Search Results (394)

Background: Early surgical intervention is associated with improved outcomes in hip fracture care, yet in patients using Direct Oral Anticoagulants (DOACs), surgery is frequently delayed due to concerns about increased intraoperative bleeding. Despite the increasing prevalence of hip fracture patients on DOACs, no consensus exists on optimal surgical timing. This has led to substantial practice variation between hospitals, with some operating within 24 h of last DOAC intake and others delaying surgery beyond 24 h. This study hypothesizes that early surgery within 24 h results in a non-inferior blood transfusion risk compared to delayed surgery 24 h or more after last DOAC intake in hip fracture patients on DOACs. This protocol describes the design and methodological rationale of a natural experiment. Methods and analysis: A multicenter cohort study designed as a natural experiment will be conducted across seven Dutch level 2 trauma centers, using predefined and standardized prospectively collected variables from electronic health records. Centers will adhere to distinct local surgical timing protocols, forming two cohorts: early surgery within 24 h and delayed surgery 24 h or more after last DOAC intake. Patients presenting with an isolated hip fracture who are using a DOAC and have taken their last dose within 24 h before admission will be included. The primary endpoint is postoperative blood transfusion. Secondary endpoints include additional bleeding-related outcomes, thrombotic and postoperative complications, and hospital length of stay. The primary analysis will be conducted on a per-protocol basis, with an intention-to-treat analysis performed as a supplementary assessment. Non-inferiority will be established if the upper bound of the one-sided 95% confidence interval for the risk difference does not exceed the predefined margin of 5%. Ethics and dissemination: Ethical approval was obtained from the Medical Ethics Committee United, Utrecht, The Netherlands. As this is a cohort study without altering clinical care, individual informed consent is not required. All data will be pseudonymized, and findings will be disseminated through peer-reviewed journals and scientific conferences. Registration details: Medical Ethics Committee United, Utrecht, The Netherlands, registration number W25.034. Full article

Tai Chi has evolved into a widely used mind–body practice increasingly incorporated into complementary therapy, rehabilitation, and public health. This study provides an updated global bibliometric overview, with VOSviewer mapping publication performance, co-authorship networks, and keyword-based thematic clusters. Articles and reviews with Tai Chi–related terms in the title were retrieved from Scopus, with no restrictions on language or publication year. A total of 2253 publications from 1978 to 2025 were analyzed, revealing steady growth, concentrated largely in the past decade. China led the publication output, while the United States had the highest number of citations, forming a dual-core pattern. The field is largely driven by a small group of authors and regional clusters, and its visibility in mainstream medical journals remains limited. Nine software-generated keyword clusters were manually synthesized into five themes: motor function (balance and fall prevention), musculoskeletal conditions (osteoarthritis, rheumatoid arthritis, fibromyalgia), chronic disease management (cardiovascular disease, stroke, COPD), psychological health (quality of life, depression, anxiety, mindfulness), and cognitive aging (dementia, mild cognitive impairment). Future progress requires greater methodological rigor, including mechanistic inquiry, long-term study designs, and community- or population-level applications, along with stronger international collaboration and deeper integration into clinical and public health practice. Full article

Background: The integration of artificial intelligence (AI) into mobile health (mHealth) applications has been accelerated by the widespread adoption of smartphones and recent technological advances, particularly in the wake of the COVID-19 pandemic. This experience has expanded the role of AI-powered apps in real-time health monitoring, early detection, and personalized treatment pathways. Aim: This review aims to summarize recent evidence on the use of AI in healthcare-related mobile applications, with a focus on clinical trends, practical implications, and future directions. Methods: Studies were prioritized based on methodological rigor, with systematic reviews forming the core of the analysis. Additional literature was considered to capture emerging trends and applications where a relevant rigorous screening and scoring procedure was applied to ensure methodological quality and relevance. Only studies addressing healthcare applications, rather than computational or computer science frameworks, were included to reflect the journal’s clinical scope. Results and Discussion: Fifty-six secondary studies were analyzed in detail. Thematic synthesis revealed a post-pandemic shift toward applications targeting mental health, chronic care management, and preventive services. Additional screening showed that, despite their increasing use in clinical contexts, few AI-based apps were formally classified as medical devices. This highlights a gap between technological innovation and regulatory oversight. Ethical concerns—including algorithm transparency, clinical responsibility, and data protection—were frequently reported across studies. Conclusions: This review underscores the growing impact of AI in mobile health, while drawing attention to unresolved challenges related to regulation, safety, and clinical accountability. A more robust integration into health systems will require clearer governance frameworks, validation standards, and interdisciplinary dialogue between developers, clinicians, and regulators. Full article

