Search Results (594)

Background/Objectives: Prevention and treatment of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major clinical issue in hospitalized patients. Some aspects of VTE management lack clarity due to differing physicians’ opinions and behaviors. Methods: A multidisciplinary steering committee identified two main areas of uncertainty: VTE prophylaxis and PE management in special settings. A multiple-choice questionnaire including 10 statements was circulated to 183 doctors trained in VTE management. The expected benefit-to-harm ratio was represented on a nine-point Likert scale, with consensus (≥75% agreement) on scores of 1–3 indicating inappropriate and 7–9 indicating appropriate care measures. Results: In online voting, a consensus was reached for 9/10 statements. Respondents considered the following to be appropriate: risk assessment of VTE (93.44%) and bleeding (91.6%) in hospitalized medical patients; low-molecular weight heparin (LMWH) prophylaxis for inpatients with pneumonia and malignancy (82.78%); therapeutic doses of LMWH/fondaparinux in patients with intermediate/high risk of PE with (80.9%) or without (77.97%) instability criteria; and echocardiography to manage patients with a post-PE syndrome (93.99%). Respondents considered the following to be inappropriate: use of 4000 IU LMWH in chronic renal failure (80.46%); use of 2000 IU LMWH in persons on dual antiplatelet therapy (77.01%); and use of low-dose apixaban (2.5 mg) in pregnancy (88.57%) or in subsegmental PE with hypoxemia (82.46%). No consensus was reached on the identification of PE cases eligible for outpatient treatment. Conclusions: Our findings show persistent gaps between guideline recommendations and clinical implementation despite improved awareness among physicians. Uncertainty persists regarding criteria for outpatient PE eligibility and/or for validation of bleeding-risk models. Full article

Feline ascites has been reported to have a poor prognosis, with a median survival time of 21 days (considering all etiologies). However, previous studies included relatively small populations (<100 cases) and there is no literature evaluating the prognosis of all causes of feline ascites within the last 20 years. This study aimed to assess the survival times of a large population of cats presenting with ascites and assess the effect of the effusion cause, signalment, clinicopathological and imaging findings on survival. Data was acquired from the medical record system of a referral hospital (including both referrals and first-opinion emergency cases). Four hundred and ninety-eight cats met the inclusion criteria and 55% of all cases survived to discharge. Median survival time post-discharge was 30.5 days. The cause of the effusion was significantly associated with survival to discharge (p = 0.002). Common etiologies of ascites included neoplasia, septic peritonitis, sterile inflammatory disease, uroperitoneum, hemoperitoneum and cardiac disease. Uroperitoneum cases had the highest rate of survival to discharge (77%), while hemoperitoneum cases had the lowest percentage surviving to discharge (40%). Subjectively assessed effusion volume on imaging was significantly associated with survival to discharge (p = 0.012). Subjective assessment of the effusion volume and effusion assessment via abdominocentesis to help obtain a diagnosis can help guide prognosis and are diagnostics that do not require advanced techniques or specialist equipment, which can provide important prognostic information for cats presenting with ascites. Full article

Sepsis is a major medical emergency, characterized by a dysfunctional immune response to infection, which often progresses to multiple organ failure and death. Early diagnosis and prognostic evaluation present significant challenges due to limitations in the specificity and sensitivity of traditional biomarkers. This narrative review summarizes recent evidence on the potential of circulating microRNAs (miRNAs) such as miR-150, miR-146a, miR-223, miR-155, miR-122, and miR-4772-5p and plasma gelsolin (pGSN) as diagnostic and prognostic markers in sepsis. We discuss mechanisms involved and their potential for integration with artificial intelligence (AI) in personalized medicine. PubMed, Embase, and Web of Science databases were searched for relevant literature. Original research, systematic reviews, and meta-analyses focused on the diagnostic or prognostic value of circulating miRNAs or pGSN in sepsis were included; opinion papers and case reports were excluded. Altered expression of certain circulating microRNAs correlates with disease severity and mortality. Among circulating microRNAs (miRNAs), miR-122 and miR-150 have become the most consistently validated biomarkers in clinical studies, associated with sepsis severity and death rates. Additionally, other miRNAs such as miR-146a, miR-155, and miR-223 play roles in modulating immune and endothelial responses, highlighting the complex regulation of sepsis pathophysiology. Low pGSN concentrations at admission are associated with severe sepsis and acute respiratory distress syndrome, and serve as an independent predictor of mortality. Preclinical studies suggest that supplementation with exogenous pGSN could increase survival. AI algorithms show promising results for early sepsis detection and optimization of therapeutic decisions. However, combining circulating miRNAs and plasma gelsolin (pGSN) into AI-based models is still an exploratory idea that needs prospective validation, assay standardization, and multicenter studies before it can be used clinically. Full article

