Stress, sleep deprivation, and burnout are significant safety risks for acute care surgeons, negatively impacting performance, well-being, and clinical outcomes. This pilot randomized controlled trial aimed to measure neurophysiological effects of prescribed music (PM) and self-selected music (SSM) on surgeon stress, burnout, and neurophysiological responses using a multimodal protocol that integrated functional magnetic resonance imaging (fMRI), wearable biosensor monitoring, and psychological self-assessments. Full-time attending surgeons at a quaternary care hospital were invited to participate in a 3-armed trial (1:1:1 block allocation). Intervention groups were instructed to listen to 30 minutes (minimum 15 minutes) of either PM or SSM daily at bedtime for 6 weeks, reflecting real-world conditions. PM comprised original compositions based on elements promoting perceived relaxation from a prior study. The control arm avoided music in the 30 minutes before bed. Allocation was concealed from the recruiting investigator; the fMRI technicians, the statistician, and lead investigators were blinded until analyses were completed. Functional connectivity patterns were measured using fMRI at baseline and 6 weeks while participants listened to simulated intensive care unit noise, PM, and SSM. Secondary outcomes included continuous actigraphy for sleep quality and self-reported anxiety, sleep quality, and burnout using validated scales (State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, and Maslach Burnout Inventory). A total of 22 surgeons were assessed; demands of fMRI and data collection schedule led 3 to decline and 2 (allocated to PM) not to finish baseline measures; 6 PM, 5 SSM, and 6 controls received allocated intervention; 2 PM participants were withdrawn for nonadherence and missing follow-up data and 1 control missed follow-up collection due to scheduling (final analysis set after missing data: PM: n=4, SSM: n=5, control: n=5). One control participant experienced transient vertigo in fMRI. Trends in fMRI data indicated that both intervention groups experienced less negative emotional arousal and anxiety, with physical tension reduced in the PM group. The PM group exhibited reduced stress response in the frontal lobes when exposed to intensive care unit alarms, suggesting diminished attentional response to the high-stress auditory environment, compared to control. However, lack of statistical significance and baseline variability entail cautious interpretation. Observations of sleep quality were mixed, and no statistically significant differences in stress surveys were observed. Both music interventions trended toward positive changes in neurophysiological responses, suggesting potential benefits in reducing surgeon stress. However, due to the small sample, mixed or nonsignificant results, and the exploratory nature of this study, findings should be considered preliminary. Further research with larger, diverse cohorts is required to confirm trends, refine both the intervention approach and recruitment strategies, and determine whether objective compositional elements or personally selected music drive the mechanisms of potential positive effects. ClinicalTrials.gov NCT05980429; https://clinicaltrials.gov/study/NCT05980429.

The COVID-19 pandemic prompted rapid changes in medical education, accelerating the adoption of online and distance learning methods as alternatives to traditional teaching. While these approaches offered logistical advantages, students worldwide reported significant limitations, particularly in terms of motivation, clinical exposure, and hands-on skill acquisition. Despite the increased use of digital teaching during the pandemic, core educational objectives and the mission of medical training remained unchanged, emphasizing the continued importance of practical experience. This study aims to investigate the impact of the COVID-19 pandemic on current teaching methods in medical education and to explore students' perceptions of online learning, telemedicine, artificial intelligence, and other modern educational alternatives. This observational, cross-sectional multicentric study surveyed a cohort of Romanian medical students using a self-developed 48-item online questionnaire distributed via social media. Data were collected over 6 weeks (February-March), yielding 451 responses, of which eligible participants included students in clinical years or preclinical students interested in surgical or orthopedic careers, with a heavy representation of the Medicine and Pharmacy University of Timisoara. Statistical analysis was performed using Microsoft Excel and JASP (University of Amsterdam; version 0.95.4). A total of 436 responses were analyzed, with students favoring online or hybrid formats for lectures but preferring on-site teaching for practical training. Reduced patient interaction and limited skill acquisition were the main drawbacks of online practical education. Acceptance of hybrid learning correlated with more positive perceptions of teaching methods and a lower perceived desire to cheat. The COVID-19 pandemic brought significant changes to the way medicine is being taught in Romania, but it also brought a clearer picture for students and medical staff on how they want medical education to be done. Online cheating remains a significant challenge, but it is being tackled at the moment with different algorithms being tested.

