Communications medicine最新文献

{"title":"A retrospective cross-sectional study showing wearable smartwatches enhance patient safety and efficiency in the intensive care unit.","authors":"Xinyue Ma, Lei Wang, Shishuai Meng, Ruifeng Xu, Ru Chen, Xiuhua Zhang, Mengyang Xin, Jiannan Zhang, Yang Chong, Peiyao Luo, Yiqi Wang, Mingbo Zhao, Mingyan Zhao, Wei Yang","doi":"10.1038/s43856-025-01072-6","DOIUrl":"10.1038/s43856-025-01072-6","url":null,"abstract":"<p><strong>Background: </strong>Wearable smartwatches present a novel approach to continuous patient monitoring in ICU settings, with the potential to enhance patient safety and clinical efficiency.</p><p><strong>Methods: </strong>This retrospective cross-sectional study evaluated the impact of smartwatch use on alarm response rates and clinical outcomes in a 27-bed ICU. Data were collected over two periods: pre-implementation (May 12, 2023, to July 11, 2023) and post-implementation (October 22, 2023, to December 22, 2023) of smartwatches worn by healthcare workers.</p><p><strong>Results: </strong>Our findings indicate that the adoption of smartwatches significantly improves alarm response rates from 12.58% to 14.85% (p < 0.0001). In addition, the reduction in response time, fatal and high alert, medium alert, and low alert within 30 s response rates increased from 51.51%,70.42%, and 74.03% to 60.04%, 74.02%, and 76.71%, respectively (p < 0.0001), resulting in fewer high and fatal alerts. Moreover, the use of smartwatches is associated with reduced durations of mechanical ventilation and ICU stays, signifying improved clinical outcomes.</p><p><strong>Conclusions: </strong>Wearable technology has the potential to simplify ICU operations, reduce alarm fatigue, and ultimately improve patient care and reduce adverse events.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"341"},"PeriodicalIF":5.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cross-national analysis of childhood predictors of physical pain.","authors":"Lucía Macchia, Chukwuemeka N Okafor, Thomas Breedlove, Koichiro Shiba, Alan Piper, Byron Johnson, Tyler J VanderWeele","doi":"10.1038/s43856-025-00997-2","DOIUrl":"10.1038/s43856-025-00997-2","url":null,"abstract":"<p><strong>Background: </strong>The socioeconomic, psychosocial, and behavioural factors that influence physical pain have been largely explored. However, evidence on the childhood circumstances that shape physical pain in adulthood is scarce.</p><p><strong>Methods: </strong>Using a nationally representative dataset of 202,898 individuals (Age range: 18-99, 49% female, 51% male, 0.03% other) from 22 countries and a random effects meta-analysis, we examine 13 potential childhood predictors of physical pain in adulthood.</p><p><strong>Results: </strong>We find that childhood experiences, personal attributes, and familial and social circumstances have meaningful and varied associations with adulthood levels of physical pain. Specifically, we find that people whose parents were divorced, single, or died (vs married) when they were children, those who reported that their family found it very difficult to live with their family's household income when they were growing up (vs got by), those who experienced abuse (vs not), felt like an outsider (vs not), reported poor physical health while growing up (vs good) and reported more frequent religious attendance at age 12 (vs never) have a greater risk of experiencing pain later in life. The strength of these associations differs by country reflecting diverse societal influences.</p><p><strong>Conclusions: </strong>Our study provides valuable insights on the early-life experiences that shape physical pain in adulthood. These findings enhance our understanding of early-life predictors of adult wellbeing and offer comprehensive evidence for designing interventions to reduce physical pain levels.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"337"},"PeriodicalIF":5.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144801087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nasal-spraying Bacillus spore probiotics for pneumonia in children with respiratory syncytial virus and bacterial co-infections: a randomized clinical trial.","authors":"Hoa Thi Le, Thuy Thi Bich Phung, Huyen Thi Bui, Hanh Thi Hong Le, Dien Minh Tran, Nhung Hong Nguyen, Hung Tuan Phan, Vu Duy Tran, Ut Vu Pham, Nha Van Phan, Huong Thu Do, Anh Hoa Nguyen, Tung Dinh Pham, Anh Thi Van Nguyen","doi":"10.1038/s43856-025-01029-9","DOIUrl":"10.1038/s43856-025-01029-9","url":null,"abstract":"<p><strong>Background: </strong>Our study addresses the pressing need for safe and effective treatments for pneumonia in young children caused by respiratory syncytial virus (RSV) and bacterial co-infections. This issue is particularly urgent given the absence of targeted RSV therapies and the growing threat of antibiotic resistance associated with managing bacterial co-infections.