Search Results (393)

Background/Objectives: The co-production of New Delhi metallo-β-lactamases (NDM) and OXA-48-like carbapenemases in Klebsiella pneumoniae represents a major therapeutic challenge due to extensive drug resistance and limited treatment options. This study aimed to investigate the molecular epidemiology, resistance profiles, and mechanisms associated with reduced susceptibility to cefiderocol in clinical isolates co-producing NDM and OXA-48-like carbapenemases. Methods: A total of 45 clinical K. pneumoniae isolates collected in healthcare settings in Northern Italy were analyzed. Antimicrobial susceptibility testing, including cefiderocol and aztreonam/avibactam, was performed according to EUCAST guidelines. Whole-genome sequencing was used to characterize sequence types, resistance determinants, virulence factors, plasmid replicons, and phylogenetic relationships. Mutations in iron uptake and transport genes were investigated in cefiderocol-resistant isolates. Results: Most isolates belonged to the high-risk clone ST147 (44/45) and were grouped into three main phylogenetic clusters. The isolates exhibited extensive multidrug resistance, with universal susceptibility only for aztreonam/avibactam. Cefiderocol resistance was observed in 42.2% of isolates and was unevenly distributed across the phylogeny. Mutations in iron uptake genes, particularly cirA and chrA, were identified in the majority of resistant isolates, although several strains retained wild-type sequences, indicating heterogeneous resistance mechanisms. Comparative phylogenetic analysis demonstrated close relatedness to international isolates, suggesting the global dissemination of related lineages. Conclusions: NDM- and OXA-48-like carbapenemase co-producing K. pneumoniae isolates are characterized by clonal dissemination, complex resistance profiles, and emerging cefiderocol resistance driven by multifactorial mechanisms. The preserved activity of aztreonam/avibactam highlights its potential as a key therapeutic option against these high-risk pathogens. Full article

Background: Southeast Asian Americans (SEAAs) experience a disproportionately high burden of hepatocellular carcinoma (HCC), with incidence in several subgroups (i.e., Cambodian, Laotian, and Vietnamese individuals) reaching up to nine times that of non-Hispanic Whites. HCC in SEAAs is largely driven by chronic hepatitis B (HBV), hepatitis C (HCV), metabolic dysfunction–associated steatotic liver disease (MASLD), and alcohol-associated liver disease (ALD). Despite established screening guidelines, under-detection and delayed diagnosis remain common. Objective: To summarize epidemiologic patterns, risk factors, screening challenges, and potential interventions aimed at reducing HCC disparities among SEAAs. Design and Methods: This narrative review synthesized evidence from population based epidemiologic studies, community-based interventions, health services research, and policy analyses. Attention was given to studies reporting disaggregated SEAA subgroup data. Findings derived from SEAA specific studies were distinguished from evidence drawn from broader Asian American or general cirrhosis populations, with inferential steps explicitly noted where subgroup specific data were limited. Key Findings: HCC incidence varies widely across SEAA subgroups, with elevated HBV- and HCV-related HCC in Vietnamese, Cambodian, and Laotian communities, and increasing MASLD-related HCC including among lean individuals who fall outside many surveillance frameworks. Screening and surveillance remain suboptimal, with fewer than 30% of patients with cirrhosis receiving recommended semiannual HCC surveillance and even lower uptake among SEAAs. Barriers include low HBV/HCV screening rates, limited disease awareness, language barriers, underinsurance, provider knowledge gaps, and lack of automated EHR-based reminders. Structural challenges such as poverty, transportation barriers, and limited access to specialty care further delay diagnosis. Proposed Interventions: Culturally tailored outreach programs, bilingual navigators, and community-based screening initiatives have demonstrated improved HBV/HCV testing and linkage to care. AI-enabled EHR tools may enhance identification of high-risk patients, streamline follow-up, and increase surveillance adherence. Expanded use of non-invasive fibrosis assessment and recognition of MASLD-related risk in non-obese individuals may support earlier detection. Policy priorities include mandatory Asian subgroup data disaggregation, expanded insurance coverage, and strengthened community-level healthcare infrastructure. Conclusions: SEAAs face a substantial and preventable HCC burden. A coordinated approach combining culturally tailored community engagement, improved provider support systems, and policy reforms is essential to improving early detection and reducing HCC disparities in this diverse population. Full article

