Healthcare最新文献

{"title":"Effect of a Peripheral Neuromodulation Protocol Combined with the Application of Therapeutic Exercise in Patients Diagnosed with Urinary Incontinence-A Study Protocol for a Randomized Controlled Trial.","authors":"Jesica Leal-García, Paula Blanco-Giménez, Eloy Jaenada-Carrillero, Marta Martínez-Soler, Borja Huertas-Ramírez, Alex Mahiques-Sanchis, Juan Vicente-Mampel","doi":"10.3390/healthcare13141759","DOIUrl":"https://doi.org/10.3390/healthcare13141759","url":null,"abstract":"<p><p><b>Introduction:</b> Overactive bladder (OAB) and urinary incontinence (UI) are prevalent, particularly in older adults, and affect quality of life. OAB involves urgency, frequency, nocturia, and urgency incontinence, often linked to involuntary detrusor contractions. Treatment guidelines recommend a stepwise approach, starting with pelvic floor muscle training (PFMT), followed by pharmacological or minimally invasive therapies, such as neuromodulation. However, the combined effects of PFMT and neuromodulation have not been well established. This study aimed to evaluate the impact of combining pelvic floor exercises with neuromodulation versus PFMT with sham neuromodulation or standard physiotherapy after a 12-week intervention in individuals with OAB and UI. <b>Methods/Materials:</b> A double-blind, randomized controlled trial was designed with three groups: PFMT + neuromodulation, PFMT + sham, and conventional physiotherapy (control) in a 1:1:1 ratio. This study followed the CONSORT guidelines and was registered at ClinicalTrials.gov (NCT06783374). The sample size was calculated using GPower^® software, assuming a Cohen's effect size of 1.04, a power of 0.80, an alpha of 0.05, and a 15% dropout rate, totaling 63 participants (21 per group). Participants attended 24 sessions over 12 weeks (2 sessions per week). The interventions were based on previously validated protocols. <b>Outcomes:</b> The primary outcomes included health-related quality of life, pelvic floor muscle function, pain, adherence, and general health. The secondary outcomes included Incontinence Quality of Life questionnaire, 3-day bladder diary, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, kinesiophobia, and electromyographic data.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 14","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatricians' Perspectives on Task Shifting in Pediatric Care: A Nationwide Survey in Japan.","authors":"Masatoshi Ishikawa, Ryoma Seto, Michiko Oguro, Yoshino Sato","doi":"10.3390/healthcare13141764","DOIUrl":"https://doi.org/10.3390/healthcare13141764","url":null,"abstract":"<p><p><b>Background/Objectives</b>: In Japan, task shifting reduces the working hours of pediatricians, who face excessive workloads. The status of task shifting under the Ministry of Health, Labor, and Welfare's reforms remains unclear. This study aimed to evaluate the current status and barriers of task shifting in pediatric care in Japan. <b>Methods</b>: A questionnaire survey was conducted among pediatricians working in hospitals in Japan. The results were compared with those from 2020. <b>Results</b>: Questionnaires were sent to 835 hospitals, and valid responses were received from 815 pediatricians in 316 hospitals (response rate: 37.8%). The largest group (31.0%) was 40-49 years, and 34.4% of the participants were women. Among the items surveyed, most pediatricians indicated \"shifted\" in \"Patient transfer (transporting between hospitals using an ambulance)\" and \"Intravenous injection of antibiotics.\" Most physicians believed task shifting improved care quality; 10.3% felt it worsened. The most common estimate for daily working hour reduction due to task shifting was \"1 to <2 h\" (44.9%). Precisely 15.8% of pediatricians believed that task shifting had \"not progressed at all,\" with rural areas and non-university hospitals showing lower task-shifting implementation. National university hospitals had a higher likelihood of task shifting than public hospitals. No significant associations were observed for the total hospital bed count or the number of full-time pediatricians. <b>Conclusions</b>: Task shifting in pediatric care remains underdeveloped. While many pediatricians support the concept and report modest reductions in working hours, actual implementation remains limited. Future efforts must address systemic, institutional, and regulatory challenges to facilitate meaningful task redistribution and improve healthcare delivery.