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MOFNet: a deep learning framework for multi-omics data fusion in cancer subtype classification

Mol Omics. 2025 Oct 1. doi: 10.1039/d5mo00221d. Online ahead of print.

ABSTRACT

BACKGROUND: cancer exhibits high molecular and clinical heterogeneity, making accurate subtyping essential for personalized treatment. Traditional single-omics approaches often fail to capture this complexity. Multi-omics integration offers a more holistic understanding, but many existing methods either lack interpretability or fail to model cross-omics correlations effectively.

METHODS: we developed MOFNet, a novel supervised deep learning framework for multi-omics integration, incorporating a similarity graph pooling (SGO) module and a view correlation discovery network (VCDN). MOFNet processes omics data-including mRNA expression, DNA methylation, and miRNA expression-via omics-specific graph learning and cross-omics label space fusion. Three cancer types-breast cancer (BRCA), low-grade glioma (LGG), and stomach adenocarcinoma (STAD)-were analyzed using datasets from the cancer genome atlas (TCGA). Statistical evaluation was performed using accuracy, weighted F1 score, and macro F1 score across stratified training/testing splits.

RESULTS: MOFNet achieved superior performance across all datasets. For BRCA, it obtained an accuracy of 85.17%, F1_weighted of 85.36%, and macro F1 of 80.93%, outperforming all baseline models by up to 18.25%. In LGG and STAD, MOFNet also showed robust gains, with maximum improvements of 23.72% and 21.56%, respectively. Omics ablation studies demonstrated enhanced performance with multi-omics integration. Functional enrichment analysis revealed that MOFNet-identified key features were involved in biologically relevant pathways such as cell cycle regulation, synaptic signaling, and ion transport.

CONCLUSIONS: MOFNet enables scalable and interpretable multi-omics data fusion for cancer subtype classification, significantly improving predictive accuracy while retaining only 25% of input features. The integration of SGO and VCDN modules offers both biological interpretability and computational efficiency. These results suggest MOFNet's promising application in precision oncology and biomarker discovery.

PMID:41031935 | DOI:10.1039/d5mo00221d

The tumour microenvironment in pancreatic cancer - new clinical challenges, but more opportunities

Nat Rev Clin Oncol. 2025 Oct 3. doi: 10.1038/s41571-025-01077-z. Online ahead of print.

ABSTRACT

Patients with advanced-stage pancreatic ductal adenocarcinoma (PDAC) predominantly receive chemotherapy, and despite initial responses in some patients, most will have disease progression and often dismal outcomes. This lack of clinical effectiveness partly reflects not only cancer cell-intrinsic factors but also the presence of a tumour microenvironment (TME) that precludes access of both systemic therapies and circulating immune cells to the primary tumour, as well as supporting the growth of PDAC cells. Combined with improved preclinical models of PDAC, advances in single-cell spatial multi-omics and machine learning-based models have provided novel methods of untangling the complexities of the TME. In this Review, we focus on the desmoplastic stroma and both the intratumoural and intertumoural heterogeneity of PDAC, with an emphasis on cancer-associated fibroblasts and their surrounding immune cell niches. We describe new approaches in converting the immunologically 'cold' PDAC TME into a 'hot' TME by priming T cell activation, overcoming T cell exhaustion and unravelling myeloid cell-mediated immunosuppression. Furthermore, we explore integrated targets involving the TME, such as points of convergence among tumour, stromal and immune cell metabolism as well as oncogenic KRAS signalling. Finally, building on our experience with failed clinical trials in the past, we consider how this evolving comprehensive understanding of the TME will ensure future success in developing more effective therapies for patients with PDAC.

