Search Results (2,470)

Background: Poor nutrition drives chronic disease, health disparities, and rising health care costs in the United States. Medically tailored meals (MTMs), designed by registered dietitians, are a Food-as-Medicine intervention with potential to improve outcomes and reduce costs. This review synthesizes evidence on the clinical, economic, and policy implications of MTMs. Methods: We conducted a narrative review of peer-reviewed studies, real-world program evaluations, and policy analyses. Sources included PubMed, Google Scholar, and grey literature from government, nonprofit, and industry organizations. Articles and reports were included if they examined MTMs in Medicare, Medicaid, or other high-risk populations. Results: Evidence demonstrates that MTMs improve health outcomes, reduce hospitalizations, and lower total cost of care. Case studies from Medicaid and Medicare Advantage plans, including those administered by Mom’s Meals^®, report reductions in emergency department visits, hospital readmissions, and total cost of care, alongside sustained high member satisfaction. Despite these findings, gaps in coverage and limited stakeholder awareness hinder broader access and adoption. Conclusions: Federal policy action can expand MTM availability and maximize utilization of existing benefits. Opportunities include establishing a Medicare Fee-for-Service demonstration, expanding and encouraging use in Medicare Advantage, and leveraging MTMs within Center for Medicare and Medicaid Innovation models. Broader implementation and utilization could reduce the nation’s chronic disease burden, advance health equity, and promote value-based care. Full article

Background: Population aging in Poland has led to rising healthcare needs, but comprehensive evidence on long-term utilization patterns is limited. This study aimed to analyze healthcare use and disease burden among older adults, with particular focus on the impact of the COVID-19 pandemic, including its effects on care pathways, continuity of services, and differences between urban and rural populations. Methods: We conducted a retrospective study using anonymized medical records from a primary healthcare network in Poland between January 2020 and December 2024. The sample included 42,844 patients aged 60 years or older patients aged ≥60 years, with a total of 738,300 consultations. Data on demographics, visit type, prescriptions, referrals, diagnostic tests, and follow up were analyzed using chi-square tests, logistic regression, and nonparametric comparisons. Results: The mean age of patients was 77.5 years (SD 9.4), and 63.7% were women. The mean number of visits in the preceding 12 months was 10.3 (range 0–460). Prescriptions were issued in 56.9% of visits, referrals in 33.5%, and diagnostic tests in 21.4%. Patients with chronic diseases were more likely to receive diagnostic tests than those without (32.4% vs. 21.1%, χ² = 1570.42, p < 0.0001), but less likely to return within 30 days (23.4% vs. 39.4%, χ² = 2243.76, p < 0.0001). First visits generated more referrals than follow ups (41.6% vs. 32.9%, χ² = 1620.51, p < 0.0001). Completed visits were strongly associated with prescription issuance (63.2% vs. 16.4%, χ² = 1048.76, p < 0.0001). Return analyses showed that patients with more prior visits were significantly more likely to re-engage at 30, 60, and 90 days (all p < 0.0001). Age correlated positively with total number of visits (ρ = 0.136, p < 0.05) with the oldest adults more likely to return at 60 and 90 days. Visit realization decreased during early pandemic phases but increased significantly post-COVID (OR = 1.76, p < 0.001). Psychiatric referrals increased the odds of return within 30 days (OR = 1.42) and 60 days (OR = 1.36). Conclusions: Older adults in Poland demonstrate high healthcare utilization, with patterns shaped by age, chronic disease status, and pandemic-related disruptions. While statistical associations were robust, effect sizes were small, highlighting the need to focus on clinically meaningful differences in planning geriatric care. The findings highlight that COVID-19 acted as a major modifying factor of healthcare engagement, revealing the vulnerability of geriatric care continuity to system-level disruptions. Full article

