Search Results (9,311)

Background: Reducing critically ill patients’ exposure to antibiotics is mandatory. In randomized controlled trials, procalcitonin (PCT)-guided algorithms (i.e., antibiotic therapy [ABT] should be stopped whenever PCT is less than 0.5 µg/L or is below 80% of the peak value) reduced the duration of (ABT) more than compliance with the current guidelines. However, the interest of such stopping rules in daily practice remains debated. Thus, we carried out a real-life study addressing this issue. Results: During the study period, 112 patients with sepsis upon intensive care unit admittance were included. The median age was 66 years (56–79). Half of the patients presented with acute respiratory failure. Pneumonia was diagnosed in 78% of them, and 41% met septic shock criteria. The initial ABT was empirical in most cases, and appropriateness rate to the isolated bacteria reached 71%. A median number of four PCT measurements was achieved in both groups. The compliance rate with the PCT algorithm was 54%. The median duration of ABT was 5 (4–7) days if the PCT algorithm was followed, as compared to 7 (5–10) days otherwise (p < 0.001). This ABT stopping rule allowed a 2-day reduction in the treatment duration as compared with those recommended by the guidelines (p < 0.001). The only independent factor associated with shorter treatment duration was compliance with the PCT algorithm (OR = 0.74, 95% CI [0.62; 0.88]; p < 0.001). Regarding safety, no difference in outcome was found between the two groups. Conclusions: Complying with one PCT-based stopping rule is associated with a significant reduction in the duration of ABT in septic critically ill patients, without apparent impact on patient outcomes. Full article

Background: Small cell lung cancer (SCLC) is a malignant carcinoma characterized by high proliferative rate and early metastatization with limited treatment options and poor prognosis. The approval of ICIs has established a new standard of care for extensive-stage (ES)-SCLC (5). Atezolizumab, an anti PD-L1 monoclonal antibody, has been the first immune checkpoint inhibitor (ICI) to be approved for SCLC patients. This study aims to retrospectively evaluate the real-world effectiveness and safety of atezolizumab in a cohort of patients with ES-SCLC. Methods: We conducted a monocentric retrospective analysis of SCLC patients who received atezolizumab in addition to chemotherapy, between January 2020 and December 2023. Study design endpoints included progression-free survival (PFS), overall survival (OS), and adverse events. Results: A total of 134 patients were included in this study. Out of 134 patients who began the CEA protocol, 100 continued maintenance. Currently, 25 are alive, 17 still on atezolizumab, 5 on second-line therapy, and 3 receiving best supportive care. The median age was 65 years. Patients received a median of four cycles of CEA (range 1–6 cycles), while the median number of atezolizumab maintenance cycles was eight (range 0–75). The overall median survival was 15 months, with patients who received more than 30 cycles of atezolizumab showing OS of 46.7% at 48 months. Common adverse events included skin disorders, pneumonitis, colitis, alanine, and aspartate deaminase increment, dysthyroidism, and blood disorders with only 3% of patients experiencing grade 3 or higher toxicities. Conclusions: In this real-world cohort, atezolizumab demonstrated comparable effectiveness to clinical trial results, with a manageable safety profile. These findings support the use of atezolizumab as a viable treatment option for ES-SCLC in routine clinical practice. Full article

Christian Liberation Theology highlights a spirituality that is deeply tied to the fight for socio-political freedom. This perspective argues that spirituality, when practiced as a way of life, is essential for meaningful liberation. It represents a fresh take on Christian faith and discipleship, one that arises from the lived realities of the poor and oppressed. This approach has significantly influenced both Catholic and evangelical communities, blending spiritual and political elements into a unique theological framework. The research underscores that within this context, Liberation Theology redefines faith and spirituality as active, lived experiences that contribute to tangible social change. Spiritual people are not detached or indifferent to the struggles of others. They express their love for God by caring deeply for His creation. Just as God aligns with and supports the oppressed, spiritual individuals take a stand against injustice and those who perpetuate it. In this way, spirituality and the struggle for socio-political justice are inseparably connected to the message of Liberation Theology. The present article intends to refute the erroneous claim that Christian liberation theology is unrelated to spirituality and faith. The article highlights the intrinsic connection between spirituality and faith within this theological framework and subsequently analyzes the spiritual outcomes it produces. Full article