PMID:41044427 | DOI:10.1038/s41571-025-01077-z

Clinical validation of an AI-based blood testing device for diagnosis and prognosis of acute infection and sepsis

Nature Medicine, Published online: 30 September 2025; doi:10.1038/s41591-025-03933-y

In a prospective study enrolling 1,222 patients from 22 emergency departments, a device using a machine-learning-based signature of blood mRNAs demonstrated clinically acceptable performance to diagnose bacterial and viral infections and to predict the all-cause need for critical care interventions within 7 days, with benchmark to established biomarkers and risk scores.

Clinical Decision Support Systems Using Home Blood Pressure Readings to Manage Patients With Hypertension: Scoping Review

Background: Home blood pressure (HBP) is an important parameter that guides clinicians in managing hypertension in patients. However, in using these records to manage patients, physicians face challenges, particularly regarding access, integration, and interpretation of the records when making clinical decisions. Clinical decision support systems (CDSSs) have been proposed to address these challenges; however, current literature reveals significant heterogeneity and gaps in CDSSs used for hypertension management. Objective: This study aimed to summarize existing studies on CDSSs that use HBP readings to manage patients with hypertension. Methods: We conducted a scoping review, with searches performed in PubMed, Embase, and Scopus on April 1, 2024. The results were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Studies that used CDSSs integrated with HBP monitoring among adult patients with hypertension in outpatient settings were included. Non-English studies were excluded. Outcomes assessed included the theoretical frameworks used for CDSS development, CDSS components (data capture, processing, and output), clinical outcomes, user experiences, and implementation processes. Results: Of the 5023 articles screened, 33 (0.66%) were included. Most of the studies were conducted in the United States (16/33, 49%) and were randomized controlled trials (21/33, 64%). Nearly two-thirds of the CDSSs (21/33, 64%) were computerized. Only 1 (3%) of the 33 studies reported using a theoretical framework for CDSS development. HBP recording and uploading were predominantly automatic (23/33, 70%). All computerized CDSSs (21/33, 64%) used rule-based algorithms, and most (19/21, 91%) incorporated alert triggers for results outside the reference range. More than a third of the studies (13/33, 39%) were based on hypertension guidelines. Among studies that reported outcomes, most reported improved blood pressure (25/29, 86%) and adjustment in antihypertensive medications (16/19, 84%). Patients and clinicians appreciated the convenience and remote monitoring (10/33, 30%) but reported challenges with usability and access to computerized CDSSs (2/21, 10%). Of the studies using noncomputerized CDSSs (12/33, 36%), all incorporated patient education, while nearly two-thirds of the studies using computerized CDSSs (13/21, 62%) did the same. Clinician training was reported in 5% (1/21) of the computerized CDSSs and 25% (3/12) of the noncomputerized CDSSs. Conclusions: While CDSSs hold promise for improving hypertension management, gaps remain in their development and implementation. Future efforts should focus on integrating robust frameworks; aligning with guidelines; enhancing manual data integration; and addressing usability to maximize effectiveness, adoption, and user satisfaction. Trial Registration: Open Science Framework 26zmn; https://osf.io/26zmn

Exploring Attitudes and Obstacles Around Digital Public Health Tools: Insights From a Statewide Cross-Sectional Survey on Washington’s Vaccine Verification System

