Interactive Journal of Medical Research最新文献

{"title":"Perspectives of Indian Gastroenterologists and Hepatologists on Nonalcoholic Fatty Liver Disease Diagnosis and Management: Insights From the Nationwide Web-Based Cross-Sectional DRIVE Survey.","authors":"Anil Arora, Yogesh Garje, Shagupta Shaikh, Shruti Dharmadhikari, Chintan Khandhedia, Neeraj Markandeywar, Amey Mane, Suyog C Mehta, Ashish Kumar","doi":"10.2196/75138","DOIUrl":"10.2196/75138","url":null,"abstract":"<p><strong>Background: </strong>Nonalcoholic fatty liver disease (NAFLD) and its progressive form, nonalcoholic steatohepatitis (NASH), represent an increasing clinical and public health burden in India. Despite their high prevalence, there are limited data on their diagnostic and management approaches among Indian health care providers. Real-world evidence on how Indian gastroenterologists and hepatologists diagnose and manage these conditions remains limited.</p><p><strong>Objective: </strong>This study aimed to understand the current disease perspectives, diagnostic modalities, and management practices for NAFLD and NASH among Indian hepatologists and gastroenterologists.</p><p><strong>Methods: </strong>A nationwide, web-based cross-sectional survey was conducted online between May 2023 and July 2023 among practicing gastroenterologists and hepatologists from health care setups, clinics, and hospitals located across India. The structured, self-administered questionnaire included 34 items covering 3 domains: disease perspectives (n=16), diagnostic modalities (n=4), and management strategies (n=14). Descriptive statistics were used to summarize responses as counts and percentages.</p><p><strong>Results: </strong>A total of 609 physicians completed the online survey (gastroenterologists: n=556, 91.3%; hepatologists: n=53, 8.7%). For 336 (55.2%) physicians, NAFLD accounted for 25% to 50% of the patients consulted per month, and 220 (36.1%) physicians reported that 10% to 20% of patients with NAFLD had NASH. Obesity (n=583, 95.7%) and diabetes (n=579, 95.1%) were cited as leading risk factors for NAFLD. Transient elastography was the diagnostic tool preferred by 558 (91.6%) physicians, followed by NAFLD fibrosis score (n=378, 62.1%) and Fibrosis-4 score (n=356, 58.5%); only 154 (25.3%) physicians used liver biopsy. For treatment, 414 (68%) physicians managed patients using pharmacotherapy and dietary and lifestyle modifications, while 195 (32%) relied on lifestyle modification alone. Antioxidant vitamins (n=543, 89.2%) and saroglitazar (n=522, 85.7%) were the most frequently prescribed therapies. The main barriers to optimal NASH management reported were lack of patient awareness (n=466, 76.5%) and limited availability of effective pharmacological options (n=303, 49.8%).</p><p><strong>Conclusions: </strong>This large, nationwide survey highlights that NAFLD and NASH constitute a major part of gastroenterology and hepatology practice in India. Although transient elastography and pharmacological agents such as saroglitazar and vitamin E are widely used, considerable heterogeneity exists in diagnostic and management approaches. The lack of patient awareness and effective treatment options remain the major hurdles in managing NAFLD and NASH. These findings underscore the need for the wider implementation of existing India-specific consensus recommendations, continued physician education, and future research focusing on tailored interventions in the man","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"15 ","pages":"e75138"},"PeriodicalIF":3.3,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12993273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of mHealth-Augmented Social Support on Health Care Use Among Patients With Diabetes: Secondary Analysis of the TExT-MED+FANS Trial.","authors":"Danielle Hazime, Liza Raffi, Elizabeth Burner","doi":"10.2196/65113","DOIUrl":"10.2196/65113","url":null,"abstract":"<p><strong>Background: </strong>The rising cost of unscheduled acute health care, particularly for emergency department (ED) visits, poses significant financial burdens. In 2021, aggregate costs for treat-and-release ED visits in the United States accounted for an estimated US $80 billion, while the total annual cost of diabetes was US $412.9 billion in 2022-representing about 1 in every 4 health care dollars, 61% of which are directly linked to diabetes.</p><p><strong>Objective: </strong>This study explores the impact of a mobile health (mHealth) intervention with augmented social support delivered via guided SMS text messaging on health care use among patients with diabetes through a secondary analysis of the TExT-MED+FANS (Trial to Examine Text-Messaging in Emergency Patients With Diabetes + Family and Friends Network Support) randomized controlled trial.</p><p><strong>Methods: </strong>The trial involved 173 participants randomized into either a FANS mHealth-augmented social support or an active control group that received the same support curriculum via mailed pamphlet; \"augmented\" social support refers to recruiting both individuals with diabetes and a designated family member or friend (\"supporter\") to participate. Supporters in the FANS arm received structured SMS guidance on how to assist the participant with diabetes in managing their condition. Health care use outcomes, including ED visits, hospitalizations, and clinic visits, were compared between groups during and after the intervention period using linear regression models on change in health care visits in the last year, with subgroup analysis by participant sex and supporter relationship.