Large language models are increasingly used for clinical guidance while their parent companies introduce advertising. We tested whether pharmaceutical ads embedded in the prompts of 12 models from OpenAI, Anthropic, and Google shift drug recommendations across 258,660 API calls and four experiments probing distinct epistemic conditions. When two drugs were both guideline-appropriate, advertising shifted selection of the advertised drug by +12.7 percentage points (P < 0.001), with some model-scenario pairs shifting from 0% to 100%. Google models were the most susceptible (+29.8 pp), followed by OpenAI (+10.9 pp), while Anthropic models showed minimal change (+2.0 pp). When the advertised product lacked evidence or was clinically suboptimal, models resisted. This reveals a structured vulnerability: advertising does not override medical knowledge but fills the space where clinical evidence is underdetermined. An open-response sub-analysis (2,340 calls across three representative models) confirmed that advertising restructures free-text clinical reasoning: models echoed ad claims at 2.7 times the baseline rate while maintaining high stated confidence and rarely disclosing the ad. Susceptibility was provider-dependent (Google: +29.8 pp; OpenAI: +10.9 pp; Anthropic: +2.0 pp). Because this bias operates within clinically correct answers, it is invisible to accuracy-based evaluation, identifying a class of AI safety vulnerability that standard testing cannot detect.
Social media has emerged as a powerful tool that has transformed communication and decision-making across the medical profession, including within the arthroplasty community. This study examined the association between social media use by arthroplasty surgeons and online patient satisfaction and research engagement. The American Association of Hip and Knee Surgeons directory was reviewed for all members in the United States. Online searches were conducted on 239 randomly sampled members for professional profiles on ResearchGate, LinkedIn, X, Instagram, Facebook, TikTok, and YouTube. The presence of personal or practice group websites was also assessed. Healthgrades, Google Reviews, and Vitals were queried for surgeons' average ratings, number of reviews, and number of comments. Surgeons' h-indices were recorded from Scopus. A summated online presence score was calculated to identify the top 15% of social media users in the sample. Two hundred thirteen adult reconstruction fellowship-trained and 26 non-adult reconstruction fellowship-trained surgeons were included in the study. The top 15% of social media users had higher average Google Reviews ratings compared to the remaining 85%. Surgeons with Instagram and Facebook profiles had higher average Google Reviews ratings than those without. Arthroplasty surgeons on LinkedIn and ResearchGate also had higher average h-indices than those without such profiles. Social media engagement was positively associated with patient ratings on physician-rating websites. Activity on LinkedIn and ResearchGate correlated with higher h-indices, reflecting greater research engagement. As social media use among arthroplasty surgeons grows, web-based marketing can create platforms to promote patient engagement and academic literature.
The pressure on publicly financed healthcare systems may necessitate decisions to not (or no longer) reimburse health technologies. Such decisions remain politically sensitive and often evoke public opposition, pressuring decision-makers to revoke or revise them. However, the elements that constitute public opposition remain unclear. This study addresses this gap by systematically reviewing the scientific literature. We searched Embase, Google Scholar, Google, and Startpage, and supplemented these with a hand search in 2021, updated in 2022 and 2024. Based on 81 articles, we developed a thematic framework of 21 categories grouped under the Five Ws-'Who, What, When, Where, and Why'-of public opposition to negative reimbursement decisions. Citizens, patients (and representatives), physicians, pharmaceutical companies, and politicians emerged as key actors. Opposition typically targets the outcomes and justifications of decisions, driven by high expectations, claims about effectiveness, or perceptions that decision-makers prioritize cost containment. Distrust in decision-makers and evidence-based decision-making may leave some actors-particularly citizens and patients-vulnerable to commercial driven information and misinformation. Other actors-including pharmaceutical companies, patient representatives, and politicians-may strategically use the media to shape opinion and amplify opposition. Public opposition is multifaceted. Understanding its dynamics may help align decision-making with public values and support efforts to address misconceptions and counter misinformation, thereby enhancing the acceptability of such decisions in healthcare.