Background: Although surgical antibiotic prophylaxis (SAP) is considered a standard of care for preventing surgical site infections, the rising incidence of antimicrobial resistance (AMR) increases the likelihood of infections caused by multidrug-resistant organisms (MDROs), which may be associated with worse surgical outcomes. Methods: A multidisciplinary working group was convened by the Italian Multidisciplinary Society for the Prevention of Healthcare-Associated Infections (SIMPIOS) to define key measures for optimizing SAP in the era of AMR. Selecting the most appropriate SAP in patients colonized with MDROs is a complex decision that cannot be generalized, as it depends on both host factors and the specific surgical procedure. At present, there is limited evidence of SAP in these patients. Results: This position paper aims to provide practical guidance for optimizing SAP in the context of an AMR era. It is structured in three sections: (1) core principles of surgical antibiotic prophylaxis; (2) the role of screening, decolonization, and targeted prophylaxis for MDROs; and (3) barriers to changing surgeons’ prescribing behaviours. Conclusions: The working group developed 15 recommendation statements based on scientific evidence. Full article

The application of machine learning (ML) in healthcare has surged, yet its adoption in high-stakes clinical domains, like the Intensive Care Unit (ICU), remains low. This gap is largely driven by a lack of clinician trust in AI decision support. Explainable AI (XAI) techniques aim to address this by explaining how an AI reaches its decisions, thereby improving transparency. However, rigorous evaluation of XAI methods in clinical settings is lacking. Therefore, we evaluated the perceived explainability of a dashboard incorporating three XAI methods for an ML model that predicts piperacillin plasma concentrations. The dashboard was evaluated by seven ICU clinicians using five distinct patient cases. We assessed the interpretation and perceived explainability of each XAI component through a targeted survey. The overall dashboard received a median score of seven out of ten for completeness of explainability, with Ceteris Paribus profiles identified as the most preferred XAI method. Our findings provide a practical framework for evaluating XAI in critical care, offering crucial insights into clinician preferences that can guide the future development and implementation of trustworthy AI in the ICU. Full article

Background/Objectives: Antimicrobial resistance (AMR) is a major global health threat, with children at higher risk due to developmental differences in drug metabolism, limited treatment options and inappropriate antibiotic use. Pediatric antimicrobial stewardship programs (ASPs) face implementation challenges, often relying on adult-based guidelines and limited pediatric-specific evidence. This study aimed to identify and prioritize the most critical areas for pediatric ASP intervention development through a structured, multi-round Delphi consensus process with experts in antimicrobial stewardship and infectious diseases. Method: A four-round modified Delphi process was conducted to identify and prioritize key pediatric ASP interventions. Experts in antimicrobial stewardship and infectious diseases were recruited through an existing clinical trial. Using an iterative survey and in-person discussions, experts provided input on priority areas, which were thematically grouped and refined across rounds. Structured feedback supported real-time refinement and consensus-building. Results: Twenty experts participated in the process, generating 25 priority items in Round 1 through open-ended responses. These were narrowed to seven key priorities through structured voting and discussion. The final items were clustered into three intersecting themes: Care Settings, Prescriptions, and Strategies. Care Settings focused on high-impact areas such as outpatient clinics and intensive care units, where misuse is common and/or care is complex. The prescriptions theme prioritized shorter durations and narrow-spectrum agents. The strategy theme highlighted the need for outcome-based metrics, improved diagnostic stewardship, and routine tracking of patient outcomes to guide and assess stewardship efforts. Conclusions: This expert consensus identified key priorities for pediatric ASPs, providing a foundation for future interventions. Findings can be used to inform policy and practice, improving the appropriate use of antimicrobials in pediatrics and combating AMR. Full article

