Search Results (655)

In Italy, access to public dental care is limited, and the characteristics of patients seeking hospital-based services are poorly described. A single-centre retrospective cross-sectional study was conducted, including all individuals attending their first appointment at the public Dental Clinic of Bari University Hospital (Southern Italy) between 1 January and 31 December 2023. Demographic and clinical variables, comorbidities, reasons for consultation, and travel distance from residence were retrieved from electronic records and analysed. Among 1361 patients (49% male; mean age 47.8 ± 23.3 years), most attended for oral surgery (35%) or oral pathology (17%), while other specialties accounted for the remaining visits. Many patients presented with multiple systemic conditions, particularly cardiovascular and metabolic diseases; however, a sizeable proportion were young, apparently healthy individuals who did not meet national eligibility criteria for publicly funded dental care. The dental clinic served a wide catchment area, including referrals from other regions. Documentation on education and behavioural risk factors was frequently incomplete. Overall, these findings show that complex oral medicine and oral surgery needs are concentrated in a small number of hospital clinics and support the expansion of Italian public dental services and improvements in routine data collection. Full article

This paper presents the design, implementation and evaluation of an agentic virtual assistant (VA) for a medical clinic, combining large language models (LLMs) with retrieval-augmented generation (RAG) technology and multi-agent artificial intelligence (AI) frameworks to enhance reliability, clinical accuracy and explainability. The assistant has multiple functionalities and is built around an orchestrator architecture in which a central agent dynamically routes user queries to specialized tools for retrieval-augmented question answering (Q&A), document interpretation and appointment scheduling. The implementation combines LangChain and LangGraph with interactive visualizations to track reasoning steps, prompts using Gemini 2.5 Flash defines tool usage and strict formatting rules, maintaining reliability and mitigating hallucinations. Prompt engineering has an important role in the implementation and thus, it is designed to assist the patient in the human–computer interaction. Evaluation through qualitative and quantitative metrics, including ROUGE, BLEU, LLM-as-a-judge and sentiment analysis, confirmed that the multi-agent architecture enhances interpretability, accuracy and context-aware performance. Evaluation shows that the multi-agent architecture improves reliability, interpretability and alignment with medical requirements, supporting diverse clinical tasks. Furthermore, the evaluation shows that Gemini 2.5 Flash combined with clinic-specific RAG significantly improves response quality, grounding and coherence compared with earlier models. SBERT analyses confirm strong semantic alignment across configurations, while LLM-as-a-judge scores highlight the superior relevance and completeness of the 2.5 RAG setup. Although some limitations remain, the updated system provides a more reliable and context-aware solution for clinical question answering. Full article

Novel smartphone-based methods offer an accessible and promising alternative to traditional tools for performing clinical gait assessments in total knee arthroplasty (TKA) patients. The OneStep app uses the smartphone’s sensors and proprietary machine learning algorithms to measure gait parameters of walking trials, including stride length, step length, step width, gait velocity, cadence, and double stance time. The objectives of this study were to (1) validate the reliability of the OneStep app against a traditional motion capture (MoCap) system and (2) use the OneStep app to measure functional recovery of TKA patients pre- and post-operatively. For Objective 1, walking trials using both OneStep and MoCap were conducted with N = 17 healthy adults (9M/8F, aged 22.29 ± 2.08 years). Results showed that of all gait variables, cadence (p < 0.0001) and gait velocity (p < 0.0001) exhibited the strongest correlations between methods indicated by their linear regression results, and step width had the weakest correlation between methods (p = 0.67). For Objective 2, OneStep gait measurements were collected for N = 11 TKA patients (5M/6F, aged 70.91 ± 6.56 years) at their pre-operative, 2-weeks post-operative, and 6-weeks post-operative appointments. Results showed marked declines in gait properties (decreased stride length, step length, cadence, and gait velocity and increased step width and double stance time) of participants relative to pre-operative values at 2-weeks pre-operative, and an increase/surpassing of pre-operative gait measurements 6-weeks post-operative. The greatest differences were observed in gait velocity between pre-operative and 2-weeks post-operative (p = 0.011) and 2-weeks post-operative to 6 weeks post-operative (p = 0.005). Full article

