Scalability gaps in Medicine

Representative open questions

Showing 30 of 72 — one per source paper, highest-quality first.

• Management of depression utilizing Traditional Chinese Medicine (2026) · doi

  The paper calls for standardization of herbal preparations, rigorous experimental design, and shared data platforms to enable reproducible science in integrated TCM-Western medicine therapy for depression, but does not specify standards for bioactive compound quantification, extraction protocols, or data repository infrastructure needed.

• Echocardiographic Assessment of Left Ventricular Mass Regression and Functional Changes after Bariatric Surgery (2026) · doi

  The research involved a small population size, which restricts the generalizability of echocardiographic findings regarding structural and functional cardiac changes after bariatric surgery. Future studies should recruit larger, more heterogeneous patient cohorts to validate whether E/A ratio improvements and LV mass regression are consistent across diverse obesity phenotypes.

• Inaugural Lifestyle Medicine Editorial (2020) · doi

  While the paper emphasizes international collaboration for vaccine development and evidence-based treatments in COVID-19, it does not address how lifestyle medicine programs can be standardized, scaled, or adapted across different healthcare systems, regulatory frameworks, and resource settings globally to achieve universal health coverage.

• City planning as preventive medicine (2015) · doi

  The paper proposes that city planners and clinicians collaborate on community health needs assessments required by the ACA and IRS, but does not address how to operationalize or scale this collaboration across municipalities with varying governance structures, planning capacities, and healthcare system configurations.

• Personalized Medicine and the Practice of Medicine in the 21st Century (2020) · doi

  Development and implementation of high-quality, integrated pharmacogenomics databases and IT-based technologies for clinical decision support requires standardization specifications and interoperability standards. The current state of infrastructure for translating pharmacogenomic findings into actionable clinical recommendations across diverse healthcare systems is inadequately defined.

• Principles of Social Emergency Medicine (2019) · doi

  The authors emphasize that emergency medicine researchers must collaborate with departments of public health, law enforcement, and case managers, but provide no concrete framework for integrating data collection, outcome tracking, or intervention evaluation across these traditionally siloed systems.

• Quantitative susceptibility mapping and MRS-based multimodal machine learning for early Parkinson’s disease classification (2026) · doi

  The four classification algorithms (Random Forest, SVM, XGBoost, LightGBM) were evaluated on an independent test cohort, but the study did not assess model robustness across external validation cohorts from different imaging centers or patient populations, which is critical for determining generalizability of the multimodal QSM-MRS approach for early PD detection.

• Clinical outcomes of the tunnelized-facial artery myomucosal island flaps in the oral cavity and comparison with cutaneous flaps in an animal model (2026) · doi

  The animal model comparing t-FAMMIF and submental skin island flap (SMIF) was exploratory with limited scale and did not investigate the mechanism underlying nerve sprouting and salivary gland preservation. Larger-scale animal experiments with temporal analysis of nerve regeneration markers (e.g., growth-associated protein 43, neurofilament) and fibrosis quantification are needed to mechanistically validate the proposed permissive microenvironment for nerve growth.

• Cerebrospinal fluid cytokine-driven immune responses in HIV-negative cryptococcal meningitis (2026) · doi

  The study included only 15 untreated cryptococcal meningitis (UCM) patients with variability in principal component scores, limiting statistical power and generalizability. Larger cohorts are needed to validate the observed correlations between CSF parameters (protein concentration, leucocyte counts, glucose ratio) and specific cytokine levels (IL-18, MCP-3, MIG, MIP-1α) in HIV-negative cryptococcal meningitis populations.

• Radiomics and artificial intelligence in precision radiotherapy for cervical cancer: a narrative review (2026) · doi

  Integration of radiomics-AI models with treatment planning systems in cervical cancer radiotherapy, inference time requirements within routine clinical workflows, regulatory requirements, data governance, model interpretability, and clinician trust mechanisms are rarely addressed in current literature.

• Traditional Korean medicine treatment patterns in patients with low back pain: A cross-sectional study based on the 2017 Korean Medicine Utilization and Herbal Medicine Consumption Survey (2020) · doi

  Treatment patterns with fewer respondents (physiotherapy alone group, specific acupuncture-cupping-pharmaco-acupuncture combinations) showed extreme results that are difficult to generalize; increasing patient numbers within each distinct treatment pattern would determine whether findings remain consistent.

• The adjunctive diagnostic value of arterial spin labeling and depth of invasion in grading tongue cancers (2026) · doi

  The conclusion calls for validation with larger sample sizes from multiple centers and at higher magnetic field strengths (implying the current study used lower field strength MRI). ASL protocols for tongue cancer grading should be optimized and prospectively validated across 3T and 7T magnetic field strengths at multicenter sites.

• Short-Term Clinical Effects of Standardized Syzygium polyanthum (Bay Leaf) Tea Infusion on Serum Uric Acid Modulation in Hyperuricemia: A Pilot Trial in Primary Care (2026) · doi

  Integration of the standardized botanical tea intervention into Indonesian primary care frameworks (specifically the Integrated Guidance Post for Non-Communicable Diseases) and village-level healthcare facilitator distribution programs requires implementation studies assessing feasibility, adherence, cost-effectiveness, and clinical outcomes when deployed at scale across rural and urban Southeast Asian populations.