Background: Development and use of digital public health tools surged during the COVID-19 pandemic. Among these tools, vaccine verification systems emerged as alternatives to paper vaccine records, aiming to help limit the spread of disease. In November 2021, the Washington State Department of Health launched “WA Verify,” a QR code–based vaccine verification system built on the SMART Health Card framework, providing residents with a convenient way to store and share proof of vaccination digitally. However, WA Verify was developed and deployed before assessments and public input regarding potential adoption challenges—such as concerns about privacy, surveillance, data sharing, trust in the technology, and the managing organizations—could be completed. Objective: This analysis used statewide survey data from Washington to identify and characterize barriers and facilitators to the adoption of WA Verify, and to understand how factors such as data privacy, security, attitudes toward public health policies and communication, and technological proficiency may influence acceptance and uptake of digital public health tools. Methods: A cross-sectional statewide survey was distributed between September 2022 and January 2023 to a random sample of 5000 Washington households. Respondents were categorized into 3 groups based on their responses indicating WA Verify “users,” “potential users,” or “unlikely users.” Comparisons were made between groups regarding experiences with and opinions on COVID-19 vaccine and test verification, public health policies, communication, digital tools, technological proficiency, sociodemographic characteristics, and health history. Poststratification weights were applied to reduce nonresponse bias. Results: Of the 1401 respondents, 359 (25.6% unweighted, 25.8% weighted) were users, 662 (47.3% unweighted, 49.8% weighted) were potential users, and 380 (27.1% unweighted, 24.4% weighted) were unlikely users. All percentages reported are based on weighted data. Compared with users and potential users, unlikely users were more likely to oppose policies requiring proof of COVID-19 vaccination or negative test results (users: 6.0%, potential users: 13.6%, unlikely users: 65.9%). Unlikely users were more likely to cite concerns about personal health data security and phone hacking or tracking, though these concerns were also notable among potential users and users. Users and potential users were more likely to perceive a digital vaccine verification system as convenient (users: 96.5%, potential users: 92.3%, unlikely users: 38.1%) and indicated openness to receiving relevant information from a range of sources. Unlikely users were more likely to report not owning a smartphone and demonstrated lower technological proficiency (users: 12.3%, potential users: 15.9%, unlikely users: 32.3%), indicating a technological divide between groups. Conclusions: While nearly three-quarters of respondents had either already adopted or were willing to adopt a tool like WA Verify, concerns about data security, lower technological proficiency, and distrust of public health characterized those least likely to adopt such tools. Identifying barriers to adoption among “unlikely users” is essential for developing effective communication strategies—such as targeted marketing and community engagement—to improve adoption and ensure equitable access to public health technologies.

Air pollution-related immune gene prognostic signature for hepatocellular carcinoma: network toxicology, machine learning and multi-omics analysis

Front Immunol. 2025 Sep 12;16:1638445. doi: 10.3389/fimmu.2025.1638445. eCollection 2025.

ABSTRACT

BACKGROUND: Air pollution may crosstalk with immune system to promote hepatocellular carcinoma (HCC) development, but its precise mechanisms and prognostic significance remain unclear.

OBJECTIVE: This study aims to construct a prognostic signature for HCC based on air pollutant-related immune genes (APIGs).

METHODS: We obtained mRNA-seq and scRNA of HCC from GEO, TCGA and ICGC. AP-related target genes were retrieved from several online databases. APIGs were obtained using WGCNA, differential gene expression analysis and immune infiltration analysis. Molecular subtypes were conducted based on APIG expression to characterize immune features. A total of 101 combinations of 10 machine learning algorithms were used to construct an APIG-based prognostic signature (APIGPS). Furthermore, we performed qRT-PCR, survival analyses, functional enrichment, immune infiltration and single-cell analyses. Subsequently, LASSO, RF, and RFE-SVM were employed to identify diagnostic genes, followed by pan-cancer analysis.

RESULTS: We identified 19 APIGs. HCC samples were divided into 3 subtypes, with C1 exhibiting a pro-tumor immune microenvironment and poorer prognosis. APIGPS constructed by 7 APIGs (CDC25C, MELK, ATG4B, SLC2A1, CDC25B, APEX1, GLS), demonstrated robust predictive ability independent of clinical features. The biological pathway differences between APIGPS-based high- and low-risk groups involved immune responses and cell proliferation and migration. APIGPS genes had stable binding to 7 APs and were mainly expressed in macrophages, with HRG exhibiting higher macrophage abundance. CDC25C was identified as the hub gene after intersecting diagnostic genes and APIGPS genes. CDC25C was associated with survival of 10 cancers, MSI in 10 cancers, TMB in 21 cancers, and immune cell abundance in 13 cancers.

