Digital twins, a newly emerging technology, are increasingly used in pulmonary medicine across various aspects of prognosis, diagnosis, and therapy. Cognition and awareness of the applications, benefits, and challenges of digital twins in pulmonary medicine are paramount in shaping future efforts by healthcare stakeholders. This study aims to map the existing literature and conduct a narrative synthesis of these determinants to provide an in-depth understanding of this topic. This scoping review was carried out in accordance with PRISMA-ScR. Web of Science, PubMed, Scopus, Google Scholar, and IEEE Xplore were searched from their inception until January 30, 2026, in conjunction with a manual search. The English papers, original research papers, and conference papers were considered. A validated data extraction form was utilized to obtain relevant data from the existing literature. The results were presented in tables, figures, descriptive statistics, and narrative synthesis. Eight studies met the inclusion criteria. A total of 41 applications, 37 benefits, and 28 challenges of digital twins in pulmonary medicine were identified. Applications are primarily focused on clinical monitoring, decision support and modeling, mechanistic modeling, technical/data and AI integration, intervention simulation, and disease management. This review provides a comprehensive overview of the current applications, benefits, and challenges of digital twins in pulmonary medicine. Mapping the existing evidence highlights the growing role of digital twins in patient monitoring, personalized care, and clinical decision support. The findings also identify critical barriers to the development of digital twins in this field. These insights can guide researchers, clinicians, healthcare organizations, and policymakers in prioritizing future research, developing implementation strategies, and supporting the safe integration of digital twins into pulmonary care.

Despite known risks, opioids are widely used for chronic non-cancer pain (CNCP). Clinical guidelines now recommend deprescribing, but factors predicting success are poorly understood. This systematic review aimed to identify clinician and patient factors associated with attaining successful opioid dose reduction or discontinuation in adults with CNCP. We searched major electronic databases on 18 March 2025 for observational studies evaluating factors associated with opioid reduction in deprescribing interventions, excluding studies on cancer/palliative care or primary substance use disorder. The primary outcome was the association between clinician- or patient-related factors and opioid reduction/discontinuation. Two reviewers independently screened studies, extracted data, and assessed bias using the ROBINS-I tool. A narrative synthesis was conducted as there was significant heterogeneity between studies which did not allow for a meta-analysis. Thirty-two studies (n = 26 retrospective cohorts) were included. Evidence on clinician factors was limited, though one study found that a documented deprescribing plan was associated with greater opioid dose reduction (aOR: 3.63, 95% CI: 2.96-4.46). Among patient factors, higher baseline dose and longer duration of opioid use were associated with a lower likelihood of opioid discontinuation in four high-quality studies. Findings for other factors (e.g., age, mental health) were conflicting. Certainty was low due to methodological limitations, with 19 studies having a serious risk of bias. In conclusion, a documented deprescribing plan was the most promising modifiable factor. While long-term opioid use is a consistent barrier, inconsistent evidence for other patient-level factors reinforces the need for individualized care. Future high-quality research should focus on clarifying inconsistent findings and addressing the critical evidence gap regarding clinician and health system-level factors (PROSPERO: CRD42021270488).

