Search Results (393)

Background: Early surgical intervention is associated with improved outcomes in hip fracture care, yet in patients using Direct Oral Anticoagulants (DOACs), surgery is frequently delayed due to concerns about increased intraoperative bleeding. Despite the increasing prevalence of hip fracture patients on DOACs, no consensus exists on optimal surgical timing. This has led to substantial practice variation between hospitals, with some operating within 24 h of last DOAC intake and others delaying surgery beyond 24 h. This study hypothesizes that early surgery within 24 h results in a non-inferior blood transfusion risk compared to delayed surgery 24 h or more after last DOAC intake in hip fracture patients on DOACs. This protocol describes the design and methodological rationale of a natural experiment. Methods and analysis: A multicenter cohort study designed as a natural experiment will be conducted across seven Dutch level 2 trauma centers, using predefined and standardized prospectively collected variables from electronic health records. Centers will adhere to distinct local surgical timing protocols, forming two cohorts: early surgery within 24 h and delayed surgery 24 h or more after last DOAC intake. Patients presenting with an isolated hip fracture who are using a DOAC and have taken their last dose within 24 h before admission will be included. The primary endpoint is postoperative blood transfusion. Secondary endpoints include additional bleeding-related outcomes, thrombotic and postoperative complications, and hospital length of stay. The primary analysis will be conducted on a per-protocol basis, with an intention-to-treat analysis performed as a supplementary assessment. Non-inferiority will be established if the upper bound of the one-sided 95% confidence interval for the risk difference does not exceed the predefined margin of 5%. Ethics and dissemination: Ethical approval was obtained from the Medical Ethics Committee United, Utrecht, The Netherlands. As this is a cohort study without altering clinical care, individual informed consent is not required. All data will be pseudonymized, and findings will be disseminated through peer-reviewed journals and scientific conferences. Registration details: Medical Ethics Committee United, Utrecht, The Netherlands, registration number W25.034 Full article

(1) Background: The climate impact of health care work has raised interest in climate-conscious health care practice. Medications contribute significantly to the carbon footprint; there has been insufficient work describing climate-conscious medication therapy management practices that could be useful to address climate change caused by health care work. (2) Methods: This exploratory qualitative research study focused on climate-conscious medication therapy management practices. A semi-structured interview protocol was used. A total of 17 primary care pharmacists were interviewed (following informed consent) to the point of thematic saturation. A constant-comparative analysis was undertaken to identify and categorize themes. The research was undertaken based on a protocol approved by the University of Toronto Research Ethics Board. (3) Result: Three main themes emerged: (a) There is insufficient evidence currently available to guide climate conscious medication therapy management; (b) seven specific climate-conscious medication therapy management strategies were identified as being most likely to be acceptable by primary care pharmacists; (c) medication therapy management services focused on climate adaptation strategies for patients should be expanded; (4) Conclusions: As medications become the primary intervention used in health care, climate-conscious medication therapy management becomes more essential than ever. Further work in providing evidence to guide climate-conscious prescribing decisions is needed. Full article

Objective: To test whether inpatient electrical muscle stimulation (EMS) using Russian current (5 kHz carrier, 50 Hz modulation; 4 s ON/6 s OFF) improves mobility and balance in elderly people with chronic cerebral ischaemia. Design: Prospective single-centre controlled observational pilot, embedded in routine inpatient rehabilitation; no concealed randomisation (EMS + standard care; sham EMS + standard care; standard care only (control)). Methods: A single-centre controlled observational study with three groups was conducted (EMS n = 27, control n = 10, sham n = 7) with 3–9 sessions over 2 weeks (20 min; quadriceps and calves). Pre/Post Outcomes: Tinetti (balance/gait), Rivermead Mobility Index, Timed Up and Go (TUG), ankle extensor maximal voluntary force (MVF), stabilography (statokinesiogram path length (L), mean velocity of COP (V), sway area (S), and myotonometry; ANOVA, α = 0.05). Ethics approval and informed consent were obtained. Between-group differences in change scores were evaluated descriptively, and no formal hypothesis-testing was planned. Results: EMS showed significant gains versus control/sham—higher Tinetti total and Rivermead scores, faster TUG, higher MVF, and improved stabilography in the eyes-closed condition (reduced L, V, and S), with good tolerability and no serious adverse events (SAEs). Conclusions: Short-course Russian-current EMS is feasible and associated with clinically meaningful improvements in balance, gait, and strength in elderly patients with chronic cerebral ischaemia; however, larger randomised trials are warranted. Full article

