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Anticholinergic drugs in late life: adverse effects on cognition but not on progress to dementia.

Impaired cognitive function associated with use of anticholinergic drugs may be partly attributed to underlying physical illness and exposure to factors that increase the risk of some physical disorders such as low socioeconomic status (SES) and less education. To estimate the extent of cognitive impairment and risk of progress to dementia associated with anticholinergic drug use and to estimate confounding by gender, APOE, family history of dementia, lower SES, less education, and lower childhood mental ability, we recruited 281 volunteers at age 77-78 without overt dementia who had taken par

Cognitive impairment in motor neuron disease with bulbar onset.

METHODS: Twenty-three patients with bulbar onset motor neuron disease/amyotrophic lateral sclerosis (MND/ALS) were clinically assessed. They subsequently underwent serial neuropsychological testing, event-related potentials (ERP) and SPECT studies. Cognitive impairment was defined by clinical evidence of dementia (DSM-IV and frontal evaluation) or by significant alteration indicated by neuropsychological testing (excluding patients with depression and major anxiety), or both. RESULTS: Eleven patients (48%) were found to be cognitively impaired. Abnormalities indicated fronto-temporal involvem

Varieties of deficit unawareness after brain injury.

The failure to recognize the existence of disease is known as anosognosia. This article provides a brief discussion of the evolution of this concept and reviews some qualitative differences in the manner in which the disavowal of neurogenic impairment is expressed. Theoretical explanations for the unawareness of deficit after neurologic illness include motivational-symbolic, cognitive subsystem, and supraordinate system theories. Observations from a clinically derived, structured awareness interview are presented, suggesting three factors that may underlie patients' apparent lack of awareness

Current indications for Helicobacter pylori eradication therapy.

Two questions need to be answered before the eradication of Helicobacter pylori infection can be discussed. Firstly, can the infection be cured, and if so, is the cure permanent or transient? Secondly, what is the long-term clinical outcome of H. pylori infection? Current indications for the eradication of H. pylori infection can be divided into three categories: well-established, equivocal and experimental. Peptic ulcer disease in patients positive for H. pylori is a well-established indication for eradication of the organism. H. pylori-positive dyspepsia and the need for prolonged treatment

A consensus conference on psychotic depression.

We report a consensus conference on psychotic depression that addressed historic, classification, phenomenologic, epidemiologic, aetiologic, … tic" episodes in those with a borderline personality disorder) and others where they modified their clinical reasoning (e.g. "if a "psychotic" feature is mood-congruent then the condition must be an affective disorder" became "if the patient has an affective disorder, the psychotic feature must be mood-congruent"). Finally, we make some recommendations for future co …

Clinical Decision-Making Case: Febrile Infant.

AUDIENCE: This clinical decision-making (CDM) case is intended for emergency medicine residents of all levels, medical students, and fellows … ropriate disposition to a higher level of care. Learners are challenged to clearly articulate their clinical reasoning and management decisions in a high-stakes environment that mirrors real-world emergency medicine practice. EDUCATIONAL OBJECTIVES: By the end of this CDM case, learners will be able to: 1) demonstrate familiarity with the CDM case format, 2) recogn …

Perspectives on Teaching the International Classification of Functioning, Disability, and Health Model to Physical Therapy Students.

BACKGROUND: During a reaccreditation visit, deficiencies were discovered in the clinical education curriculum regarding patient-centered care in a Doctorate of Physical Therapy program. To understand the problem and address those deficiencies, the clinical internship experience was examined using the International Classification of Functioning, Disability, and Health (ICF) model as a conceptual framework for clinical reasoning. OBJECTIVE: This qualitative case study aimed to study (1) perceptions of physical therapy (PT) students regarding their knowledge and learning experiences during clini…

Clinical Artificial Intelligence Agents in Nephrology: From Prediction to Action Through Workflow-Native Intelligence-A Roadmap for Workflow-Integrated Care.

Background: Artificial intelligence in nephrology has largely focused on predictive models for outcomes such as acute kidney injury (AKI), chronic kidney disease (CKD) progression, and transplant complications. Although these models demonstrate technical performance, their real-world clinical impact has remained limited because prediction alone rarely translates into coordinated clinical action. Clinical artificial intelligence agents represent workflow-native systems that operate in real time, interact bidirectionally with clinical environments, adapt to evolving patient and workflow states,

The maya behind moyamoya--the two extremes of the disease.

Two children with moyamoya disease at the extremes of the disease- one with minimal clinical involvement and the other one with profound clinical features are reported with an interesting finding of the collaterals being the reason (maya) behind such varied presentations. To the best of authors' knowledge this is the first Indian report describing the reason behind the varied presentations of moyamoya disease.

From a direct oral anticoagulant to warfarin: reasons why patients switch.

The introduction of the direct oral anticoagulants (DOACs) has led to their widespread use for stroke prevention and venous thromboembolism, but little is known about the numbers of patients switching from a DOAC to (or back to) a warfarin or the reasons for doing so. This study was an analysis of prospectively collected data from a 4-year period surveying a warfarin dose adjustment clinic in a large city centre hospital with the primary objective to identify these reasons. In our clinic with 1791 patients annually under review, 40 patients were identified as having switched from a DOAC to war

Clean, Pleasant, Governed: A Critical Discourse Analysis of Bathing Without a Battle.

Bathing Without a Battle is a widely circulated video training resource in residential dementia care, but the assumptions it advances about bathing, refusal, and appropriate nursing practice have received limited critical attention. This paper analyzes how the text constructs resistance to assisted bathing and how it frames legitimate nursing responses to that resistance. A three-part Faircloughian critical discourse analysis is used, attending to social structures, processes of production and dissemination, and the textual features through which meaning is enacted. The bulk of the analysis fo

Applying an F-words lens to planning intervention for a child with autism: a retrospective case report with prospective follow-up.

