Search Results (231)

Introduction: Prescribing errors are the most common cause of preventable patient harm. In recent years, interprofessional education (IPE) has been increasingly utilised to improve knowledge and skills through promoting interprofessional collaboration. This scoping review aimed to evaluate the effectiveness of IPE interventions for pharmacological knowledge and prescribing skills in medical students and doctors-in-training. Methods: MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO, ERIC and Scopus were searched on 18 February 2025 for studies published since 2020. Keywords included interprofessional education, medical student, medical trainee, pharmacology and prescribing. Results: Of the 2254 citations identified, 42 studies were included. There were four main types of IPE interventions: case-based learning, work-integrated-learning, didactic, and simulation and role-plays. Outcomes were spread across pharmacological knowledge, prescribing skills and interprofessional attitudes, and all studies reported one or more positive findings at Kirkpatrick IPE level 1, 2a, 2b, 3 or 4b. No study reported outcomes at Kirkpatrick IPE 4a. Conclusions: IPE interventions targeting pharmacology and prescribing are positively viewed by medical learners. IPE is effective in improving interprofessional attitudes and collaboration, as well as pharmacological knowledge and prescribing competency. Logistical challenges can be barriers to larger-group IPE implementation; nonetheless, IPE work-integrated learning in authentic clinical settings may overcome these challenges. Full article

The small (N = 102) prospective study by Bar-Sela and colleagues at Emek Medical Center in Israel) regarding diminished efficacy of immunotherapy in the setting of cannabis use would be an important discovery which could theoretically benefit the outcomes of oncology patients if verified by independent research teams, including by basic scientists. However, if this finding was spurious, clinical practice guidelines could recommend that oncology patients receiving immunotherapies be erroneously denied an evidence-based treatment for pain and chemotherapy-induced nausea and vomiting. Our full-length manuscript identified dozens of instances of unverifiable statistical information and even errors in arithmetic in this report. More briefly, our concerns regarding this well-cited (123 times) paper are as follows: (1) non-verifiable non-parametric statistics, including some that would change the statistical inferences; (2) difficulties with determining percentages; (3) switching from two-tailed tests in the Methods to one-tailed in the Results; (4) engaging in the unusual practice of floor rounding but not reporting this in the Methods; and (5) not reporting smoking, which could be a key confound. These concerns are serious errors that undermine the validity of the results and invalidate the conclusions that can be drawn from this prospective study about cannabis and immunotherapy. Full article

Background: This study aimed to evaluate the efficacy and safety of Noofen^® (Phenibut) in patients with Adjustment Disorder (AjD) and to assess the usability of the ADNM-20 (Adjustment Disorder New Module 20-item questionnaire) in routine clinical practice. This is the first study of Noofen^® in patients with AjD conducted in Latvia, and it also represents one of the first implementations of the ADNM-20 scale in routine clinical settings, where its applicability has not yet been widely established. Methods: A non-interventional observational study was conducted across several general practice offices in Latvia. Patients aged 18–70 with clinical symptoms of AjD, an ADNM-20 total score ≥ 30, and a new prescription for Noofen^® 250 mg three times daily for at least three weeks (per routine practice) were included. Exclusion criteria ruled out concomitant psychiatric or severe somatic conditions and use of medications or interventions that could affect AjD symptoms. Patients completed the ADNM-20 before and after treatment, and score changes were evaluated. Results: Ninety patients (65 women, 25 men; mean age 48 ± 12 years) completed the study. At baseline, 56.7% had high AjD symptom severity, with work-related stressors most frequently reported as triggers. After three weeks of Noofen^® treatment, ADNM-20 total scores decreased significantly (mean reduction 14.8 ± 11.3 points, p < 0.001), with greater improvement in core vs. accessory symptoms. Symptom severity shifted, with the proportion of high-severity patients decreasing 2.5-fold, and 14.4% scoring below the AjD diagnostic threshold post-treatment. Noofen^® was well tolerated. ADNM-20 showed good sensitivity to symptom change but remained vulnerable to human error during scoring. Conclusions: Noofen^® significantly reduced AjD symptoms, particularly sleep disturbance, restlessness, and anxiety, and was well tolerated. The ADNM-20 questionnaire proved useful in clinical practice and should be considered for routine use to better recognize and monitor AjD. Full article

