Search Results (6,875)

Burning Mouth Syndrome (BMS) presents diagnostic and therapeutic challenges due to its unclear etiology and complex symptomatology. This study, part of a doctoral research project, explores diagnostic delay, triggering factors, and psychotropic medication use in BMS patients. By retrospectively analyzing 300 clinical records, the study offers insight into patterns of diagnosis and treatment, with a focus on differences related to age and sex. The findings contribute to a better understanding of BMS and emphasize the need for timely diagnosis, particularly in older adults, to improve patient outcomes. Full article

Background: Electronic monitoring adherence devices (EAMDs) are increasingly being utilized in various healthcare settings to track medication adherence. Objective: To determine the accuracy of the Sensal Health MyAide™ Smart Doc in capturing dose removal from the vial, specifically the time of dose removal and the number of pills removed for each actuation of the device. Methods: This validation study compares the device’s recording of dose withdrawals from a prescription vial by simulated patients against reference documentation reported using MS Forms by the participants. Three participants completed a 4-day study consisting of two non-consecutive 1 h sessions per day encompassing six actuations from the prescription vial to be captured by the Sensal Health MyAide™ Smart Dock after their informed consent was obtained. Statistical analysis included percent agreement and Cohen’s kappa assessing agreement between user-reported data and electronic measurement data recorded by the MyAide™ Smart Dock. Outcome measures included confirmation of the specific user, time of dose removal (±1 min), and the number of pills withdrawn. Results: Three subjects were recruited to provide data for a total of 144 actuations. The study found perfect 100% agreement across the number of pills withdrawn and specific users withdrawing the pills and 99% agreement for the time of administration. The Cohen’s kappa values for the outcome measures were 1.00 (95%CI [1.00, 1.00]) for the number of pills dispensed and specific user and 0.993 (95%CI [0.990, 0.996]) for the time of administration. Conclusions: This study found that the Sensal Health MyAide™ Smart Dock can accurately record the time of administration, the number of pills dispensed, and the identity of the user dispensing the pills. Full article

Background: Inpatient palliative care consultation services operate with an interdisciplinary team, where effective handoffs are crucial for coordinated patient care. We aimed to replace encrypted email handoffs with a more concise and uniform handoff using I-PASS (illness severity, patient summary, action list, situational awareness, contingency planning, and synthesis by receiver) integrated within the electronic medical record (EMR). Aim and Measures: Within six months of launch, our goal was to achieve 90% I-PASS utilization for hospitalized acutely ill patients with cancer receiving palliative care consultation. Intervention: In January 2021, our quality improvement team, consisting of physicians, advanced practice providers, and trainees, began implementing I-PASS using the plan–do–study–act cycle. After providing training sessions for all palliative care clinicians, I-PASS went live on October 1, 2021. I-PASS utilization was tracked via random and monthly audits of EMRs. Through anonymous surveys, both pre- and post-implementation, we gathered clinician feedback and concerns about the handoff system. Survey responses were compared using the Mann–Whitney test. Outcomes: Within six months of implementation, the I-PASS utilization rate reached > 99%. The survey participation rates were 70% (45/64) and 82% (49/60) for the pre-and post-implementation periods, respectively. Respondents provided answers on one to five scale (mean, standard deviation, SD): lower accuracy with email (3.53, SD = 0.98) vs. I-PASS (4.20, SD = 0.83), p < 0.001; handoff lengthier with email (4.17, SD = 1.05) vs. I-PASS (2.1, SD = 1.15), p < 0.001; the time required was longer with email (3.0, SD = 1.22) vs. I-PASS (1.71, SD = 0.73), p < 0.001. Overall, respondents found I-PASS to be significantly better (4.69, SD = 0.58). Conclusion: I-PASS was fully adopted by the team, with nearly 100% utilization and strong clinician endorsement as an effective communication tool. Future efforts should focus on optimizing usability, particularly by educating clinicians on smartphone EMR access and enabling the timely and streamlined editing of I-PASS. Full article

