Search Results (2,858)

Background/Objectives: As use of large language models (LLMs) in clinical practice, in medical education, and by patients increases, it is essential to ensure that information provided is accurate and safe. Our objective was to compare stage two hypertension treatment plans generated by popular LLMs. Methods: ChatGPT (GPT-4o), Claude (Claude 4 Sonnet), ClinicalKey AI, Microsoft Copilot (Wave 2), DeepSeek-V3-0324, Dyna AI, Google Gemini (2.5 Flash), Grok (version 3), Meta AI assistant (Llama 4 Maverick), OpenEvidence (version 2.0), Perplexity (Sonar backend model), and Pi (Inflection-2.5) were prompted to generate a treatment plan for stage two hypertension. Six blinded reviewers scored each response in three domains: adherence to clinical guidelines, detail/clarity, and reliability/safety. Results: Perplexity received the highest composite score (8.17 out of 9), followed by OpenEvidence (7.92 out of 9). Dyna AI had the lowest overall score (3.75 out of 9). Perplexity (3.00 out of 3), Grok (2.83 out of 3), and OpenEvidence (2.75 out of 3) had the highest scores for detail/clarity, while Dyna AI had the lowest for both detail/clarity (1.00 out of 3) and reliability/safety (1.00 out of 3). ChatGPT had the highest score for adherence to guidelines (2.75 out of 3) while Pi had the lowest (1.58 out of 3). Kruskal–Wallis test showed p < 0.05 across sub-score domains and composite scores. Conclusions: LLMs tended to adhere to clinical guidelines and provide detailed responses but often did not provide sources or instruct users to see a healthcare professional. There was notable variability in quality, and medicine-specific LLMs were not superior to popular LLMs. Full article

Age-related macular degeneration (AMD) is the most common cause of blindness and vision impairment in individuals over 60 years of age in the United States (US). Despite this, current treatment options have limitations related to drug efficacy and durability. Gene therapy provides a potential solution by providing a more durable and longer- acting treatment option that can decrease treatment burden and improve long-term visual outcomes. This review presents the current treatment approaches, routes of administration, and vectors being investigated for gene therapy delivery in AMD. It also provides an update on the ongoing gene therapy clinical trials for dry and wet AMD. As these therapies advance into later-stage clinical trials, ophthalmologists need to be mindful of the many challenges pertaining to gene therapy delivery, including safety, limitations related to immunogenicity, long-term ocular and systemic side effects, and potential barriers to drug manufacturing and access. Continued efforts are required to improve precision, safety, and efficacy, including identifying the safest and most effective vectors and delivery routes, and minimizing potential adverse effects. In addition, guidelines need to be established to guide appropriate patient selection before gene therapy can be integrated into clinical practice. Full article

The definition of hypertension and the values of systolic and diastolic blood pressure (BP) that should be considered as therapeutic targets have changed over time and vary across scientific societies, which may generate uncertainty in the decision-making process among clinicians and patients. We traced the evolution and described the differences in all the 32 Clinical Practice Guidelines for the management of hypertension released by the following national and international scientific societies: World Health Organization—WHO; International Society of Hypertension—ISH; Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure—JNC; American Heart Association—AHA; American College of Cardiology—ACC; European Society of Cardiology—ESC; European Society of Hypertension—ESH; and UK National Institute for Health and Care Excellence—NICE. Throughout the decades, the BP values used for hypertension definition, treatment initiation, and targets to achieve started from SBP/DBP ≥ 160/95 mmHg, established at the end of the 70s, progressively decreased, and were differentiated by individual cardiovascular risk. In the last decade, a divergent approach emerged across scientific societies: while WHO/ISH and NICE recommended thresholds and targets for the general population at SBP/DBP < 140/90 mmHg, ESH/ESC and ACC/AHA guidelines further and markedly reduced both BP threshold values and therapeutic targets, recommending as ideal SBP/DBP values < 130/80 mmHg and encouraging an SBP < 120 mmHg. Discrepancies also emerged in the assessment of the quality of the evidence: although the methodological approaches largely improved over time and across all the institutions assessed, various degrees of incompleteness on the adopted scales were reported, and potentially conflicting situations emerged, particularly when weaker evidence was used to build strong recommendations. Although some degree of discrepancy among guidelines is expected, some of the differences are large and can lead to widely different approaches in the management of BP control. A standardization of the methodology and interpretation of the evidence supporting the guidelines may help to reduce the variability in order to provide the best possible guidance for clinical practice and patient health. Full article