Bed-dependent patients are highly vulnerable during emergencies because of restricted mobility, and their rapid evacuation presents a significant challenge for hospitals. This study aimed to identify innovative strategies and the key challenges involved in designing and manufacturing emergency evacuation devices for bed-dependent patients, with a focus on evacuation mattresses and stretchers. This study was conducted on the basis of the five-stage framework proposed by Arksey and O'Malley and in accordance with the Joanna Briggs Institute (JBI) guidelines for scoping reviews. Initially, the research question was clearly defined. A comprehensive literature search was subsequently performed without time restrictions, considering the limited number of product-oriented studies. The search utilized the keywords bed-bound patients, emergency evacuation, hospital, design, manufacture, and evacuation mattress across multiple databases, including Scopus, ProQuest, PubMed, Web of Science, and ScienceDirect, as well as the search engines Google Scholar and Google Patents. National databases such as SID and MagIran were also included. Both English and Persian keywords were finalized. Out of a total of 654 retrieved studies, after removing duplicates and irrelevant records, 28 articles met the inclusion criteria and were analyzed. The findings indicated that design requirements for hospital evacuation equipment can be classified into seven principal categories and 18 subcategories: technical-functional requirements, clinical requirements, environmental requirements, legal and standard requirements, operational barriers, design-related barriers, and technological complexity and innovation. This study demonstrates that designing hospital evacuation equipment, with a focus on mattresses and stretchers, constitutes a multidimensional and complex challenge that necessitates an integrated and innovative approach. Prototypes should be refined through analyzing and adapting, incorporating locally available materials and ergonomic principles. Prioritizing user-centered and context-adaptive innovations enhances health system capacity and ensures safer, more efficient transfer of bed-dependent patients in emergencies. Not applicable.
While new expensive medicines often offer substantial benefits to patients, they can carry inherent drawbacks such as uncertainty regarding efficacy translating into effectiveness, safety and rational use, as well as a substantial financial burden on society and/or patients. Rational use of medicines aims to maximize effectiveness whilst minimizing side effects, patient burden, and societal costs. In the Netherlands, initiatives aiming to improve the rational use of expensive medicines are being carried out with increasing frequency and in a programmatic manner. This review identified the strategies used, and includes a structured approach for their application during the medicine's use in clinical practice. Rational use initiatives, driven by clinicians and pharmacists, and funded by the Dutch Ministry of Health and the Dutch health insurers were evaluated for strategies that aim to improve the rational use of expensive medicines. In addition, a non-systematic narrative review was carried out through searches in Google, Google Scholar, Pubmed, the Artificial Intelligence (AI)- tools Global Campus and Evidence Hunt to identify additional strategies. Identified strategies were categorized by assessing whether they aimed to address the efficacy-effectiveness gap or to reduce the side effects and societal burden of expensive medicines. Thirteen strategies to improve rational use were identified. Two strategies were identified that aim to address the efficacy-effectiveness gap: optimize patient selection and generating evidence on clinical endpoints. 11 additional strategies that aim to reduce side effects or societal burden were identified: dose reduction, personalized dose optimization, interval lengthening, shortening of the treatment duration, biosimilar/generic drug use, non-medical drug switching, reduction of additional non-medication costs, reduction of drug wastage, switching the route of administration, boosting (improve drug exposure and/or reduce the dose by influencing pharmacokinetic parameters through co-interventions), and optimization of medication adherence. Rational use of expensive medications is essential as part of a drug's life cycle and can benefit patients as well as society. The framework and strategies described in this overview provide guidance for the future rational use of expensive medicines, both for those already in use and for those newly introduced.