Objective: The objective of this study is to synthesize and critically appraise how artificial intelligence (AI) is being integrated into oral and maxillofacial surgery (OMFS). This review’s novel contribution is to jointly map clinical applications (diagnostics, virtual surgical planning, intraoperative guidance) and operational uses (triage, scheduling, documentation, patient communication), quantifying evidence and validation status to provide practice-oriented guidance for adoption. Study Design: A narrative review of the recent literature and expert analysis, supplemented by illustrative multicenter implementation data from OMFS practice, was carried out. Results: AI demonstrates high performance in radiographic analysis and virtual planning (up to 96% predictive accuracy and sub-millimeter soft-tissue simulation error), with clinical reports of shorter planning times and more efficient patient communication. Early deployments in OMFS clinics have increased appointment bookings, while maintaining high patient satisfaction, and reduced the administrative burden. Remaining challenges include data quality, explainability, and limited multicenter and pediatric validation, which constrain generalizability and require clinician oversight. Conclusions: AI offers substantive benefits across the OMFS care continuum—improving diagnostic accuracy, surgical planning, and patient engagement while streamlining workflows. Responsible adoption depends on transparent validation, data governance, and targeted training, with attention to cost-effectiveness. Immediate priorities include standardized reporting of quantitative outcomes (e.g., sensitivity, specificity, time saved) and prospective multicenter studies, ensuring that AI augments—rather than replaces—human-centered care. Full article

People living in rural communities are typically underserved by public transportation services and face challenges in accessing healthcare, jobs, stores, and other destinations. Understanding the lived experiences of people who use public transportation in rural communities can help to inform a more equitable transportation system. This qualitative study gathered the perspectives of community health center employees about the public bus system for Hawai‘i Island, a rural county in the United States. Using a community-engaged research approach, the evaluation team interviewed 10 employees through either in-person small group interviews or online individual interviews between April and July 2023. Transcripts were coded and analyzed using a thematic analysis approach. While all study participants were selected for their interest in commuting to work by bus, most believed the bus was not a reliable or convenient option. Participants shared their experiences about not being able to rely on the bus schedule, feeling unsafe while walking to bus stops or waiting for the bus, and other barriers to using the bus system. Participants also shared their insights about how a reliable bus system would benefit community health center patients who needed transportation to more than just their medical appointments, but also to places like pharmacies, laboratory services, and grocery stores. These findings can be used to initiate discussions around the ways that community health centers can further address transportation as a social determinant of health and inform transportation providers about how to best plan and invest in transportation infrastructure and services to meet the needs of rural populations. Full article

(1) Background: Indwelling pleural catheters (IPCs) with vacuum-based drainage can cause pain, especially in patients with a non-expandable lung (NEL). This evaluation assessed whether the Passio™ digital drainage system offers a viable alternative for patients experiencing pain during IPC drainage. (2) Methods: All IPC patients between November 2023 and April 2024 completed questionnaires assessing pain severity on a 10-point visual analogue scale (VAS) at four points during drainage. Patients reporting drainage-related pain at the 2-week post-IPC appointment had their existing valve replaced with a Passio™ valve (n = 5). (3) Results: Twenty-seven patients (59% male) were included in this analysis. The mean VAS scores for pain with a standard vacuum bottle were not statistically different at mid-drainage and the end of drainage compared with pre-drainage. Patients who experienced pain with the vacuum bottle (n = 5) had higher mean VAS scores at mid-drainage (51.68 mm ± 16.29; p = 0.13), end of drainage (46.68 mm ± 19.45; p = 0.19), and 10 min post-drainage (61.38 mm ± 9.81; p = 0.06) compared with pre-drainage (9.16 mm ± 4.01). Post-Passio™ valve replacement (n = 5), patients had a lower VAS pain score mid-drainage (20.15 mm ± 9.34; p = 0.25), end of drainage (27.28 mm ± 12.69; p = 0.84), and 10 min post-drainage (14.81 mm ± 3.33; p = 0.0079) when compared with vacuum bottle drainage. There were no complications with the Passio™ drainage system. (4) Conclusions: Controlled pleural drainage using a digital drainage device such as Passio™ may have a role in IPC patients who experience pain with vacuum bottle drainage, especially in those with an NEL. Full article

