Search Results (17,382)

Background/Objectives: Acute myocardial infarction with ST-segment elevation (STEMI) remains a clinical condition with high mortality. The Ion Shift Index (ISI) and Naples Prognostic Score (NPS) are two prognostic indicators that have recently come to the fore. The aim of this study is to compare the predictive value of ISI and NPS in predicting in-hospital mortality in STEMI patients. Methods: This retrospective study included 214 STEMI patients (1 January 2022–1 January 2024). Exclusion criteria included active cancer, infection, autoimmune disease, or chronic kidney disease. ISI and NPS were calculated from laboratory results obtained from the emergency department at the time of initial presentation. Patients were categorized according to in-hospital survival. Logistic regression and ROC curve analyses were performed for in-hospital mortality. Results: The mean age of participants was 64.8 ± 11.2 years, and 40.2% were female; a total of 36 patients (16.8%) died during hospitalization. Hypertension and female gender were more common in those who died, and LDL cholesterol and inflammatory markers were higher. The ISI value was significantly increased in the mortality group, whereas no significant difference was observed in NPS. ROC analysis revealed that at a threshold value of 3.0, ISI had a sensitivity of 68% and specificity of 71%, with an area under the curve (AUC) of 0.70, while NPS had an AUC of 0.55 and did not demonstrate significant discriminatory power. In the multivariate analysis, ISI and increased LDL cholesterol were independently associated with mortality; decreased lymphocyte/monocyte ratio and female gender were also additional independent predictors. NPS did not emerge as an independent factor in predicting in-hospital mortality. Conclusions: ISI was found to be a superior and independent early risk predictor of in-hospital mortality in STEMI patients compared to NPS. ISI may serve as a rapid and inexpensive risk classification tool in the acute phase, as it reflects sudden changes in intracellular–extracellular ion balance, whereas NPS may not be sufficiently sensitive in the hyperacute phase, as its components reflect chronic nutritional and inflammatory states. Due to limitations such as a single-center retrospective design and low mortality rates, validation through multicenter prospective studies is required for the integration of ISI into clinical practice. Full article

Background: Telepsychiatry expanded rapidly during the COVID-19 pandemic, yet patient experience data from mixed urban and rural areas in Saudi Arabia remain scarce. Objective: We aimed to quantify the perception of telepsychiatry among adults with major depressive disorder [MDD] in Madinah City, the KSA, and to identify associated demographic and clinical factors. Methods: A cross-sectional survey was conducted at Madinah Mental Health Hospital between December 2024 and March 2025. Eligible participants were Arabic-speaking adults [≥18 years] with a clinician-confirmed diagnosis of major depressive disorder [MDD] according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5], following a scheduled video- or audio-based telepsychiatry consultation. Perception of telepsychiatry was assessed using the validated 10-item Arabic version of the Telehealth Satisfaction Scale [TeSS], which evaluates audiovisual quality, communication, and support. Variables associated with perception at p < 0.20 in the bivariable analyses were entered into a multiple linear regression model to identify independent predictors. Results: Of the 218 eligible patients, 207 participated [response rate = 95%], with similarly high participation rates being reported in comparable telepsychiatry surveys [e.g., 90–91%]. The majority were male [59%], with a mean [SD] age of 38.4 [11.2] years. The mean satisfaction score was 32.3 ± 6.3, and 36% of participants were classified as highly satisfied. In the multivariable analysis, higher satisfaction was independently associated with male gender [B = 3.0, 95% CI: 1.3–4.7], intermediate versus elementary education [B = 4.3, 95% CI: 1.1–7.6], and the presence of a chronic illness [B = 2.1, 95% CI: 0.3–3.8]. Conclusions: Telepsychiatry is generally well-accepted among adults with depression in Madinah. However, women and individuals with lower educational attainment report lower satisfaction. Targeted interventions such as improving privacy, offering digital literacy support, and tailoring communication may help improve the telepsychiatry experience for underserved groups. Full article

