Search Results (2,922)

Background: Maintenance hemodialysis is characterized by repetitive changes in fluid distribution, blood pressure, and organ perfusion. Conventional clinical examination, empirical dry-weight adjustment, and biomarkers do not fully resolve the compartment-specific nature of congestion in this population. This narrative review reframes ultrasound-based volume assessment as a multimodal diagnostic problem involving pulmonary congestion, intravascular filling, systemic venous congestion, cardiac reserve, tissue response, and perfusion vulnerability. Methods: We synthesized clinically relevant evidence indexed in PubMed and Google Scholar for studies published between January 2016 and April 2026, prioritizing dialysis-specific randomized trials, prospective cohorts, systematic reviews, consensus statements, and methodological studies related to diagnostic ultrasound, Doppler-based congestion assessment, contrast-enhanced ultrasound, elastography, artificial intelligence, point-of-care ultrasound, and remote ultrasound monitoring. Results: Lung ultrasound currently has the strongest dialysis-specific evidence for detecting and tracking pulmonary congestion. Inferior vena cava ultrasound provides adjunctive information on intravascular filling and right-sided pressure but is not a surrogate for total body water. Echocardiographic parameters help characterize filling pressure and cardiac tolerance to fluid removal, whereas venous Doppler and the Venous Excess Ultrasound Score provide an emerging approach to systemic venous congestion. Elastography and contrast-enhanced ultrasound remain investigational tools for tissue characterization and perfusion vulnerability, while AI-assisted analysis, handheld point-of-care ultrasound, and tele-ultrasound may improve standardization, automated B-line quantification, and scalability. Conclusions: Different ultrasound modalities answer different diagnostic questions in maintenance hemodialysis. A compartment-specific framework integrating congestion, perfusion, and cardiac-reserve domains may better support individualized ultrafiltration planning, hemodynamic risk assessment, and future outcome-oriented research. Full article

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are transforming obesity management, yet landmark trials often incompletely measure and report a central mediator of response: dietary intake. Because GLP-1RAs promote weight loss primarily by suppressing appetite and reducing energy consumption, capturing changes in dietary intake is essential to interpreting efficacy, safety, and translation into clinical care. This perspective argues that failure to measure and report comprehensive dietary intake raises concerns under four core bioethical principles. It undermines autonomy by limiting evidence for shared decision-making across the treatment continuum. It challenges non-maleficence because inadequate energy, protein, and micronutrient intake may contribute to lean mass loss and nutrient deficiencies, particularly in vulnerable populations. It weakens beneficence because failing to report a measurable mediator diminishes the scientific value of research requiring substantial investment and participant burden. It raises justice concerns because the equitable distribution of assessment burden and access to resulting nutritional care cannot be evaluated without transparent reporting. To meet the ethical and scientific obligations of clinical research, future trials should preregister dietary intake as a key secondary or safety endpoint. Investigators should report total energy, macronutrient, and micronutrient distribution at baseline and serial follow-up alongside dietary assessment methods, food composition databases, and assessor training. Journal editors, funders, and regulatory bodies should support development of consensus-based, nutrition-specific reporting recommendations aligned with CONSORT principles and encourage preregistration of dietary trial endpoints. Registered dietitian nutritionists should be prospectively integrated into GLP-1RA trial teams from design through data interpretation. Advancing the standard of obesity care requires that the research community look beyond the scale and ground clinical translation in the nutritional context in which pharmacotherapy operates. Full article