Introduction: This document presents recommendations of the Polish Respiratory Society on discharge instructions following hospitalization for an exacerbation of chronic obstructive pulmonary disease (COPD). Methods: The Delphi method was applied to achieve consensus among independent experts. Results: Fourteen recommendations were formulated. Experts emphasized that discharge summaries require clear graphical and editorial design to ensure readability for both patients and healthcare professionals. The involvement of a multidisciplinary team was recommended to provide coherent and comprehensive documentation. Discharge instructions should be discussed with the patient during hospitalization and supplemented with standardized educational materials provided separately. These materials should cover inhaler technique, smoking cessation, physical activity, pulmonary rehabilitation, and vaccination. For patients with respiratory failure, home oxygen therapy or non-invasive ventilation must be addressed. Discharge recommendations should highlight modifications in baseline COPD treatment and management of comorbidities. A personalized action plan for future exacerbations is essential, and dietary consultation is advised. Finally, discharge summaries should specify follow-up appointments and include prescriptions for inhaled medications. Conclusions: The Polish Respiratory Society recommends that discharge instructions be provided to all patients hospitalized for a COPD exacerbation. Full article

Background/Objectives: In low-resource settings, diagnostic delays and limited specialist access worsen health inequalities, making hypertensive disorders of pregnancy (HDPs) defined by new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of gestation, with or without proteinuria, a major cause of maternal morbidity and mortality. This study evaluated the diagnostic effectiveness of a rural-applicable clinical model for detecting HDPs in a real-world population from Hospital General San Felipe (Tegucigalpa, Honduras). Methods: A cross-sectional diagnostic accuracy study was conducted on 147 consecutive pregnant women in February 2025. Clinical documentation from the initial appointment defined HDP. We modeled HDP risk using penalized logistic regression and common factors such maternal age, gestational age, blood pressure, BMI, primary symptoms, semi-quantitative proteinuria, and medical history. Median imputation was utilized for missing numbers and stratified five-fold cross-validation assessed performance. We assessed AUROC, AUPRC, Brier score, calibration, and operational utility at a data-driven threshold. Results: Of patients, 27.9% (41/147) had HDP. The model had an AUROC of 0.614, AUPRC of 0.461 (cross-validation averages), and Brier score of 0.253. The threshold with the highest F1-score (0.474) had a sensitivity of 0.561, specificity of 0.679, positive predictive value of 0.404, and negative predictive value of 0.800. HDP had higher meaning systolic/diastolic/mean arterial pressure (130.7/82.9/98.9 vs. 120.5/76.1/90.9 mmHg) and ordinal proteinuria (0.59 vs. 0.36 units). Conclusions: The model had moderate but clinically meaningful discriminative performance using low-cost, commonly obtained variables, excellent calibration, and a good negative predictive value for first exclusion. These findings suggest modification of predictors, a larger sample size, and clinical usefulness assessment using decision curves and process outcomes, including quick referral and prophylaxis. This approach aligns with contemporary developments in the 2023–2025 European Society of Cardiology (ESC) and 2024 American Heart Association (AHA) guidelines, which emphasize earlier identification and risk-stratified management of hypertensive disorders during pregnancy as a cornerstone of women’s cardiovascular health. Full article