Background/Objectives: Effective teamwork is crucial for minimizing human error in healthcare settings. Medical teams, typically composed of physicians and nurses, supported by auxiliary professionals, achieve better outcomes when they possess strong collaborative competencies. High-quality teamwork is associated with fewer adverse events and complications and lower mortality rates. Based on this background, the objective of this study is to analyze the perception of non-technical skills and immediate learning outcomes in interprofessional simulation settings based on E-CRM items. Methods: A cross-sectional observational study was conducted involving participants from the official postgraduate Medicine and Nursing programs at the Catholic University of Murcia (UCAM) during the 2024–2025 academic year. Four interprofessional E-CRM simulation sessions were planned, involving randomly assigned groups with proportional representation of medical and nursing students. Teams worked consistently throughout the training and participated in clinical scenarios observed via video transmission by their peers. Post-scenario debriefings followed INACSL guidelines and employed the PEARLS method. Results: Findings indicate that 48.3% of participants had no difficulty identifying the team leader, while 51.7% reported minor difficulty. Role assignment posed moderate-to-high difficulty for 24.1% of respondents. Communication, situation awareness, and early help-seeking were generally managed with ease, though mobilizing resources remained a challenge for 27.5% of participants. Conclusions: This study supports the value of interprofessional education in developing essential competencies for handling urgent, emergency, and high-complexity clinical situations. Strengthening interdisciplinary collaboration contributes to safer, more effective patient care. Full article

Background/Objectives: Inborn errors of immunity (IEIs) represent a wide spectrum of diseases characterized by a predisposition to recurrent infections, as well as increased susceptibility to autoimmune, atopic, and autoinflammatory diseases and malignancies. The aim of this study was to report the registry-based frequency and describe the clinical characteristics of IEIs among patients in the Republic of Kazakhstan. Methods: We analyzed data from 269 patients belonging to 204 families who were either self-referred or referred by healthcare providers to the University Medical Center of Nazarbayev University with suspected IEIs. All patients resided in various regions across Kazakhstan. Results: A total of 269 diagnosed cases were identified in the national registry. The estimated prevalence was 1.3 per 100,000 population. The gender ratio was nearly equal, with 139 males and 130 females. The median age at diagnosis was 5 years (range: 1 month to 70 years), while the mean age was 11.3 years. The most common diagnosis was humoral immunodeficiency, observed in 120 individuals (44.6%), followed by complement deficiencies in 83 individuals (30.8%). Combined immunodeficiencies with syndromic features were found in 35 patients (13%), and phagocytic cell defects were identified in 12 patients (4.5%). The predominant clinical manifestations included severe recurrent infections and autoimmune cytopenias, while atopic and autoinflammatory symptoms were reported less frequently. Conclusions: These findings contribute to a better understanding of the registry-based distribution and clinical spectrum of IEIs in Kazakhstan and underscore the importance of early diagnosis and targeted care for affected individuals. Full article

