Pediatric operative volumes in Malawi have increased over the past decade due to an increase in the pediatric surgical workforce and improved infrastructure. Despite growth in surgical capacity, limited data exist regarding post-operative outcomes for common surgical diseases in low-resource settings. Guardians of patients < 18 years old undergoing general surgery operations at Kamuzu Central Hospital (KCH) were recruited. Two telephone call attempts 30-day after the operation were made to administer a follow-up questionnaire and an Acceptability of Intervention Measure (AIM) score. Guardians were then purposively sampled for semi-structured interviews to assess participant experiences in the telephone follow-up protocol. Feasibility of telehealth follow up, defined here as reachability and acceptability, and guardian perceived factors affecting reachability were analyzed. Of 327 families approached for recruitment, 309 (94.5%) had access to a phone. After accounting for clinical events, 292 were eligible for a 30-day phone call. The majority of patients were male (70.6%) and the median age was 2 years old (IQR: 0.02-14). Overall, 69.2% (n = 202) were reached via phone call. Participants with secondary phones had increased odds of reachability (OR = 2.0, p = 0.04) compared to those with only a primary phone. The mean AIM score of the reached group was 18.3 (SD: 2.6). Among the interviewees-phone ownership, cellular network access, phone charge, and community influence were identified as key factors affecting participation in telephone follow-up. Post-operative follow-up via phone call is feasible in Malawi as evidenced by high patient reachability and acceptability. The results of this pilot study support scaling up implementation of telehealth follow-up in Malawi and utilizing the resulting post-operative metrics to guide quality improvement of surgical care.
Despite a high burden of psychological issues in low- and middle-income sub-Saharan countries, no national-level assessment exists for Senegal. To assess the prevalence and predictors of psychological issues, we analyzed the 2023 Senegal Demographic and Health Survey (DHS) data from 75,080 household members. The prevalence of psychological issues in Senegal was 5% (95% CI = 5.2-5.6). It was highest in the Matam region (8.7%) and lowest in the Saint-Louis region (3.5%). Female gender (adjusted odds ratios [aOR] = 1.11, 95% CI = 1.02-1.22), no education (aOR = 1.24, 95% CI = 1.11-1.36), singlehood (aOR = 1.64, 95% CI = 1.46-1.85), owned housing (aOR = 1.52, 95% CI = 1.26-1.84), rural residency (aOR = 1.18, 95% CI = 1.05-1.32), higher household size (aOR = 1.01, 95% CI = 1.01-1.02), indoor second-hand smoke (SHS) (aOR = 1.57, 95% CI = 1.43-1.73), and shock events (aOR = 1.61, 95% CI = 1.48-1.76) increased the likelihood of psychological issues. Access to video players (aOR = 0.22, 95% CI = 0.12-0.41), mobile phones (aOR = 0.77, 95% CI = 0.68-0.87), and the internet (aOR = 0.79, 95% CI = 0.66-0.96) reduced the likelihood of psychological issues. The burden of psychological issues is high in Senegal. Socio-demographic predictors suggest higher vulnerability among females, the uneducated, unmarried, and rural residents. Stressors such as shock events and indoor SHS increase the risk of psychological issues among household members. Access to recreational tools such as video players, mobiles, and the internet is beneficial in reducing psychological issues. Policy reforms prioritizing strategies to reduce psychological issues and integrating mental health services into healthcare delivery are discussed and recommended.
The aim of this article is to verify the tracking of screen time (ST) on different electronic devices in school-aged adolescent during a three-year follow-up. This is a three-year longitudinal study involving students. The baseline data collection occurred in 2016, and the follow-up in 2019. A total of 151 adolescents of both sexes aged 14.9 (0.9) years participated. ST was analyzed by self-reported questions about time spent watching television (TV); video games (VG); smartphone; TV, smartphone, tablet (TST) and personal computer (PC). For analysis purposes, each device was ranked below and above the ST recommendation (2h/day). For both sexes, tracking was low for all screens, except for weak agreement in TV time for girls. For boys, TST and smartphone were the screens with the highest change percentages for subjects who migrated to high ST, respectively, 68.6% and 34.4% (p < 0.05). For girls, the same occurred for smartphones and 67.1% for TST (p < 0.05). The TST and smartphone devices were the devices that changed the most over the course.