Background: The COVID-19 pandemic caused disruptions in HPV vaccination and may have severely undermined global cervical cancer prevention, posing long-term risks to controlling cervical cancer and other HPV-related diseases. Objective: We conducted a scoping review to map and synthesize available evidence on how the COVID-19 pandemic has affected human papillomavirus (HPV) vaccination programs in low- and middle-income countries (LMICs) focusing on changes in vaccine delivery and coverage, determinants of uptake, economic and programmatic consequences and vaccine hesitancy. Methods: Inclusion criteria were limited to studies published in the English language between January 2020 to May 2025, and followed JBI and Arksey & O’Malley’s scoping review guidelines. The review proceeded through three stages: database searches, gray literature and citation tracking and used a PRISMA-ScR checklist to guide narrative and tabular synthesis. Results: A total of 1063 records, 57 studies were included in the final analysis, and these were spread out across 37 low- and middle-income countries (LMICs) mainly in Africa, Asia, and Latin America. Our analysis revealed that HPV vaccination coverage declined substantially during the COVID-19 pandemic, with reductions of up to 90% reported across the included studies, in the context of school closures, workforce redeployment, and supply-chain disruptions. Recovery efforts also faced major barriers including vaccine hesitancy, misinformation about COVID-19 vaccines, and travel restrictions. Strategies like digital tools, mobile clinics, and community health workers showed promise alongside integrated school- and facility-based approaches, although there is limited evidence on cost-effectiveness and long-term sustainability of these strategies. Conclusions: HPV vaccination in LMICs was significantly disrupted by the COVID-19 pandemic due to unreliable vaccine supply chains, health-worker shortages, and challenges tied to school-based vaccine delivery. Although recovery methods show potential, longer observation periods are needed to determine their full effectiveness. Full article

Treatment intensification with androgen receptor pathway inhibitors (ARPIs) and/or docetaxel in addition to androgen deprivation therapy (ADT) improves survival for men with metastatic hormone-sensitive prostate cancer (mHSPC), yet real-world uptake has historically been low. We conducted a population-based retrospective cohort study of Ontario men aged ≥66 years diagnosed with de novo mHSPC between 2014 and 2022 using linked administrative health data, defining treatment intensification as initiation of an ARPI and/or docetaxel with ADT within six months of diagnosis. Quarterly intensification rates were modeled using autoregressive integrated moving average (ARIMA) time-series methods with nonlinear trend specifications, and competing models were compared using information criteria, out-of-sample hold-out forecast accuracy, and long-horizon extrapolation behaviour to project uptake through 2030. Among 6099 men, 24% received treatment intensification, with quarterly intensification rates increasing from 3% in 2014 to 56% in 2022. A restricted cubic spline ARIMA model (ARIMA(1,0,1) + RCS3) was selected as the primary base-case forecast because it showed superior out-of-sample hold-out accuracy and more tempered long-horizon extrapolation. The cubic specification was retained as an upper-bound scenario, reflecting the possibility of continued aggressive momentum in treatment adoption. Both specifications captured a marked inflection after 2020 that temporally coincided with guideline updates and funding expansions. Near-term base-case projections (through 2026) suggest continued growth in intensification toward 80–85%, with the upper-bound scenario approaching saturation more quickly. Projections beyond 2026 are exploratory and presented for methodological completeness, given the eight-year horizon relative to a nine-year observation window and the widening prediction intervals at extended horizons. Despite substantial growth over time, treatment intensification remains incomplete in routine practice. These findings are temporally consistent with the impact of policy and funding changes on the adoption of evidence-based therapy and underscore the need for ongoing implementation efforts to address persistent clinical and system-level barriers to equitable access. Full article

