Search Results (1,527)

Background: Automated discharge instructions are increasingly used to support post-discharge communication, patient education, and nursing follow-up, yet the current state remains unidentified. This systematic review explores the types of automated discharge instructions used and their effectiveness in enhancing patient engagement and reducing readmission, emergency department visits and reoperation rates. Methods: A systematic search was conducted on 15 April 2025, using Embase, PubMed, Scopus, Web of Science, and CINAHL, following PRISMA guidelines. Inclusion criteria required peer-reviewed original research evaluating the utilization of automated patient discharge instructions following hospital admission or surgical stay. Exclusion criteria included correspondence, reviews, educational materials, not peer-reviewed, retracted reports, not retrievable, and no English translation. Risk of bias was assessed independently using NIH, JBI, ROB-2, and ROBINS-I tools. Two investigators independently conducted the screening, extraction, and synthesis of results using Endnote and Microsoft Excel. Results: Of the 1252 records identified, 13 studies were selected for analysis. There was a total of 34,386 patients across a diverse range of healthcare settings and clinical contexts. The average sample size per study was approximately 4912, with study samples ranging from 16 to 13,188 patients. The modalities of discharge instructions included automated phone calls (23.1%) and/or text messages (53.8%), as well as printed out auto-generated summaries (15.4%). Patient engagement was generally high, with automated phone calls showing the most consistent interaction, with completion rates ranging from 44% to 56%, often prompting clinical follow-up. SMS tools demonstrated strong scalability and response rates up to 87%. Two studies reported on hospital readmission outcomes and only a single study reported on emergency department revisit rates, while none assessed reoperation outcomes. Among those reporting readmission, automated phone calls and SMS were associated with lower or proxy-reduced readmission rates. Included studies had low to moderate levels of bias. Conclusions: While evidence on clinical outcomes such as readmissions, emergency department revisits, and reoperations remains limited and inconclusive, automated discharge tools—particularly phone calls and SMS—consistently demonstrated high patient engagement. Automated discharge tools show promise for supporting transitional care, discharge education, and post-discharge monitoring, highlighting the future role of automated tools in nursing workflows to support follow-up, escalation, and continuity of care. Full article

Type 2 diabetes (T2D) exhibits substantial phenotypic heterogeneity, resulting in diverse cardiovascular (CV) outcomes driven by multiple pathophysiological mechanisms beyond hyperglycemia alone. T2D should be recognized as a systemic cardiometabolic condition in which insulin resistance, chronic inflammation, oxidative stress, and endothelial and microvascular dysfunction promote a broad spectrum of cardiovascular diseases. The traditional “one-size-fits-all” approach to cardiovascular risk management has been proven insufficient, as individuals with T2D display marked variability in clinical presentation, disease trajectory, treatment response, and cardiovascular phenotype. In this context, personalized medicine strategies integrating clinical phenotyping, individualized risk stratification, and tailored therapeutic interventions offer the potential to optimize cardiometabolic outcomes while minimizing treatment burden and adverse effects. This narrative review examines the rationale and current evidence supporting personalized cardiovascular risk management in T2D. We discuss the heterogeneity of diabetes-related CV phenotypes, encompassing both atherosclerotic and non-atherosclerotic complications. We further examine the major cardiometabolic risk factors closely linked to diabetes, including dyslipidemia, hypertension, obesity, chronic kidney disease, and metabolic liver disease, which act synergistically to accelerate vascular damage and end-organ injury, and are essential for defining personalized prognostic and therapeutic programs. Finally, we present structured approaches to cardiovascular assessment and highlight contemporary management strategies that prioritize integrated, phenotype-driven risk reduction using cardioprotective glucose-lowering therapies together with optimized lipid-lowering, antihypertensive, antithrombotic, and weight-modifying interventions. The transition from population-based guidelines to individualized, patient-centered care represents a paradigm shift in diabetes management, with the potential to substantially reduce the excess CV burden associated with this condition. Full article