Artificial intelligence-powered conversational agents (ie, chatbots) are increasingly popular outlets for users seeking psychological support, yet little is known about how users experience early-stage prototypes or which therapeutic processes contribute to clinical improvement. A transparent evaluation of emerging chatbot prototypes is needed to clarify if, how, and why artificial intelligence companions work and to guide their continued development. This mixed methods pilot study evaluated user experience, acceptability, and preliminary clinical signals for an early-stage mental wellness chatbot. We also examined whether baseline symptom severity moderated clinical improvement. Three sequential cohorts (n=125) completed a 2-week, incentivized chatbot exposure (approximately 60 min per week). Participants provided first-impression ratings, qualitative feedback, and pre-post assessments of depressive symptoms (PHQ-8 [Patient Health Questionnaire-8]), anxiety symptoms (GAD-7 [Generalized Anxiety Disorder-7]), psychological distress, well-being, and loneliness. Statistical models estimated symptom change and tested interactions with baseline symptom severity. Mixed methods analysis integrated quantitative outcomes with large language model-assisted qualitative content analysis of open-ended responses. Participants described the chatbot as accessible, easy to use, and emotionally validating, while citing limitations in personalization and conversational depth. Qualitative responses consistently highlighted early therapeutic processes such as emotional validation, goal setting, and perceived attunement. Regression models showed significant pre-post reductions in depressive (Hedges g=-0.32) and anxiety (g=-0.32) symptoms, alongside modest improvements in distress and well-being. Baseline severity moderated improvement, with marginal effects indicating larger predicted reductions at higher PHQ-8 and GAD-7 baseline scores (eg, PHQ-8=15: g=-0.84; GAD-7=15: g=-0.62). This pilot provides a comprehensive view of early chatbot development and suggests promising user experiences and preliminary symptom improvements under structured pilot conditions. By integrating experiential and exploratory clinical data, the study identifies candidate process targets to inform ongoing refinement. Findings support continued development and demonstrate procedural feasibility for progression to larger, longer-term trials evaluating engagement and clinical outcomes under more naturalistic conditions.

Physical inactivity remains a public health concern, with 42% (around 1 in 2) of women and 34% (around 1 in 3) of men in the United Kingdom, for example, failing to meet moderate-to-vigorous physical activity guidelines. To promote physical activity (PA) at scale, smartphone-based mHealth (mobile health) software apps offer a promising solution. This study aims to evaluate the feasibility of implementing an mHealth app offering very small ("micro") financial incentives for PA in Leeds, United Kingdom. A 5-week single-arm proof-of-concept study was conducted with rolling recruitment among Caterpillar Health app users between September 12 and December 12, 2022 (Obesity-Related Behavioral Intervention Trial model, phase IIa). Users earned microincentives in the form of "points," redeemable for consumer rewards (eg, movie tickets and gym passes), for meeting personalized daily step goals (US $0.13 per goal achieved; set using data from a 5-day baseline) and completing educational quizzes (US $0.33 per quiz). Descriptive statistics assessed feasibility outcomes (ie, reach, recruitment, retention, engagement, and acceptability) and preliminary effectiveness. Paired-samples t tests (P<.05) examined changes in weekly mean daily step count (from baseline) and step goal achievement over 5 weeks. Of 285 app downloads, 46 users consented to participate (recruitment rate: 16.1%). Participants (mean age: 39.9, SD 11.1 y; 71.1%, 33/46 woman) had a baseline step count of 5598 (SD 2664) steps/day. A total of 25 participants remained engaged (ie, completed at least 1 quiz) at study week 5 (retention rate: 54.3%). Acceptability was high, with 75% of respondents (12/16) indicating they would recommend the app. Weekly mean daily step count did not significantly increase from baseline (mean difference 317, SD 2273, P=.53). Weekly daily step goal achievement rate (%) decreased from study week 1 to 5 (-23.23, SD 22.85, P=.02). Despite lower-than-expected recruitment and no statistically significant PA increase, relatively high engagement and acceptability suggest future pilot testing (Obesity-Related Behavioral Intervention Trial model, phase IIb) of a refined intervention (eg, wider selection of loyalty reward partners) and modified study protocol (eg, simplified consent process) is warranted.