Background/Objectives: Renal scintigraphy with 99mTc-MAG3 is a non-invasive tool for assessing early post-kidney-transplant function and detecting complications. While its utility in predicting delayed graft function (DGF) is established, evidence regarding its capacity to predict long-term graft survival remains limited. This study aimed to evaluate whether early post-transplant scintigraphy provides independent prognostic information for long-term graft survival. Methods: We conducted a retrospective cohort study of kidney transplantations performed at a single tertiary-care academic institution (2015–2019). Patients undergoing simultaneous multi-organ transplantation or experiencing complications precluding early scintigraphy were excluded. All included patients underwent 99mTc-MAG3 scintigraphy within 48 h post-transplantation. Renogram curves were categorized using the Heaf and Iversen classification (Grades 1–4). Univariate and multivariate Cox proportional hazards regression analyses were performed to assess death-censored graft survival. The study followed STROBE reporting guidelines. Results: Among the 317 included patients, renogram curves were distributed as follows: Grade 1 (n = 31, 9.8%), Grade 2 (n = 69, 21.8%), Grade 3 (n = 92, 29.0%), and Grade 4 (n = 125, 39.4%). The overall DGF incidence was 25.9%, with rates progressively increasing across the grades: 0% (Grade 1), 4.3% (Grade 2), 16.3% (Grade 3), and 51.2% (Grade 4) (p < 0.001). On multivariate analysis adjusting for recipient BMI, donation technique, Kidney Donor Risk Index (KDRI), and DGF, grafts with reduced uptake (Grade 4) demonstrated a significantly higher risk of graft loss compared to those with normal uptake (Grades 1–3 combined) (HR: 3.15; 95% CI: 1.34–7.40; p = 0.008). The mean follow-up was 45.6 months (IQR: 34.5–60). Conclusions: 99mTc-MAG3 scintigraphy performed within 48 h of kidney transplantation provides independent prognostic information for long-term graft survival. The Grade 4 renogram pattern identifies a high-risk subgroup with over threefold increased risk of subsequent graft loss. These findings support the integration of early scintigraphy into post-transplant risk stratification protocols, though prospective validation is warranted. Full article

Objective: Recent guidelines suggest sublobar resection as a viable option for peripheral lung cancer smaller than 2 cm. However, the presence of Spread through Air Spaces (STAS) is a well-known poor prognostic factor in early-stage lung cancer treated with sublobar resections. The aim of this study is to analyze the potential correlation between STAS and maximum standardized uptake volume (SUVmax) in this subset of patients to help define the optimal resection. Methods: A retrospective monocentric study was performed including patients diagnosed with stage IA lung cancer undergoing surgical resection. Patients were divided into two groups according to the presence/absence of STAS. As further investigation, we also separately analyzed the subgroup of patients with a peripheral nodule smaller than 2 cm. A p-value ≤ 0.05 was considered statistically significant. Results: The study cohort consists of 121 patients, 76 (62.8%) male, with a mean age of 74.2 ± 8.8 years. STAS was observed in 67 (55.4%) cases. The STAS-positive group showed a higher SUVmax value compared to the STAS-negative one (mean 5.5 ± 4.4 vs. 3.9 ± 3.0; p-value 0.007) with an AUC of 0.65 and an optimum SUVmax cut-off value of 3.0. Moreover, patients with SUVmax ≥ 3 showed a 77% increase in risk of having STAS (RR = 1.77; 95%CI = 1.21–2.59, p-value 0.014). This association was confirmed also in the subgroup of patients with nodules ≤ 2 cm (mean SUVmax 5.3 ± 4.6 vs. 3.6 ± 2.7; p value = 0.014). Conclusions: In our study, an SUVmax ≥ 3 in preoperative 18-FDG-PET is associated with the presence of STAS in stage IA lung cancer and peripheral cancer smaller than 2 cm. These findings, integrated with other clinical and radiological data, may guide surgeons to optimize the surgical strategy. Full article