Background/Objectives: Family dietary imbalance is an important source of the double burden of malnutrition, and dietary arrangements in multigenerational households are often deeply embedded in intergenerational caregiving relationships. However, the cognitive formation mechanism through which dietary caregiving behaviors driven by care and responsibility may instead lead to dietary imbalance still lacks systematic explanation. Therefore, this study aimed to examine the cognitive formation mechanism of dietary imbalance behaviors in Chinese multigenerational households. Methods: This study takes primary dietary caregivers in Chinese three-generation households as the research subjects. It integrates the false consensus effect, cognitive dissonance theory, and the information–motivation–behavioral skills (IMB) model. Based on 467 valid samples, the study conducts empirical analysis using partial least squares structural equation modeling (PLS-SEM) and importance-performance map analysis (IPMA). Results: The results show that caregivers’ subjective judgments about family members’ dietary needs based on their own experience trigger cognitive dissonance and further promote their re-examination of dietary risk information, caregiving responsibilities, and family normative expectations. Among these factors, caregiving responsibilities and subjective norms are key factors in improving dietary regulation self-efficacy, whereas the effect of risk information perception on self-efficacy is not significant. The IPMA results further show that self-efficacy is the most important factor driving the formation of behavioral intention to regulate healthy family diets. Conclusions: This study reveals the psychological mechanism through which dietary imbalance behavior in multigenerational households moves from subjective need judgment to the formation of future regulation intention. It extends the application of the IMB model in family caregiving contexts and provides a theoretical basis and practical implications for the formulation of family health promotion and dietary intervention strategies. Full article

Background: Coeliac disease (CD) is a highly heritable autoimmune disease. Given the high risk among first-degree relatives, early screening and prevention are essential, yet clinical guidelines vary. This review analyzed clinical practice guidelines issued by leading European, British, and North American organisations over a 12-year period (2014–2026) regarding genetic screening and lifestyle/dietary prevention strategies. Methods: A systematic search was conducted across official databases of prominent societies (ESSCD, UEG, ESPEN, NASPGHAN, AGA, ESPGHAN, WGO, BSG, ACG) for English-language guidelines and position papers. Extracted statements addressing genetic testing (HLA-DQ2/DQ8) and early-life risk-modifying strategies were coded into three thematic domains: (1) genetic predisposition, (2) lifestyle prevention or (3) both. Results: Eleven manuscripts yielded 399 statements, categorized into genetic predisposition (n = 23, 5.8%), lifestyle prevention (n = 30, 7.5%) and integrated approaches (n = 2, 0.5%), with the remainder (n = 344, 86.2%) addressing unrelated clinical topics. Universal consensus confirmed the high negative predictive value of HLA-DQ2/DQ8 testing to rule out CD, whereas dietary strategies (breastfeeding duration and timing of gluten introduction) showed no protective effect. ESPGHAN exclusively provided evidence regarding early-life high-risk genotypes and concluded that risk-stratified dietary guidance based on specific HLA profiles remains currently unsupported. Conclusions: Current CD guidelines demonstrate substantial international consensus regarding the role of genetic testing in disease exclusion and risk stratification. However, recommendations integrating genetic susceptibility with preventive lifestyle interventions remain scarce. Future research should focus on generating robust evidence to support precision prevention approaches and facilitate the harmonization of international guidelines. Full article

The integration of Artificial Intelligence (AI) into human resources management is driving a profound transformation in the evolution of management, and even more so in the management of human talent, which is the primary resource of any organization. This research provides an in-depth analysis of the impact of AI on core human resource management processes, covering the automation of operations that enables the exploration of dimensions such as talent acquisition, training, potential development, mental well-being, strategic workforce planning, job design, diversity, compensation, equity and inclusion, change management, culture and sustainability. The purpose of this study is to systematically synthesize the existing evidence on the impact of artificial intelligence on human management processes, identifying the scientific consensus, emerging contradictions, research gaps, and implications for sustainable organizational development. A systematic review was conducted of various sources published between 2020 and 2025 from databases such as ScienceDirect and Scopus, among others, using predefined Boolean search strategies, explicit inclusion and exclusion criteria and a structured thematic synthesis narrowing down the main studies based on search criteria. It was determined how algorithms are changing the employer-employee relationship within organizations. The findings indicate that the effectiveness of AI depends on the development of a hybrid intelligence that preserves the human factor consideration. It is concluded that AI enables the optimization of cultural change management, analytical precision, and ethical oversight—which are irreplaceable and critical human competencies in today’s digital age. This review contributes to the literature by providing a comprehensive synthesis of recent evidence, identifying unresolved research gaps, and proposing a future research agenda that will lead to the development of sustainable, responsible, and people-centered AI in human resource management. Full article

