Search Results (28)

Quantitative electroencephalography (qEEG) converts the raw EEG signal into reproducible numerical descriptors (spectral power, hemispheric symmetry, coherence and signal complexity) and has emerged as a candidate translational biomarker linking human and canine neurology. This integrative review examined the diagnostic, prognostic, pharmacological and translational value of qEEG, with emphasis on functional connectivity, and assessed the comparability of the dog as a natural model of human disease. Seventy-five studies were included, spanning epilepsy, acute brain injury, neurodegeneration, rehabilitation and paroxysmal disorders. In both species, epilepsy was consistently associated with altered spectral power and with reduced or reorganized coherence, and interictal abnormalities were demonstrable even in the absence of visible epileptiform discharges. Dogs reproduced the human patterns closely: phenobarbital induced the spectral redistribution predicted by human pharmaco-EEG data, canine cognitive dysfunction reproduced the slowing and the sleep-architecture changes described in Alzheimer’s disease, and a single machine-learning pipeline classified human and canine recordings with comparable accuracy. Conversely, acute brain injury remains virtually unexplored in the dog, and no canine normative database comparable to the human ones is yet available. The evidence was limited by heterogeneous acquisition protocols, small samples and scarce longitudinal veterinary data. qEEG, and coherence in particular, appears to be a promising cross-species biomarker of network dysfunction and supports the dog as a translational platform, although standardized validation remains necessary. Full article

Background and Objectives: Advances in medical, surgical, and acute burn care have shifted burn care from survival alone to survivorship; such improvement can be accompanied by extensive morbidity and disability in chronicity not previously encountered. The epidemiological characteristics of patients treated at a burn rehabilitation center, in the context of evolving social and occupational environments, may provide insights into current trends and their clinical implications. Notably, updated epidemiological data reflecting these changes in burn injury patterns remain scarce worldwide. To date, no epidemiological data from a burn rehabilitation center have been reported in Taiwan. Therefore, this study aimed to bridge this gap by providing a recent epidemiological review from the perspective of a burn rehabilitation center. Materials and Methods: This is a single-center, retrospective cross-sectional study enrolling patients who sustained burn injuries between January 2016 and December 2023. Data were collected from medical records and analyzed using SPSS version 20.0. Results: A total of 143 patients were recruited, of whom 101 were male (70.6%). The mean age was 38.51 years (SD = 20.28), and the mean total body surface area (TBSA) burned was 20.83% (SD = 18.77). Flame burns were the most common etiology, accounting for 67 cases (46.9%). Among the 143 patients, 73 (51.0%) sustained work-related burns, which were associated with a higher incidence of eye involvement compared with non-work-related burns (28.8% vs. 14.3%, p = 0.036). The upper extremity was the most frequently involved anatomical site, affecting 98 patients (68.5%). Conclusions: The present findings highlight an underrecognized need for stronger safety measures that address both personal and environmental risk factors. Risk-reduction strategies should particularly account for the aging workforce and vulnerable anatomical sites to mitigate preventable human and economic losses. Full article

Since its emergence in 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected a wide range of animal species, including wildlife. Although SARS-CoV-2 infection has been widely reported in wildlife, particularly in white-tailed deer (WTD; Odocoileus virginianus) across the United States, data on viral circulation in New England wildlife remain limited. Here, we investigated active SARS-CoV-2 infection and serological evidence of previous exposure in free-ranging wildlife from New England and Virginia. We examined samples from 1646 animals representing 29 wildlife species, collected through wildlife rehabilitation centers, clinics, and hunter harvests in New England and Virginia between 2022 and 2025. SARS-CoV-2 RNA was detected in three WTD from Massachusetts and Vermont. Phylogeographic analysis showed that the Vermont WTD SARS-CoV-2 sequences were closely related to contemporaneous human SARS-CoV-2 sequences from the same region, consistent with a possible human-to-deer spillover event. Serological screening by ELISA detected SARS-CoV-2 reactive samples in nine individuals from three species, including Eastern cottontail (Sylvilagus floridanus), Eastern coyote (Canis latrans), and raccoon (Procyon lotor), providing putative evidence of prior SARS-CoV-2 exposure. However, neutralizing antibodies against the SARS-CoV-2 Omicron variant were detected in only a single Eastern cottontail. Overall, these findings indicate sporadic SARS-CoV-2 detection and limited serological evidence of prior exposure among wildlife sampled in New England and Virginia, and highlight the importance of continued surveillance to detect spillover events, monitor viral evolution, and assess the potential risks associated with wildlife reservoirs. Full article

