Search Results (830)

Background: Achieving breast symmetry is an important aesthetic goal following reconstruction post-mastectomy; however, little is known about women’s awareness, attitudes, and barriers regarding Contralateral Breast Symmetry Procedures (CBSP) in Jordan. Objectives: To assess awareness, perceptions, and barriers toward contralateral breast symmetry procedures among breast cancer survivors who underwent reconstruction at King Hussein Cancer Center. Methods: A cross-sectional study was conducted from July to Oct 2025 at KHCC, among 314 women diagnosed with breast cancer who had post-breast reconstruction. Data were collected using a structured Arabic questionnaire, which was developed based on existing literature, validated by an expert panel, and piloted on 10 women for clarity and reliability. The final tool demonstrated acceptable internal-consistency (Cronbach’s α = 0.712). The questionnaire captured sociodemographic and clinical data and detailed knowledge, attitudes, and barriers related to CBSP. Descriptive statistics summarized the data. Results: Participants’ mean age was 45.8 years; the majority were married (83.8%) and held university degrees (65.6%). Most reconstructions used silicone implants (94.6%). Only 6.4% had undergone CBSP, primarily delayed breast augmentation or mastopexy, with 75% reporting satisfaction. Awareness of CBSP was limited (37.9%), and less than one-third had discussed CBSP options with their surgeon or knew about insurance coverage. While 82.5% valued symmetry for body image, 31.5% viewed it as unnecessary after cancer recovery. Main barriers included satisfaction with current appearance (48.1%), fear of additional surgery (32.2%), financial constraints (37.3%), and lack of physician counseling (27.1%). Trust in medical team recommendations was high (89.2%). Conclusions: Contralateral breast symmetry procedures are under-recognized and infrequently pursued, primarily due to limited awareness, financial concerns, and insufficient counseling. Focused education and enhanced surgeon–patient communication are essential to support women’s aesthetic and psychological needs after reconstruction in Jordan. Full article

Background/Objectives: Benzodiazepines (BZDs) are used routinely in cases requiring sedation for anxiety, insomnia, and procedures that require pain management, and daily use of these agents may extend over several months; therefore, monitoring patients is essential to reduce the risk of developing dependence. However, the high patient volume in pain and palliative-care settings often limits physicians’ ability to both conduct consultations and perform comprehensive evaluations. In this context, the pharmacist plays a key role in supporting patient care by contributing professional activities that enhance patient well-being, such as conducting systematic reviews of electronic medical records. This pharmacist-led EMR assessment enables the identification of benzodiazepine dependence patterns and supports a more robust epidemiological evaluation within the institution. Methods: A descriptive observational study (January 2022–May 2025) using electronic medical records and prescription data was conducted. Consecutive adults with an active BZD prescription and a documented BDEPQ-MX (Benzodiazepine Dependence Questionnaire, Mexican version) were included. Outcomes were BDEPQ-MX categories (No dependence; Pleasurable effects; Perceived need; Dependence) and a binary endpoint was stablished as “any dependence” (either scored in Perceived need or Dependence category) vs. No dependence (either scored as No dependence or Pleasurable effects categories). Group comparisons used χ², Student’s t, and one-way ANOVA. A logistic regression modeled any dependence; a general linear model (GLM) examined the BDEPQ-MX total score. Results: Of 181 complete cases, BDEPQ-MX categories were No dependence 33.2% (60/181), Pleasurable effects 7.2% (13/181), Perceived need 17.1% (31/181), and Dependence 42.5% (77/181); hence, 59.7% met “any dependence.” Women comprised 67.4% overall. Compared with No dependence, the any-dependence group had higher comorbidity (83.3% vs. 65.8%, p = 0.006) and markedly greater duration of BZD use (months) (22.6 ± 11.5 vs. 5.9 ± 4.9, p < 0.001), with no difference in daily dose (p = 0.6). Benzodiazepine medications shifted toward alprazolam in dependence (38.9% vs. 20.5%, p = 0.009) and away from clonazepam (43.5% vs. 58.9%, p = 0.042). In the adjusted model, the male sex was associated with lower odds of any dependence (aOR 0.29, 95% CI 0.11–0.76; p = 0.013), while the duration of BZD use (per month) increased the odds (aOR 1.32, 1.20–1.45; p < 0.001). In the GLM, the duration showed the largest effect on BDEPQ-MX total (F = 203.26; p < 0.001; partial η² = 0.545). Conclusions: In this outpatient pain and palliative-care population, benzodiazepine-related dependence phenomena were common: 59.7% of patients met the criteria for dependence based on the pharmacist-led EMR review. The involvement of the pharmacist was essential, as this systematic evaluation would have been difficult to perform within routine medical consultations. The pharmacist’s contribution enabled a detailed epidemiological characterization, revealing that the exposure duration—more than daily dose—was the principal, modifiable correlate of dependence, and that alprazolam was disproportionately represented in the higher-dependence categories. These findings underscore the value of pharmacist-supported surveillance to identify and measure BZD dependance. Full article

