Search Results (52)

Osteoarthritis (OA) remains a major contributor to pain and disability; however, the current management is largely reactive, focusing on symptoms rather than preventing irreversible cartilage loss. This review first examines the mechanistic foundations for pharmacological chondroprotection—illustrating how conventional agents, such as glucosamine sulfate and chondroitin sulfate, can potentially restore extracellular matrix (ECM) components, may attenuate catabolic enzyme activity, and might enhance joint lubrication—and explores the delivery challenges posed by avascular cartilage and synovial diffusion barriers. Subsequently, a practical “What–How–When” framework is introduced to guide community pharmacists in risk screening, DMOAD selection, chronotherapeutic dosing, safety monitoring, and lifestyle integration, as exemplified by the CHONDROMOVING infographic brochure designed for diverse health literacy levels. Building on these strategies, the P4–4P Chondroprotection Framework is proposed, integrating predictive risk profiling (physicians), preventive pharmacokinetic and chronotherapy optimization (pharmacists), personalized biomechanical interventions (physiotherapists), and participatory self-management (patients) into a unified, feedback-driven OA care model. To translate this framework into routine practice, I recommend the development of DMOAD-specific clinical guidelines, incorporation of chondroprotective chronotherapy and interprofessional collaboration into health-professional curricula, and establishment of multidisciplinary OA management pathways—supported by appropriate reimbursement structures, to support preventive, team-based management, and prioritization of large-scale randomized trials and real-world evidence studies to validate the long-term structural, functional, and quality of life benefits of synchronized DMOAD and exercise-timed interventions. This comprehensive, precision-driven paradigm aims to shift OA care from reactive palliation to true disease modification, preserving cartilage integrity and improving the quality of life for millions worldwide. Full article

Aims/Background: Polypharmacy, or the concurrent intake of five or more medications, is a significant issue in clinical practice, particularly in multimorbid elderly individuals. Despite its importance for patient safety, medical education often lacks systematic training in recognising and managing polypharmacy within the framework of patient-centred care. We investigated the impact of a structured learning intervention introducing polypharmacy as a chronic condition, assessing whether it enhances medical students’ diagnostic competence, confidence, and interprofessional collaboration. Methods: A prospective cohort study was conducted with 50 final-year medical students who received a three-phase educational intervention. Phase 1 was interactive workshops on the principles of polypharmacy, its dangers, and diagnostic tools. Phase 2 involved simulated patient consultations and medication review exercises with pharmacists. Phase 3 involved reflection through debriefing sessions, reflective diaries, and standardised patient feedback. Student knowledge, confidence, and attitudes towards polypharmacy management were assessed using pre- and post-intervention questionnaires. Quantitative data were analysed through paired t-tests, and qualitative data were analysed thematically from reflective diaries. Results: Students demonstrated considerable improvement after the intervention in identifying symptoms of polypharmacy, suggesting deprescribing strategies, and working in multidisciplinary teams. Confidence in prioritising polypharmacy as a primary diagnostic problem increased from 32% to 86% (p < 0.01), and knowledge of diagnostic tools increased from 3.1 ± 0.6 to 4.7 ± 0.3 (p < 0.01). Standardised patients felt communication and patient-centredness had improved, with satisfaction scores increasing from 3.5 ± 0.8 to 4.8 ± 0.4 (p < 0.01). Reflective diaries indicated a shift towards more holistic thinking regarding medication burden. The small sample size limits the generalisability of the results. Conclusions: Teaching polypharmacy as a chronic condition in medical school enhances diagnostic competence, interprofessional teamwork, and patient safety. Education is a structured way of integrating the management of polypharmacy into routine clinical practice. This model provides valuable insights for designing medical curricula. Future research must assess the impact of such training on patient outcomes and clinical decision-making in the long term. Full article