Clot-in-transit (CIT) is a free-floating thrombus in the right heart and can enter pulmonary circulation at any moment. Possible treatments include anticoagulation, systemic thrombolysis, surgical embolectomy, and endovascular catheter-based therapies. The optimal treatment is still undetermined, heavily relying on clinical judgment and multidisciplinary team discussion. We report a case of a 70-year-old woman presenting with tachydyspnoea following recent abdominal surgery, who was diagnosed with massive bilateral pulmonary embolism (PE) complicated by a clot-in-transit. Point-of-care ultrasonography revealed a large mobile thrombus in the right atrium with severe right ventricular dysfunction. Due to haemodynamic instability and a contraindication for systemic thrombolysis, mechanical thrombectomy was performed. A large thrombotic burden was aspirated from the right heart and pulmonary arteries, resulting in haemodynamic stabilization and recovery of right ventricular function. The patient remained stable throughout hospitalization and was discharged on oral anticoagulation therapy with complete recovery on follow-up. This case highlights several points. Firstly, CIT is a rare finding but should be considered in patients with massive pulmonary embolism and shock. Furthermore, POCUS is essential for diagnosing CIT. Finally, mechanical thrombectomy is a valuable therapeutic option in high-risk PE patients with contraindications to systemic thrombolysis and haemodynamic instability. Further studies are needed to establish adequate guidelines for the optimal management of CIT patients. Full article

We present a geodesic dynamics framework for discrete-time state evolution on the unit sphere $S^{N-1}$ that maintains exact unit-norm constraints through Riemannian exponential mapping. Given an input sequence and an initial state, the method constructs trajectories by projecting inputs to tangent spaces and updating states along geodesics, incorporating temporal memory via approximate parallel transport of velocity directions. Unlike traditional approaches requiring post hoc normalization of linear updates, the geodesic formulation preserves $\parallel {\mathbf{x}}_t\parallel =1$ to machine precision while eliminating explicit $N\times N$ transition matrices in favor of $D\times N$ input embeddings when the intrinsic input dimension D is much smaller than the ambient dimension N. The update corresponds to a first-order exponential integrator on the sphere. We establish local Lipschitz continuity of the exponential map on positively curved manifolds with careful treatment of basepoint dependence, derive perturbation bounds showing linear-to-exponential growth transitions via Grönwall-type estimates, and we prove third-order asymptotic equivalence with normalized linear systems under appropriate scaling. Numerical experiments on synthetic data validate exact norm preservation over extended time horizons, confirm theoretical perturbation growth predictions, and demonstrate the effectiveness of the temporal memory mechanism in reducing long-horizon prediction errors. The framework provides a principled geometric approach for applications requiring exact directional or compositional constraints. Full article

Cystic fibrosis (CF) is an autosomal recessive disorder caused by pathogenic variants in the cystic fibrosis transmembrane conductance regulator (CFTR) gene and primarily affects the respiratory, digestive, and reproductive systems. Globally, CF is most prevalent among European ancestry, with an incidence rate of approximately 1/2500 to 1/3500. In China, the incidence is about 1/128,000. However, CF is not extremely rare in the Chinese population; rather, its prevalence is significantly underestimated. The CFTR mutation spectrum in China is highly unique, characterized by an extremely low frequency of p.Phe508del. Instead, region-specific mutations such as p.Gly970Asp, p.Ile1023Arg, and p.Arg553Ter predominate, alongside a high proportion of splicing variants and complex rearrangements. A significant proportion of Chinese CF patients primarily present with CF-like phenotypes within the CF-related disease spectrum (such as congenital bilateral absence of the vas deferens and pseudo-Bartter syndrome), exhibiting overlapping features with classic CF but lacking typical respiratory-dominant symptoms. This review examines how these atypical symptoms deviate from the diagnostic pathways established in Western countries. Establishing localised data and functional platforms is a prerequisite for achieving precision medicine. Achieving a transition from symptom-focused care to defect-correcting therapy will require coordinated multicenter collaboration and sustained infrastructure development. Full article

Chronic obstructive pulmonary disease (COPD) represents an escalating global health challenge characterized by profound clinical and biological heterogeneity. Conventional diagnostic paradigms, primarily reliant on spirometric criteria and broad phenotypic labels, often fail to capture the complex molecular mechanisms underlying effective precision medicine. This narrative review synthesizes the evolving landscape of COPD characterization, analyzing the integration of biomarkers, advanced quantitative imaging, and multi-omics technologies. Key developments highlighted include the clinical validation of biologics targeting type 2 inflammation, which reinforce the paradigm shift from generic symptomatic management toward the identification of specific treatable traits. We further explore the role of artificial intelligence and deep learning in enhancing radiological precision and body composition analysis. Ultimately, this work proposes a transition toward a GETomics (Genetics, Environment, and Time) framework as a fundamental prerequisite for transcending the limitations of traditional classification systems and delivering truly personalized care in the 21st century. Full article

