Research on vision-language models (VLMs) in the medical field has recently increased. However, while multifaceted evaluation is necessary to avoid the high risks associated with misdiagnosis, artificial intelligence (AI)-assisted mammogram report generation remains insufficient, with no studies on objective and subjective generation. We aimed to develop an AI system that generates mammogram reports and to verify the impact of differences between objective and subjective evaluation methods on the interpretation of this AI system. We used a public dataset consisting of mammograms and their reports, preparing question prompts and performing low-rank adaptation tuning on Qwen2.5(7B). We analyzed the Breast Imaging Reporting and Data System (BI-RADS) and findings agreement rate, Recall-Oriented Understudy for Gisting Evaluation (ROUGE), and Bilingual Evaluation Understudy (BLEU) for the objective evaluation. A breast clinician performed score-based evaluations of generated reports as subjective assessments. Finally, we analyzed samples of inconsistent objective and subjective results. The BI-RADS agreement rate was 58.1%. Findings were accurately included in generated reports at 76.7% for mass and 81.4% for calcification. ROUGE-L F1 and overall BLEU were 0.672 and 0.542, respectively. Although ROUGE-L F1 or overall BLEU was above average, two samples received low scores in the generated report evaluation; these were considered over- and under-estimation. We developed an AI model that generates mammogram reports. In assessing this model, we found that multifaceted objective and subjective medical VLM evaluations are necessary for determining over- and under-estimation.
Spiritual care is a fundamental yet often under-addressed component of holistic nursing, with nurses and nursing students globally reporting limited competency. Traditional education models face challenges in accessibility, scalability, and pedagogical depth. While digital technologies offer transformative potential for learning, the evidence regarding their application and effectiveness in spiritual care education remains fragmented and insufficiently synthesized. This scoping review aims to systematically map the existing literature on the use of digital technologies in spiritual care education and training specifically for nurses and nursing students. The review will be conducted following the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported per the PRISMA-ScR guidelines. A comprehensive search will be performed across multiple databases (e.g., MEDLINE, CINAHL, PsycINFO, Web of Science, Scopus, CNKI, WanFang) from inception, supplemented by grey literature searches. Two independent reviewers will screen records, select studies, and extract data using a standardized form. We will include empirical studies focusing on digital interventions (e.g., online courses, mobile apps, virtual simulations) designed to develop spiritual care competency in the target population. Data will be analyzed using descriptive statistics and thematic analysis. The review will generate a comprehensive map and classification of existing digital spiritual education interventions, detailing their technological characteristics, pedagogical strategies, outcome measures, and implementation facilitators and barriers. It is expected to identify key evidence gaps and inconsistencies in the field. For example, we anticipate identifying virtual simulation, online modules, and mobile apps as the most common categories. This will be the first scoping review to systematically consolidate evidence on digital spiritual education for nurses. The findings will provide a foundational resource to inform the future design, implementation, and evaluation of theoretically grounded, effective, and scalable digital training models, ultimately aiming to enhance spiritual care competence in nursing practice. OSF registration number: https://doi.org/10.17605/OSF.IO/7VNHF.
This scoping review maps the literature on public involvement in pre-registration nursing education, focusing on educational activities and the explicit theories, frameworks or models used to inform or justify these activities to support educational practice. Public involvement is an established and expanding feature of pre-registration nursing education. However, there is limited clarity regarding the range of activities currently undertaken and the extent to which these are informed by theories, frameworks or models. A scoping review. A systematic search was conducted in CINAHL Ultimate, Medline, Scopus, ERIC, PsychINFO, Emcare, Australian Education Index and ProQuest Dissertations. The review followed the principles of the Joanna Briggs Institute methodology, the PRISMA-ScR checklist and guidance on artificial intelligence use in evidence synthesis. The review included 144 sources with diverse methodologies and geographical origins. A wide range of public involvement activities were identified, most commonly direct involvement in educational activities such as storytelling, teaching and developing materials. Few sources provided detailed descriptions of activities, learning outcomes, evaluation mechanisms or required resources. Only a small number of sources explicitly used theories, frameworks, or models to justify involvement or inform their educational design, although many referenced broader conceptual or policy drivers. Public involvement in pre-registration nursing education encompasses diverse activities with varied conceptual underpinnings. Greater transparency in reporting, including clearer descriptions of activities and their evaluation, is needed to strengthen the evidence base, support practice and empower stakeholders.
