Journal of Clinical Medicine

Background/Objectives: To critically review the effectiveness, safety and implementation of fully remote, hybrid and digitally supported cardiac rehabilitation (CR) in adults after coronary revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), distinguishing direct from indirect evidence. Methods: This structured narrative review drew on searches of MEDLINE (PubMed), Embase, the Cochrane Library, Scopus and Web of Science, supplemented by reference list and citation searching and by guidance from major cardiology societies. Randomized and non-randomized comparative studies, economic evaluations, qualitative studies and systematic reviews were selected purposively, appraised qualitatively for methodological limitations, and synthesized narratively by outcome, comparator, intervention comprehensiveness and directness of evidence for revascularized patients. Results: Compared with usual care, digital CR improved short-term exercise capacity; compared with center-based CR, it produced broadly similar exercise capacity and short- to intermediate-term quality of life. Lower odds of all-cause readmission with digital CR in one meta-analysis (OR 0.37, 95% CI 0.25–0.56) were based on only seven heterogeneous studies (n = 859) and are not corroborated by the 2023 Cochrane review; effects on major adverse cardiovascular events and mortality remain uncertain. Economic evaluations were generally favorable. Serious exercise-related adverse events were rarely reported in the selected, predominantly lower-risk participants studied, but surveillance was inconsistent, and safety after CABG and in higher-risk patients has not been established. Reimbursement, workforce capacity, interoperability and digital exclusion were the main implementation barriers. Conclusions: Comprehensive remote or hybrid CR is a reasonable option for appropriately assessed, clinically stable, lower-risk patients, particularly after PCI, and a promising way to reach those who would otherwise receive no rehabilitation; patients in the early period after CABG or at higher risk should start with supervised center-based or hybrid care. Digital CR should widen access to multidisciplinary rehabilitation rather than replace supervised programs, and adequately powered trials with long-term clinical and standardized safety outcomes are needed.

Background and Objectives: New psychoactive substances (NPS) are characterized by continuous growth in the market and constant evolution in their chemical structures, representing an emerging challenge for forensic medicine and toxicology. The rapid spread of NPS has led to an increase in poisoning cases, with serious implications for public health and criminal justice. These substances are often difficult to detect using traditional analytical methods due to the frequent alterations in their chemical composition, and many of them are not yet regulated or formally recognized under existing legislation. As a result, advanced analytical techniques such as chromatography and mass spectrometry are essential for the accurate identification and quantification of NPS. Materials and Methods: We conducted a comprehensive literature review covering the last five years, aiming to explore current analytical methodologies and their clinical and forensic implications, while emphasizing the critical need for ongoing research to effectively address the challenges posed by NPS. Results: These advanced approaches are crucial for timely and accurate diagnosis in both clinical and forensic settings, improving the management of poisoning cases and supporting subsequent legal investigations. Combined analytical techniques represent a significant advancement in forensic science, particularly in the identification of isomers and novel psychoactive compounds. Conclusions: This progress enhances the collaboration between clinicians, toxicologists, and forensic pathologists, raising the level of interdisciplinary knowledge required to tackle these emerging threats more effectively.

Background: Crush injuries are associated with extensive soft tissue damage leading to a high risk of complications. Differences between pediatric and adult patients remain poorly studied. This study aimed to compare outcomes after crush injury in pediatric and adult patients and to identify predictors of viability-related complications (VRCs). It was hypothesized that children sustained fewer complications than adults following extremity crush injuries. Methods: A retrospective comparative cohort study was conducted at a level-1 trauma center. Pediatric patients (<16 years) treated between 2017 and 2024 and adult patients (≥16 years) treated between 2019 and 2023 were included. Patients with crush injury not involving extremities were excluded. VRCs were defined as (secondary) tissue necrosis, infection (related to impaired tissue viability), or both. The primary outcome was incidence of VRC in pediatric patients compared to adult patients. Group comparisons were performed using Chi-square testing. Logistic regression analyses were performed to identify independent predictors of VRC. Results: A total of 116 patients were included, of whom 36 were pediatric patients and 80 were adult patients. VRC occurred in 13.9% of children, compared to 56.3% of adults (p < 0.001). Isolated necrosis did not occur in pediatric patients within the cohort. Multivariable logistic regression identified age, degloving injury and open fracture as independent predictors of VRC. ISS and fasciotomy were not associated with VRC. The risk of VRC increased progressively with age, with a 2.5% increase in odds per additional year of age. Conclusions: Pediatric patients had a substantially lower incidence of viability-related complications after crush injury than adults. The results of this study suggest the presence of age-related differences in tissue viability after trauma, which may warrant corresponding surgical approaches. An increased understanding of age-related differences will contribute to more individualized treatment strategies in complex traumatic injury.