Background/Objectives: Severe jawbone atrophy, particularly in elderly or medically compromised patients, presents a significant challenge for conventional implant placement. In cases where bone augmentation is not feasible, alternative techniques—such as short, narrow, tilted, and zygomatic implants—may be indicated for the rehabilitation of the atrophic jaw. Subperiosteal implants have re-emerged as a further viable alternative, especially with recent advancements in digital planning and custom fabrication. This study aims to evaluate the clinical outcomes and complications associated with subperiosteal implants through a literature review and a supporting case series, and to propose clinical preliminary guidelines for their use. Methods: Fourteen studies—including case reports, case series, retrospective studies, and systematic reviews—were analyzed to assess the effectiveness and risk profile of subperiosteal implants. Additionally, we present a case series of nine patients with advanced vertical and horizontal alveolar bone atrophy treated using custom-made, digitally-designed subperiosteal implants. Surgical techniques, prosthetic workflows, and complications were recorded and assessed. Results: Subperiosteal implants were found to be particularly suitable for patients with narrow alveolar crests and severe atrophy where traditional implants are contraindicated. Literature and case series data indicated favorable outcomes, with early complications such as soft tissue inflammation and prosthetic misfit being manageable. A low complication rate was recorded in our series, with digital workflows contributing to improved implant fit and reduced technical errors. Conclusions: Subperiosteal implants could offer an effective solution for complex atrophic cases, provided that patient selection, surgical precision, and prosthetic design are meticulously managed. Based on our findings, clinical recommendations are proposed to guide their application in contemporary practice. Full article

Background/Objectives: Extracting meaningful medical information from chest X-ray images and transcribing it into text is a complex task that requires a high level of expertise and directly affects clinical decision-making processes. Automatic reporting systems for this field in Turkish represent an important gap in scientific research, as they have not been sufficiently addressed in the existing literature. Methods: A deep learning-based approach called Model-SEY was developed with the aim of automatically generating Turkish medical reports from chest X-ray images. The Swin Transformer structure was used in the encoder part of the model to extract image features, while the text generation process was carried out using the cosmosGPT architecture, which was adapted specifically for the Turkish language. Results: With the permission of the ethics committee, a new dataset was created using image–report pairs obtained from Elazıg Fethi Sekin City Hospital and Indiana University Chest X-Ray dataset and experiments were conducted on this new dataset. In the tests conducted within the scope of the study, scores of 0.6412, 0.5335, 0.4395, 0.4395, 0.3716, and 0.2240 were obtained in BLEU-1, BLEU-2, BLEU-3, BLEU-4, and ROUGE word overlap evaluation metrics, respectively. Conclusions: Quantitative and qualitative analyses of medical reports autonomously generated by the proposed model have shown that they are meaningful and consistent. The proposed model is one of the first studies in the field of autonomous reporting using deep learning architectures specific to the Turkish language, representing an important step forward in this field. It will also reduce potential human errors during diagnosis by supporting doctors in their decision-making. Full article

Objective: This study aims to investigate the feasibility of an online music therapy protocol for individuals previously diagnosed with COVID-19, focusing on their perceptions of their respiratory symptoms and the intervention’s impact on psychosocial measures. Methods: A within-subject experimental design was applied to examine an eight-week weekly online music therapy protocol, including singing, wind instrument playing, and music visualizations. All self-report data were collected bi-weekly throughout the 16-weeks study period, including baseline and post-tests. The measures for respiratory symptoms included the Medical Research Council’s Dyspnea Scale (MRC Dyspnea), Chronic Respiratory Questionnaire-Mastery Scores (CRQ Mastery), and Visual Analogue Scale for breathlessness. The measures for the secondary psychosocial outcomes were the Beck Depression Inventory-Short Form, the Generalized Anxiety Disorder 7-item, the Hospital Anxiety and Depression Scale, the Fatigue Severity Scale, the Epworth Sleepiness Scale, the EuroQol 5-Dimension 5-Level, and the Connor-Davidson Resilience Scale. Results: Twenty-four participants were enrolled. The participants perceived a reduction in respiratory symptoms, and shortness of breath (MRC Dyspnea). Planned comparisons showed significant decreases in MRC from baseline to post-treatment (p = 0.008). The mixed-effects model, including pre-baseline and post-treatment, was significant (p < 0.001). Significant changes in Breathing VAS were consistent with improvements in MRC Dyspnea, showing a significant baseline-to-post difference (p = 0.01). The CRQ Mastery showed significant improvements from baseline to Week 12 (p < 0.001). No significant changes were observed in other secondary measures. Conclusions: Our preliminary findings suggest that this protocol is feasible, and as a result, may help individuals previously diagnosed with COVID-19 to cope with lasting respiratory symptoms and improve their perception of shortness of breath. Live music-making, including playing accessible wind instruments and singing, may contribute to an increase sense of control over breathing. As this was a feasibility study, we conducted multiple uncorrected statistical comparisons to explore potential effects. While this approach may increase the risk of Type I error, the findings are intended to inform hypotheses for future confirmatory studies rather than to draw definitive conclusions. Full article

