Search Results (13,511)

Background: Attention-Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder affecting executive functions such as impulse control, focus, and organization. This study addresses three research questions: current models and gaps in ADHD interventions, ways to enhance strengths and address weaknesses, and program recommendations for various ages. The aim is to develop a comprehensive framework to improve ADHD interventions, with a particular focus on youth and addressing existing gaps to enhance effectiveness. Methods: The current study systematically reviews the literature to answer these research questions. Sources were examined to identify existing intervention models, documented strengths and weaknesses, and recommendations relevant to different developmental stages. Results: Findings show that interventions for ADHD are varied and include psychological or behavioural therapy, family-school issues and parent involvement, school-based approaches, and medication. Key challenges include a lack of evidence-based practices, gaps in translational research, and insufficient teacher training. Notable strengths are family-school conference and family input, though there is less emphasis on building problem-solving capacity and family agency. Conclusions: Program recommendations highlighted in the literature include the need for family involvement, matching intervention intensity to individual needs, and ensuring professional education for special education. Addressing these gaps is essential for strengthening ADHD interventions and improving outcomes for children and youth. Full article

With the continued rise in outpatient surgical procedures, modern medicine requires more advanced tools for pain and anxiety monitoring and management. The current standard of care requires patient responses on visual analog scales, which may be subjective and are difficult to assess when a subject is unresponsive. Electrodermal activity (EDA) and pulse rate variability (PRV), two non-invasive, wearable, and objective measurements of sympathetic nervous system activity, can help provide insight into a patient’s psychological or emotional state without user input, allowing for continued monitoring even when a patient is unable to respond. However, methods based on these measurements have largely been relegated to longer duration (>60 s) or post hoc analysis, which does not suit the needs of medical care environments. Here we propose new methods for handling ultra-short (<10 s) signals to allow rapid evaluation of pain and anxiety state. We show how machine learning models trained on these signals can obtain high degrees of classification performance (AUC > 0.88) between no pain or anxiety and medium or higher pain and anxiety on signals obtained during two different forms of painful stimulation. We also show how these signals can measure the degree of stimulation irrespective of perceived pain from the patient. Further development of these algorithms will allow for greater monitoring and control of patient comfort in a clinical setting. Full article

Heat waves have intensified since the 1960s, leaving older adults uniquely susceptible to heat-related illnesses, including hyperthermia and fluid-electrolyte imbalances. While clinicians recognize that certain medications increase heat vulnerability, the specific interplay between drug use and patient characteristics remains unclear. This scoping review, following the Joanna Briggs Institute framework for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, investigated the risk of heat-related illness associated with medication use in older adults to identify research gaps. Investigators queried four databases for English-language primary literature (2000–2025) based on predefined Population, Concept, and Context criteria. Additionally, a grey literature search mapped existing United States (U.S.) mitigation strategies. Two reviewers independently screened studies via Covidence, and one extracted data. Results included 61 primary studies and 41 grey literature sources. While epidemiological data confirm higher heat-related morbidity and mortality in older populations, few experimental studies evaluate medication’s specific role. Despite many public health efforts, specific, evidence-based guidance on managing drug-heat interactions is limited. Diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), anticholinergics, and antipsychotics were the medication classes most frequently associated with heat-related illness. This review underscores a critical need for research into the confluence of age, multimorbidity, and polypharmacy to inform future clinical mitigation and protect vulnerable populations. Full article

