Search Results (136)

Background/Objectives: Adults with intellectual disability (ID) experience high rates of psychiatric comorbidity but often face diagnostic challenges and treatment barriers, leading to inappropriate psychotropic medication use. This study examined the extent to which specialized psychiatric assessment and improved diagnostic accuracy had an impact on medication management and clinical outcomes in adults with ID and co-occurring psychiatric disorders. Methods: This observational retrospective study analyzed medical records from 25 adults with ID who underwent specialized psychiatric assessment at a community-based service in Italy between January 2023 and January 2024. Psychopathological diagnoses were established according to Diagnostic Manual—Intellectual Disability, Second Edition (DM-ID2) criteria, based on clinical observation and a comprehensive assessment using validated instruments. Clinical outcomes were assessed using a psychometric tool encompassing multiple psychopathological and behavioral dimensions. Data on psychotropic prescriptions and side effects were also collected. Non-parametric analyses were performed, with significance set at α = 0.05. Results: The proportion of patients with a psychiatric diagnosis increased from 32% to 96% after specialized assessment (p < 0.001), with notable rises in depressive (0% to 32%), bipolar (8% to 36%), anxiety (4% to 24%), and impulse control (0% to 16%) disorders. First-generation antipsychotic prescriptions decreased (from 36% to 8%, p = 0.023), while antidepressant use increased (from 12% to 52%, p = 0.004). The mean number of side effects per patient declined from 1.6 to 0.5 (p < 0.001), particularly the elevated prolactin level and psychomotor retardation. Significant improvements were observed in symptom intensity and frequency across multiple domains, including aggression, mood disturbances, and compulsions (p < 0.001). Conclusions: In this single-center retrospective study, specialized psychiatric assessment was associated with improved diagnostic accuracy, medication management, and clinical outcomes in adults with ID. The increase in psychiatric diagnoses likely reflects improved identification, addressing key challenges in precision diagnosis for people with neurodevelopmental disorders. Although the overall number of prescribed medications remained stable, optimization of treatment regimens reduced first-generation antipsychotic use and related adverse effects. These findings indicates that access to specialized assessment and precision diagnosis could improve psychopharmacological interventions and outcomes for this vulnerable population, but larger, multi-center and longer-term studies are needed to confirm these results. Full article

Background: Obesity management is evolving with the integration of dual GIP/GLP-1 receptor agonists (Tirzepatide) into comprehensive Digital Weight-Loss Services (DWLSs). This model leverages virtual, app-based multidisciplinary care (MDT) to deliver continuous, supervised treatment, distinguishing it from traditional, intermittent clinic-based care. While clinical trials demonstrate high efficacy, real-world data are necessary to evaluate long-term adherence and identify predictive markers for patient persistence in these scalable care models. Specifically, there is a knowledge gap regarding the specific behavioral factors that govern 12-month persistence in these comprehensive, medicated DWLS settings. This study retrospectively assessed the 12-month effectiveness and adherence of a Tirzepatide-supported DWLS and identified demographic, clinical, and behavioral predictors of weight loss and program attrition. Methods: Data from 19,693 patients enrolled in the Juniper UK DWLS were analyzed. Adherence was defined by a minimum of 10 medication orders and 12-month weight submission. Weight loss in the full cohort was evaluated using the Last Observation Carried Forward (LOCF) method. Binary logistic and multiple linear regression models identified predictors of adherence and weight loss, respectively, using a comprehensive set of demographic, clinical (e.g., BMI, comorbidities), and behavioral variables. Results: The 12-month adherence rate was 27%. The adherent sub-cohort (n = 5322) achieved a mean weight loss of 22.60 (±7.46) percent, compared to 13.62 (±10.85) percent in the full cohort (LOCF). This difference in 12-month mean weight loss was statistically significant (p < 0.001). Consistent weekly weight tracking and health coach communication were the strongest positive predictors of long-term adherence and weight loss. Conversely, hyper-engagement, specifically intensive tracking frequency and high weight loss velocity in the first month, was a significant inverse predictor of 12-month adherence. Reporting side effects was positively correlated with adherence, suggesting a reporting bias among engaged patients. Conclusions: The DWLS model facilitates the maximum therapeutic effectiveness for adherent patients. However, patient persistence remains the primary translational challenge. As consistent weekly engagement (tracking, coaching) is the strongest predictor of success, clinical strategies should prioritize promoting sustainable, moderate behavioral pacing (i.e., emphasizing consistent weekly engagement over intensive daily tracking and rapid early weight loss) to mitigate attrition risk and optimize the public health effectiveness of medicated DWLSs. Full article

