Search Results (1,161)

Background: Point-of-care ultrasound (POCUS) has emerged as a valuable tool for rapid diagnosis, procedural guidance, and real-time clinical decision-making in neonatal and pediatric critical care. Despite its growing use in acute medicine, the evidence describing its implementation, utility, and impact in interfacility and prehospital transport settings remains limited. This scoping review aims to systematically map the current body of evidence on POCUS use during neonatal and pediatric transport and to identify knowledge gaps to inform future research, training, and clinical integration. Methods: A scoping review was conducted following PRISMA-ScR 2020 guidelines, searching PubMed, Embase, Scopus, CINAHL, and Web of Science for studies describing POCUS use during neonatal and pediatric transport. Results: Of 3676 unique articles identified, 20 met inclusion criteria, including 10 cohort studies, 3 case series, 4 case reports, 2 narrative reviews, and 1 textbook chapter. Fifteen studies reported extractable patient-level data and were included in quantitative synthesis, encompassing 4278 patients. Among these, 1153 (27.0%) patients were under 18 years old, and 576 (13.5%) had POCUS performed during transport. POCUS was primarily used for diagnostic assessment—mainly lung and cardiac imaging—with variability in protocols, operator training, and transport characteristics. Eleven studies (73.3%) reported that POCUS altered clinical management, influencing management in 106 (18.4%) patients through diagnostic clarification, resuscitation decisions, medical or ventilator adjustments, and changes in transport destination. Conclusions: Evidence suggests that POCUS supports clinical decision-making and timely intervention during neonatal and pediatric transport, though use remains inconsistent. Future studies should focus on developing structured training frameworks, validating transport-specific protocols, and assessing the impact of POCUS on clinical outcomes and transport safety. Full article

Background and objectives: Research into clinicians’ and pharmacists’ experiences and perspectives on direct oral anticoagulant (DOAC) use in Saudi Arabia and the broader Middle Eastern area is limited. Therefore, we aimed to evaluate the perspectives and experiences of physicians and pharmacists practicing in Saudi Arabia who prescribe DOACs and dispense DOAC therapy, respectively. Methods: A cross-sectional study was undertaken utilizing an online survey instrument. We collected data via Google Forms. Between June and July 2024, the study questionnaire was distributed to community pharmacists, general practitioners [GPs], cardiologists, residents in internal medicine, and hospital pharmacists (primary and secondary healthcare professionals) working in Saudi Arabia. Results: Comprising 146 doctors and 167 pharmacists, 313 total healthcare professionals participated in the study. Of the weekly DOAC prescriptions, cardiologists had the most at 35%; internal medicine residents came next at 16.3% and general practitioners at 17.5%. Among pharmacists, 16.7% of community pharmacists and 23.9% of hospital pharmacists dispensed DOACs weekly. The most often prescribed and dispensed medications were rivaroxaban, edoxaban, and apixaban. Across all categories, Lexicomp was the most often used tool. Most physicians (98%) said they lowered the DOAC dose when necessary. Especially in dosing, preoperative care, patient education, and medication interaction identification, internal medicine residents and hospital pharmacists expressed more confidence in managing DOACs. In these domains, community pharmacists expressed less trust. Conclusions: This study revealed that most participants preferred newer oral anticoagulants over warfarin and demonstrated a fairly good level of self-perceived knowledge regarding various aspects of the clinical use of DOACs. The study findings highlight the importance of focused training initiatives to standardize the use of DOACs, boost trust among community pharmacists and GPs, and ensure safe and effective patient care. Full article