Background: Diagnosing physical and mental health issues in individuals with profound intellectual and multiple disabilities (PIMD) often proves challenging, as these patients are unable to speak for themselves. Caregivers’ tacit knowledge (TK) refers to interpreting non-verbal signs, and is difficult to communicate with physicians. As limited research exists on physicians’ perspectives, we aimed to explore how intellectual disability physicians (ID physicians) perceive and value caregivers’ TK. Methods: Semi-structured interviews with ID physicians (n = 10), focusing on their perceptions and experiences with caregivers’ TK in medical care for people with PIMD, were analyzed thematically with an interpretive approach to identify key patterns and insights. Results: ID physicians perceived caregivers’ TK as a critical ability to pick up subtle signs and irregularities or as a deep sensing something is wrong, with the latter being more difficult to communicate. They understood the importance of TK for diagnostic cues and of collaborative relationships to explicate TK. Conclusions: We describe how integrating caregivers’ TK with medical knowledge relies on trust and partnership. Moreover, we discuss how to overcome communication barriers and to improve medical care in co-production with caregivers in order to enhance the physical and mental well-being of people with PIMD. Full article

Background: Digitalisation is transforming medical education, but its integration into ultrasound training remains limited. This study evaluates the needs of students and physicians regarding digitally supported ultrasound education. Materials and Methods: A multi-year cross-sectional study (2017–2022) employed two standardised questionnaires. The first assessed the perceived relevance of ultrasound in medical education, the desirability of compulsory teaching, and the integration of digital media and case-based learning. The second explored user-centred requirements for e-learning formats, including functionality, multimedia design, usability, interactivity, and financing, as well as current use of digital devices and reference materials. Data were collected using dichotomous and 7-point Likert scales (1 = high need/strong agreement, 7 = low need/weak agreement). Results: A total of 3479 responses were analysed (2821 students; 658 physicians). Both groups showed strong support for integrating ultrasound into curricula (1.3 ± 0.7) and mandatory education (1.4 ± 0.9), with students expressing significantly greater support (p < 0.001). There was broad agreement on the integration and development of digital media (1.7 ± 1.0), as well as the use of case studies (1.4 ± 0.8), with no significant differences between groups (p > 0.05). Case-based learning as a stand-alone format was less favoured (3.4 ± 1.9). In the user-centred needs analysis, both groups rated features like search functions (1.4 ± 0.8), usability (1.5 ± 0.9), and learning objective checks (2.7 ± 1.6) as important. High-quality media (1.5 ± 0.9) and pathology explanations (1.6 ± 1.1) were also highly valued. Students primarily relied on digital platforms, while physicians used a more varied mix of digital platforms, guidelines, and textbooks. Conclusions: The study highlights the need for more extensive, digitally supported ultrasound training, with a focus on functionality and usability. Standardisation through structured certification processes should be considered for future implementation. Full article

