Search Results (91)

Objectives: This study aimed to assess the incidence, nature, and clinical relevance of medication discrepancies identified during the perioperative period in polymedicated surgical patients, and to examine factors associated with the occurrence of real discrepancies. Methods: A cross-sectional study was conducted in scheduled surgical patients admitted to the General Surgery department of a tertiary-care hospital. Eligible adults were required to be taking ≥4 chronic medications, have restored oral tolerance, and remain hospitalized for more than 48 h. Medication reconciliation was performed using hospital and primary care electronic records, complemented by a structured patient interview. Discrepancies were classified as justified or real according to SEFH criteria. Statistical analysis included descriptive methods, normality testing, correlation analyses, and generalized linear models. Results: Out of 270 assessed patients, 43 met inclusion criteria. A total of 282 medications were analyzed, with 243 (86%) showing discrepancies. 44% were real discrepancies, primarily due to unjustified omission. The average number of real discrepancies per patient was 5.7 (95% CI: 4.8–6.5). Cardiovascular (35.2%) and nervous system drugs (23.2%) were most affected. Real discrepancies with potential clinical severity accounted for 36.8%, including cases of asthma exacerbation, withdrawal syndromes, insomnia, and hypertensive crises. In 73% of pre-anesthesia reports, no specific recommendations regarding chronic medication management were provided. Conclusions: Medication reconciliation revealed frequent and clinically relevant discrepancies in this high-risk cohort of polymedicated surgical patients. Larger, more representative studies are needed to confirm these findings and to inform broader perioperative safety strategies. Full article

Background: Medical child abuse (MCA), previously known as Münchausen syndrome by proxy, involves the fabrication or induction of illness by caregivers—most commonly the mother—leading to unnecessary medical interventions and potential harm to the child. Methods: This retrospective study analyzed cases of suspected or confirmed MCA managed by the GAIA multidisciplinary team at Meyer Children’s Hospital, Florence, between 2010 and 2022. Cases were identified using Rosenberg diagnostic criteria and red flags outlined by the American Academy of Pediatrics (AAP) and the Royal College of Paediatrics and Child Health (RCPCH). Data were extracted from medical records and analyzed descriptively. Results: Among 816 cases of child maltreatment, 8 (0.99%) were identified as MCA. The median age of affected children was 5 years (range: 4–12 years), with a female predominance (6/8, 75%). All perpetrators were biological mothers (8/8, 100%). Children had a median of 23 emergency department visits (range: 4–44), with the most frequent presentations being fever (6/8, 75%), minor trauma (7/8, 87.5%), respiratory complaints (5/8, 62.5%), and gastrointestinal symptoms (4/8, 50%). According to Rosenberg criteria, 5 cases (62.5%) were classified as “possible diagnosis,” 1 (12.5%) as “definitive diagnosis,” 1 (12.5%) as “diagnosis by exclusion,” and 1 (12.5%) as “inconclusive.” Conclusions: Despite its low prevalence, MCA poses serious clinical and ethical challenges. Early detection requires thorough documentation, interdisciplinary collaboration, and improved access to shared medical records. The GAIA model offers a replicable framework for effective multidisciplinary management. Full article

