Search Results (308)

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

Background/Objectives: Contrast-enhanced harmonic imaging endoscopic ultrasound (CHI-EUS) is a valuable tool for characterizing solid pancreatic tumors. However, interobserver variability remains a significant limitation in clinical interpretation. Artificial intelligence (AI) may offer objective, reproducible assessments, potentially enhancing diagnostic performance. This study compared the diagnostic accuracy and interobserver agreement of nine physicians with varying CHI-EUS experience levels vs. a dedicated AI system and a general-purpose large language model (ChatGPT) on the same 118 histologically confirmed cases. Methods: We conducted a prospective, multicenter, observer-blinded study involving 118 CHI-EUS video cases of histologically confirmed (EUS-FNB) focal pancreatic masses from three tertiary care centers in Romania. Nine readers were stratified into three groups: trainees (<5 years CHI-EUS experience), intermediates (5–10 years), and experts (>10 years). All readers and two AI models received standardized, anonymized 2 min CHI-EUS video clips. A dedicated AI system used a convolutional neural network (CNN) for lesion segmentation and time–intensity curve (TIC) extraction, followed by a feedforward neural network (FNN) for classification. ChatGPT was separately evaluated on the same videos. Diagnostic metrics (accuracy, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and AUROC) were calculated. Interobserver agreement was assessed using Fleiss’ and Cohen’s kappa statistics. Results: The dedicated AI system achieved an overall accuracy of 95.8% (sensitivity 96.6%; specificity 94.1%) in diagnosing pancreatic adenocarcinoma. Expert readers had a mean accuracy of 78.8% (sensitivity 86%, specificity 61%, and AUROC 0.74), intermediates 80.8% (sensitivity 83%, specificity 75%, and AUROC 0.84), and trainees had a mean accuracy of 67.2% (sensitivity 70%, specificity 60%, and AUROC 0.67). For the most-likely-diagnosis parameter, interobserver agreement was similar between intermediates (Fleiss’ κ = 0.407) and experts (κ = 0.389), while trainees showed lower agreement (κ = 0.203). ChatGPT correctly classified only 14.1% of PDAC cases. Conclusions: A specialized AI model for CHI-EUS video analysis can achieve expert-level performance and reduce diagnostic variability across experience levels. Integration of dedicated AI systems into CHI-EUS interpretation may enhance accuracy and serve as a valuable decision support tool in clinical and training settings. Full article

Allergic Rhinitis (AR) is an IgE-mediated inflammatory disorder that impairs quality of life and systemic function. Following the ‘one airway, one disease’ paradigm, AR-related inflammation often extends to the lower respiratory tract. This randomized controlled trial investigated the effects of an 8-week moderate-intensity aerobic exercise (MOA) program on clinical symptoms, nasal airflow, airway inflammation, pulmonary function, and cardiorespiratory parameters in young adults with physician-confirmed persistent AR. To isolate the exercise effects, all participants discontinued antihistamines, corticosteroids, and leukotriene antagonists before and during the study period. Eighteen participants were allocated to either the MOA group (n = 9), which performed treadmill walking or jogging at 50–60% heart rate reserve three times per week for eight weeks, or a control group (CON, n = 9) that maintained usual daily activities. Clinical symptoms, peak nasal inspiratory flow, fractional exhaled nitric oxide, pulmonary function, heart rate, blood pressure, aerobic fitness, and perceived exertion were assessed at baseline, week 4, and week 8 using standardized procedures. Compared with baseline and the CON group, the exercise intervention resulted in significant reductions in nasal congestion, itching, sneezing, and rhinorrhea, accompanied by increased nasal airflow and reduced airway inflammation. Pulmonary function indices and cardiorespiratory parameters also improved following training. These findings suggest that moderate-intensity aerobic exercise may offer a valuable non-pharmacological approach to support conventional care, potentially enhancing respiratory and physiological outcomes in young adults with persistent AR. Full article