Background: Chronic obstructive pulmonary disease (COPD) is a progressive condition leading to declining lung function, dyspnea, and reduced quality of life. Pulmonary rehabilitation (PR) remains a cornerstone in COPD management; however, access remains limited, with less than 3% of eligible patients participating. Inspiratory muscle training (IMT), especially through novel methods like the Test of Incremental Respiratory Endurance (TIRE), offers a potential home-based alternative to traditional rehabilitation services. Despite growing interest, a key knowledge gap persists: few randomized trials have directly compared TIRE with threshold loading IMT over extended, largely unsupervised home-based periods while concurrently evaluating inspiratory muscle endurance and adherence. This randomized controlled trial aimed to evaluate the long-term efficacy of TIRE IMT compared to traditional threshold IMT and sham training in COPD patients. The study also assessed adherence to these home-based interventions, focusing on unsupervised periods without additional motivational support. Methods: A total of 52 COPD patients were randomly assigned to one of three groups: TIRE IMT, Threshold IMT, or Sham IMT. The study consisted of an 8-week supervised Phase I followed by a 24-week unsupervised Phase II. Training details: TIRE—session template set to 50% of the day’s maximal sustained effort; 6 levels × 6 inspirations (total 36) with preset inter-breath recoveries decreasing from 60 s to 10 s. Threshold IMT—spring-loaded valve set to 50% MIP (re-set at week 4); 36 inspirations completed within ≤30 min. Sham—valve set to minimal resistance (9 cmH₂O); 36 inspirations within ≤30 min. Primary outcomes included changes in maximal inspiratory pressure (MIP) and sustained maximal inspiratory pressure. Secondary outcomes focused on adherence rates and correlations with functional capacity. Results: Of the 52 participants, 36 completed the study. Participant details: TIRE n = 12 (mean age 60.9 ± 12.9 years), Threshold n = 12 (67.4 ± 6.9 years), Sham n = 12 (67.3 ± 8.7 years); overall 21/36 (58%) men; mean BMI 30.0 ± 7.5 kg/m². The TIRE IMT group demonstrated significantly greater improvements in MIP (31.7%) and SMIP compared to both the Threshold and Sham groups at 24 weeks (p < 0.05). Despite a decline in adherence during the unsupervised phase, the TIRE group maintained superior outcomes. No adverse events were reported during the intervention period. Conclusions: In this randomized trial, TIRE IMT was associated with greater improvements in inspiratory muscle performance than threshold and sham IMT. While adherence was higher in the TIRE group, it declined during the unsupervised phase. The clinical interpretation of these findings should consider the relatively wide confidence intervals and modest sample size. Nevertheless, the mean change in MIP in the TIRE arm exceeded a recently proposed minimal important difference for COPD, suggesting potential clinical relevance; however, no universally accepted minimal important difference exists yet for SMIP. Further adequately powered trials are warranted. Full article

Background: Minimally invasive direct coronary artery bypass (MIDCAB) surgery offers advantages over off-pump coronary artery bypass (OPCAB), including reduced trauma and faster recovery. However, differences in perioperative cardiac rehabilitation (CR) outcomes between MIDCAB and OPCAB remain unclear. This study compared perioperative clinical characteristics, surgical features, and CR outcomes in patients undergoing MIDCAB versus OPCAB. Methods: This retrospective cohort analysis included 304 patients (31.2% MIDCAB, 68.8% OPCAB) who participated in a CR program, including the 6-min walk test (6MWT), from November 2023 to December 2024. Results: MIDCAB patients had shorter surgery times, fewer grafted vessels, shorter ventilator-assisted time, less total intraoperative fluid, less bleeding, and shorter postoperative hospital stays (all p < 0.05). After cardiac rehabilitation, MIDCAB patients showed shorter time to 6MWT, longer six-minute walk distance (6MWD) (200 ± 125 vs. 178 ± 125 m), higher 6MWD relative to predicted values, and greater metabolic equivalents (all p < 0.05). The median LVEF of MIDCAB patients was the same as that of OPCAB patients (p < 0.05). Conclusions: Our study demonstrates that MIDCAB patients exhibit superior exercise capacity following cardiac rehabilitation. Full article

