Search Results (2,792)

Background: Clinical reasoning is a core midwifery competency, yet adopting standardized NANDA–NIC–NOC frameworks remains challenging due to perceived abstraction. Objective: To explore the effectiveness of a pedagogical intervention combining collaborative learning, artistic mediation, and AI to enhance midwives’ clinical reasoning. Methods: A convergent parallel mixed-methods study with 40 practicing midwives at Hassan I Hospital, Morocco, involving a structured workshop with a learning game, symbolic tree creation, and AI-facilitated reflection. Inductive thematic analysis was applied to qualitative data, complemented by descriptive pre/post rubric scores assessed by two independent raters. Results: Four themes emerged: (1) improved structuring of clinical reasoning; (2) deeper conceptual appropriation of the NANDA–NIC–NOC framework; (3) enhanced reflexivity and metacognition via AI; (4) high engagement and pedagogical acceptability. Conclusions: Integrating collaborative gaming, artistic mediation, and AI showed high pedagogical acceptability and supported immediate structuring of clinical reasoning in midwifery, offering a promising and feasible model for initial and continuing training in resource-limited settings. Longitudinal studies are needed to confirm long-term clinical impact. Clinical reasoning; NANDA–NIC–NOC; artificial intelligence; simulation-based learning; collaborative learning; educational innovation. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease (CLD) globally and is closely linked to metabolic risk factors and systemic inflammation. Emerging evidence suggests that vitamin D deficiency may influence MASLD severity and outcomes, though limited real-world data often assess long-term clinical outcomes in MASLD patients stratified by vitamin D status. Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Network (2006–2025). Adult patients with MASLD were stratified into two cohorts based on serum 25-hydroxyvitamin D levels: normal (≥30 ng/mL) and deficient (<20 ng/mL). Patients with other CLD, malignancy, decompensated cirrhosis, and relevant confounding conditions were excluded. Primary outcomes included all-cause mortality, hospital readmissions, and ICU admissions at 1-year and 5-year follow-up. Results: After propensity score matching, 6959 patients were included in each cohort. Compared with patients with normal vitamin D levels, those with vitamin D deficiency had significantly higher rates of hospital readmissions, ICU admissions, and all-cause mortality at both 1-year and 5-year follow-up. A 1 year, readmissions occurred in 10% vs. 6%, ICU admissions 2.6% vs. 1.2%, and mortality 1.5% vs. 0.5% of patients (p = 0.01). Similar findings were observed at 5 years, with higher rates of readmissions 15% vs. 10%, ICU admissions 4.4% vs. 2.4% and mortality 3.2% vs. 1.3% in the vitamin D-deficient cohort (p = 0.01). Conclusions: Vitamin D deficiency was associated with significantly increased mortality, hospital readmissions, and ICU admissions among patients with MASLD. Our findings suggest that vitamin D status may represent a valuable prognostic indicator in this population. Although the observational nature of this study precluded establishing causality, our results support the consideration of routine assessment of vitamin D levels in patients with MASLD. Further prospective and mechanistic studies are needed to determine whether vitamin D supplementation can improve outcomes in this population. Full article

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease with substantial impact on quality of life. The introduction of biologics and Janus kinase (JAK) inhibitors has markedly transformed systemic treatment strategies. However, long-term prospective real-world registries evaluating drug survival, safety, phenotype-specific treatment response, and post-discontinuation outcomes remain limited, particularly in Asian populations. Methods: The Western Japan Atopic Dermatitis Registry (WJADR) is a multicenter, prospective, observational registry coordinated by Kyushu University and collaborating institutions across western Japan. Patients initiating or currently receiving systemic therapy for AD are enrolled. Longitudinal data collection includes clinical phenotype classification, disease course classification, treatment exposure, physician-assessed severity scores, patient-reported outcomes, biomarkers, and safety information. The primary outcome is drug survival, while secondary outcomes include clinical improvement, adverse events, phenotype–treatment interactions, biomarker–treatment correlations, and treatment-switch patterns. Results: WJADR was designed as a phenotype-integrated real-world registry to evaluate comprehensive systemic treatment strategies and post-discontinuation outcomes in AD prior to the completion of patient enrollment and outcome analyses. Unlike existing registries primarily focused on biologic initiator cohorts or treatment burden, WJADR integrates clinical phenotypes, biomarkers, and longitudinal outcomes to support precision medicine approaches. Conclusions: WJADR represents the first large-scale multicenter prospective AD registry in western Japan and may provide ethnicity-specific real-world evidence to support long-term safety evaluation, treatment optimization, and phenotype-guided therapeutic strategies in AD. Full article

