Search Results (2,152)

Treatment of non-small cell lung cancer (NSCLC) has been transformed by immunotherapy and targeted therapies. We aimed to characterize clinical features, treatment patterns, and healthcare resource use in patients with early and locally advanced NSCLC before incorporation of these therapies. This retrospective observational study included adults diagnosed with stage I–III NSCLC at four Spanish hospitals between 2014 and 2018, with follow-up until 2021, using artificial intelligence to extract data from electronic health records. A total of 951 patients were included (34.7% stage I, 16.7% stage II, 48.6% stage III), with a median age of 66 years and 31.9% female. Surgery was performed in 78.5% of stage I, 74.8% of stage II, and 35.5% of stage III patients. Among surgical patients, 62.5% received adjuvant chemo- and/or radiotherapy, 20.8% neoadjuvant therapy, and 15.7% both; among non-surgical patients, chemoradiotherapy was the most common treatment (50.4%). Beyond hospitalization, outpatient visits were the most frequently used healthcare resource. These findings provide a historical benchmark of NSCLC care before introduction of immunotherapy and targeted therapies in these settings, highlighting treatment variability and the need for earlier diagnosis, structured treatment pathways, and multidisciplinary management. Full article

Background/Objectives: Pharmacists play a key role in managing urinary tract infection (UTI) symptoms by providing medications, self-care advice, and over-the-counter treatments, while referring patients to a doctor when necessary. This study aimed to examine the practices of community pharmacists in managing UTI symptoms and to gain insight into their attitudes toward antibiotic use for this condition. Methods: A cross-sectional study was conducted among community pharmacists in Serbia using a previously validated online questionnaire, assessed for content and face validity and pilot-tested among pharmacists. Results: A total of 430 community pharmacists participated in the study. Patients more often consulted pharmacists before visiting a doctor than after (median 5 vs. 3 per week; p < 0.001). For uncomplicated UTIs, pharmacists primarily recommended increased fluid intake (92.8%), herbal teas (94.7%), and food supplements (85.6%), whereas for complicated UTIs, most referred patients to a doctor (95.4%). Attitudes, perceived competence, and support for over-the-counter antibiotic availability were significantly associated with gender, years of experience, and specialization. Pharmacists who agreed that antibiotics are the most effective treatment for uncomplicated urinary tract infections were more likely to refer patients to a doctor (p < 0.01). Conclusions: Pharmacists are frequently consulted for UTI management and emphasize non-antibiotic approaches for uncomplicated cases. Their attitudes influence counseling practices, highlighting the need for standardized UTI counseling services, antimicrobial stewardship education, and structured communication training to support appropriate antibiotic use. Full article

Background/Objectives: The acute complications of COVID-19 have been well characterized and are frequently associated with increased mortality. Although substantial knowledge regarding long COVID has accumulated since the beginning of the pandemic, important uncertainties remain regarding the long-term clinical, functional, radiological, and metabolic consequences of SARS-CoV-2 infection. Identification of post-COVID-19 complications is therefore essential for appropriate recognition and management. This study aimed to evaluate the long-term complications of COVID-19 at 3 and 9 months after infection. Methods: This prospective study was conducted at Inonu University Turgut Ozal Medical Center. Patients who presented with active post-COVID-19 complaints or for routine follow-up were enrolled. Participants were evaluated at the pulmonology outpatient clinic at 3 and 9 months. At each visit, persistent or new-onset symptoms were assessed, and pulmonary function tests (PFT), the six-minute walk test (6MWT), echocardiography (ECHO), and thoracic computed tomography (CT) were performed as clinically indicated. Patients were stratified into three groups according to the severity of acute illness: outpatient, ward-hospitalized, and ICU-hospitalized. Results: A total of 205 patients (120 male, 85 female) were included. Male patients had significantly higher rates of ward and ICU hospitalization than female patients (p = 0.006). At 9 months, 85.3% of patients had at least one persistent symptom; dyspnea (69.6%), cough (35.6%), and chest pain (32.5%) were the most common. FVC showed a statistically significant increase between months 3 and 9 (p = 0.014), and the 6MWT distance improved significantly (423.56 m vs. 464.10 m; p = 0.008). Ground-glass opacity, present in 90.2% of patients at admission, persisted in 44.3% at 9 months (p < 0.001). Reticular opacities, pleuroparenchymal bands, and mosaic perfusion patterns increased over time. ICU patients had significantly lower ejection fraction values compared with ward and outpatient groups at 9 months (p = 0.046). During follow-up, 13 patients developed pulmonary embolism and 7 developed new-onset diabetes mellitus. Conclusions: Despite the well-characterized acute phase, the long-term sequelae of COVID-19 remain a significant clinical challenge. Identification of late complications is critical for reducing morbidity and understanding the long-term societal and healthcare burden of the pandemic. Multidisciplinary long-term follow-up is warranted, particularly for patients who experienced severe acute illness. Full article