As artificial intelligence (AI) continues to expand across clinical environments, healthcare is transitioning from static decision-support tools to dynamic, autonomous agents capable of reasoning, coordination, and continuous interaction. In the context of geriatric medicine, a field characterized by multimorbidity, cognitive decline, and the need for long-term personalized care, this evolution opens new frontiers for delivering adaptive, assistive, and trustworthy digital support. However, the autonomy and interconnectivity of these systems introduce heightened cybersecurity and ethical challenges. This paper presents a Secure Agentic AI Architecture (SAAA) tailored to the unique demands of geriatric healthcare. The architecture is designed around seven layers, grouped into five functional domains (cognitive, coordination, security, oversight, governance) to ensure modularity, interoperability, explainability, and robust protection of sensitive health data. A review of current AI agent implementations highlights limitations in security, transparency, and regulatory alignment, especially in multi-agent clinical settings. The proposed framework is illustrated through a practical use case involving home-based care for elderly patients with chronic conditions, where AI agents manage medication adherence, monitor vital signs, and support clinician communication. The architecture’s flexibility is further demonstrated through its application in perioperative care coordination, underscoring its potential across diverse clinical domains. By embedding trust, accountability, and security into the design of agentic systems, this approach aims to advance the safe and ethical integration of AI into aging-focused healthcare environments. Full article

Background/Objectives: Sodium-glucose co-transporter 2 (SGLT2) inhibitors are essential antidiabetic medications. However, their side effects warrant careful consideration. The search for novel SGLT2 inhibitors with high affinity remains an ongoing endeavor. Medicine food homology (MFH) herbs show promise for drug development due to their nutritional and medicinal value. Methods: This study aims to address the shortcomings of existing virtual screening models for SGLT2 inhibitors by optimizing feature selection and integrating multidimensional molecular fingerprints. Subsequently, an integrated virtual screening pipeline is constructed to identify potential SGLT2 inhibitors from eight selected MFH herbs. Results: The results indicate that the optimal model (LightGBM and RF) achieved an accuracy of 0.97 and an AUC of 0.98. Following rigorous filtering, a total of 44 potential SGLT2 inhibitors were identified, among which, Isoononin (from Gancao) and Ononin (from Huangqi, Gegen, and Gancao) exhibit favorable drug likeness and safety. Molecular docking demonstrate that both compounds can effectively bind to the SGLT2 active site, establishing stable hydrophobic interactions with critical residues such as Phe98 and Phe453. Furthermore, molecular dynamics simulations confirm the stability of the interactions between the two compounds and SGLT2. Conclusions: This study significantly enhances the accuracy and stability of SGLT2 inhibitor virtual screening models by addressing deficiencies in structural characterization and feature selection. It provides candidate molecules for the development of novel SGLT2 inhibitors and offers new scientific evidence for the application of MFH herbs in the prevention and treatment of chronic metabolic diseases. Full article

Objectives: Personalized medicine is gaining rapid attention over the current drug prescription approach of ‘one-size-fits-all’. Three-dimensional (3D) printing is one such product development technique that has the potential to transform the pharmaceutical and biomedical sectors. Methods: To establish the future of 3D printing in mainstream pharmacy practice, initially, pharmaceutical preclinical and clinical scientific databases (peer-reviewed articles, patents, and marketed products) over the past 10 years were critically scrutinized. Additionally, to provide context, we developed a hypothetical case study illustrating the capabilities of the 3D printing super-compounding pharmacy in personalized patient care, emphasizing the critical role of pharmacists in this process. Results: Acknowledging the potential of 3D printing in pharmacy practice, this review effectively summarizes the advances and opportunities of pharmaceutically feasible 3D printing methods, as well as the challenges in translating this technology into a future super-compounding pharmacy facility. Furthermore, the review highlights the promising capabilities of such pharmaceutical 3D printers in enabling on-site printing of 3D medicines tailored to individual needs, which may range from dose adjustments to multidrug single tablets (polypills). Conclusions: We believe that 3D printing technology has the potential to revolutionize precision and personalized medication approaches in pharmacy practice, which will significantly benefit patient healthcare outcomes. Additionally, the adoption of such technology in pharmacies will lead to a reinvention of the role of pharmacists, thereby creating more job opportunities. Ultimately, 3D printing will create a new paradigm of super-compounding pharmacy practice, providing a new sense of excitement for those looking to enter the pharmacy profession. Full article

