Search Results (982)

Background/Objectives: To assess the acceptance of, attitudes towards, and concerns regarding allogeneic serum eye drops (Allo-SEDs) among patients treated with autologous serum eye drops (ASEDs). Methods: We conducted this investigator-initiated, cross-sectional, single-center survey at the Department of Ophthalmology, University Hospital Zurich, Switzerland. We consecutively recruited all patients using ASEDs during routine visits, who anonymously completed a 9-item questionnaire comprising eight 11-point Likert-scale items and one open numerical item on the daily application frequency. We assessed perceived ASED effectiveness, willingness to switch to Allo-SEDs under different scenarios, and concerns regarding safety, efficacy, and immunological risks. Results: Of 202 eligible patients, 107 returned the questionnaire (53.0%). The full eligible cohort had a median (IQR) age of 63.5 (49.2–75.0) years and a median ASED treatment duration of 4.0 (1.0–8.0) years. They rated ASEDs as highly effective (median 9, IQR 8.2–10.0) and applied them a median of 7 (5–10.5) times daily. Willingness to switch was low without clinical need (median 3, IQR 0–6; p = 1.0), increased when autologous production was no longer feasible (median 7, IQR 5–9; p < 0.001), and was intermediate for general openness (median 5, IQR 2–8; p = 0.7). Concerns regarding infectious disease transmission, immunological reactions, and therapeutic efficacy correlated with lower willingness to switch (all r = −0.29 to −0.46). Daily application frequency did not correlate with acceptance. Conclusions: Patients were highly satisfied with ASEDs but were reluctant to switch to Allo-SEDs unless autologous production was no longer feasible. Among the domains assessed, concerns regarding infection, immunological reactions, and efficacy were the main barriers to acceptance, supporting targeted patient education. Full article

Background/Objectives: Occupational therapy theories, models, and frameworks appear to be developed in Western countries. The philosophical framework for occupational therapy in South Africa appears to have relied upon various models, predominantly stemming from Western and European origins, with vague and fleeting references to African knowledge systems and philosophies. The objectives of the study were to explore how service users understand occupational therapy following their engagement in occupational therapy services; service users’ perceptions of the activities used during occupational therapy; and service users’ participation in decisions regarding the selection of activities during occupational therapy. Methods: This study used an interpretive qualitative design. Purposive sampling was used to select participants. A total of 21 participants were interviewed before reaching data saturation; 30 min semi structured interviews were conducted. Data were collected by the research assistant. Data were analysed using inductive thematic analysis at the latent level. Findings: Four themes were derived from the data, which are misconceptions and vagueness, impact yet optimism, limited meaningful activities, and mostly therapist-directed activity choice. Conclusions: The findings highlight systemic barriers such as language of communication in occupational therapy practice and education. They also suggest ambiguity in the understanding of therapeutic goals by service users. In the findings of this study, it is also indicated that there seems to be a lack of meaningful activities selected for therapy. This is shown by the activities, such as the exercises, in which the participants expressed their participation during occupational therapy. The power dynamics, knowledge, and use of technology in occupational therapy practice were also highlighted in the findings. Full article

AI-generated synthetic media are evolving from tools of digital manipulation into a practical antidote for persistent challenges in digital health implementation. However, the computational capabilities that characterise these technologies, their applications and downstream health-related benefits remain fragmented and insufficiently synthesised. This systematic review identified the computational capabilities that characterise AI-generated synthetic media in health, examined their applications and benefits, and developed an integrative framework linking these domains. Twenty-four studies published between 2021 and 31 May 2026 were included. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT) and findings were synthesised through thematic analysis. The synthesis revealed an integrated set of capabilities spanning photorealistic medical-image generation, modality-specific synthesis of clinical images and physiological signals, synthetic non-image health-data creation, preservation of statistical distributions, temporal patterns and clinical relationships, generation of diverse, novel and non-memorised samples and controlled transformation of medical and audiovisual content. Privacy-oriented synthesis and deepfake detection emerged as distinct components supporting privacy-conscious data use, clinical verification and healthcare safety. These demonstrated capabilities were linked to empirically evaluated and indicated applications, including data augmentation, AI model training, diagnostic model development, privacy-oriented health-data sharing, medical education, patient-facing communication, therapeutic support, clinical safety, health-system analytics and planning. The resulting Computational Capability–Application–Benefit (CAB) Framework conceptualises synthetic media as an evidence-graded pathway distinguishing demonstrated computational capabilities, evaluated health-related applications and reported, indicated or potential downstream benefits requiring further validation. AI-generated synthetic media, therefore, represent an emerging computational infrastructure with potential to support safer, privacy-conscious, adaptive and data-intensive healthcare. Full article

