Clinics and Practice

16 pages, 259 KB

Open AccessArticle

Fatigue Among Caregivers of Hospitalized Patients

by Eleni Maria Mitrou, Lamprini Avramopoulou, Dimitrios Alefragkis, Athanasia Tsami and Maria Polikandrioti

Clin. Pract. 2026, 16(1), 22; https://doi.org/10.3390/clinpract16010022 - 22 Jan 2026

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Abstract

Introduction: Caregiving has been an emerging public health priority mainly due to the rapid pace of population aging, increase in chronic diseases and shortages of health professionals. In clinical settings, caregivers have a crucial role by providing support to patients. Consequently, they [...] Read more.

Introduction: Caregiving has been an emerging public health priority mainly due to the rapid pace of population aging, increase in chronic diseases and shortages of health professionals. In clinical settings, caregivers have a crucial role by providing support to patients. Consequently, they may experience physical and emotional burden mainly attributed to environmental, personal or family stressors. The aim of this study was to evaluate fatigue and the associated factors among caregivers of hospitalized patients in medical-surgical wards. Methods and Material: In the present study caregivers of hospitalized patients in medical and surgical wards were enrolled. Collection of data was performed with the following: a. Fatigue Assessment Scale (FAS), b. Zung Self-Rating Anxiety Scale (SAS) and c. Athens Insomnia Scale (AIS), which included patients’ characteristics. In this cross-sectional study, participants were selected using the method of convenience sampling. Results: Of the 142 participants, the majority were spouses (64.8%), female (64.8%) and over 60 years old (53.6%). The mean FAS score was 25.9 ± 9.3, the mean SAS was 38.1 ± 9.0, and the mean AIS score was 7.6 ± 4.7, indicating moderate, moderate to low and moderate levels of fatigue, anxiety and insomnia, respectively. Moreover, fatigue showed a positive linear correlation with both anxiety (Spearman’s rho = 0.713) and insomnia (Spearman’s rho = 0.671). The factors found to be statistically significantly associated with caregivers’ fatigue were the following: gender (p = 0.001), length of hospitalization (p = 0.013), experience of environmental stressors (p = 0.045), experience of financial stressors (p = 0.001), and unfamiliarity with the provision of care (p = 0.001). Conclusions: Provided that caregivers’ involvement in care not only enhances patient well-being but also supports clinical teams, it is widely comprehended that addressing their needs should be emphasized. Full article

(This article belongs to the Special Issue Advances in Clinical Nursing: Integrating Advanced Surgical and Medical Nursing for Enhanced Patient Outcomes)

10 pages, 193 KB

Open AccessReview

Attention to Elderspeak: A Call for Dignity-Affirming Communication in Advanced Nursing Care

by Takahiko Nagamine

Clin. Pract. 2026, 16(1), 21; https://doi.org/10.3390/clinpract16010021 - 22 Jan 2026

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Abstract

Elderspeak is a form of communication overaccommodation directed toward older adults, characterized by simplified language and an elevated pitch. While typically well-intentioned, it is rooted in ageist stereotypes and linked to negative health outcomes. A literature search was conducted in PubMed, CINAHL, and [...] Read more.

Elderspeak is a form of communication overaccommodation directed toward older adults, characterized by simplified language and an elevated pitch. While typically well-intentioned, it is rooted in ageist stereotypes and linked to negative health outcomes. A literature search was conducted in PubMed, CINAHL, and PsycINFO (2018–2025), yielding 24 key articles focusing on acute and surgical settings. The purpose of this narrative review is to synthesize current evidence on Elderspeak within acute care hospitals and propose a research framework and intervention strategies. Elderspeak is a key determinant of resistiveness to care (RTC), particularly in acute settings where it is triggered by functional impairment. Exposure increases patient distress and negatively impacts vital signs and cooperation with medical interventions. Inconsistent measurement is being addressed through standardized schemes like the Iowa Coding Scheme for Elderspeak (ICodE). This paper proposes that future research must employ mixed-methods, longitudinal designs to capture the impact of Elderspeak on long-term outcomes. Drawing on the ICodE, we propose a qualitative self-reflection tool for clinicians to enhance awareness in high-stakes acute settings. Eliminating Elderspeak is a foundational necessity for patient safety and dignity-affirming care in advanced nursing. Full article

(This article belongs to the Special Issue Advances in Clinical Nursing: Integrating Advanced Surgical and Medical Nursing for Enhanced Patient Outcomes)

8 pages, 1395 KB

Open AccessCase Report

Primary Uterine NUT Carcinoma: A Case Report and Literature Review

by Tetsuro Shiraishi, Iori Kisu, Naomi Kaneko, Takaaki Fukuda, Jun Watanabe, Ryoma Hayashi, Akihisa Ueno, Katsura Emoto, Kanako Nakamura, Yuya Nogami, Kosuke Tsuji, Kenta Masuda and Wataru Yamagami

Clin. Pract. 2026, 16(1), 20; https://doi.org/10.3390/clinpract16010020 - 21 Jan 2026

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Abstract

Background: Nuclear protein in testis (NUT) carcinoma is a rare, aggressive, and poorly differentiated epithelial malignancy characterized by the rearrangement of NUTM1 (NUT midline carcinoma family member 1) on 15q14. It primarily originates along the midline structures, including the head, neck, thorax, [...] Read more.

Background: Nuclear protein in testis (NUT) carcinoma is a rare, aggressive, and poorly differentiated epithelial malignancy characterized by the rearrangement of NUTM1 (NUT midline carcinoma family member 1) on 15q14. It primarily originates along the midline structures, including the head, neck, thorax, and mediastinum. Although NUT carcinoma of the pelvic gynecological organs is exceedingly rare, reported cases have been limited to primary or metastatic ovarian tumors. Here, we present the first documented case of primary uterine NUT carcinoma. Case presentation: A 53-year-old postmenopausal woman presented with abnormal uterine bleeding and a uterine mass. She underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. The initial postoperative histopathological evaluation suggested undifferentiated endometrial sarcoma; however, subsequent immunohistochemical (IHC) analysis and fluorescence in situ hybridization revealed NUTM1 rearrangement, confirming the diagnosis of NUT carcinoma. The patient experienced tumor recurrence six months postoperatively and succumbed to the disease nine months later. Discussion: The pathological diagnosis was challenging; the presence of abrupt squamous differentiation prompted further IHC analysis, leading to the definitive diagnosis. Primary uterine NUT carcinoma may be misdiagnosed as other undifferentiated uterine tumors due to its rarity and histological overlap. Conclusions: Given the diagnostic challenges, NUT IHC staining and molecular testing for NUTM1 rearrangement should be considered in undifferentiated uterine tumors with ambiguous histopathological features. Full article