Background/Objectives: Children with medical complexity (CMC) living in community settings are increasingly prevalent, and appropriate care environments are essential to support their wellbeing. This study aimed to examine the relationship between care environments and environmental modifications in CMC’s daily living, as well as the factors influencing this relationship. Methods: A cross-sectional survey was conducted among families of CMC and professionals (including visiting nurses, consultation support specialists, and other professionals) across Japan. Mann–Whitney U tests were used to examine differences between families and professionals, as well as by the agent of modification. Wilcoxon signed-rank tests were performed to compare environmental scores before and after modifications. Spearman’s rank correlation coefficients were used to assess associations between environmental modification scores and post-modification environmental scores. Multiple regression analyses were conducted to identify predictors of post-modification environmental scores, including environmental modification subcategory scores and background characteristics. Results: Valid responses were obtained from 90 families (93.8%) and 221 professionals (76.2%). Significant differences in environmental modification scores were observed between families and professionals. Scores were significantly higher when modifications were conducted jointly by families and professionals and when led by professionals than when implemented solely by families. Pre- and post-modification environmental scores demonstrated significant improvements across all domains—physical, collaborative, service, and community—as well as in total score. Conclusions: Families may underappreciate professional psychological support as part of environmental modifications. Jointly planned, family-centred modifications integrating physical, service, collaborative, and community elements improve care environments and support the wellbeing of CMC and their families. Full article

Background and Objectives: Systemic inflammation plays a critical role in cancer progression and prognosis. The Systemic Inflammation Response Index (SIRI), a novel marker integrating neutrophil, monocyte, and lymphocyte counts, has been suggested as a prognostic indicator in various malignancies. This study aimed to evaluate the prognostic significance of SIRI in patients with metastatic pancreatic cancer receiving first-line chemotherapy. Materials and Methods: This retrospective study included 147 patients with metastatic pancreatic cancer who received first-line chemotherapy or best supportive care between 2010 and 2024. Clinical and laboratory data were collected from medical records. Overall survival (OS) and progression-free survival (PFS) were assessed using the Kaplan–Meier method, and prognostic factors were identified by univariate and multivariate Cox regression analyses. Results: The median OS and PFS were 7 and 4 months, respectively. Multivariate analysis revealed that ECOG ≥ 2 (HR: 2.094, p = 0.019), liver metastasis (HR: 2.039, p = 0.027), and each unit increase in SIRI (HR: 1.156, p < 0.001) were independent predictors of poorer OS. Patients with SIRI > 1.86 had significantly shorter OS compared to those with SIRI ≤ 1.86 (median OS: 4 vs. 9 months, p = 0.019). Conclusions: SIRI is an independent prognostic marker for survival in metastatic pancreatic cancer patients undergoing first-line and subsequent lines of chemotherapy. These inflammation-based markers are simple, cost-effective tools that could be integrated into routine clinical practice to aid in risk assessment and treatment planning. Full article

Human adenoviruses (HAdVs; genus Mastadenovirus, family Adenoviridae) are major etiologic agents of respiratory infections, exerting a disproportionately large impact on children. However, no long-term study to date has spanned pre- and post-pandemic periods in a Korean tertiary setting. Here, we retrospectively analyzed 23,284 nasopharyngeal swabs collected between 2007 and 2024 at a tertiary medical center in South Korea. Most specimens were obtained from inpatients and outpatients presenting with fever or respiratory symptoms for differential viral diagnosis. HAdV was detected using real-time PCR, and positivity rates were compared by year, season, and age group. Overall, 2043 tested positive for HAdV. Annual positivity peaked in 2010, 2013, and 2016, followed by a sharp decline during the coronavirus disease 2019 pandemic, reaching its lowest level in 2024. Positivity was higher in summer and spring than in winter. Children aged 1–5 years had the highest positivity, whereas adults and older adults showed markedly lower rates. The disproportionate burden among children underscores the need for targeted surveillance, school-based infection control, and region-specific preparedness strategies. These findings provide crucial long-term evidence into adenovirus circulation in the post-pandemic era and provides an evidence-based foundation for future public health policy and infection control planning. Full article