Background: Echocardiography is a non-invasive test that is readily used to detect pulmonary hypertension associated with bronchopulmonary dysplasia (BPD-PH) and right ventricular failure (RVF). However, the most feasible, reproducible and accurate parameters to measure and use for guidance in addressing patient care have not been established and may differ between subspecialties. Methods: We surveyed members of the BPD Collaborative to determine how different care providers clinically evaluate infants for BPD-PH and RVF. Perceived challenges and obstacles that limit the utility of echocardiography are also reported. Results: Of the 108 survey respondents from ~45 centers, 55.6% were neonatologists, 18.5% were pediatric pulmonologists or pediatric intensive care physicians, 15.7% were pediatric cardiologists or pulmonary hypertension specialists, and 10.2% were other providers. Responses revealed discrepancies between specialists concerning the use of standard echocardiographic protocols and parameters that can be measured serially with relative ease, metrics that should be used to best define and distinguish the severity of BPD-PH or RVF, and parameter values that should be used to determine whether changes in PH-targeted medical therapies, hemodynamic or respiratory support are needed. Free text responses identified patient-, protocol-, cardiology-, technician-, and BPD-PH definition-related obstacles that may limit the reliable utility of echocardiography. Conclusions: Although most providers agree that echocardiography is feasible and of value, variability exists between subspecialists and centers, suggesting the need for improved standardization of imaging protocols and BPD-PH definition, consistent test interpretation, and effective communication of results to improve the reproducibility and accuracy of echocardiography in infants with BPD. Full article

Background: Goals of care discussions are essential communication skills in medical training that bridge patient values with clinical decision-making. Integrating palliative care principles into these conversations enables holistic, patient-centered care, yet medical trainees often lack structured preparation for these critical interactions. Objective: This narrative review examines how medical training can effectively integrate palliative care approaches into goals of care discussions through structured communication frameworks, interdisciplinary collaboration, and emerging innovations to promote patient-centered outcomes. Methods: This narrative review is conducted using a structured literature search that includes relevant studies pertaining to goals of care (GOC) discussions, evidence-based communication frameworks, and communication training curricula. Databases used were PubMed and Google Scholar, using articles published between 2000 and 2025. The following keywords were used in our search: “SPIKES”, “REMAP”, “SUPER”, “serious illness conversation”, “goals of care,” “end of life,” “holistic care,” “palliative care,” and “medical education.” Exclusion criteria were used to select those relevant to inpatient care and training in inpatient settings. Studies in an outpatient setting were excluded. Findings were reviewed and synthesized to identify types of training approaches. An emphasis on clinical outcomes including patient satisfaction, hospice utilization, ICU transfers, and intervention intensity were examined. Educational barriers and facilitators—including communication training curricula, cultural competency, language considerations, and multidisciplinary team involvement—were evaluated. Emerging technologies supporting clinician education and practice were also assessed. Results: Training in structured communication frameworks improves patient–physician relationships, reduces patient anxiety, and increases family satisfaction. Early palliative care integration through effective discussions leads to increased hospice awareness and utilization while reducing burdensome interventions. Key educational facilitators include dedicated communication skills training, multidisciplinary team participation (including chaplains and palliative care specialists), and AI-assisted documentation tools that support learning while preserving humanistic clinician–patient interactions. Conclusions: Integrating palliative care principles into medical training for goals of care discussions is essential for developing patient-centered clinicians. Combining structured communication frameworks, interprofessional education, targeted skills training, and technological support creates a comprehensive educational approach that prepares trainees to elicit patient goals, create individualized care plans, and deliver holistic care that honors patient values. Full article

Background/Objectives: Inpatient clinical deterioration is a major contributor to adverse hospital outcomes, such as unplanned intensive care unit (ICU) admissions and death. Rapid response systems aim to address this challenge by enabling early identification and intervention in at-risk patients. This study evaluated the impact of implementing a mobile intensive care team on clinical outcomes in surgical patients. Methods: A retrospective observational cohort study was conducted in a tertiary care hospital, comparing two consecutive periods: a pre-intervention phase (PRETIM) and a post-intervention phase (TIM). The study included 17,156 adult surgical patients. The TIM consisted of a proactive outreach team composed of one attending intensivist and two resident physicians, focusing on post-ICU monitoring and early identification of clinical deterioration on surgical wards. The primary outcome was in-hospital mortality. Secondary outcomes included ICU readmission and length of stay. Multivariable logistic regression adjusted for age, sex and surgical section was performed, along with subgroup and sensitivity analyses excluding early non-modifiable deaths. Results: Baseline characteristics were comparable between groups. In-hospital mortality decreased significantly following implementation of the TIM (8.0% vs. 5.3%; p < 0.001), corresponding to an absolute risk reduction of 2.7% and a number needed to treat of 37. ICU readmission rates did not differ significantly between groups. Sensitivity analysis excluding early deaths confirmed the mortality reduction. Subgroup analysis demonstrated consistent effects across surgical specialties, with the largest reductions observed in neurosurgery and general surgery. Conclusions: The implementation of a mobile intensive care team was associated with a significant and clinically meaningful reduction in in-hospital mortality among surgical patients. The findings support the role of proactive post-ICU monitoring and early intervention strategies in improving patient outcomes in high-risk hospital populations. Full article

