Panminerva medica最新文献

Introduction: This systematic review compared the characteristics and clinical outcomes between patients with spontaneous coronary artery dissection (SCAD) and those with Takotsubo Syndrome (TS).

Evidence acquisition: A systematic literature search was performed in PubMed, Embase, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov from inspection to February 1^st, 2025, then it was updated on February 7^th, 2026. The search strategy used the following key words: "Spontaneous Coronary Artery Dissection" OR "Coronary Artery Dissection" OR "SCAD". Additional search was done by adding "Takotsubo Cardiomyopathy," "Takotsubo Cardiomyopathies," or "Takotsubo Syndrome." Data from six studies were analyzed.

Evidence synthesis: Patients with SCAD were significantly younger and exhibited lower rates of comorbidities such as dyslipidemia, hypertension, and diabetes than those with TS. Physical stress as a trigger occurred less frequently in patients with SCAD (odds ratio (OR) 0.37, 95% confidence interval (CI): 0.17; 0.83, P=0.0152; I²=91%), who tend to have higher left ventricular ejection fraction value (MD=14.12, 95% CI: 6.71; 21.62, P=0.0002; I²=100%). While there was no significant difference between the groups in terms of in-hospital death or stroke at follow-up, patients with SCAD had significantly lower risk of death at follow-up (OR=0.07, 95% CI: 0.03; 0.21, P<0.0001; I²=0%) than patients with TS.

Conclusions: In conclusion, patients with SCAD were younger with less frequent comorbidities, and exhibited better long-term survival outcome than those with TS.

Medical decluttering is a pragmatic, ethics-anchored approach to reduce low-value tests, treatments, documentation, and digital noise while preserving safety, dignity, and outcomes that matter to patients and clinicians. It reframes improvement from "doing less" to "doing better," prioritizing value delivered per unit effort and transparent measurement of treatment burden, workload, and harms. We outline why clutter proliferates - decision fatigue, cognitive biases, overdiagnosis, incidental findings, and bureaucratic drift - and how these forces fuel cascades, moral distress, and lost trust. We propose a five-step cycle-Scan, Sort, Select, Safeguard, Sustain-that operationalizes decluttering across patient, team, and system levels through category-first review, explicit thresholds, safety nets, and time-bounded reassessment. Clinical applications include deprescribing with monitored tapers, appropriateness-based testing and screening, pathway redesign to shorten time-to-decision, and courteous refusal scripts paired with contingency plans. Professional practices emphasize agenda setting, message windowing, checklists and dashboards for cognitive offloading, role clarity, digital minimalism, and indication-based telemedicine. Implementation relies on co-designed indicators, governance of order sets and alerts, audit-and-feedback, and rapid learning cycles that balance overuse and underuse while safeguarding equity. By aligning ethics, evidence, and attention, medical decluttering offers a coherent method to reduce cascades, restore focus, and make care simpler, safer, and more humane in internal medicine practice.

Introduction: This review explores the global integration of Artificial Intelligence (AI) in higher education, examining its impact on teaching, learning, and assessment, while addressing implementation challenges, ethical concerns, and opportunities for sustainable, equitable adoption.

Evidence acquisition: A scoping review was conducted following PRISMA guidelines. Peer-reviewed studies published between 2020 and 2024 were identified through Web of Science and SciFinder. Eligible articles were thematically synthesized using the Tranfield, Denyer, and Smart (2003) framework to examine AI integration in teaching, learning, assessment, and related challenges.

Evidence synthesis: Seventy-three studies were analyzed, revealing six major themes: AI for teaching support, learning enhancement, assessment, ethical considerations, implementation challenges, and opportunities. AI has enhanced instructional design, real-time feedback, and personalized learning across diverse disciplines. In assessment, AI facilitates automated grading and adaptive testing but raises concerns about integrity and human oversight. Ethical issues - such as data privacy, algorithmic bias, and academic dishonesty - were recurrent, particularly in under-resourced settings. Challenges include infrastructure deficits, misinformation, low AI literacy, and the absence of governance frameworks. However, AI also presents significant opportunities to improve equity, efficiency, and student engagement when integrated responsibly.

Conclusions: AI is reshaping higher education by enhancing pedagogy and assessment, but its adoption must be balanced with ethical safeguards, educator training, and robust policy frameworks. Institutions must prioritize equitable access, digital infrastructure, and human-centered approaches to ensure AI's responsible and effective use in education.

Background: Clinician-patient rapport is linked to safety, satisfaction, and staff wellbeing, yet large-scale, real-time listening across the National Health Service (NHS) is limited. We examined how public discourse reflects rapport experiences in UK healthcare and assessed the utility of an artificial intelligence-assisted qualitative workflow.

Methods: We conducted an observational qualitative study using reflexive thematic analysis of 5011 publicly available post submissions from the Reddit community r/NHS (1^st January - 31^st December 2024). After cleaning, deduplication, and lexical screening for rapport-related language, a large language model (LLM) supported clustering suggestions and provisional summaries; human researchers led interpretation and theme development. Trustworthiness techniques included analyst triangulation, an audit trail, negative case analysis, and stability checks. Data were non-identifiable and public; research ethics committee review was not required. This study is reported in accordance with the Standards for Reporting Qualitative Research (SRQR).

Results: Five overarching themes were identified: 1) access and delays that erode feelings of being heard; 2) first-contact experiences and gatekeeping at reception/telephone interfaces; 3) professionalism and empathy during clinical encounters; 4) emotional reciprocity and staff wellbeing shaping relational tone; and 5) service variation and perceived inequity across settings. Posts more often described administrative/communication breakdowns than clinical competence issues. Positive narratives highlighted brief empathetic acts that buffered system pressures. Cross-cutting, perceived relational communication moderated how operational strain was experienced. Paraphrased, de-identified exemplars underpin each theme.

