Search Results (244)

Background: Adolescents in Ethiopia, particularly in rural areas, face significant barriers to accessing comprehensive sexual and reproductive health (SRH) services, resulting in poor health outcomes. The youth-friendly health services (YFHS) initiative addresses these challenges by training Health Extension Workers (HEWs) to deliver tailored, age-appropriate care at the primary care level. This study evaluates the cost-effectiveness of YFHS implementation in rural health posts in the Jimma Zone, Ethiopia. Methods: Using an ingredient-based costing approach, costs were analyzed across six health posts, three implementing YFHS and three offering routine services. Health outcomes were modeled using disability-adjusted life years (DALYs) averted, and incremental cost-effectiveness ratios (ICERs) were calculated. Results: Results showed that YFHS reached 9854 adolescents annually at a cost of USD 29,680, compared to 2012.5 adolescents and USD 7519 in control sites. The study showed the ICER of USD 25.50 per DALY averted. The intervention improved health outcomes, including a 27% increase in antenatal care uptake, a 34% rise in contraceptive use, and a 0.065% reduction in abortion-related mortality, averting 52.11 DALYs versus 26.42 in controls. Conclusions: The ICER was USD 25.50 per DALY averted, well below Ethiopia’s GDP per capita, making it highly cost-effective by WHO standards. Scaling YFHS through HEWs offers a transformative, cost-effective strategy to advance adolescent SRH equity and achieve universal health coverage in Ethiopia. Full article

On a worldwide scale, neurodegenerative diseases, including multiple sclerosis, Parkinson’s, and Alzheimer’s, face considerable healthcare challenges demanding the development of novel approaches to early detection and efficient treatment. With its ability to provide real-time patient monitoring, customized medical care, and advanced predictive analytics, artificial intelligence (AI) is fundamentally transforming the way healthcare is provided. Through the integration of wearable physiological sensors, motion sensors, and neurological assessment tools, the NeuroPredict platform harnesses AI and smart sensor technologies to enhance the management of specific neurodegenerative diseases. Machine learning algorithms process these data flows to find patterns that point out disease evolution. This paper covers the design and architecture of the NeuroPredict platform, stressing the ethical and regulatory requirements that guide its development. Initial development of AI algorithms for disease monitoring, technical achievements, and constant enhancements driven by early user feedback are addressed in the discussion section. To ascertain the platform’s trustworthiness and data security, it also points towards risk analysis and mitigation approaches. The NeuroPredict platform’s capability for achieving AI-driven smart healthcare solutions is highlighted, even though it is currently in the development stage. Subsequent research is expected to focus on boosting data integration, expanding AI models, and providing regulatory compliance for clinical application. The current results are based on incremental laboratory tests using simulated user roles, with no clinical patient data involved so far. This study reports an experimental technology evaluation of modular components of the NeuroPredict platform, integrating multimodal sensors and machine learning pipelines in a laboratory-based setting, with future co-design and clinical validation foreseen for a later project phase. Full article

Background/Objectives: ST-segment deviation (STD) on electrocardiography (ECG) may reflect myocardial injury in critically ill patients. However, its prognostic significance in non-cardiac intensive care unit (ICU) populations remains unclear. We aimed to assess the association between STD on ICU admission and 30-day mortality and to evaluate its incremental prognostic value beyond the SOFA score. Methods: In this retrospective single-center study, we included 307 consecutive ICU patients (median age: 64.0 years; 65.5% men). Patients with acute cardiac conditions were excluded. STD was defined as ≥1 mm ST elevation or depression in any lead on standard 12-lead ECG performed on admission. The primary outcome was 30-day all-cause mortality. Prognostic associations were assessed using multivariable Cox regression adjusted for SOFA score. Discriminative performance was evaluated by comparing ROC curves for models with and without STD, with bootstrap-based testing (1000 iterations) to assess significance. Results: STD was present in 126 patients (41.0%) and occurred more frequently in non-survivors (47.6% vs. 36.5%, p = 0.033. In Cox regression, STD was independently associated with 30-day mortality (HR = 1.534; 95% CI: 1.081–2.177; p = 0.017), even after adjustment for SOFA score. This association remained statistically robust in bootstrap validation. The addition of STD amplitude to the SOFA score modestly improved model discrimination with a borderline significant difference between the areas under the curve (ΔAUC = 0.005, p = 0.0581). Conclusions: ST-segment deviation on the admission ECG is an independent predictor of 30-day mortality in non-cardiac critically ill patients and may enhance risk stratification beyond the SOFA score. Full article