Background/Objectives: This study explores the perceptions, experiences, and expectations of pediatric healthcare professionals regarding the implementation of virtual visits (VVs) in routine pediatric practice. Methods: Using the Consolidated Framework for Implementation Research (CFIR) to analyze individual, organizational, and contextual factors influencing the adoption of pediatric virtual visits, we conducted a descriptive cross-sectional survey distributed nationwide among pediatricians, pediatric nurses, and residents. Results: A total of 308 Spanish healthcare professionals correctly completed the REDCap survey and were included in the analysis. The mean age was 44.3 years, and respondents represented both hospital-based (55.8%) and primary care professionals (44.2%). Overall, 74.8% had previous experience with telephone consultations, while only 11% had performed virtual visits. Most professionals believed VVs could be useful in primary care (81.3%) and hospital out-patient settings (73.9%), especially for follow-up appointments, communication of test results, and chronic-care monitoring. VVs were perceived as more appropriate for older children and adolescents than for infants. Major concerns included poor internet connection (52.6%), and data security (37.4%); however, a particularly relevant finding was the low confidence in using digital tools, particularly among older professionals. Comparative analyses by age and workplace setting identified differences in interest, perceived barriers, and access to technical resources. Hospital-based clinicians reported greater interest in adopting VVs and better access to technological resources compared with primary care professionals. The professionals’ age was inversely associated with interest in VVs. Notably, 72.6% of respondents expressed interest in receiving specific VV training, and nearly 90% believed virtual visits should be offered in their workplace. Conclusions: These findings show a high overall acceptance of VVs but also underline persistent barriers related to infrastructure, digital literacy, and clinical applicability in younger children. Addressing these obstacles through training, improved equipment, and clear clinical protocols will be essential for the successful implementation of pediatric VV programs. Full article

Introduction: Vaccination has led to significant decreases in mortality over the last century but requires high levels of uptake to be successful in reducing a wide range of infectious diseases in communities. Vaccine hesitancy is on the rise in the United States with most adults not receiving all recommended vaccinations, and childhood vaccinations are declining. Living in a rural community with a lack of access to resources may further limit uptake of vaccines. Identifying strategies to enhance vaccine confidence and access may assist in increasing vaccine uptake. The purpose of this study was to describe the landscape of existing community-based vaccination efforts and assess the components of a successful community-based vaccination program in rural eastern North Carolina. To reach this purpose, we conducted qualitative interviews with those involved in running community-based vaccine education and navigation programming in rural eastern North Carolina.” Methods: Researchers conducted 25 semi-structured interviews with participants involved in vaccination efforts in three rural counties in Eastern North Carolina. Interviews were transcribed, coded in NVivo version 14, and analyzed using thematic analysis to synthesize insights from participants. Results: Study participants held manager or coordinator roles in area health agencies, clinics, and pharmacies. Reported strengths of current vaccine efforts in Eastern North Carolina included patient education, strong partnerships between organizations providing vaccines, and ability to engage community members. Successful vaccine efforts have engaged participants through social media, flyers, trusted leaders, and the provision of convenient vaccine appointments. Areas for improvement in vaccine efforts included engaging a wider audience at vaccine events, building trust in vaccines among community members, and expanding vaccine education for hard-to-reach populations. Participants supported the development of a proposed community-based education and navigation program and felt that community members would be interested. Identified challenges included low participation due to vaccine hesitancy which could be overcome through incentives and delivery from trusted individuals. Conclusions: We found that there is still a need for trust building, education, and patient engagement within the landscape of existing community-based vaccination efforts for vulnerable populations in rural eastern North Carolina. Study participants indicated support for the development of a vaccine education program and researchers determined the project to be feasible. Based on the results of this study, researchers developed and implemented an integrated vaccine education and navigation program in Eastern North Carolina. Full article