Background/Objectives: To identify independent predictors of free peritoneal cancer cells (FPCC), and to investigate survival outcomes relative to peritoneal cytology status among patients who underwent intended curative gastrectomy for adenocarcinoma of the stomach or esophagogastric junction. Methods: Medical records of patients who underwent radical surgery between January 2005 and December 2020 were retrospectively reviewed. Clinical data and cytology results were evaluated. Multivariate Cox regression analysis was used to identify independent predictors of FPCC. Kaplan–Meier survival analysis was used to estimate disease recurrence and survival outcomes. Results: Out of the 349 enrolled patients, 188 (53.8%) had negative cytology, 32 (9.2%) were positive, and 129 (36.9%) showed atypical cells in peritoneal cytology. Poor differentiation (adjusted odds ratio [aOR]: 2.63, 95% confidence interval [95%CI]: 1.04–6.82; p = 0.015), pT4 (aOR: 4.62, 95%CI: 1.28–14.34; p = 0.018), pN3 (aOR: 4.13, 95%CI: 1.14–15.03; p = 0.031), and metastatic lymph node ratio >0.40 (aOR: 6.49, 95%CI: 1.44–29.14; p = 0.015) were independent predictors of FPCC. Median overall survival was 34.1 months in the negative group, 13.1 months in the positive group, and 28.7 months in the atypical cell group (p < 0.001). Median time to disease recurrence was 20.5, 4.9, and 11.3 months, respectively (p < 0.001). Survival and recurrence outcomes in the atypical cell group were comparable to those with negative cytology. Conclusions: Poorly differentiated histology, pT4, pN3, and metastatic lymph node ratio >0.40 are independent predictors of FPCC, which is significantly associated with poor survival and disease recurrence outcomes. These findings suggest that high-risk patients may benefit from routine peritoneal cytologic screening during surgery to improve risk stratification and guide postoperative treatment planning. Full article

Background: Medical image segmentation is essential for accurate diagnosis and treatment planning. The U-Net architecture is widely regarded as the gold standard, yet its large size and high computational demand pose significant challenges for practical deployment. Methods: Real data (MRI images) from hospital patients were used in this study. We proposed a novel lightweight architecture tailored specifically for myocardium (cardiac muscle) segmentation. Results: We presented results comparable to state-of-the-art methods in terms of IoU and Dice coefficients. Nonetheless, the results achieved are much more favorable from the perspective of AI’s sustainable development. The proposed architecture ensured the following average results: IOU = 0.7889 and Dice = 0.8780 using 263 k parameters and a total of 6.24 G FLOPs. Conclusions: The proposed schema can potentially be used to support radiologists in improving the diagnostic process. The presented approach is efficient and fast. Most promisingly, the reduction in the model’s complexity is significant compared to the state-of-the-art methods. Full article

Objective: This study is designed to systematically assess the safety and efficacy profiles associated with varying procedural sequences of endovascular aortic repair (EVAR) and percutaneous coronary intervention (PCI) in clinical practice. Methods: We conducted a retrospective cohort analysis encompassing patients diagnosed with aortic aneurysm and concomitant coronary artery disease (CAD) who underwent EVAR at Beijing Anzhen Hospital, Capital Medical University, between January 2010 and December 2022, with planned staged (preoperative or postoperative) or simultaneous PCI. The cohort was stratified into three groups: PCI followed by EVAR, EVAR followed by PCI, and simultaneous EVAR and PCI. The primary endpoint was a composite of all-cause mortality, non-fatal myocardial infarction, cerebrovascular events, and aortic-related complications within 12 months post-intervention. Secondary endpoints included duration of hospital stay, total hospitalization costs, and incidence of in-hospital adverse events. Multivariate logistic regression analysis was employed to identify independent predictors of the primary endpoint. Results: The study cohort comprised 374 patients, with 209 (55.9%) undergoing PCI followed by EVAR, 133 (35.6%) receiving EVAR followed by PCI, and 32 (8.5%) undergoing simultaneous EVAR and PCI. Comparative analysis revealed no statistically significant differences in the incidence of in-hospital adverse events (p = 0.867) or the risk of primary endpoint events (p = 0.645) across the three treatment groups. Notably, the simultaneous treatment group demonstrated a significantly reduced total hospital stay (10.6 days) compared to the PCI followed by EVAR group (16.0 days) and the EVAR followed by PCI group (17.2 days) (p < 0.001), accompanied by lower hospitalization costs (p = 0.002). Conclusions: For patients with aortic aneurysm complicated by CAD requiring both EVAR and PCI, simultaneous intervention appears to be a safe and feasible therapeutic option. This approach significantly reduces hospital stay duration and associated costs without increasing the risk of in-hospital adverse events or compromising 12-month postoperative outcomes. However, this exploratory finding requires validation in large-scale randomized controlled trials. Full article