Background: Chest X-ray imaging is a widely used diagnostic modality for identifying various lung diseases. Accurate multiclass classification of lung diseases enables timely treatment and improves patient survival. However, disease detection using chest X-ray images remains challenging due to heterogeneous data, overlapping radiographic features, and data privacy concerns. Furthermore, distinguishing among different lung diseases is difficult because of their similar clinical manifestations and imaging characteristics. Method: To address these challenges, a novel chaotic evolution optimization-enabled deep channel-attention broad convolutional neural network (CCEO-DCABNet) is proposed for multiclass lung disease classification within a federated learning (FL) framework. The proposed model ensures enhanced data privacy by allowing multiple client nodes and a central server to collaboratively train the model without sharing raw data. Prior to classification, image preprocessing is performed using Gaussian filter-based denoising followed by multiscale unsharp masking-based image sharpening. Subsequently, multiclass disease classification is carried out using DCABNet, whose parameters are optimized through the proposed CCEO algorithm. In addition, the federated learning process employs an averaging strategy for local model updates and global aggregation. Results: The proposed CCEO-DCABNet achieves an accuracy, true positive rate (TPR), and true negative rate (TNR) of $96.98\%$, $96.41\%$, and $97.45\%$. Conclusions: Experimental results demonstrate that the proposed CCEO-DCABNet framework effectively classifies multiple lung diseases from chest X-ray images while preserving data privacy through federated learning. The model achieves superior classification performance and can support reliable computer-aided diagnosis in clinical settings. Full article

Background and Objectives: Kidney dysfunction and hyponatremia are prevalent in decompensated liver cirrhosis and are associated with suboptimal prognoses. Most prognostic tools used in cirrhosis are hepatic-centric and necessitate the utilization of multiple laboratory and clinical variables. This study endeavored to delineate and assess kidney function- and serum sodium-based prognostic models for the prediction of in-hospital mortality in patients with liver cirrhosis. Materials and Methods: This retrospective single-center cohort study comprised 547 hospitalized patients with liver cirrhosis and comprehensive data pertaining to serum urea, creatinine, sodium, age, sex, and in-hospital outcome. In-hospital mortality was the primary endpoint. Kidney function was evaluated via the assessment of serum urea, serum creatinine, and estimated glomerular filtration rate (eGFR), using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 equation. Simple categorical and point-based scores were constructed. Model discrimination, calibration, and operating characteristics were compared with MELD, Child–Pugh, and ALBI scores, as well as with selected combined models. Results: Of the 547 patients, 147 individuals (26.9%) succumbed during the hospitalization period. In the full model, lower eGFR, elevated urea levels, and diminished serum sodium concentrations were independently associated with in-hospital mortality, whereas age and sex did not demonstrate statistical significance. The full model appeared to exhibit moderate discrimination (AUC 0.701, 95% CI 0.652–0.750). A biochemical model based on urea, creatinine and sodium appeared to yield a similar AUC (0.696), and a renal–electrolyte model encompassing eGFR, urea, and sodium seemed to demonstrate an AUC of 0.694. A simple creatinine–sodium score may have attained an AUC of 0.681 and appeared to effectuate the stratification of mortality from 16.4% in the low-risk group to 53.1% in the high-risk group. Adding renal–electrolyte variables or the simple score to MELD did not appear to confer substantial enhancement to performance. Conclusions: Kidney dysfunction and hyponatremia at admission have been identified as independent predictors of in-hospital mortality in liver cirrhosis. A simple creatinine–sodium score may afford practical bedside risk stratification and may complement MELD-based assessment in routine clinical care. Full article