Hypophosphatasia (HPP) is an exceptional genetic bone disorder of metabolic character caused by a deficit of the tissue-nonspecific alkaline phosphatase isoenzyme (TNSALP). This protein is encoded by the ALPL (alkaline phosphatase liver/bone/kidney) gene. In the medical literature, HPP is also known as Rathbun’s syndrome, named after the Canadian physician who first identified this disorder. Patients exhibit persistently low serum alkaline phosphatase (ALP) levels. In fact, ALP renders this measure a reliable indicator of the condition. Adult HPP is varied, with some patients exhibiting only moderate, non-pathognomonic symptoms. They include arthropathy, arthrodynia, chondrocalcinosis, osteopenia, osteomalacia, and generic musculoskeletal discomfort. Healthcare may require coordinating several services to manage a patient with HPP. This comprehensive review will highlight the genetic knowledge, pathology data, and patient management approaches, including Medicare’s coverage. In addition, this paper aims to address specific themes related to HPP, including its significance, current challenges, and controversies. Full article

Graduate Medical Education trainees’ wellness has become an important topic in academic medicine. The Accreditation Council for Graduate Medical Education (ACGME) requires oversight, education, and resources, understanding that medical training happens within a complex environment. Patients, personal and psychosocial issues, overlays, administrative demands, and intense oversight at various levels add additional elements of complexity and stress. The demographics of medicine are changing, with a greater proportion of women, minorities, and international medical graduates entering training with different needs and greater expectations. GME trainees constitute a population with unique needs that demand an adaptable and broad approach toward wellbeing and training success. The University of Texas Health San Antonio (UTHSA) created the Wellness Home, a comprehensive and adaptable model inspired by those used in primary care, where support is offered to trainees and training programs. It addresses issues beyond mental health management by including interventions such as coaching, access to medical services, or financial literacy. We present here a detailed description of the program and a rationale for developing this holistic approach in other institutions. Case studies are used to illustrate the complex needs of trainees and the innovative approaches used in their support. Usage data is presented as additional evidence that this model is increasingly and successfully being used. Full article

Background: Endoscopic Electroporation (EE) is an innovative minimally invasive therapy that utilises short electrical pulses combined with intratumoural (IT) calcium or IT/intravenous (IV) chemotherapy to induce tumour cell death in colorectal cancer (CRC). Based on electrochemotherapy protocols developed for the treatment of skin cancers, EE has shown promising results in salvage therapy, local tumour control, and symptom palliation, particularly in patients who are unsuitable for surgery or standard treatments. Objective: To establish, for the first time, a comprehensive and standardised protocol for setting up a Salvage Endoscopic Electroporation (SEE) service in CRC clinical practice, covering multidisciplinary patient selection, procedural steps, equipment needs, and follow-up care. Methods: Drawing from the European Standard Operating Procedures of Electrochemotherapy (ESOPE) and emerging clinical evidence on EE from King’s College London, we detail infrastructure, treatment delivery, and monitoring for CRC. Key procedural elements, safety considerations, and patient management strategies are outlined. Electroporation pulses were delivered using the Conformité Européenne (CE) approved ePORE^® electroporation generator and single-use CE-marked EndoVE^® probe (Mirai Medical, Galway, Ireland). Results: Tumour assessment involves both clinical evaluation and endoscopic imaging, with radiological correlation. EE treatment has been safely carried out under sedation using specialised endoscopic probes, leading to effective local tumour response, symptomatic relief, and improved quality of life. Follow-up schedules allow for timely assessment of treatment response and enable repeat treatments if needed. Conclusions: This novel protocol provides a practical framework for centres aiming to implement SEE services, promoting consistency, safety, and better patient outcomes. Future prospective studies will refine indications and improve integration of this approach into colorectal cancer management pathways. Full article