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7 pages, 227 KB

Open AccessCase Report

A Hypersexuality Subset Behavior Induced by Aripiprazole Overdose in an Antipsychotic Naïve Patient: A Case Report and Review of the Literature

by Tiziano Serfilippi, Silvia Piccirillo, Alessandra Preziuso, Valentina Terenzi, Francesca Romagnoli, Marella Tarini, Vincenzo Lariccia, Agnese Secondo and Simona Magi

Clin. Pract. 2026, 16(1), 19; https://doi.org/10.3390/clinpract16010019 - 20 Jan 2026

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Abstract

Background: Aripiprazole is an atypical antipsychotic that acts as a partial agonist on the dopamine receptor D2 while also displaying agonistic activity on the 5-HT1A and antagonistic activity on the 5-HT2A receptors. As a partial agonist, aripiprazole stabilizes the activity of the [...] Read more.

Background: Aripiprazole is an atypical antipsychotic that acts as a partial agonist on the dopamine receptor D2 while also displaying agonistic activity on the 5-HT1A and antagonistic activity on the 5-HT2A receptors. As a partial agonist, aripiprazole stabilizes the activity of the D2 receptor, preventing overactivation. Case presentation: Within our deprescribing activity, we came across the case of a 30-year-old antipsychotic-naïve patient treated with the depot formulation of aripiprazole for bipolar disorder and acute mania, possibly developing hypersexuality due to an overdose that impacted negatively and heavily on his personal life. Results: The patient developed a peculiar subset of hypersexuality, changing his sexual orientation. Of interest, one month after discontinuing aripiprazole and switching to paliperidone, all the sexual-related symptoms and impulse control disorders resolved. Conclusions: We suggest stronger communication among the clinical teams involved in the patient’s care and screening patients for impulse control disorder prior to the administration of aripiprazole and monitoring them during treatment. Full article

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15 pages, 236 KB

Open AccessArticle

Anxiety and Depression in Patients with Colorectal Cancer Undergoing Ileostomy

by Panagiota Makrygianni, Maria Polikandrioti, Ioannis Koutelekos, Ilias Tsiampouris and Georgios Vasilopoulos

Clin. Pract. 2026, 16(1), 18; https://doi.org/10.3390/clinpract16010018 - 18 Jan 2026

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Abstract

Introduction: Patients with colorectal cancer who undergo ileostomy surgery confront multifaceted challenges that significantly impact their daily lives and cause symptoms of anxiety and depression. The aim of this study was to explore the anxiety and depression experienced by colorectal cancer patients undergoing [...] Read more.

Introduction: Patients with colorectal cancer who undergo ileostomy surgery confront multifaceted challenges that significantly impact their daily lives and cause symptoms of anxiety and depression. The aim of this study was to explore the anxiety and depression experienced by colorectal cancer patients undergoing ileostomy with three assessments. Materials and Methods: This longitudinal study included 96 patients with newly diagnosed colorectal cancer who underwent scheduled ileostomy surgery at two public hospitals in Attica. The Hospital Anxiety and Depression Scale (HADs) was used, which included patients’ characteristics. Measurements were collected at three distinct time points: preoperatively (Time 1), postoperatively between the 12th and 14th day (Time 2), and after stoma closure, approximately one year later (Time 3). Statistical analysis was performed using the SPSS 26.0 statistical package and the statistical significance level was set at p < 0.05. Results: The proportion of participants reporting moderate levels of anxiety (scores 8–10) was 15.6% at Time 1, which increased to 27.1% at Time 2, and had a slight increase to 28.1% at Time 3. The increase was statistically significant between Time 1 and Time 2 and at Time 1 and Time 3 (p < 0.001). Regarding high levels of anxiety (scores >11), the percentage of affected individuals increased from 13.5% at Time 1 to 17.7% at Time 2 and reached 15.6% at Time 3. The comparison between Time 1 and Time 2 revealed a statistically significant increase (p = 0.016), while the subsequent decrease between Time 2 and Time 3 was not statistically significant (p = 0.508). In terms of depression, at Time 1, 84.4% of patients had low depression, which decreased significantly to 56.3% at Time 2 and 39.6% at Time 3 (p < 0.001 for all comparisons). The percentage of patients who were moderately depressed at Time 1 was 9.4%; this percentage increased significantly to 32.3% at Time 2 and remained high, reaching 29.2% at Time 3. Finally, the proportion of patients who had high levels of depression at Time 1 was 6.3%, a figure that rose to 11.5% and 31.3% for Time 2 and Time 3, respectively. Conclusions: Anxiety and depression experienced by colorectal cancer patients undergoing ileostomy surgery escalate postoperatively and remain at high levels after ileostomy closure. Understanding these mental health challenges is crucial for providing comprehensive patient care. Further research is needed on the early recognition and management of these emotional difficulties, which are key elements of holistic oncology care. Full article

(This article belongs to the Special Issue Advances in Clinical Nursing: Integrating Advanced Surgical and Medical Nursing for Enhanced Patient Outcomes)

14 pages, 1436 KB

Open AccessArticle

Triplane Left Atrial Reservoir Strain in Cardiac Amyloidosis: A Comparative Study with Rhythm-Matched Controls

by Marina Leitman, Vladimir Tyomkin and Shmuel Fuchs

Clin. Pract. 2026, 16(1), 17; https://doi.org/10.3390/clinpract16010017 - 16 Jan 2026

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Abstract

Background: Cardiac amyloidosis is characterized by progressive myocardial and atrial infiltration, leading to atrial mechanical dysfunction, atrial fibrillation, and thromboembolic complications. Left atrial (LA) strain is an established marker of atrial function; however, data on triplane LA strain in cardiac amyloidosis are limited. [...] Read more.