Sexual dysfunction (SD) is common among childhood cancer survivors, affecting approximately 20% to 50% of patients. National guidelines recommend discussions about sexuality throughout cancer care, and prior work demonstrates patient interest in SD conversations. Despite its prevalence and importance, SD is widely underrecognized and undertreated, creating gaps in comprehensive whole-person care. Our research aims to collaborate with provider partners to co-design an SD screening intervention prototype for implementation in a clinical oncology setting. This study outlines the co-design process to serve as a case study, highlighting challenges and strategies to achieve a consensus-driven intervention and implementation plan. We engaged pediatric cancer providers in a series of co-design sessions at a National Cancer Institute-designated cancer center within an academic children's hospital. For each co-design session, the research team created a template outlining considerations from formative work (eg, patient privacy) and key decisions to be made (eg, screening modality). Co-design session moderators facilitated discussion, guiding participants toward a consensus decision for each intervention component. A final process mapping session reviewed and outlined the entire SD prototype. We conducted a rapid qualitative analysis, compiling a templated summary synthesizing and organizing findings by discussion topic and decision point. Based on co-design discussions, the research team compiled a menu of options outlining key thematic findings, core screening intervention functions, and intervention form options to allow for future expansion and tailoring of the SD prototype. Six provider participants, including attending physicians, advanced practice providers, and registered nurses representing multiple oncology subspecialty groups, engaged in a series of 5 co-design sessions. Participants assessed specific intervention component options, reached consensus on component decisions, and determined an intervention and implementation workflow for each. Throughout, providers needed to ensure workflows aligned with patient and provider priorities from foundational work and to ensure design feasibility, acceptability, and appropriateness. Key intervention and implementation decisions included target population, screening frequency, screening modality and workflow, management of screening results, clinic reminders and cues, and provider education and training. With several decisions being interconnected, there was often a cascade effect in which one decision influenced or limited future decisions and, in some cases, required revisiting prior decisions to ensure cohesive alignment into a single prototype. Co-design session moderators used several strategies (eg, reminders, redirection, providing information on feasibility, etc) to facilitate decision-making and implementation strategy selection. Engaging provider partners in co-design sessions allowed for the collaborative development of a preliminary SD screening approach for adolescents and young adults with and surviving cancer. The dynamic co-design process and moderator strategies ensured that intervention and implementation decisions reflected the patient and provider priorities identified in prior work. Future work will test, adapt, and refine the prototype SD screening approach prior to effectiveness testing and eventual dissemination.

BackgroundWomen living in rural agrarian reform communities face intersecting challenges related to social, economic, racial, and gender vulnerabilities, which significantly increase their likelihood of developing physical and mental health problems. Despite the potential of telephone-based interventions to promote mental health, there is a lack of studies assessing their feasibility and effectiveness among underserved populations in Brazil.ObjectiveThis study aimed to assess the feasibility and effectiveness of a telephone-based intervention on mental health outcomes among women living in a rural agrarian reform community in Brazil.MethodsWe conducted a descriptive, prospective pilot study with a pretest and posttest design. Data were collected at 3 time points: baseline, 1 week, and 1 month after the intervention. The outcomes assessed included quality of life, social support, self-efficacy, and common mental disorder symptoms. Nonparametric tests were used to analyze the data. The intervention consisted of 3 phone calls supported by a workbook, with content based on cognitive behavioral and psychiatric nursing principles.ResultsOf the 31 women enrolled, 23 (74.2%) completed all 3 phone-based sessions. There was a significant reduction in common mental disorder symptoms (Kendall W=0.280; P=.002), particularly in the somatic domain (P=.02). Moreover, participants reported improved perceptions of the physical domain of quality of life (Kendall W=0.131; P=.049). All women rated the intervention positively, with more than half emphasizing its practical usefulness.ConclusionsThe telephone-based intervention was feasible and showed promising results in improving mental health outcomes among women in a rural setting. These findings support integrating low-intensity, remote psychosocial strategies into primary health care, especially those led by nurses, to increase access to mental health promotion for vulnerable populations.