Automated assessment of coronary artery disease (CAD) severity from invasive X-ray angiography is important for diagnostic accuracy, but there are limitations due to limited label data and privacy issues in multi-institutional collaboration. This research proposes a Federated Graph-Transformer Network (FGTN) that models coronary vessel compositions as graphs and uses a transformer unit of measurement to encode global anatomic circumstances for severity scaling. The publicly available X-ray angiography images and SYNTAX-Score dataset will be used, consisting of 232 X-ray coronary angiography images with analogous clinically calculated SYNTAX tons and angiographic factors from 231 patients, manually annotated by a competent cardiologist. The vascular tree is a primary segment that transforms inside the node-edge graph representing bifurcation and vessel sections, continuing topological features, and then processes by graph convolutions integrated with transformer self-attention to capture simultaneously the local stenosis features and global vessel relationships. A Horizontal Federated Learning Strategy allowing collaborative model training on clinical sites without sharing raw data. The intended FGTN achieved overall accuracy of 99.4%, precision of 97.6%, recall of 98.8%, and F1-score of 98.2%, exceeding the usual CNNs, Attention-UNet, and Capsule Connection baselines by a margin of 4–7%. For non-obstructive, mild, moderate, and severe stenosis classes, the AUC values were 0.98, 0.97, 0.96, and 0.95, respectively. Moreover, the Federated Learning framework shows firm convergence with lower, compared to 1.8% performance degradation, when compared to centralized training, and confirms robustness via heterogeneous data distribution. These results show that the proposed solution automatically calculates the CAD severity grading from coronary angiography images. Full article

Objective: To explore fourth-year student pharmacists’ perspectives of the skills they develop by completing a research project in the pharmacy curriculum at one United States College of Pharmacy. Methods: Semi-structured interviews were conducted with a sample of fourth-year student pharmacists until thematic saturation was achieved. Interviews were recorded and transcribed verbatim. Thematic analysis was conducted to identify main themes. All records were reviewed by two researchers, and consensus was sought at each step of the analysis. Results: Eleven interviews were conducted. Three themes related to skills developed by students while completing a research project were apparent from the final reconciled code list: Theme 1—critical analysis skills; Theme 2—residency preparedness skills; and Theme 3—interpersonal skills. Critical analysis skills helped students review the literature and appropriately translate the findings into clinical settings. Residency preparedness skills described how students perceived completing a research project would prepare them for a residency program. Interpersonal skills were inter-related and consisted of collaboration, communication, conflict resolution, leadership, and project management skills. Conclusions: These study findings should be considered by curriculum committees as changes to the pharmacy program are considered. Future research is suggested to explore other perspectives of the research process. Full article

Family health history (FHH) is an important tool for cancer risk assessment, yet its clinical utility is undermined by incomplete data, particularly among historically marginalized communities whose family records have been systematically disrupted by slavery, forced displacement, and undocumented status. I conducted a cross-sectional online survey of 1885 US adults affected by cancer to examine associations between genealogy engagement and FHH confidence and to assess variation across sociodemographic subgroups. Genealogy research was the single strongest modifiable predictor of FHH confidence, with participants reporting genealogy research more than twice as likely to report high confidence compared to those who did not (OR = 2.07, 95% CI 1.72–2.50), a relationship that persisted after full adjustment for age, sex, race, income, and education. Despite comparable rates of genealogy engagement, Black and Hispanic respondents reported substantially lower FHH confidence than White respondents. These findings suggest that while interest in genealogy is already widespread and self-motivated in the population, current clinical tools for FHH collection are inadequate to leverage this interest equitably. Next-generation FHH tools should be designed to reflect the dynamic, collaborative features of genealogy platforms rather than static medical forms, and their development must be grounded in community-centered design principles that prioritize populations for whom incomplete family history poses an added burden. Full article

