Search Results (12,210)

Background and Objectives: Subclinical paroxysmal atrial fibrillation (AF) is often undetected by conventional screening strategies, until complications emerge. Artificial intelligence (AI) applied to sinus rhythm electrocardiograms has emerged as a promising tool to identify individuals with occult AF and to predict the risk of future incident AF. This scoping review synthesizes evidence from original studies evaluating AI models trained on sinus rhythm ECGs for AF detection or AF prediction. Materials and Methods: A comprehensive search of MEDLINE, Embase, Web of Science, Scopus, and IEEE Xplore was conducted to identify peer-reviewed studies from inception to November 2025. Eligible studies included original investigations in which the model input was a sinus rhythm ECG and the outcome was either paroxysmal AF or new-onset AF. Extracted variables included cohort characteristics, ECG acquisition parameters, AI architecture, model predictive performance, AF prediction horizon, clinical outcomes, and validation strategy. Risk of bias was assessed using PROBAST. Results: Nineteen studies met the inclusion criteria. Retrospective datasets ranging from several thousand to over one million ECGs and convolutional or deep neural network AI architectures were used in most studies. AI-ECG models demonstrated high diagnostic accuracy for detecting subclinical AF (ten studies; AUROC 0.75–0.90) and for predicting long-term new-onset AF (six studies; AUROC 0.69–0.85) from a single sinus rhythm ECG. Robust external validation was reported in eleven studies. Combining AI-ECG models with clinical risk factors improved AF predictive performance in several reports. Key limitations across studies included retrospective design, patient selection, limited calibration reporting, and sparse prospective impact data. Conclusions: AI-based analysis of sinus rhythm ECGs can detect occult AF and stratify future AF risk with moderate-to-high accuracy across multiple populations and healthcare systems. However, rigorous prospective trials, evaluating clinical benefit, cost-effectiveness, calibration across demographic groups, and real-world implementation, are required before broad adoption in clinical practice. Full article

Despite the increasing number of older Syrian refugees in Canada, little is known about how they manage their health care needs while contending with language barriers, cultural dissonance, and systemic inequities. This qualitative study explored how older Syrian refugees in the Greater Toronto Area (GTA) navigate healthcare across Canadian and transnational contexts. The study was guided by the transnational circulation of care framework and used an interpretive descriptive design. Following research ethics approval, 20 older Syrian refugees were interviewed by bilingual research assistants. In-depth individual interviews were conducted in Arabic and analyzed using reflexive thematic analysis. Four interrelated themes emerged: (1) Navigating a New System; (2) Living in Two Worlds; (3) Medication Portability, Herbal Practices, and Supplement Culture; and (4) Digital Health Across Borders. Findings demonstrate that older Syrian refugees actively construct hybrid care pathways that integrate biomedical, cultural, and transnational practices. These strategies reflect resilience and adaptability but also expose gaps in the healthcare system. The study underscores the need for culturally responsive and age-friendly healthcare practices that acknowledge transnational realities. By illuminating how care circulates across borders, this study provides actionable guidance for designing responsive health systems. Full article

Background: Pseudomonas aeruginosa is one of the leading agents causing healthcare-associated infections (HAIs) due to its intrinsic resistance, its capacity to acquire resistance mechanisms, and its persistence in hospital environments. In Mexico, it ranks among the most frequently reported pathogens in national surveillance systems. The aim of this study was to characterize antimicrobial resistance profiles and the genetic determinants associated with MDR/XDR phenotypes in P. aeruginosa strains from HAIs at Hospital Juárez de México (HJM). Methods: Sixty-three strains from patients with HAIs were analyzed. Identification was confirmed by 16S rRNA gene sequencing. Antimicrobial susceptibility testing followed CLSI guidelines. MDR/XDR phenotypes were classified according to the Latin American consensus for categorizing MDR, XDR, and PDR pathogens. Screening for resistance mechanisms was carried out by PCR for the main β-lactamases circulating at HJM. Finally, mutations in the oprD gene were detected in imipenem-resistant isolates through amino acid sequence alignment. Results: Resistant phenotypes allowed the identification of MDR and XDR profiles. Only the metallo-β-lactamase bla_VIM was detected. Analysis of oprD porin sequences revealed recurrent mutations (S103T, T115K, L170F, G186P, and T189V) associated with imipenem resistance. Conclusions: In P. aeruginosa, the presence of bla_VIM and structural alterations in OprD confirms the multifactorial nature of carbapenem resistance. These findings underscore the need to strengthen microbiological surveillance programs and antimicrobial stewardship strategies to mitigate the impact and spread of MDR/XDR isolates. Full article