Background Stereotactic radiosurgery (SRS) is an established treatment option for selected patients with brain arteriovenous malformations (bAVMs), particularly for lesions not amenable to microsurgical resection or located in surgically high-risk areas. SRS can be delivered through different platforms, including Gamma Knife, CyberKnife, and linear accelerator (LINAC)-based systems. This retrospective single-institution study evaluated outcomes of patients with bAVMs treated with LINAC-based SRS at a quaternary care center in Bogotá, Colombia. Materials and methods We conducted a retrospective observational study of patients with bAVMs treated with LINAC-based SRS guided by triple-fusion imaging between 2011 and 2017. Clinical, treatment, and imaging data were collected from medical records. Telephone interviews were used only to supplement clinical follow-up and were not used to determine radiological obliteration. The primary outcome was radiological obliteration during the available follow-up period, assessed by follow-up imaging. Actuarial obliteration rates were estimated using Kaplan-Meier analysis and interpreted as exploratory because of limited follow-up and censoring. Univariable Cox proportional hazards analyses were performed as exploratory analyses to evaluate factors associated with obliteration. Results Eighty-two patients were included. At presentation, 36 patients (44.0%) had ruptured bAVMs, 61 (74.4%) had lesions in eloquent areas, and most had Spetzler-Martin grade III malformations. Prior embolization was performed in 47 patients (57.3%). Complete radiological obliteration was documented in 27 patients (33.0%) during available follow-up. The median follow-up was 16.3 months, and 46 patients (56.1%) were lost to follow-up before completing three years of institutional follow-up. Actuarial obliteration estimates at later time points should therefore be interpreted cautiously. In exploratory univariable Cox analysis, radiosurgery dose >20 Gy was associated with a shorter time to obliteration. Conclusions This single-institution retrospective study describes radiological and clinical outcomes after LINAC-based SRS for bAVMs in a Latin American quaternary care center. The findings suggest that LINAC-based SRS is a feasible treatment approach when appropriate technology, planning expertise, and quality assurance are available. However, the short median follow-up, substantial loss to follow-up, and lack of a comparator group limit conclusions regarding effectiveness. Future prospective studies with standardized long-term imaging follow-up are needed.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may impact immune-related micro ribonucleic acids (miRNAs). The role of salivary miRNAs as predictors of severe infection in children is unknown. This study sought to examine the relationship between SARS-CoV-2 severity and salivary miRNA levels in children. A convenience sample of 400 children with SARS-CoV-2 infection was prospectively evaluated between March 2021 and February 2022 at two U.S. children's hospitals. Saliva swabs were obtained. Levels of 3 miRNAs previously implicated in SARS-CoV-2 pathophysiology were measured with quantitative polymerase chain reaction (miR-1273c, miR-296-5p, and miR-4495). The primary outcome measure was the occurrence of severe illness, including respiratory failure, shock, or death from a related cause within 1 month of evaluation. Disease resolution was determined through chart review and caretaker phone calls 4 weeks after the initial visit. Saliva samples from 395 (severe = 105) participants (mean age: 7.4 ± 5.9 years, 51.7% female, 54.7% African American) were analyzed. Children with severe outcomes had lower levels of miR-296-5p (fold difference: 0.361, d = 0.111, p = 0.046). Multivariable adjusted logistic regression analysis demonstrated an inverse association between severe outcomes and levels of miR-296-5p (adjusted odds ratio = 0.89; 95% confidence interval [0.81, 0.98], p = 0.021) while controlling for age, sex, race, weight, insurance, diabetes, asthma, fever, and symptom duration. The model had an area under curve of 0.744 (sensitivity = 0.71, specificity = 0.66). Measurement of saliva miRNA in conjunction with demographic and clinical characteristics may aid in the prediction of severe illness. Larger, longitudinal studies to assess the utility of salivary miRNAs in SARS-CoV-2 and other viral infections are needed.