Background: Cardiac amyloidosis is characterized by progressive myocardial and atrial infiltration, leading to atrial mechanical dysfunction, atrial fibrillation, and thromboembolic complications. Left atrial (LA) strain is an established marker of atrial function; however, data on triplane LA strain in cardiac amyloidosis are limited. Methods: We evaluated transthoracic echocardiographic examinations of 24 patients with cardiac amyloidosis and 24 age-, sex-, rhythm-, and ejection fraction-matched control subjects (9 with atrial fibrillation in each group). Among amyloidosis patients, 21 had transthyretin and 3 had light-chain cardiac amyloidosis. All examinations were performed during 2025. Triplane and biplane LA reservoir strain were assessed using speckle-tracking echocardiography. Two-way analysis of variance tested the effects of disease (amyloidosis vs. control) and rhythm (sinus rhythm vs. atrial fibrillation). Agreement between triplane and biplane measurements was evaluated using Pearson correlation and Bland–Altman analyses. Results: Triplane LA reservoir strain was significantly lower in patients with cardiac amyloidosis compared with controls (6.7 ± 2.7% vs. 16.2 ± 8.3%, p < 0.001). Even in sinus rhythm, amyloidosis patients demonstrated markedly impaired LA strain, with mean values similar to those observed in control subjects with atrial fibrillation. Two-way ANOVA revealed significant main effects of disease (F = 68.9, p < 0.0001) and rhythm (F = 45.0, p < 0.0001), as well as a significant disease–rhythm interaction (F = 26.5, p < 0.0001). Triplane and biplane LA strain showed strong correlation (r = 0.90, p < 0.0001) with good agreement. Reproducibility was excellent (intra-observer ICC = 0.97; inter-observer ICC = 0.94). Conclusions: Triplane LA reservoir strain is markedly reduced in cardiac amyloidosis and enables comprehensive visualization of atrial mechanical dysfunction. The technique demonstrates high reproducibility and strong agreement with biplane analysis, supporting its use as a complementary tool for characterizing amyloid atriopathy. Full article

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13 pages, 246 KB

Open AccessArticle

Effectiveness of Group Voice Therapy in Teachers with Hyperfunctional Voice Disorder

by Nataša Prebil, Rozalija Kušar, Maja Šereg Bahar and Irena Hočevar Boltežar

Clin. Pract. 2026, 16(1), 16; https://doi.org/10.3390/clinpract16010016 - 14 Jan 2026

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Abstract

Background/Objectives: The aim of this study was to assess the short-term and long-term effectiveness of group voice therapy in changing vocal behaviour and improving voice quality (VQ) among teachers with hyperfunctional voice disorders (HFVD), using both subjective and objective measures. Methods: [...] Read more.

Background/Objectives: The aim of this study was to assess the short-term and long-term effectiveness of group voice therapy in changing vocal behaviour and improving voice quality (VQ) among teachers with hyperfunctional voice disorders (HFVD), using both subjective and objective measures. Methods: Thirty-one teachers participated in a structured group voice therapy programme. Participants underwent videoendostroboscopic evaluation of laryngeal morphology and function, perceptual assessment of voice, acoustic analysis of voice samples, and aerodynamic measurements of phonation. Patients’ self-assessment of VQ and its impact on quality of life were measured using a Visual Analogue Scale (VAS) and the Voice Handicap Index-30 (VHI-30). Evaluations were conducted at four time points: pre-therapy (T0), immediately post-therapy (T1), and at 3-month (T3) and 12-month (T12) follow-up visits. Results: Significant improvement was observed between T0 and T1 in perceptual voice evaluations: grade, roughness, asthenia, strain, loudness, fast speaking rate, as well as in neck muscle tension, shimmer, patients’ most harmful vocal behaviours, VHI-30 scores, patients VQ evaluation, and its impact on quality of life (all p < 0.05). Almost all parameters of subjective and objective voice assessment improved over the 12-month observation period, with the greatest improvement between T0 and T12 (all p < 0.05), indicating lasting reduced laryngeal tension and improved phonatory efficiency. Conclusions: Group voice therapy has been shown to be an effective treatment for teachers with HFVD, leading to significant and long-lasting improvements in perceptual, acoustic, and self-assessment outcomes. Therapy also promoted healthier vocal and lifestyle behaviours, supporting its role as a successful and cost-effective rehabilitation and prevention method for occupational voice disorders. Full article

16 pages, 3571 KB

Open AccessSystematic Review

A Systematic Review of Personality Disorders in Patients with Gambling Disorder

by Ioana Ioniță, Mădălina Iuliana Mușat, Bogdan Cătălin, Constantin Alexandru Ciobanu and Adela Magdalena Ciobanu

Clin. Pract. 2026, 16(1), 15; https://doi.org/10.3390/clinpract16010015 - 9 Jan 2026

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Abstract

Background/Objectives: Gambling disorder (GD) is characterized by a high prevalence of co-occurring psychiatric disorders, including personality disorders (PDs), which may negatively influence clinical presentation, treatment outcomes, and relapse rates. The aim of this systematic review was to synthesize recent evidence regarding the association [...] Read more.

Background/Objectives: Gambling disorder (GD) is characterized by a high prevalence of co-occurring psychiatric disorders, including personality disorders (PDs), which may negatively influence clinical presentation, treatment outcomes, and relapse rates. The aim of this systematic review was to synthesize recent evidence regarding the association between GD and formally diagnosed PD and/or diagnostically anchored PD symptomatology, and to describe the main personality dimension most frequently reported in affected individuals. Methods: A systematic search was conducted in the PubMed and Dialnet databases for articles published between 30 November 2015 and 30 November 2025, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. PubMed was selected as the primary database because it is the most comprehensive source for peer-reviewed biomedical and psychiatric research, while Dialnet was included to complement PubMed by ensuring coverage of peer-reviewed psychiatric and psychological research published in other Romance-language journals, which are often underrepresented in international databases. The methodological quality and risk of bias of the included studies were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for cross-sectional studies and the Newcastle–Ottawa Scale (NOS) for observational studies. Data extraction and synthesis were performed manually by two independent reviewers. Eight studies, predominantly cross-sectional in nature, assessing exclusively formally diagnosed personality disorders in adult individuals (≥18 years) diagnosed with GD were included. Results: Eight studies met the inclusion criteria, including a total of 4607 patients with GD. Across studies, personality pathology was highly prevalent among individuals with GD, with antisocial and borderline personality disorders most consistently reported. Elevated levels of impulsivity, emotional dysregulation, and narcissistic traits were frequently observed and were additionally associated with greater gambling severity, earlier onset, and poorer clinical outcomes. Antisocial personality symptoms were strongly linked to high-risk gambling subtypes, while obsessive–compulsive personality traits showed a more heterogeneous relationship with gambling severity. Conclusions: These results underscore the importance of personality assessment in individuals with GD and highlight the need for longitudinal studies using standardized diagnostic frameworks to inform tailored prevention and treatment strategies. Full article