Background: Clinical pharmacy services (CPS) have been shown to confer significant advantages in patient care. It remains to be clarified how CPS resources are allocated across routine care settings. It remains to be clarified which recommendations are made to resolve the drug-related problems (DRP) identified by CPS and which adverse drug reactions (ADR) actually arise from the identified DRP. Methods: Following positive ethical approval, patient chart analyses, evaluation of pharmacy documentation on CPS and pharmacist interviews were performed to characterize CPS at all medical departments of the Bundeswehr Hospital Hamburg. We developed and pre-tested instruments for standardization: A Standard Operating Procedure (SOP) for the practical exercise and documentation of CPS by the pharmacists performing them, a standardized form (checklist) for retrospective data collection as part of this study, and a standardized questionnaire for conducting the pharmacist interviews including a risk assessment according to the NCC-MERP score. Results: In total, 1000 CPS were documented in 504 patients (mean age: 69.95 years; 229 female) on 16,705 treatment days. A total of 66.87% CPS was initiated when pharmacists participated in ward rounds. In all CPS, “Indications” was the topic addressed most frequently (37.70%). “Agents for obstructive respiratory diseases” was the most frequently involved drug class (11.32%). The most frequent processing time per CPS was 16–30 min (48.61%). The number of CPS ranged from 0.36/100 treatment days in dermatology to 12.47 in oncology. Severity of 358 DRP was classified “very severe” (5.03%), “severe” (42.74%), “moderate” (34.36%), “low” (15.08%), “very low” (1.40%), or “without impact” (1.40%). The probability of DRP occurrence was classified as “high” in 13.13% and “very high” in 3.35%. In 15.36% of the DRP, an ADR actually occurred. In 504 patients, 932 specific recommendations were forwarded to solve the DRP identified during CPS. Of those, 53.97% were implemented. Conclusions: In almost all CPS, a considerable number of DRP with serious clinical consequences were identified. Half of the forwarded recommendations were implemented. Full article

The challenge of accurately identifying the appropriate medical specialty based on patient symptoms leads to delays in diagnosis and treatment. This paper presents an AI model developed to classify medical specialties from symptom descriptions. The model, implemented with BERT, hosted via a Python-based Flask API v3, and integrated with an interactive frontend application, allows users to input symptoms textually or interactively select affected body parts and answer multiple choice questions. Following deployment, feedback data from doctors and residents was collected and utilized to enhance the model performance, supplemented by additional data from online medical forums. This study demonstrates significant improvements in finding the correct medical specialty, contributing to more efficient patient triage, reducing the time to diagnose and treat patients, and eliminating the presence of doctors in the initial process as they are often busy in emergency departments. The use of generative AI and large language models, notably BERT, is highlighted as a key factor in the model’s success. Full article

Background and Objectives: Timely recognition of deteriorating ward patients is critical to prevent adverse outcomes. The Deep learning–based Cardiac Arrest Risk Score (DeepCARS), an AI-based early warning system developed in Korea, has demonstrated high sensitivity and specificity, but its impact on real-world physician decision-making remains unclear, especially under healthcare resource constraints. Materials and Methods: We retrospectively analyzed 830 adult ward patients (March 2024–February 2025) who triggered DeepCARS alerts (score ≥ 91) at a tertiary hospital during a nationwide workforce shortage. Physician responses were classified as active intervention (ICU transfer, life-sustaining treatment [LST] decision, or specialty consultation) versus observation. Results: Among patients with DeepCARS ≥ 91, 58.9% received active intervention, with higher in-hospital mortality compared with those observed only (34.8% vs. 9.7%). ROC analysis suggested a cutoff of ≥94 for better intervention discrimination (AUC = 0.708). In multivariable analysis, DeepCARS ≥ 94 (OR 3.52) and chronic liver disease (OR 1.78) independently predicted active intervention. Multinomial analysis showed that patients admitted to medical departments were more often directed toward LST decisions rather than ICU transfer. Hemato-oncologic comorbidities were associated with both ICU transfer and LST decisions, while elevated respiratory rate consistently predicted either ICU transfer or LST discussions. Conclusions: DeepCARS alerts effectively triggered physician-driven decisions regarding ICU transfer and end-of-life care during a healthcare crisis. However, the ultimate clinical responses were shaped by comprehensive clinical judgment that integrated AI-generated risks with patient-specific factors, such as functional status and frailty, not captured by the algorithm. This underscores the indispensable role of individualized clinical assessment in interpreting and acting upon AI-based alerts in high-risk ward patients. Full article