Mobile phone addiction not only poses potential adverse effects on the effective implementation of educational and teaching activities, but also exerts a detrimental influence on students' mental health. Negative life events have been identified as a significant contributing factor to mobile phone addiction among vocational college students. Although prior research has investigated the relationship between life events and problematic mobile phone use, this study represents the first comprehensive examination of the sequential mediating roles of perceived stress and psychological resilience in the association between negative life events and mobile phone addiction. This investigation not only extends the application of stress-coping theory within the domain of digital behavior addiction, but also offers novel empirical insights and potential intervention strategies for understanding the psychological vulnerability and adaptive mechanisms involved in the development of mobile phone addiction among vocational college students. The present study investigates the relationship between perceived stress and psychological resilience in the context of negative life events and mobile phone addiction, as well as the underlying mechanisms that mediate this association. Data collection was carried out among 587 vocational college students in Nanchang City, Jiujiang City, and Fuzhou City of Jiangxi Province, using the Self-Rated Life Events Scale for Adolescents, the Perceived Stress Scale, the Psychological Resilience Scale, and the Mobile Phone Addiction Questionnaire. The findings are: (1) Mobile phone addiction is widespread among vocational college students, and the level of mobile phone addiction does not show significant differences in factors such as gender and place of origin. (2) Negative life events among vocational college students are positively associated with mobile phone addiction. (3) Perceived stress and psychological resilience play an independent mediating role and a chain mediating role between negative life events experienced by vocational college students and mobile phone addiction behaviors. The mediating effect includes three paths: negative life events → perceived stress → mobile phone addiction (effect size: 0.200), negative life events → psychological resilience → mobile phone addiction (effect size: 0.047), and negative life events → perceived stress → psychological resilience → mobile phone addiction (effect size: 0.024). This study highlights that negative life events are directly associated with mobile phone addiction among vocational college students, and also are indirectly associated with the degree of mobile phone addiction among vocational college students through the mediating effects of perceived stress and psychological resilience. The research results provide an important theoretical basis for higher vocational colleges to deeply understand the psychological causes of students' mobile phone addiction, which is conducive to optimizing the content of mental health education in schools and strengthening stress management training and psychological resilience cultivation in a targeted manner. It provides scientific support for educators to design stratified intervention plans and prevent problematic mobile phone usage behaviors, and also offers a powerful practical reference for promoting the formulation of digital health promotion policies for vocational college students and creating a positive and healthy campus network environment.
The Coronavirus Disease 2019 (COVID-19) pandemic raised the need for rapid approaches for measuring population-based health indicators to understand its impact on service utilization, while avoiding face-to-face interviews. The Rapid Mortality Mobile Phone Surveys (RaMMPS) aimed to test the use of mobile phone surveys (MPS) for measuring maternal health services coverage in Mozambique by comparing estimates to the nationally representative Demographic Health Survey 2022 (DHS 2022). RaMMPS used two strategies: (i) subsampling from the existing national sample registration system, Country-wide Mortality Surveillance for Action (COMSA); (ii) Random Digit Dialing (RDD) of randomly generated phone numbers. We collected data from March to August 2022 for the COMSA MPS sample, and from June to December 2022 for the RDD sample. In both cases, computer-assisted telephone interviews were conducted among women aged 15-49 years. Women were asked questions on utilization of maternal health care (MHC) services for births within the 2 years preceding the survey. We compared adjusted MHC coverage estimates between each RaMMPS sample and the DHS 2022. Despite adjustment to redress the MPS samples, MHC coverage was higher in MPS samples compared to the DHS 2022 sample. The coverage of at least one antenatal care visit was 99% [95% confidence interval (CI): 98-99] in COMSA MPS and 98% (95% CI: 95-99) in RDD samples compared to 81% (95% CI: 79-84) in the DHS 2022 sample. Additionally, coverage of at least four antenatal care visits was 76% (95% CI: 73-80) in COMSA MPS and 85% (95% CI: 81-88) in RDD samples, compared to 48% (95% CI: 45-51) in the DHS 2022. Coverage of health facility delivery was 87% (95% CI: 84-90) in COMSA MPS and 90% (95% CI: 85-93) in RDD samples compared to 40% (95% CI: 38-62) in the DHS 2022. Similarly, skilled birth attendant coverage was 86% (95% CI: 82-89) and 88% (95% CI: 84-92), respectively, in COMSA MPS and RDD samples compared to 48% (95% CI: 46-49) in the DHS 2022. MHC coverage measured through MPS was consistently overestimated compared to nationally representative surveys, even after adjustments.