Introduction: Patients with inflammatory arthritis are at increased risk of infection due to immune dysregulation and immunosuppressive therapy. National and international guidelines recommend vaccination against pneumococcal disease, influenza, COVID-19, and herpes zoster; however, uptake remains inconsistent. This study evaluated op-world uptake of multiple recommended vaccines within a large UK cohort. Methods: We conducted a cross-sectional study of adults with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis across three hospital sites serving ~800,000 people. Eligible patients had a healthcare encounter within 12 months prior to 1 January 2026. Vaccination status (pneumococcal, influenza, COVID-19, shingles) was obtained from linked primary care records. Demographic and clinical variables were collected. Uptake was reported as percentages with 95% confidence intervals. Associations with pneumococcal vaccination were assessed using Poisson regression with robust standard errors. Results: Among 2158 patients (median age 58 years; 72% female), rheumatoid arthritis was most common (61%). Most were receiving biologic or targeted synthetic DMARDs. Vaccine availability was not limited. Uptake was suboptimal: pneumococcal 30%, influenza 29%, COVID-19 53%, and shingles 12%. Pneumococcal uptake was higher in those aged ≥65 years. Increasing age (aRR 1.92, 95% CI 1.52–2.42) and at-risk comorbidities (aRR 1.42, 95% CI 1.20–1.69) were associated with higher uptake, while biologic or targeted therapy was associated with lower uptake (aRR 0.55, 95% CI 0.48–0.63). Discussion: Vaccination uptake remains suboptimal in this high-risk population. Lower uptake in patients on advanced therapies highlights a gap in care. Targeted education and better integration of vaccination pathways within rheumatology services are needed. Full article

Background: Oral cavity cancer remains a major public health challenge because many cases are diagnosed at advanced stages, when treatment is more complex and outcomes are poorer. Although oral cancer screening involves a simple, non-invasive examination, its implementation remains inconsistent across settings. This review examines barriers to oral cancer screening through a biosocial lens, with attention being paid to clinical, social, and policy factors shaping access. Materials and Methods: This study was conducted as a structured narrative review of peer-reviewed literature and policy documents. Targeted searches of PubMed and Google Scholar were taken from database from 2000 to May 2024 using MeSH terms and free-text terms related to oral cancer screening, disparities, social determinants, access, guidelines, and policy. Eligible sources included English-language studies and guidance documents addressing oral cancer screening practices, barriers, disparities, or recommendations. Findings were synthesized thematically and interpreted using a biosocial framework informed by social medicine theory. Results: The review finds that oral cancer screening is limited by variation in guideline recommendations, uneven integration across healthcare settings, and persistent disparities in access among high-risk populations. Patients with the greatest burden of risk often face the greatest barriers to early detection because of structural disadvantage, fragmented service delivery, and weak policy support. The literature also suggests that narrow evidentiary standards and cost-effectiveness debates may limit the legitimacy and uptake of screening initiatives. Conclusions: This review does not propose a wholly new model of screening; rather, it offers a biosocial interpretation of existing evidence to explain why screening inequities persist. More equitable oral cancer screening will require not only clinical attention to high-risk populations but also reforms in guideline development, service organization, and health policy to better address structural barriers to access. Full article

