Search Results (947)

Background/Objectives: Multiple sclerosis (MS) often leads to gait impairments, even in early stages, and can affect autonomy and quality of life. Traditional assessment methods, while widely used, have been criticized because they lack sensitivity to subtle gait changes. This scoping review aims to map the landscape of advanced gait analysis technologies—both wearable and non-wearable—and evaluate their application in detecting, characterizing, and monitoring possible gait dysfunction in individuals with MS. Methods: A systematic search was conducted across PubMed and Scopus databases for peer-reviewed studies published in the last decade. Inclusion criteria focused on original human research using technological tools for gait assessment in individuals with MS. Data from 113 eligible studies were extracted and categorized based on gait parameters, technologies used, study design, and clinical relevance. Results: Findings highlight a growing integration of advanced technologies such as inertial measurement units, 3D motion capture, pressure insoles, and smartphone-based tools. Studies primarily focused on spatiotemporal parameters, joint kinematics, gait variability, and coordination, with many reporting strong correlations to MS subtype, disability level, fatigue, fall risk, and cognitive load. Real-world and dual-task assessments emerged as key methodologies for detecting subtle motor and cognitive-motor impairments. Digital gait biomarkers, such as stride regularity, asymmetry, and dynamic stability demonstrated high potential for early detection and monitoring. Conclusions: Advanced gait analysis technologies can provide a multidimensional, sensitive, and ecologically valid approach to evaluating and detecting motor function in MS. Their clinical integration supports personalized rehabilitation, early diagnosis, and long-term disease monitoring. Future research should focus on standardizing metrics, validating digital biomarkers, and leveraging AI-driven analytics for real-time, patient-centered care. Full article

Background: As means of addressing ongoing challenges in accessing publicly funded specialist care, new models of care have been trialled. One such approach is using physiotherapists in advance practice roles, who in collaboration with other health professionals, act as an initial orthopedic point of contact and coordinate care. This research investigated the impact of a model of care, the Spinal Virtual Clinic Model, implemented for the first time in South Australia, using advanced practice physiotherapists in a large metropolitan hospital in South Australia. Although formally named the “Spinal Virtual Clinic” by the health service, this model does not involve direct patient contact and differs from traditional virtual or telehealth clinics. Instead, it is best understood as a physiotherapy-led referral triage and management service. Methods: This research was conducted in two stages. Stage 1 was a retrospective clinical audit of sequential patients triaged to the Spinal Virtual Clinic, as well as a follow up audit to capture any subsequent engagement with the Orthopaedic Spinal Service following the initial Spinal Virtual Clinic correspondence. Data were descriptively analysed. In Stage 2, semi-structured interviews were conducted with patients from the Spinal Virtual Clinic to explore their perspectives on this model of care. The interviews were transcribed verbatim and independently analysed using thematic analysis. The sequential use of quantitative and qualitative approaches enabled us to both describe engagement with this model of care and better understand the underlying perspectives. Results: Three hundred and nine referrals were triaged to the physiotherapy-led spinal virtual clinic over a six-month period from 1 January 2021 to 30 June 2021. Majority of referrals were triaged as low acuity did not need formal spinal specialist review and could be managed safely in primary care. Therapist-led active management strategies (80.8%), trial of neuropathic medication (35.6%) closely followed by advice regarding targeted spinal injections (foraminal and epidural), were the most common conservative management strategies recommended. Only a small proportion needed surgical review. Interviews with eleven patients revealed that while many valued the convenience, timely advice, and reassurance offered by the service, others expressed confusion about the referral process and disappointment at not seeing a specialist. A key recommendation identified was improved communication, including providing patients with direct feedback alongside general practitioner correspondence. Conclusions: This research, underpinned by quantitative and qualitative research, has showcased the potential of this model of care, the spinal virtual clinic, to have a positive impact on improving access and reducing the burden on the health system for low acuity patients. As historical models of care become unsustainable and obsolete, alternative models of care can be implemented in health care settings where outpatient demand significantly exceeds capacity. Full article