Artificial intelligence (AI) is now embedded across many aspects of healthcare, yet most implementations remain fragmented, task-specific, and layered onto legacy workflows. This paper does not review AI applications in healthcare per se; instead, it examines what an AI-first healthcare system would look like, one in which AI functions as a foundational organizing principle of care delivery rather than an adjunct technology. We synthesize evidence across ambulatory, inpatient, diagnostic, post-acute, and population health settings to assess where AI capabilities are sufficiently mature to support system-level integration and where critical gaps remain. Across domains, the literature demonstrates strong performance for narrowly defined tasks such as imaging interpretation, documentation support, predictive surveillance, and remote monitoring. However, evidence for longitudinal orchestration, cross-setting integration, and sustained impact on outcomes, costs, and equity remains limited. Key barriers include data fragmentation, workflow misalignment, algorithmic bias, insufficient governance, and lack of prospective, multi-site evaluations. We argue that advancing toward AI-first healthcare requires shifting evaluation from accuracy-centric metrics to system-level outcomes, emphasizing human-enabled AI, interoperability, continuous learning, and equity-aware design. Using hypertension management and patient journey exemplars, we illustrate how AI-first systems can enable proactive risk stratification, coordinated intervention, and continuous support across the care continuum. We further outline architectural and governance requirements, including cloud-enabled infrastructure, interoperability, operational machine learning practices, and accountability frameworks—necessary to operationalize AI-first care safely and at scale, subject to prospective validation, regulatory oversight, and post-deployment surveillance. This review contributes a system-level framework for understanding AI-first healthcare, identifies priority research and implementation gaps, and offers practical considerations for clinicians, health systems, researchers, and policymakers. By reframing AI as infrastructure rather than isolated tools, the AI-first approach provides a pathway toward more proactive, coordinated, and equitable healthcare delivery while preserving the central role of human judgment and trust. Full article

Background: According to the literature, adverse drug reactions (ADRs) account for 5–10% of hospital admissions and affect 25–30% of hospitalized patients, but no data are available for Gabon. Objectives: To estimate the incidence of ADRs among hospitalized patients at the Libreville University Hospital Center (CHUL) and to classify them according to their frequency, severity, mechanism and preventability, while proposing appropriate risk minimization strategies. Patients and Methods: A 14-month, single-center, prospective study included all patients experiencing ADRs, excluding those without ADRs or with intentional overdoses. ADRs were analyzed using the World Health Organization (WHO) causality assessment, the ATC classification, and Rawlins and Thompson criteria. Data were actively collected from patients and hospital records. Results: Among 4999 patients, 105 experienced 177 adverse events (incidence: 3.5%, 95% CI: 1.7–2.5%). Among the identified ADRs, 42% were serious. Nausea and vomiting were the most frequent ADRs, mainly caused by analgesics (nefopam, tramadol) and antibiotics (amoxicillin–clavulanic acid). The gastrointestinal and nervous systems were the most affected. According to the Rawlins and Thompson classification, 90% of ADRs were type A, 8% type B, and 2% type E (withdrawal syndrome). Overall, 90% of ADRs were preventable. Conclusions: This study highlights the importance of pharmacovigilance at CHUL, Gabon, and emphasizes the role of healthcare professionals in ADR reporting and risk minimization. Full article