Background: Accurate confirmation of nasogastric (NG) tubes is essential for patient safety, but delays and variability in interpretation remain common in clinical practice. Deep learning (DL) models have shown potential for assisting in this task, but real-world performance, particularly in detecting malpositioned tubes, remains insufficiently characterized. Methods: We conducted a pilot evaluation of a previously developed DL model using 135 chest radiographs from Kangwon National University Hospital. Expert physicians established the reference standard. Model performance was assessed and receiver operating characteristic (ROC) curve and precision recall curve (PRC) analyses were performed. Differences between correctly classified and misclassified cases were examined using Wilcoxon rank-sum and Fisher’s exact tests to explore potential clinical or radiographic contributors to model failure. Results: The model correctly classified 129 of 135 cases. The sensitivity was 96.1% (95% confidence interval (CI): 92.2–98.9%), specificity was 85.7% (95% CI: 42.2–97.7%), positive predictive value (PPV) was 99.2% (95% CI: 96.1–99.9%), negative predictive value (NPV) was 54.5% (95% CI: 25.4–80.8%), balanced accuracy was 90.8%, and F1-score was 0.976. The area under the ROC curve was 0.970 (95% CI: 0.929–1.000) and that under the PRC was 0.727 (95% CI: 0.289–1.000), reflecting substantial uncertainty related to the very small number of incomplete cases (n = 6). No statistically significant differences in clinical or radiographic characteristics were observed between correctly classified and misclassified cases. Conclusions: The DL model performed well in identifying correctly positioned NG tubes but demonstrated limited and unstable performance for detecting incomplete placements. Given the safety implications of misclassification, the model should be used only as an assistive tool with mandatory physician oversight. Larger, multi-center studies with greater representation of incomplete cases are required to obtain more reliable estimates and support safe clinical implementation. Full article

Background: The role of pulmonary metastasectomy has been increasingly questioned in the surgical community after the PulMiCC trial challenged its benefit in colorectal cancer. However, the view on pulmonary metastasectomy among people in non-surgical disciplines remains unclear. This study explored interdisciplinary attitudes toward pulmonary metastasectomy and identified the clinical expectations shaping its future role. Methods: An anonymous online survey of active board-certified physicians in oncology, urology, gynecology and dermatology was conducted (December 2024–June 2025). Twenty items covered attitudes to local ablative therapy, referral criteria, preferred modalities and future relevance. Group comparisons used Pearson’s χ²; ordinal ratings were compared by one-way ANOVA; associations were explored with Spearman’s ρ. Results: Of 2884 contacted physicians, 165 participated (≈5.7%), and 106 completed the questionnaire. All 106 (100%) endorsed local ablative therapy as meaningful; 92/106 (86.8%) favored routine integration into multimodal care. Surgical metastasectomy was selected by 49/106 (46.2%), SBRT was selected by 27/106 (25.5%) and image-guided ablation was selected by 7/106 (6.6%); preference for surgery differed by specialty (χ²(4) = 15.31, p = 0.004), while institutional availability (in-house thoracic surgery or radiation oncology) showed no association with selecting surgery or SBRT. Key referral determinants were number of lesions (105/106; 99.1%), anatomical location (86/106; 81.1%; p < 0.02 across specialties), and lesion size (81/106; 76.4%; p < 0.05); other factors showed no consistent inter-specialty differences. The perceived usefulness of metastasectomy was high (mode 8/10) and showed a weak, non-significant correlation with referral experience (ρ = 0.172, p = 0.077). Looking ahead, 46/106 (43.4%) anticipated a declining role of local ablative therapy with novel systemic therapies; interest in biomarker analysis from metastatic tissue compared to primary tumor tissue was very high 97/106 (91.5%). Conclusions: Local ablative therapy, particularly pulmonary metastasectomy, continues to be viewed as an integral and trusted element of metastatic disease management across specialties. Despite limited prospective evidence, clinicians maintain strong confidence in its clinical value and foresee its evolution toward biologically and patient-tailored indications. However, the interpretation of these findings is limited by a low response rate and potential selection bias toward European, academically affiliated respondents. To our knowledge, this is the first study to systematically capture perceptions of pulmonary metastasectomy among non-surgical oncology-related specialists. Full article