Conclusions: Public social-media listening can surface scalable signals about clinician-patient rapport across the NHS. An AI-assisted (LLM-supported) qualitative workflow is feasible and enhances, rather than replaces, human interpretation. Findings suggest targeting first-contact communication and access processes, while aligning patient-facing empathy with staff support.

Introduction: Acute pain is a common symptom that requires prompt and adequate treatment. Ketoprofen lysine salt (KLS) is a non-steroidal anti-inflammatory drug (NSAID) able to rapidly relieves mild-moderate acute pain in children and adolescents. The present study aimed to perform a meta-analysis of controlled studies on this issue.

Evidence acquisition: A scientific literature search selected three controlled trials concerning the KLS use in patients with acute pain. A meta-regression analysis was performed.

Evidence synthesis: The overall trend, modeled through weighted linear regression, confirms a significant time-dependent reduction in pain scores by KLS. The onset of action is quick and analgesic effect is prolonged.

Conclusions: This meta-regression analysis showed that KLS could relieve mild to moderate acute pain promptly and in a prolonged manner over time, as desired by a patient with acute pain.

Introduction: Hyperoncotic albumin is being discussed as an adjunct to diuretics to facilitate fluid off-loading in critically ill patients with fluid accumulation. However, its effectiveness and clinical benefits remain controversial. This critical appraisal examines the current body of evidence to evaluate both the potential benefits and limitations of albumin co-administration with diuretics and/or renal replacement therapy (RRT) in achieving effective net fluid removal in the intensive care unit (ICU).

Evidence acquisition: We performed a systematic literature review of randomized controlled trials (RCTs) and observational studies up to January 2025, adhering to Cochrane Collaboration guidelines. Studies were included if they assessed fluid balance in patients receiving albumin in conjunction with diuretics or RRT for fluid removal. The primary outcome was average daily net fluid balance and secondary outcomes included mortality, ventilator-free days, length of stay, acute kidney injury and change in Sequential Organ Failure Assessment score.

Evidence synthesis: Only four studies involving 196 patients have evaluated net fluid balance in patients receiving albumin as an adjunct to diuretics. Our analysis revealed no significant difference in the average daily net fluid balance between the albumin and control groups (mean difference: -0.22 L/d; 95% CI: -0.88 to 0.43; with high heterogeneity in the reported results. Insufficient data on secondary outcomes was found. No data on the safety-profile in fluid de-resuscitation and on cost-effectiveness are currently available. The methodology of the existing literature is biased, contradictory and of poor overall quality.

Conclusions: This review of albumin co-administration with diuretics and/or RRT in fluid de-resuscitation in the critical ill underscores the limited and often contradictory evidence currently available, despite the frequent use of this practice in clinical settings. Further high-quality research is warranted to determine its efficacy in achieving negative fluid balance and to clarify its impact on clinically relevant patient outcomes.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease characterized by motor neuron degeneration, leading to muscle weakness and respiratory issues. Enteral nutrition is used in ALS patients when they experience severe weight loss, dysphagia, dehydration, or a risk of aspiration pneumonia. Noninvasive ventilation (NIV) is essential for managing respiratory failure in ALS patients, especially during feeding tube placement procedures. This narrative review compares percutaneous endoscopic gastrostomy (PEG), percutaneous radiologic gastrostomy (PRG), and radiologically inserted G-tube (RIG) in ALS patients receiving NIV. Studies were found through electronic database searches of Medline and Embase from 2000 to June 2025, including the Cochrane Central Register of Controlled Trials (CENTRAL), EBSCO Online Research Database, and Scopus. The main outcome was the occurrence of adverse events during and within thirty days after gastrostomy tube placement in NIV. Eleven studies involving NIV during PEG/RIG procedures were included. NIV during PEG, RIG, or PRG placement seems to be safe for ALS patients, with few adverse events reported, though future studies with higher methodological quality are needed. Additionally, the review highlights the benefits of better nutritional support, improved quality of life, interdisciplinary teamwork, increased survival rates, and personalized care.

Background: Achieving optimal skin scarring after surgery is a major concern for patients and physicians worldwide. An innovative form of photobiomodulation, namely Fluorescent Light Energy (FLE), is increasingly used in clinical settings as an adjunct to the Standard of Care (SoC) to treat wounds. In Italy, a post-market observational investigation using data from the Patient and Observer Scar Assessment Scale (POSAS) was conducted to confirm the effectiveness of FLE in managing post-abdominoplasty scars as an adjunct to standard of care (SoC).

Methods: The observational investigation involved the POSAS data of 27 patients treated with FLE treatment, namely LumiHeal. LumiHeal was applied for four weeks during dressing changes following surgery. POSAS questionnaires administered during follow-up visits at three (FU1) and six (FU2) months after surgery were investigated. POSAS scores' percentage decrease and statistically significant P value were calculated.

Results: The results showed a significant decrease in the mean values on POSAS Total Scores from FU1 to FU2, and on each sub-scale of the Observer POSAS, as well as on the Patient POSAS on colour, indicative of healthy healing and aesthetically pleasing scar outcomes. In addition, no patient developed complications, including wound dehiscence or infections, or skin lesions due to FLE applications.

Conclusions: Observational POSAS data evaluation reveals to be a valid tool, suggesting that LumiHeal FLE treatment was an effective adjunctive treatment to the SoC on 27 patients in a real-life setting as an Italian clinic for postoperative scar management.