Background: Hyponatraemia is the commonest electrolyte disturbance encountered in older adults admitted with neck of femur (NOF) fracture. It is now recognised both as associated with fragility fracture and as an independent prognostic indicator for adverse post-operative outcomes. Methods: Narrative review of the literature, with emphasis on cohort studies, meta-analyses and mechanistic investigations pertinent to hip fracture in adults. Results: Admission hyponatraemia affects approximately 13–20% of NOF patients, twice the prevalence observed in age-matched community-dwelling elders and broadly comparable to general geriatric inpatients. A further 20–30% develop in-hospital, predominantly post-operative, hyponatraemia. Mild hyponatraemia (130–135 mmol/L) accounts for 75–85% of cases. Pathophysiology is multifactorial: hypovolaemia from the fracture haematoma, fasting and pre-admission “long lie”; drug effects (thiazides, selective serotonin reuptake inhibitors (SSRIs), proton pump inhibitors, carbamazepine, opioids); and non-osmotic arginine vasopressin (AVP) release driven by pain, nausea and peri-operative stress. Chronic hyponatraemia is hypothesised to contribute to fracture risk through three convergent mechanisms, direct sodium-dependent stimulation of osteoclastogenesis with AVP-mediated bone resorption, subtle cerebral dysfunction producing gait and attention deficits, and sarcopenia, although much of this mechanistic evidence derives from animal and in vitro studies rather than from patients with hip fracture. Hyponatraemia is reproducibly associated with longer length of stay, delayed surgery, and an adjusted 30-day mortality hazard of approximately 1.15–1.40. A dose–response relationship with severity is demonstrable; pre-operative correction has not been shown to improve outcomes in any randomised trial. Conclusions: Hyponatraemia in NOF fracture is consistently a consequence of the acute event and, at minimum, a robust marker of frailty and adverse prognosis. Whether it also causally contributes to fracture risk remains unproven, since the supporting human evidence is entirely observational and mechanistic, each contributing study carries methodological weaknesses that warrant caution, and no interventional study has established causality. Where hyponatraemia is mild and isolated, current evidence does not support delaying surgery; moderate and severe hyponatraemia warrant individualised assessment, with cautious correction proceeding alongside surgical planning rather than postponing it. Given the absence of interventional evidence, no correction strategy can yet be recommended to improve fracture or surgical outcomes. Prospective trials of targeted correction strategies and rehabilitation outcomes are overdue. Full article