Although the American Academy of Pediatrics has long recommended universal autism-specific screening at well-child pediatric visits, implementation challenges in primary care settings interfere with high-fidelity universal autism screening. These challenges delay autism identification for some children, leading to delays in needed services and supports. Prior findings indicate that new solutions must be developed to bridge the gap in access to autism screening for families, particularly among those who are under-resourced. One approach is expanding screening to other community settings, such as childcare centers, but there are barriers to this approach, which this commentary aims to address. We discuss challenges and barriers in childcare screening identified through our recently completed pilot study screening for autism in childcare centers, with suggested strategies to address them. These challenges include hesitation among childcare staff to guide conversations or concerns about autism, and stigma around autism diagnosis and presentation. Other challenges relate to emerging concerns regarding legal, ethical, and professional roles and responsibilities surrounding informed consent and data privacy, as well as the identification of children without timely follow-up evaluation and services. There is a need for increasing public awareness as an essential component of autism screening across settings. Our commentary discusses different considerations and practice strategies to meet these needs. Full article

Mass spectrometry-based metabolomics is a valuable tool for advancing pediatric health research. Along with nuclear magnetic resonance, it enables detailed biochemical analysis from minimal sample volumes, a critical feature for pediatric diagnosis. Metabolomics supports early detection of inherited metabolic disorders, monitors metabolic changes during growth, and identifies disease markers for a range of conditions, including metabolic, neurodevelopmental, oncological, and infectious diseases. Integrating metabolomic data with genomic, proteomic (i.e., multi-omics approaches), and clinical information enables more precise and preventive care by enhancing risk assessment and informing targeted treatments. However, routine clinical use faces several challenges, including establishing age- and sex-specific reference ranges, standardizing sample collection and processing, ensuring consistency across platforms and laboratories, expanding reference databases, and improving data comparability. Ethical and regulatory issues, including informed consent, data privacy, and equitable access, also require careful consideration. Advances in high-resolution and single-cell metabolomics, artificial intelligence for data analysis, and cost-effective testing are expected to address these barriers and support broader clinical adoption. As standards and data-sharing initiatives grow, metabolomics will play an increasingly important role in pediatric diagnostics and personalized care, enabling earlier disease detection, improved treatment monitoring, and better long-term outcomes for children. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) remains a major global health problem, affecting over 300 million people worldwide. Its high morbidity and mortality rates impose substantial psychosocial and financial burdens on patients and healthcare systems. In the emergency setting, managing acute exacerbations of COPD (AECOPD) poses a major clinical challenge, as these patients often present with multi-organ dysfunction secondary to hypoxia and hypercapnia. Identifying reliable prognostic biomarkers could improve early risk stratification, guide therapeutic decisions, and enhance patient outcomes. Methods: This multicenter, prospective, observational study aims to evaluate the prognostic significance of several novel biomarkers—resistin, club cell secretory protein 16 (CC16), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), S100β protein—alongside conventional markers such as N-terminal-pro–B-type-Natriuretic-Peptide (NT-proBNP), D-dimer, high-sensitivity troponin I (hs-cTnI), C-reactive protein (CRP), and procalcitonin in patients with AECOPD admitted to the Emergency Department (ED). Blood samples will be collected at admission. The novel biomarkers (resistin, CC16, IL-6, TNF-α, S100β) will be measured using standardized ELISA kits, while conventional biomarkers (NT-proBNP, troponin I, CRP, procalcitonin) will be analyzed using routine automated clinical laboratory methods. Correlations between biomarker levels, clinical and imaging data, severity scores (GCS, SOFA, CFS, Ottawa COPD Risk Scale, DECAF, BAP-65), and short-term outcomes (hospital discharge status and 28-day survival) will be assessed. The study has received approval from the Ethics Committee of the “Iuliu-Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, and all participating hospitals. Written informed consent will be obtained from all participants or their legal representatives. Results: This study protocol does not report results, as data collection and analysis are ongoing. Conclusions /Expected Impact: By identifying novel biomarkers with prognostic and pathophysiological relevance, this research aims to inform the development of early risk stratification tools and support future evidence-based approaches to the management of critically ill COPD patients in the ED. Full article

