Scottish Medical Journal最新文献

{"title":"ICDMS: Integrating multimodal data for intelligent clinical decision-making in healthcare: Current trends and future directions.","authors":"Shehnaz, Jameel Ahamed, Abdullah S Albaqami, Khair Ul Nisa","doi":"10.1177/00369330261449407","DOIUrl":"10.1177/00369330261449407","url":null,"abstract":"<p><p>Intelligent Clinical Decision-Making Systems have become a cornerstone of modern healthcare by enabling accurate diagnosis, prognosis and treatment planning through data-driven insights. With the growing availability of heterogeneous healthcare data such as medical images, clinical records, physiological signals and textual reports, multimodal learning has emerged as a powerful paradigm for integrating diverse data sources. This review presents a comprehensive and systematic analysis of multimodal approaches for intelligent clinical decision-making by leveraging machine learning, deep learning, transfer learning and natural language processing techniques. A structured literature search was conducted using IEEE, Elsevier, Wiley Online Library and Springer databases, focusing on peer-reviewed studies published between 2020 and 2025. The selected articles were analysed based on data modalities, learning strategies, healthcare applications, datasets and performance evaluation metrics. This review highlights the effectiveness of multimodal frameworks in addressing key challenges such as class imbalance, disease prediction, patient monitoring and treatment planning. Additionally, it discusses the benefits, open challenges and limitations of existing intelligent clinical decision frameworks, including scalability, interpretability and real-world deployment issues. Finally, the review outlines future research directions emphasizing the integration of Internet of Things-enabled healthcare data, federated learning for privacy preservation and blockchain-based secure data sharing to enhance the reliability and clinical adoption of intelligent decision-making systems.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":" ","pages":"102-119"},"PeriodicalIF":1.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842396","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":"Transient isolated right ventricular hypertrophy: A benign phenotype in neonates: Case series and review of the literature.","authors":"Swasthi Kabi Satpathy, Choudri Muzafar Paswal, Sushil Kumar Choudhary, Neeraj Gupta, Arun Kumarendu Singh","doi":"10.1177/00369330261421354","DOIUrl":"10.1177/00369330261421354","url":null,"abstract":"<p><p>BackgroundTransient isolated right ventricular hypertrophy (RVH) is an infrequently recognized cause of early neonatal cyanosis and prolonged oxygen requirement, closely mimicking cyanotic congenital heart disease or persistent pulmonary hypertension of the newborn.MethodsWe present a narrative review of published neonatal cases of transient isolated RVH and describe illustrative observations from four term neonates managed at a tertiary neonatal unit over a 3-year period. Clinical features, antenatal exposures, echocardiographic findings, management, and outcomes were reviewed. A focused literature search identified previously reported neonatal cases.ResultsIncluding the present cohort, 18 neonatal cases have been described to date. Most neonates presented within the first day of life with cyanosis. Echocardiography demonstrated isolated RVH with preserved biventricular function and absence of structural heart disease; premature ductal closure was documented in several cases. Identified risk factors included fetal or perinatal distress, maternal exposure to nonsteroidal anti-inflammatory drugs or corticosteroids, maternal diabetes, and polyphenol-rich substances. Clinical improvement occurred with supportive care, and follow-up echocardiography showed regression of RVH within 4-12 weeks.ConclusionsTransient isolated RVH represents a benign, self-limiting cause of early neonatal cyanosis. Awareness of this phenotype and its natural history may help avoid unnecessary investigations/interventions.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":" ","pages":"76-84"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228536","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":"The future of large language models in clinical and academic medicine.","authors":"James Lucocq","doi":"10.1177/00369330261441585","DOIUrl":"https://doi.org/10.1177/00369330261441585","url":null,"abstract":"","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"71 2","pages":"41-42"},"PeriodicalIF":1.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017238","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":"Evaluation of large language models with clinical guidance for vetting outpatient magnetic resonance imaging lumbar spine referrals.","authors":"William Clackett, Hatim Alsusa, Hannah Watson, Antanas Kascenas, David Scott, Avinash K Kanodia, Oliver T Barry, Alison Q O'Neil","doi":"10.1177/00369330261441582","DOIUrl":"10.1177/00369330261441582","url":null,"abstract":"<p><p>ObjectivesAccurate triage of lumbar spine magnetic resonance imaging (MRI) referrals for sciatica is important for patient assessment, diagnosis and surgical planning. This study evaluates the accuracy and speed of large language models (LLMs) in automatically vetting lumbar spine MRI referrals from general practice.MethodsThree LLMs (GPT-4, Claude