Background: Rule-based multi-agent system (MAS) architectures for healthcare coordination rely on hardcoded decision trees that cannot generalise to novel clinical scenarios or self-correct reasoning errors. These limitations are acute in surgical continuum care, where patients traverse presurgical risk stratification, intraoperative monitoring, postsurgical ICU, ward care, and remote rehabilitation over days to weeks—a complexity no fixed-policy agent architecture can address without prohibitive rule engineering. Objective: We present the first agentic large language model (LLM) framework for autonomous end-to-end surgical continuum monitoring, superseding the prior rule-based MAS Digital Twin. Six ReAct-driven tool-use agents replace fixed-policy agents with dynamic reasoning, multi-hop evidence retrieval, and Reflexion self-correction while maintaining mandatory confidence-gated Human-in-the-Loop (HITL) gating at every care-pathway-modifying decision. Methods: The framework is grounded in the ReAct paradigm and Reflexion self-evaluation, embedded within the DETER Digital Twin state engine S(t). Each agent is specified by a ReAct loop signature, a ten-function clinical tool registry, and confidence-gated HITL escalation logic. Inter-agent coordination replaces the rule-based Priority Queue Manager with an LLM-mediated Coordination Supervisor Agent reasoning over competing resource requests. Results: The framework delivers: (i) six formally specified ReAct-loop agents with explicit tool registries and authorisation boundaries; (ii) a confidence-gated HITL architecture that reduces alert fatigue while preserving safety for ambiguous clinical scenarios; (iii) an extended conflict resolution function P(p,t,context) incorporating surgical phase and DETER deterioration trajectory gradient; (iv) Reflexion self-correction with a formal N_max = 2 termination condition and Clinical Factuality Verification Layer; and (v) a multi-phase Digital Twin state engine extending S(t) to the full surgical continuum. Conclusions: The proposed framework represents a fundamental architectural departure from rule-based clinical AI—from hardcoded policies to dynamic reasoning, from static retrieval to multi-hop tool-use chains, and from fixed escalation thresholds to confidence-gated self-evaluation—providing a formally specified, clinically deployable foundation for next-generation autonomous surgical care coordination. Full article

Tactical athletes, including military service members, are exposed to occupational demands that increase their risk of mild traumatic brain injury (mTBI), particularly through blast exposure, falls, collisions, and repeated sub-concussive events. Although clinical tools and progressive return-to-activity protocols support acute management, recovery may remain fragmented when physical, cognitive, psychological, and performance domains are not integrated. Military personnel require recovery models which extend beyond symptom resolution and return-to-duty clearance. Holistic performance programming offers a multidimensional framework which incorporates subject matter experts across strength and conditioning, rehabilitation, nutrition, behavioural health, cognitive performance, and human performance optimisation. This narrative review examines the role of holistic performance programming in optimising recovery from mTBI among tactical athletes, with emphasis on interdisciplinary care, structured assessment, recovery periodisation, monitoring technologies, and return-to-duty readiness. The role of embedded subject matter experts in identifying and monitoring mTBI; interdisciplinary care models which integrate clinical and performance expertise; structured recovery pathways from assessment to reintegration; and the importance of flexibility, communication, and service member engagement are examined. In addition, the review assesses the potential use of biomarkers, wearable technologies, and multi-domain assessment tools to guide individualised recovery. Holistic performance programming may bridge the gap between clinical recovery and operational readiness following mTBI. By integrating physical, cognitive, psychological, nutritional, and sleep-related strategies, this approach may reduce fragmented care and better address the complex nature of mTBI recovery. Interdisciplinary performance teams may improve early recognition, individualised rehabilitation, safer return-to-duty decisions, and long-term readiness. Future practice should prioritise standardised assessment, real-time monitoring, education, and stigma reduction. Full article