Background: The oral microbiome differs in obese patients compared to normal-weight subjects. Microbiologic shifts very often appear after surgical interventions such as bariatric surgery (BS) and in immunocompromised patients. However, the oral microbiome composition and load in subjects after bariatric surgery are unclear. Aim: The aim of this review is to summarize the current state of the art related to the oral microbiome shift induced by bariatric surgery and to discuss its implications on oral cavity health. Methods: Electronic databases: PubMed/Medline, Web of Science, and Cochrane Library were searched for articles published up to March 30, 2025, describing prospective studies focused on changes in the oral microbiota of patients who underwent bariatric surgery. Results: Eight studies measuring the oral microbiome with different approaches—16S ribosomal RNA (16S rRNA) sequencing, polymerase chain reaction (PCR), culture, and matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI TOF MS)—were included in this review. The following bariatric techniques were used: sleeve gastrectomy, Roux-en-Y gastric bypass, Omega loop gastric bypass, and laparoscopic gastric plication. The follow-up period ranged from 3 to 12 months. The results of microbiologic studies were unequivocal. There was an increment in Streptococcus mutans reported, high levels of Candida species, and increased rates of some periodontitis-associated bacteria (Porphyromonas gingivalis) in the post-bariatric surgery period, though some studies suggested a shift towards non-pathogenic composition of the oral microbiome in prospective observations. Conclusions: The local oral microbial homeostasis becomes strongly impacted by the bariatric surgical treatment itself as well as its consequences in the further post-operative period. Therefore, obese patients undergoing BS require very careful dental observation. Full article

Spasticity is a persistent and debilitating consequence of stroke and effective rehabilitation is a healthcare priority. Botulinum neurotoxin A (BoNT-A) with supportive therapy has increasingly been embedded within clinical practice for treatment of post-stroke spasticity. But the evidence for this approach has hitherto been limited to the findings of a limited number of small trials. The InTENSE trial was undertaken specifically to provide high-quality clinical trial evidence focusing on the effect of BoNT-A and adjunctive therapy on upper limb spasticity. While the clinical trial did not detect a significant impact upon clinical outcomes, there remains a need to evaluate any impact on the broader use of healthcare resources and overall cost-effectiveness. A detailed cost–utility analysis of the InTENSE trial was undertaken. The costs over the 12-month follow-up period were compared with quality-adjusted life years (QALY) gained using utilities generated from the EQ-5D three level (EQ-5D-3L) instrument. There were no significant differences in QALY gained between the intervention and control groups identified, or in the majority of health and community care costs. The Incremental Cost-Effectiveness Ratio per QALY gained was estimated at AU $63,947.11 (Australian dollars), which is well above accepted thresholds for cost-effectiveness in Australia. The study was unable to identify evidence for the cost-effectiveness of treatment approaches combining BoNT-A with adjunctive therapy. Full article