</p><p><strong>Results: </strong>Results showed significant reductions in acute unscheduled care visits for both groups during and after the intervention, with the FANS group experiencing a reduction of 1.04 visits during the intervention and 1.10 visits after the intervention, while the mailed pamphlet group had reductions of 1.47 and 1.53 visits, respectively (both P<.001). Clinic visits increased by 1.78 during the intervention phase (P=.01) but were not sustained postintervention. Hospitalizations modestly decreased in both groups, but the decrease was statistically significant only for the mailed pamphlet group (P=.002). Sex and supporter relationship differences were observed, with females supported by spouses in the active control group showing the largest decrease in unscheduled care visits.</p><p><strong>Conclusions: </strong>The findings suggest that mHealth interventions combined with structured social support can improve diabetes management and reduce health care costs. Although these conclusions are specific to this study, they align with prior research demonstrating the benefits of social support and mHealth interventions. These findings may inform future programs, including the design of low-cost, scalable interventions in resource-limited settings.</p>","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"15 ","pages":"e65113"},"PeriodicalIF":3.3,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12954576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging Technologies and Vulnerabilities in Older Adults Without Cognitive Impairments: Systematic Review of Qualitative Evidence.","authors":"Annachiara Fasoli, Maria De Luca, Giorgia Beretta, Chris Gastmans, Virginia Sanchini","doi":"10.2196/69676","DOIUrl":"10.2196/69676","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Aged care has recently undergone major transformations due to demographic aging and the concomitant need to manage health care costs. New emerging technologies (ETs) have started to play central roles in the daily management of older adults. For these transformations to effectively promote successful and active aging, it is essential to understand the opinions of older adults on the impact that technology can have on their vulnerabilities and aging process.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This work aims to study the ethically related impact of ETs on cognitively healthy older adults' vulnerabilities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review of empirical (qualitative) evidence exploring the relationship between ETs and older adults' vulnerabilities as perceived by older adults (older than 65 years) without cognitive impairments. Five major databases (PubMed, Web of Science, Embase, CINAHL, and Philosopher's Index) were queried on March 1, 2022. After eliminating duplicates, titles, abstracts, and full texts were screened for relevance. Data analysis and synthesis followed the preparatory steps of the coding process detailed in the Qualitative Analysis Guide of Leuven methodology, which involved carefully reading the publications included, identifying significant themes, and constructing conceptual schemes for each paper. The quality of the publications was evaluated by using the Critical Appraisal Skills Program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 11,631 results were obtained. Eventually, 70 articles were included, and of these, 46 articles had a high level of methodological quality. The remaining 24 articles had moderate quality. ETs appeared to have an ambivalent effect, mitigating some already existing vulnerabilities, and at the same time, worsening already existing vulnerabilities or creating new vulnerabilities. For example, unconventional monitoring techniques (eg, wearables) often mitigated relational vulnerability, helping to maintain independence and remain at home and in one's community. Conversely, these same devices may negatively affect moral vulnerability, threatening older adults' privacy linked to data confidentiality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This systematic review, which focused on the perceptions of older adults without cognitive impairments, enriches the vast literature about the everyday management and care of seniors by exploring the ethical implications of ETs. This research is complementary to another systematic review of qualitative evidence, which analyzed the views of older people with cognitive disorders on the same topic. Although a certain ambivalence in the use of ETs was identified by both population groups, it is interesting how cognitively healthy older adults give more importance to some dimensions of vulnerability, such as the moral and re","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"15 ","pages":"e69676"},"PeriodicalIF":3.3,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12919910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146229414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internet Use and Self-Rated Health Among Older Adults: Scoping Review.","authors":"Hanan AboJabel, Fareeda Abo-Rass","doi":"10.2196/76930","DOIUrl":"10.2196/76930","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Self-rated health (SRH) is a robust predictor of morbidity, functional decline, and mortality in later life. As internet use