Invasive coronary angiography (ICA) is the reference standard for diagnosing coronary artery disease and guiding percutaneous coronary intervention, yet clinical interpretation relies largely on visual assessment, which is variable and often requires additional invasive testing to assess functional significance. Artificial intelligence (AI)-based analysis of ICA images has emerged as a potential solution to automate interpretation, improve reproducibility, and extract anatomical and physiological information directly from angiograms. We conducted a systematic review of AI applications for ICA image analysis, registered in PROSPERO and reported according to PRISMA guidelines. A total of 134 studies were included, covering tasks across the ICA workflow, including automated frame selection, vessel segmentation, lesion detection and quantification, prediction of invasive physiological indices, coronary anatomy labelling, image registration and reconstruction, outcome prediction and left ventricular function estimation. Most studies focused on vessel segmentation and lesion assessment, generally demonstrating high internal performance but marked heterogeneity in datasets, reference standards, evaluation metrics, and validation strategies. While earlier work relied predominantly on single-centre retrospective validation, more recent studies increasingly incorporate multi-centre data, external validation and prospective evaluation. AI-based prediction of invasive physiological indices appears particularly promising for reducing reliance on wire-based measurements, though robust prospective evaluation remains limited. Overall, AI-based ICA analysis has progressed from technical feasibility studies towards clinically oriented applications. However, challenges in generalizability, methodological standardization, and workflow integration must be addressed to enable reliable clinical adoption.
A supernumerary kidney is an extremely rare congenital anomaly of the genitourinary tract characterized by the presence of an accessory kidney with a separate capsule, vascular supply, and collecting system. It may be an isolated anomaly or associated with other congenital anomalies of the genitourinary tract. The fusion of a supernumerary kidney in a horseshoe configuration is a very rare developmental anomaly with few cases reported in the literature. Clinical presentation varies from incidental finding to abdominal pain, urinary tract infection, hydronephrosis, nephrolithiasis, or other complications. We report the case of a 26-year-old man in whom multimodality imaging was performed for renal evaluation in view of increased frequency of micturition. Initial ultrasonography and Doppler evaluation demonstrated anomalous renal morphology with preserved corticomedullary differentiation and no evidence of hemodynamically significant renal artery stenosis. Cross-sectional imaging further delineated the abnormal renal anatomy, confirming the presence of an accessory renal moiety with a fusion anomaly. Renal function and urinary drainage were preserved. No evidence of hydronephrosis or obstructive changes were seen. This case highlights the importance of multimodality imaging in characterizing rare congenital renal anomalies, differentiating a supernumerary kidney from more common anomalies such as duplex kidney or horseshoe kidney, and facilitating accurate diagnosis for clinical management. We also review the embryological basis, imaging characteristics, associated anomalies, and previously reported literature.
Multifocal nodular oncocytic hyperplasia (MNOH) of the salivary glands is a rare benign condition that can mimic both benign and malignant neoplasms, posing significant diagnostic challenges. Its bilateral and multifocal presentation is exceptionally uncommon. We present a unique case initially interpreted as bilateral Warthin tumor, later redefined as bilateral acinic cell carcinoma and finally reclassified as MNOH after comprehensive histopathological and immunohistochemical evaluation, and review the literature. A 71-year-old woman presented with a long-standing mass in the left mandibular angle region. Fine-needle aspiration was compatible with Warthin tumor. MRI revealed a well-defined, partially cystic, enhancing lesion in the left parotid gland and a similar nodule in the contralateral gland. A left parotid tumorectomy with synchronous submandibular nodule excision was performed, both initially reported as acinic cell carcinoma (DOG1 positive). Subsequent left total parotidectomy showed multifocal acinic cell carcinoma, with negative FISH for CRTC1/MAML2, ruling out mucoacinar carcinoma. Contralateral MRI revealed multiple nodules with perfusion curves suggestive of Warthin tumor. Right parotidectomy revealed multifocal oncocytic hyperplasia with oncocytomas and extensive clear cell change. Immunohistochemistry demonstrated DOG1 apical positivity, but focal p63 expression and SOX10 negativity favored oncocytic hyperplasia/oncocytoma. Clinicopathologic correlation confirmed the diagnosis of bilateral MNOH. This case illustrates the pitfalls in diagnosing oncocytic lesions, where radiology, cytology, and even immunohistochemistry may mimic acinic cell carcinoma. The review of published cases confirms the rarity of bilateral MNOH and highlights the importance of correlating morphology, immunoprofiles, and clinical context. MNOH should be considered in the differential diagnosis of bilateral parotid lesions to avoid overtreatment. Recognition of its histological spectrum, including clear cell and oncocytoma-like features, is essential for accurate diagnosis.