Background/Objective: Drug-related problems (DRPs) are a common, potentially avoidable cause of emergency department (ED) use. In December 2022, our hospital integrated a pharmacist-led intervention into routine ED practice. This intervention comprised medication optimization, adherence counseling, and coordinated hand-off to primary care. We quantified 30- and 90-day reconsultations after discharge and explored factors associated with DRP-related revisits. Methods: A retrospective cohort of adults (≥18 years) who attended a tertiary ED (Barcelona, Spain). We included index DRP visits from 1 December 2022 to 30 June 2024. All received the bundle. Demographic, clinical, and pharmacotherapeutic data were extracted from the Catalan Shared Health Record; an independent committee classified revisits as a DRP or non-DRP. Predictors of 30-day DRP revisits were assessed with multivariable logistic regression. Results: Among 1247 patients (mean age 78.6 ± 16.2 years; 59.2% women; and median nine drugs), 120 (9.6%) reconsulted the ED within 30 days, and 194 (15.5%) within 90 days for any cause. DRP-specific rates were 30.8% (37/120) at 30 days and 26.3% (51/194) at 90 days; 81% and 80% of these revisits, respectively, involved a recurrence of the same DRP. The most frequent index DRPs were constipation (14.2%), gastrointestinal bleeding (9.2%), hypertension (8.3%), seizures (8.3%) and hyponatraemia (6.7%). An age ≥ 80 years independently predicted fewer 30-day DRP revisits (OR 0.32; 95% CI 0.13–0.79); hypertension and cognitive impairment were not significant after adjustment. Conclusions: In this single-arm implementation cohort, overall, 30-day ED reconsultations were 9.6% and about one-third were DRP-related, predominantly recurrences, and chiefly gastrointestinal bleeding and seizures. These descriptive findings should be interpreted cautiously given potential survivorship bias and residual confounding; the apparently lower risk among patients aged ≥ 80 years is hypothesis-generating and may reflect geriatric care pathways and caregiver engagement. Targeted post-discharge monitoring for high-recurrence DRPs may help reduce avoidable ED use, and future evaluations should test this in quasi-experimental or randomized designs. Full article

Introduction. Adverse drug events (ADEs) are between the third and sixth most common cause of death worldwide. Biosimulation studies performed using real-world data could generate relevant drug safety information without exposing patients to ADEs. Methods. Iclepertin (BI-425809) was virtually added to the actual drug regimens of n = 4,405,063 individuals. Changes in risk level were estimated for drug-induced long QT syndrome and CYP450 drug interactions. The properties used for iclepertin included: dose of 10 mg (oral) once daily; bioavailability (F) = 71%; Cmax of 222 nM; CYP3A4 weak affinity substrate (partial metabolic clearance of ~80%); IC₅₀ for hERG block of 30 μM. Results. A change in total medication risk score (MRS) was observed (6.3 ± 6.6 to 7.2 ± 6.6) following the addition of iclepertin in ~50% (n = 2,138,247) of the studied population. Among individuals with a change in MRS, ~65% had a 2-unit increase (max 11 units). The number of individuals classified in the High/Severe MRS category increased by 0.33%. The addition of iclepertin to individuals receiving CYP3A4 perpetrator drugs produced a greater change in MRS (+1.5) when compared to individuals not exposed to CYP3A4 perpetrators (+0.8). An additional 0.0032% of the population (n = 139) would be at risk of QT prolongation following the intake of iclepertin. Subset analyses performed in individuals with schizophrenia (targeted indication) demonstrated that these individuals had higher MRS values (13.0 ± 10.3) compared to those without schizophrenia (6.2 ± 6.9). However, the addition of iclepertin did not produce a greater increase in MRS in the schizophrenia population vs. the control population. Our pharmacoeconomic model did not account for any beneficial effects of the drug but the model based on MRS changes predicted a USD 91 yearly increase in medical expenditures (emergency department visits and hospitalizations) per individual (USD 3172 to USD 3263) following the addition of iclepertin. A similar increase was observed in the schizophrenia population following iclepertin addition. Conclusions. The increase in MRS associated with the addition of iclepertin to the drug regimen of a large population was minimal and mostly driven by CYP3A4 interactions. Using this model, interactions can be identified a priori, making risk mitigable and preventable without exposing patients to toxicity. Full article