Aim: With the intensification of population aging, the public health challenges posed by multimorbidity have become increasingly severe. This study employs bibliometric analysis to elucidate research hotspots and trends in the field of multimorbidity against the backdrop of global aging. The immediate aim is to systematically map the intellectual landscape and evolving patterns in multimorbidity research. The ultimate long-term aim is to provide a scientific basis for optimizing chronic disease prevention systems and guiding future research directions. Methods: The study adopted the descriptive research method and employed a bibliometric approach, analyzing 8129 publications related to multimorbidity from the Web of Science Core Collection. Using CiteSpace, we constructed and visualized several knowledge structures, including collaboration networks, keyword co-occurrence networks, burst detection maps, and co-citation networks within the multimorbidity research domain. Results: The analysis included 8129 articles from 2004 to 2024, published across 1042 journals, with contributions from 740 countries/regions, 33,931 institutions, and 40,788 authors. The five most frequently occurring keywords were prevalence, health, older adult, mortality, and risk. The top five contributing countries globally were the United States, the United Kingdom, Germany, China, and Spain. Five pivotal research trajectories delineate the intellectual architecture of this field: ① Evolution of Disease Cluster Management: Initial investigations (2013–2014) prioritized disease cluster coordination within general practice settings, particularly cardiovascular comorbidity management through primary care protocols and self-management strategies. ② Paradigm Shifts in Health Impact Assessment: Multimorbidity outcome research demonstrated sequential transitions—from physical disability evaluation (2013) to mental health consequences like depression (2016), culminating in current emphasis on holistic health indicators including frailty syndromes (2015–2019). ③ Expansion of Risk Factor Exploration: Analytical frameworks evolved from singular physical activity metrics (2014) toward comprehensive lifestyle-related determinants encompassing behavioral and environmental dimensions (2021). ④ Emergence of Polypharmacy Scholarship: Medication optimization studies emerged as a distinct research stream since 2016, addressing therapeutic complexities in multimorbidity management. ⑤ Frontier Investigations: Cutting-edge directions (2019–2021) feature cardiometabolic multimorbidity patterns and their dementia correlations, signaling novel interdisciplinary interfaces. Conclusions: The prevalence of multimorbidity is on the rise globally, particularly in older populations. Therefore, it is essential to prioritize the prevention of cardiometabolic conditions in older adults and to provide them with appropriate and effective health services, including disease risk monitoring and community-based chronic disease care. Full article

Pharmacists are increasingly expected to deliver medication therapy management (MTM) services, yet many pharmacy students report insufficient confidence and preparedness in executing these complex tasks. This study evaluated a scaffolded MTM instructional series integrated into a second-year pharmacy skills laboratory, aiming to enhance student competence through progressive, structured learning. A mixed-methods design assessed changes in self-reported confidence, performance-based outcomes, and reflective insights among 154 students across three educational tracks. The 14-week intervention included sequential activities such as medication history interviews, drug-related problem (DRP) identification, care plan development, and comprehensive MTM simulations. Pre- and post-intervention surveys revealed statistically significant improvements in all 18 confidence domains, with the greatest gains in therapeutic recommendations and prescriber communication. Effect sizes ranged from small to very large (Cohen’s d 0.33–1.05), indicating gains that were both statistically reliable and educationally meaningful. Performance assessments showed consistent proficiency across MTM components, with average scores ranging from 90% to 96%. Qualitative reflections reinforced these findings, highlighting growth in communication, individualized patient care, and professional identity formation. The scaffolded approach aligns with accreditation standards and instructional design theory, offering a model for pharmacy curricula. Despite limitations such as lack of a comparator group and potential response bias, the study demonstrates that scaffolded MTM instruction effectively supports skill acquisition and confidence, preparing students for real-world clinical practice. Full article

India’s vast and diverse population presents significant healthcare challenges owing to its scale, heterogeneity, and rapid growth. The Indian healthcare system, spanning the public, private, and non-profit sectors, shows marked inter-state variation in health indicators. Persistent gaps include variable quality of service, fragmented data, and uneven access to affordable care. Health information technology (HIT), particularly clinical decision support systems (CDSSs) integrated with electronic health records (EHRs), offers a path to more consistent evidence-based decisions. When implemented effectively, CDSSs can improve patient outcomes, reduce medical errors, and enhance quality through support for diagnosis, treatment, patient management, and prevention. Although India is rapidly adopting digital health tools, CDSS uptake remains limited because of infrastructure constraints, low awareness, data quality issues, integration challenges with EHRs, professional resistance, and insufficient training. Strategic action is required to overcome these barriers. Priorities include investment in robust IT infrastructure, comprehensive training programs, and public awareness initiatives, along with tighter integration of CDSSs with EHR platforms. With coordinated efforts by government agencies, healthcare institutions, and technology providers to address these barriers, India can leverage CDSSs to improve patient care and outcomes. Full article