Global climate change is rapid and poses an alarming threat to agricultural production, significantly impacting economies. Modern agriculture has strongly emphasized improving nutrient availability in crops to address rising malnutrition and contribute to global food security. However, abiotic stresses, including warmer temperatures, drought, waterlogging stress, and elevated CO₂, have critical direct and indirect effects on nutrient availability in plants. This systematic review was conducted in accordance with the PRISMA guidelines. The literature survey followed a time period of 2–5 months, during which the conceptualization, analysis, writing, and editing of the article were conducted. In the present era, it is essential to adopt measures to improve the nutritional value [enhance Nutrient Use Efficiency (NUE)] and nutrient management of plant-based foods. Plant-associated microbiomes have co-evolved with their plant counterparts and perform essential functions in nutrient acquisition, including microbial sensing and cross-talk with the plant host, nutrient uptake and sharing, and signaling mechanisms. In natural and agricultural ecosystems, plant microbiomes offer major opportunities and can be harnessed to sustainably supply essential plant nutrients and improve NUE in crops of global importance. Crop-associated microbiomes can be precisely tailored to achieve targeted outcomes, enhancing nutrient acquisition and utilization via microbiome engineering. However, bridging knowledge gaps, understanding microbial colonization, plant–microbiome dynamics, and adopting precise editing approaches are crucial to boost sustainable outcomes and crop productivity. By elucidating plant microbiome crosstalk and microbe–microbe signaling, a better understanding of microbe-mediated nutrient acquisition in plants can be achieved, defining key implications in global food security. Full article

Soil contamination in Sub-Saharan Africa (SSA) is increasingly driven by rapid industrialization, intensive agriculture, mining activities, and urban expansion, posing significant risks to food safety, ecosystem services, and human livelihoods. Despite the growing scale of the problem, low-cost, locally adaptable remediation technologies are widely available and technically feasible within the region. Organic waste and waste-derived products—such as compost, manure, biochar, vermicompost, digestate, and agro-industrial residues—have emerged as sustainable and cost-effective amendments for the remediation of contaminated soils. These materials can immobilize heavy metals, enhance the microbial degradation of organic pollutants, and improve soil health, making them especially suitable for resource-constrained settings. This review synthesizes the current knowledge on the use of organic waste-based remediation approaches in SSA, highlighting technologies already applied at the laboratory, pilot, and field scales, as well as their effectiveness across different contaminant types. However, despite their demonstrated potential, their widespread adoption remains limited. The primary challenge is not the absence of affordable solutions, but rather the systemic constraints characteristic of many SSA countries, including limited technical capacity, weak policy and regulatory frameworks, low stakeholder awareness, and insufficient financial and institutional support for large-scale implementation. To enable broader uptake, there is a need to strengthen waste segregation and treatment systems, standardize composting and pyrolysis processes, and develop robust regulatory guidelines and certification schemes. Investments in monitoring infrastructure, practitioner training, and knowledge transfer mechanisms will also be critical to translating scientific advances into scalable, field-ready solutions for sustainable soil remediation in SSA. Full article

Hydroponic cultivation is expanding rapidly as a resource-efficient alternative to soil-based farming, but challenges related to nutrient management, abiotic or biotic stresses, and organic production still limit the system’s performance and efficiency. Biostimulants are increasingly being explored as a promising strategy to support productivity and sustainability in soilless systems. This review summarizes the current evidence on the use of plant biostimulants to support crop performance in hydroponic systems. Microbial biostimulants, such as plant growth promoting rhizobacteria, Arbuscular Mycorrhizal Fungi, and Trichoderma spp., have been reported to promote root growth by synthesizing phytohormones, enhance nutrient uptake, and reduce the impacts of salt and heat stress, with reported improvements in biomass and nutrient use efficiency. Seaweed extracts and protein hydrolysates modulate plant hormonal balance, improve antioxidant defense, and have been associated with improvements in yield and quality. Humic and fulvic acids increase micronutrient bioavailability through chelation and stimulate root activity through auxin-like effects. In organic hydroponics, biostimulants may help address the nutrient gap by accelerating organic matter mineralization. Existing key challenges include the lack of hydroponic-specific dosage guidelines and high commercialization costs. Future efforts should further evaluate system-specific strategies, including emerging tools such as artificial intelligence-optimized strategies and the use of clustered regularly interspaced short palindromic repeats-edited microbes to support the long-term sustainability of controlled environment agriculture. Full article

