Search Results (217)

Background/Objectives: Benign paroxysmal positional vertigo (BPPV) is the most prevalent vestibular disorder encountered in clinical settings and is highly responsive to evidence-based diagnostic and therapeutic interventions. However, variations in practice patterns among physician specialties can compromise timely diagnosis and effective treatment. Understanding these variations is essential for improving clinical outcomes and standardizing care. This study aimed to assess the diagnostic and treatment practices for BPPV among Ear, Nose, and Throat (ENT) specialists, neurologists, general practitioners, and family physicians in Saudi Arabia and to examine how these practices are influenced by clinical experience and patient case exposure. Methods: A cross-sectional, questionnaire-based study was conducted between April 2023 and March 2024 at King Khalid University, Abha, Saudi Arabia. A total of 413 physicians were recruited using purposive sampling. Data were analyzed using IBM SPSS version 24.0. Parametric tests, including one-way ANOVA and chi-square tests, were used to assess differences across groups. A p-value of <0.05 was considered statistically significant. Results: Overall, all physician groups exhibited limited adherence to guideline-recommended positional diagnostic and therapeutic maneuvers. However, ENT specialists and neurologists demonstrated relatively higher compliance, particularly in performing the Dix–Hallpike test, with 46.97% and 26.79% reporting “always” using the maneuver, respectively (p < 0.001, Cramér’s V = 0.22). Neurologists were the most consistent in conducting oculomotor examinations, with 73.68% reporting routine performance (p < 0.001, Cramér’s V = 0.35). Epley maneuver usage was highest among neurologists (86.36%) and ENT specialists (77.14%) compared to family physicians (50.60%) and GPs (67.50%) (p = 0.044). Physicians with 11–15 years of experience and >50 BPPV case exposures consistently showed a greater use of diagnostic maneuvers, repositioning techniques, and guideline-concordant medication use (betahistine 76.67%; p < 0.001). Continuing medical education (CME) participation and the avoidance of unnecessary imaging were also highest in this group (46.67% and 3.33%, respectively; p < 0.001). Conclusions: Significant inter-specialty differences exist in the management of BPPV in Saudi Arabia. Greater clinical experience and higher case exposure are associated with improved adherence to evidence-based practices. Targeted educational interventions are needed, particularly in primary care, to enhance guideline implementation. Full article

Background: Data accessibility remains a significant barrier in healthcare AI due to privacy constraints and logistical challenges. Synthetic data, which mimics real patient information while remaining both realistic and non-identifiable, offers a promising solution. Large Language Models (LLMs) create new opportunities to generate high-fidelity clinical conversations between patients and physicians. However, the value of this synthetic data depends on careful evaluation of its realism, accuracy, and practical relevance. Objective: To assess the performance of four leading LLMs: ChatGPT 4.5, ChatGPT 4o, Claude 3.7 Sonnet, and Gemini Pro 2.5 in generating synthetic transcripts of patient–physician interactions in plastic surgery scenarios. Methods: Each model generated transcripts for ten plastic surgery scenarios. Transcripts were independently evaluated by three clinically trained raters using a seven-criterion rubric: Medical Accuracy, Realism, Persona Consistency, Fidelity, Empathy, Relevancy, and Usability. Raters were blinded to the model identity to reduce bias. Each was rated on a 5-point Likert scale, yielding 840 total evaluations. Descriptive statistics were computed, and a two-way repeated measures ANOVA was used to test for differences across models and metrics. In addition, transcripts were analyzed using automated linguistic and content-based metrics. Results: All models achieved strong performance, with mean ratings exceeding 4.5 across all criteria. Gemini 2.5 Pro received mean scores (5.00 ± 0.00) in Medical Accuracy, Realism, Persona Consistency, Relevancy, and Usability. Claude 3.7 Sonnet matched the scores in Persona Consistency and Relevancy and led in Empathy (4.96 ± 0.18). ChatGPT 4.5 also achieved perfect scores in Relevancy, with high scores in Empathy (4.93 ± 0.25) and Usability (4.96 ± 0.18). ChatGPT 4o demonstrated consistently strong but slightly lower performance across most dimensions. ANOVA revealed no statistically significant differences across models (F(3, 6) = 0.85, p = 0.52). Automated analysis showed substantial variation in transcript length, style, and content richness: Gemini 2.5 Pro generated the longest and most emotionally expressive dialogues, while ChatGPT 4o produced the shortest and most concise outputs. Conclusions: Leading LLMs can generate medically accurate, emotionally appropriate synthetic dialogues suitable for educational and research use. Despite high performance, demographic homogeneity in generated patients highlights the need for improved diversity and bias mitigation in model outputs. These findings support the cautious, context-aware integration of LLM-generated dialogues into medical training, simulation, and research. Full article