The rapid growth of digital technologies has transformed daily activities, health management, and social interaction. Older adults, however, continue to face challenges in adopting and using these tools due to limited previous exposure, age-related sensory or cognitive decline, and low digital confidence. In Brazil, internet access among adults aged  60 years or older has increased, yet digital exclusion persists, worsening health disparities. Mobile health (mHealth) apps offer a potential strategy to promote digital inclusion, strengthen digital competencies, and support healthy aging. Nonetheless, studies show that culturally adapted, multidisciplinary interventions for this group remain scarce and are rarely assessed through both quantitative and qualitative methods. This study aimed to evaluate the impact of a lifestyle mHealth app on improving digital skills, as well as to analyze the level of satisfaction and usability of the app. In this mixed methods study, a 14-week randomized clinical trial was conducted in Ribeirão Preto, São Paulo, Brazil. A total of 40 older adult women were randomized into an intervention group (n=21), who used the mobile app, and a control group (n=19). Digital competencies were measured before and after the intervention using a semistructured questionnaire based on the Modelo de Competências Digitais para M-learning com foco em idosos (MCDMSênior; Digital Competency Model for M-learning with a focus on older adults) framework, covering 6 domains-basic technology use, internet navigation, mobile app use, online research, digital communication, and usage of digital resources. Additionally, satisfaction with the educational content was evaluated using the suitability assessment of materials, and system usability was assessed using the System Usability Scale. Qualitative data were collected through semistructured, in-person interviews conducted immediately after the intervention with all intervention participants. Interviews explored perceptions of the app's usability, satisfaction with its content, barriers, and facilitators to engagement, and perceived changes in digital skills. All interviews were audio-recorded, transcribed, and analyzed thematically by 2 independent researchers using an inductive coding approach. Postintervention analyses revealed significant differences in specific digital competencies. The intervention group demonstrated a moderate improvement in internet navigation skills, while gains in basic technology use and digital communication were minimal. Conversely, the control group exhibited moderate improvement in basic technology skills and lower effects in online research and digital communication. Overall, satisfaction with the educational content was low, and usability was rated as average. Qualitative findings indicated that, although participants valued the clarity of navigation and cultural relevance, persistent age-related fears and insecurities in using digital technologies were reported. Participants highlighted the need for more personalized guidance, ongoing motivational support, and technical adjustments to improve usability and engagement. mHealth apps can effectively enhance certain digital competencies in older women, particularly internet navigation, but improvements in content suitability and usability are needed. Refinements in design and tailored support are essential to overcome age-related barriers and foster digital inclusion.
To describe posttonsillectomy telephone triage utilization and short-term outcomes in a single tertiary pediatric system. Retrospective cohort study. Tertiary care children's hospital. All patients aged 0 to 18 years (N = 12,167) who underwent tonsillectomy between January 2020 and December 2024 were included. Primary outcomes included timing and type of telephone calls, emergency department (ED) visits, and bleeding events within 30 postoperative days. Secondary outcomes included intervention rates based on presentation pathway (telephone triage vs direct ED presentation). Among 12,167 patients, 2483 (20.4%) contacted telephone triage within 30 days. Of callers, 2273 (91.5%) were managed without ED referral; 210 (8.5%) were referred to the emergency department. Of bleeding related calls, 111 (66.9%) were managed without ED referral, and 41/60 (68.3%) patients referred to the ED did not require surgical intervention. Telephone triage demonstrated 91.5% effectiveness and prevented 2273 ED visits. Patients utilizing telephone-based triage were more likely to have Medicaid insurance (P < .001) and live in high-disadvantage neighborhoods (P < .001). Telephone-based triage is an effective measure to help reduce ED visits for pediatric posttonsillectomy patients. The majority of patients who utilized telephone-based triage were successfully managed at home across all types of complications. There is a potential $158,000 to $360,000 in healthcare savings seen after implementing this program. High-disadvantage patients were more likely to use telephone-based triage but achieved similar outcomes to low-disadvantaged peers. In this cohort, a structured phone-triage pathway safely managed most concerns without ED referral.