</p><p><strong>Methods: </strong>We conducted a double-blind, randomized clinical trial (ClinicalTrials.gov: NCT05929599) at Vietnam National Children's Hospital to evaluate nasal-spraying Bacillus spore probiotics (LiveSpo Navax containing B. subtilis ANA4 and B. clausii ANA39 at ≥1 billion CFU/mL) in children aged 1-24 months with pneumonia due to RSV and bacterial co-infection. Participants were randomly assigned in a 1:1 ratio to receive standard care plus either LiveSpo Navax or physiological saline solution, using a simple sealed-number draw at enrollment. Primary outcomes were the median duration required to resolve common pneumonia symptoms, duration of oxygen therapy, and total treatment days.</p><p><strong>Results: </strong>A total of 120 children are enrolled (60 per group). In the final analysis, 50 participants in the Control group and 51 in the Navax group are included. The trial is completed with no serious adverse events or treatment-related side effects in either group. Navax treatment shortens the duration of eight symptoms associated with RSV pneumonia by one day, oxygen therapy by two days, and overall treatment by one day.</p><p><strong>Conclusions: </strong>The nasal-spraying Bacillus spore approach presents a safe, effective, and fast treatment for young children with pneumonia due to RSV and bacterial co-infections, making it especially a promising strategy for resource-limited settings.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"336"},"PeriodicalIF":5.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optic neuritis as a link between autoimmunity and dementia risk.","authors":"Jaeryung Kim, Kyungdo Han, Jin-Hyung Jung, Sei Yeul Oh, Kyung-Ah Park, Ju-Hong Min","doi":"10.1038/s43856-025-01050-y","DOIUrl":"10.1038/s43856-025-01050-y","url":null,"abstract":"<p><strong>Background: </strong>Our limited understanding of dementia's complex pathogenesis confines treatment options primarily to symptom management rather than targeting underlying disease processes, underscoring the need for innovative treatment and preventive strategies. This study aimed to examine the relationship between optic neuritis (ON), an autoimmune inflammatory condition of the optic nerve, and the risk of developing dementia.</p><p><strong>Methods: </strong>This nationwide, population-based cohort study was conducted in Korea, analyzing a cohort of 15,286 ON patients newly diagnosed between 2010 and 2017 who were age and sex matched against 76,430 controls without ON. Primary outcomes were incident cases of Alzheimer's disease, vascular dementia, or other types of dementia. Cox proportional hazards regression models were employed to assess the association between ON and dementia risk after adjusting for demographic characteristics, lifestyle factors, and other comorbidities. Dementia risk was assessed through hazard ratios (HRs), with an average follow-up period of 3.06 years.</p><p><strong>Results: </strong>ON patients shows greater risks of all-cause dementia (HR: 1.258) and Alzheimer's disease (HR: 1.264). Associations between ON and dementia are prominent in younger patients and current smokers.</p><p><strong>Conclusion: </strong>This research suggests that autoimmunity, particularly in the form of ON, may significantly contribute to dementia development. This study implies that younger ON patients who smoke could be at a high risk of developing dementia, emphasizing the need for preventative strategies and additional research to establish causality. This work broadens the scope of known dementia risk factors and opens new avenues for research into autoimmune mechanisms as targets for therapeutic intervention.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"335"},"PeriodicalIF":5.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term trends in obesity and overweight in women in Ghana from 2003-2023.","authors":"Laura Ann Gray, Joseph Prince Mensah, Magdalena Opazo Breton, Richmond Nii Okai Aryeetey, Isaac Boadu, Emmanuel Anongeba Anaba, Afua Atuobi-Yeboah, Robert Akparibo","doi":"10.1038/s43856-025-01082-4","DOIUrl":"10.1038/s43856-025-01082-4","url":null,"abstract":"<p><strong>Background: </strong>In Ghana, overweight and obesity prevalence among women (20-49 years) reached 50% in 2022, increasing from 40% in 2014. This study aims to understand what has driven previous trends in overweight and obesity among women of reproductive age in Ghana and to predict future trends that can help inform policy making and public health surveillance.