Background: Tirzepatide is a novel therapeutic option for the management of metabolic disorders which has started to be implemented in routine practice. The study aimed to analyze the effectiveness of tirzepatide use and patient education in the field of healthy eating and weight loss, based on real-life data from the practice of a primary care physician, in metabolic syndrome (MetSyn) patients during a one-year follow-up period. Methods: This is a retrospective study based on real-life data of 118 MetSyn patients who were under the supervision of a general practitioner (GP). Analysis was conducted on 62 patients supported by trizepatide (2.5 mg for 4 weeks, then 5 mg for 4 weeks and 7 mg for 46 weeks) with dietary education and 56 patients that underwent dietary education with motivation only. Lipid profile, glucose level and blood pressure were assessed. Body Mass Index (BMI), waist-to-height ratio (WHtR), A Body Shape Index (ABSI), Lipid Accumulation Product (LAP), Visceral Adiposity Index (VAI) and Body Roundness Index (BRI) were calculated. The KomPAN^® questionnaire was used for dietary assessment and WHO Quality of Life-BREF for the quality of life assessment at 52 weeks. Results: Patients from both groups significantly reduced their body weight and WC and the values of the following indices: BMI, WHtR, ABSI, LAP and BRI. A significant increase in LDL cholesterol and triglyceride values was observed in both groups and a significant decrease in glucose level only in the group with tirzepatide combined with dietary modification. Energy value, energy density of food and nutrient intake did not differ between groups, while the intensity of beneficial nutritional features (pHDI-10) was low. Significant differences in patients’ QoL were observed, especially in the domain related to mental health (higher in trizepatide + diet group). Conclusions: Support in primary care by a physician was successful from a long-term perspective in the group using tirzepatide in combination with diet modification as well as in the group based on dietary modification only. The data do not indicate a significant advantage of any one approach for patients, prioritizing an individualized approach to treatment. Full article

Background: Probiotics have emerged as an effective therapeutic intervention in critically ill patients receiving enteral nutrition, yet their use remains inconsistent across intensive care units (ICUs). Understanding knowledge, attitudes, and practices (KAP) among healthcare professionals (HCPs) is essential for optimizing evidence-based probiotic administration in enteral nutrition, identifying perceived implementation barriers, and examining associations between KAP scores and study variables. Methods: A multicenter, cross-sectional online survey was administered to ICU physicians, nurses, clinical dietitians, pharmacists, and respiratory therapists. Participants completed a self-reported questionnaire assessing their knowledge of probiotic mechanisms, indications, and safety; attitudes toward probiotic therapy; and current practices in probiotic administration during enteral feeding. Results: A total of 935 ICU HCPs participated. Overall knowledge was insufficient, with only 33.2% achieving high knowledge scores (mean: 12.4/18 points), whereas attitudes were moderately favorable, with 35.5% demonstrating positive attitudes (mean: 23.9/30 points). A majority of respondents (58.7%) reported recommending or prescribing probiotics, most frequently clinical dietitians (84.5%). KAP varied significantly by profession, age group, and years of experience (p < 0.01). The most reported barriers were a lack of information about available probiotic products (73.2%), limited knowledge (41.2%), limited availability of clinically proven products (37.8%), and cost concerns (29.7%). Conclusions: Although ICU HCPs show interest and cautious acceptance of probiotics in enteral feeding, knowledge gaps, attitudinal variability, and practice inconsistencies persist across disciplines. These findings highlight the critical need for targeted, multidisciplinary educational interventions and the development of standardized, evidence-based institutional protocols to optimize probiotic use and improve patient outcomes. Full article