Community-based interventions (CBIs) are widely used to address behavioral risk factors for non-communicable diseases, yet evidence of their effectiveness in low- and middle-income countries (LMICs) remains limited. This study systematically reviewed evidence on the effectiveness of CBIs promoting physical activity (PA) and/or reducing sedentary behavior (SB) among community-dwelling adults in LMICs. We searched PubMed, Embase, Scopus, and the Cochrane Library (2000-2024) for CBIs in LMICs. Primary outcomes were changes in PA and/or SB. Descriptive and graphical depictions were used to draw inferences. We selected 24 studies (11 RCTs) from 15,396 for review. Most studies (n = 16) reported significant improvements in PA outcomes. Changes were observed in Metabolic Equivalents (+ 100 - +2,700), moderate-to-vigorous PA (+ 7 to + 60 min/week), and steps/day (+ 3,000). Broadly, interventions were delivered using digital/technology format (n = 10), peer-led/community health worker-facilitated (n = 8), and Environmental restructuring (n = 6), with the digital interventions depicting the most consistent significant improvements. Two studies directly measured SB as a primary outcome. Short- (≤ 6 months; n = 11) and medium-duration (6-12 months; n = 4) interventions more frequently reported significant PA improvements than long-duration interventions (> 12 months; n = 9). PA/SB-focused CBI demonstrated proportions of significant effects similar to those of broader lifestyle interventions (88.9% and 53.3%, respectively). CBIs can be effective in improving PA in LMICs, although evidence is heterogeneous and SB is less addressed. Digital interventions show more consistent positive signals, but high heterogeneity in studies precludes firm conclusions. The impact of duration on effectiveness looks counterintuitive but underscores the need for more rigorous evaluation of longer-duration interventions and SB outcomes. PROSPERO registration number: CRD42024579461.
Extended embryo culture beyond Day-6 remains controversial. While a small subset of embryos reaches the blastocyst stage on Day-7, their developmental competence and reproductive potential remain uncertain. Data from previous studies have been limited and heterogeneous, particularly for meta-analytical evaluation of euploid embryo transfers. This systematic review and meta-analysis compared clinical pregnancy (CPR) and live birth rates (LBR), as well as implantation (IR), miscarriage (MR), and ongoing pregnancy rates (OPR), between Day-7 frozen blastocysts and those obtained on Day-5 and/or Day-6. Euploidy rates by day of blastocyst development and available perinatal outcomes were also assessed. Conducted according to PRISMA guidelines, this review included full-length English-language human studies, published up to 1 April 2026, comparing frozen transfers of Day-7 versus Day-5/6 blastocysts and reporting at least clinical pregnancy and/or live birth outcomes. Random-effects models were used to estimate pooled odds ratios (ORs) with 95% confidence intervals (95% CI). Obstetric and perinatal outcomes were analysed when available. A total of 17 retrospective studies were included. Across 2908 Day-7 transfers, CPR and LBR were significantly lower than for Day-5 (CPR: OR 0.26, 95% CI 0.19-0.35, I2: 76.2%, 16 studies, 2799 and 34 442 transfers at Day-7 and Day-5, respectively; LBR: OR 0.23, 95% CI 0.16-0.33, I2: 76.3%, 12 studies, 2687 and 31 630 transfers at Day-7 and Day-5, respectively) and Day-6 blastocysts (CPR: OR 0.38, 95% CI 0.31-0.48, I2: 54.4%, 16 studies, 2799 and 28 563 transfers at Day-7 and Day-6, respectively; LBR: OR 0.37, 95% CI 0.28-0.49, I2: 60.2%, 12 studies, 2687 and 26 687 transfers at Day-7 and Day-6, respectively). Similarly, IR and OPR were significantly lower in the Day-7 group than in the Day-5 or Day-6 groups, while MR was higher compared with Day-5 blastocysts (OR 1.54, 95% CI 1.04-2.30, I2: 51.1%, 14 studies, 685 and 18 609 pregnancies at Day-7 and Day-5, respectively). When considering only PGT-A euploid blastocysts, CPR and LBR remained significantly lower in the Day-7 group compared with Day-5 (CPR: OR 0.21, 95% CI 0.14-0.33, I2: 58.0%, 7 studies, 365 