Health Care Foundation

Vericiguat is a soluble guanylate cyclase stimulator that acts by restoring the nitric oxide-cyclic guanosine monophosphate pathway, which is markedly impaired in heart failure with reduced ejection fraction (HFrEF). The VICTORIA trial demonstrated that treatment with vericiguat leads to a significant reduction in mortality and morbidity in patients with HFrEF and a recent episode of clinical decompensation. However, the role of vericiguat in clinically stable patients had remained unexplored until the recent publication of the VICTOR trial. In a population receiving optimal medical therapy and characterized by a lower risk of events, vericiguat did not demonstrate a significant reduction in the primary composite endpoint of cardiovascular death and hospitalization for heart failure. When analysing the individual components of the primary endpoint, no benefit was observed with respect to hospitalizations, whereas significant reductions in both cardiovascular and all-cause mortality were reported. This finding, which is highly unusual in the context of recent clinical trials in patients with HFrEF, warrants further consideration when interpreting the results of the study.

Accessibility of cities involves designing spaces and services to enable everyone to live independently and fully participate in urban life. This study aims to gather the perspectives of individuals with visual impairment on the accessibility of everyday environments in Padua, a midsize urban centre in Northeastern Italy. A total of 204 participants with visual impairment completed an online survey designed to meet accessibility standards, including adjustable text size, audio descriptions, and screen readers compatibility. Findings show that 70% of respondents frequently experience physical and social barriers in local services and transport; 61% in health services; 58% in commerce; 41% in sports; and 38% in both cultural and educational settings. Thematic analysis of open-ended responses further identified specific barriers, which reflected both physical and social dimensions. Social barriers, alongside physical ones, should be a primary focus in evaluating the accessibility of urban environments and in planning subsequent interventions.

Abstract Background Ventilator-associated pneumonia is the most serious acquired infection in intensive care units for patients undergoing mechanical ventilation following urinary tract infections. The mortality associated with VAP ranges from 20% to 50%, and the attributable mortality is estimated at 13%. And the knowledge of nurses working in critical areas regarding the VAP prevention bundle is not well established. This study determined the knowledge level of the VAP bundle among nurses working in cardiac critical areas. Methods A cross-sectional study design with a quantitative approach was used. A convenient sampling method was used in selecting study participants and was conducted in the adult cardiac intensive care unit and the Cardiac care unit. Participation was voluntary, and a sample of 67 nurses was selected. A structured questionnaire was used in data collection, and SPSS version 21 was used in data analysis. The data was collected in the first week of September 2025. Results Regarding the sociodemographic characteristics of the study participants, most of the study participants were aged below 24 years (58.2%), and the mean age of 25.2687. The majority of the participants were working in ACICU (85.1%). The Overall knowledge level, about 80.6% of the studied subjects had a satisfactory knowledge level (61–100% score). Computed multivariate binary logistic regression analysis, the result showed a significant relationship between the workplace, not attending the VAP or IPC training and frequency of ventilator circuit change were statistically significant with nurses’ VAP knowledge level with OR: 0.032 (C.I:0.01–0.200), p value 0.000; OR: 0.040(C.I:0-0.33), p value 0.003, and OR: 0.043 (C.I:0.000-0.660), P value 0.024 respectively Conclusion The overall nurses’ knowledge level towards VAP was satisfactory, especially for those working in ACICU. And the factors associated with nurses’ VAP knowledge level, workplace, having attended or not VAP/IPC training, and changing ventilator circuit frequency were statistically significant.

Abstract The variability in responses generated by Large Language Models (LLMs) like OpenAI’s GPT-4 poses challenges in ensuring consistent accuracy on medical knowledge assessments, such as the United States Medical Licensing Exam (USMLE). This study introduces a novel multi-agent framework—referred to as a "Council of AIs"—to enhance LLM performance through collaborative decision-making. The Council consists of multiple GPT-4 instances that iteratively discuss and reach consensus on answers facilitated by a designated "Facilitator AI." This methodology was applied to 325 USMLE questions across Step 1, Step 2 Clinical Knowledge (CK), and Step 3 exams. The Council achieved consensus responses that were correct 97%, 93%, and 94% of the time for Step 1, Step 2CK, and Step 3, respectively, outperforming single-instance GPT-4 models. In cases where there wasn’t an initial unanimous response, the Council of AI deliberations achieved a consensus that was the correct answer 83% of the time. For questions that required deliberation, the Council corrected over half (53%) of responses that majority vote had gotten incorrect. At the end of deliberation, the Council often corrected majority responses that were initially incorrect: the odds of a majority voting response changing from incorrect to correct were 5 (95% CI: 1.1, 22.8) times higher than the odds of changing from correct to incorrect after discussion. We additionally characterized the semantic entropy of the response space for each question and found that deliberations impact entropy of the response space and steadily decrease it, consistently reaching an entropy of zero in all instances. This study showed that in a Council model response variability—often viewed as a limitation—could be leveraged as a strength, enabling adaptive reasoning and collaborative refinement of answers. These findings suggest new paradigms for AI implementation and reveal diversity of responses as a strength in collective decision-making even in medical question scenarios where there is a single correct response.Author SummaryIn our study, we explored how collaboration among multiple artificial intelligence (AI) systems could improve accuracy on medical licensing exams. While individual AI models like GPT-4 often produce varying answers to the same question—a challenge known as "response variability"—we designed a "Council of AIs" to turn this variability into a strength. The Council consists of several AI models working together, discussing their answers through an iterative process until they reach consensus.When tested on 325 medical exam questions, the Council achieved 97%, 93%, and 94% accuracy on the Step 1, Step 2CK, and Step 3, respectively. This improvement was most notable when answers required debate: in cases where initial responses disagreed, the collaborative process corrected errors 83% of the time. Our findings suggest that collective decision-making— even among AIs—can enhance accuracy and AI collaboration can potentially lead to more trustworthy tools for healthcare, where accuracy is critical. By demonstrating that diverse AI perspectives can refine answers, we challenge the notion that consistency alone defines a "good" AI. Instead, embracing variability through teamwork might unlock new possibilities for AI in medicine and beyond. This approach could inspire future systems where AIs and humans collaborate (e.g. on Councils with both humans and AIs), combining strengths to solve complex problems. While technical challenges remain, our work highlights a promising path toward more robust, adaptable AI solutions.