CONCLUSIONS: We identified key APIGs and constructed a robust APIG-based prognostic signature for HCC. CDC25C was a key target through which APs impact HCC and multiple other cancers.

PMID:41019083 | PMC:PMC12463942 | DOI:10.3389/fimmu.2025.1638445

Genomically matched therapy in advanced solid tumors: the randomized phase 2 ROME trial

Nature Medicine, Published online: 29 September 2025; doi:10.1038/s41591-025-03918-x

In the proof-of-concept phase 2 ROME trial, comprehensive genomic profiling followed by molecular tumor board evaluation and randomization of patients with metastatic solid cancer to receive personalized therapy or standard of care led to a significantly higher objective response rate and longer progression-free survival in patients who received personalized therapy.

Association of HTR1F with Prognosis, Tumor Immune Microenvironment, and Drug Sensitivity in Cancer: A Multi-Omics Perspective

27 September 2025 at 18:00

Biomedicines. 2025 Sep 11;13(9):2238. doi: 10.3390/biomedicines13092238.

ABSTRACT

Background:HTR1F (5-Hydroxytryptamine Receptor 1F) encodes a G protein-coupled receptor involved in serotonin signaling. Although dysregulated HTR1F expression has been implicated in certain malignancies, its biological functions and clinical significance across cancer types remain largely unexplored. Methods: We performed an integrative pan-cancer analysis of transcriptomic and pharmacogenomic datasets covering 34 cancer types (PAN-CAN cohort, N = 19,131; normal tissues, G = 60,499). Drug sensitivity and molecular docking analyses were conducted using the GSCALite database. The protein-protein interaction (PPI) network of HTR1F was constructed via the STRING database. Additionally, we evaluated the effects of HTR1F overexpression on proliferation and invasion in human lung squamous cell carcinoma (LUSC) cell lines NCI-H520 and NCI-H226. Results:HTR1F expression was significantly upregulated in 17 cancer types and was associated with poor prognosis, with LUSC showing an AUC of 0.912 for 1-year survival prediction. In LUSC, 695 genes were upregulated and 67 downregulated in response to HTR1F overexpression. HTR1F expression correlated with immune-related genes, immune checkpoints, tumor-infiltrating immune cells, tumor mutation burden (TMB), microsatellite instability (MSI), and drug responses. Genomic alterations, including amplification and deletion, were positively associated with HTR1F expression. Drug sensitivity analysis identified compounds such as sotrastaurin (-10.2 kcal/mol), austocystin D (-9.7 kcal/mol), and tivozanib (-9.3 kcal/mol) as potentially effective inhibitors based on predicted binding affinity. Functional enrichment analyses (GO, KEGG) and GSEA revealed that HTR1F is primarily involved in cell cycle regulation, DNA replication, cellular senescence, and immune-related pathways. Functional validation showed that HTR1F overexpression promotes proliferation of LUSC cells via the MAPK signaling pathway. Conclusions: Our integrative analysis highlights HTR1F as a potential biomarker associated with prognosis, immune modulation, and drug sensitivity across multiple cancer types. These findings provide a foundation for future experimental and clinical studies to explore HTR1F-targeted therapies.

PMID:41007799 | PMC:PMC12467612 | DOI:10.3390/biomedicines13092238

Application of the Supportive Accountability Model in Digital Health Interventions: Scoping Review