Background: Inpatient palliative care consultation services operate with an interdisciplinary team, where effective handoffs are crucial for coordinated patient care. We aimed to replace encrypted email handoffs with a more concise and uniform handoff using I-PASS (illness severity, patient summary, action list, situational awareness, contingency planning, and synthesis by receiver) integrated within the electronic medical record (EMR). Aim and Measures: Within six months of launch, our goal was to achieve 90% I-PASS utilization for hospitalized acutely ill patients with cancer receiving palliative care consultation. Intervention: In January 2021, our quality improvement team, consisting of physicians, advanced practice providers, and trainees, began implementing I-PASS using the plan–do–study–act cycle. After providing training sessions for all palliative care clinicians, I-PASS went live on October 1, 2021. I-PASS utilization was tracked via random and monthly audits of EMRs. Through anonymous surveys, both pre- and post-implementation, we gathered clinician feedback and concerns about the handoff system. Survey responses were compared using the Mann–Whitney test. Outcomes: Within six months of implementation, the I-PASS utilization rate reached > 99%. The survey participation rates were 70% (45/64) and 82% (49/60) for the pre-and post-implementation periods, respectively. Respondents provided answers on one to five scale (mean, standard deviation, SD): lower accuracy with email (3.53, SD = 0.98) vs. I-PASS (4.20, SD = 0.83), p < 0.001; handoff lengthier with email (4.17, SD = 1.05) vs. I-PASS (2.1, SD = 1.15), p < 0.001; the time required was longer with email (3.0, SD = 1.22) vs. I-PASS (1.71, SD = 0.73), p < 0.001. Overall, respondents found I-PASS to be significantly better (4.69, SD = 0.58). Conclusion: I-PASS was fully adopted by the team, with nearly 100% utilization and strong clinician endorsement as an effective communication tool. Future efforts should focus on optimizing usability, particularly by educating clinicians on smartphone EMR access and enabling the timely and streamlined editing of I-PASS. Full article

Background: Autoimmune rheumatic diseases, including systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), Sjögren’s syndrome, systemic sclerosis (SSc), and rheumatoid arthritis (RA), pose significant challenges during pregnancy and are associated with increased risks of adverse maternal and fetal outcomes, such as preeclampsia, fetal growth restriction (FGR), miscarriage, and preterm birth. The aim of this review is to synthesize recent evidence on pregnancy-related risks, preconception counseling, and therapeutic strategies for these conditions, with a particular focus on the importance of disease remission, pregnancy-compatible medications, and the selective use of biologics. Methods: A structured narrative review was conducted through a comprehensive PubMed search (2020–2025). Eligible studies addressed maternal–fetal outcomes, therapeutic approaches, and predictive factors in pregnant individuals with autoimmune rheumatic diseases. Results: Pregnancy outcomes have improved with early disease control and multidisciplinary care; however, major challenges persist. These include limited access to novel therapies, underrepresentation of diverse populations in clinical trials, and insufficient data on long-term neonatal outcomes. The strongest predictors of adverse outcomes remain disease activity at conception, specific autoantibody profiles, and systemic organ involvement. Conclusions: Optimal pregnancy outcomes for women with autoimmune rheumatic diseases require coordinated multidisciplinary care, the use of pregnancy-compatible medications, and achievement of prolonged disease remission prior to conception. Further research is needed to close existing knowledge gaps and ensure equitable, high-quality maternal–fetal care. Full article