Background/Objectives: Nurses and dialysis technicians are primarily responsible for cannulation in in-center and satellite dialysis units. Despite being a core component of hemodialysis care, existing clinical guidelines offer limited standardization, resulting in practice variability across facilities. Therefore, clinical expertise and adherence to consistent standards are essential to ensure safe and effective vascular access management. The study aimed to investigate the variables related to patients and nurses that contribute to unsuccessful vascular access cannulations, as well as the actions taken in response to cannulation failure, in a tertiary dialysis center in the Eastern Region of Saudi Arabia. Methods: This retrospective analytic study reviewed the records of 228 adult hemodialysis patients at King Fahad Military Medical Complex from 2020 to 2024, analyzing demographic, clinical, vascular access, and nursing variables associated with cannulation failure using descriptive statistics, the chi-square test, and t-tests. Ethical approval was obtained, and data were de-identified and manually extracted from nursing and dialysis documentation. Results: Most patients had hypertension and diabetes, with significant comorbidity burdens. Infiltration (61%) and clot formation (30.7%) were the primary complications of cannulation failure. Significant associations emerged with recurrent stroke and peripheral vascular disease, but not with nurse or patient demographics, suggesting vascular factors outweigh staff variables in cannulation risk. Cannulation failures were most common in patients with vascular comorbidities, while staff experience and education had no significant impact. Conclusions: Recommendations include implementing tailored protocols, providing ongoing nurse education, conducting systematic vascular assessments, and holding regular team reviews to enhance access outcomes and patient safety. Full article

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common chronic liver disorder linked to obesity, insulin resistance, and dyslipidemia. Nutrition plays a central role in modulating hepatic lipid metabolism, oxidative stress, and inflammation, yet practical, evidence-based dietary strategies remain limited. This study aimed to develop Mediterranean diet-based meal plans with varying macronutrient compositions and to characterize their nutritional profiles, as well as to evaluate them using established nutritional indices and diet score calculations, such as the Dietary Inflammatory Index, Dietary Antioxidant Index, and dietary lipid indices. Methods: Clinical practice guidelines (CPGs) from various academic and professional organizations were reviewed to assess current non-pharmacological treatments for MASLD, with a focus on determining whether the Mediterranean diet is the most recommended dietary pattern. Traditional, low-carbohydrate, and low-fat MedDiet patterns were translated into food-based meal plans. A 7-day meal plan was developed and analyzed for nutrient composition, then evaluated using the Dietary Inflammatory Index (DII), Dietary Antioxidant Index (DAI), Dietary Lipophilic Index (DLI), and Dietary Lipophilic Load (DLL). A Western diet (WD) that is characterized by ultra-processed food (UPF) was included as a comparative reference. Results: The validated dietary score calculations showed that all MedDiet patterns demonstrated consistently low DII scores (−2.00 to −2.81) and high DAI scores (3 to 20.03), whereas the WD showed high DII scores (5.0 to 6.09) and low DAI scores (−12.47 to −17.99). Despite these variations in macronutrients, the menu developed in the study on three MedDiet patterns showed negative DII and positive DAI scores. When comparing the traditional MedDiet with the WD, which have similar macronutrient distributions, the WD was characterized by less favorable DII and DAI scores. Conclusions: This study provides a descriptive, guideline-informed framework for Mediterranean diet-based meal plans with varying macronutrient compositions. Utilizing DII, DAI, DLI, and DLL offers a potential framework for designing dietary interventions. Further validation through clinical studies is needed to justify the potential for practical and digital translation. Nevertheless, the study provides initial insights that may inform future research on nutritional approaches for MASLD integrating dietary indices. Full article