Background and Objectives: COVID-19 is an infection caused by the SARS-CoV-2 coronavirus that may develop several complications. Interstitial lung disease (ILD) is the major long-term complication of COVID-19 disease leading to progressive lung fibrosis and reduced respiratory function. The aim of this narrative review is to provide an updated overview of post-COVID-19 ILD by examining research publications and clinical guidelines selected from PubMed, Web of Science, and major respiratory medicine journals from 2020 to 2025. Methods: ILDs are diagnosed by medical history, physiological examination, pulmonary function tests, and chest X-ray or high-resolution computed tomography (HRCT) scan. Lung biopsy, especially cryobiopsy or video-assisted thoracoscopic (VATS) biopsy, can be performed to define histological patterns and confirm the diagnosis. Results: Post-COVID-19 ILD is a chronic condition characterized by long-term respiratory symptoms, radiological findings, and reduced lung function. Fibrotic injury is a consequence of the initial infection and could be influenced by persistent inflammation and dysregulated tissue repair. Risk factors include severe acute illness, advanced age, male sex, and smoking. Clinical course and prognosis of post-COVID-19 ILD is uncertain, as most patients experience gradual improvement or stability, whereas others develop progressive lung function decline. Treatment of post-COVID-19 ILD is not presently defined by guidelines but comprises corticosteroids, antifibrotics (including new drugs such as nerandomilast), supportive oxygen, pulmonary physiotherapy rehabilitation, smoking cessation, and vaccination. Conclusions: ILD represents a significant long-term complication of COVID-19 infection. Further investigations are required to better understand its pathophysiology and clinical management. As research progresses, more effective diagnostic and therapeutic strategies are expected to emerge. Full article

This study provides an integrated synthesis of Artificial Intelligence (AI) applications in Biomedical 3D Printing, mapping the conceptual and structural evolution of this rapidly emerging field. The bibliometric analysis, based on 229 publications indexed in the Web of Science Core Collection (2018–2025) and visualised in CiteSpace, identifies three interconnected research domains: AI-driven design and process optimisation, data-assisted bioprinting for tissue engineering, and the development of smart and adaptive materials enabling 4D functionalities. The results highlight a clear progression from algorithmic control of additive manufacturing parameters toward predictive modelling, deep learning, and autonomous fabrication systems. Leading contributors include China, India, and the USA, while journals such as Applied Sciences, Polymers, and Advanced Materials act as major dissemination platforms. Emerging clusters around “4D printing”, “deep learning”, and “shape memory polymers” indicate a shift toward intelligent, sustainable, and personalised biomanufacturing. In addition, a qualitative synthesis of the most influential papers complements the bibliometric mapping, providing interpretative depth on the scientific core driving this interdisciplinary evolution. Overall, the study reveals the consolidation of a multidisciplinary research ecosystem in which computational intelligence and biomedical engineering converge to advance the next generation of adaptive medical fabrication technologies. Full article