Background/Objectives: Taping is widely used as an adjunctive intervention in musculoskeletal and neurological rehabilitation due to its low cost, noninvasive nature, and clinical versatility. However, reported clinical effects remain inconsistent across studies, largely because of the heterogeneity in tape material properties, structural characteristics, application parameters, and clinical contexts. This structured narrative review aimed to synthesize the current evidence on the material composition, structural characteristics, mechanisms of action, and condition-specific application strategies of therapeutic taping in rehabilitation. Methods: A structured narrative review of the literature published between January 2000 and March 2025 was conducted using PubMed, Scopus, Web of Science, and Google Scholar. Peer-reviewed studies involving human participants were selected based on predefined inclusion criteria and screened through title/abstract and full-text review. Evidence was prioritized according to study design, with greater emphasis placed on randomized controlled trials, systematic reviews, and meta-analyses. Studies investigating the effects of elastic taping, non-elastic taping, and specialized techniques (e.g., diamond taping and Mulligan taping) on pain, neuromuscular function, proprioception, balance, circulation, and functional outcomes were included. Evidence was synthesized according to taping type, material characteristics, and clinical context. Results: Non-elastic taping demonstrated greater effectiveness in providing mechanical stabilization and load redistribution in acute injuries and mechanically driven joint instability. In contrast, elastic taping showed more consistent relevance in chronic musculoskeletal conditions and neurological rehabilitation, primarily through proprioceptive facilitation and neuromuscular modulation. Across studies, clinical outcomes varied substantially according to tape width, elasticity, material composition, and application tension, highlighting the influence of tape-related factors on therapeutic effects. Overall, the observed effects were predominantly short-term and condition-specific, with considerable heterogeneity across studies. Conclusions: Current evidence suggests that taping may be most appropriately used as an adjunctive intervention rather than a stand-alone treatment, particularly when combined with exercise therapy or other rehabilitation approaches. Individualized, goal-directed application that considers material properties and dose–response characteristics may be more appropriate than uniform taping protocols. However, the overall strength of the evidence remains variable, and further research with standardized protocols, longer follow-up periods, and mechanistic investigation is required to strengthen evidence-based clinical application. Full article

Background/Objectives: The optimal management of anterior cruciate ligament (ACL) rupture remains debated, especially regarding long-term outcomes after early ACL reconstruction (ACLR) versus rehabilitation-first with optional delayed ACLR. The interpretation of randomized evidence is complicated by frequent treatment crossover. This review synthesized evidence from randomized controlled trial (RCT) cohorts comparing surgical versus rehabilitation-first management strategies across available follow-up durations. Methods: A structured review based on a systematic literature search and narrative synthesis was conducted, with study identification and reporting guided by PRISMA 2020. MEDLINE (via PubMed) and Google Scholar were searched in February 2026 for English-language human RCTs (2000–2026) comparing early ACLR plus rehabilitation with rehabilitation-first management allowing delayed ACLR for persistent instability. A linked-report PubMed search using the KANON trial registration number (ISRCTN84752559) was additionally performed to identify cohort-derived follow-up publications. Reports were grouped by underlying RCT cohort. Data were extracted on crossover, follow-up, and clinical outcomes. Risk of bias for primary RCT reports was assessed with Cochrane RoB 2. Results: Twenty-seven reports representing three RCT cohorts (KANON, COMPARE, ACL SNNAP) were included; six index reports were prioritized for synthesis. In acute ACL rupture (KANON, COMPARE), early ACLR did not show a consistent long-term superiority in patient-reported outcomes versus rehabilitation-first with optional delayed ACLR, although COMPARE reported a statistically significant 2-year subjective functional difference favoring early ACLR; early ACLR more consistently improved mechanical stability and reduced instability episodes. Crossover from rehabilitation to delayed ACLR was common. In non-acute ACL injury with persistent symptomatic instability (ACL SNNAP), surgery-first improved 18-month patient-reported outcomes. Meniscal procedure rates and osteoarthritis-related outcomes did not consistently favor early ACLR. Conclusions: In acute ACL rupture, rehabilitation-first with timely access to delayed ACLR appears to provide long-term patient-reported outcomes comparable to an early ACLR strategy in many patients, while early ACLR more consistently improves knee stability. In non-acute symptomatic ACL deficiency, a surgery-first strategy appears more effective in the mid-term. These randomized trials should be interpreted as comparisons of management strategies rather than of “pure” operative versus nonoperative treatment approaches. Full article

