Search Results (1,017)

Background: Basal ganglia calcifications (BGCs) are frequently detected on brain CT scans in older adults, but their clinical relevance for mobility and fall risk is unclear. This study investigated the association of BGCs with impaired mobility and recurrent falls. Methods: In this cross-sectional study, all consecutive patients referred to the mobility clinic of a regional teaching hospital between 2019 and 2021 were included. Mobility was assessed using the Performance-Oriented Mobility Assessment (POMA) for balance, gait and overall mobility, and the Timed Up and Go (TUG) test for functional mobility. All assessments were performed by a trained physiotherapist. Recurrent falls were defined as self-reported occurrence of more than one fall in the past 12 months. Brain CT scans were evaluated for BGCs by a trained senior radiologist and were scored by severity. Univariable and multivariable logistic regression analyses were performed, adjusting for age, sex, and history of cardiovascular events. Results: A total of 253 participants were included (median age 82 years; 58% female), of whom 31% had BGCs. Falls data were available for 246 participants, and 70% reported recurrent falls. In both univariable and multivariable analyses, there was no evidence of a statistically significant association between the presence of BGCs and impaired balance, gait, overall mobility, functional mobility, or recurrent falls. Conclusions: No evidence of a statistically significant association was found between incidentally detected BGCs and impaired mobility or recurrent falls in older adults. Further longitudinal research is needed to confirm these findings and clarify whether BGCs are clinically relevant for mobility and fall risk assessment. Full article

Introduction: Remote education is increasingly used in ostomy care, but its components, timing, governance, and evaluation remain inconsistently defined. This study aimed to develop practice-oriented recommendations for implementing remote patient education for people living with an ostomy. Methods: An Italian expert consensus using a modified Delphi method and reported according to the ACCORD guidelines was conducted. An expert panel (n = 11), recruited nationally, included stomatherapists (n = 6) and people living with an ostomy (n = 5). Round 1 comprised a remotely conducted focus group to generate and refine statements informed by a targeted literature search. Rounds 2 and 3 were anonymous online surveys in which panelists rated statements on a four-point Likert scale and could provide comments or propose additional items. Consensus was predefined as ≥75% agreement. Results: Response rates were 100% across the three rounds (October–November 2025). The panel achieved consensus on 8 definitions and 14 statements, organized into six domains: (1) model of care and eligibility; (2) privacy and data protection; (3) program structure, outcomes, and evaluation; (4) educational content and teaching strategies; (5) timing, intensity, follow-up, and caregiver involvement; and (6) dignity, relational quality, and professional and organizational requirements. Recommendations supported a hybrid-by-default model with eligibility criteria, privacy-by-design using secure platforms and traceable documentation, structured programs with tailored multimodal content, staged pathways lasting 2–6 months after an initial in-person foundation, dignity-preserving options during remote encounters, professional training in communication and digital empathy, and integration into clinical planning and records. Conclusions: This consensus provides the first ostomy-specific, implementation-focused recommendations for standardizing remote patient education in Italy, with an emphasis on equity, privacy, dignity, evaluation, and workforce competencies. Full article

Diagnostic imaging is central to clinical decision-making across many care pathways, yet the expertise needed to use these images well is unevenly distributed across health systems, with workforce limitations identified as a major barrier to equitable access, particularly in low- and middle-income countries. Digital education has emerged as one response to this gap, offering scalability, asynchronous and just-in-time access, and the cost-efficiency required for global deployment. This paper examines the digital education portfolio of the International Atomic Energy Agency’s Nuclear Medicine and Diagnostic Imaging Section, hosted mainly on the open-access Human Health Campus, which in 2025 recorded approximately 45,800 active users and 150,000 views across 159 countries. The portfolio combines structured e-learning courses, interactive webinars, virtual conference access through the Livestream programme, and a broader repository of publications, teaching cases, and reference resources, supported by an internal e-learning framework and learning management system infrastructure. Partnerships with international scientific societies further extend the reach of expert knowledge and professional exchange. The paper argues that these initiatives are best understood not as content delivery alone but as a coordinated strategy to support diagnostic quality at the level of the practising physician, extending access to expertise and strengthening the conditions for better practice, while remaining a complement to, rather than a substitute for, supervised clinical training. Full article