While many continuous distributions are known, the list of discrete ones (usually derived from counting) often reported is relatively short. This list becomes even shorter when dealing with dichotomous observables: binomial, hypergeometric, negative binomial, and uniform. Binomial distribution is important for medical studies, since a finite sample from a population included in a medical study with yes/no outcome resembles a series of independent Bernoulli trials. The problem of calculating the confidence interval (CI, with conventional risk of 5% or otherwise) is revealed to be a problem of combinatorics. Several algorithms dispute the exact calculation, each according to a formal definition of its exactness. For two algorithms, four previously proposed case studies are provided, for sample sizes of 30, 50, 100, 150, and 300. In these cases, at 1% significance level, ordered sequences defining the confidence bounds were generated for two formal definitions. Images of the error’s alternation are provided and discussed. Both algorithms propose symmetric solutions in terms of both CIs and actual coverage probabilities. The CIs are not symmetric relative to the observed variable, but are mirrored symmetric relative to the middle of the observed variable domain. When comparing the solutions proposed by the algorithms, with the increase in the sample size, the ratio of identical confidence levels is increased and the difference between actual and imposed coverage is shrunk. Full article

Background: The mental health of physicians has become a pressing global concern. High rates of depression, anxiety, and burnout are reported in the literature, with each condition linked to reduced job satisfaction, increased medical errors, and ultimately suicidal ideation (SI). Although research on physicians’ mental health is emerging in Saudi Arabia, data on suicidality remain scarce. Objective: This study aims to determine the prevalence of SI and its determinants among physicians in Saudi Arabia. Methods: A cross-sectional study was conducted with 423 physicians across all medical specialties of all ranks, who were recruited using a convenience sampling technique. The study tool comprised three main sections. The first section included questions regarding sociodemographic factors, lifestyle, and work-related factors. The second section included items on suicidality and the Patient Health Questionnaire-9 to screen for depressive symptoms. The third section included the Brief Resilient Coping Scale (BRCS) to measure the coping mechanisms of the participants. Results: SI was disclosed by 9.7% of the respondents, with 0.5% reporting previous suicide attempts. Suicidal ideation was independently associated with low income (OR = 3.94, 95% CI 1.32–11.76, p = 0.014) and higher depression scores (OR = 1.09 per point, 95% CI 1.02–1.16, p = 0.008). Moreover, knowing a colleague with suicidal behavior (i.e., knowing a colleague who had contemplated suicide or had attempted suicide/died by suicide) was significantly associated with SI among our participants (p < 0.001 and p < 0.006, respectively). Higher scores on the BRCS, specifically with respect to growing from adversity and actively replacing losses, were linked to lower odds of SI (p < 0.001 and p < 0.045, respectively). Conclusions: Physicians in Saudi Arabia experience an alarming level of SI that is associated with low income and depression. The results of this study underscore the importance of additional research to evaluate the effectiveness of intervention programs designed to enhance mental health support for physicians, encourage adaptive coping mechanisms, foster peer support networks, and combat stigma associated with mental illnesses. Full article