Background: Multiple myeloma (MM) has experienced rapid therapeutic innovation over the past two decades, leading to a substantial increase in clinical trial activity. However, the geographic distribution of these trials and the representation of different economic regions remain poorly characterized. We evaluated the global distribution, growth patterns, and phase-specific trends of MM clinical trials and trial sites across different economic settings. Methods: We conducted a retrospective registry-based analysis interventional MM clinical trials registered on ClinicalTrials.gov between January 2006 and January 2026. Trials were categorized based on the economic classification of participating countries using World Bank income groups and Economic Co-operation and Development (OECD) status. Trial characteristics including phase, geographic distribution, number of participating sites, and site-years were analyzed. Population-adjusted trial density and compound annual growth rates (CAGR) were calculated to assess temporal trends and geographic representation. Results: A total of 845 interventional MM clinical trials were identified during the study period. Trial activity was highest in the United States (337 trials, 39.9%), followed by international trials (271, 32.1%), high-income-OECD countries (129, 15.3%), and upper-middle-income countries (103, 12.2%), while high-income non-OECD countries contributed only a small fraction of trials. Trial activity increased substantially over time across all regions with the highest growth observed in upper-middle-income countries (CAGR 18.5%). The US demonstrated the highest population-adjusted trial density (0.99 per million population) and accounted for the largest number of trial sites and site-years. Phase-specific analyses revealed distinct geographic patterns. Phase 1 trials were predominantly conducted in the US and in international collaborative trials. Phase 3 trials were largely international, although the majority of participating sites remained located in the US and High-income countries that are members of the OECD (HIC-OECD). Conclusions: Over the past two decades, MM clinical trial activity has expanded globally but remains highly concentrated in the United States and high income-OECD countries, particularly with respect to trial sites and population-adjusted trial density. Although upper-middle-income countries have shown the fastest growth in trial activity expanding clinical trial infrastructure and strengthening international collaboration will be essential to promote a more equitable global distribution of MM research. Full article

With a lack of population-specific reference intervals (RIs) in Bangladesh, this study aimed to determine RIs for complete blood count (CBC) and specific micronutrients, vitamin D (VitD) and zinc, and to assess the possible impact of prior history of SARS-CoV-2 infection on these parameters. Healthy participants (n = 1724) of both sexes aged ≥ 10 years from slum and non-slum areas of Dhaka city were sampled systematically. A total of 26 CBC parameters were determined using an automated hematology analyzer, whereas the micronutrients VitD and zinc were measured using automated immunoassay analyzers and atomic absorption spectrophotometry (AAS), respectively. Multiple regression analysis (MRA) was employed to determine the association of variations in reference values (RVs) of hematological and micronutrient parameters with sex, age, and slum residency of the participants. Practical significance of each factor was judged from partial correlation coefficients (r_p) by setting its minimum effect size at |r_p| = 0.2. The need to partition RVs by sex and age was assessed using the ANOVA-based standard deviation ratio (SDR). RIs were determined by parametric method after Gaussian transformation using the two-parameter Box–Cox formula, with or without the latent abnormal values exclusion (LAVE) method. By MRA, sex and age were significant source of variations for various CBC parameters, whereas slum residence was associated with increased levels of VitD and zinc Using the SDR ≥ 0.35 threshold, RVs were partitioned by sex to derive RIs for hemoglobin, hematocrit, red cell count and indices (MCH, MCHC), and plateletcrit, as well as for VitD and zinc. Comparing these RIs with those from the global collaborative studies indicated significant differences in erythrocyte and leukocyte parameters. These are the first population-specific RIs for urban Dhaka city, underscoring the need for country-specific RIs for accurate clinical use. Full article