Frontotemporal dementia (FTD) comprises a heterogeneous group of neurodegenerative syndromes with variable behavioral, cognitive, and language profiles. Longitudinal data describing its clinical course using FTD-specific instruments remain scarce. This study aimed to characterize the functional, cognitive, and behavioral trajectories of FTD subtypes in a Spanish cohort, including assessments performed remotely during the COVID-19 pandemic. Sixty-seven patients diagnosed with behavioral variant FTD (bvFTD), non-fluent variant primary progressive aphasia (nfvPPA), or semantic variant PPA (svPPA) were prospectively followed at Hospital Universitario 12 de Octubre (Madrid, Spain). Functional and neuropsychiatric status were evaluated using the Frontotemporal Dementia Rating Scale (FTD-FRS), the Interview for Deterioration in Daily Activities in Dementia (IDDD), the Neuropsychiatric Inventory (NPI), and the telephone Mini-Mental State Examination (T-MMSE). Thirty-three assessments were conducted remotely during pandemic restrictions. Over a mean follow-up of 3.1 years, significant declines were found in T-MMSE, FTD-FRS, and IDDD (p < 0.001), whereas NPI scores remained stable. The svPPA group exhibited the greatest cognitive and functional deterioration, while bvFTD showed more heterogeneous progression. Twelve participants (18%) died during follow-up, mainly older men with poorer baseline performance. Functional and cognitive decline in FTD varies across variants, with the semantic subtype showing the most aggressive course in our cohort. Remote assessments are feasible and valid for longitudinal monitoring.
Criteria-Based Dispatch (CBD) is Thailand's national telephone-based prehospital triage system used to prioritize emergency response and allocate resources. However, long-term national trends in CBD utilization and their implications for healthcare leadership remain limited. This study aimed to analyze 10-year trends in CBD utilization in Thailand (2012-2022), focusing on overall patterns, age groups, and geographic variations to inform policy and EMS planning. This retrospective descriptive study analyzed 14,763,882 emergency calls recorded in the national EMS database. Trend analyses were conducted to assess temporal changes across CBD categories, demographic subgroups, and regions. Of 14,758,415 eligible calls, CBD 25 (motor vehicle accident) was the most common category (23.6%) and showed a significant increasing trend with seasonal peaks during the New Year period (p < 0.001). Adults aged 18-59 years accounted for the largest proportion of calls (52.4%), with CBD 25 predominating (31.5%). Among older adults (≥60 years), CBD 17 (sick [unknown]/other) was most frequent (33.3%). Regionally, the Northeast had the highest call volume (46.7%), where CBD 17 predominated, while CBD 25 was most common in other regions. These findings describe important variations in EMS demand across population groups and regions and may inform workforce planning, resource allocation, and targeted prevention strategies.
The success of surgical intervention extends beyond what is done in the operating room, as the patient's postoperative rehabilitation is a major component of their clinical outcome for many orthopedic surgeries. Timing the dissemination of postoperative instructions can be an important factor in how well the patient remembers and adheres to the treatment plan. Surgery is a major stress to many patients, and it is understandable that information would be lost or forgotten. In an effort to reliably disseminate accurate and easy-to-understand instructions for postoperative care plans, we have implemented the use of individualized patient instruction videos during the postoperative discussion. The video, recorded on the patient's cell phone, provides an immediate resource the patient can return to as questions arise at home to guide their care as they recover.