Objectives: Low-intensity pulsed ultrasound (LIPUS) has been widely utilized as a biophysical modality accelerating fracture healing, particularly in bones undergoing endochondral ossification. However, its efficacy in facilitating intramembranous ossification remains unclear. This study aimed to evaluate the effects of LIPUS and autologous bone (AB) on bone healing in a critical-size bone defect (CSBD) model of the rat calvaria. Methods: We performed micro-computed tomography (micro-CT) and immunohistochemical TNF-α analysis on bone specimens to assess osteogenesis. Results: Micro-CT demonstrated significant increases in newly formed bone on day 30 compared with days 7 and 15 across all groups (p < 0.001). The highest bone volume was observed in the AB group (26.83%), followed by the LIPUS group (23.74%), and the lowest in the control (15.85%). Immunohistochemical analysis revealed significantly higher TNF-α expression on day 7 in the control group (172.0 ± 1.1) than in the AB (133.8 ± 0.9) and LIPUS (125.2 ± 0.8) groups (p < 0.001). On day 15, TNF-α expression was significantly higher in the LIPUS group (137.7 ± 1.3) than in both the AB (134.2 ± 1.8) and control (126.6 ± 2.2) groups (p < 0.001). At day 30, TNF-α levels in the LIPUS group (147.6 ± 1.9) remained significantly higher than in the control group (115.8 ± 0.9) (p < 0.001), with no significant difference compared to the AB group (146.3 ± 0.8). Conclusions: Although AB grafting achieved the greatest bone volume, LIPUS demonstrated considerable regenerative potential and may represent a promising non-invasive therapeutic approach to enhance intramembranous bone regeneration. Full article

Finite element models of the mitral valve can be useful tools for physicians as a predictive tool for surgical planning, teaching, or observation. In order to seamlessly implement these tools in a clinical setting, the process for the creation of the models needs to take into account the diagnostic procedures and tools available to physicians. In this study, a rapid patient-specific model for clinical applications is developed, creating a parametric geometry from measurements routinely taken during the diagnostic process and maintaining a low computational cost through simplifications in material and boundary conditions. The healthy valve model is then validated against ultrasound images from peak diastole to peak systole, finding a good conformity despite simplifications. These results can serve as a stepping stone towards the development of a clinical digital twin of the mitral valve that combines engineering knowledge and medical process. Full article

Introduction: Evidence supports using multicomponent lifestyle medicine programs to alleviate depression, yet few studies detail the program development process. This study aimed to systematically develop a complex lifestyle medicine program for depression based on Traditional Chinese Medicine theory. Methods: A stepwise, multi-method study was conducted. The preparation phase involved understanding the public health issue, identifying resources, and reviewing published evidence. Based on these results, a Delphi survey was performed, followed by an analysis of the context understanding as well as design and refinement of the program. Subsequently, the program was modeled, and a program theory was developed, incorporating explanations and assumptions in a relevant conceptual framework and logic model. Results: A complex lifestyle medicine program and program manual were established. The program involves three major themes, each with six 120 min weekly consecutive sessions: nourishing the heart (two sessions), nourishing according to the time (two sessions), and nourishing the Qi (two sessions). The program covered TCM theory and practice to promote healthy sleep, diet, stress management, and self-administered acupressure and TCM exercise. Teaching materials were created accordingly. Conclusions: This study reports the development of a complex multicomponent TCM lifestyle medicine program to relieve depression thoroughly and transparently, with a specific focus on the Hong Kong context and a particular focus on TCM theory. The developed program will be examined for feasibility, acceptability, and preliminary efficacy in alleviating depression in a mixed-methods clinical study. Full article