The principal objective of this paper is to analyse the treatment that Spanish law gives to the refusal to receive blood transfusions on religious grounds, with special reference to the case of Jehovah’s Witnesses. The aim is to determine how different fundamental rights are reconciled with other constitutionally protected legal rights. To this end, the position of patient autonomy, informed consent, the right to refuse treatment, and advance directives will be examined. Following this analysis, there are suggestions which aim to achieve an appropriate balance between these conflicting rights. In summary, this study seeks to establish a framework of legal and ethical protection for cases when patient autonomy and the duty to protect life come into conflict. Full article

Background: Informed consent and assent are fundamental ethical and legal requirements in paediatric healthcare, yet their application in paediatric dentistry is complex and underexplored in clinical practice. Objective: This study aimed to analyse the implementation of informed consent and assent processes in paediatric dental care within a Spanish population, identifying key characteristics and factors that influence communication, understanding, and decision-making. Methods: An observational, descriptive, cross-sectional study was conducted in Spanish Paediatric Dentistry Clinics (January–June 2023). Participants included 520 child-caregiver pairs and 52 dental students. Data were collected via a semi-structured observational protocol and interviews, assessing information provided, decision-making conditions, and influencing factors. Statistical analysis was performed using SPSS v23.0, employing Chi-square, Cochran’s Q, and Kendall’s W tests. Results: The information most frequently provided was the nature of the dental problem (92%), treatment details (88%), and benefits (85%). Information on risks (64%), alternatives (37%), and the right to withdraw consent (41%) was less consistently communicated. After multivariable adjustment, child schooling remained independently associated with the disclosure of risks and alternatives (p < 0.01), whereas caregiver education showed no independent effect. Kendall’s concordance coefficient showed moderate agreement (W = 0.62, 95% CI: 0.54–0.69, p < 0.01) among operators, caregivers, and patients, which decreased in adolescents aged 16–18 years (W = 0.41, 95% CI: 0.28–0.55, p = 0.07). Conclusions: The processes of informed consent and assent in paediatric dentistry are more strongly linked to the child’s cognitive maturity and schooling than to parental education. While communication of treatment benefits is adequate, critical aspects like risks and alternatives are often overlooked. The findings underscore the need for standardized protocols and enhanced bioethical training to ensure consistent, ethical, and participatory practices that respect the progressive autonomy of minors. Full article

Background: Telepharmacy consultations (TPCs) became a routine element of pharmacy operations. However, there is limited data available on local pharmacy customer feedback related to TPC. Methods: A customer survey was developed seeking feedback on TPC. The pharmacy customers were invited to complete the survey in two local pharmacies in Germany. The survey and corresponding informed consent form were approved by the Ethics Committee. Results: In total, 178 pharmacy customers were enrolled (median age 41–50 years). From those, 37% agreed when asked whether they were generally interested in TPC. A total of 37% had the nearest pharmacy 5–15 min from their home. A total of 42% visited their pharmacy quarterly. A total of 36% used technical devices in median 1–2 h per days. A total of 33% classified their own digital skills at least as sufficient. A total of 59% would use their smartphone as a potential device for TPC. A total of 83% rated it as (slightly) important that the pharmacist providing TPC can be heard clearly. A total of 76% each (strongly) agreed that an argument for TPC would include limited mobility or pandemic/quarantine. A total of 33% (strongly) agreed that a key argument against TPC were technical requirements. A total of 75% considered situations of immobility to be the most important future perspective for TPC. Conclusions: Many pharmacy customers see TPC as an opportunity, e.g., in cases of limited mobility or during pandemic or quarantine. However, the use of appropriate technology can be a limiting factor. Full article