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 14","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Work Stress and Eating Behavior: A Study Among Academicians in Türkiye.","authors":"Merve İnce-Palamutoğlu, Betül Oruçoğlu, Meltem İnce-Yenilmez, Gizem Ağır","doi":"10.3390/healthcare13141758","DOIUrl":"https://doi.org/10.3390/healthcare13141758","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Occupational stress is a common issue among academics. This study aims to determine the level of work stress experienced by academics depending on their titles and the relationship between this stress and eating behaviors. <b>Methods:</b> The data for the study were collected through an online survey from 649 academicians working in universities in Türkiye between January and February 2025. This is a cross-sectional study, and the snowball sampling method was used to facilitate high participation rates. Data were collected using a demographic questionnaire, the General Work Stress Scale (GWSS) to assess work stress levels, and the Turkish version of the Adult Eating Behavior Questionnaire (AEBQ-TR) to evaluate eating behaviors. <b>Results:</b> Among the participants, 47.6% were of normal weight, with an average BMI of 25.85 ± 4.56 kg/m². The median work stress score of male academicians (17.00) was significantly lower than that of female academicians (21.00) (<i>p</i> < 0.001). Similarly, the median eating behavior score was lower in male academicians (18.55) compared to females (19.78) (<i>p</i> < 0.001). Work stress levels decreased with increasing academic title, with professors reporting the lowest levels of stress (<i>p</i> < 0.001). <b>Conclusions:</b> The findings indicate that female academics are more likely to engage in emotional eating under stress, whereas male academics tend to alter their dietary preferences by avoiding certain foods. These results underscore the importance of stress management and the promotion of healthy eating habits among academics.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 14","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the Unmet Informational Needs of Young Portuguese Female Cancer Survivors: Psychometric Validation of a Multidimensional Scale.","authors":"Luana Almeida, Ana Bártolo, Sara Monteiro, Isabel S Silva, Ana Conde, Alexandra M Araújo, Luiz Lourenço, Isabel M Santos","doi":"10.3390/healthcare13141757","DOIUrl":"https://doi.org/10.3390/healthcare13141757","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Young female cancer survivors often face specific informational needs related to the physical and emotional effects of cancer and its impact on life plans, particularly fertility and parenthood. However, few tools are tailored to assess these needs during this critical life stage. This study aimed to (i) validate a multidimensional measure-the Satisfaction with Information Provided to Young Oncology Patients Scale (SIPYF-CPS)-to assess the specific informational needs of young adult female cancer survivors; and (ii) explore preferences regarding the provision of information and counseling. <b>Methods:</b> A total of 124 women (M[age] = 38.18; SD = 5.49; range 21-45), 76.6% diagnosed with breast cancer, participated in the study. Psychometric analyses included exploratory factor analysis and correlation coefficients to assess reliability and construct validity. Convergent validity was evaluated through standardized measures of anxiety, reproductive concerns, and quality of life. <b>Results:</b> A final 22-item measure demonstrated strong reliability and validity, capturing four factors: (i) Disease-Related Information, (ii) Symptoms and Functional Limitations, (iii) Implications for Fertility and Parenthood, and (iv) Support Services. Participants expressed low satisfaction with information on fertility preservation, sexual health, and support services. Lower satisfaction was moderately associated with higher anxiety and depression while positively related to quality of life. Most participants preferred phased, face-to-face communication throughout the illness trajectory. <b>Conclusions:</b> The SIPYF-CPS is a valid, multidimensional tool that captures the complex and evolving informational needs of young female cancer survivors. Its clinical use may promote earlier, personalized, and emotionally responsive communication-supporting psychological well-being, informed decision-making, and long-term survivorship care.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 14","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benchmarking AI Chatbots for Maternal Lactation Support: A Cross-Platform Evaluation of Quality, Readability, and Clinical Accuracy.","authors":"İlke Özer Aslan, Mustafa Törehan Aslan","doi":"10.3390/healthcare13141756","DOIUrl":"https://doi.org/10.3390/healthcare13141756","url":null,"abstract":"<p><p><b>Background and Objective:</b> Large language model (LLM)-based chatbots are increasingly utilized by postpartum individuals seeking guidance on breastfeeding. However, the chatbots' content quality, readability, and alignment with clinical guidelines remain uncertain. This study was conducted to evaluate and compare the quality, readability, and factual accuracy of responses generated by three publicly accessible AI chatbots-ChatGPT-4o Pro, Gemini 2.5 Pro, and Copilot Pro-when prompted with common maternal questions related to breast-milk supply. <b>Methods:</b> Twenty frequently asked breastfeeding-related questions were submitted to each chatbot in separate sessions. The responses were paraphrased to enable standardized scoring and were then evaluated using three validated tools: ensuring quality information for patients (EQIP), the simple measure of gobbledygook (SMOG), and the global quality scale (GQS). Factual accuracy was benchmarked against WHO, ACOG, CDC, and NICE guidelines using a three-point rubric. Additional user experience metrics included response time, character count, content density, and structural