Background: Periprosthetic joint infection and native hip infections often require staged surgical intervention due to extensive bone and soft tissue destruction. This study evaluates the clinical feasibility and mechanical reliability of a modified functional articulating hip spacer (FAHS) incorporating a cemented dual-mobility-bearing (DMB) metal liner. Methods: We retrospectively reviewed the cases of 20 patients who underwent a DMB-incorporated FAHS between March 2018 and December 2019. The technique involved cementing a DMB metal liner directly into the prepared acetabulum without a standard outer shell. Successful clinical outcome was defined as either transition to second-stage total hip arthroplasty (THA) or stable spacer retention, the latter including cases with definitive eradication or symptom-controlled chronic suppression therapy. Infection eradication required the clinical absence of infection for at least twelve months following the cessation of antimicrobial therapy. Construct-related mechanical complications and radiographic parameters were also analyzed. Results: The mean follow-up was 23.5 months, ranging from 6.0 to 62.6 months. Successful clinical outcome was achieved in 17 patients (85%), with seven (35%) transitioning to second-stage THA and ten (50%) opting for spacer retention. Within the retention group, seven achieved definitive eradication while three were maintained under chronic suppression therapy. Construct integrity was maintained in 80% of the cohort. Mechanical complications included two dislocations (10%) and two implant failures (10%). Radiographic analysis showed higher inclination and anteversion angles of the metal liner in the dislocation cases. Conclusions: The off-label use of DMB-incorporated FAHS represents a feasible option with acceptable mechanical performance in selected cases of PJI and native hip joint infection. However, as mechanical complications cannot be fully prevented, meticulous surgical techniques and careful patient selection remain essential. Full article

Alginate, a naturally occurring polysaccharide derived from brown algae, has emerged as a versatile cornerstone in the field of biomedical materials. Its widespread adoption is driven by its exceptional biocompatibility and the unique cation-dependent gelation defined by the “egg-box” model. This review examines the fundamental chemistry of alginate, detailing how its crosslinking mechanisms dictate the physicochemical properties essential for clinical performance. The discussion bridges the gap between polymer structure and diverse biomedical applications, including drug delivery, tissue engineering, and the clinical management of gastrointestinal reflux and wound care. Furthermore, the article evaluates the role of alginate-based systems in the biomedical and metabolic management of obesity and diabetes. By analyzing how alginate influences satiety, glycemic index modulation, and lipid absorption through biophysical mechanisms, this review highlights the transition from fundamental chemical architecture to practical clinical utility. By integrating structural chemistry with physiological impact, this work underscores the evolving potential of alginate-based materials as supportive and functional strategies in modern clinical care. Full article

Inflammatory bowel diseases (IBD) are chronic, relapsing, immune-mediated disorders that require regular and preferably noninvasive monitoring of inflammatory activity. Fecal biomarkers of neutrophilic inflammation, namely calprotectin and lactoferrin, therefore represent key analytical targets for diagnosis and longitudinal disease management. Despite their widespread clinical use, existing publications predominantly address either their clinical relevance or individual technical solutions, without establishing a comprehensive engineering-translational framework for their biosensor-based implementation. This review bridges this gap by providing an integrative analysis of the molecular and biological nature of calprotectin and lactoferrin, the mechanisms underlying their appearance in fecal matrices, and the analytical constraints that directly influence the design of hybrid point-of-care (PoC) biosensor systems. We systematically compare major biosensing platforms, emphasizing sensor architecture, signal transduction mechanisms, and sample preparation strategies as critical determinants of sensitivity, selectivity, reproducibility, and clinical relevance. The novelty of this review lies in combining the pathophysiological context of neutrophilic inflammation with physicochemical and technological aspects of biosensor development, enabling a transition from laboratory prototypes to evaluation of real translational readiness. The practical significance resides in establishing a methodological basis for rational design of next-generation hybrid-integrated biosensor systems and outlining perspectives for digital analytics and artificial intelligence in clinically interpretable IBD monitoring. Full article