Urban environments play an important influence in influencing healthy lifestyles and reducing sedentary behaviour (SB), particularly as facilitators of physical activity (PA). Urban spaces often do not support healthy lifestyles. A Community of Practice (CoP) could be a valuable strategy for co-designing proposals to enhance healthy and active urban environments. We aimed to develop strategies through a CoP to promote PA and reduce SB in the urban setting of a multicultural population based in the Barcelona Metropolitan Area, with a particular focus on people with chronic diseases. A three-session CoP involving 25 participants (community members with chronic conditions, health professionals, urban planners, and local authorities) was implemented as a participatory research approach to identify barriers and facilitators to PA and co-design feasible urban improvement proposals. Ethical approval was obtained from Bellvitge University Hospital’s Ethics Committee. Participants provided informed consent and image release forms. Participants highlighted the importance of accessible, adaptable, and interconnected urban spaces to address barriers and leverage facilitators to PA. Proposed interventions targeted four selected areas of the neighbourhood and included expanding shaded areas, creating pedestrian-friendly routes and enhancing green spaces. This study highlights the effectiveness of a CoP in identifying and addressing barriers to PA within urban environments for people with chronic diseases. Findings emphasise the impact of neighbourhood design and accessibility on reducing SB and promoting active lifestyles. The participatory approach offers a replicable model for other urban settings aiming to foster health, although its qualitative and local nature limits generalisability. Full article

The increasing availability of free-text components in electronic medical records (EMRs) offers unprecedented opportunities for machine learning research, enabling improved disease phenotyping, risk prediction, and patient stratification. However, the use of narrative clinical data raises distinct ethical challenges that are not fully addressed by conventional frameworks for structured data. We conducted a narrative review synthesizing conceptual and empirical literature on ethical issues in free-text EMR research, focusing on privacy, fairness, autonomy, interpretability, and governance. We examined technical methods, including de-identification, differential privacy, bias mitigation, and explainable AI, alongside normative approaches, such as participatory design, dynamic consent models, and multi-stakeholder governance. Our analysis highlights persistent risks, including re-identification, algorithmic bias, and inequitable access, as well as limitations in current regulatory guidance across jurisdictions. We propose ethics-by-design principles that integrate ethical reflection into all stages of machine learning research, emphasize relational accountability to patients and stakeholders, and support global harmonization in governance and stewardship. Implementing these principles can enhance transparency, trust, and social value while maintaining scientific rigor. Ethical integration is therefore not optional but essential to ensure that machine learning research using free-text EMRs aligns with both clinical relevance and societal expectations. Full article

Wearable devices are becoming widely applied in healthcare to enable continuous, noninvasive monitoring, but their use in pediatric populations remains relatively underexplored. This review synthesizes 36 clinical studies focused on pediatric hospital and outpatient wearables published between 2014 and 2025. Devices included wrist-worn trackers, adhesive biosensors, and more, capturing electrocardiography, photoplethysmography, accelerometry, and other signals. Clinical applications spanned a variety of care settings. Artificial intelligence (AI) partially enhanced interpretation for the early detection of conditions such as postoperative complications and sepsis. Despite their promising accuracy, most studies remain small, single-center pilots focused on feasibility and signal validity rather than outcomes such as mortality, readmission, or long-term recovery. Key barriers include pediatric-specific device design, motion-robust signal quality, regulatory clearance, workflow integration, and equitable adoption in low-resource settings. Ethical concerns such as privacy, consent, and incidental findings and regulatory constraints, particularly the lack of pediatric labeling and approval for consumer and AI-driven devices, further limit translation into practice. Future work should prioritize multi-center studies, multimodal analytics, explainable AI, and seamless integration into clinical pathways. With these advances, wearables can move beyond feasibility to become reliable, personalized tools that improve pediatric monitoring and care. Full article