</p><p><strong>Methods: </strong>We used data from the Ghana Demographic and Health Survey (DHS) containing information on women of reproductive age (aged 15 to 49 years). Data collected between 2003 and 2022 provided cohorts born between 1953 and 2007. Age-period-cohort (APC) analysis was used to disentangle the effects of age, time, and generation on trends in the odds of obesity and overweight.</p><p><strong>Results: </strong>The prevalence of overweight and obesity increases during the study period, especially with age, in all cohorts. In the APC analysis, the odds of obesity increase with age until age 42-43 years (odds ratio (OR): 9.37; 95% confidence interval (CI): 5.63-15.59, compared to 20-21 year olds) before levelling out. Accounting for age and birth cohort, the odds of overweight and obesity increase significantly over time between 2003 and 2015 (overweight OR: 1.76; 95% CI: 1.47-2.11, obesity OR: 2.27; 95% CI: 1.77-2.91), after which the effect levels out and appears to stabilise. There is no effect of birth cohort on the odds of overweight or obesity.</p><p><strong>Conclusions: </strong>Although high, the increasing odds of obesity and overweight in Ghana appears to be stabilising. However, the increasing odds of obesity with age, suggest that an ageing population could mean that the prevalence will increase into the future.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"338"},"PeriodicalIF":5.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12332120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144801089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of midwife continuity of carer on stillbirth rate and first feed in England.","authors":"Chris Roebuck, Jane Sandall, Robert West, Charlotte Atherden, Kate Parkyn, Owen Johnson","doi":"10.1038/s43856-025-01025-z","DOIUrl":"10.1038/s43856-025-01025-z","url":null,"abstract":"<p><strong>Background: </strong>In 2017 NHS England started rolling out a model where women have continuity of carer with the same midwifery team throughout the perinatal period. This study uses national data to test whether women of different groups receiving midwife continuity of carer had lower stillbirth rates and higher rates of a first feed of breast milk than women receiving standard care.</p><p><strong>Methods: </strong>We compared the two outcomes for women placed on the midwife continuity of carer pathway by 24 weeks and women receiving standard care in England, with logistic regression standardising between groups. We used the Maternity Services Dataset covering 922,149 women conceiving between 2020 and 2022.</p><p><strong>Results: </strong>Combining all demographic groups, women on a midwife continuity of carer pathway have a higher first feed of breast milk rate (p < 0.001), but do not show a difference in stillbirth rate, compared to women receiving standard care. However, Black women on this pathway have lower stillbirth rates (p = 0.047) compared to Black women receiving standard care, the only demographic group showing a difference. Women with no antenatal appointment at all by 24 weeks have much higher stillbirth rates than those with an appointment (p < 0.001).</p><p><strong>Conclusions: </strong>The findings that midwifery continuity of carer increases the first feed of breast milk uptake, which has health benefits. It may decrease stillbirth rates for Black women. Both findings inform future policy development and research. Further investigation and outreach around women not coming forward for timely antenatal care may also be beneficial.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"339"},"PeriodicalIF":5.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12332168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144801088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comprehensive evaluation of de novo metastatic breast cancer trends by subtype from the Dallas Metastatic Cancer Study.","authors":"Hannah L Chang, Meng Cao, Mir Lim, Anna Moscowitz, Ang Gao, Ariana Weiss, Ariel Brown, Danielle Spanbauer, Giselle Uwera, Jaeyoung Oh, Jonathan Ladner, Nathaniel Wu, Priscilla Okanlawon, Reynaldo Olivo, Ruchita Iyer, Yemariamwork Engidaw, Sangeetha M Reddy, Heather L McArthur, Lily Xu, Sakshi Mohta, Julia Maues, Christine Hodgdon, Luis Chinea, Katherine Lei, Shao-Po Huang, Rani Bansal, Isaac S Chan","doi":"10.1038/s43856-025-01011-5","DOIUrl":"10.1038/s43856-025-01011-5","url":null,"abstract":"<p><strong>Background: </strong>The Dallas Metastatic Cancer Study is a clinical database established to examine local trends associated with the diagnosis and treatment of de novo metastatic breast cancer and identify factors for further evaluation. Clinical characteristics of patients with de novo metastatic breast cancer are often underreported in the literature.