Search Results (648)

Background/Objectives: Oral mucositis is a frequent and clinically significant acute toxicity in patients undergoing radiotherapy or chemoradiotherapy for head and neck cancer, with substantial consequences for swallowing function, nutritional status, and quality of life. Conventional clinician-reported toxicity grading may not fully capture the multidimensional burden experienced by patients. This study aimed to perform a longitudinal multidimensional assessment of treatment-related oral mucositis by evaluating the relationship between clinician-reported toxicity, objective mucosal injury, patient-reported swallowing-related quality of life, and nutritional status. Methods: In this retrospective observational study, 32 of 54 consecutively screened patients with locally advanced head and neck cancer treated with curative-intent radiotherapy, with or without concurrent chemotherapy, were included. Oral mucositis was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) and the Oral Mucositis Assessment Scale (OMAS). Swallowing-related quality of life was evaluated using the MD Anderson Dysphagia Inventory (MDADI). Body weight was recorded longitudinally as an indicator of nutritional status. Correlations between OMAS scores and clinical outcome measures were analyzed at predefined timepoints using Spearman’s rank correlation coefficient. Results: All patients developed treatment-related oral mucositis, with peak severity occurring during the acute treatment phase. During the acute treatment phase, OMAS scores demonstrated a moderate positive correlation with clinician-reported toxicity (CTCAE) and inverse correlations with MDADI scores. A significant inverse association between OMAS and MDADI composite score persisted at treatment completion (ρ = −0.41, p = 0.022). Body weight progressively declined during treatment, although no statistically significant correlation with OMAS severity was observed. Conclusions: A multidimensional assessment integrating clinician-reported toxicity, objective mucosal evaluation, and patient-reported functional outcomes provides a broader characterization of oral mucositis burden in patients undergoing radiotherapy-based treatment for head and neck cancer. These findings support the potential value of integrated toxicity assessment strategies to improve supportive care monitoring in clinical practice. Full article

Background/Objectives: Postoperative monitoring of microvascular free flaps is critical for early detection of vascular complications and flap survival. Nurses play a central role in this process; however, qualitative evidence on their experiences and challenges remains limited. This study explored nurses’ experiences in free tissue flap care to identify clinical practices, challenges, and improvement needs. Methods: A phenomenological qualitative design was used. Data were collected through semi-structured interviews with nine nurses experienced in free tissue flap care, recruited via purposive and snowball sampling. Interviews were conducted online and lasted 30–45 min. Data were analyzed using content analysis with MAXQDA 2025. Inter-researcher reliability was 97%. Results: The findings were categorized into four main themes and seventeen subthemes: (1) clinical monitoring and evaluation in the care process, (2) challenges and difficulties, (3) emotional and professional reflections, and (4) suggestions for improving care. Nurses reported that flap care requires intensive monitoring, rapid decision-making, and close collaboration with physicians, especially within the first 24–48 h. Monitoring was largely based on observation and experience due to the lack of standardized protocols. Major challenges included high workload, frequent assessments, and donor site management. Emotional burden, stress, and responsibility were also prominent. Conclusions: Free flap care is a complex and demanding process for nurses. The lack of standardized monitoring tools and protocols is a key gap. Developing structured tools, improving training, and strengthening multidisciplinary collaboration may enhance patient safety and care quality. Full article

Background/Objectives: Given the limited evidence internationally, this qualitative study employed discovery interviews to explore the lived experience of patients who developed Hospital-Acquired Malnutrition (HAM) and that of their carers. Methods: Seven (two patients [(n = 1 female] and five carers [n = 3 female]) completed discovery interviews with an experienced independent interviewer. Carers were either spouses or parents. Responses were thematically analyzed using a constant comparative approach. Results: A key theme was ‘It’s not about the food, it’s the hospital system’ with the needs of the system dominating, including when patients were feeling at their worst. Subthemes were ‘integration of care’ and ‘patient acuity’, including symptoms that impacted food intake. Another theme was ‘Who is looking out for the patient?’, exploring ‘reliance on carer advocacy’, and ‘variation in staff involvement’. One carer said, “… the girl that delivered the meal tray was the only one in our hospital stay who actually said to [the patient], ‘I’m so glad you’re sitting up. I was worried about you because you hadn’t eaten for so long?” A persistent but comparatively less strong theme was ‘When it is about the food’ which explored ‘the quality of the food’ and ‘receiving information on eating and drinking’. Conclusions: The three key themes identified from carers and patients were hospital system impacts, care co-ordination and, less strongly, experiences with food quality and information. The key opportunities to prevent, or better support the nutritional care of patients with, HAM may be through improving systems and care co-ordination. Full article