Background: The Democratic Republic of the Congo accounts for approximately 12–13% of the global malaria burden. While international guidelines oppose the use of Artemisia annua infusions due to risks of sub-therapeutic dosing and resistance selection, the plant remains widely used in resource-limited regions. This study evaluates the clinical acceptability and perceptions of healthcare providers regarding the integration of Artemisia annua tea into formal malaria control in the Maniema province. Methods: A cross-sectional survey was conducted among 337 healthcare professionals in the Kalima health district using the KoboCollect digital platform. Multivariate logistic regression was employed to identify the primary socio-professional determinants of clinical acceptability. Results: The overall clinical acceptability of Artemisia annua integration was 81.0%, with 82.8% of providers perceiving the preparation as effective. Rural residency was the strongest predictor of adherence (AOR = 6.847; p = 0.003), reflecting a pragmatic response to frequent ACT stockouts and high treatment costs. Despite high acceptability, 49.0% of providers identified the lack of clinical evidence as a major barrier, and 91.4% demanded formal training on standardized dosage and biological mechanisms. Conclusions: A significant “policy–practice gap” exists between international guidelines and field realities in the DRC. Healthcare providers demonstrate high readiness for integration but emphasize the absolute necessity of galenic standardization to mitigate resistance risks. To address these concerns, a complementary genomic investigation is currently underway in the same study area, comparing PfKelch13 mutation prevalence among Artemisia tea users versus ACT-treated patients. This molecular surveillance will provide essential evidence to define safety parameters for future phytopharmaceutical integration. Full article

Treatment guidelines for Clostridioides difficile infection (CDI) have been published by infectious disease and gastroenterology professional societies; however, adherence in clinical practice remains poorly characterized, particularly for recurrent disease. We conducted a retrospective chart review of 100 patients with CDI (350 episodes: 115 initial, 235 recurrent) referred to a tertiary complicated CDI clinic between 2018 and 2023. Guideline adherence was assessed by comparing treatment with IDSA/SHEA and ACG recommendations, and referring diagnoses were compared with final specialist diagnoses. Guideline adherence was significantly higher in initial compared to recurrent episodes (70.4% vs. 41.3%, p < 0.0001). Among guideline non-adherent recurrent episodes, 51.3% used standard antibiotic regimens inappropriate for the recurrence tier. Specialist review reclassified 12.0% of episodes, with colonization increasing from 2.6% to 8.9%. Misdiagnosed colonization cases had a 6.2-fold higher treatment failure rate than confirmed CDI (39.3% vs. 6.3%, p < 0.0001). Guideline non-adherence showed a non-significant trend toward treatment failure (10.0% vs. 6.7%, p = 0.31). Guideline adherence for recurrent CDI is inadequate in pre-referral settings, and diagnostic misclassification is common. Early specialist involvement may improve both diagnostic accuracy and treatment appropriateness for patients with recurrent CDI. Full article

Background and Objectives: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce cardiovascular (CV) death and heart failure hospitalizations (HFH) in patients with heart failure with reduced ejection fraction (HFrEF). However, data regarding their use in combination with different doses of guideline-directed medical therapy (GDMT) remain limited. This study aimed to evaluate whether SGLT2i combined with low-dose conventional triple therapy is non-inferior to high-dose conventional triple therapy in preventing adverse cardiovascular outcomes. Materials and Methods: This retrospective observational study included 334 patients with HFrEF treated between 31 March 2018 and 31 March 2024. Of these, 110 received SGLT2i plus low-dose conventional triple therapy, and 224 received high-dose conventional triple therapy. A non-inferiority framework was applied to compare outcomes between groups. The primary endpoint was a composite of CV death and HFH, while secondary endpoints included the individual components. Results: The composite endpoint occurred more frequently in the SGLT2i plus low-dose group. After inverse probability of treatment weighting and multivariable Cox analysis, this group demonstrated a significantly higher risk of the composite outcome (adjusted HR 4.10, 95% CI 2.07–8.13; p < 0.001). CV death was similar between groups; however, HFH was significantly more frequent in the SGLT2i plus low-dose group. Conclusions: In patients with HFrEF, SGLT2i combined with low-dose conventional triple therapy did not demonstrate comparable clinical outcomes to high-dose conventional triple therapy in reducing CV death and HFH, particularly in patients with a higher baseline burden of disease severity. These findings underscore the importance of optimizing background GDMT dosing alongside the incorporation of SGLT2i into clinical practice. Full article