Background: Digital health interventions (DHIs) harness technological innovation to address challenges in the accessibility and scalability of health care. However, the effectiveness of DHIs is challenged by low user engagement and adherence, as users tend to drop out over time. The supportive accountability model (SAM) is a theoretical framework designed to enhance adherence to DHIs by incorporating structured human support. Objective: Guided by SAM, this scoping review answers the following research questions: (1) What is the extent of research on human support factors and their influence on engagement with and adherence to DHIs? and (2) What is the extent of research applying SAM (ie, accountability, bond, and legitimacy) to improve engagement with and adherence to DHIs? Methods: Our search strategy followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). We conducted our literature search using 6 databases selected based on relevance to our research topic: MEDLINE, PsycINFO, Embase, CINAHL, Scopus, and ClinicalTrials.gov. Search terms included (“human support” OR “supportive accountability”) AND (engagement OR adherence) AND intervention, applied to titles, abstracts, and keywords. Hand-searching was also used to identify additional relevant articles. Two authors (SPYC and GK) screened articles in multiple rounds using predefined inclusion and exclusion criteria. The final sample consisted of 36 empirical, peer-reviewed articles published in scholarly journals. All articles examined human-supported DHIs. Results: Implementation of human support among the interventions varied by the source, delivery method, and frequency and duration of support. Overall, there were inconsistencies in the application of SAM to intervention designs. Support was provided by 4 main groups: peers and peer specialists, health experts and practitioners, trained coaches, and members of the research study team. Modes of communication included phone or video calls, as well as text-based support, such as messaging or email. The frequency and duration of support varied across studies and were influenced by the communication method used, with more structured and frequent contact occurring in interventions that relied on synchronous support, such as phone or video calls. In addition, we found that some studies used human support as the primary mode of intervention delivery rather than as an adjunctive tool, focusing on improving engagement and adherence, as proposed by SAM. Aside from accountability, there was also a lack of explicit focus on other constructs within the model (eg, bond and legitimacy). Conclusions: This scoping review highlights the current use of human support to promote DHI adherence and reveals gaps in the application of SAM. Future research should address all core SAM components—not just accountability—and ensure human support is used as an adjunct to enhance engagement. These steps can help maximize the impact of DHIs on health care access and outcomes.

Using Large Language Models to Assess the Consistency of Randomized Controlled Trials on AI Interventions With CONSORT-AI: Cross-Sectional Survey

Background: Chatbots based on large language models (LLMs) have shown promise in evaluating the consistency of research. Previously, researchers used LLM to assess if randomized controlled trial (RCT) abstracts adhered to the CONSORT-Abstract guidelines. However, the consistency of artificial intelligence (AI) interventional RCTs align with the CONSORT-AI standards by LLMs remains unclear. Objective: The aim of this study is to identify the consistency of randomized controlled trials on AI interventions with CONSORT-AI using chatbots based on LLMs. Methods: This cross-sectional study employed six LLM models to assess the consistency of RCTs on AI interventions. The sample selection is based on articles published in JAMA Network Open, which included a total of 41 RCTs. All queries were submitted to LLMs through an API interface with a temperature setting of 0 to ensure deterministic responses. One researcher posed the questions to each model, while another independently verified the responses for validity before recording the results. The Overall Consistency Score (OCS), recall, inter-rater reliability and consistency of contents were analyzed. Results: We found gpt-4-0125-preview has the best average OCS (86.5%, 95%CI: 82.5%-90.5% and 81.6%, 95% CI: 77.6%-85.6%), followed by gpt-4-1106-preview(80.3%, 95%CI: 76.3%-84.3% and 78.0%, 95% CI: 74.0%-82.0%). The model with the worst average OCS is gpt-3.5-turbo-0125 (61.9%, 95%CI: 57.9%-65.9% and 63.0%, 95% CI: 59.0%-67.0%). Among the 11 unique items of CONSORT-AI, Item 2 (“State the inclusion and exclusion criteria at the level of the input data”) received the poorest overall evaluation across six models, with an average OCS of 48.8%. For other items, those with an average OCS greater than 80% across the six models included Items 1, 5, 8, and 9. Conclusions: GPT-4 variants demonstrate strong performance in assessing the consistency of RCTs with CONSORT-AI. Nonetheless, refining the prompts could enhance the precision and consistency of the outcomes. While AI tools like GPT-4 variants are valuable, they are not yet fully autonomous in addressing complex and nuanced tasks such as adherence to CONSORT-AI standards. Therefore, integrating AI with higher levels of human supervision and expertise will be crucial to ensuring more reliable and efficient evaluations, ultimately advancing the quality of medical research.