and 7064 transfers at Day-7 and Day-5, respectively; LBR: OR 0.21, 95% CI 0.17-0.28, I2: 0%, 6 studies, 364 and 5924 transfers at Day-7 and Day-5, respectively) and Day-6 (CPR: OR 0.36, 95% CI 0.28-0.46, I2: 40.8%, 7 studies, 365 and 4617 transfers at Day-7 and Day-6, respectively; LBR: OR 0.36, 95% CI 0.28-0.46, I2: 0%, 6 studies, 364 and 3782 transfers at Day-7 and Day-6, respectively), and MR was higher than Day-5 (OR 2.78, 95% CI 1.57-4.89, I2: 32.4%, 6 studies, 95 and 4018 pregnancies at Day-7 and Day-5, respectively). Euploid rates were also significantly reduced for Day-7 blastocysts compared with Day-5 and Day-6. Data on perinatal outcomes were limited but overall reassuring. The pooled analyses revealed low to high heterogeneity across studies. Despite lower success rates, including for euploid embryos, Day-7 blastocysts may still contribute to cumulative live birth rates, notably in poor-prognosis patients. Prospective studies are needed to better assess perinatal and long-term outcomes. PROSPERO (CRD420251114251).
This tutorial provides an overview of the steps involved in conducting rapid reviews of interventions based on recent methodological guidance and empirical studies from the Cochrane Rapid Reviews Methods Group (RRMG). This tutorial provides practical guidance on methods, key decisions, and strategies to optimize the balance between timeliness and rigor and is intended as a practical introduction for researchers, clinicians, and policymakers interested in conducting or using rapid reviews.
to map educational technologies developed and applied in health education for people with disabilities. scope review based on the recommendations JBI, using the following inclusion criteria: addressing the topic under study; text available in full and written or translated into Portuguese, English, and/or Spanish. Four information sources and grey literature were consulted, in January 2024. the review covered eight studies, that addressed experiences with planning, construction, evaluation, and validation of technologies aimed at the health education process for people with disabilities and the professionals involved in their care. educational technologies in health for people with disabilities constitute tools for promoting inclusion and autonomy. The predominance of methodological studies reveals gaps in effectiveness analysis and the need for more robust and diversified research.
Drug-Induced Sleep Endoscopy (DISE) is increasingly used to evaluate upper airway dynamics in obstructive sleep apnea patients (OSA). It enables real-time visualization of collapse and may support treatment selection; however, its true clinical impact and limitations remain controversial. This study aims to summarize the current evidence regarding the real role of DISE in OSA management. A structured literature review of the literature was conducted, focusing on key aspects of DISE, including its diagnostic utility, comparison with awake endoscopy, pharmacological agents used, effects on sleep architecture and muscle tone, the role of bispectral index, indications and contraindications, relevance in hypoglossal nerve stimulation selection, and its impact on surgical outcomes. DISE provides dynamic assessment of upper airway collapse, facilitating anatomical diagnosis and treatment personalization. It is useful in complex cases, treatment failures, and candidate selection for HNS. Commonly used agents -propofol, midazolam, and dexmedetomidine- differ in their effects on sleep architecture and muscle tone, none fully reproducing natural sleep. Importantly, current evidence shows no consistent improvement in surgical outcomes when DISE is used compared with awake evaluation alone. Additionally, variability in protocols and interpretation limits reproducibility. DISE is a valuable complementary tool for anatomical localization of upper airway collapse and treatment planning in OSA. However, it cannot replace polysomnography as the diagnostic gold standard and should be interpreted within a comprehensive clinical context. Further standardization and high-quality studies are needed to better define its role and optimize its clinical utility.
