Search Results (533)

As population aging accelerates, the demand for high-quality end-of-life (EOL) care continues to rise. However, a substantial proportion of patients with terminal cancer still experience death in acute-care hospitals without adequate palliative care. Consultative palliative care (CPC) represents a feasible model for delivering palliative care without requiring dedicated inpatient units, yet evidence evaluating its clinical impact remains limited. In this study, we developed a structured hospital-based CPC model tailored to the Korean healthcare system, the Korea Holistic Optimized Palliative care for End-of-life (K-HOPE) model, and prospectively evaluated its clinical impact. K-HOPE was delivered by an interdisciplinary CPC team in a tertiary hospital. Unmet needs were assessed using the Integrated Palliative care Outcome Scale (IPOS), and longitudinal changes were analyzed using mixed-effects models for repeated measures. Among patients who died during hospitalization, quality of death was evaluated using the Good Death Scale (GDS). A total of 84 patients with terminal cancer received K-HOPE. The total IPOS score significantly decreased over time (β = −10.4, 95% CI −12.8 to −8.0; p < 0.001), indicating reduced overall burden and unmet needs. Significant improvements were observed in psychological distress (p = 0.010) and communication and information needs (p < 0.001), whereas changes in physical symptoms and practical concerns were not statistically significant. Among 22 patients who died during hospitalization, 59.1% achieved a good quality of death (GDS ≥ 12). Longer duration of CPC involvement was significantly associated with higher quality of death and remained an independent predictor in multivariable analysis. These findings suggest that the K-HOPE CPC model improves communication and overall EOL care experiences among hospitalized patients with terminal cancer, indicating that meaningful improvements in EOL care can occur even during short periods of CPC involvement. Structured CPC integrated into routine oncology practice represents a feasible strategy for improving EOL care in tertiary hospitals, and a standardized CPC framework may enhance the consistency and reproducibility of care delivery within the Korean healthcare system. Full article

Antibody–drug conjugates (ADCs) are reshaping the therapeutic approach to advanced gastrointestinal cancers by integrating tumor-specific monoclonal antibodies with potent cytotoxic payloads to improve targeted tumor cell destruction while minimizing systemic exposure. Compared to traditional chemotherapy, trastuzumab deruxtecan has significantly improved objective response rates and overall survival in HER2-positive gastric and gastroesophageal junction tumors after trastuzumab-based therapy. This supports its role as an important second-line or later treatment option. The ongoing advancement of ADCs targeting CLDN18.2, TROP2, and CEACAM5 indicates that this therapeutic category will continue to expand across gastrointestinal neoplasms. Nonetheless, these advancements are accompanied by a specific and clinically significant toxicity profile. Hematologic suppression, gastrointestinal side effects, hepatotoxicity, and notably interstitial lung disease (ILD) are essential consequences that may need inpatient assessment and care. Interstitial lung disease (ILD), although uncommon, may be severe or lethal if not identified immediately and treated swiftly with medication cessation and corticosteroids. In hospitalized patients, distinguishing ADC-related toxicity from infection or disease progression is often difficult owing to overlapping clinical manifestations, requiring meticulous evaluation and interdisciplinary cooperation. As ADCs are integrated into earlier treatment lines and across a broader patient population, hospital systems must evolve to ensure prompt identification, consistent management protocols, and efficient collaboration between oncology and inpatient teams. This study analyzes the mechanisms, clinical effectiveness, and safety profile of ADCs in gastrointestinal oncology, pointing out the importance of institutional preparedness to safely incorporate these medicines into standard clinical practice. These features also align ADC therapy with personalized medicine by emphasizing biomarker-guided patient selection and individualized toxicity monitoring. Full article

