order data will include calories, saturated fat, sodium, and sugar content of children’s orders at posttest. Other outcomes include children’s in-restaurant and daily consumption of calories, saturated fat, sodium, and sugar. Results: This #Study was funded in 2019, with preregistration completed in 2020, data collection occurring from June 2021 to November 2024, and data processing, analysis, and primary outcome manuscript preparation in 2025-2026. A total of 236 families provided baseline data on children’s orders and comprise the #Study cohort; 234 of these families provided demographic data (n=184, 78.3% female parents; n=133, 56.8% female children; child mean age 6.5, SD 1.3 years). Conclusions: Given that restaurants are normative eating contexts for many children, this intervention has the potential to impact children’s dietary intake and health. If found to be successful, future directions could include scaling the current intervention approach and conducting further effectiveness, implementation, and dissemination #Research to understand its applicability and impact across different types of restaurants and sociodemographic contexts. Trial Registration: ClinicalTrials.gov NCT04334525; https://clinicaltrials.gov/#Study/NCT04334525

Background: Youth who are experiencing homelessness face a higher risk of HIV infection compared to their housed peers, and suicide and overdose remain the leading causes of death among homeless youth. Just-in-Time Adaptive Interventions (JITAIs) are gaining momentum for HIV prevention and substance use #Research. Yet, most interventions for homeless youth have not addressed modifiable real-time factors. Objective: This paper describes the development and implementation of a randomized attention-controlled trial to assess the efficacy of motivating youth to reduce infections, disconnections, and emotional dysregulation (MY-RIDE), a JITAI to improve HIV prevention and substance use in homeless youth. Methods: This #Study will enroll 320 homeless youth aged 18-25 years. The intervention was co-designed with homeless youth using the Information-Motivation-Behavioral Skills Model and consists of an individual nurse-led session about HIV prevention and 3 months of a JITAI with personalized messaging delivered by phone in real time in response to one’s current level of risk. Participants also had access to an on-demand nurse helpline through the #App. Results: Institutional review board approval was obtained in the summer of 2024. Recruitment began in the fall of 2024 at shelters, drop-in centers, and other organizations that serve homeless youth. Participants complete a baseline survey and HIV/sexually transmitted infection (STI) testing and are provided with a #Smartphone #mHealth with the intervention #App. Follow-up surveys and HIV/STI testing are conducted at immediate, 3-, 6-, and 12-month time points post intervention to assess uptake of HIV prevention strategies and substance use reduction. A total of 192 are enrolled to date. Conclusions: The results of this #Study will determine whether MY-RIDE increases HIV prevention strategies and decreases substance use when compared to homeless youth in the attention control group. We will also evaluate if MY-RIDE impacts protective factors such as willingness to take pre-exposure prophylaxis medication and use of mental health and substance use services, and antecedents of risk such as stress, substance use urge, and substance use. Trial Registration: Clinicaltrials.gov NCT06074354; https://clinicaltrials.gov/#Study/NCT06074354

Date Submitted: Oct 10, 2025. Open Peer Review Period: Oct 10, 2025 - Dec 5, 2025.

In a recent study published in the *Journal of Medical Internet Research*, researchers found that wearable technology significantly improved ...

Journal of Medical Internet Research. Ethical Partnership between Representatives of Institutions in the Implementation of Sustainable Development ...

... Shin-Yu Lien. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 09.10.2025. Publication types. Review.