During the last decade, artificial intelligence (AI) has enabled key technological innovations within the modern dementia and frailty healthcare and prevention landscape. This has boosted the impact of technology in the clinical setting, enabling earlier diagnosis with improved specificity and sensitivity, leading to accurate and time-efficient support that has driven the development of preventative interventions minimizing the risk and rate of progression. Background/Objectives: The rapid ageing of the European population places a substantial strain on the current healthcare system and imposes several challenges. COMFORTage is the joint effort of medical experts (i.e., neurologists, psychiatrists, neuropsychologists, nurses, and memory clinics), social scientists and humanists, technical experts (i.e., data scientists, AI experts, and robotic experts), digital innovation hubs (DIHs), and living labs (LLs) to establish a pan-European framework for community-based, integrated, and people-centric prevention, monitoring, and progression-managing solutions for dementia and frailty. Its main goal is to introduce an integrated and digitally enabled framework that will facilitate the provision of personalized and integrated care prevention and intervention strategies on dementia and frailty, by piloting novel technologies and producing quantified evidence on the impact to individuals’ wellbeing and quality of life. Methods: A robust and comprehensive design approach adopted through this framework provides the guidelines, tools, and methodologies necessary to empower stakeholders by enhancing their health and digital literacy. The integration of the initial information from 13 pilots across 8 European countries demonstrates the scalability and adaptability of this approach across diverse healthcare systems. Through a systematic analysis, it aims to streamline healthcare processes, reduce health inequalities in modern communities, and foster healthy and active ageing by leveraging evidence-based insights and real-world implementations across multiple regions. Results: Emerging technologies are integrated with societal and clinical innovations, as well as with advanced and evidence-based care models, toward the introduction of a comprehensive global coordination framework that: (a) improves individuals’ adherence to risk mitigation and prevention strategies; (b) delivers targeted and personalized recommendations; (c) supports societal, lifestyle, and behavioral changes; (d) empowers individuals toward their health and digital literacy; and (e) fosters inclusiveness and promotes equality of access to health and care services. Conclusions: The proposed framework is designed to enable earlier diagnosis and improved prognosis coupled with personalized prevention interventions. It capitalizes on the integration of technical, clinical, and social innovations and is deployed in 13 real-world pilots to empirically assess its potential impact, ensuring robust validation across diverse healthcare settings. Full article

The clinical case presented demonstrates how a person living with type 2 diabetes and treated with insulin reuses the same pen needle several times to save money and performs an incorrect maneuver while screwing the needle, which breaks, remains stuck at the end of the pen, and causes loss of insulin during subsequent use. The findings in this case study are observed in many others in clinical practice but have only been sporadically published. Who is responsible for incorrect injections? Indeed, health workers, diabetic patients, and all the other actors involved in diabetes care and insulin utilization share responsibility. Recommendations and guidelines are not enough to fill this gap. Moreover, not all healthcare providers (HCPs) know or adhere to them. It is observed daily that more than half of insulin users make mistakes that affect glycemic control, increase the risk of complications, and reduce the quality of life of people living with diabetes, who, by a rough estimate, make up a population of over 100 million in the world. This case study offers us the opportunity to briefly review the literature on the most common errors made during insulin injection technique and, therefore, consider how necessary it is to promote structured and coordinated actions among various actors to promote the culture of therapeutic education. Full article

Background: Unhoused individuals face significant health disparities and encounter numerous barriers to accessing adequate healthcare, resulting in high rates of chronic disease, mental illness, and untreated conditions in Houston, TX. The purpose of this study was to identify prevalent health conditions within a sample of unhoused adults and to identify patterns in patient characteristics and clinical health outcomes. Methods: This study utilized clinical and demographic data from n = 191 patients who received care at a student-run clinic embedded within a homeless drop-in center in Houston, TX. Data included patient demographics, chief complaints, social determinants of health (SDOHs), past medical history, on-site diagnoses, and provider actions. Results: The most prevalent issues were housing insecurity (36.1%), cardiovascular conditions (38.7%), and substance use (17.8%). Nearly half of all patients (46.6%) declined treatment or left before receiving care. Significant associations were found between patient demographics and provider responses, including differences by gender and age in treatment type and diagnostic categorization. Conclusions: These findings underscore critical challenges in treatment adherence, diagnostic bias, and retention among unhoused populations. The study provides actionable recommendations for improving care coordination and continuity in low-barrier, student-run clinics serving medically underserved communities. Full article

In this multicenter, nonrandomised comparative study, we evaluated the potential effectiveness of a program to promote the safe use of dipeptidyl peptidase-4 (DPP-4) inhibitors led by community pharmacists. The program facilitated early detection of gastrointestinal adverse events (GIAEs) in patients newly prescribed DPP-4 inhibitors and facilitated timely communication with physicians. Community pharmacists reviewed patient conditions and provided relevant information to physicians as needed. GIAE monitoring based on the program was conducted in 35 patients at 10 pharmacies in Japan (intervention group) between March and August 2024. The proportion of pharmacist interventions was compared with that in 451 patients from March to August 2023, before program implementation (baseline cohort). The primary outcome, pharmacist intervention rate, was significantly higher in the intervention group (5 out of 35 patients, 14.3%) than in the baseline cohort (0 out of 451 patients, 0.0%) (p < 0.001). GIAEs were identified in 13 out of 35 patients (37.1%) in the intervention group; information for five patients (14.3%) was shared with physicians, resulting in discontinuation of the DPP-4 inhibitor in one patient and addition of supportive therapy in others. Most GIAEs occurred within the first 1–2 weeks of therapy, highlighting the need for early intervention. Thus, proactive involvement of community pharmacists may improve the care process in these cases and contribute to healthcare coordination and diabetes care quality. Full article