Clinical image publications represent an important educational resource across healthcare disciplines, providing concise visual demonstrations of diseases, diagnostic findings, and therapeutic outcomes. Despite their widespread use, reporting practices remain highly heterogeneous, with substantial variability in the description of clinical context, image acquisition, ethical considerations, and educational content. Existing reporting guidelines, including the CARE Guidelines, do not specifically address the unique methodological and technical aspects of image-based publications. The aim of this study was to develop the IMAGE Statement (Improving Clinical Image Reporting Standards), a reporting guideline specifically designed for clinical image publications as an extension of the CARE Guidelines. The development process was informed by recommendations from the EQUATOR Network and included a literature review, analysis of journal instructions for authors, generation of candidate reporting items, and expert consensus. The resulting IMAGE Statement comprises 15 essential reporting items covering the title, patient information, clinical context, diagnostic assessment, image acquisition, image quality, image selection, image annotation, image description, diagnostic interpretation, final diagnosis, educational message, ethics and consent, artificial intelligence use disclosure, and figure legend. The IMAGE Statement provides a structured framework intended to improve completeness, transparency, reproducibility, educational value, and ethical reporting of clinical image publications across healthcare disciplines. Full article

Scoliosis is a complex three-dimensional spinal deformity that requires early detection, accurate radiological assessment, individualized treatment planning, and long-term monitoring. In recent years, artificial intelligence (AI) has emerged as a promising tool across multiple stages of scoliosis management, including screening, automated imaging analysis, deformity classification, prediction of progression, surgical planning, postoperative outcome assessment, and patient education. This narrative review summarizes current and emerging applications of AI in scoliosis, with particular emphasis on studies published after 2023. Deep learning algorithms, including convolutional neural networks, U-Net-based architectures, transformer models, and generative approaches, have demonstrated high accuracy in automated Cobb angle measurement, vertebral segmentation, coronal and sagittal parameter assessment, and radiation-free screening using surface topography or smartphone-based photographs. Machine learning models have also shown potential in predicting curve progression, treatment response, risk of postoperative complications, and patient-reported outcomes by integrating radiological, clinical, biomechanical, and, increasingly, multimodal data. In parallel, large language models and generative AI tools are being investigated for patient education, communication support, readability improvement, and research hypothesis generation. Despite these advances, important limitations remain, including limited external validation, dataset heterogeneity, potential algorithmic bias, insufficient interpretability, and incomplete integration into clinical workflows. Moreover, while AI systems show strong performance in automated measurement and screening tasks, their role in complex therapeutic decision-making, such as Lenke classification, fusion-level selection, and autonomous surgical planning, remains experimental. Overall, AI has the potential to improve the precision, efficiency, and personalization of scoliosis care; however, prospective multicentre studies, transparent reporting, explainable model design, and regulatory validation are essential before widespread clinical implementation. Full article