Melbourne Rapid Fields (MRF) had shorter test durations than HFA, high agreement with HFA global indices, modest bias in MD and PSD measurements, and comparable concordance and repeatability. MRF had poorer reliability indices, while maintaining good diagnostic performance. The Humphrey Field Analyzer (HFA) is the most widely used perimeter in glaucoma, but its cost and low portability limit its use in resource-constrained settings. Melbourne Rapid Fields (MRF) is a low-cost, tablet-based perimeter system that enables at-home and low-resource testing. Despite growing evidence that the MRF can obtain reliable estimates of the visual field, no study has synthesized its perimetric performance through meta-analysis and compared it with HFA. Following PROSPERO registration, we conducted a systematic review to compare MRF with HFA in patients with glaucoma. Searches were performed using controlled vocabulary related to perimetry assessment with these devices. Meta-analyses and narrative synthesis were conducted to summarize their performance. Of 290 studies screened, 9 were included, totaling 777 eyes. Pooled data comparing MRF to HFA, MRF had faster testing (-1.33min), less-negative MD (+2.08dB), and higher PSD (+0.77dB). Global agreement with HFA was high (MD ICC=0.94; MD R2=0.85; PSD ICC=0.85). Test-retest reliability was similar between devices (MRF ICC=0.96; HFA ICC=0.95). AUCs were comparable for MD (0.84 vs. 0.85) but lower for PSD (0.81 vs. 0.93). MRF had higher fixation losses, false positives, and false negatives. Melbourne Rapid Fields (MRF) had shorter test durations, high global agreement with HFA, excellent repeatability, and a bias toward less-negative global results. MRF showed greater pointwise variability at certain thresholds and worse reliability measures. Despite these differences, MRF provided diagnostic information comparable to that of HFA.

Beyond technical skills: A scoping review on emotions in critical care in situ simulation Training.

The objective of this scoping review is to map the evidence on using smartwatches to objectively measure physical activity (PA), sedentary behavior (SB), and sleep in children, adolescents, adults, and older adults. This review followed the Joanna Briggs Institute (JBI) guidelines for scoping reviews, following a previously published protocol. The searches were conducted in January 2022 on Medline, Scopus, Web of Science, IEEE Xplore Digital Library, Scielo, LILACS, Health Technology Assessment Database, Cochrane clinical trials, and clinical trials. The screening was performed independently by two authors. A narrative synthesis was used. After the electronic search, 5,925 records were identified and 2,008 duplicates removed. Screening of 3,917 titles and abstracts resulted in 491 full-text articles assessed for eligibility. A total of 427 studies were excluded for not meeting inclusion criteria, with one study added after author contact. Thus, 64 of these studies were included. Sample sizes ranged widely from 4 to 6,454 participants, with most studies (80.9%) including 100 or fewer participants. Most studies were conducted in the United States (46.9%), followed by China (9.4%). A total of 18 different smartwatch brands were identified, with Apple® being the most investigated (46.9%), followed by Samsung® (15.6), Fitbit® (14.1%), Motorola® (10.9%), Polar® (10.9%), Garmin® (9.4%), Asus® (3.1%), and others (1.6% each. Smartwatches were primarily used to validate measurements of PA, SB, and/or sleep parameters, followed by their use in assessing these variables as exposures or outcomes, testing feasibility, supporting self-monitoring, and other purposes. The most frequently measured variables were steps, total sleep time, and SB. This review can help studies, interventions, and health professionals that aim to use this technology as a measurement instrument, as well as help end users who use it on a daily basis.

Pharmacist intervention (PI) is an important strategy for reducing drug-related problems (DRP; events or circumstances related to drug therapy that actually or potentially interfere with desired health outcomes) and improving efficiency, quality, and clinical outcomes, thereby avoiding unnecessary health care costs. This systematic review aims to identify and analyze studies that have validated PI and/or DRP classification systems within inpatient hospital settings, and to assess the validity and quality of the methodological procedures adopted in these systems. This research followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. We searched MEDLINE, Embase, LILACS, Web of Science, Scopus, and the gray literature databases without restrictions on publication date or language. Two authors independently carried out study selection, data extraction, quality assessment, and analysis. A narrative synthesis was conducted, and the results were tabulated and synthesized descriptively in tables and in the text. Seventeen articles were included, in which 14 distinct classification systems for PI and/or DRP were identified. Most studies (13/17) were conducted in Europe, did not conceptualize the construct of interest (12/17), failed to disclose the undertaking of a literature review to support the generation of items for the classification system (13/17), and did not assess the content validity evidence (13/17). Also, the majority of studies (15/17) demonstrated the reliability of the classification instrument, but did not report whether the sample used was representative of the population, information on controlling confounding variables, or on evaluator blinding. Most instruments demonstrated acceptable reliability. However, few studies assessed sources of validity evidence, often with methodological limitations. Further studies employing rigorous methods for assessing validity evidence are needed to develop an instrument that is both valid and reliable for use in hospital pharmacy clinical practice.