Background: Research in personalized medicine, with applications in oncology, dermatology, cardiology, urology, and general healthcare, requires facile and safe access to accurate data. Due to its particularly sensitive character, obtaining health-related data, storing it in repositories, and federating it are challenging, especially in the context of open science and FAIR data. Methods: An online survey was conducted among medical researchers to gain insights into their knowledge and experience regarding the following topics: health data repositories and data federation, as well as their opinions regarding data sharing and their willingness to participate in sharing data. Results: The survey was completed by 189 respondents, the majority of whom were attending physicians and PhD candidates. Most of them acknowledged the complex, beneficial implications of data federation in the medical field but had concerns about data protection, with 75% declaring that they would agree to share data. A general lack of awareness (80%) about the importance of interoperability for federated data repositories was observed. Conclusions: Implementing federated data repositories in the health field requires thorough understanding, knowledge, and collaboration, enabling translational medicine to reach its full potential. Understanding the needs of all involved parties can shape the success of medical data federation initiatives, with this study serving as a foundation for further research. Full article

Medication non-adherence remains a major challenge in healthcare systems worldwide, with significant implications for patient outcomes and healthcare costs. This study explored the perceptions and practices of Key Opinion Creators (KOCs) in Kosovo regarding medication adherence. Using a qualitative approach, 15 participants representing hospitals, pharmacies, academia, pharmaceutical companies, insurance, and professional associations were surveyed through open-ended questionnaires. Findings reveal the absence of clear national policies or guidelines dedicated to adherence, limited monitoring systems, and insufficient institutional support. While KOCs recognize healthcare professionals’ (HPs) role in patient education, counseling, and monitoring, they also stressed that their engagement is often fragmented and lacks standardized reporting mechanisms. Technology and innovation were identified as promising tools to improve adherence, but their application is limited by inadequate infrastructure and resources. Key barriers include a lack of guidelines, financial and human resource constraints, low patient education, and disparities across demographic groups. The study highlights the urgent need for coordinated policies, stronger inter-professional collaboration, targeted interventions, and integration of digital health solutions to strengthen medication adherence practices in Kosovo. Full article

Neurorehabilitation has become increasingly data-enabled, yet the conditions that most strongly modulate recovery, sleep consolidation, circadian alignment, medication ecology, and social–environmental context are rarely captured or acted upon. This opinion paper argues that an exposome perspective, defined as the cumulative pattern of external and internal exposures and their biological imprints across the life course, is not ancillary to rehabilitation but foundational to making therapy learnable, timely, and equitable. We propose a pragmatic model that centers on a minimal exposure dataset collected in minutes and interpreted at the point of care. Two clinical exemplars illustrate feasibility and utility. First, sleep and circadian rhythms: brief actigraphy and standardized reporting can make daily alertness windows visible, allowing teams to align high-intensity sessions to receptive states and to justify environmental adjustments as clinical interventions. Second, anticholinergic burden: a simple, trackable index can be integrated with functional goals to guide deprescribing and optimize cognitive availability for training. Implementation hinges less on new infrastructure than on workflow design: a short intake that surfaces high-yield exposures; embedding targets, e.g., sleep efficiency thresholds or anticholinergic load reductions, into plans of care; enabling secure import of device data; and training staff to interpret rhythm metrics and burden scores. We outline a parallel research agenda comprising pragmatic trials of bundled, exposure-informed care; longitudinal cohorts with time-stamped exposure streams; and causal methods suited to time-varying confounding, all under explicit equity and ethics safeguards. By measuring a few modifiable exposures and linking them to routine decisions, neurorehabilitation can convert context from a source of unexplained variance into actionable levers that improve outcomes and narrow unjust gaps in recovery. Full article