Surface-enhanced Raman spectroscopy (SERS) has emerged as a highly promising analytical technique for disease diagnostics due to its exceptional sensitivity, molecular specificity, and ability to detect a broad range of biomarkers in complex biological matrices. This review provides a comprehensive overview of gold- and silver-nanoparticle-based SERS platforms for plasma disease diagnostics, covering advances in plasmonic nanostructures, biological sample analysis, biomarker detection, and AI-driven spectral data processing. Particular emphasis is placed on the application of SERS to clinically relevant biofluids, especially plasma, where the technique has demonstrated considerable potential for detecting diseases such as cancer, inflammatory disorders, and neurological conditions. The review also critically examines the major challenges currently limiting the clinical translation of SERS technologies. These include variability associated with substrate fabrication, matrix-induced signal fluctuations, limited interlaboratory reproducibility, and the lack of standardized protocols for spectral preprocessing and data analysis. Strategies proposed to address these issues are discussed, including comprehensive post-synthesis substrate characterization, optimization of biological sample preparation, advanced spectral preprocessing workflows, and the integration of machine learning and artificial intelligence algorithms to improve diagnostic robustness and reproducibility. Collectively, the advances summarized in this review indicate that SERS-based diagnostic technologies are rapidly progressing beyond proof-of-concept studies toward clinically applicable systems. Continued interdisciplinary collaboration and standardization efforts will be essential to bridge the remaining gap between experimental SERS methodologies and routine clinical implementation. Full article

Background/Objectives: This study aims to describe the experiences of healthcare professionals collaborating with Intercultural Mediators (IMs) in the care relationships with migrant patients. Methods: This study is a qualitative descriptive study. A total of 13 healthcare professionals (9 nurses and 4 physicians) working in two public hospitals in Italy participated in face-to-face semi-structured interviews between June and July 2024. Interviews were audio-recorded, transcribed verbatim and analyzed using inductive qualitative content analysis. Results: Three main categories emerged: (1) the experience of healthcare professionals in the relationship with migrant patients; (2) the linguistic and intercultural mediator as a supportive relational role; and (3) limitations in language and intercultural mediation. Participants described difficulties in mutual understanding due to cultural and linguistic barriers and emphasized the central role of the mediator as a bridge between diverse cultural worlds. IMs were described as essential in promoting trust, improving therapeutic adherence, and supporting culturally sensitive communication. However, organizational challenges included limited availability of IMs, poor integration into clinical teams, and the lack of structured, continuous support system. Conclusions: IMs are perceived as key actors in facilitating communication, trust, and therapeutic adherence with migrant patients. Yet their integration within healthcare teams remains underutilized due to organizational barriers. The findings inform managers and policymakers about the necessity of structurally integrating IMs within clinical teams and implementing intercultural competence programmes to ensure equitable and culturally sensitive care for migrant patients. Full article

Bladder preservation has emerged as an established treatment option for selected patients with muscle-invasive bladder cancer (MIBC), offering durable oncologic control with the potential to maintain native bladder function and quality of life. Over the past several decades, prospective trials and large institutional experiences have refined trimodality therapy (TMT)—maximal transurethral resection followed by definitive radiation therapy with concurrent radiosensitizing systemic therapy—and clarified principles of patient selection, treatment delivery, surveillance, and salvage. Randomized evidence supports combined-modality therapy as the backbone of bladder preservation, and contemporary comparative analyses suggest outcomes comparable to radical cystectomy in appropriately selected populations. This review synthesizes the clinical foundations of bladder preservation, including radiobiologic considerations, advances in radiation technique, and patterns of recurrence following TMT. We discuss outcomes in higher-risk populations, including locally advanced and node-positive disease, and examine the evolving integration of systemic therapies. The emergence of immune checkpoint inhibitors and antibody–drug conjugates in urothelial carcinoma has reshaped the systemic treatment landscape and raises important questions regarding patient selection, sequencing, and the potential expansion of organ-preserving strategies. Finally, we outline future directions—including response-adaptive approaches, advances in image-guided and adaptive radiotherapy, and ctDNA-enabled risk stratification—while emphasizing the need for prospective validation and multidisciplinary collaboration to refine and optimize bladder-preserving care. Full article