Since the late 1960s, project management researchers have studied the factors contributing to project success, with Dr. Barnes introducing the “Iron Triangle” concept in 1969. Initially composed of scope, time, and cost, subsequent interpretations have varied, with quality, stakeholder satisfaction, risk management, and sustainability proposed as additional vertices. However, it is difficult to reach a consensus on the definitive concepts of the Iron Triangle. This study proposes a new Iron Triangle that incorporates the concept of “value” along with cost and schedule, consistent with Lean Construction principles. Through a comprehensive literature review and critical analysis, the study identifies systematically excluded dimensions of the traditional Iron Triangle, emphasizing stakeholder satisfaction, sustainability, and innovation. The research aims to understand how these dimensions enhance traditional project management models by integrating Lean Construction principles. The results reveal a dynamic relationship among cost, schedule, and value, challenging the traditional assumption of inverse proportionality. The proposed model emphasizes the importance of value generation, promoting customer focus, eliminating waste, and continuous improvement. It encourages a holistic approach to project assessment, recognizing the multifaceted nature of success. This new paradigm suggests further research into strategies that assess cost, schedule, and value in construction projects. Full article

The primary aim of this study is to identify how residents on the Hungarian and Slovak sides of the Lower Ipoly Valley perceive the most considerable material and immaterial local values and unique resources of their settlements. The research was designed to explore and compare the territorial capital of the two sides of the study area based on three major capital types: natural, social, and economic capitals. Data collection included 254 semi-structured interviews, conducted with 136 residents on the Slovak side (14 settlements) and 118 residents on the Hungarian side (12 settlements). Detailed interview summaries were analysed with qualitative content analysis using emergent coding. This resulted in an analytical framework comprising nine value dimensions. Across both sides of the border, we examined the same nine value dimensions: local workforce, local enterprises, civil organisations and cultural groups, local and community events, local gastronomy, natural values, built heritage, holders of local knowledge, and local products. Items mentioned that related to each value dimension were counted for each dimension and normalised to a 0–10 scale. The quantified values were aggregated at the settlement level (90 points being the maximum score). The average score of each dimension was also calculated for both sides of the study area. Our findings show that the Hungarian side achieved a total score of 40.4, while the Slovak side reached 36.6, both reflecting a similarly weak–moderate state of the local capitals with minimal differences. This indicates that the two sides of the study area share comparable developmental challenges but also considerable potential for improvement. The Hungarian side performed slightly better in nearly all dimensions except local gastronomy, where the Slovak side proved stronger. The Hungarian side’s relative advantages include a higher presence of local enterprises, a richer network of civil and cultural groups, and more diverse built heritage; in other dimensions, differences are marginal. One of the most pressing regional challenges is improving employment opportunities and stimulating entrepreneurial activity, which are essential for enhancing population retention. Overall, the results indicate that the settlements possess substantial—yet largely underutilised—value assets, whose conscious and consensus-based development could form a strong foundation for creative and innovative local development. Each settlement’s value matrix includes elements that define its uniqueness, enabling the identification of numerous potential development pathways, whether through nature-based educational and recreational programmes, the utilisation of culturally considerable built heritage, the revitalisation of living traditions, or the promotion of local traditional gastronomy on both sides of the study area. Full article

Perinatal mental health remains a critical global challenge, with maternal mortality, preterm birth, and persistent disparities in care contributing to adverse outcomes for mothers. In addition, mental health difficulties in the perinatal period are associated with poorer developmental outcomes for young children and impose an economic burden on societies. Addressing these issues requires innovative approaches that can complement traditional clinical practices. Artificial intelligence (AI) has emerged as a powerful tool with the potential to transform perinatal care by enabling early risk prediction, personalised interventions, and scalable support systems. However, there are no existing reviews on use of AI across different stages of perinatal mental health. We conclude with a call to action for clinicians, researchers, policymakers, and technology developers to collaborate on a consensus framework that ensures ethical, safe, and equitable integration of AI into perinatal care. Full article