Inflammatory bowel disease (IBD) is a chronic, relapsing condition associated with diagnostic delays, disease misclassification, and variable treatment response. Conventional diagnostic and monitoring tools remain limited in capturing the biological complexity of IBD, prompting growing interest in metabolomics as a complementary approach. This systematic review aimed to examine the role of metabolomics in enhancing the diagnosis and management of IBD across adult and pediatric populations. Systematic review. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. PubMed, Web of Science Core Collection, ScienceDirect, Cochrane Library, and Google Scholar were searched from inception to identify eligible studies. Observational studies and clinical trials assessing metabolomics in IBD diagnosis or management were included. Methodological quality was appraised using the Newcastle-Ottawa Scale, RoB 2, and ROBINS-I. Due to substantial heterogeneity, a narrative synthesis was performed. Fourteen studies involving approximately 3700 participants met the inclusion criteria. Metabolomic analyses of serum, feces, urine, and plasma consistently identified disease-associated metabolic perturbations, particularly in amino acids, bile acids, lipids, and short-chain fatty acids. Only two studies reported formal diagnostic performance, with sensitivity and specificity exceeding 80% for distinguishing IBD subtypes. Several studies demonstrated metabolomic changes associated with treatment response and remission; however, outcome definitions varied widely across studies. Metabolomics shows significant potential to enhance IBD diagnosis and management, particularly for disease differentiation and treatment monitoring. Nonetheless, clinical translation is constrained by methodological heterogeneity and limited diagnostic validation. Future research should prioritize standardized protocols and robust diagnostic accuracy studies. This review explores metabolomics’ role in enhancing IBD diagnosis and management for both adults and children. The systematic review followed PRISMA 2020 guidelines, searching PubMed, Web of Science, Cochrane Library, ScienceDirect, and Google Scholar. Two reviewers independently screened studies and assessed risk of bias using Cochrane’s RoB 2, ROBINS-I, and NOS. A narrative synthesis was conducted due to study heterogeneity. Out of 2,630 records screened, 14 studies met eligibility criteria. These included ten observational studies, one case-control, one longitudinal observational, one RCT, and one nonrandomized trial. Six observational studies were of high quality. Metabolomics shows potential for enhancing IBD diagnosis and treatment, but high heterogeneity and a lack of diagnostic accuracy studies limit practical insights. The identified biomarkers/metabolites are consistent with previous studies, showing metabolomics’ potential in diagnosing and treating IBD in both pediatric and adult populations. Recent observational studies report sensitivity and specificity, indicating progress. Comprehensive diagnostic protocols should be developed based on previously identified biomarkers/metabolites before conducting rigorous diagnostic accuracy studies to evaluate their accuracy and improve clinical application of research findings.
To map the targets and treatment ingredients used by voice therapists in vocal and communicative harmonization programs for transgender women. A scoping review was conducted in accordance with the Joanna Briggs Institute methodology, registered in the Open Science Framework, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The search, with no language or date restrictions, included LILACS, MEDLINE, EMBASE, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials, as well as gray literature (ProQuest Dissertations and Theses, medRxiv, and Google Scholar), citation and reference mapping, and consultation with experts. Studies were included if they involved transgender women aged ≥18 years who underwent speech-language pathology interventions targeting voice and communication. Study selection and data extraction were performed independently and blindly by two reviewers. Data were extracted on study characteristics, sample characteristics, and features of the vocal and communicative harmonization programs, which were classified according to the voice rehabilitation treatment specification system. Data analysis was descriptive. A total of 1908 records were identified, of which 35 studies met the eligibility criteria. Most studies were conducted in the United States (28.6%), published in 2024 (22.9%), and appeared in the Journal of Voice (37.1%). The mean sample size was 22.34 participants per study. Most studies included participants receiving gender-affirming hormone therapy (31.4%), without prior vocal feminization surgery (65.7%), and without previous vocal harmonization programs (60.0%). Interventions were predominantly traditional, in-person, and individual, delivered weekly, with a mean of 12.49 sessions, and lacked follow-up in 54.3% of studies. The most frequent targets were vocal function (94.3%), speech and communication function (88.6%), and pedagogy and counseling (80.0%). The most commonly reported ingredients were resonance-based methods (88.6%), guidance and counseling (80.0%), pitch and loudness modification techniques (77.1%), and articulatory exercises (71.4%). Vocal and communicative harmonization programs for transgender women primarily prioritize voice- and communication-related targets; however, the treatment ingredients are largely concentrated on vocal adjustments, while components addressing broader communicative aspects remain less explored. These findings highlight the need to expand the scope of interventions to more comprehensively address global communication.
To review barriers to ethical and equitable access to disease-modifying therapies (DMTs) and newborn screening (NBS) for spinal muscular atrophy (SMA). We searched PubMed, Scopus, Web of Science, EBSCOhost, the Cochrane Library, Google Scholar, and Primo for content on the ethics or equity of access to SMA DMTs or NBS from January 2014 to May 2025. Only evidence sources that had a primary focus on equity or ethics regarding access to either DMTs or NBS for children aged less than 18 years were eligible. Forty publications were included: all but one were published in English; three-quarters were published after 2020 and were either narrative reviews (45%) or cross-sectional studies (35%). The largest proportion were from North America (40%) and only three (7%) offered commentary on low- and middle-income countries. Inequity in access to SMA DMTs and NBS were consistently reported to persist even within countries due to multiple factors, which include variation in health system resources and funding mechanisms. Lack of robust clinical data on the long-term safety, efficacy, and cost-effectiveness of DMTs hampers advocacy efforts, particularly in resource-constrained settings. Questions remain around autonomy and distributive justice in diagnosis and care for this ultra-rare disease. A decade after the approval of clinically transformative therapies, children with SMA continue to fall on the wrong side of an avoidable divide. Urgent and coordinated action is needed to establish regulated minimum clinical standards, generate robust real-world data, and redesign funding models to ensure that NBS and treatment innovation serves all populations, not only those with politico-economic advantage.