The Impact of Digital Health Interventions on Psychological Health, Self-Efficacy, and Quality of Life in Patients With End-Stage Kidney Disease: Systematic Review and Meta-Analysis

Background: End-stage kidney disease (ESKD) imposes a significant global health burden, with patients often experiencing poor quality of life (QoL) due to psychological distress and low self-efficacy. Digital health interventions (DHIs) offer potential to address these challenges. However, their effects in this population remain inconsistent, and a comprehensive synthesis of the evidence is lacking. Objective: To assess the impact of DHIs on the psychological health, self-efficacy, and QoL of ESKD patients, and to evaluate engagement, adherence and satisfaction with these interventions. Methods: A comprehensive search was conducted across six electronic databases (PubMed, Web of Science, Cochrane Library, PsycINFO, Embase, and CINAHL) up to January 21, 2025. Randomized controlled trials (RCTs) examining DHIs effects on psychological health, self-efficacy, or QoL in ESKD patients were included. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the RoB 2 tool. Meta-analysis was performed using Review Manager 5.4, with subgroup analyses by treatment modality, intervention type, and duration. Evidence quality was assessed using the GRADE approach. Results: 23 RCTs involving 2407 ESKD patients from 12 countries were included. DHIs significantly improved depression (SMD: -0.41, 95% CI: [-0.63, -0.19], P=.003) and overall QoL (SMD: 0.55, 95% CI: [0.07, 1.03], P=.03). While DHIs did not significantly improve overall self-efficacy (SMD: 0.56, 95% CI: [-0.06, 1.18], P=.08), a benefit was observed in hemodialysis patients (SMD: 0.59, 95% CI: [0.34, 0.83], P<.001 engagement was favorable with completion rates above adherence of and generally positive patient feedback on dhis. application-based interventions improved self-efficacy ci: p overall qol telemedicine depression video-based due to high heterogeneity risk bias evidence quality rated as low for moderate general anxiety very stress self-efficacy. conclusions: dhis can significantly improve the psychological health eskd patients particularly when tailored needs delivered through interactive platforms such applications telemedicine. suggest good acceptability in clinical practice. however warrants cautious interpretation. future research should involve more high-quality rcts design that address unique elderly peritoneal dialysis kidney transplant recipients. trial: prospero crd42024629357 https:>

Integrative Spatial Omics for Systems-Level Mapping of Pathological Niches

bioRxiv [Preprint]. 2025 Sep 17:2025.09.12.675904. doi: 10.1101/2025.09.12.675904.

ABSTRACT

Spatial 'omics technologies are a powerful tool for mapping the relationship between cellular organization and molecular distributions in healthy and diseased tissue microenvironments. Here, we describe a novel multimodal pipeline that represents experimental and computational advances for spatiomolecular analysis of tissue samples across molecular classes. This adaptable method integrates matrix-assisted laser desorption/ionization (MALDI) imaging mass spectrometry (IMS) lipidomics, spatial transcriptomics (ST), multiplexed immunofluorescence microscopy (MxIF), and histopathological staining to uncover spatiomolecular profiles associated with unique cellular niches and pathological features. We demonstrate the power of this approach using two different complex human disease systems: Alzheimer's disease in human brain tissue and type 2 diabetes mellitus in the human pancreas. By identifying molecular markers associated with disease pathology in the pancreas and brain, we shed light on biologically significant pathways that are impacted in these two spatially complex diseases and highlight the powerful potential of accurate, high-resolution multimodal integration approaches.

PMID:41000710 | PMC:PMC12458195 | DOI:10.1101/2025.09.12.675904

FUSION: a web-based application for in-depth exploration of multi-omics data with brightfield histology

Nat Commun. 2025 Sep 25;16(1):8388. doi: 10.1038/s41467-025-63050-9.