This review paper addresses the design and testing of ultra-low temperature (ULT) freezers, highlighting their critical functions in various industries, particularly foods, medicine, and research. ULT freezers operating at temperatures of −86 °C and lower have come a long way with improvements in freezing technology, for instance, from traditional vapor compression systems to new multi-stage refrigeration technologies. This progress has added operational reliability and energy efficiency, essential for preserving delicate samples and facilitating groundbreaking research. The article deeply explores the contribution of refrigerants to ULT freezer efficiency and sustainability. With the use of chlorofluorocarbons (CFCs), previously reliant on them, being prohibited due to environmental concerns, the sector opted for environmentally friendly substitutes like hydrofluorocarbons (HFCs), natural refrigerants, and hydrofluoroolefins (HFOs). Regulatory compliance is ensured by rigid validation protocols to guarantee ULT freezers are safe and meet quality requirements without compromising the integrity of the stored material. In addition to their wide-ranging advantages, ULT freezers also have disadvantages, such as energy efficiency, incorporating automation, the integration of IoT and AI for proactive maintenance, and the development of environmentally sustainable refrigerants. Adequate management strategies, including regular employee training and advanced monitoring systems, are vital to counteract threats from temperature variations and reduce long-term diminished performance. Finally, subsequent innovations in ULT freezer technology will not only aid in research and medical initiatives but also support sustainable practices, ensuring their core role as beacons of innovation in preserving the quality of precious biological materials and increasing public health gains. Full article

Background: Traditional Male Circumcision (TMC) has been practiced in many parts of the world. However, the impact thereof on reducing HIV transmission is still unclear. This study aimed to examine the prevalence and determinants of TMC and the associated risk of HIV transmission in Lesotho. Method: Using data from the 2023–24 Lesotho Demographic and Health Survey, the analysis included a weighted sample of 3202 men aged 15–59 years. Missing data was addressed through multiple imputations, and multilevel logistic regression was used to assess the factors associated with TMC, incorporating intra-class correlation to evaluate cluster-level variation. Results: The findings revealed that 51.0% (95% CI: 49.3–52.7) of men in Lesotho had undergone TMC. Older men, particularly those aged 35 years and above, were more likely to be circumcised compared to younger men aged 15–24 years (AOR = 1.63; 95% CI: 1.46–1.86). Other individual-level factors positively associated with TMC included smoking, being married to one partner, previous sexual experience, and rural residence. Conversely, men with formal education, unknown or undisclosed HIV status, residing in the Berea or Maseru districts, and those from middle- or high-income households were less likely to undergo TMC. Conclusion: The study highlights significant variation in TMC practices across communities and identifies both individual and contextual factors influencing its uptake. These insights underscore the need for culturally sensitive, voluntary, and medically safe circumcision programs. Public health initiatives should consider these determinants when designing interventions to ensure a safer and more effective implementation of TMC in Lesotho. Full article