China’s pork sector is a major component of the national food system. Establishing plant-based pork supply chains requires coordination across production, quality control, infrastructure, logistics, information exchange, and market formation. However, previous studies generally examine these barriers separately, limiting understanding of how they interact within the wider food-supply system. This study identifies and analyzes the systemic barriers to establishing plant-based pork supply chains in China. An integrated Fuzzy Delphi Method (FDM) and Decision-Making Trial and Evaluation Laboratory (DEMATEL) approach is applied. FDM is used to refine and validate 14 contextually relevant barriers based on expert consensus, while DEMATEL examines their direct and indirect relationships, systemic prominence, and net causal influence. Insufficient research and development funding and deficiencies in quality control emerge as the strongest net causal barriers. High infrastructure investment also belongs to the cause group, while technological, operational, and market-related barriers occupy different causal and dependent positions within the wider system. The results support a sequenced intervention strategy that begins with innovation capacity, quality assurance, and infrastructure, followed by operational coordination and market formation. This study contributes by moving beyond barrier identification and ranking to explain how multiple barrier domains interact and how interventions can be prioritized. The analysis concerns supply chain establishment and does not directly assess the environmental, economic, or social sustainability performance of plant-based pork. Full article

Background and Objectives: Shoulder disorders—including rotator cuff disease, glenohumeral osteoarthritis (GH OA), and adhesive capsulitis—are among the most prevalent musculoskeletal conditions and are frequently refractory to conservative management. Platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) have attracted increasing clinical interest as regenerative alternatives to corticosteroid injection, but a comparative appraisal of these two principal biologics across the full spectrum of shoulder pathology is lacking. Materials and Methods: This narrative review is based on structured searches of MEDLINE, Embase, Cochrane CENTRAL, and Scopus for clinical studies (randomized controlled trials [RCTs], comparative studies, and prospective series) and evidence syntheses evaluating PRP or BMAC in shoulder disorders. Studies were synthesized narratively by biologic type and disorder; no formal systematic-review or scoping-review reporting protocol was applied. Current society guidelines and consensus statements were additionally examined to position each biologic, and PRP formulation subgroups (leukocyte-rich versus leukocyte-poor) were considered. Results: PRP has the larger shoulder-specific evidence base, supported by several RCTs and meta-analyses in rotator cuff tendinopathy and in adhesive capsulitis; however, results are heterogeneous, effect sizes are generally modest, and some trials show no advantage over saline or corticosteroid. BMAC shoulder evidence is sparse and is strongest as a biological augment to rotator cuff repair (supported chiefly by a case-controlled study) rather than as a standalone injection; standalone shoulder BMAC RCTs are essentially absent. No published RCT directly compares PRP with BMAC for a shoulder disorder; the only direct randomized head-to-head comparison available is in knee osteoarthritis, where the two were reported to be equivalent at two years. Where PRP formulation was examined, leukocyte-poor preparations were associated with better structural and pain outcomes and leukocyte-rich preparations with functional gains in the surgical setting; current society guidance (e.g., the 2025 American Academy of Orthopaedic Surgeons [AAOS] rotator cuff guideline) does not endorse routine PRP use, and BMAC is not yet incorporated into shoulder guideline recommendations. Conclusions: PRP rests on a larger but still heterogeneous evidence base for shoulder disorders, whereas BMAC is biologically promising but clinically under-evidenced in the shoulder. Neither biologic is established as superior. Standardized, shoulder-specific head-to-head RCTs—incorporating biologic characterization, structural (imaging) outcomes, and longer follow-up—represent the most important research priority in this field. Full article