Policy Points Researchers investigate how recent elections in the United States have influenced mental health, especially among political- and policy-based election losers. The previous two presidential elections worsened the self-reported mental health of Americans on average. Likely partisan election losers and those who had the most to lose in terms of health policy were even more likely to have their mental health affected by the results of elections. As American politics has become increasingly polarized and the perceived stakes of elections have loomed larger in recent years, elections have become a source of worsening mental health for Americans. Politics is increasingly important to many Americans. Yet little is known about how the increasing centrality of politics affects Americans' mental health. This work aimed to evaluate how recent polarized elections have influenced Americans' mental health. To investigate this question, we compared online search interest in politically related mental health issues and self-reported mental health data. Analyses explored changes before and after election days in 2020 and 2024. The two outcome variables were aggregate Google search interest in politics-related mental health issues and individual responses to the following item from the Behavioral Risk Factor Surveillance System (BRFSS): ''Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? With BRFSS, we compared differential changes for likely Democrats and Republicans using multiple proxy measures and for those with health policy interest in the election. The 2020 and 2024 presidential elections substantially increased interest in politics-related mental health issues online. The 2020 election led to just under 0.2 additional days of poor mental health (P < .05), and the 2024 election led to just under 0.5 additional days of poorer mental health (P < .05). Likely losing partisans and those who stood to lose out from Trump's reelection in terms of health policy were found to drive most of this relationship, with just under 1 full additional day of poorer mental health for each group. The stakes of elections in this polarized era of American politics are worsening the mental health of Americans. Additional resources may be necessary to allow therapists and clinicians to navigate additional care-seeking surrounding and following elections.
Gingival squamous cell carcinoma (GSCC) is a rare subset of oral squamous cell carcinoma (OSCC), often mimicking benign or inflammatory lesions, which complicates early diagnosis. Chronic inflammation plays a pivotal role in oral carcinogenesis, yet its molecular implications in GSCC remain underexplored. This Prognostic Systematic Literature Review (SLR) presents a case-based review of GSCC and evaluates the immunohistochemical expression of key inflammatory markers - COX-2, TNF-α, IL-6, NF-κB, VEGF, iNOS, Bcl-2/Bax ratio, and HDAC6 - in OSCC to assess their diagnostic, prognostic, and therapeutic relevance. Literature search was done (1999-2025) across PubMed, Scopus, Web of Science, Cochrane, and Google Scholar to identify studies on biomarker analysis in histopathologically confirmed cases of OSCC. Data extraction focused on clinical presentation, tumour grade, invasion, metastasis, and survival. Study quality was assessed using NOS and JBI tools. From 1055 screened records,18 studies met inclusion criteria. GSCC is often masqueraded as desquamative gingivitis or periodontal abscess, causing diagnostic delays. Immunohistochemistry revealed frequent overexpression of COX-2, TNF-α, VEGF, and Bcl-2, correlating with tumour aggressiveness, angiogenesis, higher histological grade, and poor prognosis. Temporal trends indicate a shift from apoptotic dysregulation to cytokine-driven inflammatory phenotypes as key drivers of OSCC progression. To Conclude, GSCC requires high clinical vigilance due to its deceptive presentation. Biomarkers such as COX-2, TNF-α, IL-6, NF-κB, and VEGF provide critical prognostic and therapeutic insights, emphasising the role of inflammation in tumour progression and supporting biomarker-guided early detection strategies.