Background/Objectives: Platelet-rich plasma (PRP) is an autologous blood-derived biologic enriched in platelets and bioactive mediators. In urology and sexual medicine, PRP has been promoted for erectile dysfunction (ED) and a growing range of urogenital disorders on the premise that it may support angiogenesis, neuroregeneration, immune modulation, and tissue remodeling. However, clinical uptake has outpaced high-quality evidence, while heterogeneity in PRP preparation, characterization, and delivery limits interpretability and reproducibility. This structured narrative review aims to critically integrate mechanistic, preclinical, and clinical evidence regarding PRP use in ED, Peyronie’s disease (PD), stress urinary incontinence (SUI), interstitial cystitis/bladder pain syndrome (IC/BPS), and selected emerging indications. We further aim to identify sources of heterogeneity and propose an actionable minimum reporting framework (PRP-Uro Checklist) to guide future research. Methods: A structured search of PubMed/MEDLINE was conducted for studies published between 2021 and 2025. The relevant literature on PRP use in ED, PD, SUI, IC/BPS, and related indications was included for critical narrative synthesis. Emphasis was placed on PRP classification and preparation variables, outcome measure validity, and sources of heterogeneity across studies. Results: Mechanistic and preclinical evidence supports PRP’s potential to modulate nerve repair, angiogenesis, extracellular matrix remodeling, and immune polarization through a complex secretome of growth factors, cytokines, and extracellular vesicles (EVs). Clinical evidence suggests that intracavernosal PRP may improve erectile function in selected populations, but effect size, durability, and superiority over placebo remain uncertain due to small trials, substantial placebo effects, short follow-up, and incomplete biologic characterization. Evidence for PRP in PD, SUI, and IC/BPS remains preliminary and is derived largely from small cohorts, proof-of-concept studies, or uncontrolled designs, although early findings suggest potential symptom benefit and acceptable short-term tolerability. Across indications, inconsistent PRP reporting, particularly the absence of absolute platelet dose, leukocyte quantification, activation method, and standardized treatment protocols, represents a major barrier to reproducibility and evidence synthesis. Conclusions: PRP is biologically plausible and appears broadly safe, but its role in urology and sexual medicine remains investigational and is not yet supported by guideline-level evidence. To enhance reproducibility and interpretation, we propose a Minimum PRP Reporting Checklist for Urology and Sexual Medicine Trials (PRP-Uro Checklist). Future progress requires rigorous standardized reporting, indication-specific biologic characterization, rigorously designed sham-controlled trials, clinically meaningful endpoints, and longer-term follow-up. Full article

Objectives: This overview of systematic reviews aimed to synthesize and critically evaluate the current evidence on the effects of exercise performed under hypoxic or altitude conditions in adults, with particular attention to studies reporting altitude-related clinical outcomes. Materials and Methods: Following PRIOR and PRISMA guidelines, and with the protocol registered in PROSPERO CRD420261325746, a comprehensive search was conducted on 22 February 2026 across Medline/PubMed, Scopus, Web of Science, Epistemonikos, and Preprints.org, using the query “Exercise AND Hypoxic AND Altitude Sickness.” Because the search included “Altitude Sickness,” this review may miss some studies on performance or physiological adaptations under hypoxia. Eligibility was defined according to the PICOS framework, including only systematic reviews with or without meta-analyses in adults exposed to normobaric or hypobaric hypoxia. Methodological quality was assessed using AMSTAR 2. Results: A total of 137 records were identified (114 from databases and 23 through citation tracking), of which 28 systematic reviews met inclusion criteria. Nineteen included quantitative meta-analyses. Structured altitude training strategies—live high–train low (LHTL), live low–train high (LLTH), and live high–train high (LHTH)—were generally associated with improvements in maximal oxygen uptake and hematological parameters, particularly in trained and athletic populations. In contrast, acute hypoxic exposure was consistently associated with reduced exercise performance and increased susceptibility to altitude-related symptoms in unacclimatized individuals. Evidence regarding effects on body composition and metabolic outcomes was heterogeneous and inconsistent. According to AMSTAR 2, most meta-analyses presented critically low or low methodological quality. Conclusions: Exercise under hypoxic conditions may enhances aerobic and hematological adaptations in trained populations, whereas acute exposure tends to impair performance and entails clinical risks. However, given the restricted search strategy, substantial heterogeneity, lack of formal overlap quantification, and the predominance of low methodological quality reviews, these findings should be interpreted with caution. Evidence on metabolic benefits remains limited, highlighting the need for further high-quality systematic reviews and meta-analyses to clarify optimal hypoxic training protocols and outcomes. Full article