Background/Objectives: Registered nurse (RN) prescribing is increasingly discussed as a strategy to improve primary-care access, medication follow-up, chronic disease management, and service responsiveness. The available evidence, however, does not directly test a single coordinated RN prescriber–family physician/nurse practitioner (FP/NP) model. This integrative review synthesized heterogeneous evidence relevant to how RN prescribing may be organized within team-based primary care. Methods: A structured integrative review approach was used to map evidence from nurse and non-medical prescribing, RN-led primary care, nurse–physician substitution, interprofessional collaboration, chronic disease medication titration, patient-experience, and implementation research. Searches completed on 30 March 2026 included PubMed/MEDLINE, PubMed Central, the Cochrane Library search interface, publisher full-text platforms, targeted scholarly searches, citation chasing, and Canadian regulatory/professional sources. Methodological quality was appraised using AMSTAR 2- and CASP-informed criteria, and the strength of interpretation was assessed narratively. No meta-analysis was performed because of substantial heterogeneity and the risk of double-counting primary studies included in prior evidence syntheses. Results: A total of 286 records were identified. After de-duplication, screening, and eligibility assessment, 37 peer-reviewed records were included: 30 review-level or evidence-synthesis records and 7 primary, mixed-methods, or patient-experience studies. Four official regulatory/professional sources were retained separately for context. Nurse and non-medical prescribing were generally associated with comparable or favourable outcomes for blood pressure, glycated hemoglobin, low-density lipoprotein cholesterol, medication adherence, patient satisfaction, and selected access outcomes in defined contexts. Direct evidence for the exact RN prescriber–FP/NP configuration remains limited. Conclusions: Current evidence is consistent with a coordinated RN prescribing model embedded within primary-care teams, but does not establish causal superiority of this configuration over other models. Coordinated RN prescribing should therefore be understood as an evidence-informed and testable implementation model requiring prospective evaluation, particularly for diagnostic safety, adverse events, continuity, workload, cost, and patient-level outcomes. Full article

Background and Aim: Anatomy education has expanded beyond cadaver-centered teaching toward simulation-based, digital, and hybrid approaches. However, it remains unclear how the literature is distributed across these modalities and whether they differ in methodological profile and bibliometric visibility. This study aimed to map Scopus-indexed anatomy education literature across dissection-based, simulation-based, and hybrid approaches. Materials and Methods: We conducted an exploratory scientometric and methodological analysis of Scopus-indexed articles and reviews retrieved on 14 April 2026. The search combined anatomy-related, medical education-related, and modality-related terms referring to dissection or simulation. Records published from 2000 up to the search date were included. Teaching modality, study design, and outcome type were identified through semi-automated lexical coding of title, abstract, author keywords, and index keywords. Logistic regression models were used to examine associations between teaching modality and methodological characteristics, while citation visibility was examined using a multivariable linear regression model of log-transformed citations per year. Results: The final corpus comprised 2116 articles and reviews. After excluding records classified as unclear with respect to teaching modality, 2094 records were included in modality-based analyses. Dissection-based studies were the numerically dominant category, followed by hybrid and simulation-based studies. Simulation-based studies showed higher odds of being experimental than dissection-based studies, whereas both simulation-based and hybrid studies showed higher odds of reporting objective and clinical/procedural outcomes. In the bibliometric model, hybrid studies, reviews, international collaboration, and larger author teams were associated with greater citation visibility. Conclusions: The transition from dissection-centered anatomy teaching to digital and mixed approaches appears not only thematic, but also methodological and bibliometric. Simulation-oriented studies were more frequently framed through experimental and outcome-based designs, whereas hybrid studies showed the strongest independent citation visibility. These findings should be interpreted as exploratory mapping signals rather than evidence of comparative pedagogical superiority. Full article