Psychotherapy is a central part of the undergraduate clinical psychology curriculum, with a high degree of clinical practice, which is the most prominent issue lacking in traditional teaching. Case-based learning (CBL) is an instructional approach in which instructors select representative cases that align with learning objectives and use them to organize activities that may not only impart theoretical knowledge but also practical skills to undergraduates in clinical psychology. The objective of the present study was to explore the impact of CBL teaching on clinical psychology undergraduate learning outcomes. This quasi-experimental post-test study compared 13 traditional teaching students (2024 cohort) and 8 CBL students (2025 cohort). Over one term, the CBL group undertook student-centered, case-based learning under faculty guidance, while the traditional group received teacher-led, lecture-based instruction. Variables measured included teaching evaluation (Dimensions of Teaching Evaluation, Perceived Skill Improvement, Course Teaching Satisfaction) and quiz scores (formative/final tests, case item 1/2 scores). The CBL group showed significantly higher scores in selected satisfaction items, perceived skill improvement, and case item scores (all p < 0.005). CBL teaching was associated with higher learning outcomes and student satisfaction compared to traditional lectures. Findings highlight the value of active methodologies in higher education, while underscoring the need for long-term, broader studies. Full article

Acinetobacter is one of the most relevant pathogenic and nosocomial bacteria in human medicine. However, in veterinary medicine, particularly in Spain, there are very few studies on the impact and frequency of infections due to this genus. The main objective of this study was to characterise Acinetobacter isolates recovered at the Complutense Veterinary Teaching Hospital of the Complutense University of Madrid (HCV-UCM), with special emphasis on detecting antimicrobial resistance. A total of 23 isolates obtained from different animal species and samples over a 25-year period were included in the study, based on their identification as Acinetobacter by VITEK-2. Identification was made by using MALDI-TOF, VITEK-2, whole-genome sequencing (WGS) and a chromogenic medium. WGS confirmed that 13 of the 23 isolates belonged to Acinetobacter spp. Antimicrobial susceptibility was interpreted according to CLSI guidelines using the Kirby–Bauer disk diffusion and broth microdilution method. The proportion of clinical isolates identified as Acinetobacter spp. at the HCV-UCM was 0.3%. Of these, 15.4% (2/13 isolates) were classified as multidrug-resistant. Two isolates with the highest MIC for tigecycline carried the tet(X) gene, and two isolates harboured mutations in both gyrA and parC QRDR regions. The results of this study suggest that, in this hospital, antimicrobial resistance among Acinetobacter isolates may not yet be widespread. Full article

Background/Objectives: In 2018, a classification system for periodontal and peri-implant diseases and conditions defined an endo-periodontal lesion (EPL) as a pathological communication between the endodontic and periodontal tissues of a given tooth. As the evidence to define the etiology, diagnosis, prognosis and treatment was considered limited, a cross-sectional study was carried out to evaluate its prevalence in a population treated at the Periodontics Department of Faculty of Dentistry of University of Buenos Aires (FOUBA). The primary objective was to evaluate the prevalence of EPL. The secondary objective was to identify potential risk indicators associated with their prevalence. Methods: Patients referred for first time to the Periodontics Department of FOUBA during April to June 2025 were consecutively selected. Clinical and radiographic examination was carried out. Categorical outcomes were described using proportions. The crude association between the prevalence of EPL and each of the recorded factors was determined by means of the chi-square test and a logistic regression analysis. Results: A total of 182 participants (128 women and 54 men) with a mean age of 50.8 (standard deviation = 15.6) years were included. The prevalence of participants with EPL was 14.8%. The average was 1.7 teeth per participant with a minimum of 1 tooth and a maximum of 5 teeth. In total, 85.2% of participants with EPL had stage III–IV generalized periodontitis, grade B or C. The logistic regression analysis identified periodontitis stage III–IV (OR = 5.9; 95% Confidence interval [1.9: 18.9] (p = 0.003)) as a potential risk indicator for EPL. Conclusions: The prevalence of participants with EPL in a teaching hospital of the University of Buenos Aires was 14.8%. EPL was more frequently found in participants with periodontitis stage III–IV. Periodontitis stage III–IV was considered a potential risk indicator of EPL. Full article