formatting. Statistical comparisons were performed using the Kruskal-Wallis and Wilcoxon rank-sum tests with Bonferroni correction. <b>Results:</b> ChatGPT-4o Pro achieved the highest overall performance across all primary outcomes: EQIP score (85.7 ± 2.4%), SMOG score (9.78 ± 0.22), and GQS rating (4.55 ± 0.50), followed by Gemini 2.5 Pro and Copilot Pro (<i>p</i> < 0.001 for all comparisons). ChatGPT-4o Pro also demonstrated the highest factual alignment with clinical guidelines (95%), while Copilot showed more frequent omissions or simplifications. Differences in response time and formatting quality were statistically significant, although not always clinically meaningful. <b>Conclusions:</b> ChatGPT-4o Pro outperforms other chatbots in delivering structured, readable, and guideline-concordant breastfeeding information. However, substantial variability persists across the platforms, and none should be considered a substitute for professional guidance. Importantly, the phenomenon of AI hallucinations-where chatbots may generate factually incorrect or fabricated information-remains a critical risk that must be addressed to ensure safe integration into maternal health communication. Future efforts should focus on improving the transparency, accuracy, and multilingual reliability of AI chatbots to ensure their safe integration into maternal health communications.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 14","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Consequence Analysis of Semaglutide vs. Liraglutide for Managing Obese Prediabetic and Diabetic Patients in Saudi Arabia: A Single-Center Study.","authors":"Najla Bawazeer, Seham Bin Ganzal, Huda F Al-Hasinah, Yazed Alruthia","doi":"10.3390/healthcare13141755","DOIUrl":"https://doi.org/10.3390/healthcare13141755","url":null,"abstract":"<p><p><b>Background</b>: Semaglutide and Liraglutide are medications in the Glucagon-like peptide-1 agonists (GLP-1 RAs) class used to manage type 2 diabetes mellitus and obesity in Saudi Arabia. Although the 1.0 mg once weekly dosage of Semaglutide does not have a labeled indication for the management of obesity, many believe that this dosage is more effective than the 3.0 mg once daily Liraglutide dosage for the management of both diabetes and obesity. <b>Objective</b>: To compare the effectiveness of the dosage of 1.0 mg of Semaglutide administered once weekly versus 3.0 mg of Liraglutide administered once daily in controlling HbA1c levels, promoting weight loss, and evaluating their financial implications among obese patients in Saudi Arabia using real-world data. <b>Methods</b>: A retrospective review of Electronic Medical Records (EMRs) from January 2021 to June 2024 was conducted on patients prescribed Semaglutide or Liraglutide for at least 12 months. Exclusion criteria included pre-existing severe conditions (e.g., cardiovascular disease, stroke, or cancer) and missing baseline data. The primary outcomes assessed were changes in HbA1c, weight, and direct medical costs. <b>Results</b>: Two hundred patients (100 patients on the 1.0 mg once weekly dose of Semaglutide and 100 patients on the 3.0 mg once daily dose of Liraglutide) of those randomly selected from the EMRs met the inclusion criteria and were included in the analysis. Of the 200 eligible patients (65.5% female, mean age 48.54 years), weight loss was greater with Semaglutide (-8.09 kg) than Liraglutide (-5.884 kg). HbA1c reduction was also greater with Semaglutide (-1.073%) than Liraglutide (-0.298%). The use of Semaglutide resulted in lower costs of USD -1264.76 (95% CI: -1826.82 to 33.76) and greater reductions in weight of -2.22 KG (95% CI: -7.68 to -2.784), as well as lower costs of USD -1264.76 (95% CI: (-2368.16 to -239.686) and greater reductions in HbA1c of -0.77% (95% CI: -0.923 to -0.0971) in more than 95% of the cost effectiveness bootstrap distributions. <b>Conclusions</b>: Semaglutide 1.0 mg weekly seems to be more effective and cost-saving in managing prediabetes, diabetes, and obesity compared to Liraglutide 3.0 mg daily. Future studies should examine these findings using a more representative sample and a robust study design.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 14","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Family Support, C-Reactive Protein and Body Mass Index Among Outpatients with Schizophrenia.","authors":"Argyro Pachi, Athanasios Tselebis, Evgenia Kavourgia, Nikolaos Soultanis, Dimitrios Kasimis, Christos Sikaras, Spyros Baras, Ioannis Ilias","doi":"10.3390/healthcare13141754","DOIUrl":"https://doi.org/10.3390/healthcare13141754","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background/Objectives:&lt;/b&gt; Schizophrenia has been associated with increased inflammatory and metabolic disturbances. Perceived family support potentially affects inflammatory and metabolic biomarkers. The aim of this study was to determine the interrelations between family support, C-reactive protein (CRP) and Body Mass Index (BMI) in a sample of outpatients with schizophrenia. Importantly, this study sought to elucidate the effect of perceived family support on inflammatory processes among patients with schizophrenia. &lt;b&gt;Methods:&lt;/b&gt; In this cross-sectional