Background: YouTube has become one of the most widely used platforms for medical education and patient information. However, the accuracy and reliability of such unregulated content remain highly variable and sometimes misleading. This study aimed to evaluate the quality, reliability, and educational value of YouTube videos related to poisonings, insect bites, and envenomations using validated scoring systems. Methods: A cross-sectional analysis of YouTube videos was conducted using the search terms “approach to insect bites and stings,” “approach to poisonings,” “approach to scorpion envenomation,” “approach to snake envenomation,” and “approach to mushroom poisoning.” Searches were performed in incognito mode on August 1, 2025. Only English-language videos shorter than one hour were included. Video quality and reliability were evaluated using the Global Quality Score (GQS), modified DISCERN (mDISCERN), and Journal of the American Medical Association (JAMA) benchmarks, while viewer engagement was measured using the Video Power Index (VPI). Results: A total of 279 videos were analyzed. The mean ± SD scores were as follows: GQS, 3.53 ± 1.09; mDISCERN, 3.53 ± 1.08; and JAMA, 2.63 ± 0.96. Based on the GQS, 59.5% of the videos were high quality, 20.8% moderate quality, and 19.7% low quality; thus, approximately 40% of the evaluated videos (low- and moderate-quality categories combined) did not meet optimal quality standards. Videos on snake envenomation and general poisoning had significantly higher quality and reliability scores (p < 0.001). Educational, physician-sourced, and physician-presented videos achieved higher GQS, JAMA, and mDISCERN values (p < 0.001 for all). However, no significant differences were found in the VPI, indicating that popularity metrics did not correlate with content quality. Conclusions: YouTube provides wide access to poisoning-related educational materials, but content quality varies considerably, and a substantial proportion of videos fall below acceptable quality thresholds. Videos produced or presented by physicians are more reliable, whereas popularity is not a valid indicator of scientific accuracy. Active involvement of healthcare professionals and academic institutions, together with platform-level quality verification and visibility strategies, is essential to improve the credibility and impact of online health information. Full article

Background: ECHO Pain is a health professions education model that uses telehealth technology to connect specialists in academic centres to healthcare professionals who work in the community to disseminate best practice knowledge and foster interprofessional collaboration to support real patient cases. Methods: This paper summarizes 10 years of ECHO Pain implementation and evaluation in Ontario. We reviewed participants’ demographics, characteristics of cases presented in ECHO sessions, and the research output of this ECHO Pain program. Results: From June 2014 to June 2024, there were 529 sessions, 1527 healthcare professionals from urban and rural regions attended ECHO, and 25,898 h of continuing medical education credits were provided. We published 11 papers in peer-reviewed scientific journals using qualitative and quantitative research methods. Conclusions: ECHO Pain has been implemented and sustained in Ontario for 10 years, with demonstrated interprofessional education and an ongoing community of practice to discuss chronic pain cases. ECHO Pain is filling a significant gap in health professions education related to chronic pain in Ontario, especially for primary care professionals living in rural, remote, and underserved areas. Full article

Contemporary clinical medicine relies on the integration of clinical observation with physiological and pathological mechanisms to improve diagnosis, therapeutic decision-making, and patient outcomes. However, most current biomedical research interprets these mechanisms predominantly through the lens of upward emergence, according to which higher-order biological functions arise from the interaction of simpler lower-level components. Although indispensable for understanding visceral diseases, this perspective provides only partial access to biological complexity. Accumulating evidence from neuroscience, developmental biology, endocrinology, psychiatry, and regenerative medicine shows that higher-level systemic functions can also reorganize, modulate, or generate lower-level structures, a phenomenon known as downward emergence. Together, upward and downward emergence form a bidirectional framework that more accurately reflects the complex organizational pattern of biological systems. This editorial argues that clinical practice and biomedical research must explicitly acknowledge this bidirectional dynamic, as many diseases (including malignancy) cannot be fully understood through upward emergence alone. Downward emergent processes explain phenomena such as morphogenesis, regeneration, matrix remodeling, immunological reprogramming, endocrine-neurovegetative integration, and forms of pathological transformation that are difficult to interpret through classical reductionism. Viewing cancer as the pathological expression of a disturbed supracellular program provides a coherent explanation of its complex biology and highlights the possibility that malignant progression could be responsive to higher-order regulatory instructions. In this context, the Journal of Mind and Medical Sciences is undertaking a conceptual and editorial realignment, positioning itself as a journal of bidirectional emergence in health and disease. Rather than diminishing its clinical mission, this shift strengthens it by providing a more comprehensive framework for understanding physiological and pathological organization, one that integrates structure–function and function–structure relationships. As medicine moves toward increasingly integrative and mechanistic models of disease, adopting a bidirectional perspective becomes not only scientifically justified but also necessary for advancing diagnostic accuracy, therapeutic innovation, and the development of novel supracellular strategies for human health. Full article