Background: Polypharmacy, commonly defined as the use of five or more medications, is a growing concern in hospitals due to its association with adverse drug reactions, functional decline, and increased healthcare costs. Proactive deprescribing, which involves the planned discontinuation of unnecessary or potentially harmful medications, can optimise medication use. However, multiple barriers hinder its implementation. Saudi Arabia offers a unique context for deprescribing due to strong family roles in care, prevalent prescribing norms, and ongoing shifts toward value-based healthcare. This study explores the barriers and facilitators to proactive deprescribing among physicians in Saudi hospitals using the Theoretical Domains Framework (TDF). The TDF was used as it effectively identifies behavioural factors influencing clinical decision making in practice. Methods: Semi-structured interviews were conducted with 27 purposively sampled physicians experienced in managing polypharmacy. The interviews were transcribed and analysed thematically, with behavioural determinants identified and categorised according to the 14 domains of the Theory of Planned Behaviour (TDF). Results: Enablers included the availability of deprescribing guidelines, decision–support tools, interprofessional collaboration, and institutional backing. Physicians with specialised training expressed greater confidence in conducting deprescribing. Identified barriers included limited time, heavy workload, absence of standardised protocols, medico-legal concerns, resistance from patients and caregivers, and lack of formal training. These factors were categorised under seven key TDF domains, with Environmental Context and Resources, Social Influences, and Beliefs About Capabilities identified as the most influential in shaping physicians’ deprescribing practices. Interactions between factors were observed, where supportive environments and collaborative teams helped offset key barriers such as time constraints, legal concerns, and patient resistance. Conclusions: This study identified key behavioural and contextual factors influencing proactive deprescribing in Saudi hospital settings. Addressing barriers such as heavy workload, medico-legal concerns, and lack of standardised protocols through targeted interventions, including clinician training, institutional support, and multidisciplinary collaboration, may facilitate the integration of deprescribing into routine practice. The findings offer context-specific insights to inform future efforts aimed at improving medication safety and optimising prescribing in the Saudi healthcare system. Full article

Introduction: Social workers play a critical role in healthcare settings by addressing both medical and nonmedical needs. Trained in human behavior and social environments, they are best suited to screen for social determinants of health (SDOH) and connect patients with resources paving the way for optimal health and well-being. Methods: This narrative review synthesizes the existing literature on SDOH screening practices within healthcare settings, emphasizing the role of social workers. A systematic search was conducted across multiple databases. A total of 26 studies met the inclusion criteria and were analyzed using a qualitative narrative synthesis approach. Results: This review reveals variability in SDOH screening domains, tools, and implementation strategies across healthcare settings. Facilitators and barriers to implementation were identified, including workflow integration, interprofessional collaboration, and contextual readiness. Social workers emerged as key professionals in addressing health-related social risks, leveraging their expertise in patient engagement, assessment, and system navigation. We further introduced the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to suggest the effective integration of SDOH screenings, emphasizing innovation, recipient engagement, contextual readiness, and facilitation. Conclusion: The effective integration of SDOH screenings requires structured workflows, interdisciplinary collaboration, and policy support. The review provides practice models of workflows for SDOH screenings and implications within two different healthcare settings: hospitals and outpatient clinics, offering insights into best practices and areas for future research. Strengthening the role of social workers in SDOH screenings can improve patient outcomes and promote health equity. Full article

Background: Medication-related problems (MRPs) are common among home-care patients urgently needing improvement. Due to limited resources, patients with the greatest risk of MRPs should be prioritised for interventions. Objectives: We sought to develop a collaborative assessment tool for nurses and pharmacists to identify home-care patients at high risk of developing MRPs. Methods: Using Pubmed^® for a first scoping literature review, we sought existing tools identifying patients at risk of MRPs or prioritising patients for clinical pharmacy services. Extracted items were prioritised in a first interprofessional Delphi round. Results from the first Delphi round were complemented by individual risk factors identified in a second scoping literature review and again submitted to the expert panel in a second Delphi round. Each item was rated for its relevance to identify home-care patients at risk of MRPs. The highest scoring factors were combined into an interprofessional assessment tool. Results: Literature review one yielded 19 risk tools and six lists containing potentially inappropriate medications. The 78 resulting risk factors were submitted to experts (five pharmacists, five physicians, five nurses) in Delphi round one. Since the identified tools did not fit the scope (interprofessional assessment in home care) entirely, the results of Delphi round one were complemented with individual risk factors identified in a second literature review, leading to 82 potential risk factors for Delphi round two. Experts decided on a 15-item tool for future pilot testing—the doMESTIC RISK tool. It incorporated diverse factors potentially influencing medication safety: demographic information, social context, diagnosis, specific medication and health care resources use. Conclusions: With expert feedback from a Delphi process, we developed a 15-item tool to help nurses and pharmacists jointly identify home-care patients at a high risk of MRPs. Validation of the doMESTIC RISK tool will be imperative to verify its value in clinical practice. Full article

This case report explores the experience of a newly diagnosed type 2 diabetes (T2DM) patient transitioning from passive non-adherence to active adherence over a two-month period following hospital discharge. During this two-month period, he participated in four exploratory, non-interventional research interviews investigating his medication adherence, beliefs, and self-management strategies. His feedback on these research interviews highlighted the role of key communication strategies—such as patient partnership, non-judgmental communication, and interprofessional active listening—in fostering self-reflection and behavioural change. While these techniques are well-documented, there remains an urgent need to translate them into routine practice by integrating behavioural science and interprofessional collaboration into healthcare pregraduate and postgraduate education in order to increase awareness and skills in clinical environments. Full article