Background/Objectives: This study aimed to classify pre-orthodontic patients using the Caries Management by Risk Assessment (CAMBRA) system and clarify their oral characteristics and microbiome. Methods: At the Department of Orthodontics, Hiroshima University Hospital, 68 patients were included in this study. Clinical parameters, such as plaque control record, DMF index, and number of white spot lesions (WSLs), were obtained. Medical interviews and oral examinations were conducted according to the CAMBRA system, and participants were classified into four risk groups (Low, Moderate, High, and Extreme). The supragingival plaques and stimulated saliva were collected. A saliva test was performed to measure the saliva secretion volume, pH, buffering capacity, and bacterial culture. Microbial DNA was extracted from the stimulated saliva and plaque samples, and 16S rRNA metagenomic analysis was performed. For statistical analysis, the Kruskal–Wallis test was used. Results: Participants were classified into four CAMBRA risk groups, with many classified as the High group. The number of DMF teeth and WSLs were the highest in the Extreme group, which tended to have the worst oral hygiene habits. The saliva test results revealed that the Extreme group had the worst saliva secretion volume, buffering capacity, and Streptococcus mutans score, with statistically significant differences. Bacterial 16S metagenomic sequencing revealed that the genus Fusobacterium had the highest relative abundance in the saliva samples of the Low group, whereas the genus Actinomyces had the highest relative abundance in the Extreme group. Conclusions: In this single-center, cross-sectional study, CAMBRA risk classification accurately reflected the oral condition of pre-orthodontic patients. Full article

Background: Aortic stenosis (AS) is the most common valvular heart disease, associated with poor outcomes if left untreated. Current guidelines recommend that transcatheter aortic valve implantation (TAVI) procedures be performed in hospitals with an on-site cardiac surgery unit due to potential complications requiring surgical intervention. Objective: Based on our experience, we evaluated the feasibility and outcomes of implementing a TAVI program in a cardiology department without an on-site cardiac surgery unit, in collaboration with a remote hospital for surgical backup. Methods: The TAVI program involved pre- and post-procedural evaluations conducted at Meir Medical Center (Kfar Saba, Israel) with a remote surgical team available. The study population included 149 consecutive patients with severe aortic stenosis treated at the Meir valve clinic between November 2019 and December 2023. Procedures were performed by the center’s interventional cardiology team. Results: The mean age of the 149 patients was 80 ± 6 years, and 75 (50%) were female. The average STS score was 4.3, and the EuroSCORE II was 3.1. Among the patients, 68 (45%) were classified as New York Heart Association (NYHA) class III-IV. The valve types used included ACURATE neo2 (57 patients, 38%), Edwards SAPIEN 3 (43 patients, 28%), Evolut-PRO (41 patients, 27%), and Navitor (7 patients, 4%). There were no cases of moderate to severe paravalvular leak and no elevated post-implantation gradients, and there was no need for urgent cardiac surgery. One case of valve embolization was successfully managed percutaneously during the procedure. In-hospital follow-up revealed no deaths and only one major vascular complication. At one-year follow-up, six patients had died, with only one death attributed to cardiac causes. Conclusions: Our findings support the safe and effective performance of transfemoral TAVI in cardiology departments without on-site cardiac surgery, in collaboration with a remote surgical team. Further prospective, multicenter studies are warranted to confirm these results and guide broader clinical implementation of this practice. Full article

Introduction: Chronic pain affects approximately 20% of U.S. adults, imposing significant burdens on individuals and healthcare systems. Medical cannabis has emerged as a potential therapy, yet its impact on healthcare utilization remains unclear. Methods: This retrospective cohort study analyzed administrative data from a telehealth platform providing medical cannabis certifications across 36 U.S. states. Patients were classified as cannabis-exposed if they had used cannabis in the past year, while unexposed patients had no prior cannabis use. Outcomes included self-reported urgent care visits, emergency department (ED) visits, hospitalizations, and quality of life (QoL), measured using the CDC’s Healthy Days measure. Targeted Maximum Likelihood Estimation with SuperLearner estimated causal effects, adjusting for numerous covariates. Results: Medical cannabis users exhibited significantly lower healthcare utilization. Specifically, exposure was associated with a 2.0 percentage point reduction in urgent care visits (95% CI: −0.036, −0.004), a 3.2 percentage point reduction in ED visits (95% CI: −0.051, −0.012) and fewer unhealthy days per month (−3.52 days, 95% CI: −4.28, −2.76). Hospitalization rates trended lower but were not statistically significant. Covariate balance and propensity score overlap indicated well-fitting models. Conclusions: Medical cannabis use was associated with reduced healthcare utilization and improved self-reported QoL among chronic pain patients. Full article