Background: The adoption of restrictive diets without medical indication is increasing, but the cognitive factors associated with this dietary behavior remain insufficiently understood. The aim of this study was to examine the proportion of participants following restrictive diets in a self-selected online sample of adults living in Romania and to analyze the associations of nutrition knowledge, beliefs regarding the relationship between diet and health, food vigilance, and social media use with the adoption of restrictive diets without medical indication. Methods: This cross-sectional observational study was conducted online in a self-selected sample of 766 adults living in Romania. Participants were classified into three groups: no restrictive diet, medically indicated restrictive diet, and restrictive diet without medical indication. Three composite scores were constructed: Restrictive Health Beliefs, Food Vigilance, and Nutrition Knowledge. Differences between groups were assessed using non-parametric tests and χ² tests, and factors associated with the adoption of restrictive diets were analyzed using multinomial logistic regression and multiple linear regression. Results: Among the participants, 30.9% reported following a restrictive diet, and 13.1% adopted one without medical indication. Participants who followed restrictive diets scored higher for Restrictive Health Beliefs and Food Vigilance but not Nutrition Knowledge. In the multivariate analysis, Restrictive Health Beliefs showed the strongest independent association with restrictive diets without medical indication. Food Vigilance was only associated with medically indicated restrictive diets (p < 0.001), suggesting an adaptive role in a therapeutic context. Nutrition knowledge and social media use were not independently associated with restrictive diets without medical indication, although social media use was associated with higher levels of Restrictive Health Beliefs. Conclusions: The results suggest that the adoption of restrictive diets without medical indication is more closely associated with beliefs regarding the relationship between diet and health than with the level of nutrition knowledge. These findings support the development of nutrition education interventions that, in addition to conveying evidence-based information, promote the development of critical thinking and the correction of insufficiently scientifically substantiated dietary beliefs. Full article

The progressive integration of Whole Slide Imaging (WSI) technology and Artificial Intelligence (AI) architectures is driving a structural transformation in pathology and precision oncology. This structured critical review analyzes and systematizes the impact of this technological transition along two fundamental operational dimensions of the modern biopharmaceutical industry: pre-registration Clinical Research and post-launch strategies governed by Medical Affairs. The first section explores how computational pathology is improving efficiency and reducing risk in drug development. Replacing analog visual assessment—intrinsically subject to inter-observer and intra-observer variability—with quantitative algorithms for cellular classification and segmentation enables optimization of patient recruitment in clinical trials, reducing screening failure rates. This review also examines the emerging role of Spatial Biology in extracting complex topological metrics from the Tumor Microenvironment (TME) and the use of AI for the objective and auditable quantification of critical surrogate endpoints, such as Pathological Complete Response (pCR), while acknowledging that algorithmic precision remains sensitive to pre-analytical variables and dataset biases. In the second section, the study investigates the strategic evolution of Medical Affairs, acting as a vital scientific communication and translational bridge between the complexity of Data Science and clinical hospital practice. Challenges related to AI adoption by clinicians are examined, emphasizing the importance of educational programs based on Explainable AI (XAI) to overcome the cognitive limitations of the black-box paradigm and the complex regulatory validation pathway for Software as a Medical Device (SaMD) under the stringent European IVDR framework—supported by an analysis of historical regulatory benchmarks such as the Paige Prostate case. The paper also explores the potential of AI in the large-scale generation of Real-World Evidence (RWE), applied to the creation of synthetic control arms in pharmacoeconomic settings. In conclusion, the study highlights that the diagnostic algorithm has ceased to be merely a laboratory support tool and has become a strategic asset and an integral adjunct to therapeutic decision-making. Overcoming current challenges related to data privacy through Federated Learning architectures, together with the imminent transition toward Foundation Models, foreshadows a fully data-driven healthcare ecosystem, making continuous skills development (digital upskilling) an essential requirement for professionals in the biopharmaceutical sector. Full article

Background: Temporomandibular disorders (TMD) comprise a heterogeneous group of musculoskeletal conditions that may manifest during childhood and adolescence. However, standardized information regarding TMD-related clinical findings in pediatric populations remains limited because of methodological heterogeneity and the inconsistent application of validated diagnostic protocols. Objective: The aim of this study was to characterize clinical findings related to temporomandibular disorders in schoolchildren and to explore their potential contribution to individualized assessment strategies within the framework of personalized pediatric oral healthcare. Methods: A multicenter cross-sectional study was conducted in 1052 schoolchildren recruited from participating educational institutions. All participants underwent a standardized clinical examination that included assessment of masticatory muscle tenderness, temporomandibular joint tenderness, joint sounds, pain intensity, and perceived stress using an adapted pediatric DC/TMD protocol. Categorical variables were summarized as frequencies, percentages, and 95% confidence intervals (95% CIs). Associations between categorical variables were evaluated using Pearson’s chi-square test, and multivariable logistic regression was performed to identify factors independently associated with pain. Results: Pain during clinical examination was identified in 111 participants (10.6%; 95% CI: 8.8–12.6%), whereas temporomandibular joint sounds and myofascial pain were detected in 1.4% and 0.3% of participants, respectively. Most pain was classified as mild, and the masseter muscle was the most frequently affected anatomical site. Increasing age and female sex were independently associated with pain. Compared with children aged 4–6 years, participants aged 10–12 years (adjusted OR = 9.61; 95% CI: 2.22–41.51) and 13–16 years (adjusted OR = 35.49; 95% CI: 8.59–146.61) showed significantly greater odds of pain. Female participants also demonstrated higher odds of pain than males (adjusted OR = 7.49; 95% CI: 3.68–15.21; all p < 0.05). Conclusions: Clinically detectable TMD-related findings were generally uncommon among schoolchildren aged 4–16 years and were predominantly mild and muscular. Increasing age and female sex were independently associated with pain, emphasizing the importance of demographic factors in the early clinical expression of TMD. Standardized pediatric clinical examination protocols may facilitate early identification of TMD-related findings and support preventive strategies during childhood and adolescence. These findings support the implementation of individualized clinical assessment strategies for early identification of children at risk of temporomandibular disorders, contributing to personalized preventive and therapeutic approaches in pediatric oral healthcare. Full article