Remote postoperative wound assessment may help improve follow-up after laparoscopic surgery in resource-limited settings. This study evaluated the feasibility and patient satisfaction of smartphone-based postoperative wound assessment following general and bariatric laparoscopic surgery. We conducted a prospective cohort study from June 2022 to June 2023 at a public sector teaching hospital. Consecutive adult patients undergoing elective laparoscopic general or bariatric procedures were invited to participate. Consenting patients submitted wound photographs and clinical queries to their surgeon within 14 days of discharge using an encrypted messaging platform. The primary outcome was patient satisfaction measured using the Patient Satisfaction Questionnaire Short Form (PSQ-18). Secondary outcomes included the proportion of patients requiring escalation to in-person review and the type of remote intervention provided. A total of 113 patients were enrolled. Of these, 21 (18.6%) required escalation to in-person review. Among the 92 patients managed remotely, 52 (46.0%) received reassurance only and 40 (35.4%) required medication prescription or adjustment. The mean PSQ-18 score for the cohort was 79.66 ± 11.24 (range 18–90). Satisfaction was comparable across procedure types. Smartphone-based postoperative wound assessment appears feasible and acceptable in this setting, with most postoperative concerns managed remotely and favourable patient satisfaction. Further controlled studies are needed to assess safety, diagnostic accuracy, and cost-effectiveness. Full article

Background: Cardiovascular complications are the main cause of early mortality in elderly patients after hip fracture surgery. Echocardiography, although suggested by guidelines to improve risk stratification, is frequently omitted due to the risk of delaying surgery. The aim of the study was to evaluate whether in a multidisciplinary hip fracture unit, echocardiography can be performed without a delay in surgery. The secondary endpoint was to research the possible association between echocardiographic abnormalities and in-hospital mortality. Methods: The study included hip fracture patients aged > 70 admitted in the period 1 January 2019 to 31 December 2024, to the hip fracture unit of a tertiary teaching hospital. Echocardiography was indicated according to clinical criteria (detection of heart murmur, pathological electrocardiographic changes, known heart disease and the presence of ≥3 coronary risk factors). In the study, there were 2272 patients; 1593 had indications for preoperative echocardiography, which was performed in 1502. Mean age was significantly higher in the ECHO group than in the NO ECHO group (85.4 ± 8 vs. 80.5 ± 11 years, p < 0.0001). ECHO group patients more frequently had at least two comorbidities and more severe functional impairment. In-hospital mortality was 7.3% in ECHO patients compared to 2.3% in NO ECHO patients. Results: Multivariate analysis showed that decreased left ventricular ejection fraction and pulmonary hypertension, as well as age, anemia, and reduced functional capacity expressed as lost BADL, were associated with in-hospital mortality. Conclusions: Echocardiography identifies a population at a high risk of in-hospital mortality, three times higher compared to the group of NO ECHO patients. In those who underwent echocardiography, a reduced left ventricular ejection fraction and an increase in pulmonary pressure were associated with in-hospital mortality. Full article

Artificial intelligence (AI) has pervaded many fields of medicine in the last few years on the wave of similar changes in other disciplines. Adoption of AI-driven technologies will progress in pathology in the years to come and will also transform our subspecialty of dermatopathology. From the adoption of AI in teaching to its use in clinical practice and in advancing our field through improved research capabilities, we expect a great deal of changes that will hopefully improve our assessment of tissue sections for several cutaneous pathologies. In this review, we offer an overview of where the use of these tools currently stands in dermatopathology and the potential directions that will transform the way we practice and do research. We cover AI’s role in diagnosing various skin conditions, such as melanocytic lesions and other cutaneous skin cancers, and inflammatory dermatoses. The review further covers AI’s contributions to workflow automation, like mitotic figure detection and counting, predictive analytics (e.g., melanoma prognosis), and educational tools (e.g., AI-driven simulators). It also addresses critical technical aspects, including data curation, algorithm development, and model validation. We aim to provide a comprehensive overview of how AI is transforming dermatopathology, from diagnosis and prognosis to education and clinical integration. Full article

