Background Despite limited evidence for non-cancer pain, opioid use has increased substantially in Europe. We aimed to characterize patterns and treatment trajectories of inpatient opioid use and to identify clinically distinct patient subgroups of heightened risk for opioid-related harm using predefined deprescribing indicators to inform hospital-based stewardship interventions. Methods This five-year, multicenter, longitudinal, observational cohort study across three Swiss tertiary referral centers (2020–2024) included adult inpatient cases with at least one systemic opioid administration during the index hospitalization using linked electronic health record data. Daily morphine milligram equivalents (MMEs) were calculated from medication administration records. Sustained therapy was defined as ≥3 consecutive treatment days. Deprescribing indicators included high-dose therapy (>90 MMEs on the final hospital day), high-risk comorbidities, and concurrent use of central nervous system depressants. Non-cancer opioid treatment trajectories were clustered using k-means analysis. Findings Among 68,129 opioid-treated cases, 78.6% (n = 53,558) had no documented cancer diagnosis. Approximately half received sustained therapy. Collectively, 11.4% (n = 7791) of 68,129 cases met at least one predefined deprescribing indicator. Musculoskeletal disorders and injury-related conditions were the primary admission diagnoses (22.9% [n = 15,575] of 68,129 cases). Opioid treatment trajectory analysis identified three distinct MME patterns among non-cancer cases, including a stable-dose subgroup (36% [n = 19,292] of 53,558) characterized by sustained therapy (89.3% [n = 17,235] of 19,292 cases), higher comorbidity burden, and greater prevalence of deprescribing indicators (33.4% [n = 17,235] of 19,292 cases). Annually, over 1200 cases were eligible for deprescribing, predominantly older adults with musculoskeletal conditions. Interpretation Inpatient opioid exposure was overall more common in non-cancer cases and often characterized by sustained therapy with only marginal dose reductions prior to discharge. Hospitals therefore represent critical intervention points for structured deprescribing approaches to prevent transitions to potentially harmful, persistent opioid use. Funding This research did not receive external funding.
Although α-Klotho has gained attention as a promising biomarker of aging, its association with frailty and broader aging-related outcomes beyond chronic kidney disease–mineral and bone disorder remains incompletely characterized. This systematic review and meta-analysis aimed to investigate the association between circulating α-Klotho levels and aging-related outcomes, including frailty, effects of physical activity and exercise interventions, body composition, cognitive and neuropsychiatric status, sarcopenia, and bone mineral density (BMD). A comprehensive literature search was performed across multiple electronic databases, including Ovid MEDLINE, Web of Science, Scopus, PubMed, and the Cochrane Library, to identify relevant studies published up to April 30, 2025. Pooled analyses were conducted using random-effects models, with effect estimates synthesized as mean differences, odds ratios, or correlation coefficients, and heterogeneity assessed using the I2 statistic. Risk of bias was assessed using design-specific tools, including the Newcastle–Ottawa Scale, the Risk of Bias 2 tool (RoB2) of the Cochrane collaboration, and the Joanna Briggs Institute (JBI) checklists. A total of 109 studies met the inclusion criteria and were included. In our meta-analysis, higher circulating α-Klotho levels were significantly associated with lower odds of frailty (OR = 0.61, 95
Large language models (LLMs) represent a rapidly advancing subset of artificial intelligence with significant potential to augment clinical practice. These tools can assist in literature synthesis, documentation, clinical reasoning, and patient communication. Despite demonstrated capabilities, adoption in healthcare remains limited due to barriers such as limited AI literacy, trust concerns, integration challenges, and generational disparities in digital proficiency. This review critically examines the role of LLMs as cognitive adjuncts in medicine, emphasizing the need for calibrated trust, human oversight, structured implementation strategies, and robust regulatory governance. Evidence suggests that stepwise integration of LLMs, beginning with low-risk tasks, may enhance physician efficiency, reduce cognitive burden, and may support high-quality care. Key limitations, including hallucinations, data currency, environmental impact, and data security, have to be addressed, alongside the need for continuous model refinement. Rigorous clinical trials are needed to establish the efficacy of LLMs. This includes the recognition that LLMs trained on vast web data may contain personal health information, creating a significant privacy risk. Responsible adoption of LLMs is essential to meet the demands of modern medicine while preserving clinical accountability and patient-centered care.
Abstract Background Muscle lesions are common sport injuries resulting in prolonged absence from sport activity and long rehabilitation periods. The aim of this systematic review and meta-analysis was to quantify the clinical benefits of platelet-rich plasma (PRP) injections in treating acute muscle injuries. Methods The search was conducted on PubMed, Cochrane Library, and Web of Science in January 2026. The PRISMA guidelines were used. Inclusion criteria were: randomized controlled trials (RCTs) published in English comparing PRP injections with control (rehabilitation or placebo) for the treatment of acute muscle injuries. The outcomes analysed were: time to return to sport (RTS), Visual Analogue Scale (VAS) for pain, re-injury and complication rates. Two sub-analyses were performed, one on the double-blind RCTs and one on the RCTs focusing on hamstrings. A fragility analysis was performed using the fragility index (FI) and the continuous FI (CFI). The quality of each article was assessed using the Cochrane RoB 2 and the GRADE tools. Results Among the 4969 articles retrieved, nine RCTs (474 patients) were included. PRP provided faster RTS both in the overall analysis (p < 0.001, mean difference (MD) = 7.5, CFI = 188) and in the two sub-analyses (p < 0.001, MD = 8.8, CFI = 67 and p = 0.001, MD = 7.5, CFI = 97 respectively), as well as superior VAS improvement in the hamstring sub-analysis (p = 0.006, MD = 0.4, CFI = 22). No difference was found in terms of re-injury and complication rates between the two groups (FI = 5 and FI = 7, respectively). The evaluation using the RoB 2 tool showed that four studies had a “low risk” of bias and five had a “high risk” of bias. The GRADE evaluation showed a limited quality of evidence of the analysed outcomes. Conclusion PRP produced a faster RTS compared to controls in acute muscle injury patients, both in the overall analysis and in the sub-analyses. PRP was able to produce a statistically higher pain relief only in the hamstring subgroup, while no difference was found in terms of re-injury and complication rates, suggesting a similar safety profile when compared to rehabilitation alone and placebo. The fragility analysis supported the benefits in terms of RTS, although the high-quality literature addressing this topic remains limited, warranting caution in the interpretation of the current results.