Peripheral nerve injuries represent a significant challenge in legal medicine, and their proper management and evaluation are at the intersection of clinical medicine, anatomical science, and legal medicine. In this review, we aimed to integrate current knowledge about the anatomy, physiology, clinical management, and paraclinical assessment of peripheral nerve injuries, targeted explicitly for medical–legal practice. We conducted a comprehensive review of the medical–legal evaluation framework needed to evaluate peripheral nerve injuries, with particular emphasis on anatomical variations, imaging techniques, and methods to assess the timing of injury. Peripheral nerve injuries should be analyzed using a complex approach, which includes anatomical characteristics, variants, microanatomy, physiopathology, imaging, and other paraclinical evaluations. The analysis of causation and timing of injury should be heavily based on objective criteria and should be performed using a reproducible, objective, and scientifically based approach. Full article

Background and Objectives: The accurate segmentation of pulmonary nodules in computed tomography (CT) remains a critical yet challenging task due to variations in nodule size, shape, and boundary ambiguity. This study proposes CAAF-ResUNet (Context-Aware Adaptive Attention Fusion ResUNet), a novel deep learning model designed to address these challenges through adaptive feature fusion and edge-sensitive learning. Materials and Methods: Central to our approach is the Adaptive Attention Controller (AAC), which dynamically adjusts the contribution of channel and position attention based on contextual features in each input. To further enhance boundary localization, we incorporate three complementary boundary-aware loss functions: Sobel, Laplacian, and Hausdorff. Results: An extensive evaluation of two benchmark datasets demonstrates the superiority of the proposed model, achieving Dice scores of 90.88% on LUNA16 and 85.92% on LIDC-IDRI, both exceeding prior state-of-the-art methods. A clinical validation of a dataset comprising 804 CT slices from 35 patients at the University Medical Center of Ho Chi Minh City confirmed the model’s practical reliability, yielding a Dice score of 95.34% and a notably low Miss Rate of 4.60% under the Hausdorff loss configuration. Conclusions: These results establish CAAF-ResUNet as a robust and clinically viable solution for pulmonary nodule segmentation, offering enhanced boundary precision and minimized false negatives, two critical properties in early-stage lung cancer diagnosis and radiological decision support. Full article

Wound healing remains a significant hurdle within the field of medical practice, especially concerning chronic and non-healing injuries. Conventional interventions, such as skin grafts, wound dressings, and biomaterials, offer structural support for the regenerated tissues but often lack the biological signaling cues essential for tissue regeneration. However, these approaches often lack the biological signals necessary to promote effective tissue repair. An emerging strategy involves incorporating cell-secreted proteins, known as the secretome, into biomaterials. The secretome contains bioactive elements such as cytokines, growth factors, and extracellular vesicles (EVs), which enhance the wound healing process. This review explores the potential of secretome-loaded biomaterials in modulating inflammation, promoting angiogenesis, and assisting in the remodeling of the extracellular matrix (ECM). Recent advancements in biomaterial engineering technology, such as 3-dimensional (3D) bioprinting, have improved the controlled delivery and bioactivity of secretome at the wound site. These gel-based biomaterials enhance wound healing by providing sustained bioactive molecule release, improving cell growth, and tissue repair. Despite these promising outcomes, limitations including variations in secretome composition and difficulties in large-scale production. Hence, secretome-loaded biomaterials offer a promising solution for wound healing, but further research is needed to optimize formulations, ensure stability, and validate clinical applications. Full article