Access to dermatologic care remains a persistent challenge in the United States, particularly in rural and underserved areas. Delays in dermatologic evaluation and treatment are compounded by provider shortages, long wait times, and geographic barriers. Emerging tools such as artificial intelligence (AI), AI-assisted triage, and teledermatology platforms might offer scalable solutions to improve access and reduce delays. This article evaluates whether AI-assisted technology, compared to traditional in-person dermatology care, shortens wait times to less than 30 days for patients living in provider shortage areas. A systematic review was conducted between March and June 2025 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and academic library databases were queried using the following Boolean queries: "Artificial intelligence triage dermatology" and "dermatology AND access AND teledermatology AND care AND wait times." Studies were screened for relevance, and 41 met the inclusion criteria. A narrative synthesis was used due to heterogeneity in study designs and outcome measures. Each study was appraised using the Joanna Briggs Institute (JBI) critical appraisal tools. Included studies demonstrated that AI-assisted technologies, particularly when integrated into teledermatology systems, significantly reduced dermatology wait times, often to fewer than 30 days. Store-and-forward platforms enabled expedited triage, while AI-supported decision tools improved diagnostic accuracy (85-97% sensitivity) and reduced unnecessary referrals. Task shifting to nonspecialist providers with AI support was found to be safe and effective. Despite promising outcomes, concerns related to image quality, algorithmic bias, and uneven implementation remain. AI-assisted dermatologic tools show strong potential to improve access to care and reduce wait times in provider shortage areas. These technologies could support timely diagnosis, streamline referrals, and enable safe task shifting to primary care teams. Importantly, findings highlight the role of nurse practitioners (NPs), particularly those with limited dermatology training, in leveraging AI as both an educational and clinical decision support tool. By providing differential diagnoses, confidence scores, and visual explanations, AI can strengthen NP diagnostic confidence, reduce unnecessary referrals, and expand access to timely dermatologic care in underserved settings. Future research should focus on implementation in resource-limited settings, nurse-led AI triage models, and long-term health outcomes.
To evaluate contrast-enhanced ultrasound (CEUS) for endoleak detection after endovascular aneurysm repair (EVAR) against CT angiography (CTA) or CTA-centered composite references, explicitly treating CTA as an imperfect reference standard. We searched PubMed/MEDLINE, Europe PMC, Crossref, OpenAlex, and performed an institutional Embase/Scopus coverage audit through 13 May 2026, with citation checking from prior reviews and included-study bibliographies. Eligible studies included adults undergoing paired CEUS and CTA or CTA-centered reference imaging after EVAR. The primary estimand was apparent CEUS diagnostic performance for any endoleak at the paired-examination level. An approximate bivariate logit-normal random-effects model was used as the primary meta-analysis; separate logit random-effects models, leave-one-out analysis, source-basis sensitivity analysis, and paired discordance testing were prespecified support analyses. Eighteen all-endoleak studies contributed 2064 participants and 2452 paired examinations. The bivariate model estimated CEUS sensitivity as 0.905 (95% CI 0.869-0.932) and specificity as 0.943 (95% CI 0.890-0.971). Separate logit random-effects estimates were similar: sensitivity 0.909 (95% CI 0.873-0.936; I2 = 42.5%) and specificity 0.944 (95% CI 0.892-0.972; I2 = 88.7%). Results were consistent in ≤ 30-day and CTA-only subsets. CEUS-positive/reference-negative discordance exceeded CEUS-negative/reference-positive discordance (116 vs 67; ratio 1.73; p = 0.00036). CEUS shows high apparent diagnostic performance for post-EVAR endoleak detection against CTA-centered references, with sensitivity and specificity both approximately 91-94%. CEUS-positive/reference-negative discordance was more frequent than the reverse and may represent low-flow or delayed endoleaks not captured by CTA-centered reference imaging in some cases. However, substantial specificity heterogeneity and CTA-reference limitations argue against unqualified CTA replacement. CEUS is best supported as a CTA-sparing surveillance and adjudication tool in selected pathways, with CTA retained for baseline structural assessment, graft evaluation, procedural planning, and discordant or high-risk findings.
