Search Results (2,869)

Background: Acute Graft versus Host Disease (aGvHD) is a serious complication of allogeneic stem cell transplantation (Allo-SCT) associated with substantial morbidity and mortality. Enteral nutrition (EN) has been associated with improved transplant outcomes, yet standardized early EN practices remain inconsistently adopted across centers. Methods: This retrospective cohort study evaluated the adoption and clinical outcomes of a standardized Day +1 EN protocol in patients undergoing Allo-SCT. The protocol included feeding tube (FT) placement on Day +1 with EN initiated at 25 mL/h. Demographic and clinical data were extracted from electronic health records for patients treated after protocol adoption (post-protocol) and retrospective controls from one year prior (pre-protocol group). Outcomes included successful Day +1 EN initiation, gastrointestinal (GI) complications, FT removal reason, and occurrence and severity of lower GI and overall aGvHD by Day +100 (Modified Glucksberg Criteria). Group comparisons used Welch’s t-test and Fisher’s Exact test (p < 0.05). Results: The final cohort included 108 patients (67 pre-protocol and 41 post-protocol). Successful Day +1 EN initiation occurred in 95.1% (n = 39) of patients post-protocol versus 4.5% (n = 3) pre-protocol (p < 0.001). GI complications and FT removal reason did not differ significantly between groups, and no FTs were removed due to adverse events. The occurrence of lower GI aGvHD was significantly lower post-protocol (12.2% vs. 28.4%, p = 0.05). Conclusions: Adoption of a standardized Day +1 EN protocol in Allo-SCT patients was successfully implemented and well-tolerated without adverse FT-related events. The significant difference in lower GI GvHD occurrence in the post-protocol group warrants confirmation of Day+1 EN in patients receiving an Allo-SCT in a future randomized trial. Full article

Bariatric surgery (BS) is effective for treating obesity but carries significant nutritional risks. Patients often develop micronutrient deficiencies, loss of muscle mass, and other physiological complications. Standardized methods such as the Nutrition-Focused Physical Exam (NFPE) may not adequately capture physical findings specific to BS. This study aimed to develop an expanded and modified bariatric-specific NFPE tool and achieve expert consensus on its essential components using a modified Delphi methodology. A literature review identified clinical signs of malnutrition and nutritional complications unique to patients undergoing BS, which informed proposed BS-NFPE components. A three-round modified Delphi study with expert bariatric dietitians (n = 25) achieved consensus (≥75% agreement) on 43 BS-NFPE components, including physical signs of micronutrient deficiencies and toxicities, changes in muscle and fat stores, indicators of surgical complications, gastrointestinal symptoms, and mental health effects. Experts also supported incorporating functional considerations and social determinants of health. This study introduces the first evidence-informed modified BS-NFPE tool to address limitations of the standard NFPE in bariatric populations. Use of BS-specific features may help clinicians identify malnutrition earlier, tailor care, and improve long-term patient support. Future research should evaluate this tool in clinical practice. Full article

Transgenerationality refers to the psychological and behavioral elements transmitted across generations. It is intrinsically linked to unelaborated content—such as trauma, grief, secrets, conflicts, and shame—operating through implicit and partially unconscious pathways that manifest in individual behavior. In the context of nursing, transgenerationality explores how nursing care is influenced by these dynamics and how the concept can be utilized to achieve superior health-related outcomes, such as facilitating more effective healthcare transitions. Specifically, it examines how experiences, vulnerabilities, resilience factors, and health-related patterns transmitted across generations affect overall health. As a humanistic profession rooted in person-centered care, nursing must remain cognizant of the impact of this concept on healthcare. This is particularly relevant in clinical settings where nurses are pivotal practitioners, such as mental health, health literacy, chronic disease management, and healthcare transitions. Healthcare transitions represent critical periods in a person’s life, and nurses are present across all contexts to facilitate these shifts. A primary example is the transition from hospital to home, which illustrates the importance of understanding transgenerationality within the roles of both patients and caregivers. Understanding how this concept impacts healthcare allows for the perception of transition as a holistic process. Awareness of these transgenerational operations leads to more personalized care, fostering healthier and more seamless healthcare transitions. The general purpose of this paper is to define and operationalize the concept of transgenerationality within nursing care, emphasizing its critical role in achieving better health outcomes, particularly during hospital-to-home transitions. Full article

