Search Results (294)

Background/Objectives: The consumption of opioids is a public health problem that significantly affects quality of life. In Spain, 7585 people are enrolled in the Methadone Maintenance Programme (MMP), which is an effective intervention with a low adherence rate. In this study, factors associated with the quality of life of MMP users, especially perceived social support and treatment adherence, were analysed. We hypothesised that low levels of adherence and social support would be associated with poorer quality of life. Methods: This was a cross-sectional observational study with an analytical approach. Quality of life (WHOQoL-BREF), perceived social support (DUKE-UNC-11), and treatment adherence (MMAS-8) among MMP users were studied, and data on sociodemographic and clinical characteristics were collected through ad hoc questionnaires and a review of electronic medical records. Linear and logistic regression models were used. Results: A total of 70 individuals were included in this study. The mean age was 56.9 years, and 83% of the participants were male. The perceived quality of life was low in the four domains evaluated (range of 47.4–48.2). A total of 38.57% of the participants had low perceived social support. Treatment adherence was low or moderate in 77.1% of the participants. Greater perceived social support was associated with better quality of life in all domains (p < 0.05). Quality of social life was negatively associated with the use of nonbenzodiazepine neuroleptics and HIV status. Treatment adherence was lower in insulin therapy users. Conclusions: Social support is a key determinant of the quality of life of MMP users. Health policies should promote social support networks as a strategy to improve the well-being of this population. Full article

Background/Objectives: Clostridioides difficile infection (CDI) is a major cause of infectious diarrhea in the inpatient and community setting. Real-world data outside the strict environment of randomized controlled trials (RCTs) are needed to improve the quality of evidence. The aim of this study was to compare different clinical outcomes of CDI patients treated with fidaxomicin with those treated with vancomycin using a representative patient population in the United States of America (USA). Methods: Comprehensive real-world data were analyzed for this retrospective observational study, provided by the TriNetX database, an international research network with electronic health records from multiple USA healthcare providers. This includes in- and outpatients treated with fidaxomicin (FDX) or vancomycin (VAN) for CDI between 01/2013 and 12/2023. The following cohorts were compared: (i) patients treated with fidaxomicin within 10 days following CDI diagnosis (FDX group) vs. (ii) patients treated with vancomycin within 10 days following CDI diagnosis (VAN group). Outcomes analysis between the two cohorts was performed after propensity score matching and included event risk and Kaplan–Meier survival analyses for the following concomitant diseases/events occurring during an observational period of 12 months following CDI diagnosis: death, sepsis, candidiasis, infections caused by vancomycin-resistant enterococci, inflammatory bowel disease, cardiovascular disease, psychological disease, central line-associated blood stream infection, surgical site infection, and ventilator-associated pneumonia. Results: Following propensity score matching, 2170 patients were included in the FDX group and VAN groups, respectively. The event risk analysis demonstrated improved outcomes of patients treated with FDX compared to VAN in 6 out of the 10 events that were analyzed. The highest risk ratio (RR) and odds ratio (OR) were found for sepsis (RR: 3.409; OR: 3.635), candidiasis (RR: 2.347; OR: 2.431), and death (RR: 1.710; OR: 1.811). The Kaplan–Meier survival analysis showed an overall survival rate until the end of the 12-month observational period of 87.06% in the FDX group and 78.49% in the VAN group (log-rank p < 0.001). Conclusions: Our comparative event risk analysis demonstrated improved outcomes for patients treated with FDX compared to VAN in most of the observed events and underlines the results of previously conducted RCTs, highlighting the beneficial role of FDX compared to VAN. Further big data analyses from other industrialized countries are needed for comparison with our observations. Full article