Background. A major goal for a significant portion of the osteopathic community is to update osteopathic principles, satisfying three needs: sourcing from the origin, proposing original and unique practical approaches, and describing the entire process in a scientifically updated way. On this line, several interprofessional proposals for healthcare providers have already been made by implementing patient-centered care and touch-based strategies informed by the enactive model. Enactivism principles can provide a foundation for rethinking osteopathic care by integrating environmental, psychological, social, and existential factors to facilitate the patient’s biobehavioral synchronization with the environment and social context, address health needs, and enhance the quality of multiprofessional healthcare services. However, there is a need to develop a conceptual model that offers a framework for organizing and interpreting disciplinary knowledge, guiding clinical observation and practical strategies, and defining both interprofessional collaboration and the unique focus of the profession. This scoping review and integrative hypothesis aim to fulfill the need for a more detailed and comprehensive understanding of the distinctive osteopathic care to biobehavioral synchrony, emphasizing both interprofessional collaboration and the profession’s unique competencies. Methods. The present article was developed in accordance with established guidelines for writing biomedical scoping reviews. Results. A total of 36 papers were considered for thematic and qualitative analyses, which supported the integrative hypothesis. Considering the current tenets for osteopathic rational practice, we propose an integrative hypothesis to focus on a practical framework for osteopathic patient biobehavioral synchronization. Patient–practitioner–environment synchronization could be promoted through a four-step process: (1) a narrative-based sense-making and decision-making process; (2) a touch-based shared sense-making and decision-making process; (3) hands-on, mindfulness-based osteopathic manipulative treatment; (4) patient active participatory osteopathic approaches to enhance person-centered care and rational practice. Conclusions and future directions: The proposed model fosters patient–practitioner synchronization by integrating updated traditional osteopathic narratives and body representations into practice, offering a culturally sensitive approach to promoting health, addressing contemporary health needs, and improving inclusive health services. Future studies are required to assess the transferability and applicability of this framework in modern settings worldwide. Full article

Background: It is well established by research that large-scale and indiscriminate prescribing, dispensing, and use of antimicrobials drive antimicrobial resistance (AMR) endangering the health and well-being of people, animals, and the environment. In the context of low- and middle-income countries (LMICs), the prescribing of antimicrobials is often not based on biomedical rationality but involves alternative logic driven by social, cultural, and institutional factors. This paper seeks to develop a “biosocial” perspective, reflecting a unified perspective that treats the biomedical and social conditions as two sides of the same coin. Methods: This analysis is based on an empirical investigation of prescription slips that patients carry to buy drugs from the pharmacy following an outpatient department encounter with the clinician. Data collection involves mixed methods, including the quantitative analysis of the antimicrobials prescribed and a qualitative analysis of the underlying reasons for these prescriptions, as described by doctors, pharmacists, and patients. Data analysis involved triangulating quantitative and qualitative data, to develop a “biosocial” perspective, which can provide implications for the development of antimicrobial stewardship policies, particularly relevant for health institutions in low- and middle-income countries. Results: Our analysis of 1175 prescription slips showed that 98% contained antimicrobials, with 74% being broad-spectrum antimicrobials. Only 9% of cases were advised antimicrobial sensitivity testing (AST) before initiating treatment. Qualitative findings indicated that patients had poor awareness of antimicrobials and pharmacists played a crucial role in counseling. Conclusions: This study highlights that antimicrobial prescriptions in public health settings are influenced by both biomedical and social factors, supporting a biosocial perspective. Although AMS interventions are predominantly biomedical, adhering to clinical standards and best practices, this study underscores the necessity of integrating a biosocial viewpoint by incorporating the experiences of pharmacists and patient groups. Strengthening diagnostic support, patient education, and interprofessional collaboration could improve rational antimicrobial uses in low-resource settings. Full article