Introduction/Objectives: Although contemporary guidelines strongly support intensive low-density lipoprotein cholesterol (LDL-C) lowering and the use of advanced lipid biomarkers for cardiovascular risk stratification, implementation in daily clinical practice remains inconsistent. This study aimed to assess current practices, knowledge, and perceived barriers in dyslipidemia management across medical specialties. Methods: We conducted a cross-sectional, anonymous online survey from August to September 2025 among physicians actively involved in lipid management. The questionnaire evaluated the use of Systematic Coronary Risk Evaluation 2 (SCORE2)-based risk assessment, familiarity with LDL-C targets, treatment intensification strategies, awareness and use of apolipoprotein B (apoB) and lipoprotein(a) [Lp(a)], perceived barriers to LDL-C goal attainment, and responses to a standardized clinical vignette. Descriptive analyses and chi-square testing were conducted. Results: Ninety-five physicians completed the survey, the majority practicing in Europe (92.7%), including 83.2% from Portugal (41.1% general practice/family medicine; 14.7% cardiology; 14.7% internal medicine/geriatrics; 14.7% vascular surgery; 9.5% endocrinology). SCORE2 calculators were used “often” or “always” by 52.6%, with significant inter-specialty variation (p < 0.001). Familiarity with LDL-C targets was high (76.8%), and 89.4% reported frequent therapy intensification when goals were not achieved; however, consistent escalation (“always”) differed markedly across specialties (p < 0.001). Although 69.5% were aware of recommendations for lifetime assessment of apoB/non–HDL-C/Lp(a), only 17.9% implemented them routinely. Most clinicians reported never or rarely using advanced biomarkers for residual risk assessment, and in a clinical vignette only 12.6% would consistently intensify therapy despite elevated Lp(a) and apoB (p = 0.004). Patient non-adherence (86.3%) was the most frequently perceived barrier. Conclusions: Despite the widespread awareness of LDL-C targets, important gaps persist in the consistent application of guideline-directed therapy and in the use of advanced biomarkers. The underutilization of apoB and Lp(a), together with therapeutic inertia and structural barriers, limits effective residual risk management. Bridging this gap will require coordinated efforts focused on implementation, access, and multidisciplinary care. Full article

Background/Objectives: Acute cor pulmonale is a critical clinical condition often encountered in acute care settings. Optimal management demands coordinated, interdisciplinary care. The aim of this study was to assess the current knowledge and management strategies for acute cor pulmonale among different groups of physicians involved in acute care in Switzerland. Methods: A structured questionnaire, extrapolated from the Acute Cardiovascular Care Association of the European Society of Cardiology clinical consensus statement on the diagnosis and treatment of cor pulmonale, was distributed among physicians of four specialties. Results: A total of 110 physicians participated in this multicenter survey, including 15 “experts,” 71 “generalists” (internal and emergency medicine), and 24 “specialists” (cardiology and intensive care). Experts validated 29 out of 40 questionnaire items (Fleiss Kappa 0.63), which were then used for analysis. Overall, there was substantial agreement with the experts’ answers among non-experts, with most correct response rates exceeding 60%. Significant differences were observed for only two items: experts more frequently recognized the prognostic value of clinical models (87% vs. 59%, p = 0.046) and the correct indications for systemic thrombolysis (100% vs. 76%, p = 0.037). Between generalists and specialists, differences in knowledge were minimal. Specialists more accurately identified the role of repeated arterial blood gas analysis, while generalists showed better awareness of clinical prognostic models. Conclusions: The study highlights a sound knowledge of acute cor pulmonale among acute care physicians, regardless of specialty. Despite comparable levels of knowledge, some variations reflect their clinical roles and information sources. The results emphasize the value of existing educational efforts and support the need for comprehensive, accessible guidelines to standardize care in complex conditions like acute cor pulmonale. Full article