Introduction: Massage therapy delivers structured mechanosensory input that can influence brain function, yet the central mechanisms and potential for neuroplastic change have not been synthesized across neuroimaging modalities. This mechanistic review integrates evidence from electroencephalography (EEG), functional MRI (fMRI), and functional near-infrared spectroscopy (fNIRS) to map how massage alters human brain activity acutely and over time and to identify signals of longitudinal adaptation. Materials and Methods: We conducted a scoping, mechanistic review informed by PRISMA/PRISMA-ScR principles. PubMed/MEDLINE, Cochrane Library, Google Scholar, and ResearchGate were queried for English-language human trials (January 1990–July 2025) that (1) delivered a practitioner-applied manual massage (e.g., Swedish, Thai, shiatsu, tuina, reflexology, myofascial techniques) and (2) measured brain activity with EEG, fMRI, or fNIRS pre/post or between groups. Non-manual stimulation, structural-only imaging, protocols, and non-English reports were excluded. Two reviewers independently screened and extracted study, intervention, and neuroimaging details; heterogeneity precluded meta-analysis, so results were narratively synthesized by modality and linked to putative mechanisms and longitudinal effects. Results: Forty-seven studies met the criteria: 30 EEG, 12 fMRI, and 5 fNIRS. Results: Regarding EEG, massage commonly increased alpha across single sessions with reductions in beta/gamma, alongside pressure-dependent autonomic shifts; moderate pressure favored a parasympathetic/relaxation profile. Connectivity effects were state- and modality-specific (e.g., reduced inter-occipital alpha coherence after facial massage, preserved or reorganized coupling with hands-on vs. mechanical delivery). Frontal alpha asymmetry frequently shifted leftward (approach/positive affect). Pain cohorts showed decreased cortical entropy and a shift toward slower rhythms, which tracked analgesia. Somatotopy emerged during unilateral treatments (contralateral central beta suppression). Adjuncts (e.g., binaural beats) enhanced anti-fatigue indices. Longitudinally, repeated programs showed attenuation of acute EEG/cortisol responses yet improvements in stress and performance; in one program, BDNF increased across weeks. In preterm infants, twice-daily massage accelerated EEG maturation (higher alpha/beta, lower delta) in a dose-responsive fashion; the EEG background was more continuous. In fMRI studies, in-scanner touch and reflexology engaged the insula, anterior cingulate, striatum, and periaqueductal gray; somatotopic specificity was observed for mapped foot areas. Resting-state studies in chronic pain reported normalization of regional homogeneity and/or connectivity within default-mode and salience/interoceptive networks after multi-session tuina or osteopathic interventions, paralleling symptom improvement; some task-based effects persisted at delayed follow-up. fNIRS studies generally showed increased prefrontal oxygenation during/after massage; in motor-impaired cohorts, acupressure/massage enhanced lateralized sensorimotor activation, consistent with use-dependent plasticity. Some reports paired hemodynamic changes with oxytocin and autonomic markers. Conclusions: Across modalities, massage reliably modulates central activity acutely and shows convergent signals of neuroplastic adaptation with repeated dosing and in developmental windows. Evidence supports (i) rapid induction of relaxed/analgesic states (alpha increases, network rebalancing) and (ii) longer-horizon changes—network normalization in chronic pain, EEG maturation in preterm infants, and neurotrophic up-shifts—consistent with trait-level recalibration of stress, interoception, and pain circuits. These findings justify integrating massage into rehabilitation, pain management, mental health, and neonatal care and motivate larger, standardized, multimodal longitudinal trials to define dose–response relationships, durability, and mechanistic mediators (e.g., connectivity targets, neuropeptides). Full article