BackgroundHealth care professionals’ perceptions of telemedicine, its usability, and the presence of organizational barriers are important determinants of the successful implementation of digital solutions in health care. In Kazakhstan, the use of international assessment instruments requires contextual adaptation. The Telehealth Usability Questionnaire-Model for Assessment of Telemedicine-Kazakhstan version (TUQ-MAST-KZ) questionnaire was previously developed and psychometrically validated by integrating elements of the TUQ and MAST frameworks to assess perceptions of telemedicine within the national context.ObjectiveThe aim of this study was to conduct the first pilot application of the TUQ-MAST-KZ questionnaire with physicians in Kazakhstan and perform an initial assessment of the organizational, technical, and educational aspects of telemedicine implementation.MethodsThis cross-sectional study involved an anonymous online survey using the TUQ-MAST-KZ questionnaire, which covers perceptions of telemedicine, formats of use, platform usability, communication-related aspects, telemonitoring, organizational conditions, and implementation barriers. Responses from 156 physicians were analyzed. Stratified nonparametric comparisons were performed by sex, age group, work experience (years), and workplace, adjusted for multiple comparisons.ResultsThe most used telemedicine formats were telephone consultations (78/156, 50%), video consultations (69/156, 44.2%), chats and messaging applications (57/156, 36.5%), and mobile apps (48/156, 30.8%). The Kazakhstan National Telemedicine Network was used by 14.7% (23/156). Wearable devices were used by 5.8% (9/156). Telemedicine technologies incorporating artificial intelligence elements were used regularly by 13.5% (21/156) and occasionally by 32.1% (50/156) and not used by 50.6% (79/156). Positive ratings were as follows: 48.7% (76/156) regarding the simplicity and intuitiveness of telemedicine platforms; 56.4% (88/156) regarding the timeliness of patient condition monitoring; 51.9% (81/156) regarding the effectiveness of telemedicine for the management of patients with chronic diseases. The potential usefulness of telemonitoring for earlier detection of deterioration of a patient’s condition was rated as fairly or very high by 48.7% (76/156); 41% (64/156) rated it as moderate. Only 35.9% (56/156) positively rated the connection’s reliability and stability. Regarding the accuracy of wearable device data transmission, 57.1% (89/156) responded neutrally, potentially indicating ambiguity in perception, limited personal experience, or difficulty evaluating this aspect. Readiness to recommend telemonitoring at the national level was more often rated as moderate, high, or very high (78/156, 50%; 42/156, 26.9%; 14/156, 9%, respectively).ConclusionsThis pilot application of the TUQ-MAST-KZ questionnaire showed a generally moderately positive perception of telemedicine by physicians, who recognized its potential clinical and organizational value. However, we identified substantial technical and institutional barriers, including connection instability, concerns about the accuracy of data transmission, insufficient process formalization, and a need for additional training. These preliminary findings should be interpreted in light of the pilot study design; however, they may serve to inform future larger-scale research and the development of organizational measures related to physician training, protocol standardization, and infrastructure support for telemedicine implementation.

BackgroundPeriodontitis is a chronic gum disease affecting approximately 42% of adults aged 30 years and older in the United States. Training dental students to accurately diagnose and manage periodontitis is a critical component of dental education and clinical care. Recent advances in large language models offer new opportunities to support both domains, yet their performance in periodontal diagnosis remains largely unexplored, particularly for newer models such as GPT-5.ObjectiveThis study conducted an exploratory evaluation of GPT-5’s ability to stage and grade periodontitis.MethodsA total of 25 publicly available clinical cases explicitly reporting periodontitis stage and grade were identified through Google and PubMed searches. Each case description was entered into GPT-5 using a zero-shot prompting approach to assess guideline-based reasoning without exemplar conditioning. The model’s predictions were compared with the published reference diagnoses. Performance was measured using accuracy, 95% CI, unweighted Cohen κ, and weighted Cohen κ.ResultsAcross these cases, GPT-5 showed marked class-dependent performance and a tendency to overestimate disease severity. Grading performance was notably imbalanced, with high recall for grade C but substantially lower discrimination for grade B. GPT-5 achieved a staging accuracy of 68% (95% CI 48.4%-82.8%) and a grading accuracy of 77.3% (95% CI 56.6%-89.9%), with corresponding Cohen κ values of 0.454 (95% CI 11.0%-75.6%) and 0.179 (95% CI −15.8% to 63.8%), respectively. While staging performance showed fair agreement beyond chance, the low κ for grading indicates poor agreement and limited reliability in distinguishing periodontal disease severity.ConclusionsThese findings suggest that although GPT-5 demonstrates potential for guideline-based periodontitis staging and grading, its current diagnostic performance, particularly for periodontitis grading, limits its use in clinical assessment and educational training. Meaningful application in periodontal diagnosis and training will require substantial improvements in reliability and rigorous validation in larger, more diverse, and prospectively collected datasets.