Bystander intervention at the scene of illness or injury can significantly impact the outcomes of emergencies. This scoping review aims to identify the determinants of bystander behavior in such scenarios. A comprehensive search was conducted across PubMed, Cochrane, Google Scholar, CINAHL, and grey literature, resulting in 3957 studies. After removing duplicates, 2499 studies were screened for titles and abstracts by two independent reviewers, with conflicts resolved by a third reviewer. A total of 257 articles were then subjected to full-text screening, leading to the inclusion of 42 studies for data extraction. Data were collected on various factors, including the type of emergency, region, area of study, setting, age group, gender, prior training, presence of bystander intervention, and determinants of behavior. In studies presenting age‑stratified analyses, bystander intervention was reported in 75% of studies involving individuals aged ≤ 18 years and in 69% of studies focused on adults. Where training status was reported, 18% of adult‑oriented studies indicated prior training, with no such reporting among studies involving individuals ≤ 18 years. Cardiac arrest was the most common type of emergency (95%). Most studies were conducted in community settings (76%), with the remainder in institutional settings (24%). Negative determinants included lack of knowledge, skills, and self-efficacy, with variations between community and institutional settings. Motivators for intervention, though less frequently reported, included young age, education/training, and a supportive environment. The review highlights key barriers and motivators for bystander intervention, emphasizing the need for targeted education and training programs, as well as supportive environments to enhance bystander response in emergencies. These findings provide a foundation for developing multifaceted strategies to improve bystander behavior and emergency outcomes.
Digital workflows have revolutionized restorative dentistry, computer-aided design and computer-aided manufacturing (CAD/CAM) milling, and three-dimensional (3D) printing provide alternatives to conventional methods of fabrication of inlays, onlays, and veneers. However, comparative evidence of their clinical performance remains scattered. This scoping review aimed to map and synthesize current evidence on the clinical outcomes of CAD/CAM- and 3D-printed inlays, onlays, and veneers, focusing on adaptation, strength, esthetics, and workflow efficiency. This scoping review followed the methodological framework proposed by Arksey and O'Malley, with refinements suggested by Levac et al., and was reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A comprehensive search was performed in PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar for studies published from January 2000 to June 2025. Eligible studies included in vitro, clinical, and case-based reports that evaluated CAD/CAM or 3D-printed inlays, onlays, or veneers. Data were charted and analyzed thematically according to restoration type, fabrication method, material, and reported outcomes. Thirty studies were included, mainly in vitro. Inlays showed clinically acceptable adaptation, with 3D printing achieving accuracy comparable to milling, while ceramics offered superior hardness. Onlays yielded mixed outcomes: pressable ceramics had higher strength, but 3D-printed onlays often showed better adaptation. Veneers demonstrated the greatest potential for 3D printing, with printed zirconia and lithium disilicate performing well. CAD/CAM was faster and well established, whereas 3D printing provided greater customization but longer fabrication times. In conclusion, both CAD/CAM and 3D printing are capable of producing inlays, onlays, and veneers with clinically acceptable accuracy and strength. CAD/CAM remains the most established and reliable technique, particularly for ceramics, whereas 3D printing shows potential to enhance adaptation and customizability, especially for veneers. Further clinical trials are essential to validate long-term outcomes.
Catamenial pneumothorax is a rare manifestation of thoracic endometriosis syndrome and is associated with a high risk of recurrence despite surgical intervention. Increasingly, multimodal strategies combining thoracic surgery with adjunctive hormonal therapy have been put in place as standard practice however, optimal management remains uncertain. A systematic review of the literature was conducted using MEDLINE/PubMed, Scopus, CENTRAL, Google Scholar, SciSpace, and the Cochrane Library for studies published between January 2000 and December 2025. Studies reporting outcomes of surgical management for catamenial pneumothorax were included. Data was extracted on patient characteristics, surgical techniques (diaphragmatic and pleural interventions), use of postoperative hormonal therapy, and recurrence rates.  RESULTS: Analysis of 37 studies encompassing over 1,800 patients suggests that treatment approach is a major determinant of outcomes. Meta-analysis demonstrates a pooled recurrence rate of 17.3% with postoperative hormonal therapy compared to 54.2% without (p < 0.01) [1], with younger age independently associated with higher recurrence risk. Diaphragmatic intervention is critical to reducing recurrence, with studies reporting 12.5% recurrence when diaphragmatic surgery is combined with pleurodesis versus 100% with pleurodesis alone [15]. Diaphragm resection has been identified as an independent protective factor against recurrence (HR 0.16; 95% CI: 0.03-0.77; p = 0.022) [5]. The available evidence supports a multimodal approach to the management of catamenial pneumothorax. Comprehensive thoracoscopic surgery addressing diaphragmatic pathology, combined with pleurodesis and postoperative hormonal therapy, is consistently associated with reduced recurrence. Given the observational nature of the available data, these findings should be interpreted with appropriate caution and highlight the need for prospective, collaborative studies.