Background and Objectives: Traditionally, we evaluate the size of a wound by using Opsite Flexigrid transparent film dressing, placing it over the wound, tracing the edges of the wound, and then calculating the area. However, this method is both time-consuming and subjective, often leading to varying results depending on the individual performing the assessment. In this study, our goal is to provide an objective method to calculate the wound size and solve variations in photo-taking distance caused by different medical practitioners or at different times, as these can lead to inaccurate wound size assessments. To evaluate this, we employed K-means clustering and used a QR code as a reference to analyze images of the same wound captured at varying distances, objectively quantifying the areas of 40 wounds. This study aims to develop an objective method for calculating the wound size, addressing variations in photo-taking distance that occur across different medical personnel or time points—factors that can compromise measurement accuracy. By improving consistency and reducing the manual workload, this approach also seeks to enhance the efficiency of healthcare providers. We applied K-means clustering for wound segmentation and used a QR code as a spatial reference. Images of the same wounds taken at varying distances were analyzed, and the wound areas of 40 cases were objectively quantified. Materials and Methods: We employed K-means clustering and used a QR code as a reference to analyze wound photos taken by different medical practitioners in the outpatient consulting room. K-means clustering is a machine learning algorithm that segments the wound region by grouping pixels in an image according to their color similarity. It organizes data points into clusters based on shared features. Based on this algorithm, we can use it to identify the wound region and determine its pixel area. We also used a QR code as a reference because of its unique graphical pattern. We used the printed QR code on the patient’s identification sticker as a reference for length. By calculating the ratio of the number of pixels within the square area of the QR code to its actual area, we applied this ratio to the detected wound pixel area, enabling us to calculate the wound’s actual size. The printed patient identification stickers were all uniform in size and format, allowing us to apply this method consistently to every patient. Results: The results support the accuracy of our algorithm when tested on a standard one-cent coin. The paired t-test comparing the first and second photos shot yielded a p-value of 0.370, indicating no significant difference between the two. Similarly, the t-test comparing the first and third photos shot produced a p-value of 0.179, also showing no significant difference. The comparison between the second and third photos shot resulted in a p-value of 0.547, again indicating no significant difference. Since all p-values are greater than 0.05, none of the test pairs show statistically significant differences. These findings suggest that the three randomly taken photo shots produce consistent results and can be considered equivalent. Conclusions: Our algorithm for wound area assessment is highly reliable, interchangeable, and consistently produces accurate results. This objective and practical method can aid clinical decision-making by tracking wound progression over time. Full article

Background: The rapid integration of artificial intelligence (AI) into medical education in developing nations necessitates that educators develop comprehensive AI competencies and readiness. This study explores AI competence and readiness among medical educators in higher education, focusing on the five key dimensions of the ADELE technique: (A) AI Awareness, (D) Development of AI Skills, (E) AI Efficacy, (L) Leanings Towards AI, and (E) AI Enforcement. Structured surveys were used to assess AI competencies and readiness among medical educators for the sustainable integration of AI in medical education. Methods: A cross-sectional study was conducted using a 40-item survey distributed to 253 educators from the Middle East (Saudi Arabia, Egypt, Jordan) and South Asia (India, Pakistan, Philippines). Statistical analyses examined variations in AI competency and readiness by gender and nationality and assessed their predictive impact on the adoption of sustainable AI in medical education. Results: The findings revealed that AI competency and readiness are the primary drivers of sustainable AI adoption, highlighting the need to bridge the gap between theoretical knowledge and practical application. No significant differences were observed based on gender or discipline, suggesting a balanced approach to AI education. However, ethical perspectives on AI integration varied between Middle East and South Asian educators, likely reflecting cultural influences. Conclusions: This study underscores the importance of advancing from foundational AI knowledge to hands-on applications while promoting responsible AI use. The ADELE technique provides a strategic approach to enhancing AI competency in medical education within developing nations, fostering both technological proficiency and ethical awareness among educators. Full article

Osteoarthritis (OA) is a multifactorial, degenerative joint disease that significantly impairs mobility and quality of life, especially among older adults. The growing aging population and increasing obesity rates are expected to increase the incidence and prevalence of OA. In the absence of Disease-Modifying Antirheumatic Drugs (DMARDs) for OA, current treatment strategies largely focus on symptom relief rather than disease modification. These symptomatic treatments often fail to account for the substantial inter-individual variability in drug response. Pharmacogenomics (PGx), the study of how genetic variation influences drug response, offers a promising approach to personalize OA therapy. This review explores the clinical and pharmacogenomic considerations of commonly used OA medications—acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), duloxetine, and tramadol—focusing on gene–drug interactions that influence efficacy, safety, and metabolism. Evidence-based recommendations from the Clinical Pharmacogenetics Implementation Consortium guidelines are discussed, where applicable, to highlight actionable genetic variants in very important pharmacogenes such as CYP2D6, CYP2C9, and other important drug-metabolizing encoding genes such as CYP2E1 and UGT1A6. While PGx data are not currently embedded in OA clinical treatment guidelines, their integration into clinical practice may enhance therapeutic outcomes and minimize adverse drug events. This review underscores the potential of PGx as a clinical tool in OA pain management, paving the way toward truly personalized medicine. Full article