becomes increasingly embedded in older adults' daily routines, clarifying its association with SRH and the pathways through which it may operate is important for research, practice, and policy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This scoping review aimed to map and characterize the international evidence on the association between internet use and SRH among older adults, synthesize how potential mediators and moderators have been examined, and identify key methodological, theoretical, and population gaps in the literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Guided by the Joanna Briggs Institute methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting standards, we conducted a scoping review and searched 5 databases: PubMed, CINAHL, AgeLine, PsycINFO, and Web of Science. The final search was performed on February 5, 2024. Reference lists were screened, and Google Scholar searches were conducted as supplementary search methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Database searches identified 4294 records; after removing 615 duplicates, 3679 records were screened, and 77 full texts were assessed, resulting in 27 included studies. All included studies were quantitative, and the evidence base was predominantly cross-sectional (25/27). Explicit theoretical frameworks were used in 6 out of 27 studies. Most studies were published between 2019 and 2024 (22/27) and were conducted most frequently in China (11/27) and the United States (7/27). All studies were conducted in high-income countries. SRH was typically assessed using a single-item measure, while internet use was operationalized as access/use (yes/no), frequency, and/or purpose/domain-specific measures. Most studies reported a statistically significant positive association between internet use and better SRH (24/27), with socially oriented uses (eg, communication and social participation) showing the most consistent associations. Mediating pathways were examined in 6 out of 27 studies, and most often suggested social mechanisms such as greater social support, higher social engagement, and lower loneliness. Subgroup heterogeneity was reported in 10 out of 27 studies, including differences by age, gender, residence, and marital status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Overall, internet use, particularly socially oriented use, was most consistently associated with better SRH among older adults. Policy efforts should support digital inclusion by improving access, skills, and ongoing assistance that enable meaningful use for social connection and service access. At the same time, nondigital options are essential to avoid excluding older adults who do not use the internet. In addition, evidence gaps, including limited use of theoretical frameworks and scarce data from low- and ","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"15 ","pages":"e76930"},"PeriodicalIF":3.3,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12963975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146229324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Gender in Research on Intervention Programs Targeting Social Isolation and Loneliness Among Older Adults: Scoping Review.","authors":"Kenta Nomura, Naoto Kiguchi, Eisuke Inomata, Takeshi Nakamachi, Norikazu Kobayashi","doi":"10.2196/72281","DOIUrl":"10.2196/72281","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Social isolation and loneliness have considerable health implications. Research indicates that older men are generally more susceptible to social isolation compared with women, highlighting the need to integrate gender-responsive approaches in the development and implementation of interventions for mitigating social isolation and loneliness in later life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to conduct a review of intervention programs targeting social isolation and loneliness, focusing on gender-specific considerations. Specifically, it aims to examine the gender composition (male-to-female ratio) of participants in intervention programs and identify and analyze intervention strategies that demonstrate gender-sensitive effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A scoping review was conducted as per the Joanna Briggs Institute manual for evidence synthesis. A comprehensive literature search, including hand searching, was conducted across 6 English-language databases, PubMed, MEDLINE, Cochrane, CINAHL, ScienceDirect, and Web of Science, for papers and reports published in 2013-2023. The authors, country, subjects, research design, intervention method, results, and mentions of gender for each included document were presented.