Radiopharmacy is a specialized area of hospital pharmacy dedicated to the preparation and appropriate use of radiopharmaceuticals for diagnostic imaging and targeted therapies. While clinical pharmacy activities are well established in many hospital settings, their integration into radiopharmacy remains poorly documented and lacks standardization, particularly in the context of the rapid development of theranostic applications. This descriptive, cross-sectional study aimed to assess current clinical pharmacy practices in radiopharmacy across the HUGOPharm network. Between July and September 2025, an anonymous online questionnaire was distributed to radiopharmacy teams, collecting information on prescription analysis, biological monitoring, interdisciplinary collaboration, and other clinical pharmacy activities. Descriptive statistics were used to analyze responses. All participating centers reported verifying patient identity and key prescription parameters; however, substantial variability in practices was observed. Pharmacotherapeutic analysis was more frequently performed for therapeutic procedures (71%) than for diagnostic procedures (57%). Pre-procedure biological testing was common in therapeutic contexts (86%) but infrequent for diagnostic applications (29%). No center reported conducting structured medication reviews or pharmaceutical consultations. The implementation of radioligand therapies, such as [¹⁷⁷Lu]-PSMA, was associated with enhanced safety checks and increased interdisciplinary collaboration. Overall, clinical pharmacy in radiopharmacy is developing but remains inconsistently implemented. Structured clinical pharmacy activities appear particularly relevant for theranostic procedures and may represent priorities for future practice development to support patient safety and integrated care. Full article

After vessel preparation, using different strategies such as balloon angioplasty, specialty balloons, atherectomy or intravascular lithotripsy, definitive treatment has emerged as a key feature in endovascular treatment strategies. Based on current guidelines, endovascular treatment is the most common treatment option in patients with claudication. In patients with chronic limb-threatening ischemia (CLTI), on the other hand, the best treatment modality, including bypass surgery and endovascular revascularization, needs to be selected by an interdisciplinary team, focusing on individual anatomic and patient-specific characteristics, on the availability of a vein graft and on cardiovascular and other comorbidities of the patients. With endovascular therapy, currently, a plethora of options are available for the treatment of femoropopliteal lesions, which are increasingly gaining in complexity. Therefore, a practical systematic case-based approach, entailing contemporary treatment options, like drug-coated balloon (DCB) angioplasty tools, self-expanding bare-metal stents (BMSs), drug-eluting stents (DESs), interwoven stents and covered stents, is crucial. Generally, most endovascular operators adhere to the ‘leave nothing behind’ concept, meaning that, after proper lesion preparation, lesions can be treated with DCBs, avoiding the implantation of permanent metallic implants. However, in the case of severe dissections or significant recoil, stent implantation becomes necessary to achieve adequate limb perfusion. The selection between long versus spot stenting and the different stent options depends on the current scientific evidence, guidelines and expert opinion statements. An interdisciplinary expert consensus was recently compiled on how these modalities should be used in specific lesions and patients in the femoropopliteal segment. Herein we present a practical case-based approach, which is based on this algorithm and aims at harmonization of endovascular treatment strategies in daily practice and ultimately at further improvements in limb and patient outcomes. Full article

Anishnawbe Health Toronto (AHT) is Canada’s largest multidisciplinary Indigenous health centre. In 2023, the Executive Director of AHT spearheaded a community-centered research study looking at mental and spiritual health for its community of service users. This project sought to support cultural resurgence efforts in AHT health programming through the synthesis of Indigenous-informed models and understandings of mental health, rooted in the knowledge and experience of care providers at AHT. This project also sought to enhance Indigenous community research capacity by involving Indigenous community stakeholders in each stage of the qualitative research process. This paper details these methods, which follow Indigenous community ethics in research, and include both Indigenous approaches to research as well as qualitative methods. This paper then presents a summary of the study’s findings, describing the interdisciplinary mental health services of a team of Indigenous and non-Indigenous practitioners at AHT. Three major themes describe the unique features of these services: The Healing Relationship, Indigenous Spaces and Identities as a “Sacred Home”, and Healing Through Spirit. The connection between spirituality and Indigenous wellness is discussed by centering Indigenous values and ways of knowing as central to Indigenous healing, survivance, and cultural resurgence. Full article