This review investigates recent developments in cardiac mechano-electrical-fluid interaction (MEFI) modeling, with a focus on multiphysics simulation platforms and digital twin frameworks developed between 2015 and 2025. The purpose of the study is to assess how computational modeling methods—particularly finite element and immersed boundary techniques, monolithic and partitioned coupling schemes, and artificial intelligence (AI)-enhanced surrogate modeling—capture the integrated dynamics of cardiac electrophysiology, tissue mechanics, and hemodynamics. The goal is to evaluate the translational potential of MEFI models in clinical applications such as cardiac resynchronization therapy (CRT), arrhythmia classification, atrial fibrillation ablation, and surgical planning. Quantitative results from the literature demonstrate <5% error in pressure–volume loop predictions, >0.90 F1 scores in machine-learning-based arrhythmia detection, and <10% deviation in myocardial strain relative to MRI-based ground truth. These findings highlight both the promise and limitations of current MEFI approaches. While recent advances improve physiological fidelity and predictive accuracy, key challenges remain in achieving multiscale integration, model validation across diverse populations, and real-time clinical applicability. The review concludes by identifying future milestones for clinical translation, including regulatory model certification, standardization of validation protocols, and integration of patient-specific digital twins into electronic health record (EHR) systems. Full article

Delirium is a common mental health condition encountered in hospitals that increases mortality, hospital length of stay, and healthcare costs. Incarcerated individuals have higher rates of known risk factors for delirium, including mental and physical illness, psychological distress, and stigmatization and may be at increased risk of developing the condition. Despite this, there is a paucity of research in this specific area of psychiatry. We identified ethical concerns, feasibility with the electronic medical record, and stigmatization as reasons why adequate research into this population is limited. Nevertheless, we call on more dedicated research into delirium within the incarcerated population to enhance better care practices and advocate for these patients. Full article

Pancreatic ductal adenocarcinoma (PDAC) remains among the most lethal malignancies, with a five-year survival rate below 12%, largely attributable to its asymptomatic onset, late-stage diagnosis, and limited curative treatment options. Although PDAC accounts for approximately 3% of all cancers, it is projected to become the second leading cause of cancer-related mortality in the United States by 2030. A major contributor to its dismal prognosis is the lack of validated early detection strategies for asymptomatic individuals. In this review, we present a comprehensive synthesis of current advances in the early detection of PDAC, with a focus on the identification of high-risk populations, novel biomarker platforms, advanced imaging modalities, and artificial intelligence (AI)-driven tools. We highlight high-risk groups—such as those with new-onset diabetes after age 50, pancreatic steatosis, chronic pancreatitis, cystic precursor lesions, and hereditary cancer syndromes—as priority populations for targeted surveillance. Novel biomarker panels, including circulating tumor DNA (ctDNA), miRNAs, and exosomes, have demonstrated improved diagnostic accuracy in early-stage disease. Recent developments in imaging, such as multiparametric MRI, contrast-enhanced endoscopic ultrasound, and molecular imaging, offer improved sensitivity in detecting small or precursor lesions. AI-enhanced radiomics and machine learning models applied to prediagnostic CT scans and electronic health records are emerging as valuable tools for risk prediction prior to clinical presentation. We further refine the Define–Enrich–Find (DEF) framework to propose a clinically actionable strategy that integrates these innovations. Collectively, these advances pave the way for personalized, multimodal surveillance strategies with the potential to improve outcomes in this historically challenging malignancy. Full article

Background: Folic acid is essential for DNA synthesis and fetal development, with deficiency linked to anemia, cardiovascular disease and pregnancy complications. The clinical guidelines for women of reproductive age mandate supplementation as a universal preventive treatment regardless of blood folic acid levels; therefore, routine folic acid level testing is not recommended for this population. However, the vast majority of pregnant women do not implement the recommended preventive actions, indicating that new strategies are needed to improve that situation. Objectives: This study examined the impact of modifying the laboratory test-ordering interface in the medical record system, designed to simplify the ordering of folic acid level tests, on testing rates, deficiency detection and supplement consumption among women of reproductive age. Methods: This retrospective cohort analysis compared outcomes reflecting the impact of the modification on 43,952 women aged 18–42 years, assessed over one year pre- and post-integration. Statistical analyses included Chi-squared tests and logistic regression, with adjustments for age and socio-geographic status. Results: Post-intervention, testing rates increased from 14.74% to 17.35% (p < 0.0001), and deficiency detection rose from 6.30% to 7.38% (p < 0.0001). Supplement consumption tripled from 5.45% to 15.98% (p < 0.0001), with 91.37% of post-intervention consumers being new users. Conclusions: Modifying the presentation of tests in the laboratory test-ordering interface within electronic medical records significantly improved testing rates, enhanced deficiency detection and had a meaningful impact on treatment outcomes. These findings underscore the potential of system-level digital interventions to advance preventive care and overall health. Future research should focus on examining scalability, implementation and long-term outcomes across diverse healthcare settings. Full article