Osteocutaneous free flaps for reconstruction of composite hand defects: A systematic review of clinical and functional outcomes.

Psychological dispositions and behavioral adaptations are central to understanding adherence in chronic disease. This review examined how these factors influence adherence in adults with non-communicable chronic diseases, analyzing which personality traits and coping strategies shape adherence. A Scopus and Web of Science search (2013-2023) identified 20 studies (n = 82,738), following PRISMA. Risk of bias was assessed with Joanna Briggs Institute (JBI) tools, and certainty with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Narrative synthesis indicated neuroticism and avoidant coping predicted poorer adherence, whereas conscientiousness, adaptive coping, and coping self-efficacy promoted enhanced adjustment. Openness, extraversion, and agreeableness had modest yet positive effects, and emotion-focused coping yielded context-dependent outcomes. Predominant cross-sectional designs and limited Global South representation underscore the need for tailored, context-sensitive interventions. The review was preregistered in Open Science Framework (OSF) and funded by the Chilean National Agency for Research and Development. Further longitudinal research is needed to clarify mechanisms and improve generalizability.

Cognitive and emotional correlates of sleep in the peripartum period: a systematic review.

Individuals with severe cerebral palsy (CP) at Gross Motor Function Classification System (GMFCS) levels IV and V are at high risk of hip displacement causing pain, reduced sitting tolerance, and hygiene challenges. Salvage procedures such as proximal femoral resection, hip arthrodesis, or total hip arthroplasty are often required. This review evaluated preoperative characteristics, intraoperative variables, and postoperative outcomes of salvage hip surgery in non-ambulatory children and young adults with CP. EMBASE (via Ovid), Medline and PubMed were searched from inception to October 1, 2024, following PRISMA guidelines and a registered PROSPERO protocol. Forward and backward citation chasing was undertaken prior to final submisson. Eligible English-language cohort studies and case series were included. Data were extracted in duplicate and quality was assessed using Methodological Index for Non-Randomized Studies (MINORS). A narrative synthesis was used due to the lack of consistent quantitative outcomes reported. Of 3,004 records screened, 42 studies (793 patients, 1,014 hips) were included. Excision was most common (n = 34 studies), followed by arthroplasty (n = 8) and arthrodesis (n = 4). Most patients were male (56%), and 81.6% were GMFCS level V. Excision procedures had the lowest operative times (mean 2.5 h) and blood loss (mean 232 mL). Preoperative indications included pain (93% of studies) and caretaker concerns including transfer ability, hygiene, and quality of life (83% of studies). Overall, perioperative complication rates were 13.9%. Heterotopic ossification occurred in 69% of studies, proximal femoral migration occurred in 52%, and 80% reported the need for secondary procedures. Salvage surgery provides consistent pain relief and functional benefits in non-ambulatory CP but remains associated with frequent complications and repeat surgery.

A systematic review of the factors associated with lung cancer stigma.

To evaluate the efficacy of active pedagogical strategies for teaching the nursing process compared to traditional teaching methods. Systematic review with meta-analyses performed according to the recommendations of Cochrane Handbook and reported according to Preferred Reporting Items for Systematic Reviews and Metanalyses (PRISMA) Statement. Searches were carried out in February 2024 and updated in October 2025 in the databases Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Literature on Health Sciences, Excerpta Medica Database, Medical Literature Analysis and Retrieval System Online, Scopus and Web of Science. Free searches and searches in gray literature were performed in Google Scholar. The selection of studies and data extraction was performed independently by two reviewers. Data synthesis was performed through narrative synthesis and meta-analytic methods. Meta-analyses were conducted for knowledge, clinical reasoning, critical thinking and attitudinal skills. Thirty-four studies involving undergraduate and graduate nursing students were included to evaluate the effectiveness of active teaching strategies in developing nursing process related competencies. The meta-analyses demonstrated that active learning strategies significantly improved knowledge (SMD=0.95; p<0.001; I2=80%), clinical reasoning (SMD=0.48; p<0.001; I2=43%), and attitudinal skills (SMD=0.39; p=0.004; I2=81%) when compared to traditional methods. There was no difference in critical thinking (SMD=0.92; p=0.074; I2=95%). Subgroup analyses showed that among the strategies evaluated, simulation consistently showed favorable results for knowledge, clinical reasoning, and attitudinal skills. This study supports the effectiveness of active teaching strategies - particularly simulation - in enhancing learning outcomes associated with the nursing process. The findings emphasize the value of integrating structured, student-centered pedagogies in nursing curricula to foster core competencies.