Opus, Gemini) were tasked with assigning an outcome (Accept - Routine, Accept - Urgent, Reject) and flagging MRI contraindications for lumbar spine referrals. Three prompts of increasing detail, including clinical guidelines and training examples, were used. Two radiology registrars synthesised 120 referrals, vetted by two board-certified radiologists, with a third resolving disagreements. Performance was assessed using accuracy, precision, recall and F1 scores.ResultsInter-rater agreement between radiologists was substantial for vetting outcome (Cohen's <i>κ</i> = 0.76) and contraindication detection (<i>κ</i> = 0.68). Claude Opus with the full prompt achieved the highest accuracy (0.86) for vetting outcomes. GPT-4 with the instruction-only prompt achieved the highest F1 score (0.88) for contraindication detection. LLMs completed the task substantially faster than radiologists (9.8 ± 1.0 vs 135.0 ± 45.0 min).ConclusionsLLMs demonstrate promising performance in vetting radiological referrals for sciatica, particularly with detailed context. All models identified all urgent referrals, suggesting potential for prioritising vetting worklists and improving timeliness of care.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":" ","pages":"43-53"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692058","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":"The role of artificial intelligence in improving patient communication and shared decision-making in urology: A systematic review.","authors":"Nasif Bhuiyan, Solomon Bracey, Amelia Pietropaolo, Patrick Jones, Lazaros Tzelves, Bhaskar Kumar Somani","doi":"10.1177/00369330261418599","DOIUrl":"10.1177/00369330261418599","url":null,"abstract":"<p><p>BackgroundEffective communication and shared decision-making are essential for optimising urological care, making informed decisions, and improving patient outcomes. The integration of artificial intelligence (AI) in urology has the potential to act as a supportive tool in this process. This review aims to evaluate how AI-based tools support and enhance patient-provider communication and shared decision-making within urological care.MethodsFollowing PRISMA 2020 guidelines, a systematic search was performed using Cochrane, EMBASE, MEDLINE, and Scopus for literature published between 2019 and 2024. Search terms included 'Artificial Intelligence', 'Urology', 'Shared Decision-Making', and 'Communication'. Studies were screened using our predefined inclusion and exclusion criteria. Three primary themes were identified, through which the studies were analysed.ResultsOf 807 identified studies, 14 were appropriate for inclusion. Only 14 studies met criteria because most excluded articles did not evaluate AI tools designed for communication, health literacy, or shared decision-making. AI-driven tools, particularly large language models (LLMs), show the potential to reduce knowledge gaps for diverse literacy levels and improve patient comprehension. These aids may improve the readability of complex medical content and translate information with cultural sensitivity. AI may also enhance communication between patients and healthcare providers by automating repetitive tasks, such as responding to frequently asked questions. However, AI has limitations, with different LLMs displaying variable levels of effectiveness and accuracy across urological conditions.ConclusionsThe integration of AI has the potential to enhance communication and promote shared decision-making in urology. However, patients should use AI as a complement to physicians rather than a replacement. To confidently determine their role and ensure AI output accuracy, further studies, including validation against clinical standards and real-world accuracy are required.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":" ","pages":"54-67"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126335","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":"Scaling surgical education: Assessing the impact and replicability of emergency urology skills training in Ethiopia.","authors":"Tilaneh Leyeh Demilow, Ramzi Yesuf, Getaneh Tesfaye Teferi, Tizazu Tsega Abebayehu, Fitsum Gebreegziabher Gebrehiwot, Folk-Man Wong, Matthew Trail, William James Gladstone Finch, Stephen R Payne, Chandra Shekhar Biyani","doi":"10.1177/00369330261416385","DOIUrl":"10.1177/00369330261416385","url":null,"abstract":"<p><p>BackgroundTo deliver and evaluate two Emergency Urology Skills Training (EUST) courses in Ethiopia, aimed at equipping surgical and urology residents with hands-on skills and confidence in managing urological emergencies in resource-limited settings.MethodsTwo one-day, practical training courses were held in Hawassa and Addis Ababa in November 2024 and May 2025. Pre-course questionnaires assessed delegates' baseline confidence, prior training and the utility of a pre-course manual. A blended curriculum comprising didactic lectures, skill stations and one-to-one mentorship was delivered by a collaborative team of local and international faculty. Post-course evaluations measured improvements in knowledge, confidence and satisfaction.ResultsTwenty-three participants from each centre completed matched pre- and post-course multiple-choice questionnaires assessing knowledge of emergency urology procedures. Pre-course exposure to structured skills training was limited (≤30%). Both groups showed statistically significant improvements in post-course scores (Hawassa: <i>p</i> = 0.002; Addis Ababa: <i>p</i> = 0.007). Self-rated confidence and knowledge improved significantly (<i>p</i> < 0.05) in six of eight core procedures.ConclusionsThe EUST model effectively improved trainees' confidence and procedural competence in emergency urology. With adequate support, this model is scalable and applicable to other resource-limited countries seeking to strengthen urological emergency care and their training capacity.