Despite having the world’s largest HIV burden, South Africa has yet to attain the 95-95-95 targets. Accurate, complete, and timely data are critical for monitoring a country’s HIV progress. The integration of unique identifier codes (UICs) for key populations (KPs) into routine health information management systems (RHIMS) strengthens data accuracy and completeness, facilitating more targeted HIV interventions and greater accountability. This systematic review assessed how Sub-Saharan African (SSA) countries have integrated KPs’ UICs into RHIMS, highlighting key enablers, challenges, and opportunities. A comprehensive search was conducted across PubMed, Scopus, Google Scholar, MEDLINE, PLOS ONE, and various government and non-government websites to identify the published and grey literature relevant to the study objective from June 2013 to December 2024. References were managed using Zotero version 6.0.36. Two authors independently screened studies using Covidence software. The review was done in accordance with the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines and was registered with the “International Prospective Register of PROSPERO) Systematic Reviews” with the registration number CRD42023440656. Out of 1735 studies screened, 361 duplicates were removed. The review found that only nine of the fifty-three SSA countries have incorporated UICs for KPs into their RHIMS through alphanumeric codes. They include Burundi, Burkina Faso, Ghana, Mali, Kenya, Uganda, Togo, Malawi, and Liberia. Facilitators for KPs’ UIC adoption included strong data security and political will, whereas barriers encompassed compromised privacy, stigma and discrimination. In South Africa, the UIC for KPs can be integrated into the new electronic medical record (EMR) system. Full article

Background/objectives: The quantity of clinical data varies across patient populations and often reflect clinicians’ perceptions of risk and their decisions to perform certain laboratory tests. Missingness in electronic health records can be informative because it may indicate that certain clinical parameters were not measured because clinicians considered them unnecessary for stable patients. Methods: This retrospective single-center study explored the ability of a deep learning-based early warning system, the VitalCare–Major Adverse Event Score, to predict unplanned intensive care unit transfers, cardiac arrests, or death among adult inpatients 6 h in advance. We classified patients using the Charlson Comorbidity Index (CCI) and assessed whether patients with high severity and a greater volume of laboratory data benefited from more comprehensive inputs. Results: Overall, patients with high CCI scores underwent more testing and had fewer missing values, whereas those with moderate-to-low CCI scores underwent less testing and had more missing data. Within the event cohorts, however, the high-CCI and moderate/low-CCI groups showed similar proportions and patterns of missing values. The discriminative ability of the model remained robust across both groups, implying that the clinical context of missingness outweighed the raw quantity of available data. Conclusions: These findings support a nuanced view of data completeness and highlight that preserving the real-world patterns of ordering laboratory tests may enhance predictive performance. Full article

Background: Chronic thoracic pain is commonly caused by thoracic facet dysfunction, intercostal neuralgia, surgery, or thoracic pain secondary to cancer and is present in approximately 15% of the population. Conventional treatments, including pharmacotherapy and transcutaneous electrical nerve stimulation, are often ineffective and are often associated with poorly tolerated adverse effects. Cooled radiofrequency ablation (c-RFA) is a minimally invasive procedure that uses radiofrequency energy delivered through a probe to lesion the targeted nerve and provide significant and lasting relief. Methods: This study was a retrospective analysis of data extracted from UW-Health Electronic Medical Health records from October 2015 through June 2024. Patient data were collected, including diagnosis, pre-operative pain score, post-operative pain score, duration of relief, age, sex, and BMI. A two-tailed paired t-test was used to analyze the pre-operative and post-operative pain scores. A p-value < 0.05 was considered significant. Results: A total of 111 thoracic c-RFA procedures were reviewed; 43 were excluded due to absent pre-operative or post-operative pain scores in medical records. A total of 68 procedures were included in the analysis, comprising 55 patients: 25 females and 30 males with an average age of 51.31 ± 18.22 years and a BMI of 29.79 ± 6.48 kg/m². Improvement in pain scores was reported in 77.94% (n = 53), 16.18% (n = 11) reported no change, and 5.88% (n = 4) reported worsening pain. Patients reported an average pre-operative pain score of 5.98 (M = 5.98, SD = 1.91) and an average post-operative pain score of 3.06 (M = 3.06, SD = 2.52); this achieved significance (p < 0.0001). Of the 77.94% (n = 53) charts that noted improvement, there is an average of 62.83 ± 28.48% reduction from their pre-operative pain scores. The average duration of relief lasted 11.85 ± 13.42 months. Conclusions: This study supports the efficacy and safety of c-RFA as a minimally invasive therapy for chronic thoracic pain refractory to conservative measures. Full article