To explore and synthesise qualitative research about the experience of maternity care for lesbian and bisexual mothers. To provide recommendations to healthcare providers on how to support lesbian and bisexual mothers during their maternity experience. The past 14 years has seen significant legal changes for same-sex parents worldwide. Previous reviews of lesbian mothers' experiences of maternity care identified that they experience covert and overt homophobia during their maternity care journey; that curiosity and knowledge of lesbian and bisexual life is important for healthcare professionals, and disclosure of sexual orientation can feel risky. Five databases were searched for studies published from May 2011 to December 2024. Qualitative research studies published in English that explored the maternity care experience of lesbian and/or bisexual mothers were included. Stenfors criteria for quality bias assessment was used, 10 studies were included. Findings were synthesised using a narrative synthesis approach. Four categories were identified, these were: 'heteronormativity', 'acceptance and inclusion', 'finding your own path', and 'knowledge and power of professionals'. The findings are discussed in the context of current research and compared to the findings of the previous systematic review. Recommendations for maternity healthcare providers and healthcare professionals have been provided and include: an increased awareness of how heteronormative views and assumptions can present in services, education on how to challenge and reduce heteronormativity for healthcare professionals, explicit acceptance to be offered, and for professionals to be more aware of the power they may hold.

Bias, fairness, and equity in artificial intelligence systems used in dental imaging: A systematic review.

Clinically meaningful thresholds in patient-reported outcome measures (PROMs) for arthroscopic meniscal surgery: A systematic review with narrative synthesis.

ObjectivesA lack of palliative care training for nurses has been identified as a barrier to patients' access to palliative care services. Although nurses account for nearly 50% of the global healthcare workforce, those in low- and middle-income countries (LMICs) often lack sufficient training and education in palliative care. This review identified and synthesised literature on palliative care education for students and practicing nurses at LMICs.MethodsA systematic review approach with narrative synthesis was employed to review studies published in English from January 2002 to October 2022, focusing on training interventions in palliative care education programmes for nurses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines guided this review. The study protocol was registered in PROSPERO.ResultsThe review included 56 studies. Key topics in the palliative care education interventions focused on helping patients and their families understand disease processes, symptom management, empathetic communication, decision-making, cultural concerns, quality of life, breaking bad news, bereavement, and post-mortem care. The most common instructional materials were presentation slides. However, some programmes used e-learning resources, role-plays, high-fidelity simulation manikins, storytelling, reflection, riddles, and poems. Intervention outcomes included improved attitudes, confidence, and knowledge acquisition.ConclusionsPalliative care education interventions can effectively enhance nurses' knowledge and confidence in providing care to individuals needing such services. Findings suggest the need for further research and the implementation of practical, innovative educational approaches in various regions, particularly Africa and Eastern Europe.