Newborn screening (NBS) is evolving as novel technologies offer the opportunities to include a broader range of treatable disorders in its programs. Multiplexable, high-throughput DNA-based technologies such as next-generation sequencing (NGS) are being explored to improve and expand disease detection, although several issues have been raised with its use. This scoping review aimed to identify multiplexable, high-throughput, DNA-based technologies that were used for screening or confirmatory testing of newborn disorders in published studies. Available evidence on the appropriateness of technologies in the NBS context was extracted. A literature search (Medline, Embase, and Web of Science) was performed from inception up to April 2024 in collaboration with a medical information specialist. After selection, 26 journal articles were included that used these technologies for either screening (n = 12) or confirmatory testing (n = 14). Five technologies were identified: whole-genome sequencing, whole-exome sequencing, targeted gene sequencing (TGS), quantitative polymerase chain reaction, and MassARRAY. The majority used TGS (n = 19, 73.08%). The data extracted concern mainly technical aspects, and these suggest that a combined approach, i.e., testing via NGS plus a biochemical test, in parallel or reflex, emerges as the optimal option. Ethical and economic evidence is limited and rarely reported in the reviewed articles. Full article

Background: Although progress has been made, substantial barriers exist in the development and implementation of pediatric palliative care (PPC) in mainland China, Hong Kong, and Taiwan. Possible explanations include the idea that cultural taboos erect barriers that short-circuit PPC discussions among stakeholders, and secondly, regional guidelines intended to support PPC fail to do so effectively. Here, we aimed to identify and document the scope of barriers to and facilitators of PPC practices in these regions and to explore to what extent and how regional PPC guidelines address these barriers/facilitators. Methods: We identified and compared two kinds of documents: (1) recent journal articles reporting on empirical studies of barriers to/facilitators of PPC practices in mainland China, Hong Kong, or Taiwan and (2) published PPC regional guidelines from the three regions. International and regional databases were searched to identify articles, along with PPC professional organizations in the three regions to identify PPC guidelines. Inductive content analysis was used for data analysis, synthesis, and document comparison. Results: Seventeen relevant articles on PPC barriers/facilitators and 16 documents with PPC guidelines were identified. Barriers/facilitators were reported on three organizational levels: micro, meso, and macro levels. Micro refers to children and parents, meso to medical institutions and healthcare providers (HCPs), and macro to policy/guidelines and networks. Most barriers were addressed by PPC guidelines, and most facilitators were acknowledged and endorsed in the guidelines. For instance, HCPs reported that insufficient PPC-related knowledge among stakeholders was a barrier, while PPC guidelines provided detailed information to address this shortfall. Unaddressed barriers in the guidelines were also uncovered, such as the cultural taboo of discussing death, suggesting that HCPs often struggled to have effective PPC conversations with parents and the child. Conclusions: Our finding that PPC guidelines addressed most barriers/facilitators while HCPs still struggled with implementing PPC indicates that mature PPC guidelines are necessary but not sufficient for PPC practices to improve in these three regions. The wide availability of PPC guidelines and PPC education/training for HCPs and families needs to improve. Full article

Background/Objectives: As safe, eco-friendly, and legally compliant solutions for the disposal of unwanted medications, drug take-back systems have attracted extensive research attention. However, there is a lack of systematic mapping of global trends, collaborative networks, research themes, and hotspots in this field. This study aimed to conduct a comprehensive bibliometric analysis and review of global academic research on drug take-back programs. Methods: Peer-reviewed research articles on drug take-back programs, published between 2005 and 2025, were retrieved from the Web of Science Core Database. Microsoft Office Excel 2019, VOSviewer (v.1.6.17), and CiteSpace (v.6.1.R3 Advanced) were used to assess publication/citation trends, countries, institutions, authors, journals, disciplines, references, and keywords. Narrative analysis was employed to synthesize data from the included articles and identify core research themes. Results: A total of 149 eligible articles with 4520 citations were included, involving 619 authors, 52 countries/regions, 310 institutions, and 95 journals. Publication/citation counts increased significantly between 2005 and 2025. The United States led in both publication output and collaborative research; Mercer University was the most influential institution, but international and cross-institutional collaboration remained limited. Environmental Sciences ranked first among disciplinary categories in drug take-back research, followed by Pharmacology/Pharmacy. Core research themes underpinning this field included stakeholders’ knowledge–attitude–practice assessment (76 articles), returned medication treatment (37 articles), intervention evaluation (25 articles), policy analysis (7 articles), and the role of drug take-back programs in mitigating environmental and public health hazards caused by medicine wastes (4 articles). Conclusions: Scholarly attention to drug take-back programs has grown steadily. Future research should prioritize cross-sectoral and international cooperation, develop and adopt evidence-based interventions to optimize the safety, sustainability, and accessibility of drug take-back systems on a global scale. Full article