Background/Objectives: Qatar and other Gulf Cooperation Council (GCC) countries are experiencing a growing incidence of diet-related non-communicable diseases (NCDs). The lack of a culturally relevant food exchange list (FEL) for commonly consumed foods in Qatar and the GCC limits the application of cultural preferences in medical nutrition therapy (MNT) for managing diet-related NCDs, thereby reducing patient adherence and metabolic outcomes. Therefore, the primary objective of this study was to develop a culturally tailored FEL for 50 main course dishes widely consumed in the region. Methods: A four-phase approach was followed in this developmental study. First, common Qatari and GCC dishes were identified based on cultural practices and market availability. Second, nutrient composition was compiled from regional food composition tables and validated using dietary analysis software. Pearson correlation was conducted to compare macronutrient values, with significance set at p < 0.05. Third, standard serving sizes were determined using Wheeler et al.’s methodology and converted into household measures using a kitchen scale. Finally, we developed a macronutrient exchange list for the dishes based on the established Wheeler rounding-off criteria. Results: A culturally tailored FEL for 50 frequently consumed Qatari and GCC dishes was successfully developed. Significant correlations were observed between laboratory-derived and software-derived values for carbohydrates (r = 0.7) and protein (r = 0.9), with a weaker correlation for fat (r = 0.5). Macronutrient exchange analysis revealed substantial variation across dishes, with several carbohydrate-based dishes also contributing meaningful protein and fat exchanges. Findings indicated that visual assumptions about nutrient composition may not accurately reflect exchange values, highlighting the need for systematic analysis in diet planning. Conclusions: This study developed a novel culturally relevant FEL for commonly consumed composite dishes in Qatar and the GCC. The exchange list provides a practical tool for dietitians and healthcare professionals to support culturally tailored MNT and public health interventions in the region. It also serves as a valuable resource for researchers in nutritional epidemiology, enabling the analysis of dietary data by converting raw food intake information. Full article

Gerstmann syndrome (GS) is characterised by the tetrad of agraphia, acalculia, finger agnosia, and right-left disorientation, which was first described by Josef Gerstmann in 1924 and is conventionally linked to lesions of the dominant angular gyrus. Contemporary neuroimaging and lesion mapping research indicates that a more dispersed parietal and occipito-temporal network may be involved. Bilateral parietal lobe infarcts are uncommon and usually arise from embolic events or small artery pathology, frequently resulting in multifocal cognitive and perceptual impairments. A 52-year-old male presented with acute confusion, perseverative speech, and an inability to follow commands. The neurological examination indicated the presence of the complete Gerstmann tetrad. The Magnetic Resonance Imaging (MRI brain) revealed bilateral parieto-occipital infarcts, with greater severity on the left, indicative of ischaemia in the territory of the posterior cerebral artery (PCA). The medical team provided supportive care and implemented secondary stroke prevention, leading to partial neurocognitive recovery over a period of three weeks. This case highlights a rare presentation of Gerstmann syndrome due to bilateral parieto-occipital infarcts and emphasises that the syndrome can arise from bilateral or widespread parietal injury rather than lesions limited to the angular gyrus. The prompt identification of the Gerstmann constellation helps localise the lesion, enhances diagnostic accuracy, and aids in rehabilitation planning. 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

Copay accumulator (CA) and copay maximizer (CM) programs in the United States, which prevent manufacturer copay assistance from counting toward deductibles or out-of-pocket (OOP) maximums, are increasingly used, raising concerns about costs and outcomes for patients with major depressive disorder (MDD) or bipolar disorder (BPD) treated with branded atypical antipsychotics (AAPs) and/or antidepressants (ADs). This retrospective claims study used Kythera commercial data (2020–2024) in the United States to identify adults with MDD or BPD who had at least 1 diagnosis and one branded AAP or AD prescription between 2021 and 2023, requiring 12 months’ continuous enrollment pre- (2020–2021) and post-index (2023–2024) and at least three months of post-index branded medication use. This retrospective claims study used Kythera commercial data (2020–2024) to identify adults with MDD or BPD who had at least one diagnosis and one branded AAP or AD prescription between 2021 and 2023, requiring 12 months’ continuous enrollment pre- and post-index and at least 3 months of post-index branded medication use. Patients were stratified into CA, CM, or standard copay plan (SCP) cohorts, and propensity score matching was used to compare treatment patterns and costs. Both CA and CM groups had significantly higher median OOP costs than SCPs (e.g., $75/$60 vs. $16 for MDD+AAP; p < 0.0001), and higher pharmacy costs among adherent patients. CA patients had poorer adherence and persistence, shorter treatment duration, and higher discontinuation and abandonment rates than SCPs. These findings highlight higher OOP burden and adherence challenges with CA and CM programs, underscoring the need for careful benefit design for US mental health patients. Full article