• Radiopharmaceutical Therapy in Oncology: Perspectives from Transatlantic Experts (2026) · doi

  The paper identifies the need to establish reliable distribution networks capable of safe and timely radiopharmaceutical delivery with ability for 'upscaling' to meet rapid increases in demand, but does not specify logistics models, distribution infrastructure requirements, or scalability thresholds needed to ensure access across countries with varying nuclear medicine facility availability.

• Elevated carbonic anhydrase-1 in the aqueous humor in diabetic macular edema: associations between inflammatory cytokines and retinal vascular dysfunction (2026) · doi

  The sample was recruited exclusively from a tertiary hospital in southwest China with severe and complex conditions, and the relatively small sample size may have insufficient statistical power to detect weaker associations between CA-1 and structural biomarkers (CRT, SRF, CME, EZ disruption, HRF); larger multicentre studies across diverse geographic regions and disease severity ranges are needed to validate the CA-1 correlation patterns.

• Marburg virus disease: the next threat in the making? (2026) · doi

  Safe delivery of intensive care for Marburg virus disease in Rwanda is documented, but the scalability of these clinical management protocols to other endemic regions with varying healthcare infrastructure and resource availability is not addressed.

• Hypoxic burden calculation in patients with obstructive sleep apnea diagnosed by peripheral arterial tonometry: diagnostic accuracy and clinical implications (2026) · doi

  The study used an institutional algorithm for HB calculation based on ≥4% desaturation events from WatchPAT® platform; direct extrapolation of absolute HB values to other pulse oximetry platforms with differing sampling dynamics and technical specifications requires comparative validation studies.

• Palliative Care Social Work Standards of Practice – Review of Select International Protocols (2026) · doi

  Existing bodies and networks associated with PCSW should initiate discussions on the formulation of standards of practice for PCSW in the Indian context.

• Ovarian tissue quality assessment and fertility preservation strategies enabled by multi-omics and artificial intelligence: current applications and clinical perspectives (2026) · doi

  Transform fertility preservation from an experience-driven practice to a discipline guided by precision medicine through systematic integration of multi-omics and artificial intelligence technologies.

• Artificial intelligence in preoperative assessment and optimization: a narrative review (2026) · doi

  Future AI systems should aggregate data from multiple sources (EHR, wearable devices, genomics, etc.) for comprehensive 360-degree preoperative assessment and outcome simulation across different scenarios.

• PENATALAKSANAAN FISIOTERAPI PADA KASUS LUKA BAKAR GRADE 2-3 BILATERAL TANGAN DENGAN MODALITAS EXERCISE PADA ANAK USIA 12 TAHUN (2026) · doi

  The study is a single case study on one 12-year-old patient with bilateral grade 2-3 hand burns; generalization to other burn cases, age groups, and burn locations requires further research with larger sample sizes.

• The predictive and prognostic role of baseline 2-[18F]FDG PET/CT volumetric and dissemination features in classical Hodgkin lymphoma (2026) · doi

  Lack of complete standardization in MTV calculation methods across different centers remains a challenge for widespread clinical implementation despite use of specialized…

• A multicenter multifunctional assessment of large language models in pure-tone audiogram interpretation for patients (2026) · doi

  The study lacks discussion of how LLM performance might scale to high-volume clinical settings or how integration into existing clinical workflows would be implemented.

• Editorial: Development and validation of new molecular probes of nuclear medicine and new targets of nuclear drugs in cancers (2026) · doi

  Implementation of integrated precision theranostics in routine clinical practice requires standardization and broader prospective validation across multiple clinical centers.

• “Desquamative Interstitial Pneumonia” with Early Diagnosis (2019) · doi

  The study is limited to a single case presentation; larger-scale studies with multiple patients are needed to validate the efficacy of smoking cessation as monotherapy in DIP.

• Improving After-Clinic Work Workflow in a Family Medicine Residency (2021) · doi

  The study is limited to a residency clinic at a specific Federally Qualified Health Center (FQHC) in San Bernardino, raising questions about generalizability to other settings and clinic types.

• Rate of History of Tuberculosis Among Healthcare Workers in Turkey: A Cross-Sectional Study (2021) · doi

  The study was conducted only in the Eastern Black Sea Region of Turkey, limiting generalizability to other geographic regions and healthcare settings with different TB prevalence rates.

• KNOWLEDGE, ATTITUDES AND PRACTICES REGARDING CERVICAL CANCER AND HUMAN PAPILLOMA VIRUS AMONG PHYSICIANS IN ARAR CITY, SAUDI ARABIA (2021) · doi

  The study was conducted only in Arar City, Saudi Arabia, limiting generalizability of findings to other regions within Saudi Arabia or other countries with different healthcare systems and HPV vaccination policies.

• Why rare disease needs precision medicine—and precision medicine needs rare disease (2022) · doi

  The Undiagnosed Diseases Network (UDN), one of the most effective efforts to accelerate understanding of the human genome, is set to end soon with no equivalent effort planned to replace it.

• Clinical Characteristics of Patients with COVID-19 in a Primary Care Center in Tijuana, Mexico (2022) · doi

  Future research should expand to multiple primary care centers and different geographic regions in Mexico to improve the representativeness and applicability of COVID-19 clinical characteristics.