Background/Objectives: Primary care clinics increasingly receive urgent and semi-urgent requests from patients who may otherwise attend emergency departments or urgent care centres when timely appointments are unavailable. This article describes and evaluates the Cranston Ridge Medical Clinic Registered Nurse Prescriber-led Triage–Treatment–Continuity model in Calgary, Alberta, Canada. Methods: The manuscript is reported as a single-clinic practice innovation and service evaluation using aggregate, non-identifying operational data from 1 April 2025 to 31 March 2026. The model combines medical office assistant emergency recognition, RN prescriber-led stability assessment, traffic-light urgency classification, a booking-contingency algorithm, clinical support tools, diagnostic test ordering and prescribing within authorized scope, safety-netting, and communication with the patient’s primary care provider through the electronic medical record. Results: During the evaluation period, 5032 pathway contacts were managed. Of 5030 stable contacts assigned traffic-light categories, 4950 (98.4%) were Code Red same-day contacts, 55 (1.1%) were Code Yellow 24–48-h contacts, and 25 (0.5%) were Code Green non-urgent contacts. Two contacts triggered EMS/911 activation before traffic-light classification. Following RN prescriber assessment, 9 emergency department referrals, 2 urgent care referrals, 85 primary care provider follow-up appointments, and 5 patient refusals were recorded; no safety incidents or complaints were recorded in the aggregate monitoring dataset. A CIHI-informed 15% reference scenario corresponds to approximately 755 potentially avoided ED/UCC visits, but no confirmed diversion or monetary savings are claimed. Conclusions: The model reframes triage as an integrated primary care intervention that combines assessment, treatment, escalation, and continuity. Further ethics-approved research is required to evaluate patient-level outcomes, safety, confirmed health-system utilization effects, stakeholder experience, and cost-effectiveness. Full article

Lychee, an entomophilous fruit crop cultivated in tropical and subtropical regions, depends heavily on pollination services for optimal fruit yield and the economic sustainability of farmers. However, information on its pollinator interactions remains limited. This study was conducted over three flowering seasons to document the pollinator assemblage of lychee and examine variation in their activity under different physical conditions, including time of day, panicle height, and light–shade environments. Several insects (here, 47, including many butterflies, bees and flies) were recorded as flower visitors of lychee. The most effective pollinators were Apis cerana, Apis dorsata, Apis florea, Braunsapis mixta, and Tetragonula pagdeni. Pollinator abundance, species richness, diversity, and foraging traits (e.g., flower visitation rate and flower handling time) varied with daytime, inflorescence height, and light availability (light versus shade). Greater abundance, richness, and diversity were documented between 8:00 and 12:00 h, at mid-canopy height (2–6 m), and on well-lit inflorescences. Flower visitation rate was higher under these conditions, whereas flower handling time was lower. This study uncovered the key pollinators of lychee and demonstrated that plant–pollinator interactions vary across different physical conditions. These findings may help to improve pollinator management and enhance pollination services in lychee cultivation. Full article

Background: Obesity is a growing public health crisis in Saudi Arabia. Community pharmacists are well-positioned to deliver accessible weight management services, but data on public willingness to pay (WTP) for these interventions remains limited. Aim: To assess the willingness of the Saudi Arabian public to pay for community pharmacist-led weight management services and identify factors associated with WTP. Methods: A cross-sectional, face-to-face survey was conducted among adults in a medical city in Riyadh between October 2025 and January 2026. WTP was elicited using the Payment Card method based on a hypothetical pharmacist-led service scenario. Payment values were validated by an expert panel. Univariable and multivariable regression models were used to identify independent predictors of WTP and payment amounts. Results: Of 746 participants, 66% expressed willingness to pay for the service. The most frequently selected maximum payment was 50 SAR per session. Multivariable logistic regression revealed that WTP was significantly associated with younger age, higher monthly income, perceived usefulness of pharmacy services (aOR: 3.10; 95% CI: 1.83–5.26), frequent pharmacy visits, and prior or desired access to a dietitian. Clinical burden, including BMI and chronic conditions, did not significantly influence WTP. Among those willing to pay, male gender was independently associated with a lower stated payment amount compared to females (β = −3.8 SAR; p = 0.006). Conclusions: Among adults attending a large academic medical city in Riyadh, there is substantial willingness to pay for pharmacist-led weight management services, with perceived value and healthcare engagement as the primary drivers. These preliminary findings warrant replication in broader, nationally representative samples. Full article