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major contributor to ischemic stroke, heart failure, hospitalization, and mortality. AF-related strokes account for approximately 20–30% of all ischemic strokes and are typically associated with more severe neurological deficits and poorer long-term outcomes. As the prevalence of AF continues to rise with population aging, optimizing both stroke prevention and post-stroke management has become increasingly important. This narrative review summarizes current evidence on AF in the context of ischemic stroke, with particular emphasis on anticoagulation, acute stroke management, and early neurorehabilitation. Special attention is given to the unique challenges of AF-associated stroke, including hemodynamic instability, recurrent embolic risk, bleeding risk during anticoagulation, and the need for individualized rehabilitation strategies. We also discuss interdisciplinary care models, including the Hemodynamic Gating Matrix and the Heart–Brain Team approach, as potential frameworks for integrating cardiovascular and neurological management during recovery. AF-related stroke requires coordinated care across cardiology, neurology, and rehabilitation medicine. A physiology-guided and interdisciplinary approach may improve functional recovery while maintaining cardiovascular safety in this high-risk population. Full article

Background/Objectives: Deep endometriosis is a chronic inflammatory disease that significantly affects fertility. The objective was to evaluate the magnitude of the effect of minimally invasive nerve-sparing complete excision of endometriosis on natural conception rate in women with documented infertility. Methods: This pre-planned interdisciplinary retrospective observational study included 45 patients who wished to conceive naturally (spontaneous pregnancy) and were followed for 12 months after surgery. Results: The spontaneous conception rate was 33.3% (95% CI: 20.0–46.7) and the mean time to conception was 6.7 months. Age, body mass index, and history of infertility showed no significant differences between the success and failure spontaneous pregnancy groups, but annual income was positively associated with reproductive success (p = 0.022). None of the procedures needed to be converted to open surgery, required colostomy/ileostomy, blood transfusion or abdominal drains. No cases of urinary retention were observed across different levels of nerve preservation. In addition, the absence of serious surgical complications (Clavien–Dindo III/IV) supports the safety of this intervention for infertile patients. Conclusions: The absence of serious surgical complications in this cohort supports the concept that minimally invasive nerve-sparing complete excision of endometriosis is a safe intervention when performed by an experienced team. The results underscore the importance of exploring socioeconomic-related factors through an individualized assessment of patients who wish to conceive naturally after minimally invasive nerve-sparing surgery. Future studies focusing on personalized management of endometriosis should attempt to identify socioeconomic-related covariates that influence natural conception. Full article

As communities face intensifying climate hazards, it is vital to strengthen resilience in ways that explicitly prioritize social equity. This study examines how higher education institutions can better support government, nonprofit, and community partners in advancing equity-centered coastal resilience in the U.S. Utilizing a qualitative research design, we analyze discussions among researchers and practitioners during a three-day workshop. We present a framework derived from a thematic analysis of breakout group transcripts from a three-day national virtual workshop involving 113 researchers and practitioners. The analysis identified four core themes: the necessity of aligning projects with community-defined priorities; the foundational role of long-term trust and relationship-building; the requirement for flexible funding to support sustained engagement; and the value of interdisciplinary, multifunctional teams. Findings indicate that while engaged and applied research can significantly advance equitable outcomes, academic researchers face systemic barriers, including rigid tenure timelines and insufficient institutional infrastructure. Consequently, we offer a three-pronged framework centered on early and continuous engagement, robust collaboration with extension services, and supportive university infrastructure. This framework provides practical guidance for institutions to transition from traditional ‘town and gown’ models toward meaningful, community-embedded, and equity-driven coastal resilience partnerships. Full article