ObjectiveThe objective of this review is to consolidate the role of native and recombinant spider silk in drug delivery systems. It aims to classify and compare their performance with natural and synthetic polymers, and emphasises their potential biomedical applications. It also evaluates the limitations and technical challenges, while offering perspectives on future directions to advance the clinical practices of spider silk-based drug delivery systems.SignificanceSpider silk offers biocompatibility, biodegradability, high mechanical strength, low immunogenicity and stability, making it an outstanding candidate for an advanced drug delivery system. Its unique ability to self-assemble into nanoparticles, hydrogels and films allows for encapsulation of various drugs.Key findingsThis review highlights that recombinant silk proteins possess unique properties that make them superior to many natural and synthetic polymers for drug delivery. Recombinant production technologies allow precise control over amino acid sequences, enabling modification for targeted and sustained delivery. In drug delivery, recombinant spider silk-based systems have exhibited promise in cancer therapy, regenerative medicine, including wound healing in tissue engineering, and serving as carriers.ConclusionRecombinant spider silk protein represents a versatile and biocompatible platform for advanced drug delivery systems. Although challenges in scalability and clinical translation exist, advances in engineering emphasise spider silk as a next-generation drug delivery biomaterial.
Anal squamous cell carcinoma (SCC) is a rare cancer. Metastatic anal SCC is still a significant clinical challenge due to limited treatment options and poor outcomes. This review paper will focus on retifanlimab, a humanized monoclonal antibody targeting the programmed cell death protein 1 (PD-1) pathway, and its role in the treatment of metastatic anal SCC, both as monotherapy or in combination with chemotherapy. This review will evaluate its efficacy, safety, and place within the current therapeutic landscape. The POD1UM-303 trial is the first randomized phase III study for patients with metastatic and locally, advanced unresectable anal SCC. The results from POD1UM-303 are practice-changing, establishing retifanlimab in combination with carboplatin and paclitaxel as a new standard of care for first-line treatment in this setting. Current research includes investigating earlier integration of PD-(L)1 inhibitors with definitive chemoradiotherapy in the locally advanced setting. Further biomarker-driven studies are essential to guide treatment and improve patient selection.
Synovial sarcoma is a mesenchymal malignancy that most commonly arises in the lower extremities. Fewer than 5% of cases originate in the head and neck, and laryngeal involvement is exceptionally rare. A 22-year-old man presented with a 6-month history of progressive hoarseness and hemoptysis. Direct laryngoscopy was performed, and biopsies were obtained. Histopathological examination established the diagnosis of laryngeal synovial sarcoma. The patient received three cycles of neoadjuvant chemotherapy, followed by total laryngectomy with bilateral neck dissection. Adjuvant radiotherapy was initiated postoperatively, and the patient remained recurrence-free at 12 months of follow-up. Fewer than 5% of synovial sarcomas occur in the head and neck, and laryngeal involvement is rare. Three histopathological subtypes are recognized: monophasic, biphasic, and poorly differentiated. Immunohistochemistry and detection of the t(X; 18) translocation play a key role in diagnosis. Surgical resection remains the mainstay of treatment, although chemoradiotherapy may also be beneficial. Recurrence is a major concern, with local recurrence reported in up to 45% of patients and distant metastasis in approximately 33%. Because laryngeal synovial sarcoma is rare, reporting such cases may improve future diagnosis, evaluation, and management of this uncommon entity.