Background: The diffusing capacity of the lung for carbon monoxide (DLCO) is a key measure of alveolar–capillary gas exchange, but its clinical significance in chronic obstructive pulmonary disease (COPD) remains incompletely defined. This study aimed to characterize the demographic, clinical, functional, and comorbid profiles of COPD patients stratified by the degree of DLCO impairment, and to evaluate the potential value of DLCO as a marker for disease severity and clinical phenotyping in a Chinese cohort. Methods: This single-center retrospective cross-sectional study enrolled 650 patients diagnosed with COPD (according to GOLD 2025 criteria) who underwent pulmonary function tests between January 2024 and February 2025 at the university-town hospital of Chongqing Medical University. Patients were stratified by predicted DLCO% into four groups: normal (≥80%), mild impairment (60–79%), moderate impairment (40–59%), and severe impairment (<40%). Demographic, clinical, laboratory, pulmonary function, echocardiographic, and chest CT data were collected. Comparisons across groups were performed using ANOVA/Kruskal–Wallis tests, chi-square or Fisher’s exact tests, and Spearman correlation analysis (IBM SPSS Statistics 25.0). Due to the exploratory nature of the study, no adjustment for multiple comparisons was applied. Results: Progressive DLCO impairment was associated with a higher proportion of male patients (69.2% to 90.9%, p = 0.018), older age (67.3 ± 9.0 to 72.9 ± 6.7 years, p < 0.001), lower BMI (median from 23.9 to 20.0 kg/m², p < 0.001), and higher smoking prevalence (58.7% to 87.5%, p = 0.001). The prevalence of pulmonary tuberculosis rose markedly (0.58% to 9.09%, p = 0.037). All spirometric parameters declined (e.g., FEV1%pred from 67.3% to 32.6%, p < 0.001). Systemic inflammatory markers (NLR, SII) increased, while hemoglobin and albumin decreased (both p < 0.001). Respiratory failure occurred in 30.0% of the severe DLCO group (predominantly type I, p <0.001). Echocardiography revealed a decline in left ventricular ejection fraction (61.2 ± 5.0% to 59.1 ± 4.0%, p = 0.012) and a trend toward higher pulmonary hypertension risk (27.8%, p = 0.056). DLCO%pred correlated positively with FEV1%pred (r = 0.394, p < 0.001) and oxygen saturation (r = 0.151, p < 0.001), and negatively with NLR (r = −0.165, p < 0.001) and SII (r = −0.149, p < 0.001). Conclusions: In COPD, DLCO impairment is associated with distinct clinical phenotypes, including male sex, advanced age, malnutrition, increased tuberculosis risk, worse lung function, systemic inflammation, and respiratory/cardiac dysfunction. These findings support DLCO as a valuable complementary marker for disease severity characterization in COPD. Longitudinal studies are needed to confirm its prognostic value. Full article

Rising planetary temperatures and extreme heat events have led to an increased incidence of heat-related illnesses, such as heat stroke, globally. Widespread adoption of measures to prevent and treat heat-related illnesses is an increasingly urgent issue given the rising global temperatures; promotion of such evidence-based strategies is needed to reduce heat-related morbidity and mortality globally. Such heat-related environmental illnesses are differentially experienced by those without access to ambient cooling and those engaged in outdoor work and recreation. Moreover, the adverse impacts of heat-related illness experienced by residents of the Global South necessitates the inclusion of high-quality recommendations around prevention and treatment into clinical and public health practice in order to address health equity and human rights considerations. The current guidance on prevention strategies and therapeutic interventions for heat-related illness has been iterated and published by the Wilderness Medical Society (WMS). In this critical appraisal, we have summarized the evidence-based guidelines and highlighted the updated recommendations that reflect evolving issues in heat illness research. Application of the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework has enabled a quality assessment of the guidelines to be performed, which we present herein. The adoption of evidence-based practices around heat-related illness has the potential to reduce morbidity and mortality and improve global population-level health in light of the warming climate. Full article

This study explored faculty perceptions of using Facial Recognition Technology (FRT) for tracking medical student attendance at a private Saudi medical college. Using a mixed-methods approach, researchers surveyed 112 faculty members and conducted focus groups with 26 participants. The findings revealed a balanced but divided perspective. While a slight majority (51.8%) showed good acceptance, a significant minority (48.2%) did not. Faculty rated the technology highly for its perceived ease of use (85.7%) and effectiveness (75%). However, significant privacy concerns were a major issue for over half of the respondents (55.3%). Qualitative data highlighted key themes, including initial staff reactions to FR technology, the need for better staff communication and training, the balance between efficiency and technical challenges, and deep-seated ethical and privacy concerns related to surveillance. The study concludes that, while faculty see the potential benefits of FRT, successful implementation depends on addressing their legitimate concerns. To succeed, institutions must develop comprehensive strategies that include transparent privacy policies, reliable technology, and robust training for staff. Prioritizing stakeholder engagement and creating culturally sensitive implementation plans are crucial for balancing the benefits of FRT with privacy and ethical considerations. Full article