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30 pages, 1851 KB

Open AccessReview

Telehealth for Sexual and Reproductive Healthcare: Evidence Map of Effectiveness, Patient and Provider Experiences and Preferences, and Patient Engagement Strategies

by Romil R. Parikh, Nishka U. Shetty, Chinar Singhal, Prachi Patel, Priyanka Manghani, Ashwin A. Pillai, Luz Angela Chocontá-Piraquive and Mary E. Butler

Clin. Pract. 2026, 16(1), 14; https://doi.org/10.3390/clinpract16010014 - 9 Jan 2026

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Abstract

Objective: The aim of this study was to systematically map evidence to inform best practices for sexual and reproductive healthcare delivered via telehealth (TeleSRH) in United States-based Title X-funded clinics. Methods: We searched three databases (2017–2025) for studies evaluating effectiveness, harms, patient and [...] Read more.

Objective: The aim of this study was to systematically map evidence to inform best practices for sexual and reproductive healthcare delivered via telehealth (TeleSRH) in United States-based Title X-funded clinics. Methods: We searched three databases (2017–2025) for studies evaluating effectiveness, harms, patient and provider experiences, barriers/facilitators, and engagement strategies encompassing TeleSRH for sexually transmitted infections (STIs), contraceptive care/family planning (CC/FP), and sexual wellness, in countries with a human development index of ≥0.8. Results: From 5963 references and 436 articles, we included 142 eligible publications. TeleSRH use declined since the COVID-19 pandemic’s peak but remains higher than pre-pandemic. Evidence comes mostly from poor-quality studies. TeleSRH increases access and adherence to STI prevention (e.g., pre-exposure prophylaxis for HIV). Tele-follow-up may safely facilitate HIV care continuity. For CC/FP, TeleSRH is comparable to in-person care for patient satisfaction and uptake; patients are less likely to select long-acting reversible contraception but post-initiation tele-follow-up may increase its continuation rates. Vasectomy completion rates may be similar between pre-procedural counseling via telehealth versus in-person. TeleSRH’s potential benefits might include reduced travel time, wait times, no-show rates, and clinic human resource burden (via tele-triaging) and increased preventative screening rates for STIs and non-communicable diseases, prescription refill rates, ability to receive confidential care in preferred settings, and rural/marginalized community outreach. Implementation challenges span technological and capital constraints, provider availability, staff capability building, restrictive policies, language incompatibility, and patient mistrust. Supplementing synchronous TeleSRH with asynchronous communication (e.g., mobile application) may improve continued patient engagement. Conclusions: Preventive, diagnostic, and therapeutic TeleSRH can be effective, with high patient acceptability; however, effectiveness and adoption hinge on contextual factors outlined in this review. Full article

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12 pages, 716 KB

Open AccessCase Report

Ventricular Asystole During Le Fort I Orthognathic Surgery: A Case Consistent with Trigeminocardiac Reflex and a Mini Review

by Sucharu Ghosh, Sandra Armanious, Anirudh Nair, Zeynep Ulku, Daniel Sultan and Robert Pellecchia

Clin. Pract. 2026, 16(1), 13; https://doi.org/10.3390/clinpract16010013 - 7 Jan 2026

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Abstract

Introduction: The trigeminocardiac reflex (TCR) is a brainstem reflex in which trigeminal stimulation precipitates abrupt vagally mediated cardiovascular changes, ranging from bradycardia to asystole. While classically described during down-fracture or pterygomaxillary disjunction in Le Fort I osteotomy, rhinocardiac events from lateral nasal wall [...] Read more.

Introduction: The trigeminocardiac reflex (TCR) is a brainstem reflex in which trigeminal stimulation precipitates abrupt vagally mediated cardiovascular changes, ranging from bradycardia to asystole. While classically described during down-fracture or pterygomaxillary disjunction in Le Fort I osteotomy, rhinocardiac events from lateral nasal wall manipulation are less emphasized in orthognathic surgery. Case presentation: A 32-year-old man undergoing Le Fort I osteotomy developed ventricular asystole during lateral nasal osteotomy. The maneuver was stopped immediately; chest compressions and a single dose of epinephrine were administered, with return of spontaneous circulation within approximately one minute. Surgery was aborted and the patient was transferred to the surgical ICU. Clinical discussion: The temporal association with lateral nasal wall manipulation, in the setting of controlled hypotension and multimodal anesthesia, is most compatible with a peripheral (V2) TCR-type event, although drug-related and hemodynamic contributors cannot be excluded. A mini review of orthognathic TCR reports underscores recurring high-risk steps (down-fracture, pterygomaxillary disjunction, mandibular maneuvers) and highlights lateral nasal osteotomy as a potential additional trigger. Management principles remain the immediate cessation of the stimulus, optimization of oxygenation and ventilation, anticholinergics for bradycardia, and epinephrine/advanced cardiac life support for instability or arrest. Conclusion: Lateral nasal osteotomy may trigger a TCR-like event with severe bradyarrhythmia or asystole during Le Fort I osteotomy, particularly in hemodynamically vulnerable patients. Anticipation, swift recognition, and prompt, protocolized management are essential for favorable outcomes. Full article

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25 pages, 1413 KB

Open AccessArticle

Early Trajectories of Suicidality in Adolescents and Young Adults: A Retrospective Study from a Community Mental Health Facility in Northern Italy

by Miriam Olivola, Serena Chiara Civardi, Silvia Carnevali, Roberta Anniverno, Federico Durbano and Bernardo Maria Dell’Osso

Clin. Pract. 2026, 16(1), 12; https://doi.org/10.3390/clinpract16010012 - 4 Jan 2026

Viewed by 467

Abstract

Background/Objectives: Suicide is the second leading cause of death among adolescents and young adults. Those suffering from psychiatric illnesses are at particular risk. Our study, conducted at an outpatient mental health facility in Northern Italy, aimed at delineating demographic and psychopathological features [...] Read more.