Background/Objectives: The therapeutic effectiveness of chronic rhinosinusitis with nasal polyposis (CRSwNP) depends on an accurate diagnosis that identifies disease characteristics, evaluates sinus patency, and detects paranasal sinus obliteration. This study aims to assess a novel artificial intelligence (AI) system integrated with radiomic analysis for the radiological evaluation of CRSwNP, developing a reliable and predictive clinical-radiological scoring system. Methods: This study retrospectively evaluates CT scans of patients with CRSwNP. Image analysis was performed using Radiomica LifeX (Local Image Features Extraction) version 7.5. The extracted densitometric volumes were compared to the Lund-Mackay Score (LMS) to develop a novel scoring system (P-ABCD score) and assess its radiomic predictive capability. Results: Twenty patients with CRSwNP undergoing Dupilumab therapy participated in this study. The P-ABCD score, derived from sinus CT imaging data, served as a valuable objective measure of clinical improvement following CRSwNP treatment. Conclusions: Advanced radiomic imaging techniques of the sinus cavity provide precise volumetric data combined with texture analysis. These techniques offer high sensitivity by accurately quantifying the true extent of inflammatory involvement in the paranasal sinuses, enabling effective disease stratification. Full article

Stock market investors and traders operate in high-pressure environments marked by volatility, uncertainty, financial risk, and intense performance demands. These conditions lead to substantial psychological distress, increasing vulnerability to psychiatric disorders and suicidal behavior. Key psychological risk factors in this population include acute financial loss, chronic stress, impulsivity, perfectionism, and identity fusion with professional performance. Evidence from behavioral psychology and clinical psychiatry indicates elevated rates of mood disorders, anxiety, and burnout in trading environments. Resilience—including emotional regulation, effective stress-coping mechanisms, strong social support, and cognitive flexibility—emerges as a critical protective factor that mitigates suicide risk and promotes adaptive functioning. Strengthening psychological resilience and implementing evidence-based mental-health strategies may help reduce suicide risk and support overall well-being. The medico-legal dimensions of this issue encompass duty of care within high-stress financial workplaces, clinical obligations related to suicide risk assessment and documentation, confidentiality and safety considerations, and questions of foreseeability of suicide in cases involving severe or catastrophic financial loss. Despite growing awareness of mental health challenges in financial professions, the intersection of suicide risk, resilience, and medico-legal responsibilities in this population remains underexplored. Further research is needed to refine assessment frameworks and develop targeted suicide prevention interventions for this at-risk group. Full article

Background: Disruptions in social and circadian rhythms are increasingly recognized as key contributors to depressive symptomatology and impaired quality of life, particularly in older adults, for whom daily regularity represents a crucial determinant of psychological and functional stability. Understanding the interplay between rhythm dysregulation, mood disturbances, and perceived well-being may inform preventive strategies in aging populations. Objective: This study aimed to examine the association between social rhythm dysregulation, depressive symptoms, and perceived quality of life in a sample of community-dwelling older adults. Methods: A cross-sectional observational study was conducted among 119 older adults (mean age 72.26 ± 4.72 years) enrolled in an active aging program. Social rhythms were assessed using the Brief Social Rhythm Scale (BSRS), depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9), and health-related quality of life with the SF-12 Health Survey. Pearson correlation analyses and multiple linear regression models were applied. Results: Greater social rhythm dysregulation was significantly associated with higher depressive symptom levels (r = 0.41, p < 0.001) and lower perceived quality of life (r = −0.39, p < 0.001). In multivariate analyses, both rhythm dysregulation (β = −0.1863, p < 0.001) and depressive symptoms (β = −0.2885, p = 0.037) independently predicted poorer quality of life. Conclusions: In community-dwelling older adults, irregular social rhythms and depressive symptoms are independently and jointly associated with reduced quality of life. These findings highlight social rhythm regulation as a relevant and potentially modifiable target for preventive and supportive interventions aimed at promoting mental well-being and resilience in later life. Full article

Background/Objectives: Severe brain injuries generate complex, long-term needs requiring intensive physical, cognitive and relational care. These conditions also profoundly affect families, who often experience emotional distress, uncertainty and a heavy caregiving burden. Although neuro-palliative care is increasingly recognised, the early integration of palliative care for this population remains limited. This study aimed to explore healthcare professionals’ perceptions of the palliative care needs of patients with severe brain injuries and their caregivers and to identify factors that hinder or facilitate early palliative care implementation in specialised settings. Methods: An interpretive qualitative study was conducted using Reflexive Thematic Analysis. Fifteen semi-structured narrative interviews were carried out with healthcare professionals working in specialised hospital units in Northern Italy. Data were analysed inductively through an iterative and reflexive process following Braun and Clarke’s six phases. Methodological rigour and transparency were ensured using the COREQ checklist. Results: Five themes were identified: (1) intensive, individualised patient care needs with complex communication issues; (2) palliative needs centred on dignity, quality of life and early integrated management; (3) caregivers’ involvement and expectation-related difficulties; (4) continuous or anticipatory grief requiring structured psychological support; (5) facilitators and barriers influencing care pathways. Conclusions: Healthcare professionals identify intertwined and evolving palliative care needs in both patients with severe brain injuries and their families. The findings highlight the perceived importance of early, integrated and multidisciplinary neuro-palliative care models focused on dignity, symptom relief and sustained emotional support. Full article