Background/Objectives: Persons living with dementia (PLwD) receive informal care services from loved ones, commonly referred to as care partners (CPs). While the symptoms (e.g., depressive affect, cognitive impairment) experienced by PLwD are recognized to influence CP wellbeing, longitudinal investigations into the association of CP QoL and PLwD symptoms have yet to be fully explored. The present study sought to address this gap and highlight how CP QoL and PLwD symptoms systematically covary over time. Methods: Participants were composed of 33 dyads (PLwD and their CP) who partook in the Voices in Motion project, a social-cognitive intervention for dementia. CP QoL (WHOQOL-BREF), PLwD depressive symptomology (Patient Health Questionnaire-9) and PLwD global cognitive functioning (Mini-Mental State Examination) were assessed every three to four weeks in an intensive repeated-measures design. Time-varying covariation models using multilevel modeling examined systematic covariation between CP QoL and PLwD symptoms between and within dyads. Results: Increased CP psychological and social QoL were both associated with increased PLwD global cognitive functioning between dyads and vice versa (p < 0.05). Within dyads, increased CP social QoL was associated with improved PLwD depressive symptoms (p < 0.05), while increased CP environmental QoL was associated with increased depressive symptoms (p < 0.05). Conclusions: Significant coupling associations were observed both between and within dyads. Such results highlight the association between CP QoL and the symptoms experienced by their care recipient and provide important, novel longitudinal contributions to the literature. Full article

Background/Objectives: Given the growing need for prenatal care, Nordic Walking (NW) is a promising intervention for maintaining maternal physical activity and quality of life (QoL). We aimed to investigate the influence of NW on gait kinematics, pelvic girdle pain, low back pain (LBP), and QoL during pregnancy. Methods: This is a single-blind randomized controlled trial. A total of 44 pregnant women aged 20 to 40 years with 13–28 weeks of gestation and mild to moderate musculoskeletal pain were included. Participants were randomly assigned to either the study (NW) group or the control group. The study group received the NW program for 12 weeks, three sessions per week, each lasting 45 min. The control group received standard prenatal care plus 30 min of moderate walking three days a week. The GAITRite system was used to measure gait kinematics, and the Visual Analog Scale (VAS) for pain and the SF-36 for QoL were administered at baseline, the fourth week, and the twelfth week. Results: NW significantly improved gait kinematics and reduced musculoskeletal pain (p < 0.001) with improvements in pain and gait speed exceeding the previous reported MCID thresholds. QoL improved across all SF-36 domains in the NW group (p < 0.001) compared with the control group, with large effect sizes observed for the primary outcomes. Conversely, the control group experienced declines in several QoL domains, including energy/fatigue and emotional well-being, despite moderate walking exercise and standard prenatal care over 12 weeks. Conclusions: NW may represent an effective prenatal exercise regimen associated with improved gait, reduced pain, and better overall QoL compared with moderate exercise, consistent with standard prenatal care. Full article