This scoping review synthesized evidence on the psychosocial burden of tuberculosis (TB) and on evidence-based psychosocial interventions aimed at improving treatment adherence. Specifically, it examined: (a) the most frequent mental health problems associated with TB; (b) the main barriers to adherence; (c) the components and effects of psychosocial interventions; and (d) gaps in the literature and directions for future research. Bibliographic searches were conducted in PubMed and Scopus, covering articles published between 2005 and 2025. Nineteen studies met the inclusion criteria. Depression and anxiety were the most frequently reported mental health problems, while psychosis appeared mainly in multidrug-resistant TB (MDR-TB) populations. Across studies, stigma, fear of transmission, socioeconomic disadvantage, treatment duration, and medication side effects emerged as major barriers to adherence. Evidence-based interventions—including psychoeducation, motivational enhancement therapy, cognitive behavioral therapy, acceptance and commitment therapy, and multicomponent psychosocial support—were associated with improved psychological outcomes and, in several studies, better adherence-related indicators. Overall, the evidence suggests that psychosocial distress is common among people with TB and may compromise treatment engagement. Integrating psychosocial and mental health support into TB services may therefore strengthen adherence and improve patient-centered outcomes, although more rigorous and context-sensitive research is still needed. Full article

Purpose: This study explores how older adults with chronic back pain (CBP) evaluate different user interface (UI) designs and gamification elements for an ultrasound-based wearable providing real-time biofeedback during segmental stabilization exercises (SSE). The aim is to identify design preferences and motivational factors to enhance usability, engagement, and adherence in this specific population. Methods: We conducted a mixed-methods study with 15 older adults (aged ≥ 65) experiencing CBP. Participants interacted with three UI mockups (simple, anatomical, and playful) via a Wizard-of-Oz simulation and evaluated additional motivational elements (e.g., points, badges, progress charts). Semi-structured interviews and the Technology Usage Inventory (TUI) subscales were used to assess usability, acceptance, and intention to use. Results: Participants preferred the simple and anatomical UI designs, citing clarity, professionalism, and ease of interpretation. The playful design was viewed as less appropriate due to perceived infantilization. Game elements such as progress tracking, points, and levels were positively received, while competitive features like leaderboards were viewed critically. Most participants expressed interest in integrating pain education, favoring multimedia formats. Conclusions: Digital health tools for older adults must prioritize intuitive, medically reliable interfaces and allow personalization of motivational and educational components. The findings highlight the need for age-appropriate UI design and suggest that well-balanced gamification and educational features may enhance perceived acceptance and have the potential to support long-term use, which should be evaluated in longitudinal studies. Full article

Background/Objectives: Percent achieved of predicted peak exercise oxygen uptake (%VO_2pred) is a prognostic factor for patients with Fontan circulation. The main purpose of this study was to determine predictors of higher %VO_2pred in a cohort of adult Fontan patients. Methods: Medical records of 50 adult Fontan patients who underwent cardiopulmonary exercise testing were reviewed. All patients were divided into two groups according to the mean value of %VO_2pred and, in separate analysis, according to the morphology of the systemic ventricle. Spearman’s rank correlation was used to examine the relationship between %VO_2pred and blood biomarkers. Regression analyses were used to identify predictors of %VO_2pred. Results: The median age of all patients was 22 years, and 50% were female. The systemic ventricle was dominant right in 23 patients. Negative correlations were found between %VO_2pred and N-terminal prohormone of brain natriuretic peptide, mean cell hemoglobin concentration, and ferritin, and positive correlations were found between %VO_2pred and total protein, total iron-binding capacity. Higher chronotropic index [CI] (β = 0.31; p = 0.009), higher maximal diastolic blood pressure during CPET [DBP_max] (β = 0.4; p = 0.001), and lower serum concentration of high-sensitivity troponin T [hsTnT] (β = −0.31; p = 0.007) were significantly and independently associated with %VO_2pred. Conclusions: Higher CI and DBP_max and lower hsTnT were identified as independent predictors of %VO_2pred in this cohort. These findings suggest that the absence of chronotropic incompetence is a positive predictor of exercise capacity. Furthermore, hsTnT shows potential as a useful biomarker in this population. Further studies are needed to validate these parameters for clinical assessment and risk stratification in Fontan patients. Full article