The “theory of embodied mathematics cognition for young children” is based on the use of the senses and body movement to perceive reality and, in turn, produce different perceptions and concepts. Given the importance of embodied mathematics learning for young children and the lack of relevant research, using embodied mathematics teaching modules to promote children’s understanding of mathematics at the kindergarten level is essential. Accordingly, the main purpose of this study was to enhance young children’s mathematics learning by implementing designated embodied mathematics teaching modules as an intervention. A quasi-experimental design with pre- and post-tests was employed, using the “Taiwanese Embodied Mathematics Assessment—Short Form (TEMA-SF)” to collect data through clinical interviews. The data were then analyzed quantitatively, along with exploratory descriptions. The findings and discussions of this study are reported in two major sections: First, we reveal and discuss how the revised version of the 10 embodied mathematics teaching modules, as the intervention for the experimental group, significantly promoted the children’s embodied mathematics learning in overall scores and geometry. Then, since the TEMA-SF was administered through clinical interviews, we explore how the TEMA-SF can serve as a comprehensive yet developmentally appropriate assessment tool for measuring young children’s mathematics learning performance. Full article

Patients with ileostomy face unique pharmacotherapeutic challenges, including altered drug absorption, yet structured pharmaceutical care for this population is rarely integrated into routine clinical practice. This retrospective monocentric cohort study evaluated the reach, effectiveness, adoption, implementation, and maintenance of a structured ileostomy-specific clinical pharmacy service using the implementation science-based RE-AIM framework at a 1245-bed teaching hospital in Vienna, Austria. Sixty-two patients (54.8% male; median age of 65.5 years) were included, receiving a median of 11 medications. A total of 324 drug-related problems (DRPs) were identified, of which 202 (62.3%) were classified as stoma-specific drug-related problems (SDRPs), representing a predefined subgroup of DRPs associated with ileostomy-related pharmacotherapy challenges. This distinction enabled separate evaluation of the clinical relevance of stoma-specific pharmaceutical interventions. The implementation rate was significantly higher for SDRP-related interventions than for general DRP recommendations (92.0% vs. 63.9%; p < 0.001), with no significant interdepartmental differences observed in either DRPs (p = 0.137) or SDRPs (p = 0.071). Patients with high-output stoma (HOS) had significantly more SDRPs than those without (p < 0.001), while no differences were observed in general DRPs. The service demonstrated wide adoption, high interprofessional acceptance, full protocol fidelity, and continuous implementation over 30 months. The findings provide implementation evidence that may support healthcare decision-makers, hospital administrators, and policy stakeholders in establishing and sustaining structured clinical pharmacy services for ileostomy patients in Austria and similar healthcare settings. Full article

Visceral leishmaniasis (VL) is a rare but increasingly recognized parasitic infection in non-endemic European regions, including Romania. We report two cases of VL diagnosed in Timiș County, Western Romania, in 2020: a 57-year-old male presenting with fever, massive splenomegaly, and severe pancytopenia, and a 51-year-old male presenting atypically with fatigue, bicytopenia, and absence of organomegaly. Both patients were diagnosed through bone marrow aspirate examination revealing Leishmania amastigotes. Both cases were classified as imported VL, with exposure linked to endemic regions of eastern Spain (Castellón and València). These cases highlight the importance of maintaining a high index of clinical suspicion for VL in patients presenting with unexplained cytopenias and elevated inflammatory markers, even in the absence of classic features such as hepatosplenomegaly. The present report underscores the relevance of travel history in non-endemic regions such as Romania and the need for clinical awareness of imported VL in patients returning from endemic areas of southern Europe. Full article