Objectives: To evaluate the association between European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) scores and treatment recommendations from European Society for Medical Oncology, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) in curative and metastatic breast cancer (BC), and to assess inter-guideline concordance. Methods: We conducted a comparative review of 47 systemic BC therapies with published ESMO-MCBS scores (accessed 30 June 2025). Guideline recommendations from ESMO, NCCN, and ASCO were extracted from the most recent versions and harmonized into ordinal tiers. Associations between MCBS scores and recommendation categories were evaluated using Fisher’s exact test and Spearman’s rank correlation in the palliative setting. Curative therapies were analyzed descriptively due to limited variability. Results: Among 38 palliative therapies, 40% achieved high clinical benefit (MCBS 4–5). A significant association was observed between MCBS scores and NCCN recommendations (p = 0.003; ρ = 0.48), with 62% of NCCN Category 1 therapies demonstrating high benefit versus 13% in other categories. No significant associations were observed with ASCO (p = 0.101; ρ = 0.18) or ESMO guideline recommendations (p = 0.073; ρ = 0.19). Inter-guideline concordance was strongest between ASCO and ESMO (p = 0.033; ρ = 0.48). In the curative setting (n = 9), most therapies received an MCBS grade A and top-tier guideline endorsement. Conclusions: Alignment between ESMO-MCBS and guideline recommendations is moderate and framework-dependent, strongest with NCCN in metastatic BC. Discordance primarily reflects differences between magnitude-of-benefit thresholds and evidence-certainty frameworks. ESMO-MCBS may serve as a complementary tool to enhance value-based clinical and policy decision-making. Full article

Background/Objectives: Prostate cancer (PCa) incidence is rising, with radical prostatectomy (RP) as the main curative surgery for localised cases, which includes removing seminal vesicles (SV). SV invasion (SVI) predicts poor oncological outcomes, making accurate preoperative staging to identify SVI crucial for surgical planning. This ensures oncological safety by enabling wide excision when needed, while preserving tissue to maintain function. This review synthesises current evidence on pre-biopsy MRI findings and/or clinicopathological parameters to diagnose SVI in PCa. Methods: A literature search (2005–2025) using OVID for studies assessing pre-biopsy MRI findings, with a priori eligibility for clinicopathological or combined MRI–clinicopathological models (index tests), for detecting SVI (outcome) compared to RP histopathology (standard reference) in patients with primary localised PCa (patients). This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was evaluated with QUADAS-2, and pooled diagnostic accuracy metrics and study heterogeneity were analysed. Results: Five studies qualified, while three used binary mpMRI classification and were quantitatively analysed. No eligible studies assessed clinicopathological predictors or combined MRI–clinicopathological models; all included studies evaluated pre-biopsy MRI findings only, and none included high-dimensional radiomics. The pooled sensitivity was 0.66 (95% CI: 0.52–0.78), specificity 0.94 (0.89–0.97), positive predictive value (PPV) 0.76 (0.60–0.87), negative predictive value (NPV) 0.92 (0.85–0.94), and diagnostic odds ratio 30.13 (12.36–73.47), with moderate heterogeneity. All included studies were retrospective cohorts with considerable risk of bias. Conclusions: In the small number of heterogeneous, single-centre retrospective studies available, pre-biopsy MRI findings show high specificity and NPV for preoperative detection of SVI but only moderate sensitivity, which limits its reliability as a standalone tool. The pooled diagnostic accuracy estimates should be interpreted as exploratory. These findings should therefore be interpreted cautiously. Future studies must integrate MRI with clinicopathological data, addressing this key evidence gap before firm conclusions can be drawn or clinical practice changed. Full article