Background: When it comes to professional stress, the work environment is one of its most important sources. Today, great attention is paid to researching the specifics of professional stress. Its sources and consequences for physical and mental health, as well as work productivity, are particularly important. Aim: To examine how many nurses and medical technicians employed at the Sremska Mitrovica Health Center are affected by burnout syndrome. Materials and Methods: A cross-sectional, descriptive study was conducted using the Burnout Syndrome Intensity at Work questionnaire, which is publicly available under the name "Burnout Syndrome" - HDOD. The study included 50 nurses and medical technicians employed at the Health Center in Sremska Mitrovica. The research was conducted during June and July 2025. Results: Of the total number of respondents, burnout syndrome was present in 14%. Additionally, 2% of respondents were already burned out at work, 38% were at risk of burnout syndrome, 26% were at risk, and 20% reported feeling well. No statistically significant correlation was found between gender, education level, workplace, and subjective feelings of burnout. A statistically significant positive correlation was found between respondents' age and the length of their work experience. Conclusion: Nurses and medical technicians are exposed to relatively high levels of stress. Burnout syndrome represents not only a psychological but also a physical disorder; therefore, it is important to recognize its onset in time before it seriously threatens health, daily functioning, and work productivity.

Background: Individuals with advanced HIV disease (AHD) have a heightened risk of mortality despite access to antiretroviral therapy (ART). Sub-Saharan Africa (SSA) has a disproportionate burden of AHD-associated deaths. However, there is limited country-specific data on AHD's burden and associated risk factors to help design targeted interventions. Therefore, this study determined the prevalence and factors associated with AHD among ART-naïve and ART-experienced adults with HIV at five AIDS Healthcare Foundation (AHF)-supported facilities in Zambia. Methodology: We conducted a cross-sectional study among 231 ART-naïve and ART-experienced people living with HIV (PLHIV) and collected demographic and clinical data using a structured questionnaire. The primary outcome was AHD, defined as a CD4 count less than 200 cells/µL using the VISITECT® CD4 point-of-care test. Multivariable logistic regression was used to assess factors associated with AHD. Results: Among the study participants, 59.7% were female, and 54% were aged 19–35 years. Most participants were ART-naïve (79.2%), with 85.3% classified in WHO clinical stage 1. The prevalence of AHD was 47.6% (110/231), significantly higher among ART-naïve participants [51.9% (95/183)] compared to ART-experienced participants [31.2% (15/48), p=0.011]. ART-naïve participants aged 19–35 years exhibited a notably higher prevalence of AHD (51.6%) compared to those aged 13-18, 36-45, and >45 years (5.3%, 34.7%, and 8.4%, respectively) and had significantly higher baseline viral load values (25,000 copies/mL vs. 9,690 copies/mL, p=0.037). Additionally, among ART-naïve participants, a significantly higher proportion of individuals in WHO stages 2, 3, and 4 had AHD compared to those without AHD. Across all participants, the factors significantly associated with AHD included anemia (adjusted odds ratio [aOR] 3.03, 95% confidence interval [CI]: 1.15–7.97) and being from the New Masala Clinic health facility (aOR 3.79, 95% CI: 1.17–12.30) Conclusion: Advanced HIV disease was prevalent, particularly among ART-naïve individuals, and it was significantly associated with anemia and health facility location. There is a need for formulation of interventions, especially among ART-naïve PLHIV who are anemic. Additionally, studies to integrate point-of-care diagnostics such as the VISITECT® CD4 test into routine HIV care be conducted in resource-limited settings are warranted for early detection of AHD.