Background: Clear post-extraction sessions are vital for good patient outcomes. Traditional methods, such as verbal and printed information, have historically been prevalent; however, digital health care methods for analysis and communication are increasingly being adopted. Still, evidence comparing preferences for digital versus traditional instruction, especially for routine post-extraction care, remains limited. Objectives: This study aimed to evaluate preferences between digital methods (QR code-based videos) and traditional methods (verbal and printed leaflets) for delivering post-extraction care instructions among dental patients and students. It also assesses perceptions of communication quality, confidence, and patient interaction associated with each method. Methods: A cross-sectional study involved 200 dental students and 200 patients undergoing routine tooth extractions. The sample size was determined based on a 5% margin of error at a 95% confidence level for proportion estimation. Participants experienced all three instructional delivery methods—verbal, printed leaflet, and QR code-based video—for post-extraction care and completed validated questionnaires. The study assessed preferences for each delivery method, communication quality, confidence in following or providing instructions, ease of access, perceived usefulness, and impact on patient-provider interaction. Data were analyzed using descriptive statistics, the Mann–Whitney U test for group comparisons, and Spearman correlation for relationships among ordinal data. Results: Among all participants, 67.5% chose QR codes as the preferred method for improving communication (p < 0.001). Among dental students, 49% favored QR codes as the best method for postoperative instructions, and 50.5% indicated that QR codes boosted their confidence in providing instructions to patients. Preference for QR codes ranged from 43.5% to 65.5% across different aspects evaluated. Notably, among patients aged 60 years or older, 65.5% considered QR codes the most convenient for the elderly. Mann–Whitney U tests showed statistically significant differences between students and patients for ease of access (p = 0.009, rank biserial r = −0.143), video length appropriateness (p = 0.003, rank biserial r = −0.160), and the unlikelihood of missing instructions (p < 0.001, rank biserial r = −0.446). Conclusions: QR code-based video instructions were widely preferred over traditional methods by both dental students and patients for post-extraction care delivery. These findings support the integration of digital communication tools into post-extraction care protocols as a complement to traditional instruction delivery methods, though longitudinal studies assessing actual clinical outcomes are needed. Full article

Background: Community-based mental health and social interventions focusing on housing stability, integrated care and psychosocial support are being increasingly recognised as essential for improving the mental health and wellbeing of people experiencing homelessness. However, evidence regarding the effectiveness of these interventions remains fragmented across different models of care and study designs. This review synthesises how these interventions address mental health and social determinants of health. Methods: Following PRISMA 2020 guidelines, a systematic search of six electronic databases (2019–2025) was conducted (PROSPERO: CRD420250653260). The review included 29 quantitative, qualitative, and mixed-methods studies examining community-based interventions for people experiencing homelessness and mental health conditions according to predefined eligibility criteria. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Results: Community-based interventions, particularly Housing First models, were frequently associated with improved housing stability, mental health outcomes, and programme retention. Integrated multidisciplinary services and outreach promote psychosocial wellbeing, continuity of care and reducing emergency service use. Peer-led programmes support social integration, although evidence regarding technology-based interventions was inconsistent, with some studies reporting improved engagement and access to support, while others found limited effects on mental health outcomes. Conclusions: Addressing social determinants of health through structured community-based interventions is essential to tackle mental health inequalities. The findings support the implementation of integrated community-based services combining housing, mental health, and social support. These results may inform policymakers, healthcare providers, and community organisations seeking to reduce mental health inequalities among people experiencing homelessness. Full article

Minimally invasive gastrectomy has become an established surgical approach for gastric cancer, supported by randomized trials demonstrating oncologic outcomes comparable to open surgery. Initially applied mainly to early-stage disease, laparoscopic gastrectomy has gradually expanded to selected patients with advanced gastric cancer and to more complex procedures, including total gastrectomy. In parallel, robotic surgery and reduced-port techniques have further broadened the technical spectrum of minimally invasive gastric cancer surgery. This review summarizes current evidence on laparoscopic, robotic, and reduced-port gastrectomy, with emphasis on randomized trials, large-scale clinical studies, and recent guideline recommendations. Laparoscopic distal gastrectomy has shown robust oncologic equivalence in early and selected advanced gastric cancer, while evidence for laparoscopic total gastrectomy continues to grow, particularly in experienced centers. Robotic and reduced-port approaches appear feasible and safe in selected settings, although clear superiority over standard laparoscopy has not been established. As minimally invasive techniques are adopted more widely, careful consideration is needed during program development and expansion. Patient selection, surgeon experience, learning curve, institutional volume, standardized operative procedures, quality control, and multidisciplinary support are important factors for safe implementation. Future studies should focus not only on comparing surgical approaches, but also on defining how minimally invasive gastrectomy can be applied safely and consistently across diverse clinical settings. Full article