Background/Objectives: Dyspnea is one of the main causes of visits to the Emergency Department (ED) and hospitalization, with its differential diagnosis representing a challenge for the clinician. Lung ultrasound (LUS) is a widely used tool in ED. The objective of this study was to evaluate the impact of LUS, performed by a non-expert operator, in determining diagnosis and prognosis of patients with dyspnea. Methods: A total of 60 patients presenting with dyspnea at the ED were prospectively enrolled and underwent LUS examination by a medical student, after brief training, within 3 h of triage. LUS findings were classified into four patterns: N.1, absence of notable ultrasound findings, attributable to COPD/ASMA exacerbation; N.2, bilateral interstitial syndrome, suggestive of acute heart failure; N.3, subpleural changes/parenchymal consolidations, suggestive of pneumoniae; and N.4, isolate polygonal triangular consolidation, attributable to infarction in the context of pulmonary thromboembolism. Results: The diagnostic hypothesis formulated after LUS was compared with the final diagnosis after further investigations in the ED, showing agreement in 90% of cases. The mean LUS score value was higher in patterns N.2 (18.4 ± 8.5) and N.3 (17 ± 6.6), compared to patterns N.1 and N.4 (9.8± 6.7 and 11.5 ± 2.1). Given the high prevalence of pattern N.2, the diagnostic accuracy of LUS in this context was further evaluated, showing a sensitivity of 82% and specificity of 100%. In terms of the prognostic value of LUS, hospitalized patients had a higher LUS score compared to those discharged (17.3 ± 8.1 vs. 8.5 ± 6.8, p value 0.004). A similar trend was obtained in the subgroup of patients requiring non-invasive ventilation (NIV), who present a higher LUS score (21.1 ± 6.6 vs. 13.1 ± 8.1, p value 0.002). When considering a combined outcome (death and NIV), patients with worse outcomes more often had a LUS score > 15 (p value < 0.001). Conclusions: In conclusion, this study confirms that LUS is a very useful tool in the ED, assisting the clinical evaluation for diagnosis, treatment decision, and determination of the appropriate care setting for patients with acute dyspnea. Its short learning curve allows even non-expert staff to use it effectively. Full article

Objectives: Kawasaki Disease (KD) is an acute vasculitis associated with systemic inflammation. This study aimed to investigate the level and clinical significance of soluble ST2 (sST2) in children with KD. Methods: A retrospective analysis was conducted on 287 pediatric KD patients treated at the Pediatric Cardiology Department of Shengjing Hospital, China Medical University, from November 2021 to December 2022. Patients were stratified into subgroups based on the presence of myocardial damage (MD), coronary artery lesions (CAL), multi-organ involvement (MOD; ≥3 organs) and/or intravenous immunoglobulin-resistant KD (IVIG-R KD). In each group, we analyzed the correlation between sST2 levels and various laboratory parameters, including white blood cell count (WBC), hemoglobin (HB), platelet count (PLT), C-reactive protein (CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), N-terminal pro-brain natriuretic peptide (NT-pro BNP), D-dimer, and albumin (ALB). Results: Patients in the CAL group were significantly younger and predominantly male (p < 0.05). In the MD, CAL, MOD, and IVIG-R KD groups, levels of sST2, CRP, NT-pro BNP, and D-dimer were significantly higher than in their respective comparison groups (p < 0.05). sST2 showed weak positive correlations with WBC, CRP, IL-6, NT-pro BNP, and D-dimer, and weak negative correlations with HB and ALB (p < 0.05). sST2, HB, and IL-6 were identified as independent risk factors for MOD (p < 0.05). sST2 and HB were independent risk factors for IVIG-R KD (p < 0.05). Among acute-phase patients, four cases had sST2 levels > 200 ng/mL—all were classified as IVIG-R KD and MOD; three of these also developed coronary artery aneurysms (CAA). Conclusions: Elevated sST2 levels in the acute phase of KD may serve as a clinical indicator of IVIG-R KD, CAA, MOD, and MD. Full article