Background/Objectives: Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder frequently associated with other neuropsychiatric conditions, characterized by high clinical heterogeneity and a complex genetic background. Recent studies suggest that copy number variations (CNVs) may contribute to ADHD susceptibility, particularly when involving genes related to brain development, attention regulation, and impulse control. This study investigated the association between CNVs and ADHD phenotype by identifying patients with and without potential pathogenic CNVs. Methods: We evaluated 152 well-characterized ADHD pediatric patients through comprehensive clinical assessments, including dysmorphic features, brain MRI, EEG patterns, and cognitive testing. CNVs were identified using array Comparative Genomic Hybridization (array-CGH). Participants were classified as carrying potentially causative CNVs (PC-CNVs), non-causative CNVs (NC-CNVs), or without CNVs (W-CNVs) and statistically compared across clinical and neurodevelopmental measures. Results: CNVs were identified in 81 participants (53%), comprising 13 with PC-CNVs (8.5%) and 68 with NC-CNVs (44.7%). ADHD symptoms were pronounced across all groups, but PC-CNVs showed a higher burden of comorbidities, suggesting a stronger genetic contribution to ADHD complexity. Significant differences were observed in oppositional behavior, inattentive symptoms, brain MRI findings, and developmental language anomalies. Several CNVs involved genes previously implicated in neurodevelopmental disorders, supporting a potential genetic contribution to the clinical complexity of ADHD. Conclusions: This exploratory study supports the role of CNVs in ADHD susceptibility and highlights the value of genetic screening for understanding clinical variability. Larger studies are needed to clarify genotype–phenotype correlations in ADHD and to guide personalized clinical management. Full article

Background: Although several epidemiological studies have suggested a potential association between infections and Parkinson’s disease (PD), relatively few have specifically examined the relationship between upper respiratory tract infections (URIs) and PD, apart from coronavirus disease 2019 (COVID-19). Objectives: We investigated whether a history of URI was associated with the diagnosis of PD among Korean individuals aged ≥40 years, using data from the Korean National Health Insurance Service–Health Screening Cohort. Methods: A total of 5844 patients newly diagnosed with PD were identified and matched with 23,376 control participants at a 1:4 ratio based on age, sex, income, and geographical region. Conditional logistic regression analyses were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for PD, adjusting for potential confounders including smoking, alcohol consumption, body mass index, blood pressure, comorbidity scores, blood glucose, and serum cholesterol levels. Results: Overall, no significant association was found between a history of URI and PD when considering a two-year exposure window. However, in the one-year window analysis, individuals with a history of URI had a modestly reduced odds of PD (≥1, ≥2, or ≥3 episodes: (adjusted OR: 0.93, 95% CI: 0.88–0.97, aOR: 0.91, 95% CI: 0.87–0.96 and aOR: 0.92, 95% CI: 0.87–0.98, respectively). Subgroup analyses revealed that the inverse association was more pronounced among women, older adults (≥65 years), and those with higher comorbidity scores. No clear dose–response trend was observed across increasing frequencies of URI diagnoses. Conclusions: Our findings suggest that the apparent protective association between recent URI history and PD is unlikely to be causal and may instead reflect confounding by medication use or reverse causation related to the prodromal phase of PD. These results should therefore be interpreted with caution and regarded as hypothesis-generating. Further prospective studies incorporating detailed prescription data and long-term follow-up are warranted to clarify the role of infections and anti-inflammatory medications in the pathogenesis of PD. Full article

Background: Fetuin-A, a hepatokine implicated in metabolic regulation, has been associated with both metabolic syndrome and cardiovascular disease. However, its specific role in type 2 diabetes mellitus (T2DM) remains incompletely understood. Objective: This study aimed to investigate the relationship between fetuin-A levels and key components of metabolic syndrome (abdominal obesity, arterial hypertension, hyperglycemia, hypertriglyceridemia and low high-density lipoprotein cholesterol) as well as other cardiovascular risk markers, including metabolic dysfunction-associated fatty liver disease (MAFLD), carotid intima-media thickness (CIMT), and the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Methods: A total of 51 patients with T2DM not receiving insulin therapy were enrolled. Participants underwent clinical, biochemical, and imaging evaluations. Hepatic steatosis was assessed via abdominal ultrasonography, and subclinical atherosclerosis was evaluated using CIMT measured with Doppler ultrasonography. Serum fetuin-A was quantified by ELISA. Results: Hepatic steatosis was significantly associated with metabolic syndrome, increased CIMT, and dyslipidemia (elevated total cholesterol, triglycerides, and reduced HDL cholesterol). Although no direct correlation was found between fetuin-A levels and hepatic steatosis, multivariate analysis revealed that fetuin-A concentrations were significantly influenced by total cholesterol and LDL cholesterol levels. Conclusions: Fetuin-A appears to be linked to lipid abnormalities in T2DM and may contribute to cardiovascular risk in this population. These findings support the potential utility of fetuin-A as a biomarker and possible therapeutic target for dyslipidemia management in diabetic patients. Full article