</p><p><strong>Methods: </strong>We report data from 2010 to 2021 for patients with de novo metastatic breast cancer along with the impact of clinical variables such as age, BMI, race and ethnicity, insurance status, hypertension, diabetes, and site of metastasis with survival analysis with respect to subtype.</p><p><strong>Results: </strong>Black race (HR 2.07, 95% CI 1.56-2.74), public insurance (HR 1.64, 95% CI 1.23-2.18), no insurance (HR 1.69, 95% CI 1.24-2.31), hypertension (HR 1.50, 95% CI 1.18-1.91), diabetes (HR 1.69, 95% CI 1.24-2.31), and visceral metastases including brain (HR 1.68, 95% CI 1.20-2.36), liver (HR 1.80, 95% CI 1.40-2.30), and lung (HR 1.50, 95% CI 1.17-1.92) were associated with increased mortality and remained significant when controlled for subtype. In the multivariate analysis, diabetes (HR 1.74, 95% CI 1.22-2.49) and presence of liver metastases (HR 1.97, 95% CI 1.43-2.49) remained independently associated with decreased overall survival regardless of subtype and other variables. Patients diagnosed at 40 and younger were less likely to have hypertension and diabetes, more likely to be Hispanic, and showed distinct subtype distributions compared to those diagnosed at older ages.</p><p><strong>Conclusions: </strong>Future work will focus on these associations at the patient level to identify targets for intervention.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"333"},"PeriodicalIF":5.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12325588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalised bactericidal combination regimens against carbapenem-resistant Pseudomonas aeruginosa.","authors":"Jocelyn Qimin Teo, Jing Heng Toh, Hong Yi Chang, Si Hui Tan, Jayden Jun-Yuan Ho, Zhi Wei Ong, Winnie Lee, Yen Ee Tan, Tse Hua Nicholas Wong, Shimin Jasmine Chung, Thuan Tong Tan, Tze Peng Lim, Andrea Lay-Hoon Kwa","doi":"10.1038/s43856-025-01022-2","DOIUrl":"10.1038/s43856-025-01022-2","url":null,"abstract":"<p><strong>Background: </strong>Limited treatment options are available for carbapenem-resistant Pseudomonas aeruginosa (CRPA), especially those harbouring carbapenemases. Given the variability in effectiveness of antibiotic combinations, in vitro test-guided antibiotic therapies have been suggested to improve the outcomes of patients receiving combination therapy. We investigated the in vitro bactericidal activities of various combinations against CRPA and described our experience of using a personalised test-guided approach in managing these difficult-to-treat infections.</p><p><strong>Methods: </strong>In vitro antibiotic combination tests (iACTs) comprising up to 180 unique combinations at clinically relevant unbound concentrations were performed for CRPA isolates collected for a monocentric prospective cohort study conducted between 2017 and 2022.</p><p><strong>Results: </strong>In vitro activities of antibiotic combinations are highly strain-specific. Polymyxin-containing combinations exhibit the highest bactericidal activity [454/497 (91%) isolate-combination pairs] against 66 isolates tested. Most of the CRPA produce carbapenemases (73%). Polymyxin-sparing combinations exhibiting >60% bactericidal activity include fosfomycin + aztreonam (40/58) and fosfomycin + cefepime (37/58). We show good outcomes in the 42 patients who eventually received at least 72 h of personalised iACT-guided therapy [end-of-treatment clinical response rate: 93%; 30-day all-cause mortality: 2%]. We observe microbiological eradication for all bloodstream infections, but 13% of patients get reinfected with CRPA subsequently.</p><p><strong>Conclusions: </strong>Polymyxin-containing combinations exhibit the highest bactericidal activity against CRPA, while fosfomycin +  aztreonam or fosfomycin + cefepime represent promising polymyxin-sparing options. A personalised in vitro test-guided treatment approach may be feasible for managing P. aeruginosa infections, particularly those involving carbapenemase production and/or difficult-to-treat phenotypes.