Background and Objectives: Osteoarthritis, the most common degenerative joint disease, causes pain, decreased mobility, and functional disability, having a significant impact on patients’ quality of life. This study aimed to evaluate the impact of hip osteoarthritis (HOA) and knee osteoarthritis (KOA) on physical functioning and quality of life, and to explore how these outcomes vary according to sex, disease stage, and common comorbidities. Materials and Methods: A cross-sectional study was conducted between 1 October and 30 December 2024, at the Medical Rehabilitation Department of Avram Iancu Clinical Hospital in Oradea, Romania. A total of 133 adult patients diagnosed with HOA or KOA, based on clinical and radiographic criteria, were included. Functional status was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), while quality of life was evaluated using the World Health Organization quality of life questionnaire-BREF version (WHOQOL-BREF). The main outcomes were the total scores of these instruments, analyzed in relation to demographic and clinical variables. Results: Based on the clinical staging criteria applied in the study, 23 patients (17.3%) were classified as being in the early stage, 98 (73.7%) in the progressive stage, and 12 (9.0%) in the advanced or end stage of the disease. The mean WOMAC total score was 52.0 ± 7.9 (scale: 0–96), indicating moderate to severe functional impairment. The mean WHOQOL-BREF score was 67.9 ± 13.1 (scale: 0–100), reflecting a moderately reduced quality of life. A moderate, statistically significant inverse correlation was observed between WOMAC and WHOQOL-BREF scores (Spearman’s rho = −0.565, p < 0.001). Patients with knee osteoarthritis reported significantly lower quality of life compared to those without this condition (66.48 ± 12.73 vs. 71.76 ± 13.31, p = 0.006). No statistically significant differences were found in functional, or quality-of-life scores based on sex. Conclusions: Knee osteoarthritis, particularly when combined with hip involvement, is associated with a substantial decline in quality of life and functional capacity. The severity and location of joint involvement appear to be the primary determinants of disability in this patient population, while systemic comorbidities have a less pronounced influence in the rehabilitation setting. Full article

This research develops large language models (LLMs) to alleviate the workload of healthcare professionals by classifying medical records into their departments. The models utilize medical records as a dataset for fine-tuning and use clinical knowledge bases to enhance accuracy and efficiency in identifying appropriate departments. This study explores the integration of advanced large language models (LLMs) with quantized low-rank adaptation (QLoRA) for efficient training. The medical department classifier demonstrated impressive performance in diagnosing medical conditions, with an accuracy of 96.26. The findings suggest that LLM-based solutions could significantly improve the efficiency of clinical consultations. What is more, the trained models are hosted on GitHub and are publicly available for use, empowering the wider community to benefit from this research. Full article

Background: This study aimed to evaluate the clinical and forensic characteristics of cases admitted to a high-volume tertiary emergency department, focusing on severity-based classification using treatability with simple medical intervention (SMI) and life-threatening status. Methods: We retrospectively analyzed 3014 forensic cases over one year. Patients were classified based on injury severity, anatomical region, and clinical outcomes. Documentation practices and report types were also reviewed. Results: Among all the cases, 60.4% were treatable with SMI, and 10.5% were identified as life threatening. Notably, all patients who died (1.3% mortality) were in the life-threatening group, and none of the SMI-treated patients died, underscoring the accuracy of early triage and alignment between documentation and outcomes. Road traffic accidents were the leading cause of life-threatening injury and hospitalization, while assault cases were predominantly minor and managed conservatively. Seasonal variation peaked in July, and sex-based differences revealed a higher SMI eligibility among female patients. Final forensic reports were more frequently issued in SMI cases, while preliminary reports were predominant in severe trauma. Conclusions: Severity-based classification using SMI and life-threatening categories offers valuable insight for clinical decision-making and forensic documentation. Integrating structured triage, anatomical injury mapping, and standardized report templates can enhance both patient safety and legal reliability. Full article