Background/Objectives: Suicide is the second leading cause of death among adolescents and young adults. Those suffering from psychiatric illnesses are at particular risk. Our study, conducted at an outpatient mental health facility in Northern Italy, aimed at delineating demographic and psychopathological features of youths aged 16–29 who attempted suicide and were referred to our community-based outpatient service. Methods: We identified 63 subjects, most of whom suffered from personality disorders, mood disorders, and schizophrenia spectrum disorders. Analysis of variance and post hoc pairwise comparisons were performed. Results: Inferential analysis yielded significant results in terms of age at index suicide attempt across diagnostic groups. Patients with personality disorders attempted suicide at a younger age (M = 18.70) compared to those with schizophrenia spectrum disorders (M = 23.64; η² = 0.32). Conclusions: Our findings highlighted the period of transition from adolescence to adulthood as a stress on the need of preventive approaches towards suicidality in young people in both clinical and non-clinical settings. Moreover, the difference of age at index suicide attempt across different diagnostic groups stresses the need for tailored clinical interventions based on the specific psychopathological trajectories and natural histories of the diseases. Full article

(This article belongs to the Special Issue Innovations in Youth Psychiatry and Psychology: Challenges and Advances)

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27 pages, 865 KB

Open AccessArticle

by George M. Pamboris, Spyridon Plakias, Charalambos Papacharalambous, Kyriakos Pavlou, Andrew Smythe, Anna Christakou and Eleftherios Paraskevopoulos

Clin. Pract. 2026, 16(1), 11; https://doi.org/10.3390/clinpract16010011 - 4 Jan 2026

Viewed by 494

Abstract

Background: Rotator cuff-related shoulder pain (RCRSP) is a prevalent musculoskeletal disorder treated by physiotherapists. Although international guidelines support active, exercise-based management, little is known about current physiotherapy practices in Cyprus. Aim: To investigate physiotherapy management practices for RCRSP in Cyprus, assess adherence to [...] Read more.

Background: Rotator cuff-related shoulder pain (RCRSP) is a prevalent musculoskeletal disorder treated by physiotherapists. Although international guidelines support active, exercise-based management, little is known about current physiotherapy practices in Cyprus. Aim: To investigate physiotherapy management practices for RCRSP in Cyprus, assess adherence to recommended clinical guidelines, and compare findings with practices in other countries. Methods: A cross-sectional online survey was conducted among Cypriot physiotherapists between June and July 2024. An English case vignette-based questionnaire, adapted from validated international surveys, examined demographics, clinical reasoning, treatment preferences, and guideline adherence. Descriptive statistics summarised responses; chi-square tests and logistic regression identified associations between demographics and clinical decisions. Content analysis was performed on open-ended responses. Results: A total of 143 physiotherapists completed the survey. Most adhered to guideline-recommended care, with 99.3% (n = 142/143) prescribing exercise and 100% (n = 143/143) providing patient education. Conservative management was preferred, with 64.3% (n = 91/143) not recommending imaging, 72.0% (n = 103/143) not recommending injections, and 73.4% (n = 104/143) not recommending surgical referrals. Significant associations were found between special interest in shoulder conditions and recommendations for surgery (χ² = 4.937, p = 0.026) and injections (χ² = 9.143, p = 0.002). Physiotherapists recommending surgery were nearly seven times more likely to suggest MRI (Exp(B) = 6.944, p < 0.001). Conclusions: Cypriot physiotherapists predominantly use exercise and education for the management of RCRSP, aligning closely with international recommendations. Conservative strategies were favoured, with limited use of imaging, injections, and surgical referrals. However, variation in clinical decision-making, particularly regarding referrals and imaging, indicates partial adherence to best practice and highlights opportunities for enhanced guideline implementation and targeted clinical training. Full article

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2 pages, 159 KB

Open AccessComment

Comment on Hasan et al. Clinico-Pathological Features and Immunohistochemical Comparison of p16, p53, and Ki-67 Expression in Muscle-Invasive and Non-Muscle-Invasive Conventional Urothelial Bladder Carcinoma. Clin. Pract. 2023, 13, 806–819

by Stefan Harsanyi, Zuzana Varchulova Novakova, Stanislav Ziaran, Lubos Danisovic and Katarina Bevizova

Clin. Pract. 2026, 16(1), 9; https://doi.org/10.3390/clinpract16010009 - 31 Dec 2025

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Abstract

We read with great interest the article Clinico-Pathological Features and Immunohistochemical Comparison of p16, p53, and Ki-67 Expression in Muscle-Invasive and Non-Muscle-Invasive Conventional Urothelial Bladder Carcinoma by Hasan et al [...] Full article

15 pages, 774 KB

Open AccessArticle

Burden and Determinants of Drug–Drug Interactions at Hospital Discharge: Warfarin as a Model for High-Risk Medication Safety

by Kanthida Methaset and Arom Jedsadayanmata

Clin. Pract. 2026, 16(1), 8; https://doi.org/10.3390/clinpract16010008 - 31 Dec 2025

Viewed by 523

Abstract

Background: Potential drug–drug interactions (pDDIs) present substantial challenges to medication safety during care transitions. Warfarin, with its narrow therapeutic index and extensive interaction profile, provides a strategic model for examining pDDIs at discharge. This study aimed to characterize the burden and determinants [...] Read more.