Glaucoma is one of the most common causes of irreversible visual impairment world wide. Providing low vision rehabilitation (LVR) services is a primary mode of support for patients with permanent vision loss. This retrospective, cross-sectional study evaluated the rate at which patients with severe open-angle glaucoma (OAG) were referred for LVR services at an academic medical center. Patient demographics, glaucoma severity, appointment history, performance on visual field (VF) testing, presenting visual acuity (VA), and change in best-corrected visual acuity (BCVA) after low vision refraction were abstracted from the electronic record and summarized by using descriptive statistics. Logistic regression analysis was used to assess the relationship between study variables and the likelihood of referral for LVR evaluation. Out of 522 patients with severe OAG, 88% of whom qualified as having low vision, 14 were referred for an LVR evaluation (2.7%). Referrals were most strongly associated with VA (adjusted odds ratio [aOR], 7.20; 95% confidence interval [CI], 2.11–24.64, p = 0.001) but not glaucoma-associated VF loss (aOR, 0.90; 95% CI, 0.24–3.37, p = 0.876). Thirteen of 14 patients referred for LVR completed visits (93%). More than one-third of those patients improved in their better-seeing eye after a low vision refraction, gaining an average of −0.18 ± 0.24 logMAR (half gaining ≥2-lines of BCVA). Patients with severe OAG are at risk of progressive visual disability from their eye disease. We found, however, that the majority of these patients were not referred to LVR services, despite meeting eligibility criteria and growing evidence demonstrating their potential benefit. Full article

Chronic kidney disease (CKD) is estimated to affect 843.6 million people, accounting for more than 10% of the world’s population, making it a serious public health issue. Dietary therapy is important for suppressing CKD progression risk factors such as hypertension. Fruits granola (FGR), which is rich in dietary fiber, including β-glucan and polyphenols, is expected to contribute to improving the intestinal environment and providing anti-inflammatory effects. We previously reported that FGR consumption improves blood pressure and the intestinal environment in hemodialysis patients. However, the safety and efficacy of FGR for patients with moderate CKD remain unclear. Therefore, we examined the effects of FGR by replacing the breakfast of 24 patients with moderate CKD at least 5 days per week over a total of 2 months. Patients with moderate CKD who were attending outpatient appointments at the Department of Nephrology at Juntendo University Hospital and whose condition was stable were included. Patients with cancer or poor nutritional status were excluded from this study. The results revealed lower systolic blood pressure, low-density lipoprotein cholesterol (LDL-C) levels, and LDL-C/HDL-C ratios after FGR intake. Furthermore, N-acetyl-β-D-glucosaminidase (NAG), a marker of renal tubular damage, was also reduced. Regarding the intestinal environment, improved bowel movements and stool quality were observed. Based on the results of this FGR intervention study, consuming dietary fiber, which is often deficient in moderate CKD patients, may have contributed to reducing risks for cardiovascular disease and urinary tubular dysfunction through FGR intake. Full article

Introduction: Infrared thermography (IRT) is a non-invasive, non-ionizing imaging modality capable of rapidly capturing surface temperature variation. In dentistry, particularly orthodontics and TMD evaluation, IRT may serve as a valuable complementary tool to be added in conventional diagnostic protocols. Objective: Correlate possible relationships between thermographic findings of orofacial structures and cephalometric landmarks. Methods: An infrared imaging camera, FLIR^® i7, was used to record the regions of interest, correspondent to the temporal, masseter and orbicular oris muscles, in adolescents (n = 22). Bilateral temperature differences were considered as thermal asymmetries with a conventional threshold of 0.3 °C to distinguish an eventual hyperactivity or hyperfunctions of detrimental structures. The Trevisi cephalometric parameters that were taken into consideration for the study were SNA, SNB, ANB, OccltoSn, Wits relation to base and Molar/canine classes. Results: Most of the participants showed a normal temperature difference ΔΤ for the upper and lower orbicular oris muscle, right vs. left, 96% and 92%, respectively. The other ROIs presented a mixed pattern of thermal asymmetries; however, no statistically significant differences were found when crossed with the cephalometric landmarks. Conclusions: Asymmetrical patterns of infrared thermography can aid on the diagnosis and treatment plan of an orthodontic appointment, since the actual stability of pos-orthodontic treatment is highly dependent on the muscular activity of the tongue and lips, in particular when the patient has atypical swallowing. Our findings suggest that this technique can be used to quantify anatomical landmarks relevant to craniofacial morphology in specific populations, particularly at ages where muscular functional activity is strongly correlated with dentoskeletal development. Full article