Background: Admission to an intensive care unit (ICU) exposes family members of adult patients to substantial informational, emotional, and decisional burden. In recent years, digital tools have increasingly been used to support communication, information delivery, virtual visiting, psychological support, diary writing, and surrogate decision making in ICU settings, although the available literature remains heterogeneous in terms of intervention type, purpose, timing, and outcomes assessed. Methods: A scoping review was conducted according to Joanna Briggs Institute methodology and reported following PRISMA-ScR. The literature search was performed between January and March 2026 in PubMed/MEDLINE, Scopus, and CINAHL. After duplicate removal, title/abstract screening, and full-text assessment, 32 studies were included in the qualitative synthesis. Results: The included studies were published between 2016 and 2026, used heterogeneous methodological designs, and originated from different international contexts. Six main categories of digital tools were identified: educational websites and online information resources; decision aids and tablet-based tools; virtual visiting and video communication systems; digital diaries and writing practices; psychological support or self-management applications; and digital assessment or family-engagement platforms. Overall, informational and communication-oriented tools appeared to provide the clearest signals of usefulness for family orientation, information access, communication, and relational continuity, whereas evidence regarding psychological and decisional outcomes remained more variable and largely preliminary. Conclusions: Digital tools for family members of adult ICU patients represent a relevant and evolving component of family-centered critical care. Their value appears to depend on the family need addressed, the timing of implementation, and their integration into clinical workflows. Overall, the available literature suggests that digital tools may be particularly useful for family orientation, information access, and communication, whereas their impact on psychological and decisional outcomes remains less certain and requires further investigation. Full article

Background: The utilization of renal replacement therapy (RRT) is crucial for the management of patients with acute kidney injury (AKI) in emergency departments (EDs). The prompt initiation of RRT, encompassing both intermittent hemodialysis (HD) and continuous renal replacement therapy (CRRT), is acknowledged as beneficial for critically ill patients. The purpose of this study is to investigate the implementation of RRT within EDs and its impact on ED length of stay (EDLOS) in South Korea. Methods: This retrospective study utilized data from the National Emergency Department Information System (NEDIS) for the year 2019 to assess the utilization of RRT in emergency medical centers (EMCs) across South Korea. The analysis focused on RRT, which includes intermittent HD and CRRT, as identified through insurance billing codes for patients treated during ED visits and subsequent admissions. EMCs were categorized into three groups based on the frequency of RRT sessions, and the median EDLOS was evaluated. Results: Among 5,937,569 ED visits to Level I and II emergency medical centers (EMCs), 40,130 cases (0.68%) received RRT. Of the 162 EMCs, 58 centers (35.8%) did not perform intermittent HD in the ED and 106 centers (65.4%) did not perform CRRT in the ED during the study period. Centers that frequently performed CRRT in the ED showed significantly longer EDLOS compared with centers that seldom or never performed CRRT (588 min [IQR 286–767] vs. 270 min [IQR 147–337] and 205 min [IQR 149–363], respectively; p = 0.01). Regional disparities in the availability of ED-based RRT were also observed across South Korea. Conclusions: The frequency of RRT administration in EMCs in South Korea varied by region and facility. ED-based RRT utilization was associated with longer EDLOS, particularly in centers frequently performing CRRT. These findings suggest that patient acuity, institutional characteristics, and RRT-related resource utilization should be considered when evaluating EMC performance based on EDLOS. Full article

Globally, mycotoxin contamination of maize is a fundamental concern due to significant economic losses and toxic health effects on humans and animals. This study analyses the perceived effects of mycotoxin contamination and the use of control measures among smallholder maize farmers in South Africa using Mbombela as a case study. A two-stage sampling procedure was used to select 152 registered smallholder maize farmers in Mbombela, South Africa. Data was collected with a structured questionnaire administered by trained enumerators. Descriptive and multiple linear regression analyses were carried out using SPSS (Version 28). The findings revealed that many farmers had a high perception of the effects of mycotoxin contamination, and the most prominent prevention and control practices were good field management, storage of maize in clean, well-ventilated stores, and proper sorting of harvested grains. Multiple linear regression results revealed that farming experience, media exposure, extension visit, mycotoxin-related training, mycotoxin awareness, and perception index significantly influenced farmers’ utilization of mycotoxin prevention and control practices. The study recommended that agricultural professionals develop robust mycotoxin-related training and advisory services to enhance and strengthen farmers’ awareness and perceptions, and to promote the sustained use of effective agricultural practices to combat mycotoxin contamination. Full article