Background: Sepsis remains a leading cause of mortality in intensive care units (ICUs) worldwide. Machine learning models for clinical prediction must be accurate, fair, transparent, and reliable to ensure that physicians feel confident in their decision-making processes. Methods: We used the MIMIC-IV (version 3.1) database to evaluate several machine learning architectures, including Logistic Regression, XGBoost, LightGBM, LSTM (Long Short-Term Memory) networks and Transformer models. We predicted three main clinical targets—hospital mortality, length of stay, and septic shock onset—using artificial intelligence algorithms, with respect for responsible AI principles. Model interpretability was assessed using Shapley Additive Explanations (SHAP). Results: The XGBoost model demonstrated superior performance in prediction tasks, particularly for hospital mortality (AUROC 0.874), outperforming traditional LSTM networks, Transformers, and linear baselines. The importance analysis of the variables confirmed the clinical relevance of the model. Conclusions: While XGBoost and ensemble algorithms demonstrate superior predictive power for sepsis prognosis, their clinical adoption necessitates robust explainability mechanisms to gain trust among doctors. Full article

Background: Despite the widespread implementation of treat-to-target strategies and modern disease-modifying antirheumatic drugs, a substantial proportion of patients with rheumatoid arthritis (RA) continue to report unmet needs (UNs), defined as a mismatch between patient expectations and symptom burden on the one hand and outcomes achieved with current care on the other. Patient–physician discordance in global assessments may reflect multidimensional influences, including pain mechanisms, psychosocial factors, functional impairment, and communication gaps, extending beyond inflammatory disease activity. Methods: In this cross-sectional study, 133 patients with RA and 57 healthy controls were included. UNs were operationalized as the signed difference between patient global assessment and physician global assessment (ΔPGA–PhGA). Clinical variables, patient-reported outcomes, and Short Form-36 (SF-36) domains were incorporated into two regularized partial correlation network models estimated using the extended Bayesian information criterion graphical least absolute shrinkage and selection operator (EBICglasso). Node centrality indices (strength, signed strength, betweenness, and closeness) were calculated. Network stability was evaluated using 2000 bootstrap resamples and correlation stability (CS) coefficients. Results: In the clinical network, pain intensity demonstrated the highest strength centrality and the strongest direct association with UNs. In contrast, Disease Activity Score in 28 joints with C-reactive protein (DAS28-CRP) showed no direct association with UNs after accounting for shared variance. In the SF-36-based quality-of-life network, UNs exhibited inverse associations, particularly with perceived health change and role–emotional functioning. Stability analyses indicated acceptable to good robustness (clinical network: CS = 0.59 for edge weights and 0.44 for strength; SF-36 network: CS = 0.59), supporting the reliability of the estimated network structures. Conclusions: UNs in RA are not solely determined by inflammatory disease activity but are embedded within interconnected clinical and psychosocial domains. Pain occupies a structurally central position in the clinical network, whereas perceived health change and emotional role limitations characterize the quality-of-life context of UNs. These findings underscore the importance of multidimensional and patient-centered assessment strategies in RA management. Full article

Background/Objectives: A persistent mismatch between organ supply and transplant demand affects healthcare systems worldwide, particularly in underdeveloped and transitional systems. Intensive care units (ICUs) represent the primary setting for donor identification following brain death, placing intensive care physicians at the center of organ donation pathways. This nationwide cross-sectional survey aimed to evaluate Romanian intensivists’ knowledge, attitudes, and reported clinical practices regarding brain death determination, communication with families, and system-level barriers to organ donation, to identify modifiable factors relevant to transplant policy development. Methods: A prospective, nationwide, questionnaire-based survey was conducted among intensive care physicians in Romania. The structured questionnaire explored their knowledge and attitudes regarding brain death, communication with families, involvement in donation processes, ethical perceptions, and views on the organization of the transplant system. The survey was distributed through the Romanian Society of Anesthesia and Intensive Care, and descriptive exploratory analyses were performed. Results: A total of 117 ICU physicians participated (mean age 41.0 ± 9.9 years). Although 84.6% agreed with the current brain death diagnostic criteria, and 83% considered the protocol sufficiently clear. The mean number of brain-dead patients managed annually was 8.25 ± 12.90. 69.3% of respondents perceived communication competencies as insufficient. 77.8% considered family consent decisive in donation decisions, while 87% supported the establishment of a national donor registry and 77% favored a donor card system. Organ procurement was reported as a priority in only 38.5% of ICUs. Institutional prioritization of organ procurement and structured training was inconsistent. Conclusions: This nationwide survey identifies key educational, organizational, and systemic barriers limiting organ donation performance in Romania. Targeted training, improved communication strategies, integration of donation pathways into routine intensive care practice, and the adoption of national consent instruments represent essential clinical and policy priorities for low-performing transplant systems. Full article