Background/Objectives: European healthcare systems are increasingly adopting automation technologies to improve efficiency. This study evaluates the economic viability of hospital automation and medication management digitalization. Methods: An economic evaluation was based on a standardized hospital model comprising 561 beds, representative of an average acute care hospital across EU27 + UK. For each technology, several cost items were estimated using country-specific parameters such as labor costs, medication error rates, healthcare expenditure, and money discount rate. The financial metrics (Return On Investment—ROI, Net Present Value—NPV, Payback Time—PBT) were first calculated at the hospital level. These results were then extrapolated to the national level by scaling the per-hospital estimates according to the total number of hospital beds reported in each country. Finally, national results were aggregated to derive the overall European impact. Results: The analysis estimated a total European investment of EUR 3.55 billion, with an average PBT of 4.46 years and annual savings of 1,96 billion. ROI averaged 167%, and the total NPV was 8.21 billion. A major saving driver was the reduction in Medication Administration Errors that has an impact of 37.2% on the total savings. Payback times ranged from 3 years in high-GDP countries, to 7 years in lower-GDP nations. Conclusions: These findings demonstrate how providing structured data on hospital automation benefits could support decision-making processes, highlighting the organizational and economic feasibility of the investment across different European national contexts. Full article

Background: Fever and pain are among the most frequent symptoms in pediatric care, requiring timely and appropriate management. While evidence-based guidelines are available, adherence in real-world practice remains variable. This study aimed to explore the attitudes and prescribing behaviors of Italian Primary Care Pediatricians (PCPs) in the management of fever and pain, and to assess their alignment with current clinical recommendations. Materials and Methods: An anonymous, cross-sectional survey consisting of 30 multiple-choice questions was administered to 900 PCPs between 1 July and 30 October 2024. The questionnaire assessed therapeutic preferences, dosing strategies, and perceived knowledge gaps. Invitations were distributed via pediatric scientific societies and regional professional networks. Results: A total of 244 PCPs completed the survey (response rate 27.1%). The majority were aged over 55 years (72.1%), worked in urban settings (71.3%), and had more than 20 years of clinical experience (74.6%). Most respondents (77%) reported managing pediatric fever or pain on a daily basis. Paracetamol was the preferred first-line treatment for fever (95.9%), primarily due to its perceived safety (82.4%). Ibuprofen was favored by 51.6% of those who selected it for its greater effectiveness. The alternating use of paracetamol and ibuprofen for fever was never adopted by 49.6%, while 31.6% employed this strategy, believing it to be more effective. For pain, 67.6% used paracetamol and 26.2% used ibuprofen as first-line treatments; 15.2% reported alternating the two drugs. Correct dosage practices were followed by 63.9% for both medications, although 40.2% did not differentiate dosages between fever and pain management. Conclusions: While general trends showed alignment with current guidelines, notable inconsistencies were observed in drug selection, dosage, and the use of alternating therapies. These findings highlight a pressing need to improve the dissemination and implementation of pediatric fever and pain management guidelines among PCPs in order to reduce unsafe practices, avoid therapeutic errors, and prevent unnecessary strain on emergency care services. Full article

Background: The role of clinical pharmacists in the emergency department continues to gain recognition, particularly during cardiac and trauma resuscitations. However, their contributions to patient outcomes remain unclear. The objective of this scoping review with narrative synthesis was to determine the impact of pharmacists on medication and patient outcomes during cardiac and trauma resuscitations and to identify barriers to integration. Methods: A literature search of databases in September 2024 identified randomized and non-randomized control trials, evaluating the impact of pharmacists’ involvement in cardiac or trauma resuscitations. Excluded were studies on acute stroke, acute hemorrhage, and sepsis. Data were extracted and analyzed for primary (e.g., medication errors and Advanced Cardiovascular Life Support [ACLS] compliance) and secondary outcomes (e.g., pharmacists’ education and training). Results: Of the 560 records screened, 26 records were included in the final analysis. Due to heterogeneity, quantitative analysis was not feasible. Among primary outcomes, ACLS guideline compliance and medication errors were commonly reported; mortality and length of stay were less commonly reported. ACLS certification improved pharmacists’ confidence in their tasks. Pharmacists’ presence also correlated with reduced healthcare costs. Conclusions: Our analysis suggests that the involvement of pharmacists in the context of emergency cardiac or trauma resuscitations may benefit direct patient outcomes and indirect outcomes. Full article