correlation study, 206 outpatients with schizophrenia in clinical remission completed a standardized self-report questionnaire that assessed family support (Family Support Scale-FSS). Sociodemographic, clinical and laboratory data were also recorded. &lt;b&gt;Results:&lt;/b&gt; Among the participants, 49.5% had detectable CRP values (≥0.11 mg/dL), whereas 14.6% had positive CRP levels (&gt;0.6 mg/dL). There was a significant difference in CRP levels among the different BMI groups (normal weight/overweight vs. obese). For obese patients, the crude odds ratios (ORs) for detectable and positive CRP values were 1.980 (95% confidence interval (CI) [1.056, 3.713]) and 27.818 (95% CI [6.300, 122.838]), respectively. Significant positive correlations were observed among CRP, BMI and illness duration, while scores on the FSS were negatively associated with these variables. The results of binary logistic regression analysis indicated that both BMI and family support were significant factors in determining the likelihood of having positive CRP levels, with each unit increase in the BMI associated with a 17% (95% CI [0.025, 0.337]) increase in the odds, and with each unit increase in family support leading to an 8.6% (95% CI [0.018, 0.15]) decrease. A moderation analysis revealed that the association between family support and the probability of having positive CRP levels depends on the BMI value, but only for obese patients did the protective effect of family support significantly decrease the magnitude of the risk of having positive CRP (b = -0.1972, SE = 0.053, OR = 0.821, &lt;i&gt;p&lt;/i&gt; = 0.000, 95% CI [-0.3010, -0.0934]). &lt;b&gt;Conclusions:&lt;/b&gt; The effect of perceived family support on inflammatory responses becomes evident in cases where beyond metabolic complications, inflammatory processes have already been established. Increased perceived family support seems to protect against inflammation and, notably, the association between low perceived family support and increased inflammation is even stronger. Establishing the role of family involvement during the treatment of patients with schizophrenia through inflammatory processes is a novelty of this study, emphasizing the need to incorporate family therapy into psychiatric treatment plans. However, primary interventions are considered necessary for patients with schizophrenia in order to maintain their BMI within normal limits and avoid the subsequent nosological ","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 14","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Six-Year Longitudinal Study of Psychological Distress, Depression, Anxiety, and Internet Addiction Among Students at One Medical Faculty.","authors":"Meltem Akdemir, Yonca Sonmez, Yesim Yigiter Şenol, Erol Gurpinar, Mehmet Rifki Aktekin","doi":"10.3390/healthcare13141750","DOIUrl":"https://doi.org/10.3390/healthcare13141750","url":null,"abstract":"<p><p><b>Background</b>: Medical education is considered one of the most academically and emotionally demanding training programs. Throughout their education, medical students are exposed to various factors that can lead to psychological distress, depression, and anxiety. The aim of this longitudinal study was to examine the changes in psychological distress, depression, anxiety levels and internet addiction among medical students throughout their six-year education and to identify the contributing factors. <b>Methods</b>: The study cohort consisted of 282 students who enrolled in the medical faculty in the 2017-2018 academic year. A questionnaire including sociodemographic characteristics, the General Health Questionnaire-12 (GHQ-12), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Young Internet Addiction Test (IAT) was administered to the students during the first week of their education. The same questionnaire was readministered at the end of the third and sixth years. Friedman's variance analysis was used to compare measurement data across the three time points, while Cochran's Q Test was employed for categorical variables. <b>Results</b>: The median scores of the GHQ-12, BDI, S-Anxiety, and IAT significantly increased from the first to the sixth year (<i>p</i> < 0.05). The prevalence of depressive symptoms, S-Anxiety, and risky internet use significantly increased from the first to the final year, particularly between the third and sixth years. According to logistic regression analysis based on sixth-year data, students whose fathers were university graduates, who had been diagnosed with COVID-19, and who were dissatisfied with their social lives were found to be at increased risk for psychological distress and depression. Students with high parental expectations were found to be at risk of depression and S-anxiety. Those dissatisfied with their occupational choice were at risk for both psychological distress and S-anxiety. <b>Conclusions</b>: It was found that the mental health of medical students deteriorated during their education, especially during the clinical years. Given that these students will be responsible for protecting and improving public health in the future, it is essential to prioritize their own mental well-being. Interventions aimed at preserving the mental health of medical students should be planned.