Attention Deficit Hyperactivity Disorder (ADHD) is a neuro-behavioural condition associated with limitations and deficits. Previous literature has largely focused on the lived experiences of males with ADHD. Despite a recent increase in studies on females with ADHD, there is a lack of empirical research on school experiences. This study aimed to address this gap in the literature by examining the perceived effect of ADHD on the school experiences of women. 13 women aged between 18–35 with a medical diagnosis of ADHD answered a series of questions in qualitative semi-structured interviews. Three were diagnosed during school and ten were diagnosed after school. The data was analysed using structured inductive thematic analysis. Four themes emerged, with sub-themes as follows: (1) Personal impact; the impact ADHD had on self-identity in school pre- and post-diagnosis. (2) Attitudes and opinions of others; how parents, teachers and societal attitudes on gender affected diagnoses and school experiences. (3) Friendships and relationships; how ADHD affected personality and socialising in school, and (4) ADHD and academia; the academic struggles participants faced whether diagnosed in school or not. The results suggest that ADHD contributed to negative school experiences for all participants. While the perception was that gender and attitudes towards ADHD in females often delayed diagnoses and that early diagnosis would have improved self-identity and school experience, results suggest even with early diagnosis, it is important that teachers are educated about the symptoms and deficits affecting females with ADHD and that schools provide resources to support female students with ADHD to ensure the best school experience. Full article

Background/Objectives: According to recent literature, the prevalence and incidence of long-term illnesses such as asthma and diabetes in young people have substantially risen over the past 13 years. Recent figures indicate that, in England, 4.10% of all prescriptions were prescribed for young people. The aim of this study was to investigate young people’s perspectives of pharmaceutical services provided by primary care pharmacists relating to medication. Methods: A cross-sectional survey using both online and paper-based tools was conducted from March to November 2019. The population for this survey was young people from 18 to 24 years old registered as students at one of the universities in England. The survey consisted of twenty-four questions, and they were a mix of closed-ended questions, such as multiple-choice and Likert scales, and open-ended questions. Results: A total of 210 out of 800 survey responses were completed from different recruitment sources, achieving a response rate of 26.25%. Most participants were female (62.38%), and the most frequent age was 18 years (35.24%). Among participants, 15.70% were diagnosed with long-term illnesses, of which 33.33% were reported as the respiratory disease, asthma. Pharmacists were not utilised as a source of information for young people, with the majority (60.60%) obtaining information from their doctors. Most of the participants (96.97%) had not taken part in a Medicines Use Review (MUR) or New Medicine Service (NMS), and 78.79% were not aware of any services or support groups by their pharmacist. Among different healthcare professionals, GPs and hospital doctors were the most frequently reported to discuss with young people about their illnesses. Conclusions: There is an opportunity to further develop pharmaceutical services and support by primary care pharmacists for young people with long-term illnesses. Policymakers and primary care pharmacists in the future could utilise the perceptions and opinions of young people found in the current study to inform the development of primary care pharmacy services to meet young people’s needs and perceptions. These results are of benefit to policymakers in assisting in the development of pharmacy services. Further research will enhance understanding of the perceptions of young people about the pharmaceutical services offered by primary care pharmacists with respect to medications. Full article

Background: Energy drink [ED] consumption is common among young adults and has been linked to adverse health effects and risky behaviors. This study compared medical and non-medical university students to assess whether health education influences knowledge, consumption, and attitudes toward EDs. Although medical and non-medical students are not minors, their opinions on the national ban on EDs sales to individuals under 18 provide valuable insight into attitudes toward regulation. Material and Methods: A cross-sectional online survey was conducted among 871 students (42.1% medical, 57.9% non-medical). The questionnaire assessed demographics, ED consumption, knowledge, motivations, and regulatory attitudes. It was pilot-tested on 30 students to ensure clarity, and internal consistency was confirmed (Cronbach’s α = 0.78 for knowledge; α = 0.81 for attitudes). Non-parametric tests (Mann–Whitney U, Kruskal–Wallis) and chi-square analyses compared groups. Results: Participants’ mean age was 22.1 years; most were female (73.2%). Medical students demonstrated significantly better knowledge of ED ingredients (simple sugars, B vitamins, L-carnitine, electrolytes; p < 0.01) and adverse effects (e.g., irritability, dizziness, nausea; p < 0.05). However, ED consumption frequency did not differ between medical and non-medical students. The main reasons for ED use were energy and concentration; social motives were less frequent. Female students more often supported the ban on ED sales to minors and additional advertising restrictions (p < 0.001), while overall confidence in enforcement was low. Conclusions: Despite greater awareness, medical students consume EDs at rates comparable to non-medical students. Educating medical students on safe caffeine use is crucial, since shift work may promote stimulant intake. Combining targeted education with stronger enforcement could enhance the impact of regulatory policies and reduce risky consumption among young adults. Full article