Background and Objectives: Chronic wounds pose a significant challenge to healthcare systems, requiring long-term management and multidisciplinary approaches. The absence of a standardized national therapeutic protocol in Romania has resulted in inconsistent clinical practices, which in turn affect treatment efficacy and patient outcomes. The implementation of structured guidelines and the integration of regenerative therapies could enhance the management of chronic wounds. Materials and Methods: This study employs a cross-sectional observational design to assess the current management strategies among physicians treating chronic wounds and to identify variations in treatment approaches. A 37-question questionnaire was distributed among plastic surgeons, general surgeons, vascular surgeons, and dermatologists via Google Forms. The data collection period spanned one month, resulting in a total of 240 responses from medical centers in Bucharest, Romania. Results: The study found that most physicians treated several cases per week (40.8%) of delayed healing wounds, with the most frequent types being bedsores (57.5%) and diabetic (58.3%) or venous ulcers (55%). Challenges in wound care included patient reluctance, financial constraints, and the psychological burden on caregivers. The most relevant decision factor for surgical treatment was wound stage (86.7%). Most physicians used an initial conservative approach in wound care (52.5%) or did not have a standard approach (44.2%). Around a quarter of respondents (25.8%) used PRP as a treatment method, considering it to have moderate effectiveness (51.6%). The most important factor for encouraging PRP usage was having the necessary equipment for the procedure (72.5%). The most frequently considered benefit in the case of implementing a treatment protocol was increased treatment efficacy (62.5%). Physicians were also highly interested in the use of a standardized treatment protocol (40%). Approximately 41.7% of the physicians expressed a very high interest in having a standardized diagnostic system for chronic wounds. Conclusions: This study highlights that wound care practices remain variable and that the decision-making process is often challenging. There is a moderate belief in the effectiveness of PRP, suggesting that logistical barriers need to be addressed to facilitate access to it. Therapeutic protocols were seen as key to improving care efficacy and consistency, therefore pressing the need for national strategies that support protocol development. Full article