Background: We investigated the role of pharmacists in adverse event (AE) management during renal cell carcinoma (RCC) drug therapy by surveying patients, physicians, and pharmacists. We identified the types of AEs for which pharmacist involvement is beneficial and explored measures to promote pharmacist intervention. Methods: This was an ad hoc analysis of a questionnaire-based cross-sectional web survey conducted from May to June 2022 among patients undergoing RCC drug therapy, physicians prescribing RCC treatments, and pharmacists involved in oncology care in Japan. Results: A total of 83 patients with metastatic RCC, 165 physicians, and 218 pharmacists were included. Among patients, 28.9% reported experiencing AEs or symptoms requiring pharmacist intervention. Most physicians (78.2%) and pharmacists (96.3%) supported pharmacist involvement in AE management. Notably, 35.6% of patients who reported no AEs or symptoms requiring pharmacist intervention acknowledged difficulty in communicating AEs to their physicians. Regarding desired pharmacist interventions for AEs, patients prioritized rash/pruritus, fatigue, and diarrhea; physicians emphasized stomatitis and anorexia; pharmacists identified constipation, stomatitis, and diarrhea. The most common reason patients valued pharmacist involvement was the reassurance of support from multiple healthcare providers. Physicians and pharmacists valued pharmacists’ greater familiarity with AE management, particularly considering physicians’ limited time. Raising awareness among patients and healthcare professionals, patient requests, and improving institutional support were strategies to enhance pharmacist involvement. Over 86% of healthcare professionals considered pharmaceutical outpatient clinics necessary to strengthen interdisciplinary collaboration. Conclusions: This study highlights widespread support among patients, physicians, and pharmacists for pharmacist involvement in managing AEs during RCC drug therapy. 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

Italian Court of Cassation Ruling Decree 30032 of 30 October 2023 discusses a medical malpractice case concerning the diagnosis of dermatofibrosarcoma protuberans and the alleged diagnostic and therapeutic delay. By examining how the ruling frames the role of histopathology in proving pathology benignity, authors prompt to reflect on diagnostic path, the allocation of the burden of proof, and the role of dermatologist’s expertise in professional liability issues. Over a four-year period, five health professionals were involved in a claim concerning an initial diagnosis of an epidermoid cyst and a subsequent diagnosis of dermatofibrosarcoma protuberans. The plaintiff questioned the delay in diagnosis, and the Court of Cassation found two physicians liable because they could not prove that the treated pathology was initially benign. We argue that equating diagnostic correctness exclusively with histological confirmation is unnecessary, both clinically and legally, in typical cases, if the reasoning and findings are adequately documented. Additionally, we examine the value of dermatologists’ experience and the scope of professional competence as measures of liability. Finally, we outline the minimum standards of clinical documentation necessary to make the diagnostic pathway traceable and verifiable. The diagnostic process is a discretionary effort that integrates multiple sources of information, both instrumental and experiential, to reach the most reasonable hypothesis. While histopathology is a crucial tool, it is not the sole gateway to a correct diagnosis of every cutaneous alteration. Adequate disclosure and structured documentation of the diagnostic reasoning are fundamental to the care process and fair assessment of professional responsibility. Full article