Artificial intelligence (AI) has increasingly become a transformative tool in cardiology, particularly in diagnosing and managing atrial fibrillation (AF), the most prevalent cardiac arrhythmia. This review aims to critically assess and synthesize current AI methodologies and their clinical relevance in AF diagnosis, risk prediction, and therapeutic guidance. It systematically evaluates recent advancements in AI methodologies, including machine learning, deep learning, and natural language processing, for AF detection, risk stratification, and therapeutic decision-making. AI-driven tools have demonstrated superior accuracy and efficiency in interpreting electrocardiograms (ECGs), continuous monitoring via wearable devices, and predicting AF onset and progression compared to traditional clinical approaches. Deep learning algorithms, notably convolutional neural networks (CNNs) and recurrent neural networks (RNNs), have revolutionized ECG analysis, identifying subtle waveform features predictive of AF development. Additionally, AI models significantly enhance clinical decision-making by personalizing anticoagulation therapy, optimizing rhythm versus rate-control strategies, and predicting procedural outcomes for catheter ablation. Despite considerable potential, practical adoption of AI in clinical practice is constrained by challenges including data privacy, explainability, and integration into clinical workflows. Addressing these challenges through robust validation studies, transparent algorithm development, and interdisciplinary collaborations will be crucial. In conclusion, AI represents a paradigm shift in AF management, promising improvements in diagnostic precision, personalized care, and patient outcomes. This review highlights the growing clinical importance of AI in AF care and provides a consolidated perspective on current applications, limitations, and future directions. Full article

Background/Objectives: Sinonasal anatomical variations, particularly Haller cells (HCs) and the accessory maxillary ostium (AMO), are critical structural factors that may increase surgical risks in dental and otorhinolaryngological (ENT) procedures and predispose individuals to chronic sinusitis. This study aimed to investigate the relationship between HCs, AMO dimensions, maxillary sinus ostium, and sinus pathologies using cone-beam computed tomography (CBCT). Methods: In this cross-sectional retrospective study, CBCT images of 443 patients (226 males, mean age 48.4 ± 15.4 years; 217 females, mean age 46.1 ± 15.2 years) were analyzed. The presence of HCs, AMO, ostium narrowing, and ostium obstruction were recorded, along with ostium dimensions. Relationships between these variations and sinus pathologies were statistically evaluated, with a p-value < 0.05 considered significant. Results: HC prevalence was 34.5% on the right and 39.5% on the left, while AMO was present in 39.5% on the right and 34.5% on the left. Bilateral AMO was significantly associated with localized mucosal thickening, and partial opacification was more common in cases with ostium obstruction. Significant relationships were observed between HC presence and ostium narrowing. While HCs and ostium narrowing did not significantly influence maxillary sinus pathologies, sex (right OR = 0.335; left OR = 0.384; p < 0.001) and the AMO (right OR = 1.698, p = 0.018; left OR = 1.713, p = 0.014) were found to have a significant impact. Conclusions: It was concluded that (i) HCs may contribute to ostium narrowing and impaired sinus drainage, thereby increasing the risk of chronic sinusitis; (ii) the presence of a bilateral AMO is strongly associated with localized mucosal thickening; (iii) sex and the presence of an AMO emerge as independent predictors of maxillary sinus pathologies; and (iv) the careful evaluation of these anatomical variations using CBCT can support multidisciplinary treatment planning in both dental and ENT practice, enhance surgical safety, and help minimize postoperative complications. Full article

Hormone replacement therapy (HRT) has been utilized in clinical practice for decades as a main therapeutic approach for mitigating menopausal symptoms. The symptoms mostly encompass vasomotor and genitourinary issues resulting from the deficiency of estrogen and progesterone. Initially identified as a universally advantageous and indispensable intervention, hormone replacement therapy subsequently became the subject of considerable scientific and clinical debate, especially after the publication of extensive epidemiological studies indicating potential adverse effects associated with cardiovascular and cancer risk. This study aims to reassess the role of HRT in clinical practice by analyzing its historical evolution, expanded clinical uses, and changes in guidelines necessitated by resent scientific studies. Current evidence from clinical studies and meta-analyses unequivocally demonstrates that hormone replacement therapy is the most efficacious treatment for vasomotor and urogenital symptoms, and also acknowledging its potential role in osteoporosis prevention. The administration of HRT requires careful individual assessment, considering the patient’s age, timing of initiation, existence of comorbidities. In this setting, therapy decisions have to be based on a combination of the most up-to-date clinical guidelines, risk stratification, and the patient’s preferences. In conclusion, the assessment of HRT confirms its primary role in reducing menopausal symptoms while also highlighting the imperative for a individual strategy that balances benefits and risks to improve outcomes for women. Full article