Functional neurosurgery has emerged as a potential therapeutic option for patients with severe, treatment-resistant psychiatric disorders such as obsessive–compulsive disorder (OCD) and major depressive disorder (MDD). Among the most studied interventions, deep brain stimulation (DBS) has shown promising outcomes in open-label studies, though controlled trials have yielded more modest results. This discrepancy, along with concerns about surgical risks, neuropsychiatric side effects, and ethical challenges, has limited the broader implementation of psychiatric neurosurgery. This review explores the clinical complications of DBS—including vascular events, infections, and hardware-related issues—as well as cognitive and behavioral changes such as hypomania, apathy, and impulse control disorders. Ethical concerns are also addressed, including the difficulty of obtaining truly informed consent and the potential impact on personal identity. The article emphasizes the need for multidisciplinary teams, dynamic consent models, standardized protocols, and high-quality clinical trials to ensure safe, ethical, and effective use of neurosurgical interventions in psychiatry. Ultimately, the responsible integration of functional neurosurgery into psychiatric care requires not only technical precision but also ethical rigor and patient-centered collaboration. Full article

Genealogy has shifted from the private domain of family history to a central mechanism in law and governance. This article examines how genealogical claims are used as evidence in three critical domains: citizenship, inheritance, and indigenous recognition. Using a comparative socio-legal approach, the study analyses statutes, case law, and interdisciplinary scholarship to reveal both convergences and divergences in evidentiary practice. Across legal systems, descent remains decisive in allocating rights and recognition, yet the hierarchy of proof varies. Civil law states privilege documentary records, common law courts increasingly rely on DNA testing, and indigenous forums continue to give authority to oral genealogies. The rapid growth of genetic genealogy databases adds new complexity. While these technologies expand opportunities for verification, they also create ethical challenges concerning privacy, consent, and the extension of genealogical data into surveillance. To address these dynamics, the article develops an evidence regime framework that treats genealogy as criteria of proof, media of proof, institutional gatekeepers, and social consequences. The findings highlight genealogy’s dual character: it enables claims to rights yet also reproduces exclusion when evidentiary hierarchies are imposed. The article argues for pluralist standards that respect documentary, genetic, and oral genealogies, offering a pathway toward more inclusive and just legal recognition. Full article

Background: Central nervous system (CNS) tumors during pregnancy are rare but present significant diagnostic, therapeutic, and ethical challenges. These include both primary and metastatic lesions, which share overlapping clinical features and management complexities. Their clinical course is influenced by gestational physiological changes, which can mask symptoms and delay diagnosis, thereby increasing maternal and fetal risks. Objective: This review aims to synthesize current evidence on the epidemiology, pathophysiology, clinical presentation, diagnostic strategies, treatment options, prognosis, and ethical considerations related to CNS tumors in pregnant patients. Methods: A comprehensive literature review was conducted, including retrospective and prospective studies, clinical guidelines, and systematic reviews focusing on brain and spinal tumors diagnosed during pregnancy. Particular attention was given to the impact of gestational age, tumor histology, and maternal condition on treatment outcomes. Results: Hormone-sensitive tumors such as meningiomas and prolactinomas may exhibit accelerated growth during pregnancy due to elevated progesterone and prolactin levels. Diagnosis is often delayed due to symptom overlap with normal gestational changes. MRI without contrast remains the imaging modality of choice. Glucocorticoids and selected chemotherapy agents can be cautiously used depending on gestational age. Surgical resection, particularly in the second trimester, has been shown to be safe and effective in appropriate clinical scenarios. Multidisciplinary coordination is essential. Prognosis varies based on tumor type and timing of intervention, with maternal survival prioritized in high-risk situations. Ethical management hinges on patient autonomy, informed consent, and proportionality of medical interventions. Conclusions: CNS tumors during pregnancy require early recognition, individualized treatment planning, and ethical vigilance. Multidisciplinary collaboration is vital to optimizing outcomes for both mother and fetus. Future efforts should focus on developing standardized protocols and expanding evidence through multicenter studies. Full article