Purpose: The treatment of proximal humerus fractures (PHFs) remains debated, and similar fracture patterns may be managed with different strategies. The aim of this retrospective single-center case series without a control group was to evaluate clinical and radiographic outcomes after treatment of selected PHFs with the Galaxy Fixation System. The primary endpoint was functional recovery at 12 months, assessed using the Constant Shoulder Score and QuickDASH. Secondary endpoints included radiographic maintenance of reduction, quality of life, treatment-related complications, and need for revision surgery. Methods: We retrospectively analyzed 48 consecutive patients with proximal humeral fractures treated at the Orthopaedic and Traumatology Unit of Versilia Hospital, Viareggio, Italy, between November 2017 and February 2022. Fractures were assessed using trauma-series radiographs and computed tomography when required, and were classified by two senior surgeons according to the Neer, AO/OTA, and Hertel classifications. Eligible patterns included 2-part, 3-part, and selected 4-part fractures with at least two-thirds of intact metaphyseal bone stock. Results: Forty-six patients completed the 12-month follow-up; two patients died during follow-up from causes unrelated to the index procedure. The mean Constant Shoulder Score improved from 62.7 at 6 months to 69.3 at 12 months, and the mean QuickDASH improved from 9.4 to 8.1. The mean postoperative head-shaft angle was 137.2 degrees and remained substantially stable at 135.1 degrees at 12 months. Pin-tract infection occurred in 5 patients, pin migration in 4, algodystrophic syndrome in 1, and avascular necrosis requiring revision arthroplasty in 1. Conclusions: In this retrospective uncontrolled series, external fixation with the Galaxy system was associated with progressive functional recovery, satisfactory radiographic maintenance of reduction, and a low rate of revision surgery in carefully selected PHFs. These findings should be interpreted cautiously because of the retrospective design, limited sample size, absence of a control group, incomplete availability of some baseline variables, and lack of formal comparative or cost-effectiveness analyses. Full article

Background & Aim: The entry of Hepatitis D Virus (HDV) depends on HBV surface proteins (HBsAg) composed of three isoforms: large-, middle, and small HBsAg. Here, we investigate the levels of total HBsAg and HBsAg isoforms and their correlations with HDV-RNA, HBcrAg, and transaminases in the setting of untreated chronic hepatitis D (CHD). Methods: This study includes 316 HBeAg-negative patients: 192 CHD and 124 with chronic hepatitis B (CHB) as a control group. HBsAg isoforms were quantified by ad hoc-designed ELISAs. Results: The composition of HBsAg isoforms varied between the two groups of patients, with remarkably higher small HBsAg, middle-HBsAg, and large HBsAg in CHD than in CHB. This data was confirmed by multivariable analysis (p < 0.0001). Among CHD, HBsAg isoforms positively correlated with HDV-RNA (p < 0.0001) and HBcrAg (p < 0.0001) but not with HBV-DNA. The results were confirmed by stratifying patients according to HDV-RNA (< or >1000 IU/mL) and HBcrAg (< or >3 logU/mL). Furthermore, CHD patients with ALT > upper limit of normal presented significantly higher S-HBsAg and M-HBsAg levels. Conclusions: CHD is characterized by a more elevated HBsAg isoform production, paralleling HDV-RNA and HBcrAg release. This may suggest a preferential recruitment of HBsAg isoforms in HDV virions at the expense of HBV virions. The association of HBsAg isoforms with higher ALT also suggests their potential contribution in supporting HDV-induced pro-inflammatory stimuli. Full article