Background/Objective: Insulin resistance (IR) during pregnancy, even in women with normal body mass index (BMI), may affect maternal and fetal metabolic and immune status. This study aimed to evaluate neopterin (NPT), leptin, insulin, and ghrelin concentrations in maternal blood (MB) and umbilical cord blood (CB) in normoglycemic women with and without IR, all with normal BMI. Methods: Peripheral and cord blood was collected from 36 Caucasian women with term, uncomplicated vaginal deliveries. The participants were classified into control (n = 16; age = 30.81 ± 4.875 years) and IR (n = 20; age = 31.95 ± 4.979 years) groups based on a professional medical diagnosis. Anthropometric parameters were recorded, and metabolic/hormonal markers were measured using ELISA and RIA. Results: NPT concentrations in CB were significantly higher in the IR group (p < 0.05), correlated positively with MB NPT levels (r = 0.3809, p < 0.05). A significantly higher concentration of both insulin and leptin was observed in the MB of women with IR compared to the control group (p < 0.0001), whereas in CB, only insulin concentration was significantly higher in the IR group than in healthy controls (p < 0.05). Ghrelin levels did not differ between the groups. Conclusions: Insulin resistance in non-obese pregnant women is associated with increased NPT concentration in CB, which may suggest fetal immune activation. However, defining the role of NTP as a metabolic “messenger” between mother and child requires further study. Full article

Invasive infections caused by rare moulds (RM) are increasingly reported and often exhibit resistance to antifungal agents. Their epidemiology varies regionally, yet data from Greece are scarce. To address this gap, we conducted a 15-year retrospective study of RM fungaemia at a tertiary academic hospital in Athens, Greece. All microbiologically confirmed cases in hospitalised patients between 2010 and 2024 were reviewed. Demographic and clinical data were retrieved from medical records. Incidence rates were calculated per 1000 admissions and 10,000 bed-days. Isolates were morphologically identified and, when available, molecularly characterised and tested for antifungal susceptibility according to EUCAST guidelines. Eight RM fungaemia episodes (0.8% of total fungaemias) were identified, with an incidence of 0.01/1000 admissions and 0.03/10,000 bed-days, without bacterial co-infections. Haematological malignancies (62%) were the most common underlying condition. Fusarium spp. were the predominant pathogens (6/8), followed by single cases due to Lomentospora prolificans and Acremonium spp. Amphotericin B showed the highest in vitro activity against Fusarium isolates (MIC 0.5–1 mg/L), followed by voriconazole (MICs 2–8 mg/L) whereas other azoles showed no in vitro activity (MICs ≥ 8 mg/L). Half of the infections were breakthrough, whereas in 3/8 cases, the diagnosis was established post-mortem (n = 2) or post-discharge. Among the five patients who received treatment, the crude mortality rate was 60%. This first epidemiological report on RM fungaemia in Greece highlights the predominance of Fusarium spp., the frequency of breakthrough infections, and the challenges in early diagnosis and management. Increased clinical awareness and regional surveillance are essential for optimising outcomes. Full article

Background/Objectives: Anorexia–Cachexia Syndrome (ACS) is a multifactorial condition common in advanced chronic illnesses, leading to significant impacts on prognosis and quality of life. This retrospective cohort study aimed to evaluate the prevalence, management strategies, and clinical and patient-centered outcomes of ACS in a home-based palliative care team. Methods: Clinical records of 128 adult patients followed between 2021 and 2024 were analyzed. Data collected included sociodemographic variables, clinical diagnosis, nutritional parameters (Palliative Performance Scale (PPS), Mini Nutritional Assessment (MNA)), symptoms (anorexia, fatigue), interventions (enteral nutrition, psychological and rehabilitative support), and relevant medications. Statistical analysis included descriptive, inferential, and multivariable proportional hazard regression analysis to identify independent predictors of weight loss and anorexia. Results: Manifestations of ACS were observed across both oncologic and non-oncologic conditions. The prevalence of weight loss and anorexia were interrelated and were not different between diagnostic groups. Using multivariable analysis, higher baseline MNA scores (HR = 3.797, p = 0.006) and the use of enteral nutrition (HR = 7.418, p = 0.014) were independently associated with an increased risk of significant weight loss. Lower baseline PPS scores (HR = 0.069), use of enteral nutrition (HR = −0.890), and the presence of psychological support were protective for subsequent anorexia. Dexamethasone use was associated with greater nutritional decline in univariate models. Conclusions: The management of ACS in home palliative care requires the early identification of symptoms, multidisciplinary intervention, and personalized strategies beyond disease etiology. Risk of weight loss is associated with higher MNA scores, and these are best managed in the first week. In anorexia cases, psychological support is protective. Full article