Background: Bladder cancer (BC) incidence in Greenland is lower than in other Nordic countries, yet mortality is disproportionately high, suggesting delayed detection. Cystoscopy is the diagnostic gold standard to detect BC, but access in Greenland is often limited by geographic and logistical challenges, underscoring the need for more accessible diagnostic tools. Objectives: This study evaluated the performance of the urinary biomarker test Xpert^® Bladder Cancer Detection (XBCD) among patients referred for cystoscopy within the Greenlandic healthcare system. Methods: In this prospective observational study, 198 patients referred for urological evaluation due to hematuria or other urologic symptoms were recruited from five Greenlandic towns. All participants provided a urine sample for XBCD testing prior to cystoscopy, which served as the reference standard. Results: Among 194 patients with valid test results, seven BC cases were detected. XBCD identified five true positives and 166 true negatives, yielding a sensitivity of 71.4%, specificity of 88.8%, and a negative predictive value of 98.8%. Conclusions: In this low-prevalence setting, XBCD demonstrated potential as a triage tool to reduce the number of procedures and support earlier BC detection, although findings are limited by the small number of cancer cases. Full article

Background: Neurogenic bowel dysfunction (NBD) is a major chronic sequela of spinal cord injury (SCI) with substantial implications for rehabilitation and long-term management. However, population-level evidence describing how gastrointestinal (GI) diagnostic codes are used following SCI, particularly within administrative healthcare systems, remains limited. Methods: We conducted a nationwide retrospective cohort study using administrative claims data from the Korean National Health Insurance Service (NHIS). A total of 584,266 adults with trauma-related SCI encounters between 2009 and 2019 were identified. GI diagnostic codes—paralytic ileus (K56), irritable bowel syndrome (K58), and functional bowel disorders (K59)—were evaluated as administrative proxies for bowel dysfunction. Demographic characteristics, disability status, regional factors, and health behaviors were analyzed using multivariable logistic regression. Results: GI diagnostic codes were frequently recorded after SCI, most commonly irritable bowel syndrome (approximately 30%) and functional bowel disorders (approximately 37%), whereas paralytic ileus was uncommon. Greater disability severity, female sex, older age, and rural residence were consistently associated with higher odds of GI diagnostic coding. Physical activity showed robust inverse associations across all models. Inverse associations observed with smoking and alcohol consumption were interpreted as reflecting residual confounding or health-related selection, rather than biological protective effects. Conclusions: Patterns of GI diagnostic coding after SCI likely reflect the clinical burden and management needs of neurogenic bowel dysfunction within healthcare systems, rather than the development of new gastrointestinal diseases. These findings underscore the importance of individualized bowel management, incorporation of structured physical activity into rehabilitation programs, and equitable access to SCI rehabilitation services, particularly for individuals with greater disability or those living in rural areas. Full article

Background: Palliative care addresses not only physical symptoms but also the social, psychological, and spiritual needs of patients. Nurses play a key role in identifying and responding to these needs, yet their perceptions and preparedness may vary. Objectives: This study aimed to explore nurses’ perspectives on the psychological, social, and spiritual needs of palliative patients, assess how well these needs are being met, and examine the influence of nurses’ self-assessed education levels on their evaluations. Methods: A cross-sectional survey was conducted among 237 registered nurses with palliative care experience in Split-Dalmatia County, Croatia. Two validated questionnaires were used to assess the perceived importance of 53 patient needs and the extent to which these needs were satisfied. Results: Findings revealed significant discrepancies between the perceived importance and satisfaction of nearly all psychological, social, and spiritual needs (p < 0.001), particularly regarding fear of death, suffering, and future uncertainty. Only 38.4% of nurses considered themselves adequately trained in palliative care, though most had some educational exposure to it. No statistical differences were found in need assessment based on nurses’ self-rated education. Most nurses reported emotional exhaustion (72.6%) and supported interdisciplinary care (95.8%), while 90.3% noted that responsibility for care often falls on families. Conclusions: Nurses recognize critical unmet needs in palliative patients and feel insufficiently prepared to address them. These findings underscore the need to improve palliative care education, provide emotional support for nurses, and implement systemic healthcare reforms to ensure comprehensive, dignified care. Full article