Recognizing and understanding the nuances of mental health and how issues can present at various levels of healthcare for both patients and the interprofessional (IP) healthcare team can be crucial for the success and well-being of team members, as well as for achieving positive patient outcomes. Learners from various allied healthcare disciplines participated in a Case-Based Learning-Sequential Disclosure Activity (CBL-SDA) to address navigating appropriate approaches to fostering wellness in the clinical encounter and within healthcare teams from a multidisciplinary perspective. The CBL-SDA was delivered to a cohort of allied health students (N = 90) using a 4-step process during an interprofessional education (IPE) event of (i) Orientation, (ii) Sequential Disclosure, (iii) IPE Forum, (iv) Wrap-up. Pre- and post-activity surveys were voluntarily collected to gauge participants’ perceptions of the content and delivery method, with a response rate of 90% (N = 81). Overall, participants reported gaining confidence in their understanding of wellness, in identifying and providing support for a person struggling with wellness, in having tools to promote wellness, and also rated their own wellness higher, following the one-hour training session. It can be concluded that IPE activities highlighting wellness and mental health are beneficial and necessary in allied health care training. Full article

Background/Objectives: High-quality prognostic communication in pediatric oncology is essential to support informed decision making, foster trust, and honor goals of care. While families differ in their preferences for how prognosis is discussed, clinicians often rely on assumptions rather than directly eliciting these preferences, risking misalignment and distress. To address this gap, we aimed to characterize patient, parent, and oncologist perspectives on key variables, experiences, and circumstances that influence their preferences for prognostic communication. Methods: Semi-structured interviews were conducted with 85 participants (25 patients aged 12–25, 40 parents, and 20 oncologists) to elicit their preferences for prognostic communication and the reasons behind these preferences. Rapid analysis was conducted to generate themes and identify patterns and variances across participant cohorts. Results: Four distinct themes underpinning prognostic communication preferences were described by patients, parents, and oncologists: (1) personality, ideals, and values; (2) general life experiences; (3) prior interactions with the medical system; and (4) faith. Participants emphasized that personal identity and prior experiences significantly shaped how they wished to receive prognostic information. Clinicians and parents often linked preferences to core aspects of their professional or caregiver identities. Conclusions: Understanding the individualized factors shaping communication preferences can guide clinicians in tailoring prognostic discussions. Open-ended inquiry into identity, personal values, and past experiences can foster respectful, personalized communication in pediatric oncology. Further research is needed to determine best practices for prompting discussion about prognostic communication preferences that incorporates the reasons underpinning these preferences. Full article

Background: Evidence of the real-world management of dedifferentiated liposarcoma (DDLPS) is limited by the patient size and coding. The objective of this study is to generate consensus expert opinion on locally advanced or metastatic DDLPS diagnosis, treatment, and unmet needs. Methods: A three-round Delphi consensus panel was conducted with 9 DDLPS clinical experts from November to December 2023. Expert panelists were recruited across academic specialty and traditional settings and US regions. The Delphi panel included two rounds of surveys followed by a consensus building workshop. Surveys contained multiple-choice and free response questions, and statements for level of agreement rating. Panelists rated each statement for level of agreement on a 9-point Likert scale. Statements with ≥75% of scores ≥ 7 achieved consensus, and those that did not achieve consensus agreement were modified or removed from subsequent testing. A virtual workshop was held to discuss areas which did not achieve consensus and refine previously agreed upon statements. Results: In total 25 consensus statements were developed by the Delphi panel. Survey 1 achieved 7 consensus statements across the areas of burden, treatment, and unmet needs of DDLPS. Survey 2 generated an additional 10 consensus statements. During the workshop, eight more statements achieved consensus, and four statements were refined for enhanced clarity and precision. The study findings are limited by the number of Delphi panel participants and consensus statements may not be fully representative of clinician perspectives across the US. Conclusions: Consensus areas identified by the Delphi panel help better understand the decision factors for surgical and non-surgical treatments and anticipated utilization. These results could be used to inform both drug development programs as well as care delivery challenges for liposarcoma patients. Full article