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 14","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benchmarking ChatGPT-3.5 and OpenAI o3 Against Clinical Pharmacists: Preliminary Insights into Clinical Accuracy, Sensitivity, and Specificity in Pharmacy MCQs.","authors":"Esraa M Alsaudi, Sireen A Shilbayeh, Rana K Abu-Farha","doi":"10.3390/healthcare13141751","DOIUrl":"https://doi.org/10.3390/healthcare13141751","url":null,"abstract":"<p><p><b>Objective:</b> This proof-of-concept study aimed to evaluate and compare the clinical performance of two AI language models (ChatGPT-3.5 and OpenAI o3) in answering clinical pharmacy multiple-choice questions (MCQs), benchmarked against responses from specialist clinical pharmacists in Jordan, including academic preceptors and hospital-based clinicians. <b>Methods:</b> A total of 60 clinical pharmacy MCQs were developed based on current guidelines across four therapeutic areas: cardiovascular, endocrine, infectious, and respiratory diseases. Each item was reviewed by academic and clinical experts and then pilot-tested with five pharmacists to determine clarity and difficulty. Two ChatGPT models-GPT-3.5 and OpenAI o3-were tested using a standardized prompt for each MCQ, entered in separate sessions to avoid memory retention. Their answers were classified as true/false positives or negatives and retested after two weeks to assess reproducibility. Simultaneously, 25 licensed pharmacists (primarily from one academic institution and several hospitals in Amman) completed the same MCQs using validated references (excluding AI tools). Accuracy, sensitivity, specificity, and Cohen's Kappa were used to compare AI and human performance, with statistical analysis conducted using appropriate tests at a significance level of <i>p</i> ≤ 0.05. <b>Results:</b> OpenAI o3 achieved the highest accuracy (83.3%), sensitivity (90.0%), and specificity (70.0%), outperforming GPT-3.5 (70.0%, 77.5%, 55.0%) and pharmacists (69.7%, 77.0%, 55.0%). AI performance declined significantly with increasing question difficulty. OpenAI o3 showed the highest accuracy in the cardiovascular domain (93.3%), while GPT-3.5 performed best in infectious diseases (80.0%). Reproducibility was higher for GPT-3.5 (81.6%, κ = 0.556) than OpenAI o3 (76.7%, κ = 0.364). Over two test rounds, GPT-3.5's accuracy remained stable, whereas OpenAI o3's accuracy decreased from 83.3% to 70.0%, indicating some variability. <b>Conclusions:</b> OpenAI o3 shows strong promise as a clinical decision-support tool in pharmacy, especially for low- to moderate-difficulty questions. However, inconsistencies in reproducibility and limitations in complex cases highlight the importance of cautious, supervised integration alongside human expertise.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 14","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reinforcement Learning and Its Clinical Applications Within Healthcare: A Systematic Review of Precision Medicine and Dynamic Treatment Regimes.","authors":"Timothy C Frommeyer, Michael M Gilbert, Reid M Fursmidt, Youngjun Park, John Paul Khouzam, Garrett V Brittain, Daniel P Frommeyer, Ean S Bett, Trevor J Bihl","doi":"10.3390/healthcare13141752","DOIUrl":"https://doi.org/10.3390/healthcare13141752","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Reinforcement learning (RL), a subset of machine learning, has emerged as a promising tool for supporting precision medicine and dynamic treatment regimes by enabling adaptive, data-driven clinical decision making. Despite its potential, challenges such as interpretability, reward definition, data limitations, and clinician adoption remain. This review aims to evaluate the recent advancements in RL in precision medicine and dynamic treatment regimes, highlight clinical fields of application, and propose practical frameworks for future integration into medical practice. <b>Methods</b>: A systematic review was conducted following PRISMA guidelines across PubMed, MEDLINE, and Web of Science databases, focusing on studies from January 2014 to December 2024. Articles were included based on their relevance to RL applications in precision medicine and dynamic treatment regime within healthcare. Data extraction captured study characteristics, algorithms used, specialty area, and outcomes. <b>Results</b>: Forty-six studies met the inclusion criteria. RL applications were concentrated in endocrinology, critical care, oncology, and behavioral health, with a focus on dynamic and personalized treatment planning. Hybrid and value-based RL methods were the most utilized. Since 2020, there has been a sharp increase in RL research in healthcare, driven by advances in computational power, digital health technologies, and increased use of wearable devices. <b>Conclusions</b>: RL offers a powerful opportunity to augment clinical decision making by enabling dynamic and individualized patient care. Addressing key barriers related to transparency, data availability, and alignment with clinical workflows will be critical to translating RL into everyday medical practice.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 14","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}