Today, the right to easy access to medical care for all citizens is one of the universal rights promoted by the WHO to achieve the health goals of sustainable development. Furthermore, an intelligent reevaluation of hospital management is becoming an absolute necessity in light of the pressure that healthcare and public health establishments worldwide face. A management based on the capitalization and exploitation of vast quantities of knowledge. In the 21st century, medicine has already moved to the “in silico” phase, where healthcare professionals must use knowledge bases to make clinical decisions. Indeed, knowledge gains greater value when it’s actively engaged with through dynamic knowledge bases. There is a plethora of research on hospital management, but few studies have approached it from the angle of informational intelligence governed by knowledge management. In this article, we adopt a positivist posture, using deductive logic and the Delphi method based on expert opinion and consensus. We aim to approach hospital management from an informational intelligence perspective, inspired by knowledge representation systems and the object approach. We present an initial vision of the intelligent hospital management model, showing its strengths in relation to its predecessors, as well as its potential uses. Full article

Acute respiratory infections are highly prevalent and significantly impair quality of life and productivity. Despite their impact, they are often not managed according to best medical practice. A lack of knowledge about symptomatic therapies leads to mis- and under-treatment. Thus, this narrative expert opinion paper aims to highlight the importance of appropriate and early symptomatic treatment in order to assist informed therapeutic decision making and advance efforts to reduce antibiotics misuse. Clinical and mechanistic evidence supports the use of several herbal and synthetic non-antibiotic treatment options. While acute respiratory infections are usually self-limiting, treatment alleviates symptom severity, reducing the risk of inflammatory escalation. Timing of the intervention is crucial, as early initiation shortens illness duration. In conclusion, optimizing the management of acute respiratory infections could relieve the individual and societal burden of illness and slow the increase in antimicrobial resistances. Full article

Background: Uterus transplantation (UTx) is a proven treatment for individuals affected by absolute uterine factor infertility (AUFI) who desire biological motherhood. Despite the fact that over 130 procedures have been performed worldwide in the past decade, UTx remains relatively unfamiliar, even among healthcare professionals. This study aimed to identify knowledge gaps regarding and evaluate attitudes toward UTx among Hungarian obstetricians/gynecologists and transplantation providers, in anticipation of the first procedure to be performed in the country. Methods: A Microsoft Forms^® questionnaire was distributed electronically among Hungarian medical professionals via e-mail, including members of the Hungarian Society of Obstetrics and Gynaecology and the Hungarian Transplantation Society. Additionally, participants of the “Update 2024” OB/GYN conference (held 28–29 November 2024, in Visegrád, Hungary) were invited to complete the survey through a QR code displayed during the event. Results: A total of 290 medical professionals completed the survey (response rate: 27.6%, 290/1050). Most of the respondents specialized in obstetrics and gynecology (81.7%, n = 237), with the remainder representing transplantation fields (18.3%, n = 53). Over half (56.6%, n = 161) reported they would recommend UTx to patients with AUFI, and 64.1% (n = 186) agreed that UTx should be available as a treatment option. The medical risks associated with the procedure were deemed acceptable for both living donors (58.0%, n = 168) and recipients (54.8%, n = 159). Conclusions: This is the first study to explore perceptions of UTx among Hungarian medical professionals. The findings suggest there is a generally favorable professional attitude toward its future clinical implementation. Full article