Acute deep vein thrombosis (DVT) continues to represent a significant global contributor to morbidity and mortality. Although multiple international societies have published evidence-based clinical practice guidelines, important differences persist. This structured narrative review compares contemporary international guidance to identify areas of consensus, methodological divergence, evidence gaps, and priorities for future research. Recommendations were compared across diagnostic evaluation, anticoagulant selection, treatment duration, outpatient management, compression therapy, endovascular intervention, and special populations. Broad agreement was identified regarding clinical pretest probability assessment, D-dimer testing, compression ultrasonography, and direct oral anticoagulants as first-line therapy for most eligible patients with acute DVT. Clinically important differences remain, however, in the management of isolated distal DVT, anticoagulation duration, catheter-directed interventions, compression therapy, and selected high-risk populations. These discrepancies primarily reflect differences in publication timing, methodological frameworks, interpretation of emerging evidence, and healthcare-system context rather than fundamentally conflicting evidence. Contemporary international guidance therefore demonstrates substantial convergence on the core principles of acute DVT management while continuing to differ in areas supported by limited or evolving evidence. Future harmonization will require high-quality randomized trials, broader international collaboration, and the integration of precision medicine, validated risk-prediction models, biomarkers, and emerging anticoagulant strategies into guideline development. Full article

Professional and elite sport represents a high-pressure healthcare environment in which standard principles of patient-centered care, confidentiality, informed consent, shared decision-making, and clinical independence are tested by organizational and performance-related pressures. This narrative review examines reliance management in athlete–physician relationships. Reliance is conceptually distinguished from trust: whereas trust is an interpersonal attitude that can be betrayed, reliance denotes the broader dependence of the athlete-patient on the physician, the care process, and the surrounding governance system—a dependence that may persist even where trust is absent. Reliance management is conceptualized as the deliberate, multi-level design and maintenance of communicative, ethical, and governance conditions under which such reliance is well-placed. A structured, non-systematic literature search of PubMed, Scopus, Web of Science, SPORTDiscus, and Google Scholar, supplemented by backward citation tracking, informed a thematic synthesis organized around three dimensions: clinical ethics, patient-centered care, and governance. The synthesis distinguishes empirical findings, professional consensus guidance, ethical and legal analysis, and illustrative cases, and identifies domains in which evidence remains weak. An integrative conceptual model is proposed that links governance antecedents at the dyadic, clinical, organizational, and system levels to mechanisms of well-placed reliance and to outcomes that require empirical evaluation. Proposed safeguards—independent medical oversight, documented return-to-play pathways, formal data-sharing rules, second-opinion access, and contractual protection of physician autonomy—are intended to protect patient-centered care and patient safety; their effectiveness has, however, rarely been evaluated and should be the object of future intervention research. Full article

Informed consent is fundamental to Australian newborn bloodspot screening (NBS), but emerging genomic screening technologies pose new challenges to clinical care and research. Optimizing consent processes is necessary to support ethical practice and maintain public trust as NBS evolves. This study aimed to identify gaps and opportunities to improve NBS consent processes in Queensland, Australia, while also exploring preliminary insights into the evolving complexity of consent in the context of genomic NBS (gNBS) and NBS-related research. A qualitative study design was used, with two facilitated interest-holder workshops (a total of 12 h) involving 86 participants (healthcare professionals, policy-makers, researchers, genomics experts, and consumer representatives). Workshop 1 (n = 25) was held virtually, and Workshop 2 (n = 61) was held in person. Thematic analysis was used to identify practical recommendations and ethical considerations. Participants identified three priority domains for improving consent in Queensland’s NBS program: (1) revision of the Guthrie Card and consent statement, (2) development of consistent, antenatal information resources across healthcare providers, and (3) standardized consent delivery training for healthcare staff. Discussions also highlighted tensions around information requirements for informed consent, revealing growing complexities regarding layered consent models. While recommendations on research consent were not fully developed at the workshop, insights highlighted the growing complexity and divergence of views on layered consent models. Findings suggest that improving NBS consent requires both operational reform and reassessment of ethical standards, alongside broader interest-holder engagement and feasible, scalable models also suited to genomic technologies. A nationally consistent framework is needed. Full article