Background/Objectives: This study aimed to analyze the perceptions and experiences of health professionals regarding teamwork as an interprofessional competency within the context of Intensive Care Units (ICUs) in a Brazilian public teaching hospital. Methods: This was a qualitative, exploratory study guided by a constructivist–interpretative perspective. The scenario consisted of Intensive Care Units of a public teaching hospital, which is a reference for emergency care, located in Brazil. Sampling was intentional and involved 29 professionals, most of whom, 25 (86.20%), were females, including nurses, nursing technicians, physicians, physiotherapists, and others. In order to collect data, individual semi-structured face-to-face interviews were conducted in 2025, which were audio-recorded and fully transcribed. The criterion for determining the number of participants was theoretical saturation. Data analysis followed the steps of Braun and Clarke’s thematic analysis, conducted inductively, with peer validation and the use of illustrative quotations to ensure credibility. Results: Five main categories emerged: “Understanding teamwork as an interprofessional competency,” “Factors that facilitate interprofessional teamwork,” “Factors that hinder teamwork,” “Tools used in the ICU to develop interprofessional teamwork” and “Individual actions to develop interprofessional teamwork.” The analysis revealed a central tension: although professionals discursively value interprofessional teamwork, its practical implementation is constrained by organizational and hierarchical barriers. Communication was identified as a transversal axis, functioning at times as a facilitator and at other times as a barrier. Conclusions: This study demonstrates that interprofessionality in Brazilian ICUs cannot be sustained solely through individual initiatives, but requires structured institutional strategies, such as formal collaboration protocols, interprofessional education programs, and a revision of hospital organizational culture. Furthermore, although health professionals value interprofessional teamwork, their practice still faces significant barriers. These findings may support managers’ reflection on the need to implement in-service teaching and learning strategies that facilitate interprofessional teamwork, especially those in high-technology units, thus enhancing collaborative practice in health. Full article

Background/Objectives: Franz Tappeiner (1816–1902) is often celebrated as a pioneer of alpine medicine and the founder of Tappeiner Promenade in Meran (South Tyrol, Italy). However, his legacy extends far beyond the scenic infrastructure, encompassing a comprehensive vision of physical activity as a public health intervention. His multidisciplinary practice anticipated the principles of contemporary rehabilitation, preventive medicine, and climate-sensitive public health. Methods: This historical public health analysis, combining biographical, contextual, and material–spatial approaches, reinterprets Tappeiner’s writings, institutional engagements, and civic projects through the lens of modern public health frameworks. Drawing on primary materials (e.g., published articles, autobiographical fragments, and commemorative texts) and recent evidence from rehabilitation and environmental health research, these contributions were contextualized. Results: Tappeiner’s early focus on infectious disease prevention (e.g., cholera and tuberculosis) transitioned into a strategic emphasis on recovery and behavioral therapy through environmental design. The walking therapy model of Max Joseph Oertel, locally realized in the Tappeiner Promenade, prefigured modern concepts such as structured green rehabilitation, walkability, and urban-health citizenship. His systematic integration of graded walking into civic infrastructure represents one of the earliest documented examples of embedding physical activity promotion at the population level. He contributed substantial personal funds to the path’s construction, embedding therapeutic gradients, curating vegetation, and promoting inclusive design to support convalescence. Contemporary research supports the intuition that green, low- to moderate-intensity walking improves cardiometabolic health, psychological well-being, and functional capacity. Moreover, his integrative ethos, merging clinical medicine, civic ethics, and spatial intervention, parallels contemporary eco-social models of public health. Conclusions: Franz Tappeiner’s career exemplifies a still-relevant model of physician leadership that is empirically grounded, socially accountable, and ecologically attuned, with physical activity promotion embedded as a central element of his public health vision. His work invites reflection on how medical professionals can shape not only individual care but also urban environments and collective health futures. Full article