Over recent years, venous ulcer wound care has experienced significant advancements through the application of machine learning (ML) models. The aim of the present study is a systematic, comprehensive analysis of prior research studies in this field covering the period between 2001 and August 2025. By searching multiple academic databases, including the Web of Science, Scopus, and PubMed, using relevant keywords and different queries, and screening reference lists of previously published manuscripts and review papers with a focus on the application of artificial intelligence in dermatology and medicine, an initial set of potential studies for review was obtained. To ensure the scope and relevance of the review, several inclusion and exclusion criteria were used to derive the final set of relevant research studies upon which a database for research data management was created. As a result, a total of 79 relevant research studies were comprehensively analysed, upon which detailed meta-analysis and analysis of application areas of ML models within venous ulcer wound care were conducted. Afterwards, a summary of benefits for medical systems and patients was given along with a general discussion regarding ML model limitations, trends, and opportunities, as well as research studies’ limitations and possible future research directions. The presented analyses may be valuable for researchers interested in applying ML models not only to venous ulcer wound care but also to other types of chronic wound care. Full article

Background: Primary Biliary Cholangitis (PBC) requires early diagnosis and specialized management to prevent progression to cirrhosis. This study evaluates the awareness levels of Turkish physicians from various specialties regarding the clinical features, diagnostic criteria, and current treatment protocols of PBC. Methods: A multi-regional cross-sectional survey was conducted with 269 physicians across Türkiye. Knowledge levels were assessed through a 28-item instrument covering epidemiology, diagnosis and therapy. Data distribution was non-normal (Skewness: −1.296, Kurtosis: 2.857), necessitating the use of the Kruskal–Wallis H test and Dunn–Bonferroni post hoc procedure for inter-group comparisons. Internal consistency was confirmed with a Cronbach’s alpha of 0.80. Results: The overall mean awareness score was 62.6%. Item-level analysis revealed a near-universal understanding of the non-mandatory role of liver biopsy in diagnosis (99.1%) yet identified a critical knowledge gap regarding second-line therapies, particularly the use of steroids (6.8%). Significant disparities were observed among specialties (p < 0.001). Gastroenterologists (Median: 91.07%) and gastroenterology fellows (Median: 85.71%) exhibited significantly higher proficiency compared to general practitioners (64.29%) and family medicine residents (67.86%). Internal medicine specialists outperformed primary care providers, while no significant differences were found among other subgroups after Bonferroni adjustment. Conclusions: Professional specialization is the primary determinant of PBC awareness. While core diagnostic knowledge is stable, significant gaps exist in pharmacological management among non-specialists. Targeted medical education for primary care physicians is essential to ensure timely referral and optimize patient outcomes. Full article

Microwave sensing technology is rapidly advancing and increasingly finding its way into biomedical applications, promising significant improvements for medical care. Concurrently, the rise of artificial intelligence (AI) is enabling significant enhancements in the biomedical domain. Close scrutiny of the recent literature reveals intense activity in both fields, with particularly impactful outcomes deriving from the combined use of advanced microwave techniques and AI for biomedical monitoring. In this review, an up-to-date compilation, from the perspective of the authors, of the most significant works published on these topics in recent years is given, focusing on their integration and current challenges. With the objective of analyzing the current landscape, we survey and compare state-of-the-art biosensors and imaging systems at all healthcare levels, from outpatient contexts to specialized medical equipment and laboratory analysis tools. We also delve into the relevant applications of AI in medicine for processing microwave-derived data. As our core focus, we analyze the synergistic integration of AI in the design of microwave devices and the processing of the acquired data, which have shown notable performances, opening new avenues for compact, affordable, and multi-functional medical devices. We conclude by synthesizing the prevailing technical, algorithmic, and translational challenges that must be addressed to realize this potential. Full article