Aim: With the intensification of population aging, the public health challenges posed by multimorbidity have become increasingly severe. This study employs bibliometric analysis to elucidate research hotspots and trends in the field of multimorbidity against the backdrop of global aging. The immediate aim is to systematically map the intellectual landscape and evolving patterns in multimorbidity research. The ultimate long-term aim is to provide a scientific basis for optimizing chronic disease prevention systems and guiding future research directions. Methods: The study adopted the descriptive research method and employed a bibliometric approach, analyzing 8129 publications related to multimorbidity from the Web of Science Core Collection. Using CiteSpace, we constructed and visualized several knowledge structures, including collaboration networks, keyword co-occurrence networks, burst detection maps, and co-citation networks within the multimorbidity research domain. Results: The analysis included 8129 articles from 2004 to 2024, published across 1042 journals, with contributions from 740 countries/regions, 33,931 institutions, and 40,788 authors. The five most frequently occurring keywords were prevalence, health, older adult, mortality, and risk. The top five contributing countries globally were the United States, the United Kingdom, Germany, China, and Spain. Five pivotal research trajectories delineate the intellectual architecture of this field: ① Evolution of Disease Cluster Management: Initial investigations (2013–2014) prioritized disease cluster coordination within general practice settings, particularly cardiovascular comorbidity management through primary care protocols and self-management strategies. ② Paradigm Shifts in Health Impact Assessment: Multimorbidity outcome research demonstrated sequential transitions—from physical disability evaluation (2013) to mental health consequences like depression (2016), culminating in current emphasis on holistic health indicators including frailty syndromes (2015–2019). ③ Expansion of Risk Factor Exploration: Analytical frameworks evolved from singular physical activity metrics (2014) toward comprehensive lifestyle-related determinants encompassing behavioral and environmental dimensions (2021). ④ Emergence of Polypharmacy Scholarship: Medication optimization studies emerged as a distinct research stream since 2016, addressing therapeutic complexities in multimorbidity management. ⑤ Frontier Investigations: Cutting-edge directions (2019–2021) feature cardiometabolic multimorbidity patterns and their dementia correlations, signaling novel interdisciplinary interfaces. Conclusions: The prevalence of multimorbidity is on the rise globally, particularly in older populations. Therefore, it is essential to prioritize the prevention of cardiometabolic conditions in older adults and to provide them with appropriate and effective health services, including disease risk monitoring and community-based chronic disease care. Full article

Background: The number of publications related to rivaroxaban is growing, making it difficult for scientists to review relevant materials. Objectives: This bibliometric analysis is focused on highlighting hot spots and new trends associated with rivaroxaban studies and provides references and guidance for further research. Methods: A comparison between countries, journals, authors, and organizations was performed. Microsoft Excel 2021 and VOSviewer were used to process and visualize data extracted from Web of Science. The time range was set from 1991 to late 2024. A total of 6979 articles were analyzed and bibliometric maps of co-citations of references and co-occurrences of the keywords were built. Results: Relative research interest increased until 2021, when it started to drop. The new trends in publications related to rivaroxaban are associated with a comparison of NOAC therapy outcomes with previously used vitamin K antagonists (warfarin). The research was focused also on new NOAC representatives, medical conditions treated with NOAC, and safety of the therapy. New trending topics are related to ABCB1, peripheral artery disease, direct-acting oral anticoagulants, PCI, and SARS-CoV-2. Conclusions: This bibliometric analysis showed that increasing attention is being paid to the medical conditions treated with NOACs and issues related to the safety of this therapy. Full article