Wipe-out is defined as a sudden, unexplained, and irreversible loss of residual central vision following glaucoma surgery, typically in eyes with advanced visual field damage and severely compromised optic nerves. The purpose of this review is to critically assess the current incidence, risk factors, pathophysiological mechanisms, and clinical relevance of “wipe-out”, a rare but devastating complication of glaucoma surgery characterized by sudden, unexplained central vision loss postoperatively. A comprehensive literature review was conducted, analyzing key peer-reviewed studies from electronic databases (PubMed, Medline, and Google Scholar) published up to 2025. The data from the literature published prior to the year 2000 suggest that wipe-out incidences range broadly from <1% to 13%. Contemporary prospective studies and large-scale reviews indicate a significantly lower current incidence, frequently below 1%. Identified risk factors include severe preoperative visual field loss (especially split fixation), older age, immediate postoperative hypotony, and compromised optic nerve head perfusion. The proposed mechanisms involve acute vascular insults, ischemia–reperfusion injury, and accelerated apoptosis of already vulnerable retinal ganglion cells. Modern MIGS and refined trabeculectomy techniques exhibit notably lower wipe-out risks compared to historical data. The literature emphasizes preventive management, including careful patient selection, incremental intraocular pressure reduction, and minimally invasive anesthetic approaches. Although wipe-out syndrome represents a serious complication, its incidence in modern glaucoma surgery is minimal. The considerable benefits of contemporary surgical approaches—particularly MIGS—in preserving vision clearly outweigh this very low risk. Ophthalmologists should remain vigilant but confident in the safety and efficacy of modern glaucoma surgical techniques, emphasizing proactive intervention to prevent blindness rather than avoiding necessary surgery in consideration of the minimal risk of wipe-out. Full article

Background/Objectives: CKD-associated pruritus (CKD-aP) is a serious systemic comorbidity occurring in patients with CKD. Despite the burden of CKD-aP, there are limited efficacious treatments available for its management; difelikefalin is the only approved treatment based on its efficacy and safety demonstrated in two clinical studies, namely KALM-1 and KALM-2. This study aimed to evaluate the cost-effectiveness of difelikefalin plus best supportive care (BSC) versus BSC alone when treating moderate-to-severe CKD-aP in patients receiving in-centre haemodialysis, from the perspective of the UK healthcare system. Methods: A de novo lifetime Markov health economic model was built to assess the cost-effectiveness of difelikefalin. The modelled efficacy of difelikefalin was based on data from KALM-1 and KALM-2 pooled at the patient level. The main efficacy driver was the total 5-D Itch scale score. Per-cycle probabilities of changing health states defined by CKD-aP severity were used to derive transition matrices; the model also estimated time-dependent annual probabilities of death and transplant for people on haemodialysis. An increased risk of mortality for modelled patients with very severe, severe, or moderate CKD-aP was applied. Health state utilities and management costs were based on published evidence. Results: Modelled patients treated with difelikefalin were estimated to have a reduced severity of CKD-aP. Consequently, difelikefalin plus BSC was associated with an increased life expectancy of 0.11 years per person and improved HRQoL compared with BSC alone. This translated to higher quality-adjusted life years, at 0.26 per person gained compared to BSC alone. Improved patient outcomes were achieved at an incremental cost of £7814 per person. Conclusions: Overall, at a price of £31.90/vial, difelikefalin was estimated to be a cost-effective treatment for moderate-to-severe CKD-aP at a willingness-to-pay threshold of £30,000/QALY, with conclusions robust to sensitivity analysis. Full article