Background/Objectives: Attitudes toward health conditions involving physical dysfunction may differ between healthcare professionals (HCPs) and the general public. This study compared affective responses to stroke, femoral neck fracture (FNF), and spinal cord injury (SCI) across both groups within a unified framework. Methods: We conducted an online cross-sectional survey of 400 members of the general public (stratified by age and gender) and 400 HCPs representing 18 professions. Affective responses were measured using scales assessing negative affect, interpersonal avoidance, and impressions (physical strength, mental resilience, and mental strength). A 2 × 3 mixed-model ANOVA (group × condition) and correlation analyses were conducted. Results: Negative affect showed a significant group × condition interaction (p < 0.001, ηp² = 0.030). HCPs scored lower than the general public for stroke and FNF, with no significant difference for SCI. HCPs also reported lower interpersonal avoidance across all conditions. Impression scales showed no interaction; however, HCPs rated higher physical strength and mental strength, while mental resilience showed no group difference. Condition effects were significant, with a consistent hierarchy of SCI > stroke > FNF for both negative affect and interpersonal avoidance. Negative affect and interpersonal avoidance were moderately correlated in both groups. Among HCPs, FNF-related interpersonal avoidance negatively correlated with years of clinical experience. Conclusions: HCPs generally report less negative affect and interpersonal avoidance and hold more positive perceptions of patient capability than the general public. However, both groups share a negativity hierarchy across conditions, suggesting persistent perceptions associated with specific health labels. Full article

Background/Objectives: Adolescence is a critical period in terms of mental health, with the family environment being a key determinant. Parental resilience, the ability to adapt and recover from stress, is a parental psychological resource that may shape the family context of adolescent development but population-based evidence is scarce. This study examined if parental resilience is linked to adolescent mental well-being, mediated by perceived family support, and whether it varies by sex or developmental stage. Methods: This population-based cross-sectional study analyzed data from 2004 adolescents aged 11–19 years from the COP-S Wave 4 survey in Italy. Parental resilience was assessed using a Brief Resilience Scale. Perceived social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS), and mental well-being was assessed across five outcomes: health-related quality of life (KIDSCREEN-10), emotional difficulties (SDQ), depressive symptoms (PHQ-2), anxiety symptoms (SCARED), and psychosomatic complaints (HBSC-SCL). Regression models were used to examine associations, and mediation analyses were conducted using the PROCESS macro with bootstrap confidence intervals (5000 resamples). Results: Parental resilience was independently associated with better health-related quality of life, lower emotional and behavioral difficulties, fewer depressive and anxiety symptoms, and fewer psychosomatic complaints, after adjusting for adolescent social support and demographics. Parental resilience showed weak positive associations with the MSPSS subscales; the hypothesis of the strongest family support association was unsupported. The analyses did not support family support as a mediator and no moderation by sex or development was found. Conclusions: In this population-based sample, parental resilience was associated with multiple dimensions of adolescent mental well-being that were distinct from adolescents’ perceptions of social support. These findings suggest that strengthening parental resilience may promote adolescent mental health at the population level. Full article

Background: Pediatric liver disease is frequently associated with abnormal conventional coagulation tests; however, prothrombin time expressed as international normalized ratio (PT-INR) incompletely reflect global hemostatic balance. Thrombin generation assay (TGA) provide an integrated assessment of coagulation and may offer complementary information in children with acute liver failure (ALF) and chronic liver disease (CLD). Methods: We enrolled 61 pediatric patients with liver disease (50 CLD, 8 ALF, 3 extrahepatic portal vein obstruction EHPVO) and 51 healthy controls. Platelet-poor plasma was prepared according to international recommendations. Thrombin generation was measured using ST Genesia (STG) with normalization to reference plasma. Group comparisons were performed using non-parametric tests; correlations between PT-INR and thrombin generation parameters were assessed, and principal component analysis (PCA) was used to explore the variance structure of thrombin generation indices and conventional coagulation variables. Results: PT-INR was significantly higher in patients than controls, particularly in ALF. Bleeding events were uncommon. Compared with controls, patients showed reduced levels of fibrinogen and multiple procoagulant/anticoagulant factors (including antithrombin and protein C), with increased factor VIII. Among thrombin generation parameters, the endogenous thrombin potential (ETP) ratio differed significantly across groups (p = 0.001), while correlations between PT-INR and thrombin generation parameters were weak or absent, no significant associations were observed even at higher Pediatric/Model for End-Stage Liver Disease scores. PCA separated thrombin generation indices from PT-INR and conventional coagulation factors, suggesting complementary information. Conclusions: In pediatric liver disease, PT-INR does not reliably reflect global coagulation capacity. Thrombin generation testing provides additional, integrative information on hemostasis and may improve laboratory assessment beyond conventional tests. Full article