Background: Effective and safe sedation is essential in pediatric dental practice to manage anxiety, pain, and cooperation during procedures. Objective: This exploratory systematic review and meta-analysis aimed to synthesize available RCT evidence comparing dexmedetomidine and ketamine across different sedation strategies (premedication and procedural sedation) in children undergoing dental procedures. Methods: This study was conducted and reported in accordance with the PRISMA 2020 statement. A comprehensive literature search was performed across PubMed, Web of Science, Scopus, and ScienceDirect for studies between 1990 and 2026. Randomized controlled trials (RCTs) were included. The primary outcomes assessed were intraoperative and postoperative analgesia, heart rate, systolic and diastolic blood pressure (SBP and DBP), oxygen saturation (SpO₂), and recovery time. A meta-analysis of the extracted data was performed, and the risk of bias was assessed using the Cochrane risk of bias tool 2. Results: The review included four RCTs involving 178 children, with a mean age of 6.5–9.1 years. Intraoperative and postoperative analgesia did not differ significantly between groups (p = 0.09 and p = 0.08, respectively). Pooled analysis showed numerically lower heart rates with dexmedetomidine compared to ketamine, but the difference was not statistically significant (MD = −11.70; 95% CI: −29.27 to 5.86; p = 0.07). Systolic blood pressure was significantly lower with dexmedetomidine (MD = −6.69; 95% CI: −6.91 to −6.47; p = 0.002). Oxygen saturation did not differ significantly between groups (p = 0.35). Two studies were rated as having a low risk of bias. The remaining two had some concerns, related to unverified blinding and lack of outcome pre-specification. Conclusions: Based on limited and clinically heterogeneous evidence, both dexmedetomidine and ketamine appear to be viable options for sedation in pediatric dental settings, though no firm superiority conclusion can be drawn. Further randomized controlled trials with larger sample sizes and standardized sedation protocols are recommended to strengthen these findings and inform practice guidelines. Full article

Background/Objectives: The use of personal smartphones by healthcare professionals in clinical settings has become a growing area of concern as practice may not consistently align with policy guidance. This study enhances our understanding of how and why medical residents are using smartphones to communicate patient healthcare information with other physicians in daily practice and provides insights into the role that institutional governance, policies, and structures play in the use of smartphones. Methods: This study used qualitative techniques to examine medical residents’ use of smartphones to communicate healthcare-related information with colleagues. Additionally, a neo-institutional theory lens was applied to assess the role that regulative (guidelines/policies), normative (what peers/staff are doing), and cultural-cognitive (beliefs/perceptions) factors play in smartphone use by medical residents. Results: The results suggest that behaviour related to smartphone use is based primarily on normative and cultural-cognitive factors rather than regulative factors. Regulative elements around smartphone use play a smaller role in shaping behaviour, particularly when they: (1) lack clarity; (2) are not seen as credible/legitimate; or (3) are viewed as cumbersome and do not align with workflow needs. Conclusions: The implementation of future guidelines/policies should consider the use of mentorships throughout postgraduate medical training whereby staff physicians educate, model, and promote behaviour in accordance with the associated policies/guidelines. Full article

Background: Cow’s milk protein allergy (CMPA) is a common cause of gastrointestinal and dermatologic symptoms in infancy. In clinical practice, infants with atopic dermatitis (AD) and suspected non-IgE-mediated CMPA are frequently managed with formula modification, although real-world comparative data across different formula strategies remain limited. Aim: To evaluate gastrointestinal symptom resolution, improvement in AD, and growth outcomes following formula modification in infants with AD and suspected non-IgE-mediated CMPA. Methods: This retrospective comparative cohort study included 107 infants aged ≤12 months with documented AD and suspected non-IgE-mediated CMPA evaluated at a tertiary academic center between January 2024 and December 2025. Infants were categorized according to initial management strategy: switch to extensively hydrolyzed formula (eHF; n = 63), switch to amino acid formula (AAF; n = 29), or continued standard cow’s milk-based formula (n = 15). The primary outcome was resolution of gastrointestinal symptoms within 2–4 weeks. Secondary outcomes included improvement in AD, weight gain, and need for further formula escalation. Multivariable logistic regression was performed to adjust for potential confounders. Results: Overall, gastrointestinal symptom resolution occurred in 74 of 107 infants (69.2%). Resolution rates were 71.4% in the eHF group, 79.3% in the AAF group, and 40% in the standard formula group (p = 0.01). In adjusted analysis, switching to eHF (aOR 2.8; 95% CI 1.1–7.3; p = 0.03) and AAF (aOR 4.1; 95% CI 1.3–12.5; p = 0.01) was independently associated with higher odds of symptom resolution compared with continued standard formula. Improvement in AD was observed in 57.9% of infants overall and differed significantly across groups (p = 0.04). Mean weight gain during follow-up did not differ significantly between groups (p = 0.63). Subsequent formula escalation was more frequent in the standard formula group (46.7%) compared with eHF (17.5%) and AAF (13.8%) groups (p = 0.004). Conclusions: In infants with AD and suspected non-IgE-mediated CMPA, substitution with extensively hydrolyzed or amino acid formula was independently associated with greater gastrointestinal symptom resolution and improvement in dermatitis compared with continued standard formula, without evidence of compromised growth. These findings provide supportive real-world evidence consistent with current international guidelines; however, given the observational design and potential for residual confounding, they should be interpreted as hypothesis-generating rather than confirmatory evidence of causal treatment effects. Full article