The adoption of telehealth has surged in recent years, particularly following the COVID-19 pandemic, due to its ability to increase access, reduce logistical burdens, and improve convenience for patients and providers alike. In the context of gender-affirming surgery (GAS), where barriers such as stigma, geographic distance, and cost persist, telehealth offers a promising alternative to traditional in-person care. Telehealth in the gender affirmation surgery setting, virtual vs. in-person initial consultations in a surgical setting, and surgical conversion rates by initial consultation venue, are under-examined. This study aims to examine differences in patient "conversion rates" (completion of surgery) based on modality of initial consultation: phone call, video, or in-person. All patients at a single gender affirmation surgery practice from practice inception to March 2023 were reviewed for initial consultation appointment modality, patient demographics, payor mix, type of surgery, and conversion to surgery. Data were compared via Chi-square independence analysis. Of the 3581 patients who had initial consultations, 1728 (48.3%) pursued surgery. Of the 3402 initial consultations, 1898 (55.8%) selected video visits, while 1061 (31.2%) chose phone visits and only 443 (13%) chose in-person visits. No significant differences in surgical conversion rates between groups (46.1-47.9%, p=0.81) were seen. Subgroup analysis by type of surgery showed no significant differences in conversion rates versus consultation modality. Most patients at our practice have initial consultations virtually. Virtual consultations for gender affirmation surgery do not demonstrate significantly different surgical uptake rates compared to in-person visits.
Daily positive and stressful events are determinants of everyday well-being, yet little is known about how they shift alongside normative cognitive aging. Losses in executive functioning and episodic memory may come along with a reduction in daily life engagement, such as the extent to which people experience positive events and stressors. Thus, we examined whether a nine-year change in cognitive functioning tracked with contemporaneous change in daily events. 988 adults from the Midlife in the United States study (baseline mean age 53.7 years) completed telephone assessments of executive functioning and episodic memory, and eight consecutive days of diaries assessing the occurrence of daily events at two waves about nine years apart. Using structural equation models, we estimated mean change and co-change across cognition and daily positive events, and stressors. On average, executive functioning showed declines in the overall sample, whereas episodic memory only showed declines among the older participants. Positive events increased while stressors slightly decreased. There was a positive association between changes in positive events and stressors: people who experienced an increase in positive events also experienced an increase in the number of stressors. Changes in cognition, however, were unrelated to changes in either event type. In this population-based sample, normative cognitive aging appeared largely decoupled from concurrent shifts in daily affective events, which suggests that age-related changes in the frequency of daily events and cognition are driven by different underlying mechanisms.
Telemedicine in Africa has evolved from small-scale pilots to an essential tool for enhancing healthcare access, efficiency, and equity. Early efforts faced challenges due to limited infrastructure, high costs, and weak policies. The COVID-19 pandemic accelerated telemedicine adoption, exposing the need for stronger digital health strategies. Despite interest, many countries still struggle with regulation, coordination, and scaling sustainable implementations. This review examines the development and policy adoption of telemedicine across Africa before and after the pandemic, identifying key innovations, ongoing challenges, and lessons to guide future digital health planning. A narrative review was conducted, with study selection guided by PRISMA transparency standards. A structured search was conducted across PubMed, Google Scholar, Web of Science, Cochrane Library, Scopus, and policy databases from the WHO, the African Union, and UNECA. The search included publications from 2000 to 2025, focusing on English-language studies addressing telemedicine policies or implementation in African countries. The COVID-19 pandemic accelerated adoption, driving rapid innovation and policy shifts. In Nigeria, platforms such as MobiHealth, Tremendoc, and Dokilink expanded access via phone and WhatsApp, maintaining care during lockdowns. In South Africa, regulatory reforms enabled consultations without prior doctor-patient relationships, allowing 97% of patients to be managed virtually and reducing hospital burden. Nurse-led teleconsultations improved access, while a remote diabetes program reduced mortality by 20% among high-risk patients. Telepsychiatry expanded mental health services, and SMS-based interventions remained the most widely used due to affordability and accessibility. Despite progress, policy responses were uneven. South Africa's rapid reforms contrasted with Nigeria's fragmented frameworks, which lacked enforceable telemedicine provisions. Persistent challenges include weak data governance, limited interoperability, inadequate funding, and "pilotitis," where projects fail to scale. Telemedicine adoption in Africa has grown markedly since COVID-19 but remains constrained by infrastructural and regulatory weaknesses, and variable acceptance. Strengthening legal frameworks, improving infrastructure, and increasing awareness among providers and communities are vital to sustain progress, integrate telehealth into routine care, foster innovation, and enhance equitable healthcare across the continent.