Background/Objectives: The transition from the intensive care unit (ICU) to the hospital ward is a critical high-risk period for patients. Early ICU discharge reduces costs and frees up ICU resources but can lead to readmission or unexpected death if patients are discharged prematurely. Despite the availability of risk stratification tools such as the Stability and Workload Index for Transfer (SWIFT) score, predicting ICU readmission remains challenging and inconsistent. However, artificial intelligence (AI) and machine learning (ML) techniques have recently shown promise in improving clinical decision support systems, particularly in the ICU. This study aimed to identify the risk factors and assess the performance of AI models in predicting readmission or death within seven days of ICU discharge using the MIMIC-IV (between 2008 and 2019) and Kangwon National University Hospital (KNUH, between 1 January 2016 and 28 February 2023) databases. Methods: This retrospective cohort study utilized the MIMIC-IV database for model training and internal validation and the KNUH database for external validation. Various machine learning and deep learning models have been developed to predict ICU readmission or death within seven days of discharge. The performance of the primary model, GRU-D++, was compared to the SWIFT score. Statistical analysis focused on the area under the receiver operating characteristic curve (AUROC) data to evaluate model accuracy. Results: The GRU-D++ model outperformed the SWIFT score, achieving AUROC of 0.802 and 0.756 for internal and external validations, respectively. Both datasets demonstrated that the GRU-D++ model provided better predictive performance for ICU readmission or death within seven days than the traditional SWIFT score. Conclusions: Our findings suggest that the GRU-D++ deep learning model is a valuable tool for the early detection of patient deterioration after ICU discharge, potentially aiding the prevention of ICU readmission. This study highlights the potential of AI to improve clinical decision-making in intensive care settings. Full article

Background/Objectives: Transfusion-dependent β-thalassaemia (TDT) is a lifelong condition requiring coordinated multidisciplinary care. In France, where the disease is rare, transition from pediatric to adult care remains poorly structured, potentially compromising adherence and long-term outcomes. Methods: This national retrospective study evaluated current transition practices and their clinical impact among young adults with TDT. Patients aged 20–25 years in December 2022 were identified from the national NaThalY registry. Those diagnosed and managed in France before age 15 were included. Clinical data were collected for the two years preceding and following transition. Transition practices were assessed using a standardized questionnaire sent to pediatric centers. Results: Thirty-four patients were included (mean transition age: 19 years). The rate of response to the questionnaire was 90.5%, with feedback from 19 centers. Only one-third of centers offered joint pediatric–adult consultations, and one-quarter provided transition-focused education. No written transition protocols were reported. Mean pre-transfusion hemoglobin levels were significantly lower after the transition (8.5 vs. 8.0 g/dL; p = 0.01). Ferritin levels showed a non-significant increase, with no statistically significant changes observed in hepatic or cardiac iron concentrations. Conclusions: This study demonstrates marked heterogeneity and limited formalization of transition practices in France. Development of structured, standardized transition pathways is urgently needed to ensure continuity of care and optimal disease management in adults with TDT. Full article

In the face of intensifying climate disruptions, coastal landscapes like Necoclí in Colombia’s Department of Antioquia are sites of both vulnerability and resilience. This paper examines how thick mapping acts as a methodology for decentralized spatial planning and a practice of revolutionary care by amplifying youth voices and fostering situated climate adaptation. Drawing from a participatory mapping process co-developed with young people, we reflect on how community-based approaches can trigger territorial restructuring from the bottom up. Through storytelling, visual documentation, and collective drawing, the mapping process brought to light lived experiences and local ecological knowledge that are often excluded from technocratic spatial integration strategies. These thick maps function as tools for sub-local territorial agency, allowing youth to reconnect with their landscapes while providing municipal administrations with the granular data needed for equitable spatial development. The paper explores how this form of mapping challenges top-down adaptation narratives and enables more inclusive planning for just futures by centering the territorial dimensions of climate risk. Our findings reveal a profound divergence in territorial perception: while older settlers maintain a narrative of loss tied to a lush, forested past, children’s drawings expose an internalized ecological thinning, characterized by the absence of native flora and the threatening proximity of a rising sea. Ultimately, this study demonstrates how thick mapping contributes to socio-ecological transitioning by bridging the gap between national climate policies and the spatial expression of local needs in frontline communities. Full article