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study identified 1282 papers and reports, of which 10 were selected for analysis. Only 1 study reported a higher number of male participants compared with female ones; in contrast, all other studies included predominantly female samples. The studies assessed outcomes based on 2 indicators of social isolation, 4 indicators of loneliness, and 29 other indicators. Exercise and workshops proved effective for social isolation and loneliness, while meditation and laughter therapy were effective for loneliness. The intervention with the highest percentage of male participants (264/323, 82%) was a customized meditation program. Conversely, physical activities, social support, and community-based group health classes drew more female participants. In total, 8 studies did not mention gender in the discussion section, and none considered gender-specific issues in formulating research objectives and outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Research on social isolation and loneliness has generally ignored the influence of gender. The review also indicated a gender bias in participant selection, with women markedly overrepresented in study samples. The study found that women tend to prefer interventions emphasizing conversations, shared experiences, and emotional exchange. In contrast, men showed the highest participation in a meditation program focused on self-dialogue, which required minimal interaction. Importantly, interventions aimed at promoting social interaction or participation are unlikely to succeed without consideration of gender-specific issues. Therefore, systematically identifying conditions necessary for effective interventions that ta","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"15 ","pages":"e72281"},"PeriodicalIF":3.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12961394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146222038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-Based Self-Management Strategies for Fibromyalgia: Foundations for Digital Therapeutic Applications.","authors":"Thomas Lebeau Foustoukos, Isabelle Leclercq, Marc Blanchard, Thomas Hügle","doi":"10.2196/67523","DOIUrl":"10.2196/67523","url":null,"abstract":"<p><p>Fibromyalgia is a prevalent musculoskeletal pain condition that causes major personal, social, and societal burden. Pharmacological therapies often provide only limited benefit, making multimodal approaches and self-management the cornerstones of care. Such strategies, spanning lifestyle modification, physical activity, psychoeducation, and cognitive-behavioral approaches, target the biopsychosocial complexity of fibromyalgia and promote sustainable coping. In parallel, digital health technologies are transforming how these interventions can be delivered and coordinated in the form of digital therapeutics. This viewpoint draws on a multiphase investigation to appraise the current and future landscape of fibromyalgia self-management in the digital era. Its objective is to present an evidence-based framework and recommendations to guide the development of a mobile health self-management program for patients with fibromyalgia. In phase 1, we conducted a review of international guidelines and randomized controlled trial-based systematic reviews addressing nondigital self-management interventions for fibromyalgia and related nociplastic pain conditions. In phase 2, we analyzed the content and certification status of currently available mobile and virtual health applications for fibromyalgia. In phase 3, we convened a multidisciplinary focus group of rheumatologists, patients, and digital health developers to identify priorities for translating evidence-based self-management content into mobile health formats. Collectively, we suggest that effective digital self-management for fibromyalgia should evolve beyond single-domain interventions toward validated, personalized, and interactive multimodal platforms. Virtual care may increasingly function at the point of care, linking monitoring, education, and behavioral support in one continuum.</p>","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"15 ","pages":"e67523"},"PeriodicalIF":3.3,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12957949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Usability of Continuous Monitoring Devices With Deterioration Alerting Systems in Noncritical Care Units: Scoping Review.","authors":"Jo-Fan Pan, Dawn Dowding, David Wong, Ashley Scott, Qimeng Zhao","doi":"10.2196/75713","DOIUrl":"10.2196/75713","url":null,"abstract":"<p><strong>Background: </strong>Delayed recognition of patient deterioration in a non-intensive care unit (ICU) setting contributes to serious adverse events. Continuous monitoring devices with alerting systems offer real-time data to support early detection, but their effectiveness depends on usability. While prior reviews focus on clinical outcomes, usability-defined by effectiveness, efficiency, and satisfaction-remains underexplored.</p><p><strong>Objective: </strong>This study aims to scope the evidence related to the usability of continuous monitoring devices with deterioration alerting in noncritical adult care units.</p><p><strong>Methods: </strong>A scoping review was conducted following the Joanna Briggs Institute methodology and reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A comprehensive search of MEDLINE, Embase, Emcare, Web of Science, and IEEE Xplore was performed for studies published up to November 2024. Title and abstract screening, full-text review, and data extraction were independently conducted by 2 reviewers. Studies were included if they (1) evaluated the usability-defined as effectiveness, efficiency, or satisfaction-of continuous monitoring devices; (2) focused on adult patients in non-ICU hospital settings; (3) used primary data; (4) were published in English; and (5) described how clinicians received alerts.</p><p><strong>Results: </strong>The search identified 1284 papers, with 35 included. Most studies focused on postoperative patients in surgical wards, mainly from the United States and the Netherlands. Only 2 studies used mixed methods, and 10 reported clinician characteristics. While effectiveness (71%) and efficiency (74%) were widely studied, satisfaction (46%) and usability barriers (29%) received less attention.