Background/Objectives: The Tropis^® ID device (PharmaJet^®), a needle-free injection system, is a World Health Organization prequalified, hand-held device, which delivers intradermal injections without the use of needles and has previously been used for the delivery of fractional doses of inactivated polio vaccine (fIPV) in campaign and house-to-house settings. This implementation research study aimed to comparatively evaluate the vaccine coverage, cost, feasibility, and acceptability of using Tropis for fIPV for routine immunizations in two states in Nigeria (Kano and Oyo). Methods: The study included: (i) a cluster randomized trial (22 intervention facilities using Tropis for fIPV and 30 control facilities using the standard of care [SoC—full-dose IPV]) to assess the effectiveness in terms of improving the coverage of two doses of IPV, using a coverage survey involving 3433 children (aged 3–12 months); (ii) a pre- and post-implementation micro-costing evaluation involving the intervention facilities to estimate the costs; and (iii) mixed methods assessments (post-training assessment, provider survey, key informant interviews, and focus group discussions) to assess the feasibility and acceptability of fIPV delivery using Tropis. Results: The intention-to-treat analysis among the 3433 children surveyed did not show any difference between the intervention and control groups, primarily due to low compliance (approximately 50% of target beneficiaries reported Tropis use). The more relevant per protocol analysis, adjusting for lower compliance, showed that among those vaccinated with Tropis, second dose IPV coverage was 11.2% higher than the SoC. The delivery of fIPV using Tropis compared to the SoC resulted in incremental program cost savings, ranging from USD 0.07 to USD 1.00 per dose, administered across the scenarios evaluated. High acceptability was seen amongst caregivers (94%), and 95% of healthcare workers preferred Tropis over the SoC. Conclusions: Tropis is effective, feasible, acceptable, and saves costs when used as part of routine immunization programs. Full article

Machine Learning models, more specifically Artificial Neural Networks, are transforming medical imaging by enabling precise liver segmentation, a crucial task for diagnosing and treating liver diseases. However, these models often face challenges in adapting to diverse clinical data sources as differences in dataset volume, resolution, and origin impact generalization and performance. This study introduces a Private Data Incrementalization, a data-centric approach to enhance the adaptability of Artificial Neural Networks by progressively exposing them to varied clinical data. As the target of this study is not to propose a new image segmentation model, the existing medical imaging segmentation models—including U-Net, ResUNet++, Fully Convolutional Network, and a modified algorithm based on the Conditional Bernoulli Diffusion Model—are used. The study evaluates these four models using a curated private dataset of computed tomography scans from Coimbra University Hospital, supplemented by two public datasets, 3D-IRCADb01 and CHAOS. The Private Data Incrementalization method systematically increases the volume and diversity of training data, simulating real-world conditions where models must handle varied imaging contexts. Pre-processing and post-processing stages, incremental training, and performance evaluations reveal that structured exposure to diverse datasets improves segmentation performance, with ResUNet++ achieving the highest accuracy (0.9972) and Dice Similarity Coefficient (0.9449), and the best Average Symmetric Surface Distance (0.0053 mm), demonstrating the importance of dataset diversity and volume for segmentation models’ robustness and generalization. Private Data Incrementalization thus offers a scalable strategy for building resilient segmentation models, ultimately benefiting clinical workflows, patient care, and healthcare resource management by addressing the variability inherent in clinical imaging data. Full article

Objective: This paper reviews the current research on hearing device technology, outlines key challenges, and identifies priorities for future investigation. Method: This paper presents an informal narrative review of the current literature on hearing technology, supplemented by expert insights to identify key challenges and future directions. Results: The proliferation of direct-to-consumer (DTC) hearing devices with varied features and prices underscores the need to assess whether advanced technologies offer meaningful improvements. Understanding these incremental benefits is critical for determining the minimum technology required for optimal outcomes. The paper highlights the limitations in current clinical trials, which often suffer from selection bias, and the inadequacies of existing hearing aid outcome measures that may not capture real-life benefits. It emphasizes the need for real-world evidence and the development of assessment tools that better reflect everyday experiences. While existing research provides some insights into the potential benefits of incremental advances in hearing device technology, the evidence remains inconclusive. Conclusions: Addressing the cost, accessibility, and technological diversity of hearing devices is crucial to advancing hearing healthcare. Future research should prioritize the development of affordable, high-quality devices and establish comprehensive outcome measures that capture real-world benefits. A deeper understanding of these factors can lead to more accessible and effective hearing care, ultimately improving quality of life for individuals with hearing loss. Full article