Antimicrobial resistance continues to escalate worldwide, threatening effective medical care, patient safety, and global health security. Traditional antibiotics are increasingly unreliable against multidrug-resistant pathogens, resulting in delayed appropriate therapy, prolonged illness, higher healthcare costs, and increased mortality. In this context, antimicrobial stewardship must evolve beyond the preservation of older drugs to include the judicious, evidence-based use of newer antibiotics. When used empirically in high-risk scenarios, novel agents can improve clinical outcomes by ensuring timely, effective coverage against MDR organisms while reducing the need for broad-spectrum combinations that drive collateral resistance and adverse effects. A major challenge, however, is the underutilization of these agents, which not only limits patient benefit but also undermines incentives for continued pharmaceutical innovation. To address this gap, stewardship programs must incorporate strategies for appropriate empiric deployment of new antibiotics, guided by local epidemiology, risk stratification, rapid diagnostics, and multidisciplinary decision-making. A coordinated global effort, linking stewardship, innovation, and policy reform, will be critical to optimize the role of novel antimicrobials in clinical practice moving forward. Full article

Failure to rescue (FTR), defined as death following a potentially treatable postoperative complication, has emerged as a critical quality metric in thoracic surgery. In patients undergoing lung cancer resection, who are often at high risk due to comorbidities and limited pulmonary reserve, FTR significantly influences morbidity, mortality, recovery, and overall quality of life. This review explores the multifactorial nature of FTR in lung cancer surgery, highlighting key patient-related and system-level risk factors, such as surgical complexity, delayed complication recognition, inadequate escalation of care, and limited critical care resources. Existing models for patient rescue emphasize early detection and timely intervention, but often overlook the institutional and cultural changes required for sustainable improvement. Building on current evidence and integrating Kotter’s eight-step change model, we propose a novel multidimensional roadmap to reduce FTR through proactive monitoring, structured escalation protocols, multidisciplinary coordination, and continuous learning. Finally, reducing FTR in lung cancer resection requires more than clinical responsiveness. This necessitates a systemic transformation that aligns frontline practice with institutional readiness and a culture of safety. Full article

Background and Clinical Significance: Left ventricular hypoplasia is often repaired surgically in sequence to a Fontan circulation, which is a physiologic state that presents unique challenges during pregnancy. Although women with Fontan physiology can achieve successful pregnancy outcomes, they remain at elevated risk for cardiac, thrombotic, and obstetric complications. Case Presentation: We describe a 38-year-old woman with Fontan physiology and acquired von Willebrand syndrome (AVWS) who was admitted at 23 weeks gestation for preterm premature rupture of membranes. The patient had history of prior classical cesarean delivery and two previous miscarriages. Her pregnancy was further complicated by abnormal placental vasculature and uterine arteriovenous malformation. Given her bleeding diathesis, hematology advised against anticoagulation or antiplatelet therapy, and she ultimately underwent a successful low transverse cesarean delivery under general anesthesia at 24 weeks. Postpartum hemorrhage was managed with clotting factor replacement and supportive care. Conclusions: This case illustrates how AVWS may mitigate thrombotic risk in Fontan physiology and how early activation of a cardio-obstetrics team can enable tailored planning. As more patients with complex congenital heart disease reach reproductive age, multidisciplinary coordination, shared infrastructure, and individualized birth plans will be essential to achieving optimal maternal–fetal outcomes. Full article