Evaluations of medical artificial intelligence (AI) explanations often rely on self-reported trust, perceived usefulness, acceptance, or final decision outcomes, while less directly characterizing whether users check evidence around AI outputs during decision making. In AI-assisted chest radiograph interpretation, a critical process-level question is whether users return from the AI output to the original image evidence when further scrutiny is needed. To address this question, we examined whether verifiable explanations—explanations designed to make AI recommendations checkable against the original image evidence—are associated with process markers of visual evidence checking in AI-assisted chest radiograph interpretation using eye-tracking and human-factors process measures. A 2 × 2 between-subjects experiment manipulated verifiable explanations (present vs. absent) and risk context (high vs. low), with AI recommendation correctness embedded at the trial level. Fifty-six clinically trained participants each completed 24 interpretation trials. Analyses focused primarily on gaze transitions between the AI output and the original image and dwell time on the original image, with response time and exploratory verification-related behavioral states used as auxiliary process measures. Verifiable explanations did not simply increase acceptance of AI recommendations. Instead, when AI recommendations were incorrect, they were most clearly associated with more frequent AI–image transitions and longer absolute dwell time on the original image evidence. Exploratory state-based analyses further suggested a lower tendency toward no-verify adopt under incorrect AI recommendations, but these findings were treated as complementary rather than primary evidence. Overall, the value of verifiable explanations lies not only in final decisions but in whether they make AI recommendations more inspectable against the original evidence. These findings provide eye-tracking evidence consistent with visual evidence checking in AI-assisted diagnostic interfaces and underscore the value of process-sensitive human-factors measures in medical AI evaluation. Full article

The advent of robotic surgery has revolutionized multiple medical fields, notably in urology, gynecology, and both general and cardiovascular surgery. This article aims to explore the journey of robotic-assisted surgery (multi/single-port) in abdomen and pelvic surgeries, tracing its historical roots, examining its current landscape, and considering the potential future impact. A comprehensive review of the literature was conducted through PubMed/MEDLINE, utilizing keywords such as “robotic surgical systems,” “robotic surgery devices,” and “robotics AND urology.” Reference lists from selected articles were also explored to ensure a broad scope of understanding. The focus was on robotic systems designed for laparoscopic urological surgeries, all of which have been granted regulatory approval for clinical use. The historical trajectory of robotic surgery is traced back to the late 1980s with early systems like the Probot^®, preceding the transformative introduction of the daVinci^® system in the early 2000s. In addition to daVinci^®, the article introduces newer robotic platforms, including Senhance^®, Revo-I^®, Versius^®, Avatera^®, Hinotori^®, Edge^®, Shurui and HugoTM RAS, which are emerging as serious competitors. While daVinci^® has been the dominant force in robotic surgery for over a decade, these new systems are making significant strides with innovative designs, enhanced precision, and improved cost-efficiency. The growing competition among these platforms promises to expand their potential applications, increase accessibility, and optimize surgical outcomes across various specialties. Furthermore, as new technologies continue to evolve, there is a clear need for more extensive clinical trials and real-world data to assess their long-term impact on surgical practices, healthcare delivery, and patient outcomes. It remains to be seen how these advanced systems will integrate into healthcare infrastructures and their ultimate role in shaping the future of minimally invasive surgery. Full article

Male infertility, implicated in nearly 50% of couples’ infertility cases, represents a major medical and sociocultural challenge in Morocco. This narrative review synthesizes available epidemiological, etiological, and genetic data within national and international contexts. In Morocco, male infertility is characterized by the frequent involvement of modifiable factors, notably varicocele, smoking, and occupational exposures. From a genetic standpoint, chromosomal abnormalities, particularly Klinefelter syndrome, together with Y chromosome microdeletions, especially within the AZFc region, represent the main identified etiologies. Emerging technologies, such as next-generation sequencing, offer promising diagnostic perspectives, although their clinical application remains limited and mainly confined to research. Despite advances in medically assisted reproduction, the management of male infertility in Morocco continues to face psychosocial and economic barriers, as well as inequalities in access to care. These findings underscore the need to establish national registries, conduct multicenter studies, and facilitate the translation of innovations (particularly multi-omics approaches) into clinical practice to improve male infertility management in the Moroccan context. Full article