Mild cognitive impairment (MCI), also known as mild neurocognitive disorder, represents a transitional stage between normal cognitive aging and dementia and often signals early neurodegenerative change. Despite its clinical importance, MCI remains poorly understood by the public and family care partners, leading to uncertainty and distress following diagnosis. This study evaluated UnderstandingMCI.ca, a brief multimedia e-learning lesson designed to improve MCI literacy among the public and care partners. The lesson was disseminated through the McMaster Optimal Aging Portal, with web analytics tracking uptake, progress, and completion, and a post-lesson survey incorporating the Net Promoter Score (NPS), the Information Assessment Method for all (IAM4all) questionnaire, and open-text feedback assessing perceived impact. Between 15 January and 7 February 2025, over 5000 users initiated the lesson, 1537 completed it, and 984 responded to the survey. Respondents were predominantly women aged 65 years or older. The NPS was 72 (“excellent”); 942 respondents (96%) found the lesson relevant, 937 (95%) anticipated benefits from using the information, and nearly all (982 respondents) reported understanding the material. Thematic analysis of 296 comments identified greater understanding of MCI versus normal aging and dementia, emotional reassurance, and motivation for proactive brain-health behaviors. UnderstandingMCI.ca was well-received, with respondents reporting that the lesson was understandable and relevant, and that they intended to use the information, suggesting it may be a feasible and scalable approach to public and care partner education about MCI. Full article

Postnatal corticosteroids are frequently administered to extremely preterm infants to support respiratory management, yet their effects on the immature cardiovascular system are complex and underexplored. As the second installment in a series on physiology-informed steroid use, this narrative review focuses on the cardiovascular consequences of systemic corticosteroid therapy in preterm neonates. We examine how corticosteroids influence key aspects of cardiovascular physiology, including ductal closure, systemic and pulmonary vascular resistance, myocardial remodeling, and autonomic regulation. Attention is given to the hemodynamic transition of early postnatal life and how steroid exposure may interact with patency of the ductus arteriosus and vascular development. The potential for corticosteroids to contribute to reactive myocardial hypertrophy, systemic hypertension, and pulmonary hypertension is also reviewed in the context of both short- and long-term outcomes. Emerging diagnostic and monitoring tools are discussed for their potential to guide individualized therapy. These include targeted neonatal echocardiography (TnECHO) to assess cardiac function and structure, electrocardiography (ECG) for rhythm and conduction abnormalities, heart rate variability analysis for autonomic function, and circulating biomarkers to evaluate myocardial stress and inflammation. Together, these tools may inform tailored steroid timing and dosing, especially in the research context, while monitoring for signs of cardiovascular side effects in real time. By synthesizing mechanistic insights with evolving clinical evidence, this review highlights the need for a more nuanced understanding of how corticosteroids affect the developing cardiovascular system. It underscores the importance of integrating cardiovascular monitoring into routine care to optimize therapeutic benefit while minimizing unintended harm. Alongside companion reviews addressing respiratory and growth impacts, this installment contributes to a broader framework for individualized, physiology-driven steroid use in extremely preterm infants. Full article

The small molecule SR8278 was initially identified as an antagonist of the REV-ERB (reverse c-ERBAa) nuclear receptor proteins, which play important roles in metabolism and circadian rhythms. Though SR8278 has been shown to have beneficial physiological effects in a variety of different preclinical disease contexts, its impact on gene expression and cell proliferation in keratinocytes has not previously been examined. We therefore carried out an RNA-seq analysis and found that genes involved in the G1/S transition of the cell cycle were significantly impacted by SR8278 treatment, and these effects were confirmed at both the RNA and protein level by RT-qPCR and Western blotting, respectively. Cell proliferation assays showed that SR8278 slowed cell growth but did not induce genotoxic stress or apoptosis. Finally, the use of CRISPR/Cas9 genome editing and siRNA-mediated disruption of REV-ERB gene expression showed that the loss of the REV-ERB proteins did not impact the effect of SR8278 on gene expression and cell proliferation. We conclude that the anti-proliferative effects of SR8278 are not mediated by the REV-ERB proteins, and, thus, care should be taken when interpreting studies involving this compound unless complementary genetic approaches are also shown, particularly in studies involving cell proliferation. Full article