Children with Autism Spectrum Disorder (ASD) present with complex, multi-domain functional challenges that single-domain intervention approaches fail to address adequately. This retrospective case report, with prospective follow-up from age 7 years, applies CanChild's F-words and the F-words Lens Tool to examine intervention planning and developmental outcomes across a five-year trajectory for an eight-year-old autistic girl with co-occurring hypotonia and joint hypermobility. For each developmental period, from 24 months to eight years, we identify the functional challenge encountered, drawin

Precision Medicine Through Network Language: Integrating Clinical Insight and Data Expertise.

Precision medicine is facing a critical transition driven by the growing complexity of biological data and the insufficient ability of current models to translate such data into clinically meaningful information. Linear, single-gene approaches are no longer adequate to explain the multifactorial nature of most modern diseases, whose phenotypes emerge from combinations of genetic, molecular, and environmental factors. Network-based precision medicine addresses this by providing a systemic framework capable of integrating heterogeneous omics data, interactomes, and clinical information to identi

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… These two worlds adopt different cognitive paradigms, methodologies and objectives: on the one hand, abstraction, modeling and quantitative analysis; on the other hand, clinical reasoning based on experience, patient context and uncertainty management. …

Evaluating Medical Students' Perceptions of AI-Assisted Clinical Documentation (CarePilot): Cross-Sectional Study.

BACKGROUND: Artificial intelligence (AI) is increasingly being integrated into health care to streamline documentation and improve clinician … headache. Using CarePilot, participants documented patient history, physical examination findings, clinical reasoning, and management decisions. Afterward, they completed a 27-item Likert scale survey assessing ease of use, documentation efficiency, organization, and overall satisfaction. RESULTS: The majority of respondents rated ease of use, learnability, interf …

SPARNet: A Framework for Airway Invasion Tracking from Fluoroscopic Videos of Dysphagia Patients.

The videofluoroscopic swallowing study (VFSS) is the clinical gold standard for evaluating dysphagia and detecting airway invasion. However, manual interpretation is time-consuming, subjective, and prone to rater variability due to the rapid and complex nature of swallowing events. Existing deep learning approaches for airway invasion are limited by relying on manual frame selection, a lack of interpretability, and black-box decision-making. In this study, we propose SPARNet (Swallowing Phase Airway Risk Network), AI pipeline integrates swallowing-phase classification, bolus and airway delinea

UK Defence Rehabilitation consensus agreement for the conservative management of Achilles and patellar tendinopathy: a modified Delphi approach.

Achilles and patellar tendinopathy are common in military personnel due to the repetitive high loads and challenging extrinsic risk factors associated with the demands of their role. Sports medicine is rapidly evolving. Up-to-date evidence-based research is essential, alongside clinical reasoning, to deliver best-practice treatment to service personnel, underpinned by the duty of care to their long-term career.The aim of this research was to develop recommendations on conservative management of Achilles and patellar tendinopathy in relation to the military population. A systematic review was c…

Evaluating the Accuracy, Safety, and Equity of Multimodal Large Language Models for Real-World Ocular Surface Disease Diagnosis.

Ocular surface diseases impose a substantial burden in resource-limited regions, where diagnostic access remains scarce. Although multimodal large language models (M-LLMs) show potential for clinical support, their real-world accuracy, safety, and equity have not been systematically evaluated. A comprehensive assessment was performed on five leading M-LLMs (GPT-5, Gemini-2.5 Pro, Gemini-2.5 Flash, GLM-4.5V, and Claude-Sonnet-4.5) for ocular surface disease diagnosis using a retrospective multimodal data set of 259 representative cases from Aksu, China, including anterior segment photographs an

Zosteriform Lichen Planus in a Young Woman: A Case Report of the Diagnostic Challenges and Psychodermatologic Associations.

Lichen planus (LP) is a chronic T-cell-mediated inflammatory dermatosis affecting the skin, mucous membranes, nails, and scalp. Zosteriform … linically diagnosed ZLP in a resource-limited setting and demonstrates the importance of systematic clinical reasoning when biopsy is not feasible, while reaffirming that histopathologic confirmation remains the preferred method whenever available. It also supports formal psychosocial assessment as a valuable adjunct to the multidisciplinary management of selected p …

Enigmatic Cases of Finger Proximal Interphalangeal Joint Swelling: Case Series and Focused Review of the Literature.

Objectives: This case series and focused literature review address the diagnostic challenges and management strategies for patients presenting with atraumatic, isolated swelling, and stiffness of a single finger's proximal interphalangeal (PIP) joint. The dual emphasis is on synthesizing the lessons learned from our case series and providing a structured framework for clinical reasoning, including imaging, biopsy, and laboratory assessment. Non-traumatic causes of finger swelling may include rheumatological disease, atypical infection, tumor, or metabolic conditions. Routine evaluation include…

Pelvic Pain, Mental Health and Quality of Life in Adolescents with Endometriosis after Surgery and Dienogest Treatment.

BACKGROUND: Diagnostic and treatment delays have caused significant impacts on the physical and emotional well-being of adolescents with endometriosis, though such research is limited. This study aimed to assess the effects of one-year dienogest therapy on the clinical picture, pain patterns, psycho-emotional status, and quality-of-life indicators in adolescents with endometriosis after surgical treatment. METHODS: The study enrolled 32 girls aged 13-17 with peritoneal endometriosis to analyze one-year dynamics of the Visual Analog Scale (VAS), McGill Pain Questionnaire, Beck Depression Scale