To assess the evidence supporting the implementation of nurse-led, technology-based interventions to improve the self-care of patients discharged from hospital with heart failure (HF) and at high risk of poor health outcomes. We followed PRISMA guidelines, searching PubMed, Scopus, Web of Science, EMBASE, ScienceDirect, CINAHL, Clinical Key, Cochrane CENTRAL, ClinicalTrials.gov, and Google Scholar for randomized controlled trials (RCTs) comparing post-discharge, nurse-led, technology-based self-care programs (e.g., telehealth education, mobile apps) versus usual care applied to adult HF patients. The main outcome measure was the Self-Care of Heart Failure Index (SCHFI). Data was pooled in RevMan 5.4.1 using random effects. Overall, 9 RCTs comprising 952 participants with a mean age ∼59-78 years, 65% male and most NHYA Class II-III were included. Seven trials applied telephone-based support, one a mobile-health (mHealth) app, and the other an avatar-based app. Intervention content included structured education, motivational interviewing, and symptom monitoring. Technology-based, nurse-delivered interventions showed statistically significant positive effects on self-maintenance (SMD = 0.97; 95% CI: 0.57-1.37), self-management (SMD = 0.84; 95% CI: 0.40-1.28), and self-confidence (SMD = 0.80; 95% CI: 0.47-1.13) with m-health and telephone-based approaches demonstrating the most significant effects. However, heterogeneity was consistently high across all outcomes (I2 = 82%-90%), which may be explained by variations in follow-up. Nurse-led, technology-based interventions significantly enhanced self-care maintenance, management, and confidence in post-discharge HF patients, whilst demonstrating other benefits. However, high between-study variability, reflecting diverse care settings, cultures, and technologies, also limits their generalizability. PROSPERO CRD42025633134.
The aim of the study was to evaluate the accuracy of responses from three common artificial intelligence (AI) tools - ChatGPT, Claude, and DeepSeek - to patient enquiries regarding lower urinary tract symptoms (LUTS), comparing these responses to European Association of Urology (EAU) 2025 guidelines. As patients increasingly turn to large language models (LLMs), it is crucial to assess their reliability. Prospective face-to-face and telephone general urology clinics were conducted between April and May 2025, during which consented patients were asked to state the questions they would submit to an AI tool if they were to enquire about their LUTS. These questions were submitted to ChatGPT (GPT-4), Claude (Sonnet 4.0), and DeepSeek (V3), and the responses were summarised and compared against the EAU guidelines. Each response was categorised as correct, missing key elements from the guidelines, or incorrect/misleading. Sixteen patients participated in the study, and following removal of duplicate questions, a total of 13 were included for analysis. These questions covered symptom causation, diagnostic workup and management of LUTS. All models provided correct information in 92.3% of their responses when compared to the EAU guidelines. However, 92.3-100% of answers omitted key elements from the guidelines, and 30.8-92.3% contained incorrect or misleading content. Current LLMs provide readily accessible guidance on LUTS; however, their unsupervised use in clinical decision-making remains a concern and may be considered premature.