Background: Breast cancer is a major health concern in Poland, with significant incidence and mortality rates despite national screening programs. This retrospective study aimed to evaluate critical aspects of breast cancer management, focusing on waiting times, treatment coordination, cancer characteristics, diagnostic testing, and staging. Methods: We retrospectively analyzed 587 medical records of breast cancer patients (585 female, 2 male) collected between March 2023 and June 2024 through a data donation model. Data included tumor characteristics (histological type, grade, stage, biological subtype, receptor status, Ki-67), diagnostic and genetic tests, and timelines of key events in the diagnostic and therapeutic pathways. Results: Although referral to first oncology consult (18 days) and MDT referral/admission to treatment (10 days) met NFZ guidelines, diagnosis to surgery (94 days) and diagnosis to drug treatment (109 days) were significantly delayed. No records showed oncology coordinator assignment or educational material provision. Clinically, invasive carcinoma NST (77%) and early-stage (IA/IIA, 61%) were prevalent, with Luminal B (HER2-negative) being the most common biological subtype. BRCA1/2 testing was common, but Oncotype DX was not. For 314 HR+ HER2- patients, stage IA (44%) was most common, with no BRCA1/2 mutations found. Conclusion: Breast cancer care in the Łódź voivodeship falls short of national guidelines due to long waiting times and poor care coordination, a problem worsened by incomplete data. Improving record-keeping and speeding up diagnostic and treatment pathways are crucial for better breast cancer management in Poland. While patient data donation can help analyze real clinical pathways, data completeness, and consistency remain challenges. Full article

Invasive candidiasis (IC) in Latin America is undergoing a significant epidemiological shift, increasingly driven by non-albicans strains such as Candida tropicalis, Candida parapsilosis, and Candidozyma auris. These pathogens often exhibit multidrug resistance, which complicates treatment and increases mortality. Diagnostic limitations, particularly in rural and public hospitals, delay detection and hinder the provision of rapid care. Environmental pressures, such as climate change and the widespread use of azoles in agriculture, appear to favor the selection of resistant and thermotolerant strains. Migratory birds may also play a role in the environmental transmission of pathogenic fungi. These factors are amplified by socioeconomic inequalities that restrict access to diagnostics and first-line antifungals. To help mitigate this emerging challenge, a One Health-oriented framework combining integrated environmental surveillance, robust antifungal-stewardship programmers, broader diagnostic access, and coordinated cross-sector public health actions should be developed. Reinforcing these pillars could lessen the regional burden of IC and slow the advance of antifungal resistance. Full article

Hemophilias and hemoglobinopathies—including hemophilias A and B, sickle cell disease (SCD), and β-thalassemia—are debilitating genetic disorders associated with significant global health burdens. While traditional management has centered on factor replacement and transfusions, these approaches remain palliative, with limited access and durability in many regions. Recent advances in immune-based therapeutics (e.g., emicizumab, concizumab, crizanlizumab), viral vector-mediated gene addition (e.g., Roctavian, Hemgenix), and gene-modified autologous stem cell therapies (e.g., Zynteglo, Casgevy) have ushered in a new era of disease-modifying and potentially curative interventions. These therapies offer durable efficacy and improved quality of life, particularly in adult populations. However, implementation remains uneven across global health systems due to high costs, limited infrastructure, and regulatory heterogeneity. Additionally, ethical considerations such as long-term surveillance, informed consent in vulnerable populations, and social perceptions of genetic modification present ongoing challenges. Innovations such as multiplex genome editing, immune-evasive donor platforms, synthetic biology, and AI-driven treatment modeling are poised to expand therapeutic horizons. Equitable access, particularly in regions bearing the highest disease burden, will require collaborative funding strategies, regional capacity building, and inclusive regulatory frameworks. This review summarizes the current landscape of curative therapy, outlines implementation barriers, and calls for coordinated international action to ensure that transformative care reaches all affected individuals worldwide. Full article

Aging parents caring for adult children with disabilities or other care needs face significant challenges and health-related issues over extended periods. The aim of this study was to explore the experiences of aging parents with caregiving responsibilities. This qualitative participatory study followed the research process of a photovoice study. Thirteen parents, aged 51 to 76 years, of adult children with care needs, aged 20 to 49 years, participated in this study. The parents captured photographs depicting their daily lives which were contextualized and coded during group discussions. The data were analyzed using thematic analysis and reviewed collaboratively with the participants. Six key themes emerged in the data analysis. 1. mastering complexity, 2. being an expert and advocate, 3. balancing autonomy and care, 4. care as a lifelong journey, 5. standing on the margins of society, and 6. worrying about the future. This study underscores the urgent need for comprehensive and coordinated support systems that ensure the well-being of aging caregivers while addressing the evolving needs of their adult children. Full article