The wide application of light emitting diodes (LEDs) in lighting systems has necessitated the inclusion of spectral tunability by using multi-color LED chips. Since the lighting requirement depends on the specific application, it is very important to have flexibility in terms of the driving conditions. While many applications use single or rather white color, some recent applications require multi-spectral lighting systems especially for agricultural or human-medical treatment applications. These systems are underexplored and pose specific challenges. In this paper, a mixture of red, green, blue, white (RGB-W) LED chips was used to develop a compact light engine specifically for agricultural applications. A computational study was performed to understand the optical distribution. Later, attention was turned into development of prototype light engines followed by experimental validation for both the thermal and optical characteristics. Each LED string was driven separately at different current levels enabling an option for obtaining an infinite number of colors for numerous applications. Each LED string on the developed light engine was driven at 300 mA, 500 mA, 700 mA, and 900 mA current levels, and the optical and thermal parameters were recorded simultaneously. A set of computational models and an experimental study were performed to understand the optical and thermal characteristics simultaneously. Full article

Background: Social determinants of health (SDOH) are critical contributors to cancer disparities, influencing prevention, early detection, treatment access, and survival outcomes. Addressing these disparities is essential in achieving equitable oncology care. Artificial intelligence (AI) is revolutionizing oncology by leveraging advanced computational methods to address SDOH-driven disparities through predictive analytics, data integration, and precision medicine. Methods: This review synthesizes findings from systematic reviews and original research on AI applications in cancer-focused SDOH research. Key methodologies include machine learning (ML), natural language processing (NLP), deep learning-based medical imaging, and explainable AI (XAI). Special emphasis is placed on AI’s ability to analyze large-scale oncology datasets, including electronic health records (EHRs), geographic information systems (GIS), and real-world clinical trial data, to enhance cancer risk stratification, optimize screening programs, and improve resource allocation. Results: AI has demonstrated significant advancements in cancer diagnostics, treatment planning, and survival prediction by integrating SDOH data. AI-driven radiomics and histopathology have enhanced early detection, particularly in underserved populations. Predictive modeling has improved personalized oncology care, enabling stratification based on socioeconomic and environmental factors. However, challenges remain, including AI bias in screening, trial underrepresentation, and treatment recommendation disparities. Conclusions: AI holds substantial potential to reduce cancer disparities by integrating SDOH into risk prediction, screening, and treatment personalization. Ethical deployment, bias mitigation, and robust regulatory frameworks are essential in ensuring fairness in AI-driven oncology. Integrating AI into precision oncology and public health strategies can bridge cancer care gaps, enhance early detection, and improve treatment outcomes for vulnerable populations. Full article

Implant placement in the mandibular anterior region is often limited by narrow alveolar ridge width, particularly in older or medically compromised patients, where bone grafting is contraindicated or undesirable. This area is also crucial for esthetics, necessitating immediate restoration after tooth loss. This retrospective study evaluates the short- and long-term survival and complication rates of narrow-diameter implants (NDIs) placed for immediate provisional restoration in the mandibular anterior region. This study includes 22 one-piece NDIs (Osstem, Korea) placed in 13 patients with narrow ridges, immediately restored with non-functional provisional prostheses. Clinical records and follow-up data throughout 2023 were reviewed. Marginal bone loss (MBL) was assessed using standardized periapical radiographs. A generalized linear mixed model was used to analyze the correlation between MBL and clinical variables. The implant survival rate was 100% (95% CI: 82.7–100) over an average follow-up period of 7 years. Biological and mechanical complication rates were 18.18% and 4.54%, respectively; patient-based complications occurred in 30.77% of cases. No statistically significant predictors of MBL were identified, although smoking showed a trend toward significance (p = 0.096; OR = 8.00; 95% CI: 0.69–92.70). NDIs may be a viable option for immediate provisional restoration in this region, although findings should be interpreted cautiously. Full article