Background: Potential drug–drug interactions (pDDIs) present substantial challenges to medication safety during care transitions. Warfarin, with its narrow therapeutic index and extensive interaction profile, provides a strategic model for examining pDDIs at discharge. This study aimed to characterize the burden and determinants of major warfarin pDDIs among patients discharged from a tertiary-care hospital. Methods: This retrospective cross-sectional study analyzed electronic health records of 1667 patients discharged home on warfarin. Major pDDIs were identified using the Micromedex^® Drug Interaction database. Log-binomial regression was used to assess predictors of ≥1 major pDDIs, and generalized Poisson regression was used to model the number of pDDIs per patient. Results: Major warfarin pDDIs were identified in 81.6% (95% CI: 79.6–83.4%) of patients at hospital discharge. The burden was considerable: 35.1% (95% CI: 32.8–37.4%) of patients had one major pDDI, while 46.5% (95% CI: 44.1–48.9%) had two or more. Polypharmacy (≥5 concurrent medications) was the strongest predictor, associated with a higher risk of any major pDDI (adjusted risk ratio 1.72, 95% CI: 1.46–2.02) and nearly three times the burden of interactions per patient (adjusted incidence rate ratio (IRR) 2.87, 95% CI: 2.36–3.49). When modeled as a continuous variable, each additional discharge medication was associated with a 9% increase in predicted pDDI burden (IRR 1.09, 95% CI: 1.08–1.10). Conclusions: Using warfarin as a model for high-risk medication safety, major pDDIs were highly prevalent at hospital discharge, with polypharmacy as a significant predictor of both the presence and burden of interactions. These findings emphasize the importance of identifying polypharmacy-related pDDIs to reduce potential drug interaction risk during care transitions. Full article

(This article belongs to the Special Issue Advances in Thromboembolism: Precision Prevention and Clinical Management)

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2 pages, 151 KB

Open AccessReply

Reply to Harsanyi et al. Comment on “Hasan et al. Clinico-Pathological Features and Immunohistochemical Comparison of p16, p53, and Ki-67 Expression in Muscle-Invasive and Non-Muscle-Invasive Conventional Urothelial Bladder Carcinoma. Clin. Pract. 2023, 13, 806–819”

by Abdulkarim Hasan, Yasien Mohammed, Mostafa Basiony, Mehenaz Hanbazazh, Abdulhadi Samman, Mohamed Fayek Abdelaleem, Mohamed Nasr, Hesham Abozeid, Hassan Ismail Mohamed, Mahmoud Faisal, Eslam Mohamed, Diaa Ashmawy, Mohamed Tharwat, Deaa Fekri Morsi, Abeer Said Farag, Eman Mohamed Ahmed, Noha M. Aly, Hala E. Abdel-Hamied, Doaa E. A. Salama and Essam Mandour

Clin. Pract. 2026, 16(1), 10; https://doi.org/10.3390/clinpract16010010 - 31 Dec 2025

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Abstract

We would like to thank Harsanyi et al [...] Full article

12 pages, 227 KB

Open AccessArticle

Age- and Risk-Based Stratification in Dyspepsia: Redefining Endoscopic Thresholds for Clinically Significant and Malignant Findings

by Oren Gal, Dorin Nicola, Amir Mari, Randa Natour, Noor Fanadka, Ahlam Bsoul, Ahmad Mahamid, Rawi Hazzan and Fadi Abu Baker

Clin. Pract. 2026, 16(1), 7; https://doi.org/10.3390/clinpract16010007 - 30 Dec 2025

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Abstract

Background: Dyspepsia is a common indication for gastroscopy, yet its diagnostic yield for malignancy and other clinically significant findings (CSF) remains low. Improved risk stratification is therefore essential to guide endoscopic referral. This study evaluates the diagnostic yield of gastroscopy in dyspepsia and [...] Read more.

Background: Dyspepsia is a common indication for gastroscopy, yet its diagnostic yield for malignancy and other clinically significant findings (CSF) remains low. Improved risk stratification is therefore essential to guide endoscopic referral. This study evaluates the diagnostic yield of gastroscopy in dyspepsia and investigates the predictive roles of age, ethnicity, and alarm symptoms. Methods: This retrospective single-center study was conducted at a university-affiliated hospital in Israel and included 3022 patients who underwent gastroscopy for dyspepsia over a five-year period. Multivariate logistic regression identified independent predictors of CSF, and receiver operating characteristic (ROC) analysis determined optimal age thresholds for malignancy and CSF. Results: Functional dyspepsia accounted for 55.9% of cases, while precancerous gastric lesions and upper gastrointestinal malignancies were identified in 12.8% and 0.79%, respectively. In multivariable models, age ≥ 50 years (OR = 2.59; CI: 2.02–3.32) and alarm symptoms (OR = 1.79; 95% CI: 1.33–2.41) independently predicted CSFs. Malignancy was similarly associated with age ≥ 50 years (OR = 4.89; CI: 1.11–21.60) and alarm symptoms (OR = 31.42; CI: 10.26–96.19). ROC analysis identified optimal age thresholds of 50 years for CSF (AUC = 0.65) and 54 years for malignancy (AUC = 0.72). Ethnicity did not independently predict malignancy, though minority patients showed differing precancerous lesion patterns. Conclusions: Age ≥ 50 years and alarm symptoms significantly increased the likelihood of CSFs and malignancy, supporting a selective approach to gastroscopy. ROC-derived thresholds may support reconsideration of age criteria in settings with similar epidemiologic patterns, highlighting the need for region-specific risk stratification. Full article

17 pages, 1008 KB

Open AccessSystematic Review

Electrochemotherapy in the Management of Vascular Malformations: An Updated Systematic Review

by Antonios Michailidis, Ioannis Tsifountoudis, Evangelos Perdikakis, Georgios Fragkos, Ola Furmaga-Rokou, Prodromos Koutoukoglou, Danae Makri, Evangelos Petsatodis and Stefanos Finitsis

Clin. Pract. 2026, 16(1), 6; https://doi.org/10.3390/clinpract16010006 - 26 Dec 2025

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Abstract

Background: Vascular malformations (VMs) are congenital anomalies of the vascular system—capillary, venous, lymphatic, arteriovenous, or combined—frequently associated with notable morbidity and reduced quality of life. Electrochemotherapy (ECT), a locoregional treatment that combines chemotherapeutic agents (most commonly bleomycin) with electroporation, has emerged as [...] Read more.