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"334"},"PeriodicalIF":5.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12325961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gated recurrent unit with decay has real-time capability for postoperative ileus surveillance and offers cross-hospital transferability.","authors":"Xiaoyang Ruan, Sunyang Fu, Heling Jia, Kellie L Mathis, Cornelius A Thiels, Schaeferle M Gavin, Patrick M Wilson, Curtis B Storlie, Hongfang Liu","doi":"10.1038/s43856-025-01053-9","DOIUrl":"10.1038/s43856-025-01053-9","url":null,"abstract":"<p><strong>Background: </strong>Ileus, a postoperative complication after colorectal surgery, increases morbidity, costs, and hospital stays. Assessing risk of ileus is crucial, especially with the trend towards early discharge. Prior studies assessed risk of ileus with regression models, the role of deep learning remains unexplored.</p><p><strong>Methods: </strong>We evaluated the Gated Recurrent Unit with Decay (GRU-D) for real-time ileus risk assessment in 7349 colorectal surgeries across three Mayo Clinic sites with two Electronic Health Record (EHR) systems. The results were compared with atemporal models on a panel of benchmark metrics.</p><p><strong>Results: </strong>Here we show that despite extreme data sparsity (e.g., 72.2% of labs, 26.9% of vitals lack measurements within 24 h post-surgery), GRU-D demonstrates improved performance by integrating new measurements and exhibits robust transferability. In brute-force transfer, AUROC decreases by no more than 5%, while multi-source instance transfer yields up to a 2.6% improvement in AUROC and an 86% narrower confidence interval. Although atemporal models perform better at certain pre-surgical time points, their performance fluctuates considerably and generally falls short of GRU-D in post-surgical hours.</p><p><strong>Conclusions: </strong>GRU-D's dynamic risk assessment capability is crucial in scenarios where clinical follow-up is essential, warranting further research on built-in explainability for clinical integration.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"331"},"PeriodicalIF":5.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating acute image ordering for real-world patient cases via language model alignment with radiological guidelines.","authors":"Michael S Yao, Allison Chae, Piya Saraiya, Charles E Kahn, Walter R Witschey, James C Gee, Hersh Sagreiya, Osbert Bastani","doi":"10.1038/s43856-025-01061-9","DOIUrl":"10.1038/s43856-025-01061-9","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic imaging studies are increasingly important in the management of acutely presenting patients. However, ordering appropriate imaging studies in the emergency department is a challenging task with a high degree of variability among healthcare providers. To address this issue, recent work has investigated whether generative AI and large language models can be leveraged to recommend diagnostic imaging studies in accordance with evidence-based medical guidelines. However, it remains challenging to ensure that these tools can provide recommendations that correctly align with medical guidelines, especially given the limited diagnostic information available in acute care settings.</p><p><strong>Methods: </strong>In this study, we introduce a framework to intelligently leverage language models by recommending imaging studies for patient cases that align with the American College of Radiology's Appropriateness Criteria, a set of evidence-based guidelines. To power our experiments, we introduce RadCases, a dataset of over 1500 annotated case summaries reflecting common patient presentations, and apply our framework to enable state-of-the-art language models to reason about appropriate imaging choices.</p><p><strong>Results: </strong>Using our framework, state-of-the-art language models achieve accuracy comparable to clinicians in ordering imaging studies. Furthermore, we demonstrate that our language model-based pipeline can be used as an intelligent assistant by clinicians to support image ordering workflows and improve the accuracy of acute image ordering according to the American College of Radiology's Appropriateness Criteria.</p><p><strong>Conclusions: </strong>Our work demonstrates and validates a strategy to leverage AI-based software to improve trustworthy clinical decision-making in alignment with expert evidence-based guidelines.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"332"},"PeriodicalIF":5.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}