Background: Work-Related Quality of Life (WRQoL) is an essential aspect of the sustainability of the healthcare workforce, intimately connected to employee well-being, job fulfillment, and the standard of patient care. This research sought to evaluate WRQoL among healthcare employees in Greek public hospitals, concentrating on the influence of demographic and work-related factors in a healthcare system affected by prolonged economic and public health crises. Methods: A cross-sectional study was conducted with 1022 staff members from 23 hospitals in the 1st Health Region of Attica, utilizing the validated Work-Related Quality of Life Scale (WRQoL). Data were analyzed using non-parametric tests, including Chi-square and Linear-by-Linear Association analyses. Results: The findings showed that 44.3% of employees experienced low WRQoL, with the lowest ratings found among younger workers, those on temporary contracts, and individuals working in pediatric hospitals. Holding a leadership position, being over 40 years old, and having a permanent job were linked to notably greater well-being and job satisfaction. A significant portion of participants viewed the working conditions and autonomy as insufficient, particularly in demanding institutional environments. Conclusions: These results emphasize the necessity for focused policy measures to enhance working conditions, guarantee job stability, and reinforce organizational support structures. Tackling structural shortcomings in the healthcare system is crucial for protecting workforce stability and the standard of public health services. Full article

Intracerebral hemorrhage (ICH) remains the least treatable form of stroke, with inflammation implicated as a major pathophysiological feature. Hence, this study sought to associate serum proteins and hormones associated with inflammation and ICH outcomes. Patients presenting to Duke University Hospital with computed tomography-verified spontaneous, supratentorial, non-traumatic ICH within 24 h of symptom onset were prospectively recruited. In this pilot study, equal numbers of men and women and Black and White individuals were included and matched by a 6-month modified Rankin Score (mRS). The primary analyses were the correlation of L-ratios (LR; Log2(Day 2/Day 1 concentrations)) of serum gonadal hormones and neuroinflammatory proteins with mRS > 3 at 6 months. A total of 40 participants were included in this pilot study. LRs were significantly higher for C-reactive protein (CRP; p = 0.013) and lower for interleukin-6 (IL-6; p = 0.026) and surfactant protein-D (p = 0.036) in participants with unfavorable outcomes at 6 months after ICH. Further, higher CRP (p = 0.02) and lower IL-6 (p = 0.035) and surfactant protein-D (p = 0.041) LRs were associated with mRS > 3 at 6 months after ICH in multiple logistic regression analyses, adjusted for race and sex. The relationship amongst gonadal hormones, neuroinflammatory proteins, and ICH outcome is complex. In this pilot study, unfavorable outcomes after ICH may have been associated with selected inflammatory biomarkers. A larger scale study is warranted to define interactions between hormones, proteins, and their effects on ICH outcomes. Full article

Background/Objectives: Advanced lung cancer is a highly distressing disease that negatively impacts older adults. Supportive care interventions designed for this population are scarce and often inaccessible due to competing demands and transportation access. We adapted and refined an evidence-based treatment, Self-System Therapy (SST), to address the unmet needs of older adults with advanced cancer. Methods: Guided by principles of implementation science, we conducted patient interviews, focus groups, and user testing to refine our new SST for the lung cancer (SST-LC) protocol. We then conducted a single-arm pilot trial (clinicaltrials.gov NCT04057196) for patients aged 65+ and above with Stage III or IV lung cancer (N = 30). Benchmarks for acceptability, feasibility, and preliminary changes in outcome measures were assessed. Results: Our study met the desired recruitment goals and demonstrated high treatment adherence rates (89%) and satisfaction rates (85%), indicating that SST-LC was feasible and well-received. Participants also showed reductions in distress and depression, and improvements in emotional and functional well-being from baseline to post-intervention, with effects mostly maintained at follow-up. Physical well-being, social well-being, and quality of life showed smaller, non-significant changes. Feedback from participants also suggested that SST enhanced their resilience and ability to cope with cancer-related challenges, but also indicated a preference for fewer sessions. Conclusions: SST for older adults living with advanced lung cancer is feasible and acceptable. Moreover, this supportive care intervention shows promise in addressing psychological distress, emotional well-being, and functional well-being in older adults. Future research will include testing the efficacy of SST in a larger randomized controlled trial. Full article