Background/Objectives: Wearable activity monitors and sensor-based devices are increasingly used to quantify mobility, load, and recovery in orthopaedic patients, yet clinicians lack practical guidance on selection, implementation, and interpretation. This qualitative expert consensus study synthesized real-world experiences from leaders in orthopaedics, rehabilitation, biomechanics, and digital health who implemented wearables at scale. Methods: Semi-structured interviews were conducted with 16 experts (64% response rate) recruited via hybrid purposive and snowball sampling. Participants included orthopaedic surgeons and research scientists with 124 cumulative years of wearable experience across over 9000 monitored patients. Interviews addressed device selection, clinical workflow, data management, and adoption barriers. Data were charted into a structured extraction matrix and analyzed using Inductive Thematic Analysis and a Framework Approach, reported per COREQ guidelines. Results: Experts utilized diverse sensor platforms across arthroplasty, trauma, spine, and sports medicine. Four key themes emerged: (1) device selection prioritized usability and patient compliance over technical sophistication; (2) workflow required defined team roles to manage data volume and avoid clinical burden; (3) patient engagement favored simplified, actionable feedback amid divergent views on data transparency; (4) future outlook anticipated AI-driven proactive risk prediction. Conclusions: No single wearable suits all orthopaedic practices; success hinges on aligning sensor placement with clinical questions, rigorous data quality checks, and integration into care plans. This study offers a practical checklist and roadmap for point-of-care adoption. Full article

Objective: To quantify the gap between oral cancer disease burden and public awareness in Germany, and to characterize research dissemination patterns across social media platforms. Methods: We conducted a multi-dimensional analysis integrating: (1) Robert Koch Institut cancer registry data for oral and maxillofacial malignancies (ICD-10: C00–C06) from 2015 to 2023; (2) Google Trends search interest for cancer-related German terms; (3) Altmetric data for 2581 PubMed-indexed oral cancer publications; and (4) sentiment analysis of 10,308 social media posts. Age-standardized incidence rates were calculated using the European Standard Population. Results: Over the study period, 65,757 oral cavity cancer cases were registered. Google Trends analysis revealed a 64% attention deficit for “Mundkrebs” (oral cancer; mean: 17) compared to “Brustkrebs” (breast cancer; mean: 47). Case numbers declined from 7577 (2019) to 6870 (2023; −9.3%), while age-standardized rates decreased by 15.5% (11.6 to 9.8 per 100,000), with males disproportionately affected (−17.7%). Research dissemination was dominated by X/Twitter (86.2%), with minimal policy document (0.3%) or clinical guideline (0.3%) citations. Sentiment analysis revealed 77% positive public reception. Regional analysis identified an East–West divide, with Eastern German states showing 22% higher search interest. Conclusions: A substantial public awareness deficit exists for oral cancer in Germany, paradoxically widening during a period of declining diagnoses potentially associated with COVID-19-related diagnostic delays. The positive public sentiment toward oral cancer research suggests a favorable environment for targeted awareness campaigns, particularly in Western German states where search interest is lowest. These findings have practical implications for designing regionally tailored awareness campaigns prioritizing anatomically specific terminology. Future research should evaluate the effectiveness of such targeted interventions and assess whether post-pandemic diagnoses present at more advanced stages. Full article