Background: Chronic diseases require long-term and multidimensional care, but traditional medical education has emphasised acute care and episodic interventions. This gap limits the understanding of future clinicians about the complexity of managing chronic conditions over decades. This mix-methods quantitative–qualitative pilot study describes “Time Capsule Medicine”, an innovative educational framework in which medical students acted out the progressive challenges that patients with chronic illnesses might face over a continuous period of 20 years. This paper aims to report the outcomes of this innovative educational technique. Methods: Thirty final-year medical students were engaged in the three-phase programme which included preparation, immersive simulation, and reflection and evaluation. The preparation consisted of online workshops in chronic disease progression, age-related changes, and continuity of care, while the immersive simulation featured appropriate role-play exercises in small groups that simulated the chronic disease process across four five-year increments. The reflection and evaluation consisted of debriefing sessions and reflective journals, while pre- and post-simulation questionnaires tested learning outcomes. The physical constraints included weighted garments with visual impairments simulating the age-related limitations. Results: A gender- and ethnically diverse cohort of thirty final-year medical students from three medical schools in North London participated in the programme. The simulation significantly enhanced students’ confidence in managing long-term disease trajectories (pre-simulation score: 2.8 ± 0.9; post-simulation score: 4.3 ± 0.6; p < 0.01) and understanding of age-related challenges (from 3.1 ± 1.0 to 4.5 ± 0.5; p < 0.01). Empathy scores increased from 3.0 ± 0.9 to 4.7 ± 0.5 p < 0.01. The qualitative analysis showed an increased appreciation of the continuity of care, recognition of systemic barriers, and insights into the emotional burdens of chronic conditions. For many students, the simulation was transformative, changing the way they approached holistic, patient-centred care. Conclusions: This experiential learning approach has succeeded in effectively addressing one of the most important gaps known in traditional medical education in developing empathy, understanding, and confidence in the long-term management of chronic diseases. The integration of similar simulations into medical curricula may adequately arm future clinicians with the complexities of continuity of care and patient management. Further studies need to be performed exploring scalability and its impact on long-term clinical practice. Full article

Increased availability of dialysis services has led to both an increase in the number of elderly, frail, co-morbid patients with advanced chronic kidney disease now being offered dialysis and starting dialysis with residual kidney function. Traditionally, these patients would have been offered in-centre haemodialysis. However, the introduction of an assisted peritoneal dialysis service has allowed more of these elderly patients to be considered for peritoneal dialysis, a home-based treatment, with the exchanges performed by family members or visiting health care staff. It is now realised that the amount of dialytic clearance any individual requires varies, and as such, treatment targets have changed over time from achieving minimum clearance targets to a more holistic approach, considering patient lifestyles, and adapting dialysis prescriptions and schedules to the needs of the individual patient. As dietary intake is often lower in the elderly, coupled with the physiological loss of muscle mass, this results in a reduced generation of waste products of metabolism and consequently requires less dialytic clearance. Thus, this allows many elderly patients to benefit from an incremental approach to starting peritoneal dialysis, potentially beginning with only one or two continuous ambulatory peritoneal dialysis exchanges, or an overnight cycler for only a few nights/week. Full article

