INTRODUCTION:Patients with diabetes have a 2% annual risk of developing a Diabetic Foot Ulcer (DFU). Novel methods of reducing the risk of re-ulceration could reduce the cost of diabetic foot disease. MATERIALS AND METHODS:Fifty-two patients with active foot disease, a history of prior DFU and/or high-risk feet were included in this study. Patients were randomly assigned 50:50 to be educated conventionally by a podiatrist or to view a bespoke foot self-care educational animation developed by the research team for this exploratory pilot study. A modified Nottingham Assessment of Functional Footcare (NAFF) questionnaire was used to record knowledge of safe foot care behaviors pre- and post-intervention. The primary outcome was change in self-care knowledge score. In parallel, a mixed-methods acceptability study was carried out for the 26 patients in the intervention arm, with quantitative data obtained using a 20-item technology acceptance model. Qualitative data were obtained by face-to-face interviews in the clinic setting and examined using thematic analysis. RESULTS:While foot self-care knowledge scores were numerically higher in both groups, only the intervention group showed a statistically significant within-group improvement. There was a trend toward a greater magnitude of increase in the knowledge score in favor of the intervention group, but this did not reach statistical significance. Among the 26 patients who completed the technology acceptability study, the majority of responses were in favor of the educational video. CONCLUSIONS:This randomized controlled and mixed-methods study demonstrated positive results in terms of improvements in foot self-care knowledge and acceptability.

Background:Hypertension affects about a third of the global population and stays poorly controlled in many patients despite effective treatments being available. Clinical inertia, meaning the failure to intensify or reassess therapy when it is indicated, is one contributor. Home blood pressure (BP) monitoring and other mobile health (mHealth) tools generate frequent readings, but this adds to the interpretive work asked of clinicians. How clinicians turn home BP readings into follow-up scheduling decisions has had little empirical study. Objective:To elicit and characterise clinician scheduling preferences for follow-up appointments in newly diagnosed hypertensive patients, using simulated home BP data, as a first step toward mHealth-based scheduling support. Methods:An online questionnaire presented 15 simulated clinical scenarios depicting newly diagnosed hypertensive patients with 7 days of home BP measurements, and was distributed to physicians in two rounds. Physicians indicated their preferred timing for follow-up (0-5 weeks). We analysed 555 scheduling decisions from 37 physicians using a linear mixed-effects model with a random intercept by physician, which accounts for within-physician correlation. Results:On the same data used for model fitting, predictions correlated with stated decisions (Pearson r = 0.83; median absolute difference 0.1 weeks). This is an internal goodness-of-fit measure and not out-of-sample validation. The most recent follow-up BP was the dominant driver of scheduling. Above the 140 mmHg systolic threshold, higher BP was associated with earlier follow-up (0.13 weeks earlier per 1 mmHg increase; 95% CI 0.09-0.17). Consultants and non-consultants differed: non-consultants scheduled later follow-up at lower BP but earlier follow-up at higher BP. Conclusions:In simulated scenarios, clinicians appear to use a small set of interpretable rules, chiefly the recent BP value relative to 140 mmHg, when stating preferences for follow-up timing in newly diagnosed hypertensive patients. The formalised rules show meaningful variation between clinicians and give a methodological basis for mHealth scheduling tools. Because the scenarios were simplified and the model has not been tested out of sample, the findings should be read as hypothesis-generating. Whether algorithm-assisted scheduling improves clinical outcomes or reduces workload needs prospective evaluation in real-world settings.

Magnetic-resonant implantable sensors enable minimally invasive, continuous monitoring of hemodynamic parameters, with performance critically dependent on the electromagnetic coupling to an external reader. In this work, we investigate the coupling mechanisms in such systems, highlighting the limitations of the conventional magneto-quasistatic (MQS) approximation when accounting for the dielectric properties of biological tissues. A case study of an aortic wall sensor for Abdominal Aortic Aneurysm monitoring is presented, employing both MQS and mid-field electromagnetic models within a realistic multi-layer anatomical setup. Results indicate that the optimal operating frequency for magnetic-resonant sensors lies between 13 and 30 MHz. Depending on the implant size, the transition from near-field to mid-field coupling occurs between 40 and 70 MHz, where tissue-induced phase reversal between reader and sensor coils is observed. These findings are translated into design guidelines, offering practical strategies to maximize wireless power transfer and ensure reliable sensor readout in implantable magnetic-resonant systems.