This study investigates how digital transformation in healthcare shapes sustainable customer value by analyzing the role of digital quality and its influence on satisfaction and loyalty within an AI-based diabetes prognostic service. Drawing on system, information, and service quality as core dimensions of digital quality, the study examines their direct effects on satisfaction and their contribution to loyalty formation relative to traditional service factors. Using survey data collected from over 1000 users of a digital healthcare platform equipped with an AI-driven diabetes prognostic algorithm, 800 valid responses were analyzed through PLS-SEM in SmartPLS 4.0. The results show that both traditional service attributes and digital quality significantly enhance customer satisfaction, which in turn promotes loyalty. However, digital quality does not strengthen the satisfaction–loyalty linkage, indicating that its value lies in establishing baseline trust and usability rather than amplifying loyalty outcomes. Environmental uncertainty—captured as technological and market uncertainty—also positively affects loyalty. This study contributes to digital healthcare research by providing empirical evidence from an AI-based long-term prognostic service and clarifying that digital quality operates as a foundational hygiene factor essential for sustainable customer value, rather than as a competitive differentiator. Full article

Cervical cancer is a largely preventable disease, with over 90% of cases caused by persistent infection with human papillomavirus (HPV). Despite the availability of HPV vaccination and cervical screening, incidence rates in Canada have been rising since 2015, particularly among underserved populations. This study investigates contributing factors behind cervical cancer diagnoses in Eastern Ontario over a two-year period to identify gaps leading to failures in prevention and screening. A retrospective chart review was conducted for cervical cancer cases diagnosed between January 2022 and December 2023 at two regional cancer centres in Eastern Ontario. Cases were categorized as screen-detected, inadequately screened, or system failure, based on prior screening history and care processes. Data was collected on patient, screening, and cancer characteristics. Of 132 cases, 22 (16.7%) were screen-detected, 73 (55.3%) were inadequately screened, and 37 (28.0%) were attributed to healthcare system failure. Later-stage disease was significantly more common in the latter two groups. Thirty-one (23.5%) cases presented with palliative diagnoses, and 18 (13.6%) individuals died within 2.5 years. Inadequate screening was associated with rurality, deprivation, and lack of a primary care provider. System failures included false-negative Pap tests, loss to follow-up, and misapplication of screening guidelines. This study evaluated failures in cervical cancer prevention, which led to cervical cancer diagnoses in Eastern Ontario. Gaps included suboptimal screening participation, lack of access to care, health care system breakdowns, and limitations of the Pap test. Findings provide concrete suggestions for eliminating cervical cancer in Canada. Full article

The 2S LGBTQIA+ (Two-Spirit, Lesbian, Gay, Bisexual, Trans, Queer and/or Questioning, Intersex, Asexual, and additional sexually and gender-diverse self-identities) population often faces barriers to care in the context of cervical cancer screening. With the shift from primary cervical cytology (Papanicolaou test) to primary human papillomavirus (HPV)-DNA testing, it is crucial to examine these populations’ healthcare needs. An intersectionality framework with an anti-oppressive lens is needed to restructure a healthcare system whose systems have traditionally erased the care needs of diverse populations through colonial, racialized, and cis-heteronormative practices. Barriers to cervical screening in 2S LGBTQIA+ populations include stigma, discrimination, limited provider guidance and understanding, and high rates of physical, sexual, and medical trauma. Self-sampling for HPV is a less invasive alternative to traditional Pap tests with a high rate of acceptability. The option to self-sample may increase participation in cervical screening based on improved privacy, comfort, and feelings of empowerment. Organizational, psychosocial, and physical recommendations for practice are shared to create a welcoming environment that reflects the diversity of populations in all aspects of healthcare. Affirmative care aims to make clients feel safe and accommodated by prioritizing dignity and respect as essential elements of eliminating cervical cancer in 2S LGBTQIA+ populations. Full article