Background/Objectives: Food is Medicine (FIM) programs have been shown to be effective at addressing food and nutrition insecurity among individuals. However, more evidence is needed to determine effective interventions at the household level and their impact on child health outcomes. Feeding the Family is a randomized controlled trial which aims to determine whether the amount of food provided and the ability to select foods in FIM interventions have an incremental effect on child and caregiver clinical outcomes relative to nutrition counseling alone. The objective of this paper is to describe the population at baseline among those enrolled in Feeding the Family, an FIM family intervention. Methods: A pragmatic randomized controlled trial (pRCT) with a 2 × 2 factorial study design was used at an urban primary care clinic. Participants were randomized into one of four arms for a 3-month intervention: (1) medically tailored meals (MTMs), (2) grocery prescription (GP), (3) combined MTMs + GP, and (4) delayed control. Primary outcomes consisted of child and caregiver biomarkers (BMI, blood pressure, A1c, LDL, and HDL). Secondary outcomes included child and caregiver dietary behaviors, nutrition security, and food security. Spearman correlations and Kruskal–Wallis rank sum tests determined correlations between caregiver and child biomarkers, as well as correlations between caregiver socioeconomic factors and child outcomes, respectively. Results: Thirty-one caregivers and fifty-one children were enrolled. Nearly 90% of caregivers reported low–very low household food security; 93.6% experienced ongoing financial strain. Several caregiver–child biomarker correlations were observed, including caregiver and child BMI (r = 0.59, p = 0.043), caregiver LDL and child A1c (r = −0.79, p = 0.004), and caregiver total cholesterol and child BMI (r = −0.62, p = 0.032). In addition, food assistance status was associated with child vegetable intake (H = 6.16, df = 2, p = 0.046), and caregiver food security score was associated with child food security score (H = 18.31, df = 9, p = 0.032). Conclusions: There are robust correlations between caregiver and child clinical outcomes at baseline. These findings underscore the need for FIM research to examine how a tailored program can improve the clinical outcomes of entire households to address health disparities effectively. Full article

Background/Objectives: Sepsis detection remains challenging due to clinical heterogeneity and limitations of traditional scoring systems. This study developed and validated a hospital-wide machine learning model for sepsis detection using retrospectively developed data from prospectively expert-validated cases, aiming to improve diagnostic accuracy beyond conventional approaches. Methods: This retrospective cohort study analysed 218,715 hospital episodes (2014–2018) at a tertiary care centre. Sepsis cases (n = 11,864, 5.42%) were prospectively validated in real-time by a Multidisciplinary Sepsis Unit using modified Sepsis-2 criteria with organ dysfunction. The model integrated structured data (26.95%) and unstructured clinical notes (73.04%) extracted via natural language processing from 2829 variables, selecting 230 relevant predictors. Thirty models including random forests, support vector machines, neural networks, and gradient boosting were developed and evaluated. The dataset was randomly split (5/7 training, 2/7 testing) with preserved patient-level independence. Results: The BiAlert Sepsis model (random forest + Sepsis-2 ensemble) achieved an AUC-ROC of 0.95, sensitivity of 0.93, and specificity of 0.84, significantly outperforming traditional approaches. Compared to the best rule-based method (Sepsis-2 + qSOFA, AUC-ROC 0.90), BiAlert reduced false positives by 39.6% (13.10% vs. 21.70%, p < 0.01). Novel predictors included eosinopenia and hypoalbuminemia, while traditional variables (MAP, GCS, platelets) showed minimal univariate association. The model received European Medicines Agency approval as a medical device in June 2024. Conclusions: This hospital-wide machine learning model, trained on prospectively expert-validated cases and integrating extensive NLP-derived features, demonstrates superior sepsis detection performance compared to conventional scoring systems. External validation and prospective clinical impact studies are needed before widespread implementation. Full article