This study reports the development of a fiber-optic localized surface plasmon resonance (FO-LSPR) sensor incorporating a three-dimensional micropillar array functionalized with gold nanoparticles. The micropillar structures were fabricated on the fiber facet using a single-mask imprint lithography process, followed by nanoparticle immobilization to create a composite plasmonic surface. Compared with flat polymer-coated fibers, the micropillar array markedly increased the effective sensing surface and enhanced light trapping by providing anti-reflective conditions at the interface. Consequently, the sensor demonstrated superior performance in refractive index sensing, yielding a sensitivity of 4.54 with an R² of 0.984, in contrast to 3.13 and 0.979 obtained for the flat counterpart. To validate its biosensing applicability, Interleukin-8 (IL-8), a cancer-associated cytokine, was selected as a model analyte. Direct immunoassays revealed quantitative detection across a broad dynamic range (0.1–1000 pg/mL) with a limit of detection of 0.013 pg/mL, while specificity was confirmed against non-target proteins. The proposed FO-LSPR platform thus offers a cost-effective and reproducible route to overcome the surface-area limitations of conventional designs, providing enhanced sensitivity and stability. These results highlight the potential of the micropillar-based FO-LSPR sensor for practical deployment in point-of-care diagnostics and real-time biomolecular monitoring. Full article

Atrial fibrillation (AF) is the supraventricular tachy-arrhythmia most commonly detected in the general population, with significant sex-related differences in epidemiology, pathophysiology, and treatment outcomes. Emerging evidence highlights the role of sex hormones—particularly estrogen and testosterone—in modulating left atrial electrophysiologic substrate, structural remodeling, inflammation, and thromboembolic risk. Hormonal fluctuations across different lifespan influence AF onset, progression, and therapeutic response, yet current management approaches largely overlook such determinants. This narrative review integrates data from basic, translational, and clinical research to examine hormonal effects on atrial substrate, disease progression, and differential results of treatments, including stroke prevention, pharmacological options, and transcatheter ablation. It also explores the potential of hormone-targeted interventions, antifibrotic therapies, and precision strategies tailored to hormonal status. Addressing these mechanisms could optimize patient-specific management, improve outcomes and guide future clinical practice recommendations. Advancing toward sex-specific, hormone-informed AF care requires further mechanistic studies, hormonal profiling, and sex-stratified clinical trials. Full article

Operating rooms (ORs) represent strategic targets for climate mitigation efforts, given their significant environmental footprint and the need for increased surgical capacity to meet the global surgical burden of disease. OR teams are often unaware of impacts of unsustainable surgical practices. Although research supports the integration of planetary health into clinical education, there is limited data on the availability, structure, and surgical content of such courses. This study examines the availability and accessibility of planetary health courses (PHCs) worldwide, with a focus on identifying surgical content within curricula. An environmental scan was conducted using internet searches, reviewing curricula from the top ten universities in each global region and cross-referencing existing course collections. Courses were evaluated based on type, cost, language, and whether they addressed the environmental impact of surgery. A total of 248 courses were identified, primarily at the graduate level, offered in English, and concentrated in North America and Europe. Only four courses included content on the intersection of planetary health and surgery. These findings demonstrate the lack of surgical content in planetary health education and emphasize the need to develop comprehensive, accessible, and globally representative courses that address the environmental impacts of surgical care. Full article