Background: Chronic pain (CP) is one of the biggest burdens for health systems across the globe. It frequently presents in conjunction with comorbidities and considerable challenges for the maintenance of homeostasis and well-being. The lack of long-term effective treatments requires further attention and innovative approaches from the health care community. The present observational study aims to prove the feasibility of a breathing protocol focused on long exhalations (LEx) as a complementary treatment for CP populations. Methods: Eighteen CP patients (nine men and nine women) were selected for this observational pilot study. The inclusion criteria were having pain for more than 3 months, not having any previous experience with breathing exercises and not having a clinical diagnosis for the condition suffered. In addition to the usual physiotherapy care, the participants were trained in breathing techniques and the effects of LEx. Before each appointment, the Numeric Pain Rating Scale (NPRS), Pain Catastrophising Scale (PCS) and exhalatory times were registered. The data analysis consisted of a repeated measures ANOVA and a Pearson Correlation Coefficient. Results: A total of 18 participants completed the breath intervention and the assessments. All participants improved their exhalation times by 4.78 s (SD = 3.19) or 64% (F = 45.62, p < 0.001) and their pain scores: NPRS by 2.55 units (SD = 2.2) or 47% (F = 34.19, p < 0.001); and PCS by 11.34 units (SD = 16.05) or 33% (F = 24.05, p < 0.001). There was a moderate positive correlation (r = 0.49, p = 0.05) between exhalation times and NPRS. Conclusions: Breathing techniques focused on LEx in combination with the usual physiotherapy care are a feasible pain management protocol to reduce subjective pain perception and pain catastrophizing scores. Long-term studies with bigger samples might benefit from the inclusion of accurate and reproducible measures for exhalation times. Full article

Background/Objectives: Late presentations of advanced hepatocellular carcinoma (HCC) indicate a lack of detection of underlying cirrhosis and a need to identify clinical and socioeconomic risk factors contributing to early-stage HCC recognition. This study tested associations between early diagnostics of HCC and demographic, socioeconomic, clinical, and healthcare-related indicators. Methods: A retrospective analysis of clinical data accumulated between February 2018 and February 2024 was completed at a quaternary care centre (South Australia). Results: We identified 388 cases of newly diagnosed HCC during a six-year period. There were 131 (33.7%) patients with early-stage (Barcelona clinic liver cancer (BCLC) stage 0–A) and 257 (66.3%) patients with late-stage (BCLC B–D) HCC. Late-stage HCC was found in 66.3% of patients, with half of the cohort not having a diagnosis of cirrhosis at the time of HCC detection. A retrospectively calculated Fibrosis Index (FIB-4) of >3.25 was present in nearly half of patients with newly diagnosed HCC with no prior diagnosis of cirrhosis. Engagement with healthcare (p < 0.05), a history of liver cirrhosis (p < 0.001), and gastroenterologist-led care with surveillance programmes (p < 0.001) was associated with early-stage presentation and curative treatment. Late-stage HCC was associated with male sex (p = 0.041), failing to attend appointments (p < 0.001), and liver function tests ordered by general physicians (p = 0.002) or non-gastroenterologist specialists (p = 0.023). Logistic regression analysis indicated that engaging in a surveillance programme, assessment by a gastroenterologist, and Model for End-Stage Liver Disease scores were important factors contributing to early detection of HCC; the area under the curve for this model on the ROC analysis was 0.892 (95% CI 0.855–0.929). Conclusions: Better cirrhosis detection is required, given that 60% of patients had a retrospectively calculated FIB-4 > 3.25. Routine use of non-invasive scores by all healthcare providers may increase engagement with surveillance and improve HCC screening. Full article