Toe-in (inward) and toe-out (outward) foot alignments significantly affect gait, posture, and joint stress, causing issues like abnormal gait, joint strain, and foot conditions such as plantar fasciitis and high arches. Addressing these alignments is crucial for improving mobility and comfort. This study introduces IoTToe, a wearable IoT device designed to detect and monitor gait patterns by using six ADXL345 sensors positioned on the foot, allowing healthcare providers to remotely monitor alignment via a webpage, reducing the need for physical tests. Tested on 45 participants aged 20–25 years with diverse BMIs, IoTToe proved suitable for both children and adults, supporting therapy and diagnostics. Statistical tests, including ICC, DFA, and ANOVA, confirmed the device’s effectiveness in detecting gait and postural control differences between legs. Gait variability results indicated that left leg showed more adaptability (DFA close to 0.5), compared to the right leg which was found more consistent (DFA close to 1). Postural control showed stable and agile standing with values between 0.5 and 1. Sensor combinations revealed that removing sensor B (on the gastrocnemius muscle) did not affect data quality. Moreover, taller individuals displayed smaller ankle angle changes, highlighting challenges in balance and upper body stability. IoTToe offers accurate data collection, reliability, portability, and significant potential for gait monitoring and injury prevention. Future studies would expand participation, especially among women and those with alignment issues, to enhance the system’s applicability for foot health management, safety and rehabilitation, further supporting telemetric applications in healthcare. Full article

Background: Large language models (LLMs) are increasingly integrated into clinical documentation, decision support, and patient-facing applications across healthcare, including plastic and reconstructive surgery. Yet, their evaluation remains bottlenecked by costly, time-consuming human review. This has given rise to LLM-as-a-judge, in which LLMs are used to evaluate the outputs of other AI systems. Methods: This review examines LLM-as-a-judge in healthcare with particular attention to judging architectures, validation strategies, and emerging applications. A narrative review of the literature was conducted, synthesizing LLM judge methodologies as well as judging paradigms, including those applied to clinical documentation, medical question-answering systems, and clinical conversation assessment. Results: Across tasks, LLM judges align most closely with clinicians on objective criteria (e.g., factuality, grammaticality, internal consistency), benefit from structured evaluation and chain-of-thought prompting, and can approach or exceed inter-clinician agreement, but remain limited for subjective or affective judgments and by dataset quality and task specificity. Conclusions: The literature indicates that LLM judges can enable efficient, standardized evaluation in controlled settings; however, their appropriate role remains supportive rather than substitutive, and their performance may not generalize to complex plastic surgery environments. Their safe use depends on rigorous human oversight and explicit governance structures. Full article

In response to the growing demand for environmentally friendly and sustainable yet functional technical textiles, this research developed a spun-bonded nonwoven from the biodegradable thermoplastic starch-based biopolymer BIOPLAST^®, incorporating fruit extracts as natural sources of polyphenolic compounds and surface-active additives. Extracts from Vaccinium myrtillus L. and Sambucus nigra L. were applied onto a nonwoven’s surface via aerographic spraying using a water/ethanol system. The resulting materials were characterized in terms of morphology, physicochemical and mechanical behavior, surface characteristics, and stability under accelerated ageing and hydrolytic conditions. Treatment with the extracts increased the tensile strength by roughly 38% and elongation at break by about 50%, and it changed the surface from hydrophobic (contact angle of 115°) to hydrophilic, with contact angles of 83° for the blueberry-modified nonwoven and 55° for the elderberry-modified nonwoven. The modified nonwovens also showed sustained release of polyphenolic compounds over 72 h, which is beneficial for biomedical, healthcare, and cosmetic applications, where short-term use, controlled release of active compounds, and bioactivity are more important than long-term durability. Overall, the results indicate that BIOPLAST^®-based spun-bonded nonwovens can serve as fully bio-based carriers for fruit extracts in MedTech-related technical textiles, offering a straightforward way to introduce additional functionality into biodegradable nonwovens. Full article

The growing economic pressures on healthcare systems have heightened the need for effective and sustainable cost management strategies. This study presents a PRISMA-based systematic review of 210 peer-reviewed articles published between 1974 and 2024, retrieved from the Scopus and Web of Science databases. Following a structured selection and screening process, the articles were analysed to identify dominant cost control tools, contextual applications, and methodological trends across diverse health systems. The findings highlight a strong prevalence of Activity-Based Costing (ABC), Diagnosis-Related Groups (DRG), and benchmarking practices, predominantly in public hospital settings. However, significant thematic gaps remain, particularly concerning low-income countries, interdisciplinary integration, and the evaluation of digital technologies for financial optimisation. This review provides a comprehensive thematic synthesis of international research, consolidating knowledge in healthcare cost management and offering evidence-based recommendations to guide future empirical research, policy design, and strategic planning in health finance. Full article