Artificial intelligence is entering surgical practice not as an extension of the surgeon's hand, eyes, or dexterity, but of surgical judgment itself. This creates a growing informational asymmetry between well-resourced and under-resourced operative environments, with implications for training, competence, accountability, and equity. This commentary, derived from the Karl Storz Lecture delivered at the SAGES 2026 Annual Meeting, proposes the Digital Scalpel: a five-layer conceptual architecture (data infrastructure, connected systems, computational vision, cognitive augmentation, and human judgment) for understanding AI-enabled surgical practice. The current evidence base for each layer is appraised, with particular reference to AI assessment of the Critical View of Safety in laparoscopic cholecystectomy. Computational vision is the most mature layer, with deep-learning systems demonstrating high concordance with expert assessment of the Critical View of Safety, though validation remains largely confined to elective, uninflamed, single-centre cases. Three risks are identified: automation complacency, an unresolved accountability gap, and a digital inverse care law under which AI-augmented capability tracks existing resource inequities. The most evidence-supported entry point for most institutions is routine operative video capture and structured review, not real-time guidance. The surgeon of 2035 will require four attributes: preserved technical excellence, data literacy as a core competency, ethical fluency, and institutionalised clinician-engineer collaboration. The Digital Scalpel demands active, critical, and equitable engagement rather than passive technological adoption.

OBJECTIVE:Distinguishing between pituitary corticotropin (ACTH)-dependent Cushing disease (CD) and ectopic ACTH-dependent Cushing syndrome (EADCS) is diagnostically challenging. This study compared the diagnostic performance of bilateral inferior petrosal sinus sampling (BIPSS) and bilateral internal jugular vein sampling (BIJVS). METHODS:We retrospectively reviewed 109 patients at Mayo Clinic (1998-2018) who underwent simultaneous BIPSS and BIJVS. Eighty-four patients proceeded to pituitary surgery based on BIPSS results, and 81 ultimately received confirmed diagnoses: 74 with CD and 7 with EADCS. Sensitivity and specificity were calculated using pre- and post-corticotropin-releasing hormone (CRH) stimulation criteria. RESULTS:BIJVS was positive in 35/74 CD patients at baseline and 59/74 post-CRH, compared with 68/74 and 72/74, respectively, for BIPSS. Combined pre- and post-CRH criteria yielded 82% sensitivity and 86% specificity for BIJVS, compared with 100% sensitivity and specificity for BIPSS. CONCLUSION:BIPSS is superior to BIJVS for establishing the source of ACTH hypersecretion in ACTH-dependent Cushing syndrome. BIJVS demonstrates limited diagnostic utility in clinical practice.

Background:Artificial intelligence (AI) chatbots have shown competency in a range of areas, including clinical note taking, diagnosis, research, and emotional support. An obesity epidemic, alongside a growth in novel injectable pharmacological solutions, has put a strain on limited resources. Objective:This study aimed to investigate the use of a chatbot integrated with a digital avatar to create a "digital clinician." This was used to provide mandatory patient education for those beginning semaglutide once-weekly self-administered injections for the treatment of overweight and obesity at a national center. Methods:A "digital clinician" with facial and vocal recognition technology was generated with a bespoke 10- to 15-minute clinician-validated tutorial. A feasibility randomized controlled noninferiority trial compared knowledge test scores, self-efficacy, consultation satisfaction, and trust levels between those using the AI-powered clinician avatar onsite and those receiving conventional semaglutide education from nursing staff. Attitudes were recorded immediately after the intervention and again at 2 weeks after the education session. Results:A total of 43 participants were recruited, 27 to the intervention group and 16 to the control group. Patients in the "digital clinician" group were significantly more knowledgeable postconsultation (median 10, IQR 10-11 vs median 8, IQR 7-9.3; P<.001). Patients in the control group were more satisfied with their consultation (median 7, IQR 6-7 vs median 7, IQR 7-7; P<.001) and had more trust in their education provider (median 7, IQR 4.8-7 vs median 7, IQR 7-7; P<.001). There was no significant difference in reported levels of self-efficacy (P=.57). 81% (22/27) participants in the intervention group said they would use the resource in their own time. Conclusions:Bespoke AI chatbots integrated with digital avatars to create a "digital clinician" may perform health care education in a clinical environment. They can ensure higher levels of knowledge transfer yet are not as trusted as their human counterparts. "Digital clinicians" may have the potential to aid the redistribution of resources, alleviating pressure on bariatric services and health care systems, the extent to which remains to be determined in future studies.