Background/Objectives: Large language models (LLMs) are increasingly consulted for information about cleft lip and palate (CLP), yet the reliability of their outputs across clinical domains has not been evaluated. This study aimed to compare the quality of CLP-related information generated by GPT-4o and Gemini 2.5 Pro across multiple thematic domains using a validated quality instrument and a reliability-first analytic framework. Methods: Fifty-four standardized CLP questions across six domains were submitted to GPT-4o (OpenAI) and Gemini 2.5 Pro (Google DeepMind) on 25 September 2024 via their public interfaces, using new, history-free sessions and default settings, yielding 108 responses. Three independent, CLP-experienced raters scored each response using the Global Quality Score (GQS; 1–5 scale assessing accuracy, completeness, and clinical usefulness). Before comparing models, we applied a reliability-first filter: only domains where all three raters showed substantial agreement (Fleiss’ kappa [κ] ≥ 0.60) were included in statistical comparisons. Domains that failed this threshold were analyzed qualitatively to identify the source of disagreement. A descriptive taxonomy of errors was developed for low-scoring responses. Results: Three domains met the reliability threshold (General Care Information, General Cleft Information, and Pre-Treatment Information; 30 paired questions). Both models performed at a high and practically equivalent level: GPT-4o median GQS 4.33 (IQR 4.00–5.00) versus Gemini 2.5 Pro 5.00 (IQR 4.00–5.00); the difference was not statistically significant (Wilcoxon V = 139.00, p = 0.691; Hodges–Lehmann median difference 0.00, 95% CI −0.33 to 0.67). Three domains were excluded because rater agreement was insufficient; qualitative review showed this reflected genuine clinical practice variation rather than clear model errors. The most common inaccuracies were overgeneralization of outcomes, outdated surgical timing, and omission of multidisciplinary team roles. Conclusions: Both models provided high-quality CLP information in domains supported by clinical consensus, indicating they may serve as useful adjuncts for general patient and family counseling. Clinicians should, however, verify any treatment-specific content against current institutional protocols before relaying it to patients. Future research should assess readability, alignment with health literacy, and patient comprehension of AI-generated CLP information. Full article

Objectives: This study aimed to identify the oral health conditions of homeless individuals in Rome, the most frequently required dental treatments, and to describe a standardized, replicable clinical protocol tailored to the specific needs and access barriers of this vulnerable population. Methods: Five hundred homeless individuals received comprehensive dental examinations at the Primary Care Services of the Dicastery for the Charity Services (Vatican City) between September 2023 and January 2026. Clinical assessments included oral hygiene status, periodontal health, caries prevalence, and degree of edentulism. Treatment interventions were programmed by scheduling subsequent appointments. For patients requiring prosthetic rehabilitation, treatment was sequenced into distinct steps: preparatory treatments (hygiene, extractions, conservative procedures), impression taking, prosthesis try-in, and delivery. Results: Oral health assessment revealed poor or absent hygiene (85.4%), high DMFT scores (63.0%), and root residues (22.4%). Periodontal disease affected 94.0% of participants (gingivitis 73.0%, periodontitis 21.0%). Tooth loss patterns included partial edentulism (12.0%) and complete edentulism (24.0%). A total of 440 appointments were scheduled, with an attendance rate of 78.4%. Prosthetic rehabilitation was completed in 150 patients: 50 received partial dentures (33.3%) and 100 complete dentures (66.7%). Conclusions: The examined homeless individuals experienced severe oral health deterioration characterized by extensive tooth loss and advanced periodontal disease. A substantial prosthetic rehabilitation was needed in this sample. The proposed sequential treatment protocol demonstrated high feasibility and patient adherence in this vulnerable population. Comprehensive dental services that address both immediate emergency needs and long-term rehabilitative care are crucial for improving oral health-related quality of life and facilitating social reintegration. Patient-reported outcomes indicated meaningful improvements in digestive function, aesthetic satisfaction, and employment opportunities following prosthetic rehabilitation. Full article