</p><p><strong>Conclusions: </strong>Continuous monitoring devices with deterioration alerts may reduce rapid response team calls and ICU transfers, save time, and maintain acceptable alarm frequencies with high user satisfaction. However, usability challenges persist, including technical issues, alarm fatigue, patient discomfort, and limited training or workflow integration. This review mapped current use, usability, and barriers, categorized key usability factors for improvement, and identified the need for further research on clinician perspectives and broader health care settings to enhance generalizability.</p>","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"15 ","pages":"e75713"},"PeriodicalIF":1.9,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12892175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146159080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Eye-Opening Approach: Cancer of Unknown Primary Source With Choroidal Metastasis Case Report.","authors":"Erin Kaser, Vedin Barve, Alexander Blaschke, Constance Fry, Corey Waldman, Sarah Hackman, William Kelly","doi":"10.2196/77895","DOIUrl":"10.2196/77895","url":null,"abstract":"<p><strong>Unlabelled: </strong>Choroidal metastases (CM) represent a rare but clinically significant manifestation of systemic malignancy, most frequently from lung cancer., The choroid's vascular anatomy allows hematogenous tumor seeding. Although CM may be the first clinical sign of an underlying malignancy, evidence guiding its management in the modern immunotherapy era remains limited, as most published cases predate the widespread use of immune checkpoint-inhibitors., We describe a 33-year-old male patient presenting with ocular pain and visual disturbance, who was found to have an amelanotic choroidal lesion. Systemic workup revealed small pulmonary nodules and an iliac crest lesion. Sequential biopsies suggested that this was metastatic adenocarcinoma of unknown primary origin, but most likely of lung origin, without actionable mutations or PD-L1 (programmed death-ligand 1) expression. Management required multidisciplinary coordination and included carboplatin, paclitaxel, and pembrolizumab, followed by radiation to the orbit, iliac crest, and mediastinal sites of disease. Unfortunately, he experienced progression while on maintenance immunotherapy with new rib and brain lesions, for which he underwent treatment with platinum, pemetrexed, and bevacizumab with additional radiotherapy. Despite loss of vision in the affected eye, he achieved durable disease control and remains free of radiographic recurrent disease>4 years after diagnosis., This case illustrates that multimodality salvage strategies-integrating systemic therapy with aggressive local radiation-can provide unexpectedly prolonged survival even after immunotherapy failure. Importantly, current guidelines offer minimal direction on managing CM in this context, and prior case reports do not reflect present-day treatment realities. The key message for clinicians is that CM should not automatically be approached with palliative intent; carefully selected patients may benefit from an oligometastatic strategy that actively targets limited metastatic sites to prolong survival. Our findings underscore the need for ophthalmology, radiation oncology, and medical oncology collaboration when vision-threatening or occult metastatic lesions arise., For readers, the takeaway is that choroidal metastasis-particularly in the era of immunotherapy-warrants individualized, multidisciplinary evaluation rather than default palliation. Our case demonstrates that coordinated multimodality management can achieve long-term disease control, highlighting a treatment paradigm worth considering for selected patients and calling for updated guidelines that reflect modern therapeutic capabilities.</p>","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"15 ","pages":"e77895"},"PeriodicalIF":1.9,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12875659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends, Predictors, and Outcomes of Monitored Acute Care Unit Admissions in Older Adults: 10-Year Retrospective Analysis.","authors":"Ludovic van Delden, Stephan von Düring, Frederic Rouyer, Anne Rossel, Christophe Marti, Sara Cereghetti, Xavier Roux, Thibaut Desmettre, Olivier Grosgurin, Christophe A Fehlmann","doi":"10.2196/80629","DOIUrl":"10.2196/80629","url":null,"abstract":"<p><strong>Background: </strong>Global population aging places an increasing burden on health care systems. This is driven by multimorbidity, frailty, and polypharmacy. Older adults, particularly those aged 65 years or older, use emergency departments (EDs) more frequently and experience poorer outcomes. In this population, decisions regarding admission to monitored acute care units-intensive care units, intermediate care units, and operating rooms-are frequent and complex. While ED and intensive care unit use are well documented, data on monitored acute care units as a whole remain limited. Evidence on admission trends, patient characteristics, and outcomes in older adults is scarce.</p><p><strong>Objective: </strong>This study aimed to describe temporal trends in monitored acute care unit admissions, identify predictors of such admissions, and assess outcomes following these admissions.