ABSTRACT

Spatial technologies examining the cell and tissue microenvironment at near single-cell resolution are revealing important molecular insights. However, few tools enable integrated, interactive analysis of spatial-omics with tissue morphology in the same functional tissue unit. Here, we present FUSION (Functional Unit State Identification in Whole Slide Images), a web-based platform for visualizing and analyzing spatial-omics data with high-resolution histology. FUSION provides workflows for assessing cell compositions, quantitative morphometrics, and comparative tissue analyses. We demonstrate applicability across spatial assays, including 10x Visium, Visium HD, 10x Xenium, Cell DIVE, and PhenoCycler, applied to healthy and diseased tissues from kidney, small intestine, lung, and skin in the Human BioMolecular Atlas Program. FUSION is cloud-based, open-source, and accessible at https://fusion.hubmapconsortium.org/ , hosting over 50 paired datasets and tutorials. In a series of use cases, we show its capacity to distinguish renal glomeruli injury states, quantify morphometric changes, and characterize fibrosis with immune infiltration.

PMID:40998789 | PMC:PMC12462499 | DOI:10.1038/s41467-025-63050-9

Application of Nudges to Design Clinical Decision Support Tools: Systematic Approach Guided by Implementation Science

Background: Clinical decision support (CDS) is one strategy to increase evidence-based practices by clinicians. Despite its potential, CDS tools have had mixed results and are often disliked by clinicians. Principles from behavioral economics, including “nudges,” may improve the effectiveness and clinician satisfaction of CDS tools. Objective: This paper outlines a pragmatic approach grounded in implementation science to identify and prioritize how to incorporate different types of nudges into CDS tools. Methods: We applied the Messenger, Incentives, Norms, Defaults, Salience, Priming, Affect, Commitments and Ego (MINDSPACE) nudge framework and the Practical, Robust Implementation and Sustainability Model (PRISM) implementation science framework to systematically and pragmatically identify and prioritize different types of nudges for CDS tools. A case example of a CDS tool to improve guideline-concordant prescribing for patients with heart failure was used to illustrate how these frameworks can be applied in real-life scenarios. We describe a process of how these frameworks can be used pragmatically by clinicians and informaticists or more technical CDS builders to apply nudge theory to CDS tools. Results: Four iterative steps guided by PRISM were defined: 1) engage partners for user-centered design, 2) develop a shared understanding of the nudge types, 3) determine the nudge type for the overarching CDS format, and 4) brainstorm and prioritize nudge types and forms to address each modifiable contextual issue. These steps are iterative and intended to be adapted to align with the local resources and needs of various clinical scenarios and settings. We provide illustrative examples of how this approach was applied to the case example, including who we engaged, details of nudge design decisions, and lessons learned. Conclusions: We present a pragmatic approach to guide the selection and prioritization of nudges, informed by implementation science. This approach can be used to comprehensively and systematically consider key issues in designing CDS to optimize clinician satisfaction, effectiveness, equity, and sustainability while minimizing the potential for unintended consequences. The findings can be adapted and generalized to other health settings and clinical situations, advancing the goals of learning health systems to expedite the translation of evidence into practice.

Multimodal foundation model and benchmark for comprehensive retinal OCT image analysis

npj Digital Medicine, Published online: 25 September 2025; doi:10.1038/s41746-025-01852-3

Multimodal foundation model and benchmark for comprehensive retinal OCT image analysis

Quality safety and disparity of an AI chatbot in managing chronic diseases: simulated patient experiments

npj Digital Medicine, Published online: 25 September 2025; doi:10.1038/s41746-025-01956-w

Quality safety and disparity of an AI chatbot in managing chronic diseases: simulated patient experiments

Ophthalmic drug discovery and development using artificial intelligence and digital health technologies

npj Digital Medicine, Published online: 25 September 2025; doi:10.1038/s41746-025-01954-y

Ophthalmic drug discovery and development using artificial intelligence and digital health technologies
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