Background/Objectives: Effective communication between healthcare professionals and patient caregivers is paramount in the surgical waiting area, particularly during periods of heightened stress and emotional vulnerability. Globally, communication practices exhibit considerable variability, from traditional face-to-face interactions to integrating advanced digital technologies. Despite innovations, a comprehensive understanding of the impact of diverse communication strategies on patient caregiver satisfaction remains underdeveloped. This scoping review was designed to systematically map the existing literature on healthcare communication practices and identify strategies that may influence satisfaction among patient caregivers. Methods: A thorough search of multiple databases—Scopus, PubMed, CINAHL, Embase, ProQuest, Web of Science, the Cochrane Library, and clinical trial registries—was conducted. Only studies published in English or those for which an English full text was accessible were included. Eligible studies were those undertaken in hospital settings, including operating theaters, surgical units, surgical waiting areas, postoperative intensive care units, emergency departments, and other clinical areas focusing on patient caregivers. The review adhered to the methodological framework recommended by the Joanna Briggs Institute for scoping reviews and was reported following the most recent PRISMA-ScR guidelines. Results: Ultimately, five studies met the inclusion criteria. The selection process involved a structured search utilizing Medical Subject Headings (MeSH), keywords, and index terms, supplemented by manual reference list screening. Initial screening was performed based on titles and abstracts, followed by full-text evaluation using a standardized selection form. Data extraction focused on the communication methods, study designs, and outcomes related to patient caregiver satisfaction. The findings are synthesized narratively and presented through tables and figures, offering a comprehensive overview of global communication practices and their influence on patient caregiver satisfaction in surgical environments. Across the five included studies, digital communication interventions such as SMS, mobile apps, or video updates reported improved patient caregiver satisfaction (e.g., 70.8% in Canada and 97% in Switzerland) and also reduced patient caregiver anxiety (e.g., STAI score ≥ 44) in 74.2% of Ethiopian patient caregivers. Worldwide evidence highlights the practical importance of tailored digital communication practices to support providing timely and accessible information to patient caregivers, while also revealing gaps linked to insurance status, digital literacy, and various communication approaches in healthcare systems. Conclusions: The five studies included showed considerable variation in communication practices across surgical settings. The main findings reveal that structured, timely, and transparent communication, mainly via digital tools such as SMS updates and mobile applications, enhanced patient caregiver satisfaction and alleviated their emotional distress too. Nevertheless, gaps were identified in postoperative communication, and challenges, such as technological accessibility, digital literacy skills of patient caregivers, and inconsistent methods for measuring satisfaction outcomes, were noted across studies. This scoping review identified the different types of healthcare communication practices adopted globally in surgical care settings and also demonstrated their influence on patient caregiver satisfaction. Traditional and digital communication practices both have their significant impact on patient caregiver experiences in surgical healthcare settings, focusing more on timely and consistent real-time updates and culturally sensitive information. Addressing the existing communication gaps and having tailored communication approaches to specific contexts may lead to improved patient caregiver support and surgical outcomes. Full article

Zn-Ag alloys are deemed extremely promising materials for manufacturing biodegradable medical implants. Nonetheless, their practical applications are still constrained by inferior mechanical properties. To tackle this issue, Zn-0.5Ag alloy was alloyed with Mg (0.2 wt.%) and processed by combined equal-channel angular pressing (ECAP) and rolling, with different rolling reductions (40%, 60%, and 75%). ECAP-processed Zn-0.5Ag-0.2Mg alloy exhibited superior mechanical properties to its as-cast counterpart. Subsequent rolling of 40% further enhances the mechanical performance of ECAP-processed Zn-0.5Ag-0.2Mg alloy, with yield strength (YS), ultimate tensile strength (UTS), and elongation (EL) reaching 255 MPa, 309 MPa, and 52%, respectively, surpassing the application requirements. As the rolling reduction increased to 60% and further to 75%, YS and UTS declined, whereas EL rose continuously. The underlying mechanisms for the variation in strength and ductility were elucidated based on microstructure evolution analysis through optical microscopy (OM), scanning electron microscopy (SEM), and electron backscatter diffraction (EBSD) characterizations. Full article

Background and Objective: Innovation is a key enabler of patient-centered care in cardiology, with new medical devices and digital health technologies offering the potential to improve outcomes and efficiency. However, the evaluation of these innovations poses challenges for clinicians, regulators, and procurement stakeholders, particularly within the complex European healthcare landscape. This review aims to explore the current state of health technology assessment (HTA) for cardiology-related medical devices in Europe, offering a clinical perspective. Material and Methods: Three independent scoping reviews were conducted following the PRISMA-ScR guidelines. Keywords included “innovation”, “health technology assessment”, and “cardiology”. The search was supplemented by the relevant literature on European HTA policies, regulatory directives, and emerging technologies. Results: The review identified three central themes: (1) the evolving role of clinicians in HTA processes, (2) the integration of innovative technologies such as digital tools and artificial intelligence within HTA frameworks, and (3) the considerable variation in HTA practices and policies across EU member states. Conclusions: HTA in Europe is undergoing a transformation, with increasing emphasis on interdisciplinary collaboration and frameworks that support innovation. While the goal of harmonization across the EU remains a work in progress, new regulatory efforts, such as the HTA Regulation (HTAR), offer promising avenues for aligning clinical practice with evidence-based assessment and reimbursement decisions. 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