Background/Objectives: People living with MND (plwMND) commonly develop difficulty swallowing and subsequent difficulty clearing saliva from the airway. Medical saliva interventions include pharmacological agents, botulinum toxin injections, and radiation to salivary glands, with associated side effects. Non-invasive behavioural strategies and natural remedies are also recommended. Saliva symptom management is guided by the multidisciplinary MND team (typically through a three-monthly clinic) alongside community clinicians. Some plwMND report difficulty recalling and implementing treatments between clinics. This study aimed to enhance the content and method of providing recommendations for self-management of saliva symptoms by (i) developing MND-specific resources and (ii) evaluating resource use and preliminary clinical benefit. Methods: In Phase 1 plwMND, caregivers, and clinicians co-designed saliva management resources. Phase 2 examined the use of these resources via a hospital-based MND clinic with 28 plwMND, their caregivers, and community clinicians. In the clinic, plwMND were given a written treatment plan and relevant resources. During reviews at weeks 2, 6, and 12 saliva treatment was adjusted and clinical outcomes evaluated using the Clinical Saliva Scale for MND (CSS-MND). Community clinicians, plwMND, and caregivers were surveyed regarding the resource utility. Results: People living with MND reported the resources assisted saliva symptom self-management. Community clinicians found the resources informative and beneficial in supporting patient care. All plwMND required multiple treatment strategies and adjustments to manage symptoms. Of the treatments prescribed, 91% were non-invasive and 9% were medical interventions. For 54% (n = 15) of plwMND, improved CSS-MND scores were sustained over the three-month evaluation. Conclusions: Co-designed saliva resources and regular reviews assisted plwMND to implement their individualised saliva treatment, to self-manage saliva symptoms between clinics. Full article

Oral cancer represents a life-threatening malignancy with profound implications for patient survival and quality of life. Oral squamous cell carcinoma (OSCC), the predominant histological variant of oral cancer, constitutes a substantial healthcare challenge wherein early detection remains critical for therapeutic efficacy and enhanced survival outcomes. Recent advances in deep learning methodologies have demonstrated superior performance in medical imaging applications. However, existing investigations have predominantly employed unimodal image data for oral lesion classification, thereby neglecting the potential advantages of multimodal data integration. To address this limitation, we propose a comprehensive multimodal pipeline for the classification of OSCC versus leukoplakia through the integration of histopathological imagery with tabular data encompassing anatomical characteristics and behavioral risk factors. Our methodology achieved a precision of 0.97, F1-score of 0.97, recall of 0.98, and accuracy of 0.97. These findings demonstrate the enhanced diagnostic precision and efficacy afforded by multimodal approaches in oral cancer classification, suggesting a promising avenue for improved diagnostic accuracy and treatment planning optimization. Full article

The integration of artificial intelligence (AI) is rapidly transforming the field of breast reconstruction, with applications spanning surgical planning, complication prediction, patient-reported outcome assessment, esthetic evaluation, and patient education. A comprehensive narrative review was performed to evaluate the integration of AI technologies in breast reconstruction, encompassing preoperative planning, intraoperative use, and postoperative care. Emerging evidence highlights AI’s growing utility across these domains. Machine learning algorithms can predict postoperative complications and patient-reported outcomes by leveraging clinical, surgical, and patient-specific factors. Neural networks provide objective assessments of breast esthetics following reconstruction, while large language models enhance patient education by guiding consultation questions and reinforcing in-clinic discussions with accessible medical information. As these tools continue to advance, their adoption in everyday practice is becoming increasingly relevant. Staying current with AI applications is essential for plastic surgeons, as AI is not only reshaping breast reconstruction today, but is also poised to become an integral component of routine clinical care. Full article