Alcoholic cardiomyopathy (ACM) is a potentially reversible form of dilated cardiomyopathy associated with chronic excessive alcohol consumption. Although recovery of left ventricular function after alcohol abstinence has been reported, the clinical course of patients presenting with cardiogenic shock or cardiac arrest requiring mechanical circulatory support (MCS) remains poorly characterized. This study aimed to evaluate survival outcomes and myocardial recovery in patients with ACM presenting with severe circulatory failure. A systematic literature search was conducted in PubMed, Web of Science, Google Scholar, and Ichushi-Web from database inception to February 28, 2026. Studies describing patients with ACM presenting with cardiogenic shock or severe circulatory failure requiring temporary MCS (including ECMO, Impella, intra-aortic balloon pump, or LVAD) were included. Extracted data included patient characteristics, type of circulatory support, survival outcomes, and recovery of left ventricular function. Five studies (three case reports and two case series), including 10 patients, were identified. The median age was 43 years (IQR, 38-46), and 9 of 10 patients (90%) were male. The median baseline LVEF was 15% (IQR, 15-20%). Cardiac arrest occurred in 3 patients (30%). Veno-arterial extracorporeal support, including VA-ECMO/PCPS, was used in 9 patients (90%), Impella in 1 patient (10%), and LVAD support in 3 patients (30%). One patient ultimately underwent heart transplantation. All published cases survived. Among patients with available follow-up data, the median LVEF improved to 55% (IQR, 45-60%), representing a median absolute increase of approximately 40 percentage points. Published case-based evidence suggests that alcoholic cardiomyopathy may retain clinically meaningful reversibility even in selected patients with severe circulatory failure requiring mechanical circulatory support. Although favorable outcomes may be overrepresented in published reports, awareness of this potentially reversible phenotype may support timely recognition and appropriate management of severe circulatory failure.
Detached Mindfulness (DM) is a central, transdiagnostic technique within Metacognitive Therapy (MCT). It involves increasing meta-awareness of intrusions while decentring from and disengaging with them, and is used to reduce the Cognitive Attentional Syndrome and dysfunctional metacognitive beliefs-key components of the metacognitive model of psychological disorders. Although DM is typically delivered within a full MCT protocol, recent research has begun to evaluate DM as a stand-alone intervention. The current study aimed to systematically review and meta-analyse its effects. Studies were included in the systematic review if they examined DM delivered as a stand-alone intervention in clinical or non-clinical samples. Searches were carried out in PubMed, Scopus, Web of Science, and Google Scholar in May 2025. Methodological quality and risk of bias were assessed using an adapted quality appraisal checklist. Random-effects meta-analyses were conducted for clinical trials, and narrative synthesis for experimental studies. Fourteen studies met inclusion criteria, representing twelve independent samples exposed to DM (N = 256; all aged ≥17). Three samples evaluated DM as a stand-alone treatment in clinical trials (two in obsessive-compulsive disorder and one in panic disorder). Of the remaining nine samples, seven (one clinical, six non-clinical) examined the effects of DM on experimentally induced psychological symptoms, and two (non-clinical) on pre-existing symptoms. Across the three clinical trials, DM was associated with large symptom reductions (pooled Hedges' g for primary outcomes = -1.80, 95% CI [-2.84, -0.76]; pooled g for depressive symptoms measured as a secondary outcome = -1.15, 95% CI [-2.23, -0.08]. Of the remaining nine samples, eight reported beneficial effects of DM on at least one outcome, with significant effects typically in the medium-to-large range. These findings provide converging, but still limited, evidence that DM as a stand-alone intervention is associated with improvements in psychological symptoms and related processes. The results have implications for future component analyses of MCT and for the development of brief, transdiagnostic metacognitive interventions. However, there are significant limitations to the current research base including the small number of studies, methodological shortcomings, and lack of long-term follow-up; these are discussed as well as suggestions for future studies.