Background During the COVID-19 pandemic, in-person visitation within hospitals was restricted and sometimes eliminated to reduce the risk of transmission of SARS-CoV-2. Many health care professionals created novel strategies that were deployed to maintain a patient-centered approach. Although pandemic-related restrictions have eased, these systems, including videoconferencing or web-based bedside visits, remain relevant for visitors who cannot be present due to other reasons (lack of access to transport, socioeconomic restraints, geographical distance, etc). Objective The aims of this study were (1) to report the experience of intensive care nursing staff using a bespoke videoconferencing system called ICU FamilyLink; (2) to examine the scenarios in which the nursing staff used the system; and (3) to assess the future use of videoconferencing systems to enhance communication with families. Methods A modified Telehealth Usability questionnaire was administered to the nursing staff (N=22) of an intensive care unit in a model 4 tertiary hospital in Ireland 1 year after implementing the bespoke videoconferencing system. Results In total, 22 nurses working in the intensive care department at University Hospital Galway, Ireland, responded to the survey. A total of 23% (n=5) of participants were between the ages of 25 and 34 years, 54% (n=12) were between 35 and 44 years, and 23% (n=5) were between 45 and 54 years. Most (n=15, 68%) of the participants reported never using videoconferencing in the intensive care setting to communicate with family members before March 2020. The modified Telehealth Usability Questionnaire showed overall satisfaction scores for each subcategory of ease of use and learnability, interface quality, interaction quality, reliability, satisfaction and future use, and usefulness. In total, 21 (95%) participants agreed or strongly agreed with the statement, “I would use the ICU FamilyLink system in future circumstances in which family members cannot be physically present (ie, pandemics, abroad, inability to travel, etc),” and 1 participant responded neutrally. One participant highlighted a common scenario in intensive care settings in which a videoconferencing system can be used “Even without COVID, web-based communication is important when patients become unexpectedly ill and when families are abroad.” Conclusions This study provides valuable insights into health care professionals’ experience using a videoconferencing system to facilitate web-based visits for families. We conclude that videoconferencing systems when appropriately tailored to the environment with the users in mind can be an acceptable solution to maintain communication with family members who cannot be physically present at the bedside. The bespoke videoconferencing system had an overall positive response from 22 nursing staff who interacted with the system at varying frequency levels.

Despite the availability of affordable pharmaceuticals treating cardiovascular diseases (CVDs), many of the risk factors remain poorly controlled. Fixed-dose combinations (FDCs), a form of incremental innovation, have already demonstrated improvements over combinations of single medicines in adherence and hard clinical endpoints. Nevertheless, there are many barriers related to the wider use of FDCs in CVDs. Our aim was to identify these barriers and explore system-level facilitators from a multi-stakeholder perspective. Identified barriers include (i) hurdles in evidence generation for manufacturers, (ii) limited acceptance of adherence as an endpoint by clinical guideline developers and policymakers, (iii) limited options for a price premium for incremental innovation for healthcare payers, (iv) limited availability of real-world evidence, and (v) methodological issues to measure improved adherence. Initiatives to standardize and link healthcare databases in European countries, movements towards improved patient centricity in healthcare, and extended value assessment provide opportunities to capture the benefits of FDCs. Still, there is an emerging need to facilitate the generalizability of sporadic clinical evidence across different FDCs and to improve adherence measures. Finally, healthcare payers need to be convinced to pay a fair premium price for the added value of FDCs to incentivize incremental innovation in CVD treatment.

ABSTRACT Aims/Introduction Patients with a healed diabetic foot ulcer (DFU) have a 40% risk of ulcer recurrence within a year. New and effective measures to prevent DFU recurrence are essential. We aimed to highlight emerging trends and future research opportunities in the use of plantar pressure measurement to prevent DFU recurrence. Materials and Methods Our scoping review protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta‐analysis – Scoping Review protocol. Peer‐reviewed, English‐language papers were included that addressed both plantar pressure measurement and diabetic foot disease, either as primary studies that have advanced the field or as review papers that provide summaries and/or opinion on the field as a whole, as well as specific papers that provide guidelines for future research and advancement in the field. Results A total of 24 eligible publications were identified in a literature search using PubMed. A further 36 eligible studies were included after searching the references sections of these publications, leaving a total of 60 publications included in this scoping review. Conclusions Plantar pressure measurement can and will play a major role in the prevention of DFU. There is already a strong, albeit limited, evidence base in place to prove its benefit in reducing DFU recurrence. More research is required in larger populations, using remote monitoring in real‐world settings, and with improved technology.

Background: Various studies have evaluated the safety and efficacy of using insulin pumps during Ramadan; some of them demonstrated favorable outcomes in reducing hypoglycemia and hyperglycemia. However, there is no consensus on the recommendations for basal insulin adjustments and the utilization of technical features of insulin pumps to improve glycemic control. Objectives: We aimed to investigate the effects of different insulin pump settings on time in range in patients with type 1 diabetes during Ramadan. Methods: In this randomized pilot study, 30 patients classified to have low to moderate risk for fasting were assigned to either a control group to receive basal insulin adjustments only or an intervention group to use the temporary basal rate and extended bolus features in addition to the basal insulin modifications. The percentage of time spent at different glucose ranges was measured by continuous glucose monitoring. Results: The percentage of time spent within target (70-180 mg/dL) increased significantly in the intervention group from 63.0 ± 10.7 to 76 ± 16.2% (mean difference, 27% points; P < .001). The percentage of time spent in hyperglycemia level 1 (>180 mg/dL) and level 2 (>250 mg/dL) met the criterion of significance, indicating that the intervention group spent less time in hyperglycemia. However, there was no significant difference in the percentage of time spent in hypoglycemia ranges. Conclusions: Incorporating technological approaches of pump therapy with clinical practice guidelines could improve glycemic control during Ramadan.