The British National Institute for Health and Care Excellence (NICE) published its updated guidelines for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in October 2021. NICE concluded, after an extensive review of the literature, that graded exercise therapy (GET) is harmful and should not be used, and that cognitive behavioural therapy (CBT) is only an adjunctive and not a curative treatment. An article by White et al., which is written by 51 researchers, claims that there are eight anomalies in the review process and the interpretation of the evidence by NICE. In this article, we reviewed the evidence they used to support their claims. Their three most important claims are that NICE redefined the disease, that CBT and GET are effective, and that fixed incremental increases are not part of GET. However, our analysis shows that the disease was not redefined by NICE. Instead, it was redefined in the 1990s by a group of doctors, including a number of authors of White et al., when they erased the main characteristic of the disease (an abnormally delayed muscle recovery after trivial exertion, which, over the years, has evolved into post-exertional malaise) and replaced it with chronic disabling severe fatigue. Their own studies show that CBT and GET do not lead to a substantial improvement of the quality-of-life scores or a reduction in CFS symptom count, nor do they lead to objective improvement. Also, both treatments have a negative instead of a positive effect on work and disability status. Moreover, a recent systematic review, which included one of the authors of White et al., showed that ME/CFS patients remain severely disabled after treatment with CBT. Our analysis of, for example, the PACE trial’s GET manual for therapists exposes the fixed incremental nature of GET. Why the authors are not aware of that is unclear because eight of them were involved in the PACE trial. Three of them were centre leaders and its principal investigators, four others were also centre leaders, and another one was one of the three independent safety assessors of the trial. Moreover, many of these eight authors wrote, or were involved in writing, this manual. In conclusion, our analysis shows that the arguments that are used to claim that there are eight anomalies in the review process and the interpretation of the evidence by NICE are anomalous and highlight the absence of evidence for the claims that are made. Furthermore, our analysis not only exposes the fixed incremental nature of GET, but also of CBT for ME/CFS. Full article

Introduction: In British Columbia (BC), Canada, COVID-19 and associated control measures impacted routine care for patients with diabetes. Some of these measures may have impacted timely screening and diagnosis of type 2 diabetes. We assessed the impact of control measures on screening and diagnosis of type 2 diabetes in BC. Methods: We used data from the BC COVID-19 Cohort, which includes COVID-19 and healthcare administrative data on all residents of BC. We assessed and compared screening (≥40 yrs) and diagnosis (≥18 yrs) of diabetes among the adult population during the pandemic period (1 April 2020–31 December 2022), with 1 January 2016–31 March 2020 used as a historical reference period. We used interrupted time series with generalized additive models to evaluate the impact of policy measures on screening and diagnoses trends. Results: We observed an initial decline in the mean number of screenings and diagnoses. In the third post-policy phase (January 2022–December 2022), there was a 4.8% (−5.1, 15.4) increase in screenings while after an initial reduction in diabetes diagnoses, we observed a significant increase of 31.6% (17.8, 46.6) in the third post-policy phase. Further stratification by age and sex showed the entire increase in diagnoses trends was driven by younger females with a 56.4% (25.1, 92.9) and 58.7% (38.2, 81.3) increment in diagnoses in the 18–29 and 40–49 age groups, respectively. Conclusions: The initial reduced number of screenings and diagnoses followed by the significant upward trend in diabetes diagnoses in the later post-policy phase have important clinical and public health implications. Further research is needed to understand the post-pandemic increase in diabetes among females. Full article

Efficient ice protection systems are essential to ensure the operability and reliability of aircraft. In recent years, electromechanical resonant ice protection systems have emerged as a promising low-power alternative to current solutions. These systems can operate in two primary resonant modes: flexural and extensional. While extensional modes enable effective de-icing over large surface areas, their performance can be compromised by interference from flexural modes, particularly in thin, ice-covered substrates where natural mode coupling occurs. This study presents a strategy based on material selection for making the Young’s modulus-to-density ratio uniform. The final objective of this paper is to establish the design rules for a composite leading edge de-icing system. For this purpose, an incremental approach will be used on profiles with different radii of curvature: plate or beam (infinite radius), circular profile (constant radius), NACA profile (variable radius). For beam and plate structures, the paper shows that this coupling can be mitigated by selecting materials with a Young’s modulus-to-density ratio comparable to that of ice. For curved structures, the curvature-induced effect is another source of parasitic flexion, which cannot be controlled solely by material selection and requires careful thickness optimization. This study presents analytical and numerical approaches to investigate the origin of this effect and a design methodology to minimize parasitic flexion in curved structures. The methodology is applied to the design optimization of a glass fiber NACA 0024 airfoil leading edge, the performance of which is subsequently evaluated through icing wind tunnel testing. Full article