Background: The Objective Structured Clinical Examination (OSCE) has been the backbone of assessment in medical education, and the number of stations required to achieve sufficient reliability in high-stakes examinations is an important consideration for resource-limited programs. Methods: The correlation between the number of stations and psychometric performance was simulated using post hoc resampling of the 17-station Final MBBS Medicine and Therapeutics OSCE across three campuses of the University of the West Indies. Blueprint coverage was maintained in balanced subsets of six, eight, ten, and twelve stations. For subsets and the full exam, we compared failure rates, internal consistency, generalizability, and correlation of scores. Results: Failure rates increased as the number of stations decreased; however, none of the differences between subset and full-exam performance were significant. Station count was positively related to internal consistency using alpha (α ≈ 0.32–0.61 at six stations; α ≈ 0.64–0.70 at 17 stations) and G-coefficients (≈0.18–0.42 at six and ≈0.36–0.70 at 17 stations). However, all reliability coefficients were <0.80. Strong internal consistency was maintained for all subsets, even at six stations (r ≥ 0.79), and approached 1.0 for the 17-station subset. There was a subset size effect on mean values for Campuses 1 and 2 but not for Campus 3. Conclusions: Shorter subset exams maintained strong internal consistency. Reliability at ten–twelve stations approached that of the 17-station total. Intercampus variability highlighted the need for examiner training, station quality checks, and improved standard setting. Full article

The clinical skills of physical therapists (PTs) are crucial, as high-quality clinical competence leads to trustworthy patient care, reliable assessments, and effective therapeutic choice. Clinical practice hours (CP hours) may be used to validate theoretical knowledge acquired during training, especially among novice PTs. This exploratory, single-center, cross-sectional study examined the relationship between total CP hours during undergraduate education and novice PTs’ clinical competence. The small convenience sample comprised 25 newly recruited PTs employed by the Department of Rehabilitation at a general hospital in Japan between April 2022 and April 2023. CP hours were surveyed using Google Forms. Clinical competence was assessed using the Objective Structured Clinical Examination, employing two tasks frequently performed in clinical settings: range-of-motion exercises and muscle-strengthening exercises. Total CP hours during undergraduate education were significantly and positively correlated with clinical competence for range-of-motion exercise (ρ = 0.68; 95% CI, 0.3450–0.8677, p < 0.001). A positive trend was observed for muscle strengthening exercise (MSex) (ρ = 0.197; 95% CI, −0.3061–0.6029, p = 0.346), suggesting a ceiling effect for MSex, with relatively low correlation but high acquisition levels, even with fewer total CP hours. Overall, this study revealed a significant correlation between total CP hours during undergraduate education and novice PTs’ clinical competence. Full article