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":" ","pages":"68-75"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146066512","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":"Scientific approaches to improve precision in clinical medicine: Prediction scores, radiomics, machine learning in imaging and artificial intelligence.","authors":"Ghulam Nabi","doi":"10.1177/00369330261420059","DOIUrl":"https://doi.org/10.1177/00369330261420059","url":null,"abstract":"","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"71 1","pages":"1-2"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271772","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":"Scottish Society of Physicians 67^th Annual Meeting Thursday 18 & Friday 19 September 2025.","authors":"","doi":"10.1177/00369330251412950","DOIUrl":"https://doi.org/10.1177/00369330251412950","url":null,"abstract":"","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"71 1","pages":"NP1-NP44"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271815","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":"Survival outcomes and prognostic factors in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: A single-center retrospective study.","authors":"Özgür Kılınçarslan, Volkan Sayur, Erkan Güler, Recep Temel, Özgün Cevdet Köse, Ozan Verendağ, Taylan Özgür Sezer","doi":"10.1177/00369330251394182","DOIUrl":"10.1177/00369330251394182","url":null,"abstract":"<p><p>BackgroundPeritoneal carcinomatosis (PC) represents an advanced stage of intra-abdominal malignancies with poor prognosis. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) offers promising outcomes in selected patients. This study evaluated survival and prognostic factors in patients undergoing CRS-HIPEC for malignancy-associated PC.MethodsA retrospective analysis was performed on 116 patients treated with CRS-HIPEC between 2015 and 2023. Data included demographics, tumor origin, peritoneal cancer index (PCI), completeness of cytoreduction (CC) score, complications, and survival outcomes. Kaplan-Meier and Cox regression analyses were used.ResultsThe mean age was 55.2 years; 61.2% were female. Common primary tumors were colorectal (34.5%), gastric (20.7%), ovarian (17.2%), and appendiceal (16.4%). Mean PCI was 11.9, and complete cytoreduction (CC-0) was achieved in 89.7%. Overall survival was highest in appendiceal (76.9 months) and lowest in gastric cancer (24.7 months). Median disease-free and overall survival were 36 and 43.9 months, respectively. Postoperative complications occurred in 31.8%; mortality was 5.17%. High PCI and incomplete cytoreduction were independently associated with worse survival.ConclusionCRS-HIPEC provides encouraging survival in selected PC patients, especially with low PCI and complete cytoreduction. Careful patient selection remains key to optimizing outcomes.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":" ","pages":"9-16"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513778","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":"Septoplasty waiting list validation using the nasal obstruction symptom evaluation (NOSE) score: A quality improvement project.","authors":"Rabii Aboul Hosn, Fergus Cooper, Kim Wong Ah-See, Vamsidhar Vallamkondu","doi":"10.1177/00369330251394181","DOIUrl":"10.1177/00369330251394181","url":null,"abstract":"<p><p>Background and aimsNational Health Service waiting lists for some routine procedures are currently very long, and patients' conditions may change during the wait, requiring reassessment before surgery can be offered. The objective of this study was to implement a septoplasty waiting list validation process incorporating the nasal obstruction symptom evaluation (NOSE) questionnaire to help streamline patient selection for septoplasty.Methods and resultsA telephone consultation incorporating the NOSE questionnaire was designed to validate the local septoplasty waiting list. NOSE scores were evaluated pre- and post-operatively. A total of 112 patients met the inclusion criteria. Thirty-three patients were removed from the waiting list on initial consultation, of whom the majority had a NOSE score ≤30 or had not trialled maximal medical management. In total, 86% of patients removed from the waiting list had not sought any further ENT input at the 4-year follow-up period. The mean NOSE score improved between pre- and post-operative evaluations (57.7 vs. 26.9, respectively, <i>p</i> < 0.0001). There was a strong correlation between higher pre-operative NOSE scores and improvement in NOSE scores post-operatively (<i>r</i> = 0.57293).ConclusionsThe NOSE score is an effective way to validate septoplasty waiting lists and assists in appropriate patient selection for septoplasty.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":" ","pages":"3-8"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145542313","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}