Clinical guidelines serve as summaries of available treatment options, often coupled with specific recommendations related to treatment selection, and have benefits and limitations. Guidelines often influence how individual clinicians and/or third-party payors select treatments for patients. This expert position article reviews the intent of treatment guidelines, discusses guidelines for topical psoriasis therapies, and provides recommendations for guideline updates. The recommended approaches discussed in this article by the authors align directly with therapy selection made when clinicians incorporate shared decision-making with the individual patient. A comprehensive literature search of PubMed, Scopus, and Google Scholar was completed on May 20, 2025, using a combination of keywords "psoriasis," "topical," "treatments," "adverse effects," and "clinical guidelines" along with Boolean term "AND" for English-language original research articles, systematic reviews, narrative reviews, and meta-analyses without date restrictions. The expert position presented by the authors is limited to a discussion of topical therapies for psoriasis. Clinical guidelines are developed with the overall intent of enhancing healthcare quality; however, they are not designed to constrain or supplant the clinician's decisions in determining a suitable treatment for an individual patient. Limitations of published guidelines include susceptibility to becoming outdated, lack of individualized care, variability in development, and incomplete reflection of evolving practice patterns or individual patient circumstances. The results of this review of clinical guidelines reflect the authors' conclusions from analysis of the published data, including the evaluation of how they may influence treatment selection for psoriasis by clinicians. Regarding topical psoriasis treatment, initial therapy should be supported by Food and Drug Administration (FDA) approval and labeling. These include topical roflumilast, tapinarof, topical corticosteroids, and vitamin D analogs in the same category, with no utilization management criteria dictating order of use. The results of this review are limited by the inability to include literature that was not present in the databases queried. As this review is based on previously published data, there is potential for reporting and publication bias. This expert position paper encourages decision-makers to work with clinicians in providing individualized, accessible care, rather than relying solely on treatment guidelines to establish utilization management protocols. It is crucial that clinical guidelines evolve in a timely manner to reflect new therapeutic developments. Following FDA-approved indications, step-through requirements for any topical psoriasis therapy need to be abandoned, as this results in delays in treatment for the patient, unnecessary healthcare costs, and wasted use of healthcare resources.
Young adults aged 18-25 in rural communities face barriers to accessing sexual and reproductive health (SRH) information, including provider shortages, clinic closures, and privacy concerns in close-knit communities. When clinical care is inaccessible, many turn to online sources of varying quality, where one analysis found that roughly 40% of birth-control video content was inaccurate or misleading. AI-enabled conversational health tools (chatbots) offer a potentially scalable, private approach to delivering SRH information; however, their implementation in rural communities may be limited by low institutional trust, privacy concerns, and the underrepresentation of rural users in AI development. SARHAchat is an AI-enabled SRH conversational health prototype developed through prior work; this protocol describes a funded study to co-design and evaluate it with rural young adults, treating trust as a design input rather than a post-deployment outcome. This study aims to (1) identify multilevel determinants of trust and acceptability related to AI-enabled conversational health tools among rural pregnant-capable individuals aged 18-25 in North and South Carolina; (2) co-design an enhanced SARHAchat prototype with rural stakeholders using human-centered design (HCD); and (3) evaluate the feasibility, acceptability, usability, trust, and early implementation outcomes of the enhanced prototype in a community-based pilot. The broader goal is to develop methods and provide preliminary evidence to support the responsible development and implementation of conversational AI health tools in rural and underserved communities. This protocol employs a 3-phase mixed-methods design, using an exploratory sequential logic to link the phases. In phase 1, we will conduct semi-structured interviews (target n=24; range 14-32 assessed for thematic saturation) with pregnant-capable individuals aged 18-25 living in HRSA-designated rural counties in NC and SC to identify determinants of trust and acceptability and develop a conceptual framework. In phase 2, we will convene 5-8 stakeholders per session across 2 iterative community feedback sessions to co-design and refine SARHAchat using HCD principles. In phase 3, we will conduct a non-randomized feasibility pilot with 75 pregnant-capable individuals aged 18-25 from HRSA-designated rural counties in NC and SC, who will be deployed on community-identified social media platforms. An explanatory sequential approach (quantitative surveys followed by qualitative interviews with a purposive subsample of 20) will assess feasibility, acceptability, usability, and implementation outcomes. This proposal was funded in February, 2026. All three phases have been approved by the University of North Carolina at Chapel Hill Institutional Review Board 26-0669). 14 participants have been enrolled in phase 1. Phase 2 co-design activities are planned for August-October 2026, and phase 3 pilot recruitment is expected to begin in January 2027, with data collection concluding in October 2027. Findings are anticipated to be submitted for publication in spring 2028. This protocol describes a feasibility study of a community-informed AI-enabled conversational SRH tool for rural young adults. By characterizing trust-related design needs, refining a prototype through co-design, and generating preliminary feasibility, acceptability, usability, and implementation data, the study aims to establish trust-by-design methods that guide future effectiveness testing and may transfer to other sensitive health domains and underserved communities.