Background and Objectives: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic procedure that has demonstrated both safety and effectiveness in the treatment of obesity. By reducing the stomach’s volume without the need for surgical incisions, ESG promotes weight loss and can improve obesity-related comorbidities. However, patient responses to ESG can vary significantly. Materials and Methods: A comprehensive search was performed on PubMed, Embase, and Cochrane for studies with endoscopic sleeve gastroplasty; the main outcomes of interest are BMI, weight loss, and postinterventional complications. The search strategy employed a combination of keywords and Medical Subject Heading (MeSH) terms, including “endoscopic sleeve gastroplasty,” “endoscopy,” and “overweight”. To ensure the thoroughness of the review, additional manual searches of key journals and the reference lists of identified studies were performed. Grey literature, such as dissertations and conference abstracts, meta-analysis, and systematic reviews, was excluded to maintain a focus on peer-reviewed evidence. Duplicate records were identified and removed using Rayyan software to streamline the screening process. The I2 test was employed for heterogeneity assessment, while the risk of bias was evaluated utilizing ROBINS-I. Results: Our literature search resulted in the inclusion of 38 studies. Endoscopic sleeve gastroplasty for weight loss is important since it is more effective than pharmacological treatments and lifestyle changes and presents lower adverse event rates compared to bariatric surgery. Long-term weight loss outcomes varied, with total body weight loss ranging from 16% to 20.9% over a period from 2 to 5 years, while excess weight loss ranged from 13% to 79%. Revisional procedures showed higher failure rates, with up to 34.3% of patients experiencing insufficient weight loss. Most interventions led to clinically significant and sustained weight loss, though variability in outcomes highlights the need for further research to optimize long-term weight management strategies. Conclusions: Endoscopic sleeve gastroplasty (ESG) emerges as a promising minimally invasive option for weight loss, offering significant improvements in both weight reduction and obesity-related comorbidities, such as diabetes, hypertension, and dyslipidemia. Full article

Background/Objectives: Hydrogels are highly hydrated, biocompatible polymer networks increasingly investigated as drug-delivery systems (DDS) for analgesics. Their ability to modulate local release, prolong drug residence time, and reduce systemic toxicity positions them as promising platforms in perioperative, chronic, and localized pain settings. This scoping review aimed to systematically map clinical applications, efficacy, and safety of hydrogel-based DDS for analgesics, while also documenting non-DDS uses where the matrix itself contributes to pain modulation through physical mechanisms. Methods: Following PRISMA-ScR guidance, PubMed, Embase, and Cochrane databases were searched without publication date restrictions. Only peer-reviewed clinical studies were included; preclinical studies and non-journal literature were excluded. Screening and selection were performed in duplicate. Data extracted included drug class, hydrogel technology, clinical setting, outcomes, and safety. Protocol was registered with Open Science Framework. Results: A total of 26 clinical studies evaluating hydrogel formulations as DDS for analgesics were included. Most were randomized controlled trials, spanning 1996–2024. Local anesthetics were the most frequent drug class, followed by opioids, corticosteroids, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), and neuromodulators. Application sites were predominantly topical/transdermal and perioperative/incisional. Across the DDS cohort, most of the studies reported improved analgesic outcomes, including reduced pain scores and lower rescue medication use; neutral or unclear results were rare. Safety reporting was limited, but tolerability was generally favorable. Additionally, 38 non-DDS studies demonstrated pain reduction through hydrogel-mediated cooling, lubrication, or barrier effects, particularly in burns, ocular surface disorders, and discogenic pain. Conclusions: Hydrogel-based DDS for analgesics show consistent clinical signals of benefit across diverse contexts, aligning with their mechanistic rationale. While current evidence supports their role as effective, well-tolerated platforms, translational gaps remain, particularly for hybrid nanotechnology systems and standardized safety reporting. Non-DDS applications confirm the intrinsic analgesic potential of hydrogel matrices, underscoring their relevance in multimodal pain management strategies. Full article