Background: Malnutrition is a universal challenge in long-term care, significantly affecting vulnerable populations. Residents with Intellectual Developmental Disability (IDD) rely heavily on Direct Support Professionals (DSPs) for assisted feeding. Understanding DSP’s mealtime experiences is essential for improving nutritional care and well-being. Objective: To examine multilevel factors associated with DSPs’ mealtime experiences. Methods: This exploratory cross-sectional case study used a survey administrated to DSPs working in a long-term residential setting. Statistical analyses examined the associations between multilevel factors and DSP’s positive and negative mealtime experiences. Results: The sample included 46 DSP’s (98% women) from a single facility in Israel. Although DSPs reported high levels of positive feelings and satisfaction with their daily work efficacy, negative feelings were significantly associated with some organizational, environmental and resident-related factors. Negative feelings were higher among DSPs caring for residents who use wheelchairs compared to those working with residents who do not use wheelchairs (t = −2.99, p < 0.01). Negative feelings were negatively associated with institutional support (r = −0.49, p < 0.001), and perceived accessibility and adaptability of the environment (r = −0.46, p = 0.001), and showed a more modest association with communication with residents (r = −0.38, p = 0.01). DSPs’ seniority, education level, and prior feeding-related training were not significantly associated with mealtime experience. Conclusions: The findings highlight that negative mealtime experiences among DSPs are associated with organizational, environmental, and resident-related factors, rather than with individual DSP’s characteristics. Policy and practical adjustments to address mealtime experiences for residents with IDD are suggested. Full article

Background/Objectives: Human immunodeficiency virus remains a significant public health challenge, with breastfeeding contributing to the risk of mother-to-child transmission. Although antiretroviral therapy significantly reduces this risk, obstetric nurses face complex challenges in translating evolving guidelines into clinical practice. This scoping review aims to map existing scientific evidence on obstetric nurses’ approaches to evidence-based practice regarding breastfeeding in the context of HIV. Methods: Following the Joanna Briggs Institute methodology and PRISMA-ScR guidelines, a search was conducted across PubMed, Scopus and EBSCOhost (MEDLINE Complete, CINAHL Complete, Cochrane Central Register of Controlled Trials, and Nursing & Allied Health Collection: Comprehensive) for studies published in Englissh and Portuguese between 2015 and 2025. Studies were included if they focused on the role of obstetric nurses, nurse-midwives, or midwives in infant-feeding practices for women living with HIV. Results: Eight studies were included, predominantly from sub-Saharan Africa, with additional evidence from Europe and Canada. Findings reveal that infant-feeding counseling is shaped by a complex interplay of clinical protocols and personal beliefs. Significant gaps in knowledge translation were identified. While nurses demonstrate high technical confidence in lactation support, their distinct professional contribution is often obscured by research that aggregates all healthcare providers. Conclusions: The challenge of supporting breastfeeding in the context of HIV extends beyond technical protocol adherence. It points to persistent gaps in knowledge translation, variability in counselling practices, and the influence of contextual and professional factors on guideline implementation. Strengthening care requires sustained investment in profession-specific education, institutional support, and evidence-informed practice frameworks that enable obstetric nurses to exercise informed clinical judgement. Full article

Background/Objectives: Fibromyalgia (FM) syndrome is characterised by constant and pervasive musculoskeletal pain and may be comorbid with obesity. Glucagon Peptide-1 Receptor Agonists (GLP-1RAs) are relatively new pharmacotherapies developed for the treatment of type 2 diabetes mellitus (T2DM) and have been repurposed for the treatment of obesity. In addition to their well-established impact on glucose balance, new evidence indicates that GLP-1RAs may have anti-inflammatory properties beyond glycaemic regulation. The use of GLP-1RAs has been proposed to modulate the central pain pathways in patients with FM; however, few studies have directly evaluated their effects on central pain. Hence, the purpose of this study is to review the relationship between FM and obesity and to explore the potential role of GLP-1RAs in the management of FM. Methods: A literature search was conducted across four databases—PubMed/Medline, Cochrane, Google Scholar, and PEDro—up to May 2025. The literature was sparse, and no formal evaluation process was performed; however, papers were excluded if they failed to address either FM or GLP-1RAs. The key characteristics of each study were extracted and summarised in table form to enable efficient narrative synthesis. Results: Of the 56 included studies, 24 were preclinical reviews, 16 were clinical reviews, 8 examined preclinical animal models, and only 8 focused on human data, limited to retrospective analyses of data and self-reporting. There is some evidence that GLP-1RAs may reduce neuronal excitability, inhibit pain signalling, and decrease inflammation. Conclusions: However, no clinical trials directly evaluating GLP-1RAs in FM were identified, and therefore no conclusions can be drawn regarding clinical efficacy in FM, including in patients with comorbid obesity. Full article