Health financing is a core determinant of the resilience and equity of health systems. Using WHO’s three-pillar framework as an orienting reference—rather than a prescriptive template—this article analyzes the evolution, structural shortcomings, and policy dilemmas of the Greek health financing model, within a comparative European context. While many EU countries have strengthened public financing to ensure universal access, Greece maintains a hybrid, fragmented model in which out-of-pocket payments play a disproportionately large role. Despite recurrent reform attempts, Greece has not developed a cohesive public system with a clear commitment to social solidarity. Instead, the system has silently shifted into a de facto semi-privatized two-tier model that exacerbates social inequities, limits access and undermines efficiency. Drawing on international experience and documented policy lessons, the article proposes a strategic redesign of the health financing architecture. The proposal is conceptual and does not enter implementation specifics. Its central axis is the establishment of two national single purchasers of health services by level of care, with a clear allocation of responsibilities and authority, the Ministry of Health for hospital care, and the National Organization for Healthcare Services Provision (EOPYY) for primary, outpatient, and post-acute/rehabilitation care, to strengthen prevention, equitable access, and chronic care management while easing pressure on hospitals. The proposed model includes targeted investments in human resources and infrastructure, the enhancement of prospective payment mechanisms, the strengthening of primary care networks, and the leveraging of innovation. At the same time, it provides for reforms in governance, digital transformation of the system, and reallocation of resources based on principles of equity and efficiency. The proposed overall restructuring aims to strengthen financial protection, reduce inequities in access, and improve health outcomes through a publicly oriented, socially responsive, and strategically governed system. Full article

Background: Patients with neurodevelopmental and neuromuscular disorders often show overlapping clinical phenotypes. Pathogenic variants in KMT5B, a histone lysine methyltransferase, have been linked to neurodevelopmental disorders, yet their effects on human skeletal muscle remain unexplored. We report on a patient with KMT5B-linked disease who presented to a neuromuscular specialty clinic with significant involvement of skeletal muscle, where a multi-omics approach established the genetic diagnosis and revealed neuromuscular findings relevant for diagnosis, care and rehabilitation. Methods: Whole-exome sequencing was performed from blood and data was analyzed using the RD-Connect Genome Phenome Analysis Platform. Histological analysis and proteomic profiling were performed on muscle tissue. Results: Whole-exome sequencing revealed a pathogenic heterozygous variant (c.554_557del, p.Tyr185Cysfs*27) in KMT5B. Histological examination revealed fiber-type grouping, angular fibers, increased fast-twitch fiber proportion, and lipid droplet accumulation, indicative of muscle denervation. Proteomic profiling identified 77 dysregulated proteins, including upregulation of sarcomeric proteins, mitochondrial and glycolytic enzymes, acute-phase and complement factors, and extracellular matrix components, reflecting structural remodeling, metabolic adaptation, and inflammatory activation. These findings align with the role types observed in Kmt5b mouse models, supporting a role of KMT5B in neuromuscular function. Conclusions: We present the first combined histological and proteomic analysis of quadriceps muscle from a patient carrying a pathogenic KMT5B variant with a neuromuscular phenotype. The convergence of histological and proteomic alterations suggests that KMT5B haploinsufficiency may be associated with fiber-type shifts, denervation, and metabolic stress in human skeletal muscle. Understanding these processes provides mechanistic insight into motor deficits and informs targeted therapeutic strategies, including physiotherapeutic interventions, and early compensatory measures. Full article

Acute transverse myelitis (ATM) is a rare, immune-mediated disorder of the spinal cord characterized by sensory, motor, and autonomic dysfunction. Although the human papillomavirus (HPV) vaccine is widely regarded as safe, isolated reports have suggested a potential temporal association with autoimmune neurological events, including ATM. We present a case of a 21-year-old woman who developed ATM two weeks following administration of the first dose of the HPV vaccine (Cervarix). The clinical presentation included rapid-onset paraparesis, sensory deficits, and sphincter dysfunction. An MRI revealed a T2-hyperintense lesion at the Th10–Th12 level. A cerebrospinal fluid analysis showed elevated protein levels. The patient underwent corticosteroid therapy, plasmapheresis, and IVIG, followed by a comprehensive, individualized rehabilitation program. This included balance and stability training, Redcord-based neuromuscular activation, electrostimulation, and pelvic floor therapy. Although no causal link between HPV vaccination and ATM has been established, this case emphasizes the importance of considering post-vaccinal autoimmune phenomena. More importantly, it illustrates the critical role of early, targeted rehabilitation—particularly pelvic floor re-education and neuromodulation—in improving outcomes in patients with significant motor and autonomic deficits. Full article