Background/Objectives: Lumbar puncture (LP) is an essential diagnostic and therapeutic procedure in neurological practice. Despite its clinical value, misconceptions and fear may influence its acceptance among the public. This study aimed to assess knowledge, attitudes, and misconceptions regarding LP among adults in Saudi Arabia and to examine associated sociodemographic factors. Methods: A cross-sectional study was conducted between June 2025 and January 2026 using a structured, self-administered online questionnaire adapted from a previously validated instrument. Adults aged ≥18 years residing in Saudi Arabia were recruited via convenience sampling through open social media channels, so the sample is self-selected rather than population-representative. Knowledge and attitude scores were categorized into defined levels, and multivariable regression analyses were performed to identify independent predictors. Results: A total of 1267 participants were included. Knowledge of LP was limited (mean 6.1 ± 3.9 of 18), with 905 (71%) scoring poor and only 362 (29%) demonstrating good knowledge; misconceptions about complications such as urinary incontinence and erectile dysfunction were common. Attitudes appeared favorable, with 1182 (93%) reaching the pre-specified 50% threshold, but this cut-off is lenient because an entirely neutral respondent scores 60% on a summed five-point scale, and only 692 (55%) agreed they would sign consent if their physician recommended LP. Knowledge and attitude were weakly but significantly related (r = 0.21, 95% CI 0.16 to 0.26; adjusted β = 0.25 per additional correct item, p < 0.001). Higher education, student status, healthcare occupation, and higher income predicted better knowledge, and male sex predicted lower knowledge (all p < 0.05), whereas sociodemographic factors were weakly associated with attitude. Conclusions: Among self-selected online respondents in Saudi Arabia, knowledge of lumbar puncture was limited while attitudes were comparatively favorable, and the two were weakly but positively related. Targeted educational interventions are warranted to address misconceptions, enhance public awareness, and support informed decision-making within the healthcare system. Full article

Background and Objectives: This study aimed to characterize physicians’ knowledge and practice patterns regarding the use of probiotics in the management of irritable bowel syndrome (IBS). By examining clinical experiences and barriers to adoption, this research sought to identify critical gaps in practice and establish a foundation for evidence-based improvements in patient care. Materials and Methods: The survey was conducted in accordance with the CROSS (Consensus-based Checklist for Reporting of Survey Studies) guidelines. Attendees of a medical congress, specifically general practitioners, gastroenterologists, surgeons, and internists with an interest in the clinical significance and therapeutic modulation of the human microbiome, were invited to participate. Participants completed a 38-item, paper-based questionnaire. The instrument assessed respondents’ self-perceived knowledge of probiotics, their understanding of probiotic definitions and specific strains, and their current clinical practice patterns—particularly regarding the management of irritable bowel syndrome (IBS). Additionally, the survey explored information sources, the frequency of self-prescription, and the perceived need for further education, with a specific focus on safety profiles and clinical concerns. Results: Of the 70 invited attendees, 68 completed the survey, yielding a response rate of 97.1%. The respondent cohort included 40 general practitioners (GPs), 20 gastroenterologists (GEs), four surgeons (SSs), and four internists (SIMs). More than half of the respondents were female (n = 37, 54.4%), with a median age of 43 years (range: 28–70). Exactly half of the respondents (n = 34, 50.0%) agreed that probiotics always have a role in the management of irritable bowel syndrome (IBS); however, only 44.1% (n = 30) reported familiarity with the relevant scientific literature on probiotics. Furthermore, respondents more frequently recognized bacterial species associated with single-strain probiotic formulations compared to those in multi-strain mixtures. The primary concern regarding the administration of probiotics for IBS was this lack of familiarity with the scientific literature, cited by 23.5% of respondents. Notably, 100% of the surveyed cohort expressed a need for further education on the topic. Conclusions: The emergence of scientific and clinical evidence results in a clinical practice characterized by high prescribing habits, despite the lack of formal approval. These findings highlight evidence showing the effectiveness of certain probiotic strains in managing IBS symptoms, suggesting the need for standardized guidelines. Given the demonstrated need for further education among the surveyed cohort, integrating probiotic-specific training into both undergraduate medical curricula and continuing professional development programs could significantly enhance the clinical knowledge and awareness of both current and future practitioners. Full article