Background and Objective: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by widespread inflammation and multisystem involvement, leading to substantial morbidity. Given the immunomodulatory role of vitamin D and its association with disease activity in SLE, supplementation has emerged as a potential therapeutic strategy. However, findings across individual studies remain inconsistent, underscoring the need for a systematic review and meta-analysis to synthesize the current evidence on vitamin D supplementation for this disease. Thus, this study aimed to conduct a systematic review and meta-analysis on the effects of vitamin D supplementation on disease activity among patients with SLE. Methods: Systematic searches were carried out in four electronic databases (PubMed, Scopus, Web of Science, and Science Direct) with only studies published after 2013 as a restriction for the search strategy. An assessment of the included studies was conducted according to the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions, using the risk of bias assessment tool in Review Manager (Revman) version 5.3. Included studies were randomized trials with vitamin D supplementation in patients with SLE and with pre–post intervention measures of disease activity. Meta-analyses were performed using random-effects models to estimate mean differences with 95% confidence intervals (CIs). Heterogeneity was evaluated using the I² test, and sensitivity analysis and publication bias assessment were also performed. Results: A total of 186 articles were retrieved, of which 21 studies met the inclusion criteria. These studies had a combined sample size of 3177 adult participants and were conducted across 16 different countries. Regarding the impact of vitamin D supplementation on SLE patients, twelve (n = 12) studies reported positive associations, including reduced disease activity and improvements in clinical and laboratory parameters such as inflammatory markers, fatigue, and bone mineral density. In contrast, nine (n = 9) studies found no significant effects. In terms of meta-analytical data, our results indicate that, at the end of the supplementation, participants with vitamin D supplementation had significantly higher serum vitamin D levels compared to participants that receive a placebo (MD: 13.11 ng/mL; 95% CI: 8 to 19; p < 0.00001) despite comparable values before the onset of the supplementation. In addition, participants with vitamin D supplementation had lower scores in the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) compared to participants who received a placebo (MD: −1; 95% CI: −2 to −0.43; p = 0.002) despite comparable values before the onset of the supplementation. Conclusions: Our systematic review and meta-analysis suggest that vitamin D supplementation leads to a statistically significant reduction in SLEDAI scores, reflecting a meaningful decrease in disease activity. Given its immunomodulatory effects and favorable safety profile, vitamin D supplementation represents a simple and accessible adjunctive strategy that could support SLE management and improve patient outcomes in clinical practice. Full article

Background: Pharmacy professionals have an important role in delivering patient-centred care, with effective communication skills forming the foundation of interactions with patients. This study aimed to explore how pharmacy students perceived their own communication skills; along with the communication skills education and training experiences in their undergraduate pharmacy degree in the UK. Methods: A 22-item questionnaire was designed and piloted before being distributed online. Snowball sampling was employed to recruit participants undertaking an undergraduate pharmacy degree. Quantitative statistical and qualitative thematic analysis was conducted. Results: A range of pharmacy schools were represented in the data set (n = 10) with 217 responses collected. Participants rated their communication skills highly (53.03%, n = 114), but stated they still required improvement (79.72%, n = 173). A proportion of participants stated that they could appropriately make professional decisions (52.08%, n = 100) and that their communication skills had facilitated their professional decision-making skills (57.89%, n = 110). Effective teaching methods reported included role play with peers (80%, n = 156) and small-group teaching sessions (64.10%, n = 125). Participants felt that interprofessional education and simulated patients could help improve their communication skills further. Conclusions: Communication education is a crucial element in developing future healthcare professionals. Thus, investment in resources is required to facilitate communication skills in the earlier stages of the undergraduate pharmacy degree. Full article