Purpose: Child sexual abuse (CSA) is a major public health and forensic concern, often involving delayed disclosure that limits evidence collection and affects judicial outcomes. This study analyzed disclosure patterns, victim–perpetrator characteristics, and forensic findings in CSA cases evaluated in Greece, contributing to the limited Southern European evidence base. Material and Methods: A retrospective review of 89 CSA cases (2014–2024) examined by a certified forensic physician at the Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, was conducted. Data from official medico-legal reports included demographics, abuse context, forensic findings, and disclosure interval. Statistical analyses explored factors associated with delayed disclosure (>7 days). Results: Victims were predominantly female (69.7%) with a mean age of 9.8 years. Most perpetrators were adult males, and over half of cases (53.9%) involved intrafamilial abuse. The mean delay in disclosure was 79 days; only 29.2% reported within one week. Recurrent abuse correlated with delayed disclosure (p = 0.006), while early disclosure was associated with biological evidence collection (p < 0.001). Physical injuries were observed in 23.6% of victims, genital findings in 17%, and anal findings in 3.4%. Conclusions: Delayed disclosure was common and significantly reduced the likelihood of identifying forensic evidence. The early application of trauma-informed examinations, which adopt a child-centered approach emphasizing safety, emotional regulation, and the prevention of re-traumatization, is essential for the medical and forensic evaluation of abused children. Adopting hospital-based multidisciplinary units could improve forensic documentation, interagency coordination, and psychosocial care in Greece. Full article

Background/Objectives: Dizziness is a symptom of many disorders across a wide range of etiologies. If dizzy patients are seen for vestibular evaluation with an audiologist and no vestibular reason for the patient’s dizziness is found, the medical referral pathway can become convoluted. This can leave patients feeling discouraged and unable to manage their symptoms. Clinically symptomatic chronic respiratory alkalosis (CSCRA) is an acid–base disorder that typically presents with dizziness but is unfamiliar to practitioners in vestibular and balance care settings. Methods: In a retrospective chart review deemed exempt by the Mayo Clinic Institutional Review Board, 74 patients at Mayo Clinic Arizona were included. All had consultations with both Audiology and Aerospace Medicine to assess their dizzy symptoms. Results: After completing vestibular testing, arterial blood gas (ABG) testing, and a functional test developed at Mayo Clinic Arizona called the Capnic Challenge test, 40% of patients were found to have CSCRA contributing to their dizzy symptoms. Many of these patients also had common comorbidities of CSCRA, like postural orthostatic tachycardia syndrome (POTS), migraines, and sleep apnea. Fewer than one-fourth of these patients had measurable vestibulopathies causing their dizziness. Half of the patients referred by the vestibular audiologist to Aerospace Medicine had a diagnosis of CSCRA. Conclusions: Assessment for CSCRA should be considered as a next step for patients presenting with dizziness without a vestibular component. Being aware of the prevalence of CSCRA and its comorbidities may help balance providers offer quality interprofessional referrals and improve patient quality of life. Full article

Background/Objectives: Refeeding syndrome (RFS) is challenging to prevent and manage in hospitalized patients receiving enteral nutrition (EN). Nebraska Medicine implemented an Electronic Medical Record (EMR) Refeeding Risk Order Set (RROS) to standardize prevention measures, including structured electrolyte monitoring, thiamine supplementation, and conservative EN initiation. This study evaluated whether RROS implementation reduced RFS occurrence or severity and assessed its operational impact. Methods: In this retrospective cohort study, adults receiving EN before and after RROS implementation were compared. Primary outcomes were RFS occurrence and severity; secondary outcomes included EN initiation and advancement rates, electrolyte trends, lab frequency, and electrolyte repletion. Results: RFS occurrence did not differ significantly between groups (92.3% vs. 91.3%, p = 0.694), nor did severity (p = 0.535). The post-RROS group received more electrolyte boluses on EN Day 0 (p = 0.027) and had a lower EN starting rate (15.7 vs. 18.3 mL/h, p = 0.045). Conclusions: Although the RROS did not reduce RFS occurrence or severity, integrating American Society for Parenteral and Enteral Nutrition (ASPEN)-based guidance into the EMR was highly feasible and adopted immediately. Automating electrolyte monitoring, micronutrient supplementation, and conservative feeding initiation reduces the risk of errors and promotes consistent care. These benefits improve workflow efficiency and support providers during high census periods, limited staffing, or when experience varies. Future research should explore combining EMR tools with predictive analytics to optimize early risk identification and individualized management. Full article