Background: Vascular malformations (VMs) are congenital anomalies of the vascular system—capillary, venous, lymphatic, arteriovenous, or combined—frequently associated with notable morbidity and reduced quality of life. Electrochemotherapy (ECT), a locoregional treatment that combines chemotherapeutic agents (most commonly bleomycin) with electroporation, has emerged as a promising alternative in managing therapy-resistant or anatomically challenging lesions. Methods: A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and the Cochrane Library were searched from inception to January 2025 for studies reporting on the efficacy and/or safety of ECT for vascular malformations. Data extraction encompassed study design, patient demographics, VM type, ECT protocols, outcomes, follow-up duration, and adverse events. Studies that lacked relevant outcome data or focused solely on other therapeutic approaches were excluded. Results: Twelve primary studies met the inclusion criteria and were analyzed. These covered diverse VMs, including venous, slow-flow, high-flow malformations, aggressive hemangiomas, and composite lesions in adult and pediatric populations. ECT protocols usually combined bleomycin (or occasionally other agents such as pingyangmycin or polidocanol foam) with various electroporation parameters. Across studies, ECT resulted in meaningful lesion-size reduction (50–97% in most cohorts), symptom relief (e.g., reduced pain and bleeding), and favorable cosmetic outcomes. While side effects (local edema, hyperpigmentation, procedure-related discomfort) were occasionally reported, they were typically mild and transient. Conclusions: ECT represents a valuable minimally invasive option in the therapeutic armamentarium for vascular malformations. Despite consistent demonstrations of efficacy and acceptable toxicity profiles, future high-quality, multicenter studies are warranted to confirm outcomes, refine treatment guidelines, and potentially expand its use as a standard of care. Full article

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16 pages, 392 KB

Open AccessArticle

Pharmacy Undergraduate Education: Can Student Primary Care Placements Add Value to Learning and Teaching?

by Amit Bharkhada, Neena Lakhani, Sandra Hall and Martin Grootveld

Clin. Pract. 2026, 16(1), 5; https://doi.org/10.3390/clinpract16010005 - 25 Dec 2025

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Abstract

Background: Clinical pharmacists are increasingly demonstrating their value within primary care; this process directly improves patient experiences and outcomes. However, many undergraduate pharmacy students have little or no experience in this area, so that when they first qualify from training, their previous lack [...] Read more.

Background: Clinical pharmacists are increasingly demonstrating their value within primary care; this process directly improves patient experiences and outcomes. However, many undergraduate pharmacy students have little or no experience in this area, so that when they first qualify from training, their previous lack of exposure could affect future patient care in this environment. Aim: This study aims to evaluate how pharmacy undergraduate students’ learning and development of competencies are managed and received by general practitioner (GP) educators, clinical tutors, students, and patients in a general practice setting. Design and setting: The General Practice Pharmacy Educational Placement (GPEP) for undergraduates was designed and delivered in half-a-day each week across five weeks in general practice. Students observed patient consultations, interviewed patients, conducted medication reviews, used medicines reconciliation techniques, and also produced patient care plans. Method: Students participating in GPEP completed both pre- and post-course questionnaires rating eight learning outcomes, using a five-point Likert scale. Data analysis incorporated multivariate principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) strategies, and thematic analysis was applied to student focus groups, patient interviews, and GP staff interviews. Following the patient medication interview, students recorded findings and potential interventions for consideration. Results: A total of 112/157 students (71%) completed the questionnaires (June 2016–March 2019), with significant statistical differences in student confidence (p < 0.0005 for all learning outcomes). Thematic analysis revealed largely positive attitudes towards GPEP. Healthcare professionals highlighted benefits and challenges of GPEP. More than 40 issues relating to medicines optimisation and patient safety were identified, with some requiring immediate interventions from GP teams. Conclusions: GPEP demonstrated a positive clinical impact, improving patient safety. The undergraduate activities may encourage students to consider roles in primary and community care, enabling a resilient and able future workforce. Full article

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20 pages, 7167 KB

Open AccessArticle

Patterns of Ocular Involvement and Associated Factors in Adult Measles: A Retrospective Study from a Romanian Tertiary Hospital

by Dragoș Ștefan Lazăr, Adina-Alexandra Nanu, Ilie-Andrei Condurache, Maria Nica, Catrinel Tudosie, Maria Alexandra Malciolu-Nica, Alexandra Ioana Grigore, George Sebastian Gherlan, Corneliu Petru Popescu and Simin Aysel Florescu

Clin. Pract. 2026, 16(1), 4; https://doi.org/10.3390/clinpract16010004 - 25 Dec 2025

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Abstract

Background: Measles re-emergence has been reported across Europe, with Romania being among the most affected countries in 2023–2024. Although ocular manifestations are recognized in measles, their frequency and inflammatory correlates in hospitalized adults have not been well characterized. Methods: This study retrospectively analyzed [...] Read more.

Background: Measles re-emergence has been reported across Europe, with Romania being among the most affected countries in 2023–2024. Although ocular manifestations are recognized in measles, their frequency and inflammatory correlates in hospitalized adults have not been well characterized. Methods: This study retrospectively analyzed the medical records of adults treated for laboratory-confirmed measles at a Bucharest hospital between July 2023 and July 2024. Data from specialist eye examinations were used to compare patients with keratitis against those with other ocular issues. Results: A total of 250 adult patients were included. Of the 88 patients referred for ophthalmologic examination, 93.2% showed ocular lesions. Keratitis was the primary form, identified in 64.6% of these cases. Patients with keratitis had blood markers indicating a more activated inflammatory profile (higher neutrophile-to-lymphocytes ratio). Pneumonia and respiratory failure were not associated with ocular lesion status; inflammatory markers were more strongly linked to respiratory failure than to ocular involvement. Conclusions: Ocular lesions were highly prevalent in hospitalized adult measles cases during the 2023–2024 Romanian epidemic wave, and keratitis was common. Ocular involvement correlated with mucosal disease expression and systemic inflammatory activation. Systematic ophthalmologic assessment should be considered during measles epidemic peaks to improve early identification of clinically relevant ocular complications. Full article

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35 pages, 485 KB

Open AccessArticle

Cone-Specific Filter-Based Neuromodulation: A Proposed Clinical Framework for Amblyopia, Strabismus, and ADHD

by Danjela Ibrahimi and José R. García-Martínez

Clin. Pract. 2026, 16(1), 3; https://doi.org/10.3390/clinpract16010003 - 25 Dec 2025

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Abstract

Aim: To propose a standardized clinical protocol for cone-specific neuromodulation that classifies therapeutic filters for selective stimulation of S-, M-, and L-cones and translates optical and safety parameters into condition-specific frameworks for amblyopia, strabismus, and ADHD. Methods: Previously characterized spectral filters were re-evaluated [...] Read more.