Edible insects are increasingly recognized for their high nutritional value and favorable environmental profile, yet their acceptance (defined as the continuum from willingness to try and purchase to repeated consumption) in Western and globalized food systems remains limited by cultural, sensory, regulatory, and economic barriers. This narrative review critically synthesizes recent advances in understanding the multidimensional determinants of consumer acceptance of insect-based foods and evaluates the technological, cultural, and policy-driven strategies proposed to overcome them, drawing on interdisciplinary evidence from food science, consumer behavior, and sustainability research. Evidence indicates that processing approaches such as protein hydrolysis, extrusion, fermentation, and encapsulation can significantly improve sensory quality, functionality, and product integration into familiar food matrices. In parallel, targeted marketing, consumer education, and transparent regulatory frameworks emerge as essential to building trust and reducing neophobia. This narrative synthesis provides a comprehensive conceptual framework for advancing the mainstream adoption of insect-based foods. The analysis highlights research gaps related to sensory optimization, traceability, sustainability assessment, and cross-cultural consumer studies, offering evidence-based directions to support the development of safe, acceptable, and nutritionally valuable insect-derived products within contemporary food systems.

To map evidence linking maternal exposure to ambient air pollution during pregnancy and around birth when reported, with perinatal outcomes. We searched PubMed, Embase and Web of Science for studies evaluating air quality index, fine particulate matter less than 2.5 μm, nitrogen dioxide or ozone in relation to birth weight, preterm birth, stillbirth, neonatal mortality, congenital anomalies or neonatal intensive care unit admission. Two reviewers screened and extracted data independently. We performed a narrative scoping synthesis; pooled odds ratios came from included meta-analyses. Twenty studies were included: 12 cohort studies, 3 case-control studies, 4 systematic reviews with meta-analyses and 1 cross-sectional study. Most assessed in utero exposure by trimester or pregnancy averages; a few assessed exposure around delivery, and none primarily evaluated preconception exposure. Fine particulate matter less than 2.5 μm showed the most consistent associations with lower birth weight and higher preterm birth risk. Nitrogen dioxide was also associated with preterm birth and reduced birth weight. Ambient air pollution, especially fine particulate matter less than 2.5 μm and nitrogen dioxide, is associated with adverse perinatal and neonatal outcomes and supports exposure reduction during pregnancy and better research on critical exposure windows.

Since its inception, osteopathic medicine has included pediatric patients within its clinical scope, addressing a wide range of congenital, postural, respiratory, neurological, and musculoskeletal conditions. This study aimed to review historical osteopathic literature for the analysis of osteopathic manipulative treatment (OMT) utilized for the management of pediatric patients. This structured historical literature review, conducted between June and October 2025, examined osteopathic literature published from 1874 to 1950, with a focus on pediatric OMT. Online archive searches were conducted utilizing Medical Subject Headings (MeSH)-derived keywords. Articles were screened for relevance to OMT in pediatric patients and caregiver guidance, excluding those that did not provide details on manipulative interventions. The assessed outcomes encompassed reported health conditions, the use of OMT, the duration of osteopathic interventions, guidance provided to caregivers, and the outcomes reported. Data were analyzed utilizing a reflective brainstorming model, with findings organized into key themes relevant to contemporary osteopathic practice. Articles lacking descriptions of manipulative interventions were excluded. The initial literature search identified 227 articles, of which 126 were excluded for not meeting the inclusion criteria. A total of 28 articles were deemed eligible and included in this review. The extracted data are structured into five thematic areas: health issues reported, OMT, time frame of. OMT, caregiver guidance and behavioral approaches, and reported outcomes. These data are presented through integrated narrative and tabular syntheses. This review highlights the evolution of osteopathic medicine in pediatrics, emphasizing its role in managing various pediatric conditions with gentle, individualized treatments. Osteopathic medicine focuses on improving health, restoring function, and preventing invasive interventions. Its child- and family-centered approach aligns with modern healthcare models that prioritize prevention and well-being. Given its safety and effectiveness, particularly in musculoskeletal and developmental disorders, osteopathic medicine remains a valuable tool in pediatric care. Further research is needed to validate these findings and to expand osteopathic medicine's role in child health, fostering a more integrated healthcaremodel.

Anxiety detection using neural and physiological signals and artificial intelligence: A comprehensive review.