Background/Objectives: This Phase 3, randomised, double-blind, multicentre trial evaluated the efficacy and safety of a novel hyaluronic acid hydrogel cross-linked with hexamethylenediamine (HMDA-HA) compared to a conventional 1,4-butanediol diglycidyl ether cross-linked HA (BDDE-HA) in patients with mild-to-moderate knee osteoarthritis (OA). Methods: A total of 223 adults (mean age 63.5 years; 167 women) with Kellgren–Lawrence (KL) grade I–III knee OA were randomised 1:1 to receive two intra-articular injections of HMDA-HA or BDDE-HA at baseline and at 24 weeks. The primary endpoint was changes from baseline in weight-bearing pain (WBP) on a 100 mm visual analogue scale (VAS) at Week 12, assessed in the per-protocol population. A non-inferiority margin of 10 mm was predefined. Secondary outcomes included global assessments, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index scores, responder rates, and rescue medication use [ClinicalTrials.gov: NCT06307847]. Results: At Week 12, least squares mean change (standard error [SE]) in WBP was −23.72 (1.88) mm in the HMDA-HA group (n = 83) and −25.99 (1.76) mm in the BDDE-HA group (n = 95), yielding a difference of 2.26 mm (95% confidence interval [CI]: −2.83 to 7.34; p = 0.3825), thus demonstrating the non-inferiority of HMDA-HA to BDDE-HA. Secondary outcomes were comparable between groups. A total of 136 adverse events were reported: 44 (41.1%) in the HMDA-HA group and 32 (28.1%) in the BDDE-HA group, with no treatment-related adverse drug reactions. Conclusions: A single-injection intra-articular regimen of HMDA-HA was effective and safe for the treatment of adult patients with mild-to-moderate knee OA. Full article

Background and objectives: As part of Vision 2030, Saudi Arabia aims to strengthen its healthcare system by enhancing efficiency, reducing medical errors, and ensuring drug safety. Evidence on pharmacists’ experiences with adverse drug reactions (ADRs) in daily practice remains limited. Gaining insight into their perspectives is essential for improving patient safety and optimizing pharmaceutical care. Therefore, we aimed to assess pharmacists’ ability to identify ADRs in daily practice and the subsequent actions taken upon identification. Methods: Between July and August 2024, an email-based invitation was sent to randomly selected registered community and hospital pharmacists in Saudi Arabia to participate in the study, which employed a piloted questionnaire. Results: The study involved 305 pharmacists, including 169 hospital/clinical pharmacists (HCPs, 55.4%) and 136 community pharmacists (CPs, 44.6%). A majority (n = 251, 82.3%) indicated direct patient encounters, while 67.2% (n = 205) reported observing suspected ADRs in the preceding 12 months. Most respondents filed ADR reports to the Saudi Food and Drug Administration/National Pharmacovigilance Centre (HCP = 103, CP = 60) and hospital drug information centers (HCP = 89, CP = 64), with online forms being the favored mode (HCP = 122, CP = 96). Awareness of ADR reporting procedures was reported by 128 HCPs and 80 CPs. Conclusions: More than two-thirds of participants reported having participated in ADR reporting, with greater adherence observed in hospital settings. Pharmacists predominantly depend on the Saudi Food and Drug Administration/National Pharmacovigilance Centre and hospital drug information centers for reporting, with a preference for online submission methods. Targeted educational interventions addressing gaps in knowledge, reporting procedures, and form complexity could improve ADR reporting practices. These findings support the need for structured training and policy measures to strengthen pharmacovigilance system. Full article