Aim: To propose a standardized clinical protocol for cone-specific neuromodulation that classifies therapeutic filters for selective stimulation of S-, M-, and L-cones and translates optical and safety parameters into condition-specific frameworks for amblyopia, strabismus, and ADHD. Methods: Previously characterized spectral filters were re-evaluated using published transmittance and cone-excitation data to identify a reduced set of monochromatic and combined options with meaningful cone bias. These were integrated with

α

-opic metrology, international photobiological and flicker standards, and condition-specific neurophysiological evidence to define reproducible ranges for wavelength, corneal illuminance, exposure timing, temporal modulation, and safety verification. Results: The protocol consolidates eleven monochromatic and six combined filters into operational classes mapped onto mechanistic profiles for amblyopia, esotropia, exotropia, vertical deviations, and exploratory ADHD applications. All time frames and applications are presented as methodological anchors rather than efficacy claims. Conclusions: This work provides a structured, safety-anchored framework intended to guide protocol design and comparability in future cone-specific neuromodulation trials; therapeutic benefit must be demonstrated in prospective clinical studies. Full article

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12 pages, 487 KB

Open AccessArticle

Quality of Online Information on Patient-Specific Knee Arthroplasty and Its Impact on Personalized Care

by Patrick F. Marko, Lukas K. Kriechbaumer, Marian Mitterer and Sebastian Filipp

Clin. Pract. 2026, 16(1), 2; https://doi.org/10.3390/clinpract16010002 - 25 Dec 2025

Viewed by 254

Abstract

Background: Patient-specific instrumentation (PSI) in total knee arthroplasty represents an increasingly relevant component of personalized surgical planning. As nearly half of orthopedic patients search online for medical information before or after clinical consultation, the quality, accuracy, and readability of publicly available digital resources [...] Read more.

Background: Patient-specific instrumentation (PSI) in total knee arthroplasty represents an increasingly relevant component of personalized surgical planning. As nearly half of orthopedic patients search online for medical information before or after clinical consultation, the quality, accuracy, and readability of publicly available digital resources directly influence patient expectations, shared decision-making, and rehabilitation engagement. This study assessed the content, quality, and readability of online information about PSI in TKA. Methods: Google searches using four predefined PSI-related terms were conducted on 6 March 2025. After applying exclusion criteria, 71 websites were included for evaluation. Websites were categorized as academic or non-academic and analyzed for authorship, reporting of advantages and disadvantages, inaccurate assertions, use of peer-reviewed references, multimedia content, and mention of specific PSI platforms. Website quality was assessed using validated quality evaluation tools (QUEST and JAMA criteria), and readability was evaluated using established readability indices (SMOG, FKGL, and FRE). Results: Academic websites demonstrated significantly higher quality than non-academic sources based on QUEST (25.4 vs. 9.8; p < 0.001) and JAMA criteria (3.7 vs. 1.7; p < 0.001). Disadvantages of PSI were reported in 69.1% of academic sites versus 12.5% of non-academic sites (p < 0.001). Inaccurate claims occurred in 31.3% of non-academic sites but were absent in academic sources (p < 0.001). Peer-reviewed references were present in 81.8% of academic websites and only 12.5% of non-academic sites (p < 0.001). Readability was uniformly poor across all websites, with no significant group differences (mean SMOG 13.5; mean FKGL 11.8; mean FRE 32.4). Conclusions: Online information about PSI in total knee arthroplasty varies widely in transparency and accuracy, with non-academic websites frequently omitting risks or presenting misleading claims. Given the role of individualized implant planning, accessible and evidence-based digital content is essential to support personalized patient education and shared decision-making. Because limited readability restricts patient comprehension and informed participation in personalized orthopedic care, improving the clarity and accessibility of digital patient resources is essential. Full article

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13 pages, 21619 KB

Open AccessCase Report

Subcapital Femoral Neck Fracture Despite Cement-Augmented Cephalomedullary Nail Fixation for an Osteoporotic Intertrochanteric Fracture: A Case Report and Position- and Sliding-Based Decision Guide

by Suguru Yokoo, Yukimasa Okada, Kyotaro Ohno, Takahiko Ichikawa, Chuji Terada and Keiya Yamana

Clin. Pract. 2026, 16(1), 1; https://doi.org/10.3390/clinpract16010001 - 22 Dec 2025

Viewed by 284

Abstract

Background/Objectives: Cement augmentation of cephalomedullary head elements can improve the purchase of osteoporotic bone; however, it does not eliminate the need for accurate implant positioning or the preservation of sliding. We report the case of an 87-year-old woman who underwent intramedullary nailing with [...] Read more.

Background/Objectives: Cement augmentation of cephalomedullary head elements can improve the purchase of osteoporotic bone; however, it does not eliminate the need for accurate implant positioning or the preservation of sliding. We report the case of an 87-year-old woman who underwent intramedullary nailing with a cement-augmented helical blade for intertrochanteric fracture. Methods: This is a single-patient case report. Calibrated radiographic measurements—tip–apex distance (TAD), calcar-referenced TAD (CalTAD), neck–shaft angle (NSA), and telescoping—were obtained immediately postoperatively and at 4, 7, 12, and 15 months. CT was performed at postoperative week 1 and at failure, and MRI was performed for clinical deterioration. In addition, a targeted narrative review summarizes the evidence on the head-element position, sliding behavior, reduction alignment, and augmentation. Results: Immediate postoperative indices were within the accepted targets: TAD 22.6 mm, CalTAD 22.8 mm, NSA 134°, with the head element inferior on the anteroposterior view and central on the lateral view. Rehabilitation proceeded with full weight bearing as tolerated. Early telescoping was minimal (3.8–3.9 mm). Between 7 and 15 months, progressive varus with shortening of TAD/CalTAD and little additional telescoping was observed, radiographically consistent with relative proximal migration of the head–cement complex and a cleavage plane along the inferior cement mantle, culminating in a subcapital femoral neck fracture with the implant in situ. Emphasis should be placed on accurate implant positioning and preservation of sliding capacity, because cement augmentation alone may not prevent mechanical failure when the implant position or load transfer is suboptimal. Conclusions: Cement augmentation stiffens the interface and reduces micromotion but does not neutralize malposition-induced stresses. Accurate positioning, preservation of sliding, and timely conversion when sliding fails to progress are advisable; these findings are hypothesis-generating from a single case. We propose a position- and sliding-based decision guide to support clinical decision-making; its usefulness remains to be validated in larger studies. Full article

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Clin. Pract., Volume 16, Issue 1 (January 2026) – 22 articles

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