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

Metabolic syndrome (MetS)—characterized by dyslipidemia, hypertension, hyperglycemia, and abdominal obesity—is a common, modifiable condition that contributes to functional decline and premature mortality in older adults. The accumulation of MetS components increases the risk of cardiovascular, cerebrovascular, and renal diseases, as well as cognitive impairment and polypharmacy in aging populations. A narrative review was conducted focusing on the management of MetS in adults aged 65 and older. Sources were identified through targeted searches of PubMed and relevant guidelines, with an emphasis on literature discussing geriatric-specific considerations. The review was structured using the Institute for Healthcare Improvement’s (IHI) 4Ms Framework: What Matters, Medication, Mentation, and Mobility. Findings highlight that current MetS guidelines are often extrapolated from younger populations and insufficiently account for geriatric-specific factors such as altered pharmacokinetics, multimorbidity, and social determinants of health. The 4Ms Framework provides a comprehensive lens to adapt these guidelines, supporting individualized treatment plans that consider patient goals, cognitive status, and functional capacity. Incorporating social services and aligning interventions with socioeconomic realities can further bridge disparities in care. The 4Ms framework can help healthcare providers communicate effectively with patients, ensuring treatment plans align with evidence-based practices and the patient’s individual priorities. Treatment of MetS must be tailored to individual patient needs based on presented risk factors, severity of risks, and social determinants of health. Adjusting treatment plans in accordance with the socioeconomic status (SES) of patients will allow for systematic improvement of outcomes. Full article

This article describes the design, methods, and baseline characteristics of the social needs assessment (SNA) of participants enrolled in an ongoing randomized clinical trial implementing a comprehensive approach to improving diabetes self-management and providing an intensive Diabetes Self-Management Education and Support (iDSMES) Program at St. Vincent’s House Clinic, a primary care practice serving resource-challenged diverse populations in Galveston, Texas. Standardized SNA was conducted to collect information on financial needs, psychosocial well-being, and other chronic health conditions. Based on their identified needs, participants were referred to non-medical existing community resources. A series of in-depth interviews were conducted with a subset of participants. A team member independently categorized these SNA narratives and aggregated them into two overarching groups: medical and social needs. Fifty-nine participants (with a mean age of 53 years and equal representation of men and women) completed an SNA. Most (71%) did not have health insurance. Among 12 potential social needs surveyed, the most frequently requested resources were occupational therapy (78%), utility assistance (73%), and food pantry services (71%). SNA provided data with the potential to address barriers that may hinder participation, retention, and outcomes in diabetes self-management. SNA findings may serve as tertiary prevention to mitigate diabetes-related complications and disparities. Full article

(1) Background: Patient-centered care for individuals with breast cancer requires multidisciplinary cooperation to ensure the appropriate use of medication and prevent medication-related problems. Pharmaceutical care has been associated with improved adherence in breast cancer management, a factor linked to patient outcomes and mortality. This study aims to summarize and explore the provision and utilization of pharmaceutical services for breast cancer patients by pharmacists. (2) Methods: A scoping review was performed to assess the pharmacist’s role in providing pharmaceutical services for patients with breast cancer. A comprehensive review of four databases (PubMed, Ovid Embase, Ovid International Pharmaceutical Abstracts, and Scopus) was completed between 1 January 2012 and 8 April 2025 according to PRISMA-ScR framework. (3) Results: A total of 46 articles met the inclusion criteria, which included RCTs, observatory studies, cohort studies, and reviews. Findings suggest that both clinical and community pharmacists play an important role in prevention, management, and education for breast cancer patients. (4) Conclusions: Pharmacists can improve health outcomes by providing pharmaceutical service in breast cancer care. Optimizing interventions, expanding services, and evaluating long-term cost-effectiveness is needed in the future. Full article