Background/Objectives: American football (AF) is a contact sport with a high injury risk, where an integrated model of interdisciplinary care may support recovery. The aim of this study was to assess the relationship between diet quality, supplementation, dietician’s and physiotherapist’s support, injury rates and musculoskeletal pain among AF players in Poland. Methods: The study involved 53 male players from the FA Panthers Wrocław team and was conducted using the KomPAN questionnaire and an original survey on supplementation, injuries and pain intensity. Results: The results showed that, although players using supplements had a significantly greater proportion of healthy foods in their overall diet (p = 0.02), they did not report fewer injuries in the last 12 months and 7 days than those who did not use supplements (p = 0.87; p = 0.58, respectively). However, a positive correlation (p$\le$ 0.001, r = 0.53) was found between the healthy diet index and the number of injuries. Those who used the services of a dietitian and physiotherapist showed a higher quality of diet (p$=$ $0.02$; p$=$ $0.02$, respectively) and reported higher total pain intensity (p$=$ $0.009$; p$=$ $0.03$), while those who used only the services of a physiotherapist reported higher average pain intensity (p$\le$ 0.001). Conclusions: These results suggest that supplementation and professional support in this group are primarily due to exposure after injuries caused by severe pain, rather than serving a preventive function. Full article

Psychosocial and cognitive interventions are increasingly implemented in pediatric hospital settings. However, evidence regarding their structure, delivery, and outcomes remains dispersed. This scoping review aimed to synthesize current evidence on these interventions, focusing on their design, professional delivery, reported outcomes, and existing research gaps. It was conducted using established scoping review methodology and is reported in accordance with PRISMA-ScR guidelines. Systematic searches were conducted in PubMed, Scopus, Web of Science, PsycINFO, and ProQuest Dissertations to identify peer-reviewed and grey literature published between 2009 and 2024. Following study selection based on predefined inclusion criteria, data were charted using a standardized data extraction form and analyzed to synthesize and map key characteristics of interventions and outcomes in relation to the review questions. Sixty-one studies met the inclusion criteria. Interventions primarily targeted school-aged children and adolescents and were delivered by psychologists, educators, and nurses, frequently within interdisciplinary teams. A wide range of materials and resources were used, including digital technologies, playful and artistic materials, audiovisual and informational supports, and sensory or therapeutic objects. Techniques primarily involved guided conversation, cognitive and body-based exercises, and play-based approaches. Outcomes mainly focused on emotional well-being and recovery, while fewer interventions explicitly addressed cognitive processes such as attention and executive functioning. Overall, reported effects were generally positive. These findings suggest that psychosocial and cognitive interventions in pediatric hospital settings reflect a wide range of approaches, while also revealing methodological heterogeneity, variability in reporting, and the underrepresentation of low- and middle-income countries, pointing to the need for more robust and inclusive future research. Full article

Background: Proton beam therapy (PBT) is a valuable alternative to photon radiotherapy of CNS tumors in children and adolescents. While most recent studies deal with the outcome or long-term side effects of PBT, the aim of this study was to investigate the feasibility of PBT with a particular focus on the acute toxicity of a simultaneous radiochemotherapy (sPBCT). Patients and methods: We enrolled 199 children [median age 7.4 years (range, 0.9–17.9)], who received altogether 200 courses of PBT/sPBCT at initial diagnosis (n = 121) or at relapse (n = 79) with sPBCT in 52 (26%) courses. Data collection to PBT/sPBCT was based on the medical records and the KiProReg (Registry study of Standard Proton Therapy in Children at West German Proton Therapy Center) with a primarily descriptive-statistical and logistic regression analysis. Results: During PBT/sPBCT a total of n = 704 adverse events (AEs, mean 3.4 per course) were observed. Eighty-seven of them were graded as high-grade adverse events (HGAEs, Common Terminology Criteria for Adverse Eventº ≥3 (CTCAE)) which occurred in 67 (33.5%) PBT/sPBCT courses. HGAEs were in particular hematotoxicity (n = 43; 64.1%) and infections (n = 18; 26.8%). A significantly higher rate of HGAEs was documented in patients treated with sPBCT (n = 33/52; 63.5%) compared to those with PBT only (n = 34/148; 23.0%) (p = 0.001). In children with sPBCT, 15 (28.8%) patients could not receive the recommended dose or schedule of the planned chemotherapy (CTx) due to HGAEs, with the rate of planned CTx courses performed being significantly lower in patients receiving intensive intravenous CTx (p < 0.001). Interruptions of PBT and of simultaneous CTx were both significantly associated with the occurrence of infections [Odds ratios 3.002 (95% CI 1.005–8.971, p = 0.049) and 3.905 (95% CI 1.005–15.174, p = 0.049)]. Total discontinuation of treatment did not occur. Conclusions: Concurrent CTx during proton therapy is associated with a significant increased risk for HGAE occurrence and therapy interruptions requiring individual dose and schedule adjustments dependent on CTx intensity, very experienced interdisciplinary teams as well as intensive care and in-/out-patient oncology facilities on site. Full article