Digitalization in geriatric rehabilitation presents unique challenges, making it essential to align eHealth solutions with patients' digital skills. The Quickscan Digital Skills (QDS) is a tool designed to help health care professionals match eHealth interventions to individual skill levels. This study aimed to explore the applicability of QDS by comparing it to self-reported digital skills and to gain insight into the digital skills of patients in geriatric rehabilitation. In this multicenter cross-sectional study, participants from 13 geriatric rehabilitation centers in the Netherlands completed a survey, including demographic questions, QDS, and a numeric rating scale (NRS) for self-reported digital skills. Participants were categorized into 3 skill levels (beginner, intermediate, and experienced) based on the cutoff points in QDS scores. Cutoff points were predetermined, guided by the information provided on QDS. Descriptive statistics for median age and frequencies for skill levels were calculated. Comparative analysis using a Kruskal-Wallis test assessed differences between QDS and NRS within these groups, and Spearman rank-order correlation examined the relationship between the two measures. To gain more insight into the different skill levels between groups, data were visualized and associations among age, gender, and digital skill levels were examined using ordinal logistic regression analysis. A total of 463 patients (median age 78, IQR 12 years; 282/463, 60.9% female) participated in this study. Based on QDS scores, 42.1% (195/463) were classified as beginners, 19.4% (90/463) as intermediates, and 38.4% (178/463) as experienced users. A moderate positive correlation was found between QDS and NRS scores. Digital skills generally declined with age: 69.8% (37/53) of participants younger than 65 years were experienced users compared to only 13.2% (5/38) of those older than 91 years. A logistic regression analysis showed that increasing age was significantly associated with lower digital skill levels (odds ratio 0.93, 95% CI 0.92-0.95; P<.001). The association between age and digital skills does not differ between males and females. This study suggests that QDS is a promising and practical screening tool for assessing digital skills in patients in geriatric rehabilitation. Self-reported digital skills with an NRS do not capture the differentiation in the assessed abilities by QDS. QDS could be a practical tool for identifying digital skill levels in patients in geriatric rehabilitation and can support more personalized eHealth implementation. Further research should explore the parametric properties of QDS and how the scores relate to actual eHealth use.

BackgroundThe period following discharge from psychiatric inpatient care represents a critical transition phase marked by heightened vulnerability to relapse, including increased risks of emergency department (ED) utilization. Understanding the risk factors for ED utilization after hospital discharge will help identify individuals who should be targeted for enhanced follow up care in the community.ObjectiveThis study aimed to examine the sociodemographic and clinical factors associated with psychiatric ED utilization within six months of discharge from inpatient psychiatric care among individuals assigned to different postdischarge interventions. The goal is to identify high-risk groups to inform targeted follow up strategies and enhance transitional care planning.MethodsThis study analyzed secondary data from a pragmatic stepped-wedge cluster-randomized trial which recruited patients across ten health care sites in Alberta, Canada, from March 2022 to February 2024. For the primary study, a total of 1098 psychiatric inpatients were allocated to one of three post-discharge conditions: treatment as usual (TAU), SMS, or SMS plus peer support (SMS+ PS). Sociodemographic and clinical data were collected at discharge. ED visits 6-months postdischarge were recorded. χ2 tests identified variables associated with ED utilization. Significant predictors were entered into a logistic regression model to determine adjusted odds ratios (ORs) and 95% CIs.ResultsOf the 1098 participants, demographic and clinical variables were examined for association with mental health ED visits at 6-months post discharge. Univariate analysis identified six significant predictors: age, ethnicity, relationship status, employment, housing status, and prior ED use. Logistic regression analysis identified several predictors of mental health ED visits 6-months postdischarge. Compared to participants under 25 years, those aged 26‐40 was less likely to revisit the ED (OR 0.66, 95% CI 0.46‐0.95), as were those over 40 years (OR 0.58, 95% CI 0.37‐0.92). Individuals identifying as mixed or other ethnicity were less likely than White people to return to the ED (OR 0.52, 95% CI 0.28‐0.96). Unemployed participants had higher odds of ED use than those employed (OR 1.66, 95% CI 1.18‐2.34). Prior ED attendance was the strongest predictor (OR 2.45, 95% CI 1.03‐5.80). Housing status showed varied but nonsignificant effects.ConclusionsThis study highlights key demographic and clinical factors influencing psychiatric ED use following inpatient discharge. The findings emphasize the importance of targeted transitional care interventions, particularly for high-risk groups such as younger, unemployed, and previously ED-utilizing individuals, and support the integration of scalable approaches like SMS and peer support into discharge planning.