Hyperammonaemia in dogs is most frequently associated with hepatic encephalopathy caused by portosystemic shunting. This retrospective multicentre study aimed to investigate the prevalence of hyperammonaemia and hepatic encephalopathy in dogs with recent or ongoing epileptic seizures. Furthermore, we sought to evaluate if transient post-ictal hyperammonaemia as a sequela to seizure activity occurs, as reported in humans and recently in cats. The medical records of all dogs presented between 2014 and 2024 to ten AniCura Veterinary Hospitals in Sweden were retrospectively reviewed to obtain those with recent or ongoing epileptic seizures with concurrent analysis of ammonia. The records of 267 dogs were extracted for further review. Inclusion criteria included information regarding the description and characterisation of the seizures and the analysis of ammonia within 24 h after last reported seizure activity. Additionally, hepatic function tests were required in dogs with elevated ammonia. In total, 58 dogs fulfilled the inclusion criteria, and 10 of those dogs (17%) had hyperammonaemia. Three dogs had documented hepatopathy, and two of them had surgically corrected portosystemic shunts. In seven dogs, no definitive cause of hyperammonaemia could be established. Three of the seven dogs had no evidence of portosystemic shunts, and six had no laboratory evidence supporting acute liver failure. According to the findings in this retrospective study, hyperammonaemia in the absence of evident acute hepatic failure or portosystemic shunting can occur in dogs with epileptic seizures, indicating that other differentials than hepatic encephalopathy should be considered. This study could not confirm the hypothesis of hyperammonaemia being a transient consequence of seizures. Full article

Background and Objectives: Musculoskeletal pain is a global public health issue. Eight Constitution Medicine (ECM), a type of East Asian Traditional Medicine, offers personalized, minimally invasive treatment through Eight Constitution Acupuncture (ECA) and Eight Constitution Lifestyle Intervention (ECLI). Despite its clinical use, scientific evidence supporting ECM’s effectiveness remains limited. This study aimed to evaluate the effectiveness in treating musculoskeletal pain in primary care settings. Materials and Methods: This retrospective study analyzed medical records from three ECM clinics (Gangnam-Shingwang, Yeson, and Yebon) between January 2018 and August 2023. A total of 163 patients were included, with 44 providing follow-up data. Pain intensity, quality of life, and functional outcomes were assessed using validated instruments including the PainDETECT questionnaire, Korean Cancer Pain Assessment Tool (KCPAT) somatic pain scores, EuroQol 5-Dimension 5-Level (EQ-5D-5L), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oswestry Disability Index (ODI), Neck Disability Index (NDI), and Shoulder Pain and Disability Index (SPADI). Pre- and post-treatment scores were statistically analyzed. Results: Significant decreases were observed in KCPAT somatic pain scores (11.77 ± 4.77 to 9.77 ± 5.32) and significant improvements in EQ-5D-5L scores (0.74 ± 0.12 to 0.80 ± 0.07). WOMAC and ODI scores also showed significant improvements. However, the changes in the NDI, SPADI, and PainDETECT scores were not statistically significant. No adverse events were reported. Conclusions: ECM, through ECA and ECLI, may offer effective personalized treatment for musculoskeletal pain, improving both pain intensity and quality of life. Despite its small sample size and retrospective design, this study offers valuable preliminary evidence for ECM. Further large-scale prospective studies are needed to confirm these findings. Full article

Background and Aims: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, raising concerns about periprocedural safety in elective endoscopy. We aimed to evaluate the association between pre-procedural GLP-1 RA use and post-procedural complications such as aspiration pneumonia. Methods: In this retrospective cohort study, adults (18–89 years) undergoing outpatient esophagogastroduodenoscopy or colonoscopy within the HCA Healthcare network from 1 July 2021 to 31 March 2024 were identified. Patients were classified as GLP-1 RA users (n = 953) or non-users (n = 3289) based on home medication records. Primary outcomes included aspiration, post-procedural oxygen requirement, hypotension, hospitalization, ICU admission, length of stay, and all-cause inpatient mortality. Multivariable logistic and negative-binomial regression models, incorporating an interaction term for anesthesia type, were adjusted for age, sex, body mass index, ASA class, and key comorbidities. Results: No aspiration events were reported in either group. GLP-1 RA use was associated with lower odds of post-procedural oxygen requirement (OR 0.43, 95% CI 0.25–0.76), hospitalization (OR 0.73, 95% CI 0.39–1.36), and mortality (0.1 vs. 0.9%, p = 0.014), and a shorter hospital stay (IRR 0.54, 95% CI 0.40–0.71). Rates of hypotension and ICU admission were similar between both groups. In anesthesia-stratified analysis among GLP-1 RA users, those receiving MAC/MS had higher odds of hospitalization compared with GA (OR 1.87, 95% CI 1.23–2.85, p = 0.003), whereas other outcomes were not significant. Conclusions: Pre-procedural GLP-1 RA therapy was not associated with increased peri-procedural complications. Although hospitalization was more frequent with MAC/MS, this difference did not extend to other clinically significant outcomes. Further prospective studies are needed to clarify the clinical implications of anesthesia choice. Full article