Background: Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic inflammatory rheumatic diseases associated with impaired quality of life, persistent disease burden, and increased healthcare utilization. Treatment adherence and psychosocial factors may influence outcomes, but their longitudinal associations in real-world hospitalized populations remain insufficiently characterized. Methods: We conducted a single-center, retrospective, mid-term longitudinal observational study including 50 adults with RA or AS who experienced repeated hospitalizations over a four-year period. The final dataset comprised 196 hospitalization episodes analyzed as repeated observations nested within individual patients. Disease activity was assessed using DAS28 in RA and ASDAS and/or BASDAI in AS, according to data availability and routine clinical practice. Treatment adherence, quality of life, anxiety, social isolation, patient–provider communication, dietary support, inflammatory markers, and hospitalization-related outcomes were extracted from medical records and structured inpatient assessments. Linear mixed-effects models were used for continuous outcomes, and ordinal mixed-effects models were used for ordered categorical outcomes, with adjustment for age, sex, and time where appropriate. Results: In RA, higher treatment adherence was associated with lower disease activity over time. In AS, comparable associations were not detected, possibly reflecting disease-specific factors, limited variability in adherence, and reduced statistical power in the smaller AS subgroup. Better patient–provider communication was associated with higher adherence and lower anxiety, whereas greater social isolation was associated with poorer quality of life. More favorable dietary support was associated with better adherence, although the magnitude of this association should be interpreted cautiously because of sparse categories and wide confidence intervals. Lower inflammatory burden, particularly lower CRP over time, was associated with lower hospitalization-related costs. Conclusions: In this selected cohort of repeatedly hospitalized patients with RA or AS, treatment adherence, psychosocial factors, and supportive care indicators were associated with clinically relevant longitudinal outcomes. The findings support a multidisciplinary, patient-centered approach to inflammatory rheumatic disease care. However, because of the retrospective design, modest sample size, selected inpatient population, non-standardized assessment of several variables, and possible instability of some ordinal model estimates, the results should be interpreted as exploratory and confirmed in larger prospective cohorts. Full article

Importance: Immune checkpoint inhibitors (ICIs) have transformed the management of cancers affecting reproductive-age patients, yet their impact on pregnancy outcomes remains incompletely understood. We describe two cases of maternal and fetal outcomes associated with ICI exposure during pregnancy and present a comprehensive literature review. Methods: A retrospective chart review was conducted at MD Anderson Cancer Center (1 January 2015 to 31 December 2024) to identify patients exposed to ICIs during pregnancy. Clinical data including cancer type, treatment timing, pregnancy course, and maternal and neonatal outcomes were collected. A narrative literature review was also performed using PubMed to identify reported cases of ICI exposure during pregnancy. Observations: Two patients were identified at our institution, both treated with ICIs for advanced melanoma. One patient received pembrolizumab during early pregnancy, with the final dose administered five days after conception, and subsequently gave birth to a healthy term infant without complications. The second patient conceived while receiving adjuvant nivolumab and experienced a miscarriage at 13 weeks of gestation. Neither patient experienced immune-related toxicity during pregnancy, and both remained without evidence of disease at follow-up. The literature review identified 21 reported pregnancies with ICI exposure and variable outcomes. Most resulted in live births (85.7%), though preterm delivery occurred in approximately 50% of cases, often due to maternal or fetal indications. Additional reported outcomes included miscarriage, neonatal death, fetal growth restriction, preeclampsia, and rare immune-related neonatal effects. Congenital anomalies were reported in a small number of cases. Conclusions and Relevance: These findings suggest that, while many pregnancies exposed to ICIs result in live births, there may be an increased risk of adverse maternal and fetal outcomes. However, causality cannot be established due to the limited quality and quantity of available data. These findings underscore the importance of effective contraception during ICI therapy and careful multidisciplinary counseling when exposure occurs during pregnancy. Full article