In agreement with WHO recommendations, the Emilia-Romagna Region, Italy, implemented a population-wide HCV screening program for the treatment of the large asymptomatic infected population. From January 2022, the free-of-charge screening targeted all residents born between 1969 and 1989, prison inmates, and injection drug users. Participants were recruited using phone messages, electronic health record notifications, public advertisement, and direct contact with general practitioners. A single blood sample was collected for anti-HCV IgG testing and, if positive, for reflex HCV–RNA testing. Infected subjects were offered an evidence-based therapeutic pathway. By June 2024, 72.8% of high-risk subjects (n = 19,732), and 36.9% of the general population (n = 488,065) had been screened. A total of 1032 individuals were positive based on the HCV–RNA test, and the detection rate widely differed between the high-risk and the general population (23.8‰ vs. 1.2‰, respectively). Of the infected individuals, 88.1% were seen by a specialist physician, and 74.3% (n = 767) started antiviral therapy. Thanks to multiple recruitment approaches, over one third of the general population participated in HCV screening. The program performance was substantially greater among high-risk individuals compared to the general population. To achieve WHO targets, policymakers might consider expanding the screening to other high-risk subgroups and/or adapting birth cohorts. Full article

Potentially inappropriate medications (PIMs) increase the risk of adverse drug reactions, hospitalizations, and worsened health outcomes in older adults, particularly those with cognitive impairment (CI) or dementia. This study was designed to compare the Beers Criteria^® 2023 and the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP) Criteria 2023 to determine which identifies a higher prevalence of PIMs in older adults with CI or dementia attending primary care-based memory clinics. PIMs were identified with the use of the updated Beers Criteria^® 2023 and STOPP Criteria 2023, from electronic medical records of study participants from January to August 2023. The study identified PIMs and analyzed associated risk factors using bivariate logistic regression. Of 44 older adults, 47.7% (n = 21) were detected with one PIM based on Beers Criteria^® 2023, and 27.2% (n = 12) were identified with at least one PIM using STOPP criteria. Using the updated Beers Criteria^® 2023 and STOPP Criteria 2023, the study identified 50 PIMs (averaging 0.9 PIMs per participant) based on Beers Criteria^® and 31 PIMs (averaging 0.6 PIMs per participant) based on STOPP Criteria, respectively. Bivariate logistic regression revealed a significant association between having nine or more comorbidities and PIMs according to Beers Criteria^® (odds ratio (OR) = 8.4, 95% confidence interval (CIn) = 1.27–55.39, p = 0.027). This study highlights the high prevalence of PIMs among older adults with CI or dementia, emphasizing the need for regular medication reviews. Implementing both criteria can enhance medication management and improve patient safety in this vulnerable population. Full article