Spondyloarthritis (SpA) comprises a heterogeneous group of chronic inflammatory diseases. Axial SpA (axSpA) predominantly involves the sacroiliac joints and the spine and typically presents with back pain and stiffness. Modern imaging techniques, especially MRI, allow earlier detection of axSpA compared to conventional radiography, but imaging findings still need cautious interpretation to facilitate a clinical diagnosis.This cohort study of patients with suspected SpA is designed to (1) compare demographic, clinical, laboratory, imaging data and patient-reported outcomes (PROs) of patients diagnosed with or without axSpA (2) to identify prognostic factors for the diagnosis of axSpA and high disease activity (3) to compare performance of different imaging modalities for establishing a diagnosis of axSpA. The study is a 2-year prospective observational cohort study of consecutive patients with low back pain ≥3 months and ≤3 years and symptom onset at age 18-45 years, suspected of axSpA.Clinical visits are conducted at baseline, week 6, 12 (telephone consultation), 24, 48, 72 and 96. Demographics, clinical data, laboratory findings and PROs are collected. Radiography (only at baseline), MRI, low-dose computed tomography (ldCT) and dual-energy CT (DECT) are performed at baseline and prior to the last study visit. Clinical, laboratory and imaging data are prior to visits at week 6 and week 96 assessed at a multidisciplinary team (MDT) conference involving a musculoskeletal radiologist and a rheumatologist, where a diagnosis of axSpA or not will be determined.Descriptive statistics are used to summarise clinical, PROs and imaging data. Comparisons between axSpA patients and non-axSpA patients are made cross-sectionally at baseline and week 96. We want to investigate and compare the diagnostic performance, the ability to detect structural and inflammatory lesions and the incremental diagnostic value of ldCT and DECT compared to MRI and radiography. The ethical committee of the Region of Southern Denmark (S-20230055) has approved the study. The study is registered at clinicaltrials.gov (NCT06337513). Results will be presented at both national and international conferences, as well as published in peer-reviewed journals.
Clasp-retained dentures are high-risk esophageal foreign bodies that carry a substantial risk of severe esophageal injury. Reliable protection strategies are therefore critical for safe endoscopic extraction. We present a case of successful endoscopic removal of a clasp-retained denture impacted at the aortic arch level using a retrievable silicone-covered esophageal stent as a protection device. A 50-year-old man with hypertension and coronary stent implantation was admitted with retrosternal pain and dysphagia for 4 h after accidental ingestion of a broken denture. Computed tomography confirmed a 1.3 × 2.0 × 4.7 cm foreign body impacted at the aortic arch level. The foreign body was successfully removed under general anesthesia with tracheal intubation, and no intraoperative complications occurred. Postoperative recovery was uneventful. Telephone follow-up at 1 week, 1 month, and 3 months showed that the patient had a normal diet with no discomfort, and the patient declined endoscopic reexamination. This case confirms that a retrievable silicone-covered esophageal stent is a safe and feasible protection device for endoscopic extraction of high-risk dentures at the aortic arch level, with favorable short- and medium-term outcomes. It provides a valuable clinical reference for managing such life-threatening foreign bodies.
Appendicitis is one of the most common diseases of the gastrointestinal tract with a lifetime incidence of 7 to 9%. Appendectomy is one of the most performed emergency surgeries. Recently, non-operative treatments are emerging. It is almost impossible to keep the overview on the large and growing body of evidence on appendicitis. Therefore, the aim of this project was to create a systematic and living Evidence Map of Appendicitis. PubMed, CENTRAL, Web of Science, EMBASE were systematically and continuously searched for all published and ongoing randomized controlled trials (RCT) and systematic reviews (SR) dealing with diagnosis and treatment of appendicitis. Outcomes from every existing RCT were extracted and trial quality was assessed. RCTs and SRs on identical subjects were grouped to research topics. For specific treatment outcomes, meta-analyses were performed for all research topics with more than 3 RCTs. Out of 16373 articles screened, 527 RCTs on 104331 patients and 408 SRs were included and grouped into 74 research topics with 31 living meta-analyses. Most RCTs were from Asia (43%),followed by Europe (32%) and North America (15%). Living meta-analyses were performed for 31 out of 74 research topics. For three out of 74 research topics (4%) there were no RCT available. The Evidence Map of Appendicitis is the ultimate go-to source for evidence on appendicitis. Constantly updated and freely accessible via www.EVIglance.com and as mobile phone app. Clinical decision-making, evidence-based patient information are supported by the primary data provided, as well as by living meta-analyses. PROSPERO 2023 CRD42023482686.