Rehabilitation of gait function in post-stroke hemiplegic patients is critical for improving mobility and quality of life, requiring a comprehensive understanding of individual gait patterns. Previous studies on gait analysis using unsupervised clustering often involve manual feature extraction, which introduces limitations such as low accuracy, low consistency, and potential bias due to human intervention. This cross-sectional study aimed to identify and cluster gait patterns using an end-to-end deep learning approach that autonomously extracts features from joint angle trajectories for a gait cycle, minimizing human intervention. A total of 74 sub-acute post-stroke hemiplegic patients with lower limb impairments were included in the analysis. The dataset comprised 219 sagittal plane joint angle and angular velocity trajectories from the hip, knee, and ankle joints during gait cycles. Deep temporal clustering was employed to cluster them in an end-to-end manner by simultaneously optimizing feature extraction and clustering, with hyperparameter tuning tailored for kinematic gait cycle data. Through this method, six optimal clusters were selected with a silhouette score of 0.2831, which is a relatively higher value compared to other clustering algorithms. To clarify the characteristics of the selected groups, in-depth statistics of spatiotemporal, kinematic, and clinical features are presented in the results. The results demonstrate the effectiveness of end-to-end deep learning-based clustering, yielding significant performance improvements without the need for manual feature extraction. While this study primarily utilizes sagittal plane data, future analysis incorporating coronal and transverse planes as well as muscle activity and gait symmetry could provide a more comprehensive understanding of gait patterns. Full article

Background/Objectives: Spinal cord injury (SCI) care in Germany was established after the Second World War, following Guttman’s philosophy that post-SCI rehabilitation should not be separated from the acute treatment phase. Reimbursement is negotiated with only rudimentary eligibility requirements. Over time, however, more and more centers have emerged that offer “only” rehabilitation. Therefore, in 2014, the German-Speaking Paraplegic Society (DMGP) saw the need to establish a certification and grading process to protect existing centers and enable qualified reimbursement negotiations. Methods: In a modified delpi process, key data reflecting the human resources and equipment of the units were collected, and, after lengthy consensus negotiations, a grading was proposed which recognizes four levels of performance. Level Ia—24/7 coverage for all SCI-related emergencies (including intensive care unit care and surgery)—to Level IIb (rehab only, no intensive care unit). Results: In 2019, the grading was accepted by the extended board of the DMGP, and all but one of the 27 SCI centers applied to be graded and certified according to a self-reported questionnaire (2020). Conclusions: The development of the certification requirements and grading system was a complicated process, but it was possible to reach a solution which allowed its acceptance by all German SCI centers. Whether it will result in better care for the patients remains to be seen. Full article

Patients with substance use disorders may view healthcare professionals as capable of supporting them through their suffering and experience. Although numerous studies have focused on the roles, approaches, and attitudes of healthcare professionals, there is a lack of information on the nursing perspective. This study aims to explore the experiences and nursing approaches towards patients with psychoactive substance dependence admitted to an Italian acute hospital ward. A qualitative phenomenological study was conducted. Data were collected using semi-structured face-to-face interviews. The interviews were transcribed, read thoroughly, and analysed. Fifteen nurses were interviewed. Six main themes were extracted: (1) origin context, (2) participants’ personal thoughts, (3) type of approach provided, (4) school education received on the topic, (5) effectiveness of rehabilitative therapy, and (6) methods that can improve nursing care. The findings suggest that most respondents experience stigma and discrimination when providing care to these patients. In response to the results obtained, models have been suggested, such as Jean Watson’s Human Caring Theory, which shows how practising a holistic approach based on empathy and active listening can improve the relationship between nurses and patients. Furthermore, to eliminate stereotypes, it would be appropriate to act on the university education of nurses. This study was not registered. Full article