Background: Childhood cancer survivors (CCSs) often experience impaired humoral immunity because of cancer treatments that increase their susceptibility to vaccine-preventable diseases. This study aimed to assess the seroprevalence of tetanus and rubella antibodies in CCSs compared to healthy, age-matched controls. Additionally, we explored the impact of cancer treatments on vaccine-induced immunity, examined the extent of revaccination after treatment completion, and evaluated the effectiveness of revaccination on seroprevalence. Methods: This retrospective study included 180 CCSs previously treated at Astrid Lindgren Children’s Hospital, Stockholm, between March 2019 and January 2023. Patient data were retrieved from electronic medical records. Seroprevalence data for rubella and tetanus antibodies in the 15–19-year age group were also obtained from a national seroprevalence study conducted by the Public Health Agency of Sweden. Results: CCSs exhibited significantly lower seroprevalence for both tetanus (77.7% vs. 92.7%) and rubella (79.1% vs. 97.5%) compared to age-matched controls. Revaccination with DTP-containing vaccines was more frequently administered than with the MMR vaccine. Tetanus and rubella seroprevalence were the lowest in children who had received intense chemotherapy. Among those who were revaccinated with the DTP vaccine after intensive treatment, 81 out of 98 (82.6%) had tetanus IgG levels above the threshold, compared to 24 out of 48 (50%) unvaccinated CCSs. In contrast, among those revaccinated with MMR, 57 out of 73 (78.1%) had positive rubella IgG, compared to 53 out of 73 (72.6%) unvaccinated CCSs with rubella IgG levels above the cut-off. Conclusions: Our findings highlight that vaccines are underutilized in CCSs with a notable gap in immunity, particularly among those who have undergone intensive treatments. Unexpectedly, MMR revaccination did not significantly affect rubella immunity. Given the increasing number of CCSs, it is essential to better understand how to effectively restore vaccine immunity in this population. Full article

Drug interactions (DIs) can alter the effects of medications or result in adverse reactions. This scoping review aimed to map the existing scientific evidence regarding the DI between penicillin and hormonal contraceptives in women. Following the PRISMA-ScR, we conducted electronic searches in the MEDLINE, Embase, Web of Science, and the Virtual Health Library databases from August 2023 to January 2024. Observational studies, monographs, dissertations, theses, and conference abstracts with adolescent, adult, and elderly women who were concurrently using hormonal contraceptives and penicillin were eligible. DIs were defined based on the signs/symptoms presented by the women and self-reported pregnancies. Of the 4023 records identified in the databases, nine studies, published between 1979 and 2021, were included. Variability was found among the studies in terms of sample size, data collection method, participant’s age, medication types, diagnostic approach used to confirm the pregnancy, and the author’s recommendation of the DI. It could therefore be concluded that while the literature suggests a DI between hormonal contraceptives and penicillin, the level of scientific evidence is still scarce. Additional research on systemic and population factors is essential to better understand this DI and its repercussions. Full article

Background/Objectives: In hospital settings, the wide variability of acute and complex chronic conditions—among both adult and pediatric patients—requires advanced approaches to detect early signs of clinical deterioration and the risk of transfer to the intensive care unit (ICU). Nursing diagnoses (NDs), standardized representations of patient responses to actual or potential health problems, reflect nursing complexity. However, most studies have focused on the total number of NDs rather than the individual role each diagnosis may play in relation to outcomes such as ICU transfer. This study aimed to identify and rank the specific NDs most strongly associated with ICU transfers in hospitalized adult and pediatric patients. Methods: A retrospective, monocentric observational study was conducted using electronic health records from an Italian tertiary hospital. The dataset included 42,735 patients (40,649 adults and 2086 pediatric), and sociodemographic, clinical, and nursing data were collected. A random forest model was applied to assess the predictive relevance (i.e., variable importance) of individual NDs in relation to ICU transfers. Results: Among adult patients, the NDs most strongly associated with ICU transfer were Physical mobility impairment, Injury risk, Skin integrity impairment risk, Acute pain, and Fall risk. In the pediatric population, Acute pain, Injury risk, Sleep pattern disturbance, Skin integrity impairment risk, and Airway clearance impairment emerged as the NDs most frequently linked to ICU transfer. The models showed good performance and generalizability, with stable out-of-bag and validation errors across iterations. Conclusions: A prioritized ranking of NDs appears to be associated with ICU transfers, suggesting their potential utility as early warning indicators of clinical deterioration. Patients presenting with high-risk diagnostic profiles should be prioritized for enhanced clinical surveillance and proactive intervention, as they may represent vulnerable populations. Full article