Background and Objectives: The growing number of patients seeking medical care in the internal medicine departments over the past decades has been accompanied by an increase in the bed occupancy rate. This is associated with a heavier work burden among the professional staff members, which may lead to a lower quality of care. Therefore, this study aimed to evaluate the association between the bed occupancy rate and staff compliance with hand hygiene regulations. Materials and Methods: This ecological study included 9 internal medicine departments (~300 beds) in a single medical center between 01/2017 and 12/2019. Routine hand hygiene performance was evaluated randomly, and the association between the bed occupancy rate and the staff’s compliance with the hospital regulations was studied. Univariate and multivariable analyses were performed by the generalized estimating equation model. Results: The study included 12,736 episodes that warranted hand hygiene practices (“opportunities”). The overall hand hygiene performance rate was 78.3% (physicians 76.2%, nurses 80.7%, and healthcare assistants 76.9%). There was an approximately 2% decline in staff compliance for each 10% increase in bed occupancy rate (adjusted IRR 0.98, 95%CI 0.97–0.99, p < 0.001). Stratification by staff members showed a significant decline in routine hand hygiene practices among physicians (adjusted IRR 0.97, 95%CI 0.95–0.99, p < 0.001) and healthcare assistants (adjusted IRR 0.97, 95%CI 0.96–0.99, p < 0.001) but not among nurses (adjusted IRR 0.99, 95%CI 0.98–1.01, p = 0.392). Conclusions: An increase in bed occupancy rate is associated with a decrease in the hospital staff’s compliance with hand hygiene and therefore may lead to a lower quality of care. Full article

Background: Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) for clavicle fracture pain management carry significant adverse effect and allergic reaction risks. This study assessed ultrasound-guided nerve block (USNB) efficacy for acute clavicle fracture pain in emergency department (ED) patients, providing an alternative to NSAIDs and opioids with fewer adverse effects. Methods: This retrospective, single-center observational study was conducted in accordance with Methods of Medical Record Review Studies in Emergency Medicine Research guidelines. Adult patients (≥20 years) who presented to the ED with traumatic clavicle fractures between 1 January 2015 and 30 November 2023 were included. Of the 343 eligible patients, 12 received ultrasound-guided nerve blocks (USNB) and 331 received standard care. To improve exchangeability, 1:10 matching with replacement was performed according to patients’ characteristics, such as age, sex, initial pain score, and comorbidities. The primary outcome was pain relief, assessed via the pain intensity difference (PID) on the Numerical Rating Scale within 360 min post-intervention. Meaningful pain relief was defined as a PID ≥ 4. Secondary outcomes included rescue opioid use, ED length of stay, hospital length of stay, and USNB-associated complications, such as vascular puncture, nerve injury, or local anesthetic systemic toxicity. Data were analyzed using time-course, time-to-event (time to meaningful pain relief), and linear regression analyses. Results: A total of 12 patients in the USNB group and 85 matched patients in the standard care group were analyzed after baseline characteristics matching with replacement. Compared to standard care, USNB was associated with significantly greater pain relief (p < 0.001). In the time-to-event analysis, USNB led to a 3.41-fold faster achievement of meaningful pain relief compared with that achieved with standard care (HR = 3.41; 95% CI, 1.47–7.90; p = 0.004). No significant differences were observed between groups in rescue opioid use, ED length of stay, or hospital length of stay. No USNB-associated complication developed in the USNB group. Conclusions: In patients with traumatic clavicle fractures, USNB provides more rapid and sustained pain relief than standard analgesic care in the ED, without increasing the ED length of stay. Large prospective studies are needed to confirm these findings. Full article