Frailty assessment in older adults typically relies on subjective clinical tools that are time-consuming and require trained personnel, limiting their use in routine or large-scale screening. Wearable sensor-based gait analysis offers a promising objective alternative; however, comprehensive evaluations of deep learning models for multi-class frailty classification using structured gait metrics remain limited. This study evaluates multiple deep learning architectures for three-class frailty classification using structured gait features derived from a single wearable inertial measurement unit (IMU). Four architectures (Transformer, ShapeFormer, InceptionTime, and LSTM-CNN) were evaluated using the publicly available GSTRIDE dataset, comprising 163 older adults (non-frail: n = 65, pre-frail: n = 77, frail: n = 21). Eleven clinically interpretable stride-level gait variables, extracted from a single IMU, were used as model input. A 10-fold participant-level cross-validation scheme, matching the default configuration of the original implementation (cv_seed = 1), was applied to ensure robust performance estimation and prevent data leakage. The four architectures yielded comparable mean accuracy under a unified protocol (ShapeFormer 73.1% ± 10.6%, Transformer 72.6% ± 6.0%, InceptionTime 70.5% ± 9.5%, LSTM-CNN 65.9% ± 9.8%). A Friedman omnibus test on the per-fold scores did not reject the null of equal performance (borderline on accuracy and macro-F1 (p = 0.050 and 0.056 respectively), with no significant difference for macro-AUC [p = 0.840]), indicating that the apparent ranking is within sampling variability. Performance was higher for non-frail and pre-frail individuals, while classification of frail individuals remained challenging across all models. Multi-class frailty classification using structured gait metrics from a single wearable sensor is feasible, though performance varies across models and frailty classes. Model stability and sensitivity to specific classes represent important trade-offs. These findings support the development of scalable, objective approaches to frailty assessment and underscore the importance of selecting models based on clinical priorities.
Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a rare, life-threatening variant of stiff-person spectrum disorder that is primarily associated with anti-glycine receptor (GlyR) antibodies. Although advanced age and intensive care unit admission have been associated with poor outcomes for patients with GlyR antibody-positive PERM, detailed management strategies for elderly patients with multiple comorbidities remain limited. We report the successful individualized management of a 79-year-old male with glycine receptor 1 (GlyR1) antibody-positive PERM, who is among the oldest reported survivors of severe PERM. The patient initially presented with paroxysmal limb spasms, which were misattributed to spinal degeneration and a minor thalamic infarction. The subsequent development of a prominent startle response, respiratory failure, and autonomic instability prompted an autoimmune evaluation, confirming the presence of anti-GlyR1 antibodies in both serum and cerebrospinal fluid. High-dose corticosteroid pulse therapy was avoided because of an active pulmonary infection and comorbidity-related safety concerns. Intravenous immunoglobulin (IVIg) was selected as the initial immunomodulatory therapy, while plasma exchange was deferred and later discontinued after a single session because of procedure-related complications and hemodynamic instability. The patient received three sequential courses of IVIg; in addition, a single 20-mg subcutaneous dose of ofatumumab was administered as individualized off-label sequential/salvage immunotherapy. A major clinical improvement, including a reduction in spasms, successful extubation, antibody seroconversion, and excellent functional recovery with a modified Rankin scale (mRS) score of 1, occurred after repeated IVIg courses. At the 12-month follow-up, the patient remained clinically stable and had sustained negative GlyR1 antibody results. This case report highlights the importance of the early recognition of stimulus-sensitive spasms and the startle response in elderly patients with misleading age-related imaging findings. These findings also suggest that repeated IVIg courses may represent a feasible salvage strategy when conventional immunotherapies are limited, but the independent therapeutic contribution of ofatumumab remains uncertain. Serial GlyR1 antibody titers may be useful for monitoring the treatment response, although this result requires confirmation in larger studies.