Chronic diseases—including diabetes mellitus, cardiovascular disease, chronic kidney disease, and autoimmune disorders—remain the leading causes of global morbidity and mortality. While biomedical pathophysiology defines the etiology and progression of these conditions, cultural factors significantly modulate how patients perceive illness, engage in treatment, and adhere to medical recommendations. This review synthesizes evidence from cross-cultural studies, with a specific focus on medical manifestations and therapeutic challenges, to examine how sociocultural determinants intersect with biological disease processes. We highlight nuanced case comparisons between South Asian, East Asian, Middle Eastern, African, Latinx, and Indigenous populations, illustrating how cultural constructs such as collectivism, fatalism, stigma, reliance on traditional medicine, and health literacy directly influence outcomes in chronic disease management. Importantly, we integrate evidence-based recommendations for healthcare professionals, emphasizing culturally tailored interventions, precision medicine approaches, and the role of interdisciplinary care teams. Full article

Community and hospital pharmacists in Romania are valuable to healthcare, but their involvement in multidisciplinary teams is still not up to the mark when measured against international standards. A systematic literature review search was conducted using the PubMed, Embase, Web of Science, and Scopus databases, following the PRISMA 2020 guidelines, complemented by a bibliometric analysis with VOSviewer, to identify research trends and key contributors in the field. This review examines studies such as counseling effectiveness, clinical contribution, and professional obstacles faced by pharmacists in Romania published between 2014 and 2025 that mainly focus on community practice, integration into hospitals, and new areas such as pharmacogenetics and pharmacovigilance. The studies surveyed patients on how they evaluated counseling, tracked clinical pharmacists who adjusted drug doses through therapeutic monitoring, checked whether healthcare professionals followed safety warnings, and checked management systems within institutions. High costs and the removal of pharmacovigilance from compulsory university courses add to the obstacles. Romanian pharmacists already possess the knowledge or skills to raise treatment success and shield patients from unsafe self-medication through timely clinical advice. To use this capacity fully, the system must change, including health insurance covering pharmaceutical services, compulsory updating of course content, and official interdisciplinary protocols for this potential to be fully exploited. Full article

The authors provide further elements in support of the hypothesized use at Pompeii of an advanced repeating dart-thrower. This article primarily emphasizes the strong formal analogy between Philo of Byzantium’s description (3rd century BC) of the damage produced by the polybolos and the distinctive configurations of quadrangular cavities arranged at short intervals along a curved line, identified and documented during the 2024 digital survey and metric documentation campaigns. The processed trace models, selected as emblematic case studies, constitute the starting point of the workflows developed in collaboration with the interdisciplinary team participating in the SCORPiò-NIDI project (PRIN22). The resulting hypotheses were formulated with awareness of fundamental polemological knowledge, as well as of the historical and technological development of Roman artillery, whose functional principles are now largely clarified. The originality of the study lies in the possibility of “certifying” the dimensional module on which the entire weapon is proportioned, once the terminal ballistic parameters are assessed within a dedicated digital analytical environment. This activity is intended to be further developed, in the hope of fostering broader and more participatory interdisciplinary collaboration within the archeological area of Pompeii. At present, the article reconstructs the research experience acquired so far, highlighting connections between previous publications and proposing both a starting point for further research and a methodological tool for further investigations required to verify the hypothesis and reconstruct the polybolos. The historical relationship between Rhodes and the military decisions preceding the siege of Pompeii provides additional contextual background for the proposed scenario. Full article