This article examines online hate as a driver of cyberbullying and a barrier to inclusive schooling, integrating theoretical, philosophical and methodological perspectives. We approach hate speech as communicative practices that legitimise discrimination and exclusion and, once amplified by social media affordances, erode equity, belonging and well-being in educational settings. The study adopts a qualitative, exploratory–descriptive design using focus groups with pre-service teachers from initial teacher education programmes across several Chilean regions. Participants reflected on the presence, trajectories and classroom effects of cyberhate/cyberbullying. Data were analysed thematically with ATLAS.ti24. Findings describe a recurrent pathway in which anonymous posts lead to public exposure, followed by heightened anxiety and eventual withdrawal. This shows how online aggression spills into classrooms, normalises everyday disparagement and fuels self-censorship, especially among minoritised students. The analysis also highlights the amplifying role of educator authority (tone, feedback, modelling) and institutional inaction. In response, participants identified protective practices: explicit dialogic norms, rapid and caring classroom interventions, restorative and care-centred feedback, partnership with families and peers, and critical digital citizenship that links platform literacy with ethical reasoning. The article contributes evidence to inform anti-bullying policy, inclusive curriculums and teacher education by proposing actionable, context-sensitive strategies that strengthen equity, dignity and belonging. Full article

Lower respiratory tract infections (LRTIs) represent a significant global health concern, and the accurate identification of pathogens is crucial for patient care. Culture-based methods are the gold standard, but their detection abilities are limited. Next-generation sequencing (NGS) offers a promising method for comprehensive microbial detection, providing valuable information for clinical practice. In this study, 144 bronchoalveolar lavage fluid samples were collected, culture-based diagnostics were performed, and bacterial microbiome profiles were generated by short-read sequencing of the V4 region of the 16S rRNA gene using Illumina technologies and long-read sequencing with Oxford Nanopore Technologies (ONT) to determine the full-length 16S rRNA gene. The most common genera detected by NGS included Streptococcus, Staphylococcus, Veillonella, Prevotella, Rothia, Enterococcus, and Haemophilus. Short-read sequencing detected cultured bacteria at the genus level in ~85% of cases, while long-read sequencing demonstrated agreement with cultured species in ~62% of cases. In three cases, long-read sequencing identified the uncommon potential lung pathogen Tropheryma whipplei not detected with traditional culturing techniques. The NGS results showed a partial overlap with culture as the current diagnostic gold standard in LRTI. Additionally, NGS detected a broader spectrum of bacteria, revealed fastidious potential pathogens, and offered deeper insights into the complex microbial ecosystem of the lungs. Full article

This paper presents the first exploration of young carers in early childhood (YCEC), in the context of whole family support, through the application of the Power Threat Meaning Framework (PTMF). Existing contributions to young carer research have shaped social policy, legislation, and practice concerned with whole family approaches to the identification, assessment, and support for young carers globally. To date, the literature has predominantly focused on young carers in middle childhood to young adulthood, contributing to socially constructed Eurocentric ideologies of who young carers are likely to be. As such, YCEC remain disempowered in broader young carer and family science discourse. This qualitative exploration centers upon the experiences of three families. Primary data collated retrospective accounts of two adult siblings supported by documentary data obtained by participants through a subject access request (SAR). Secondary data derived from two case studies, drawn from the lead author’s master’s dissertation, offering experiences of families each with a young carer aged four years old. Participants lived in England, United Kingdom (UK). Deductive analysis utilized dual methodological approaches, offering nuanced insight. Thematic codes were synthesized into predetermined themes. ‘Power,’ ‘threat,’ ‘meaning,’ ‘threat responses,’ and ‘strengths’ to explore the application of the PTMF beyond individual experience. Findings show systemic and structural powers held within the lives of YCEC. This disempowers the ethos of whole family support, which should serve to endorse integrated working and foster the autonomous functioning of family life. Findings consider threats, worsening vulnerabilities, and exposure to harm. Meaning is deduced from findings offering recommendations for future research, practice, and policy decisions. In conclusion, opportunities for the prevention of inappropriate caring roles, early identification, and intervention have been missed. This study adds to the growing exploration of the PTMF. It harnesses its potential application as a holistic assessment tool and qualitative data analysis framework, helping to bridge structural and developmental viewpoints which typically frame the current understanding of family functioning and related social policy. Full article