Individuals with cystic fibrosis (CF) face significant treatment burdens, and as life expectancy has increased, there is growing emphasis on their psychosocial well-being. Prevalence data indicate that approximately one-quarter to one-third of individuals with CF and their caregivers experience clinically significant anxiety or depression. Specifically, pooled global estimates report an anxiety prevalence of 24.9% (95% CI: 20.8–28.9%) and depression prevalence of 13–33% in adults with CF, with caregivers experiencing even higher rates (anxiety: 35–38%; depression: 20–35%). Depression is independently associated with a nearly twofold increase in mortality risk and substantially higher healthcare costs, underscoring its prognostic significance. These mental health comorbidities are consistently associated with reduced treatment adherence, diminished quality of life, increased healthcare utilisation, and decreased survival. Accordingly, psychological well-being has emerged as a key patient outcome that directly shapes engagement with care and the effectiveness of long-term CF management. International CF guidelines now recommend routine mental health screening within multidisciplinary care frameworks. Evidence-based interventions include cognitive–behavioural therapy (CBT), which is endorsed as a primary treatment, although access remains limited, and stepped-care pharmacotherapy, primarily selective serotonin reuptake inhibitors (SSRIs), for moderate to severe symptoms. Telemedicine and other digital health approaches have expanded access to psychological support, with remote CBT and online programmes demonstrating feasibility and symptom improvement during the COVID-19 pandemic and beyond. The advent of CFTR modulator therapies has significantly altered clinical outcomes, enabling many patients to achieve improved lung function and daily functioning. Nevertheless, mental health challenges persist, as individuals navigate new identity shifts and anxieties despite enhanced physical health. The implementation of mental healthcare remains inconsistent; while screening rates have increased, timely follow-up and integrated psychosocial support are frequently insufficient across care centres. This narrative review highlights the ongoing need to integrate mental health management into CF care to optimise adherence, patient outcomes, and long-term survival in the current therapeutic landscape. Full article

Background/Objectives: Military and Veteran families face unique challenges, including deployment-related difficulties and transitions, mental health issues, educational setbacks, and more. The needs of Veteran families, specifically, are often overlooked and research among this population is insufficient. In an effort to promote the well-being of children of Veterans and their families, we developed a screening tool for identifying family needs and a workflow to implement the screening tool within the Veterans Health Administration. The objective of this quality improvement initiative was to then provide those in need with appropriate referrals and connect them to timely care. Methods: The screening tool was developed with input from key stakeholders and adjusted after an initial pilot. Screens were offered to all Veterans seen at the participating sites. Veterans completed the self-report screen consisting of demographic information and items regarding household composition, the quality of relationships with family members, and the Veteran’s perceptions of difficulties experienced by family members. Descriptive statistics were conducted to summarize the data with regard to demographics, relationship difficulties, and related needs of Veteran family members. Results: Among familial relationships, Veterans reported experiencing the most difficulties with their partner/spouse as compared to other family members. Veterans self-reported that many of their children 18 years old and younger demonstrated difficulties related to learning, development, and behavioral and emotional concerns. Conclusions: More than a third of Veterans screened in this process requested further contact for consultation and referrals, and half of those were provided referrals. The development and implementation of this screening tool and referral procedure was successful in identifying needs and facilitating a connection to care that might otherwise have not occurred, bridging the gap between research and practice as it relates to Veteran family needs. Full article

Background/Objectives: Age-related musculoskeletal (MSK) disorders lead to pain, reduced function, and diminished quality of life. This study aimed to evaluate the impact of a virtually delivered MSK care program on pain and function in older adults. Methods: A single-arm pre–post study was conducted analyzing self-reported outcomes of 902 patients aged ≥ 65 years who completed an initial evaluation with both an MSK specialty physician/nurse practitioner and a physical therapist, followed by two or more clinical visits. Outcome measures included pain (NPRS), function (SANE and PROMIS-10 GPH), and mental health (GAD-2, PHQ-2, and PROMIS-10 GMH). Results: Across 891 patients, mean pain intensity decreased from 4.56 ± 0.07 to 2.30 ± 0.07 (49.6%, p < 0.001) with 693 patients (77.8%) experiencing pain relief (63.2%, p < 0.001). In 172 patients with severe baseline pain (NPRS ≥ 7), 91.3% reported decreased pain (60.9%, p < 0.001). Functional gains were clinically meaningful, with SANE scores increasing from 53.85 ± 0.90 to 76.62 ± 0.75 (n = 795, 42.3%, p < 0.001). Pain reduction correlated with functional improvement (ρ = −0.29, p < 0.001) with modest correlations between engagement and improved pain (ρ = −0.09) and function (ρ = 0.23). Mental health outcomes remained stable, with marked improvement among patients with baseline symptoms of anxiety or depression, 44.2% and 57.1%, respectively. Conclusions: The virtual MSK care program produced meaningful improvements in pain and function while maintaining overall health. This highlights the potential for virtual MSK-focused integrated practice units (IPUs) to support holistic well-being and healthy aging in older adults. Full article