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using routinely collected electronic health record data. We included patients aged 65 years or older who visited the EDs of the Geneva University Hospitals, Switzerland, between 2009 and 2019. The primary outcome was admission to a monitored acute care unit. The secondary outcomes were hospital length of stay, 7-day mortality, and 1-year mortality. Logistic regression models were used to identify factors associated with monitored acute care unit admission and to assess the association between age and mortality.</p><p><strong>Results: </strong>During the 10-year period, 701,838 ED visits were recorded. Annual visits increased from 56,944 to 76,368 (+34.1%). The increase was greater among patients aged 65 years or older (+56.1%) than among younger patients (+26.5%). A total of 180,189 older patients presented to the ED. Of these, 887 (0.5%) died in the ED, 97,238 (54.0%) were discharged home, 63,025 (35.0%) were admitted to a ward, and 19,039 (10.6%) were admitted to a monitored acute care unit. Monitored acute care unit admissions increased from 1379 (10.3%) in 2009 to 2240 (11.1%) in 2019. This represented an absolute increase of 62.4% and a relative increase of 0.8%. Predictors of monitored acute care unit admission included younger age, male sex, ambulance arrival, higher triage level, being married or in a relationship, not residing in a nursing home, and French as the primary language. Among patients admitted to a monitored acute care unit, mortality was 5.8% (1105/19,039) at 7 days and 22.3% (4251/18,039) at 1 year. Older age was associated with higher 7-day mortality (adjusted odds ratio 1.55, 95% CI 1.14-2.10) and 1-year mortality (adjusted odds ratio 1.28, 95% CI 1.08-1.51).</p><p><strong>Conclusions: </strong>Admissions to monitored acute care units among older patients increased over time. These findings indicate a growing demand for high-level care in this population. Hospitals should adapt infrastructure and resource allocation to address the needs of an aging population.</p>","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"15 ","pages":"e80629"},"PeriodicalIF":1.9,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effectiveness, Facilitators, and Barriers of Digital Mental Health Services for First Nations People in Australia: Systematic Scoping Review.","authors":"Siyu Zhai, Andrew Goodman, Anthony C Smith, Sandra Diminic, Xiaoyun Zhou","doi":"10.2196/80386","DOIUrl":"10.2196/80386","url":null,"abstract":"<p><strong>Background: </strong>First Nations people in Australia experience inequitable mental health outcomes and service access. Digital mental health (DMH) services, which refer to offering mental health services through digital platforms, are considered potential solutions to address such mental health service inequities and improve the mental health outcomes of First Nations Australians. However, evidence on the effectiveness of DMH services for First Nations people in Australia is yet to be synthesized.</p><p><strong>Objective: </strong>This systematic scoping review aims to fill this gap and to identify the facilitators and barriers that influence the implementation of DMH services among First Nations people in Australia.</p><p><strong>Methods: </strong>A systematic search was conducted across 6 academic databases to search for studies related to DMH services for First Nations people in Australia. Search terms relating to First Nations people, geographic terminologies of Australia, mental health, and DMH services were used. Studies were included if they assessed the effectiveness of DMH services or the determinants of the facilitators and barriers of implementing DMH interventions among First Nations people in Australia. Data were extracted based on study design, targeted services, and research findings, and were then synthesized using a thematic analysis framework.</p><p><strong>Results: </strong>In total, 22 studies met the inclusion criteria. DMH services were used to support and treat First Nations Australians and conduct psychological assessments in these individuals. Evidence of effectiveness was stronger for nonsevere mental health conditions. The determinants of the facilitators and barriers of the implementation of DMH services included the following: (1) organizational and administrative factors; (2) cultural appropriateness; (3) accessibility; (4) integration of DMH services in the existing health system; (5) engagement between clients and service providers; (6) coverage of different conditions and clients; (7) acceptability to DMH services; (8) digital literacy; and (9) efficiency.</p><p><strong>Conclusions: </strong>Evidence on the use of DMH services for First Nations Australians remains heterogeneous in terms of study design and outcome measurement. DMH services appear to be most effective for managing nonsevere mental health conditions. Successful implementation requires multilevel structural support, including policy and organizational commitment, enhanced digital infrastructure, workforce training and engagement, and the design of culturally responsive DMH models to improve uptake and equitable access to mental health care among First Nations Australians.</p>","PeriodicalId":51757,"journal":{"name":"Interactive Journal of Medical Research","volume":"15 ","pages":"e80386"},"PeriodicalIF":3.3,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12841858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}