Background/Objectives: Indigenous children in La Guajira, Colombia, live in a context of structural vulnerability that may compromise growth and nutritional status. This study aimed to characterize anthropometric patterns and longitudinal nutritional changes in Wayúu children under five years of age. Methods: A quantitative cross-sectional analysis was conducted in 398 children from 27 Wayúu communities in Manaure, La Guajira, Colombia, with an exploratory longitudinal follow-up subgroup assessed over an 8-month period. Anthropometric measurements were obtained by trained pediatricians and classified using standard WHO growth references. Descriptive and bivariate analyses were performed for the full sample, and exploratory longitudinal changes were assessed in the follow-up subgroup. Results: At baseline, 92.46% of children presented at least one nutritional alteration, and 89.95% had malnutrition or nutritional impairment. Stunting was the most frequent condition (60.1%), whereas acute malnutrition was less common. In the exploratory longitudinal subgroup, 41.67% of children showed descriptive changes in at least one anthropometric indicator, with a significant increase in nutritional risk between visits. Older children showed significantly lower weight-for-age and height-for-age values than younger children, while no significant differences were observed by sex. Conclusions: Wayúu children under five years in Manaure show a pattern dominated by chronic growth impairment with worsening anthropometric indicators over time. These findings highlight the need for sustained, culturally adapted, and multisectoral strategies to prevent and manage childhood malnutrition in Indigenous populations. Full article

Background: Network medicine has reshaped how systemic comorbidities are quantified, but the internal comorbidity structure of oral diseases remains undescribed at four-character ICD-10 granularity. Methods: A total of 2,863,671 outpatient visit records from 583,614 patients (2011–2025) were analyzed. Using ICD-10 four-character codes (75 disease nodes), comorbidity networks were constructed for five age strata, with edges selected by relative risk (RR) > 1.5 and Bonferroni-corrected Fisher’s exact tests. Patient-level longitudinal sequences were mined for progression trajectories, and quasi-causal analyses—Cox regression, negative outcome controls, and Baron–Kenny mediation—were used to evaluate pathway directionality and specificity. Results: The all-age network contained 75 nodes and 167 edges (modularity = 0.53), forming eight communities. Network complexity peaked at 18–29 years and declined with age. Dental caries emerged as the strongest hub in the 60+ stratum (degree = 9). Cox regression adjusted for age, sex, and healthcare utilization confirmed pathway directionality (pulpitis → tooth defect: hazard ratio (HR) = 2.65; caries → pulpitis: HR = 2.25), and negative outcome controls confirmed biological specificity. Mediation analysis showed that pulpitis completely mediated the caries → tooth defect association (proportion mediated ≈ 100%; 95% confidence interval (CI), 90–128%). An oral mucosal immune cluster (burning mouth syndrome, lichen planus, candidiasis, and xerostomia) emerged as a clinically actionable community. Conclusions: Oral diseases form biologically coherent, age-evolving comorbidity communities, and pulpitis is the critical mediating intervention point in the caries-to-tooth-defect cascade. The framework provides a reusable network-medicine substrate for age- and sex-specific risk-stratified oral disease management. Full article

The research scope comprises the analysis of disjunctions between photographic representations, architectural landmarks, tourist icons, and urbanized surroundings. Given the problem posed by imagery distortions in human cognition, the guiding hypothesis is that the perception of scenes of constructed touristic attractions is distorted with respect to their associated built vicinities. Therefore, the general objective is to systematize guidelines for integrating public policies on visual communication and urban management. Using multi-method, applied, qualitative–quantitative, and exploratory approaches, an investigation is conducted in four main parts: a literature review highlighting knowledge gaps on the topic; procedural methods involving the selection of study areas (cities) and objects (architectures) from those most visited worldwide in the pre-pandemic period followed by submitting their representative photographs for interpretation by experts and the public; analysis involving interpreting respondents’ feedback in association with specific criteria; and an integrated discussion leading to the formulation of directives. As a synthesis of the answers to the research question, the results diagnose a misrepresentation of the immediate and nearby surroundings of architectural sites due to the exclusive observation of images published on official tourism websites, confirming the proposed hypothesis and concluding that the methodological essay is feasible, with case-specific adaptations, as a reference for adequately conveying touristic landscapes in contemporary cities. Full article