Introduction: Optimization of guideline-directed medical therapy in chronic heart failure remains challenging in real-world practice, particularly outside settings with routine cardiopulmonary exercise testing. In this context, cardiovascular rehabilitation can improve functional capacity, symptoms, and quality of life, while structured follow-up may also facilitate treatment adjustment. We therefore evaluated whether exposure to a structured multimodal functional assessment pathway, embedded within a more intensive follow-up model, was associated with pharmacological optimization and functional change in chronic heart failure. Methods: We conducted a retrospective, single-center cohort study including adults with chronic heart failure with reduced or mildly reduced ejection fraction managed in a tertiary university clinic. Patients were classified according to documented exposure to an integrated pathway that combined standardized 6 min walk testing, heart rate dynamics, oxygen saturation response, perceived exertion, validated quality-of-life assessment, and prespecified interim reassessment, versus usual care. The integrated pathway involved more frequent clinical contact than usual care. The primary outcome was change in 6 min walk distance over 6 months. Secondary outcomes included changes in heart rate recovery, oxygen saturation nadir, Borg perceived exertion score, quality-of-life score, intensity of guideline-directed medical therapy, treatment intensification rates, and heart failure hospitalization. Results: The study included 250 patients with comparable baseline demographic and clinical characteristics. Patients managed within the structured pathway showed greater improvement in 6 min walk distance at 6 months than those receiving usual care, together with more pronounced improvement in secondary functional parameters and quality-of-life scores. Pharmacological optimization, reflected by higher uptake and intensification of guideline-directed medical therapy, also occurred more frequently in the structured pathway group. The integrated group, however, also had higher follow-up intensity, which limits causal interpretation of the observed between-group differences. Conclusions: In this real-world heart failure cohort, exposure to a structured care pathway combining repeated multimodal functional profiling with closer follow-up was associated with greater functional improvement and more intensive pharmacological optimization. These findings should be interpreted as pathway-level associations rather than proof that functional assessment alone drove benefit, and they require prospective validation. Full article

Background/Objectives: Despite demonstrated mortality benefits, annual low-dose computed tomography (LDCT) screening faces challenges in real-world adoption due to low uptake and poor longitudinal adherence. This review evaluates patient- and provider-level factors that influence screening participation and highlights strategies to strengthen equitable engagement throughout the screening pathway. Methods: A structured literature search of PubMed and Web of Science was performed to identify studies published between 2013 and November 2025 (search conducted on 25 November 2025). Eligible publications included qualitative and quantitative studies, study protocols, and reviews examining LDCT screening uptake, adherence, and follow-up practices. Extracted evidence was synthesized, with particular attention being paid to patient- and provider-level determinants. Results: The evidence demonstrates that both patient- and provider-level factors substantially influence screening participation and continuity. At the patient level, limited awareness of screening, misconceptions regarding asymptomatic disease, and psychosocial factors such as fear, fatalism, stigma, and medical mistrust were consistently associated with reduced uptake and adherence. At the provider level, gaps in guideline familiarity, time constraints, and challenges in delivering high-quality shared decision-making limited referrals and follow-up. Conclusions: Improving real-world effectiveness of LDCT lung cancer screening requires reframing screening as a longitudinal program of care. Strategies that support patient navigation, enhance provider capacity for sustained engagement, and integrate tobacco dependence treatment into screening pathways are central to improving adherence and reducing disparities. Full article