Acute type-A aortic dissection is a life-threatening emergency requiring prompt surgical intervention. However, the management of patients presenting with concomitant intracerebral haemorrhage remains challenging, as the risk of neurological deterioration during surgery must be balanced against the risk of fatal aortic rupture. We report the rare case of a 68-year-old patient diagnosed with acute intracerebral haemorrhage involving the parietal lobe and right frontal region in association with acute type-A aortic dissection. Due to the neurological condition, a delayed surgical strategy was chosen. Six weeks after the initial diagnosis, supracoronary hemiarch replacement of the ascending aorta was successfully performed without postoperative neurological complications. This case highlights the complexity of decision-making in patients with simultaneous acute aortic pathology and intracranial bleeding. This educational report emphasises that immediate surgical repair remains the standard of care. The delayed strategy described here was dictated by an absolute contraindication to anticoagulation and reflects an exceptional, individualised management approach rather than a general therapeutic recommendation. Full article

Background/Objectives: Fibromyalgia (FM) is a chronic pain condition characterized by widespread pain, fatigue, sleep disturbances, and psychosocial challenges. Although physiotherapists play a key role in FM management, little is known about how biopsychosocial principles are applied in clinical practice. This study explored physiotherapists’ clinical reasoning, therapeutic strategies, and approaches to promoting adherence and functional recovery in FM. Methods: A qualitative study was conducted within a constructivist–interpretative paradigm. Thirteen physiotherapists with experience in FM management across different healthcare settings in Spain participated in semi-structured interviews. Participants were recruited through purposive and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis following Braun and Clarke’s framework. Methodological rigor was ensured through reflexive engagement among researchers with differing backgrounds, reflexive practice, and adherence to COREQ guidelines. Results: Three overarching themes and seven sub-themes were identified. Clinical validation emerged as a key strategy to reduce uncertainty and facilitate engagement. Therapeutic goals were progressively shifted from pain reduction toward function, autonomy, and participation. Pain neuroscience education and individualized exercise were identified as the main therapeutic strategies, while group-based interventions promoted social support, motivation, and adherence. Lifestyle recommendations, including stable routines, social participation, and work adaptation, complemented treatment. Conclusions: Physiotherapists perceive FM management as a multidimensional process extending beyond symptom reduction. Validation, pain neuroscience education, individualized exercise, and group-based support appear to facilitate adherence, self-management, and functional recovery within a biopsychosocial framework. Full article

Background: Neutrophil extracellular traps (NETs) promote tumor progression and immune evasion across multiple cancers. However, the mechanisms governing NET formation (NETosis) within the tumor immune microenvironment remain incompletely understood. Low P2RY13 expression is associated with the pro-tumor activity of neutrophils in lung adenocarcinoma. Methods: Pan-cancer bioinformatics analyses were performed, including differential gene expression, prognostic, tumor-infiltrating immune cell, and NET scoring analyses. Single-cell profiling was conducted using the Tumor Immune Single-cell Hub 2 database. Immunohistochemical (IHC) and multiplex immunofluorescence (mIF) staining of tissue microarrays (TMAs) was performed to validate findings in lung adenocarcinoma (LUAD), liver hepatocellular carcinoma (LIHC), and colorectal cancer (CRC). In vitro validation was conducted using gene modulation, tumor-cell-conditioned medium (CM) education, tumor-associated macrophage (TAM)-like macrophage CM transfer, immunofluorescence staining, and ELISA. Results: Bioinformatics analyses suggested that P2RY13 is frequently dysregulated in multiple cancers and that low P2RY13 expression is associated with poor prognosis and reduced immunotherapy responsiveness. Single-cell analyses revealed that P2RY13 is predominantly expressed in TAMs rather than tumor cells. Macrophages without detectable P2RY13 transcripts were markedly enriched in tumor tissues compared with paired normal tissues, and their high infiltration appeared to be associated with elevated NET scores. Tissue microarray-based IHC and mIF analyses further validated this infiltration pattern in LUAD, LIHC, and CRC. In vitro, CM from P2RY13-silenced, tumor-educated TAM-like macrophages enhanced neutrophil NETosis, whereas P2RY13 re-expression attenuated this effect. Furthermore, TMA staining indicated a positive correlation between P2RY13⁻CD68⁺ TAM infiltration and NET expression in the three malignancies. Conclusions: We identified a potentially conserved NETosis-regulating pattern in multiple cancers in which P2RY13-negative TAMs promote NET formation and are associated with adverse clinical outcomes. These findings suggest a previously unrecognized tumor-promoting mechanism and highlight potential therapeutic targets for cancer treatment. Full article