Background: Heparin-induced thrombocytopenia (HIT) is a rapid, life-threatening adverse drug reaction, with the widely used 4T score being the critical clinical tool guiding the need for serological confirmation. This study aimed to validate the diagnostic utility of the 4T score and evaluate its application in a tertiary hospital in Saudi Arabia. Methods: In this retrospective cohort study, we analyzed 449 patients with suspected HIT, comparing their initially recorded clinical 4T scores with those recalculated by trained specialists, using the anti-PF4/heparin IgG ELISA as the reference standard for HIT confirmation. Results: Of the 292 patients who underwent laboratory testing, the HIT positivity rate was 6.5% (n = 19). The primary finding was a markedly low agreement (15.4%) between the system-recorded and the standardized physician-calculated 4T scores, indicating significant inter-observer variability. Despite this, higher calculated 4T scores remained significantly associated with positive HIT test results, and the anti-PF4/heparin IgG ELISA demonstrated 100% sensitivity and 100% negative predictive value (NPV). Conclusions: While the 4T score is indispensable for guiding the diagnostic pathway, the observed profound inter-observer variability highlights an urgent need for standardized scoring training and protocol refinement to enhance diagnostic accuracy and reduce inappropriate therapeutic interventions. Full article

Background: While the 2024 ESC Guidelines provide guidance on utilising incidental CAC findings from non-gated CT scans to enhance risk stratification and guide treatment decisions, there remain gaps in detailed protocols for managing such incidental findings, particularly in inpatient settings. An incidental finding of CAC in a patient without known atherosclerosis provides an opportunity to assess cardiac risk, promote risk factor optimisation and evaluate need for further cardiac work up. The aim of this study was to assess the prevalence of incidental coronary artery calcification on non-cardiac dedicated gated CT thorax scans among general medical inpatients and to evaluate the subsequent management of these findings. Methods: This was a single-centre retrospective observational study of consecutive general medical inpatients aged 40–75, who had undergone a non-cardiac gated CT thorax during their admission, between February and March 2025. Data were collected using local electronic health records. Exclusion criteria were patients with known ischaemic heart disease (IHD). Risk factor assessment was noted by documentation of smoking status, hypertension, diabetes and low-density lipoprotein (LDL) values. Results: A total of 186 patients with thoracic CT scans were identified. On review of all CT reports, 53 (28.4%) patients had CAC reported, of whom 17 had known IHD. Therefore 36 (19.4%) patients were identified for further analysis. An exercise stress test was booked in none of the patients. A coronary angiogram was booked in 1 patient. Conclusions: One fifth of medical inpatients in our study had a new finding of CAC on thoracic imaging. Cardiovascular risk factors of LDL and HbA1c were checked in less than half of patients. None of these patients went on to have functional testing. There is a valuable opportunity to optimise cardiac risk factors and evaluate the need for functional testing in a subset of patients with CAC reported on non-cardiac CTs. This can be facilitated by raising awareness and implementing a flowchart tool for hospital physicians to reference. Full article

Background/Objectives: The European Society for Emergency Medicine reports that emergency department visits have increased by nearly 30% over the past decade, yet resources have not kept pace with this growing demand. Lean Healthcare Management has emerged as a promising approach to optimizing emergency department operations. This study aims analyze the specific Lean Healthcare Management interventions implemented across three major Barcelona hospitals. Methods: Three Barcelona hospitals were analyzed. Revision of the Lean Healthcare Management tools, hospital staff observation and focus groups with nurses, physicians, and administrators were performed to evaluate impact of Lean Healthcare Management interventions. A cumulative SWOT analysis was performed as a synthesis of individual responses and focus groups for the three included hospitals separately. Results: The average adherence scores to implemented Lean Healthcare Management solutions were 87% at Vall d’Hebron, 85% at Sant Joan de Déu, and 89% at Hospital Clínic de Barcelona. Implementation of Lean Healthcare Management led to 20% fewer cancelations of scheduled surgical procedures, decreased patient hospitalization times for targeted pathways (from 8 h to 70 min) and significant increase in patient satisfaction. All centers shared a common foundation in Value Stream Mapping. Implemented Lean Healthcare Management solutions were personalized for each hospital. Conclusions: Lean Healthcare Management’s effectiveness is contingent on aligning the Lean approach with the hospital’s specific mission, constraints, and patient population. This contextual dependency explains the variation in the tools adopted and the outcomes prioritized across the three analyzed hospitals. Full article