International medical graduates (IMGs) make up a significant proportion of general practitioners (GPs) in high-income countries such as the United Kingdom (UK), the United States of America (USA), Australia, and Canada. This paper compares views about IMGs with their own views in relation to the timing of GP placements in GP specialty training programs in the UK. It presents an inductive thematic analysis of focus groups with GP specialty trainers and trainees (149 participants across 32 focus groups), examining opinions about the ideal timing of GP placements. Trainers and home graduates argued that for home graduates, the ideal sequence depends on the trainee’s previous experience. They also suggested that IMGs should start in a hospital placement to develop familiarity with the healthcare system. In contrast, most IMGs expressed a preference for starting in a GP placement, so that they can gain an understanding of the requirements of their specialty as early as possible. There is a contrast between what IMGs said about themselves and the views shared by trainers and home graduates. This highlights the need to involve IMGs in the design of support programs targeted towards them. Recommendations include tailoring training to account for individual career paths and providing training about the healthcare system before the start of the first placement. This could improve the efficiency of GP training programs at a time of extreme pressure on healthcare systems and training providers. Full article

Air pollution is a leading environmental risk that causes respiratory morbidity and mortality. The increasing availability of high-resolution environmental data and air pollution-related health cases have accelerated the use of machine learning models (ML) to estimate environmental exposure–response relationships, forecast health risks and call for the needed policy and practical interventions. Unfortunately, ML models are opaque, in a sense that, it is unclear how these models combine various data inputs to make a concise decision. Thus, limiting its trust and use in clinical matters. Explainable artificial intelligence (xAI) models offer the necessary techniques to ensure transparent and interpretable models. This systematic review explores online data repositories through the lens of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline to synthesize articles from 2020 to 2025. Various inclusion and exclusion criteria were established to narrow the search to a final selection of 92 articles, which were thoroughly reviewed by independent researchers to reduce bias in article assessment. Equally, the ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions) domain strategy was helpful in further reducing any possible risk in the article assessment and its reproducibility. The findings reveal a growing adoption of ML techniques such as random forests, XGBoost, parallel lightweight diagnosis models and deep neural networks for health risk prediction, with SHAP (SHapley Additive exPlanations) emerging as the dominant technique for these models’ interpretability. The extremely randomized tree (ERT) technique demonstrated optimal performance but lacks explainability. Moreover, the limitations of these models include generalizability, data limitations and policy translation. This review’s outcome suggests limited research on the integration of LIME (Local Interpretable Model-Agnostic Explanations) in the current ML model; it recommends that future research could focus on causal-xAI-ML models. Again, the use of such models in respiratory health issues may be complemented with a medical professional’s opinion. Full article

Background: Public discourse on social media plays an increasingly influential role in shaping health-related perceptions and behaviours. Individuals share experiences, concerns, and opinions beyond clinical settings around different issues. X (formerly Twitter) provides a unique lens through which to examine how different treatments are perceived, used, and debated across diverse communities over time. Objective: The study aims to (a) identify the types of ADHD medications mentioned in posts, depending on language and user type; (b) evaluate the popularity of content related to these medications, considering language and user type; (c) analyse temporal changes in the frequency of mentions between 2006 and 2022; and (d) examine the distribution of tweets across different content categories. By addressing these objectives, this study provides insights into public perceptions of ADHD medications, which may help healthcare professionals better understand online discussions and improve their communication with patients, facilitating more informed treatment decisions. Methods: An observational study was conducted analysing 254,952 tweets in Spanish and English about ADHD medications from January 2006 to December 2022. Content analysis combined inductive and deductive approaches to develop a categorisation codebook. BERTWEET and BETO models were used for machine learning classification of English and Spanish tweets, respectively. Descriptive statistical analysis was performed. Results: Overall, stimulant medications were posted more frequently and received higher engagement than non-stimulant medications. Methylphenidate, dextroamphetamine, and atomoxetine were the most commonly mentioned medications, especially by patients, who emerged as the most active users among the English tweets. Regarding medical content, tweets in English contained more than twice the number of mentions of inappropriate use compared to those in Spanish. There was a high content of online medication requests and offers in both languages. Conclusions: In this study, conducted on X, discussions on ADHD medications highlighted concerns about misuse, adherence, and trivialisation, with clear differences between English and Spanish tweets regarding focus and type of user participation. These findings suggest that monitoring social media can provide early signals about emerging trends, helping clinicians address misconceptions during consultations and informing public health strategies aimed at the safer and more responsible use of ADHD medications. Full article