Colorectal cancer is a major global health burden, with most cases arising from adenomatous polyps. Although colonoscopy is the gold standard for detection, its effectiveness is operator-dependent. Artificial intelligence-assisted systems have been developed to improve adenoma detection, but their comparative performance remains unclear. We performed a systematic review and Bayesian network meta-analysis of randomized controlled trials comparing artificial intelligence-assisted with standard colonoscopy. PubMed, Scopus, and Google Scholar were searched up to 4 November 2025. Eligible studies included adults undergoing colonoscopy and reporting adenoma detection rate (ADR) and adenomas per colonoscopy (APC). Secondary outcomes included withdrawal time and detection of advanced and sessile serrated lesions. Risk of bias was assessed using Cochrane RoB 2.0, and certainty of evidence was evaluated with CINeMA. A total of 48 randomized controlled trials (34 106 participants) were included. Artificial intelligence-assisted colonoscopy significantly improved ADR compared with standard colonoscopy. EndoAngel showed the greatest effect [odds ratio (OR): 1.84, surface under the cumulative ranking curve (SUCRA): 0.9], followed by EndoAID (OR: 1.64, SUCRA: 0.7), CAD-EYE (OR: 1.46, SUCRA: 0.5), and GI Genius (OR: 1.45, SUCRA: 0.5). For APC, EndoAID demonstrated the largest benefit (mean difference: 0.62). EndoAngel modestly increased withdrawal time (mean difference: 1.14 minutes). No system significantly improved detection of advanced or sessile serrated lesions. Heterogeneity was low, and certainty of evidence was moderate. Artificial intelligence-assisted colonoscopy improves adenoma detection; however, differences between systems are small, and benefits for high-risk lesions remain uncertain. Further head-to-head trials and cost-effectiveness studies are needed.
The Critical Appraisal Tool for Anatomical Meta-analysis (CATAM) was introduced to support anatomy-specific appraisal of the methodological quality and reporting of anatomical meta-analyses (AMAs). While prior work has supported its face and content validity and suggested high overall reliability under selected conditions, comprehensive evidence regarding its inter-rater reliability, item-level agreement, and sources of measurement error remains limited. This study aimed to provide an in-depth psychometric evaluation of CATAM by assessing (i) inter-rater reliability of the total score, (ii) item-level inter-rater agreement using robust ordinal multi-rater statistics, and (iii) sources of variance using Generalizability Theory, with the additional objective of identifying domains in which disagreement concentrated under independent, uncalibrated application. Fifty AMAs published in 2024 were identified through structured searches of PubMed, Scopus, and Google Scholar and independently evaluated by four blinded raters using the 14-item CATAM instrument. Inter-rater reliability of total scores was assessed using two-way random-effects intraclass correlation coefficients (ICC). Item-level agreement was evaluated using Gwet's AC2 with ordinal weights (primary) and Krippendorff's α (secondary). Generalizability Theory was applied under a fully crossed p × r × i design to partition variance attributable to meta-analyses, raters, items, and their interactions. Decision studies examined how reliability varies as a function of the number of raters and items. Single-rater reliability of the total CATAM score was low, whereas averaging scores across four raters yielded acceptable reliability under the present protocol (ICC(2,4)≈0.69). Item-level agreement varied substantially, ranging from perfect agreement to poor agreement across items. Five items (Abstract, Introduction, Methods/Searching Strategy, Results/Outcomes, and Discussion) fell below the pragmatic Gwet's AC2 screening threshold of 0.60, although two of these (Methods/Searching Strategy and Discussion) were near-threshold findings that should be interpreted cautiously. Generalizability analysis revealed that item-related variance dominated total score variability, while rater main effects and meta-analysis × rater interactions were negligible. The generalizability coefficient for relative decisions was moderate (G≈0.66), and the dependability coefficient for absolute decisions treating items as fixed was Φ≈0.59. Decision studies indicated that four raters provide an efficient balance between feasibility and reliability. Overall, CATAM demonstrated acceptable reliability when ratings were aggregated across multiple independent raters under the present protocol, although item-linked variance exceeded rater main-effect variance and these analyses cannot fully separate item characteristics from differences in how raters operationalized the published guidance. These findings support calibration with explicit decision rules and rescoring as the next methodological step; only if disagreement persists after that process should any future Delphi-based refinement be considered.