Background: Oral candidiasis is a prevalent opportunistic infection, predominantly caused by Candida albicans (CA), though non-albicans Candida (NAC) species are increasing worldwide. This study aimed to characterize the prevalence of Candida species, evaluate antifungal susceptibility, and identify predisposing risk factors in patients with oral mucosal candidiasis. Methods: A retrospective review of 1286 electronic patient medical records (788 women, 498 men) from 2018 to 2022 was conducted at the Department of Periodontal and Oral Mucosa Diseases, Medical University of Silesia. Swabs from the oral cavity were processed to identify Candida strains by mass spectrometry, followed by drug susceptibility testing for amphotericin B, nystatin, flucytosine, econazole, ketoconazole, miconazole, and fluconazole. Relevant local and systemic predisposing factors were recorded and analyzed statistically. Results: Among 958 patients with positive fungal cultures, CA accounted for 66.79% of isolates, while NAC constituted 33.21%. Multi-strain infections were detected in 8.46% of patients. CA showed lower resistance (<10%) to amphotericin B, nystatin, and flucytosine, but up to 30% resistance to azoles. NAC strains demonstrated elevated resistance rates (>40% for most azoles), with C. krusei exhibiting the highest resistance to the previously mentioned antifungal agents. Key risk factors included wearing removable dentures (p = 0.042) and uncontrolled diabetes mellitus (p = 0.0431). Additional factors, including poor oral hygiene, reduced salivary flow, and immunosuppressive conditions, further increased infection risk. Patients presenting with multiple risk factors were more likely to have multi-strain infections and more severe disease courses. Conclusions: This retrospective analysis highlights the growing prevalence of NAC, rising antifungal resistance (particularly to azoles), and the importance of identifying risk factors, especially denture use and poor glycemic control. Enhanced preventive strategies, robust diagnostic approaches, and optimized antifungal regimens are essential to address this evolving clinical challenge. Full article

The ongoing global shortage of healthcare personnel, exacerbated by demographic changes and the aftermath of the COVID-19 pandemic, has highlighted the need for efficient workforce utilization and innovative technological support in healthcare. This paper presents LifeLink Monitoring, a prototype of an integrated remote patient monitoring system designed to optimize clinical workflows, support medical personnel, and enhance patient care without replacing human expertise. The system enables real-time patient observation through AI-powered devices, providing automated alerts, live video feeds, and intelligent task management to reduce the burden of non-clinical duties on healthcare professionals. Applications include hospitals, hospices, home care, and remote locations. Key features include seamless integration with medical devices and national health records, advanced computer vision and audio analysis, multi-level deployment models, and a blockchain-secured architecture ensuring high data privacy and cybersecurity standards. Additionally, LifeLink incorporates an entertainment module aimed at improving patient emotional well-being. The solution represents a convergence of artificial and human intelligence to improve healthcare delivery, personnel efficiency, and patient outcomes. Full article

(1) Background: Mobile populations living in disadvantaged circumstances often face disrupted continuity of care due to incomplete or inaccessible health records. This feasibility study explored the perceived usefulness of Electronic Personal Health Records (EPHRs) in enhancing access to and continuity of care for mobile populations across Denmark, Ghana, Kenya, and The Netherlands. (2) Methods: A qualitative study using ninety semi-structured interviews, with multi-level stakeholders ranging from policymakers to mobile individuals, recruited through purposive and convenience sampling. Interview guides and analysis were informed by the Technology Acceptance Model (TAM), and analysis by the Unified Theory of Acceptance and Use of Technology (UTAUT). (3) Results: Stakeholders highlighted the value of improved medical data sharing and ownership and considered EPHRs promising for enhancing care continuity and efficiency. Key concerns included limited digital and health literacy, and data security and privacy, underscoring the need for education and safeguards against inappropriate data sharing. Due to differences in digital readiness and privacy guidelines, a one-size-fits-all EPHR is unlikely to succeed. (4) Conclusions: EPHRs are considered valuable tools to enhance care continuity and increase patient ownership, but they face technical, structural, and social challenges, including data security and varying levels of digital (health) literacy. Successful implementation requires context-sensitive, co-created solutions supported by strong policy frameworks. Full article