Background: Spasticity is a frequent and disabling complication in patients with prolonged disorders of consciousness (PDOC), yet its prevalence, distribution, evolution, and relationship with recovery of consciousness remain poorly characterized. The aim was to investigate the prevalence, severity, distribution, and evolution of spasticity in PDOC patients undergoing early intensive neurorehabilitation (EIN), and to explore clinical factors associated with spasticity and its relationship with level of consciousness (LOC). Methods: This study was embedded in the nationwide prospective DOCTOR cohort and included 126 PDOC patients admitted for EIN in the Netherlands between 2019 and 2023. Spasticity was assessed at admission and discharge using the Ashworth Scale (AS) across seven bilateral muscle groups. Associations between spasticity, demographic and clinical variables, medication use, nociception, and recovery of consciousness were analyzed. Results: Spasticity was highly prevalent at EIN admission (88%) and discharge (90%), with mostly bilateral and widespread involvement. Elbow flexors, wrist flexors, hip adductors, and knee flexors were most frequently affected. Severe spasticity was present in 19% at admission and 30% at discharge. Spasticity severity correlated positively with pain scores and use of spasmolytics, but not with LOC. No association was found between spasticity at admission and recovery of consciousness. Conclusions: Spasticity is nearly ubiquitous and often progressive in PDOC, even during specialized neurorehabilitation. Its evolution appears independent of recovery of consciousness, underscoring the need to assess and manage spasticity as a distinct clinical entity. Prospective interventional studies are warranted to optimize spasticity treatment in this population. Full article

Haemoglobin (Hb) concentration is a key biomarker for several diseases. Traditional laboratory methods often have limitations due to their time-consuming nature, the need for skilled personnel, or the use of high-cost instrumentation. This work presents a sensing strategy for developing new point-of-care tests (POCTs) for Hb detection via a proof of concept. The proposed sensing approach is implemented using plasmonic plastic optical fiber (POF) sensor chips that integrate an electropolymerized molecularly imprinted polymer (eMIP) film on the plasmonic surface for Hb-selective detection. The developed sensor system demonstrates an ultra-low detection limit of 80 fM in buffer, about five orders of magnitude lower than that of other comparable Hb sensors. Selectivity tests against common interfering proteins, such as bovine serum albumin (BSA) and immunoglobulin G (IgG), confirmed high specificity towards the target analyte. Moreover, the sensor’s performance was tested using a whole-blood sample, yielding results consistent with those of standard haematology analysis. The proposed sensor system, based on simple equipment, provides a quick (about 10 min) and cost-effective (about 10 euros per chip) label-free diagnostic tool for POCTs in real-world scenarios, such as finger-prick sampling, offering a less invasive alternative to traditional laboratory methods, towards devices useful for Internet of Medical Things (IoMT). Full article

Polydeoxyribonucleotide (PDRN) activates the adenosine A2A receptor (A2AR), triggering anti-inflammatory signaling and providing essential nucleotides for the salvage pathway, thereby helping bypass metabolic bottlenecks and promoting tissue repair. Combining PDRN with biochemical agents and physical stimuli represents a significant shift in medical treatment, moving from monotherapy to an integrated, multi-target regenerative approach. These combinatorial strategies effectively address the limitations of PDRN, such as its rapid degradation and diffusion, by simultaneously meeting the structural, metabolic, and signaling needs of injured tissues. The mechanism of action for PDRN involves a synergistic effect with hyaluronic acid, amplification of growth factors (e.g., Platelet-Rich Plasma (PRP), Epidermal Growth Factor (EGF), Platelet-Derived Growth Factor (PDGF)), and enhancements from extracorporeal shockwave therapy (ESWT) and lasers. This results in a notable acceleration of the repair process for chronic wounds, musculoskeletal disorders, and neurological injuries. As intelligent delivery systems like responsive hydrogels and sustainable L-PDRN production continue to advance, these synergistic protocols are poised to redefine global standards of care in regenerative medicine and esthetic dermatology. Future clinical success will hinge on the standardization of sequence-specific protocols and large-scale validation to ensure long-term safety and efficacy. Full article