Given the central role of phosphorus in key metabolic processes, including glucose phosphorylation, ATP synthesis, insulin signalling, and energy metabolism, dietary phosphorus availability may influence postprandial metabolic responses. This systematic review evaluates the effects of inorganic phosphorus supplementation on diet-induced thermogenesis, postprandial glycaemia, and postprandial lipidemia in healthy adults. A systematic search of PubMed, Google Scholar, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. Only experimental intervention studies assessing phosphorus supplementation as the primary exposure and postprandial metabolic outcomes as primary endpoints were included. Eligible participants were healthy adults aged 18-64 years. Secondary outcomes included changes in body weight, energy intake, and satiety. Ten randomised crossover trials met inclusion criteria, comprising a total of 225 participants. Three out of four studies reported a significant positive association between phosphorus supplementation and diet-induced thermogenesis (P < 0.05). Evidence regarding the effects of phosphorus on postprandial glycaemia and lipidemia was inconsistent. An inverse association was observed between phosphorus intake and weight gain (P < 0.001) and energy intake (P < 0.01), alongside a positive association with satiety (P < 0.05). While these findings indicate potential metabolic benefits of dietary phosphorus, particularly in relation to thermogenesis and energy regulation, interpretation is tempered by the small number of available studies, modest sample sizes, and methodological heterogeneity. These limitations restrict causal inference and generalizability. Further rigorously designed, adequately powered clinical trials are therefore warranted to substantiate these associations and to clarify the effects of phosphorus on postprandial glycaemic and lipid outcomes.
To investigate the relationship between type 2 diabetes mellitus and postmenopausal women with fracture risk when using PPIs. We conducted an observational study to investigate the association between PPI use and an increased fracture risk in postmenopausal women and type 2 diabetes mellitus. We searched for epidemiological studies published between 2006 and 2023 in PubMed, Google Scholar, and other bibliographies of the retrieved papers. The pooled OR was obtained using the random-effects model, and a subgroup analysis was conducted. Eight studies, including six cohorts and two case-control studies, were conducted with 1.3 million participants. In these studies, 1,63,346 cases of fracture risk were identified. The pooled effect estimate of these studies was OR 1.61, with a 95% CI of 1.36-1.90. This indicates a significant correlation between Type 2 diabetes mellitus, post-menopausal women, and the risk of fractures. The OR for type 2 DM alone was 1.34 (95% CI 1.14-1.57), and for menopausal women alone, the OR was 2.15 (95% CI 1.36-1.90). Notably, there was no evidence of publication bias. This meta-analysis provides strong evidence that PPI use in type 2 DM and menopausal women is significantly associated with the risk of developing fractures.
Kawasaki disease (KD) is an acute, immune-mediated medium-vessel vasculitis and the leading cause of acquired heart disease in children, yet its underlying etiology remains only partially defined. Emerging evidence implicates the gut microbiota as a key modulator of KD susceptibility, immune dysregulation, and therapeutic response. This narrative review aims to synthesise current insights linking gut microbial dysbiosis and microbial metabolites to the pathogenesis, clinical expression, and treatment of KD, and to explore microbiome-informed strategies with diagnostic and therapeutic potential. We conducted a comprehensive search of PubMed, Embase, Web of Science, and Google Scholar from database inception to April 2025 for English-language studies on Kawasaki disease and the gut microbiota, including terms related to microbiome, microbial dysbiosis, metabolites, pathogenesis, immunity, inflammation, and therapy. Reference lists of relevant articles and key reviews were also screened. Children with acute KD exhibit characteristic alterations in gut microbial composition, including an overrepresentation of Streptococcus species, depletion of short-chain fatty acid (SCFA)-producing taxa such as Faecalibacterium, Ruminococcus, and Roseburia, and a significant reduction in fecal butyrate. These changes have been associated with impaired intestinal barrier integrity, heightened NLRP3 inflammasome activation, and dysregulated cytokine signalling, contributing to systemic inflammation and vascular injury. Additional factors, such as antibiotic exposure and concurrent respiratory or oropharyngeal infections, can intensify dysbiosis and have been linked to resistance to intravenous immunoglobulin (IVIG) and an increased risk of coronary artery aneurysms. Conclusions: Gut microbial imbalance and metabolite disruption are likely associated with KD, potentially through interaction with host genetics and immune pathways. Microbiome-targeted approaches, including probiotics, dietary modulation, and metabolite-based therapies, hold promise for improving diagnostic precision, predicting treatment response, and guiding the development of targeted interventions in KD.