Internet of Things (IoT) technology in healthcare has enabled innovative services that enhance patient monitoring, diagnostics and medical data management. However, securing sensitive health data while maintaining system efficiency of resource-constrained IoT devices remains a critical challenge. This work presents a comprehensive end-to-end IoT security framework for healthcare environments, addressing encryption at two key levels: lightweight encryption at the edge for resource-constrained devices and robust end-to-end encryption when transmitting data to the cloud via MQTT cloud brokers. The proposed system leverages multi-broker MQTT architecture to optimize resource utilization and enhance message reliability. At the edge, lightweight cryptographic techniques ensure low-latency encryption before transmitting data via a secure MQTT broker hosted within the hospital infrastructure. To safeguard data as it moves beyond the hospital to the cloud, stronger end-to-end encryption are applied to ensure end-to-end security, such as AES-256 and TLS 1.3, to ensure confidentiality and resilience over untrusted networks. A proof-of-concept Python 3.10 -based MQTT implementation is developed using open-source technologies. Security and performance evaluations demonstrate the feasibility of the multi-layer encryption approach, effectively balancing computational overhead with data protection. Security and performance evaluations demonstrate that our novel HECS4MQTT (Health Edge Cloud Security for MQTT) framework achieves a unique balance between efficiency and security. Unlike existing solutions that either impose high computational overhead at the edge or rely solely on transport-layer protection, HECS4MQTT introduces a layered encryption strategy that decouples edge and cloud security requirements. This design minimizes processing delays on constrained devices while maintaining strong cryptographic protection when data crosses trust boundaries. The framework also introduces a lightweight bridge component for re-encryption and integrity enforcement, thereby reducing broker compromise risk and supporting compliance with healthcare security regulations. Our HECS4MQTT framework offers a scalable, adaptable, and trust-separated security model, ensuring enhanced confidentiality, integrity, and availability of healthcare data while remaining suitable for deployment in real-world, latency-sensitive, and resource-limited medical environments. Full article

Background: Social isolation, national turmoil, and an adolescent mental health crisis in the wake of the COVID-19 pandemic have resulted in a significant uptick in inpatient admissions and re-admissions for high-risk patients. This trend persists even as the pandemic wanes. Intensive outpatient programs (IOPs) serve as a critical steppingstone between the community and inpatient mental health services, providing comprehensive psychiatric care for at-risk youth. Significant research has identified family engagement as a key element of successful collaborative care in adolescents. Objectives: This article provides models of family-centered care in the adolescent IOP through a case study detailing the six-week course of care of an adolescent struggling with increased emotionality and distress intolerance in the context of family conflicts. Methods: This case highlights five family engagement components, including (1) family-centered psychiatric medication management, (2) individualized case management, parental education, and peer support, (3) Measurement Based Care (MBC) family assessment and feedback sessions, (4) Dialectical Behavior Therapy (DBT) multi-family skill groups, and (5) Compassionate Home Action Together (CHATogether) family intervention to address teen–parent relational health and communication. Results: This case showed improvement in depressive and anxiety symptoms, family conflict behaviors, self-reported suicide risk, and help-seeking attitudes towards parents/adults. The case family, along with others (n = 26), endorsed the parent peer support groups’ acceptability and feasibility implemented in the adolescent IOP. Conclusions: This article emphasizes the importance of family engagement during clinical care and provides a practical guide to implement collaborative family-centered therapeutic interventions in intensive outpatient services. Full article

As an emerging development field, in recent years, emergency industrial parks in China have faced increasingly complex and high-risk challenges. This article proposes the establishment of a scientific safety risk assessment and grading model to help improve the safety management level of emergency industrial parks, in response to the problems of the multi-source heterogeneity of fire risks in emergency industrial parks and the difficulty of comprehensive assessment using traditional methods. This approach combines enterprise type classification with multi-level assessment for the first time, effectively identifying high-risk links such as fires and explosions and playing an effective role in preventing accidents such as fires in the park. Enterprises within the park are categorized into seven distinct groups based on their characteristics and associated safety risks: medical and healthcare, new energy storage, composite materials and new materials, intelligent manufacturing, mechanical manufacturing, consulting and technical services, and construction and installation. The following models are constructed: (1) a risk assessment model based on AHP-FCE, which can assess the safety risk levels of individual enterprises and the industrial park at a macro level; (2) a risk grading model based on the risk matrix method, which can inspect and control specific risk sources at a micro level. The integration of these two methods establishes a comprehensive model for safety risk assessment and grading in emergency industrial parks, significantly improving both the accuracy and the systematic nature of risk management processes. Full article