Background and Objectives: This study aimed to characterize physicians’ knowledge and practice patterns regarding the use of probiotics in the management of irritable bowel syndrome (IBS). By examining clinical experiences and barriers to adoption, this research sought to identify critical gaps in practice and establish a foundation for evidence-based improvements in patient care. Materials and Methods: The survey was conducted in accordance with the CROSS (Consensus-based Checklist for Reporting of Survey Studies) guidelines. Attendees of a medical congress, specifically general practitioners, gastroenterologists, surgeons, and internists with an interest in the clinical significance and therapeutic modulation of the human microbiome, were invited to participate. Participants completed a 38-item, paper-based questionnaire. The instrument assessed respondents’ self-perceived knowledge of probiotics, their understanding of probiotic definitions and specific strains, and their current clinical practice patterns—particularly regarding the management of irritable bowel syndrome (IBS). Additionally, the survey explored information sources, the frequency of self-prescription, and the perceived need for further education, with a specific focus on safety profiles and clinical concerns. Results: Of the 70 invited attendees, 68 completed the survey, yielding a response rate of 97.1%. The respondent cohort included 40 general practitioners (GPs), 20 gastroenterologists (GEs), four surgeons (SSs), and four internists (SIMs). More than half of the respondents were female (n = 37, 54.4%), with a median age of 43 years (range: 28–70). Exactly half of the respondents (n = 34, 50.0%) agreed that probiotics always have a role in the management of irritable bowel syndrome (IBS); however, only 44.1% (n = 30) reported familiarity with the relevant scientific literature on probiotics. Furthermore, respondents more frequently recognized bacterial species associated with single-strain probiotic formulations compared to those in multi-strain mixtures. The primary concern regarding the administration of probiotics for IBS was this lack of familiarity with the scientific literature, cited by 23.5% of respondents. Notably, 100% of the surveyed cohort expressed a need for further education on the topic. Conclusions: The emergence of scientific and clinical evidence results in a clinical practice characterized by high prescribing habits, despite the lack of formal approval. These findings highlight evidence showing the effectiveness of certain probiotic strains in managing IBS symptoms, suggesting the need for standardized guidelines. Given the demonstrated need for further education among the surveyed cohort, integrating probiotic-specific training into both undergraduate medical curricula and continuing professional development programs could significantly enhance the clinical knowledge and awareness of both current and future practitioners. Full article

Metabolic syndrome (MetS) is a complex multisystem disorder characterized by insulin resistance, central obesity, dyslipidemia, hypertension, and chronic low-grade inflammation, all of which substantially increase the risk of type 2 diabetes mellitus and cardiovascular disease. The aim of this narrative review is to examine the role of vitamin D in the pathophysiology of MetS from a multisystem perspective. Specifically, it synthesizes current evidence on the molecular mechanisms through which vitamin D may influence inter-organ communication, insulin resistance, adipose tissue dysfunction, hepatic metabolism, skeletal muscle function, chronic inflammation, oxidative stress, and mitochondrial homeostasis, highlighting its potential contribution to the prevention and management of MetS. Current evidence indicates that MetS should not be regarded merely as a cluster of isolated metabolic abnormalities but rather as a disorder characterized by disrupted molecular signaling and impaired communication among metabolically active organs. In this context, experimental and preclinical evidence suggests that vitamin D, through activation of the vitamin D receptor (VDR), modulates key signaling pathways, including AMP-activated protein kinase (AMPK), the mechanistic target of rapamycin (mTOR), nuclear factor kappa B (NF-κB), and peroxisome proliferator-activated receptor gamma (PPAR-γ), thereby influencing insulin sensitivity, inflammation, oxidative stress, mitochondrial function, and metabolic homeostasis. Nevertheless, clinical evidence remains heterogeneous due, in part, to the lack of consensus regarding serum 25-hydroxyvitamin D thresholds for defining vitamin D status, as well as differences in baseline vitamin D concentrations, supplementation regimens, study populations, and methodological designs. Overall, the available evidence suggests that vitamin D should be considered an adjunct to lifestyle-based interventions rather than a stand-alone therapeutic strategy. Future research is warranted to clarify its clinical utility in the prevention and management of MetS. Full article