Acute promyelocytic leukemia (APL) evolved from the most lethal to the most curable subtype of acute leukemia today, owing to targeted therapy with all-trans retinoic acid (ATRA) and arsenic trioxide. Despite cure rates exceeding 90% and the rarity of relapse or refractoriness, early death (ED)—occurring within 30 days of diagnosis—remains unacceptably high, reaching up to 30% in population-based studies. ED is the major barrier to universal cure, with fatal hemorrhage as the predominant cause, followed by infection, differentiation syndrome, and thrombosis. Patients who survive the initial month generally achieve excellent long-term outcomes. This review synthesizes data from clinical trials and large real-world cohorts to provide a comprehensive overview of the incidence, causes, and predictors of ED in APL. Higher white blood cell count and older age emerge as the most consistently validated predictors, followed by increased IRB/BICcreatinine, low albumin, thrombocytopenia, and coagulopathy, although their predictive value is not uniform across studies. Risk scores such as the Sanz classification, the Österroos ED model, and dynamic disseminated intravascular coagulation (DIC) assessments represent practical tools for identifying patients at high risk of ED. Importantly, ED rates remain significantly higher in real-world populations than in clinical trials, highlighting the impact of age and comorbidities, delayed diagnosis, and barriers to immediate ATRA initiation and supportive care. Addressing ED in APL requires intensified early supportive strategies, physician awareness and education, and rapid treatment initiation. Refinement and validation of predictive models may guide tailored interventions and inform strategies to finally overcome this persistent unmet need. Full article

Speaker diarization is a key component of automatic speech recognition (ASR) systems, particularly in interview scenarios where speech segments must be assigned to individual speakers. This study presents a diarization algorithm based on sound intensity analysis using an Acoustic Vector Sensor (AVS). The algorithm determines the azimuth of each speaker, defines directional beams, and detects speaker activity by analyzing intensity distributions within each beam, enabling identification of both single and overlapping speech segments. A dedicated dataset of interview recordings involving five speakers was created for evaluation. Performance was assessed using the Diarization Error Rate (DER) metric and compared with the State-of-the-Art Pyannote.audio system. The proposed AVS-based method achieved a lower DER value (0.112) than Pyannote (0.213) without overlapping speech, and a DER equal to 0.187 with overlapping speech included, demonstrating improved diarization accuracy and better handling of overlapping speech. The algorithm does not require training, operates independently of speaker-specific features, and can be adapted to various acoustic conditions. The results confirm that AVS-based diarization provides a robust and interpretable alternative to neural approaches, particularly suitable for structured two-speaker dialogues such as physician–patient or interviewer–interviewee scenarios. Full article

Nutrition knowledge is essential for optimizing performance, recovery, and overall health in athletes. This study aimed to (1) adapt and validate the Hungarian version of the ANSKQ (Trakman et al., 2017) (ANSKQ-HU) and (2) assess the nutrition knowledge of Hungarian elite and recreational athletes. Following standard translation procedures and expert review, face validity was established. Data were collected from 1.335 athletes, and item difficulty, exploratory factor analysis (EFA), and reliability analyses were performed. A three-factor structure emerged: (1) Fundamentals of nutrition, energy needs, and prohibited substances; (2) Micronutrients and performance-enhancing sports nutrition; and (3) Utilization of macronutrients. While Cronbach’s alpha values were low (α = 0.41–0.62), this seemed acceptable given the dichotomous nature of the questionnaire. Most participants scored poorly (63.3%), with the lowest results in the micronutrients and performance-enhancing nutrition factor. Only 6.9% had formal nutrition education and most frequently respondents received help from coaches, family members, and friends. These findings highlight a significant gap in sports nutrition knowledge among Hungarian athletes and support the need for educative activities organized by sport nutrition professionals. The ANSKQ-HU is a reliable and valid tool for assessing nutrition knowledge in Hungarian athletes and can be a useful questionnaire for their support team (nutritionists, physicians). Full article