Background and Objectives: Despite recent advancement, neovascular age-related macular degeneration (nAMD) remains a leading cause of irreversible vision loss. Undertreatment, fewer anti-VEGF injections and longer intervals than in clinical trials have been associated with sub-optimal visual outcomes. Visit-based regimens (Treat-and-Extend, PRN) may permit intervals of unrecognized retinal fluid between office visits. A home OCT system with near-daily self-imaging provides frequent structural retinal information between office visits that can support early detection of persistent or recurring fluid. The objective was to evaluate the duration and magnitude of fluid exposure between standard care visits and estimate the potential to shorten that exposure. Materials andMethods: Ad hoc analysis of three cohorts of treatment naïve and experienced nAMD eyes managed by standard care while participating in observational studies of the home OCT system, with treating physicians masked to home OCT data. AI-based analysis of fluid volume, rate of change and time of fluid onset was performed. Results: Data from 209 participants, mean age 76.4 years, 53% female, who performed 10,110 scans (6.0 scans/week) were analyzed. An amount of 119 eligible eyes provided data from 185 standard care intervals. Persistent or recurring fluid was identified in 121 (65%) intervals, on average 32 days prior to the next office visit. Of these, 84 (69%) had potential visit advancement within labeled minimal treatment intervals of 19 days. Mean fluid volume at the earliest possible notification was 26 nL and recurrence rate averaged 4.4 nL/day. Conclusions: A substantial proportion of patients experience unrecognized disease activity between visits. Home OCT monitoring provides adjunctive information to support early detection of fluid and may facilitate timely clinical evaluation. In this context, such monitoring may be considered reasonable and necessary to inform management of nAMD within established standards of care, while not replacing clinician-directed diagnosis or treatment decisions. Full article

Background/Objectives: Nursing home (NH) residents who become acutely unwell may frequently be conveyed to emergency departments (EDs). However, at least half of such low-acuity visits could be avoided. Telehealth-supported acute care programmes may potentially reduce unnecessary ED attendances and subsequent hospital utilization. This study aimed to describe a telehealth-based acute care programme for NH residents and to explore a pragmatic method for estimating potential inpatient bed-day savings using publicly available diagnosis-related group (DRG)-based average-length-of-stay (ALOS) data. Methods: A telehealth-based programme was implemented at Sengkang General Hospital (SKH) to support NH staff in the management of acutely unwell residents. NH residents were prospectively tracked for ED non-attendance within 14 days following teleconsultation. Potential inpatient bed-day savings were estimated by mapping teleconsultation diagnoses to relevant DRGs and referencing Singapore Ministry of Health Hospital Bill Size and Fee Benchmarks. Institution-specific and nationally derived ALOS estimates were compared using exploratory Bland–Altman agreement analysis. Results: Over two financial year periods, seven NHs participated in the programme. A total of 726 teleconsultations were conducted, of which 424 encounters were successfully managed within NHs without ED attendance within 14 days (ED non-attendance rate being 58.4%). Using DRG-based estimation, the projected inpatient bed-day savings for FY2023 were 694.31 days using institution-specific ALOS and 805.42 days using nationally derived ALOS estimates. Exploratory Bland–Altman analysis across 34 mapped diagnostic categories demonstrated a mean bias of 0.098 days (approximately 2.4 h), with 95% limits of agreement ranging from −1.31 to +1.51 days. Conclusions: The acute care programme may reduce ED attendances and hospitalizations among NH residents. Publicly available national DRG-based ALOS data may provide a pragmatic approach for estimating the potential inpatient hospital bed-day savings when institution-specific data are unavailable. Full article

Background/Objectives: Alcohol-related frequent attenders (ARFAs) constitute a small but resource-intensive emergency department (ED) population. Methods: Following PRISMA-ScR guidelines, we searched MEDLINE, PsycINFO, CINAHL Complete, and EMBASE from inception to May 2025 for empirical studies examining ED frequent attendance with alcohol involvement. Definitions had high heterogeneity; therefore, narrative synthesis was conducted. Results: A total of 73 studies were included, most retrospective (57.5%), encompassing sample sizes from 14 to over 4.1 million participants: 59 frequent attender (FA) studies with alcohol subgroup analyses and 14 pure ARFA studies. Research was concentrated in North America and Europe (56/73, 76.7%), with limited Asia-Pacific representation (21.9%). Seven distinct definition threshold categories were identified (≥2 to ≥20 visits annually); 31.5% utilised different definitions. Qualitative studies (n = 6) identified push factors (dependence, mental health crises, housing instability, fragmented services) and pull factors (24/7 access, crisis care model, immediate service) driving frequent attendance. Eight studies evaluated interventions; all employed non-randomised designs examining case management, integrated pathways, and community-based treatments. Conclusions: Critical gaps include the absence of standardised definitions for comparison across studies, a concentration of research in Western settings limiting global applicability, and insufficient rigorous intervention evidence. Priorities include developing empirically validated definitions, expanding non-Western research, and conducting randomised controlled trials with adequate follow-up. Full article