The University of Otago School of Pharmacy Clinic serves as a model for innovative medication management, tackling critical medication-related problems (MRPs) to enhance patient outcomes and advance pharmacy education. This study evaluated the clinic’s impact, examining 456 patient consultations over four years, with a focus on MRPs such as dosing errors, non-adherence, and inadequate monitoring. Using the DOCUMENT classification system, pharmacists identified 754 MRPs and issued 836 recommendations, primarily related to medication adjustments and monitoring. Patients reported significant improvements in health-related quality of life, as measured by the SF12V2 survey, with notable gains in mental and physical health metrics. This outcome highlights the clinic’s dual role in optimising patient care and providing pharmacy students with experiential learning opportunities. By integrating hands-on training within a supervised clinical environment, the clinic addresses workforce shortages and reinforces the value of pharmacist-led interventions. The findings advocate for university-based clinics as pivotal hubs for resolving MRPs through interprofessional collaboration, targeted interventions, and innovative technologies such as telepharmacy. The study underscores the need for expanded roles for clinical pharmacists in healthcare policy and practice, showcasing their potential to prevent medication errors, enhance lives, and reshape the future of pharmacy education and patient care. Full article

Pharmacogenetic (PGx) testing is a promising approach for optimizing drug therapies. However, there is limited knowledge regarding its real-world utilization and long-term impact in clinical practice. This study assessed how often PGx information informs treatment decisions and evaluated patients’ perspectives on its use and non-use, identifying enablers for PGx implementation. A mixed-methods study was conducted with 24 patients with a median of 1 year after PGx testing. Medication and health-related data were collected at enrollment and at the follow-up 1 year later using a semi-structured questionnaire. At the follow-up, 62 medication changes were identified in 18 patients. A median of four medication changes per patient were initiated mainly by medical specialists (58%). PGx information was considered for 15 patients in 39 medication changes (63%). Patient-reported factors contributing to the non-use of PGx information included a lack of knowledge and interest among healthcare professionals (HCPs), structural and administrative barriers, and an over-reliance on patient advocacy. Potential enablers should address targeted PGx education, interprofessional collaboration, awareness among policymakers, and concise recommendations focused on PGx-actionable drugs from testing providers. By implementing these interdependent enablers, PGx can evolve into a long-term, clinically integrated cornerstone of individualized pharmacotherapy. Full article

Background/objectives: Malnutrition and sarcopenia are interrelated health concerns among the elderly. Each condition is associated with increased mortality, morbidity, rehospitalization rates, longer hospital stays, higher healthcare costs, and reduced quality of life. Their combination leads to the development of “Malnutrition–Sarcopenia Syndrome” (MSS), characterized by reductions in body weight, muscle mass, strength, and physical function. Despite being preventable and reversible through nutritional and physical interventions, the clinical competence of physical therapists (PTs) in managing MSS remains underexplored. This study aims to assess the clinical competency of PTs in MSS management. Methods: An anonymous cross-sectional survey was conducted from January to August 2024 among 337 certified PTs in Israel, using the “Qualtrics” platform. The survey assessed prior familiarity with MSS concepts, MSS knowledge levels, screening and treatment skills, attitudes and beliefs toward MSS management, and interprofessional collaboration practices. Results: While 52% of PTs were familiar with MSS, familiarity with diagnostic guidelines was low (EWGSOP2: 3.6%; GLIM: 0.6%). The MSS knowledge score was moderate, but screening and treatment skills were low. Attitudes toward MSS management were moderately positive, but self-belief in diagnosing and treating MSS was low. Interprofessional collaboration was limited, particularly in malnutrition care. PTs familiar with MSS had higher knowledge, better skills, more positive attitudes and beliefs, and greater interprofessional collaboration. Conclusions: Significant gaps exist in the clinical competency of Israeli PTs in MSS management. Integrating MSS content into physical therapy curricula and providing continuing professional development are necessary to enhance competencies. Equipping PTs with essential tools, clarifying roles, and promoting interprofessional collaboration can optimize MSS management and improve patient outcomes. Full article

Background/Objectives: Since the importance of robust theory-driven research is emphasized in medical education and little data are available on the intentions of medical and healthcare students regarding interprofessional collaboration, this study aimed to analyze the behavioral intentions of Polish medical and healthcare students to undertake interprofessional collaboration in their future work. This study follows the assumptions of the theory of planned behavior, including analysis of the students’ attitudes, subjective norms, and perceived behavioral control in this regard. Methods: Data were collected from March to July 2023 on the population of students at Poznan University of Medical Sciences (Poland) using a questionnaire developed using dedicated manuals on the theory. Results: The students demonstrated generally positive behavioral intentions and attitudes, with a mean total attitude score of 103.13 ± 33.31 in a possible range of −231 to 231. Their sense of social pressure to engage in interprofessional collaboration was weak to moderate positive, as indicated by their total subjective norm score equal on average to 57.01 ± 42.98 in a possible range of −189 to 189, or mixed when evaluated directly. Furthermore, even though they presented a neutral or moderately positive direct assessment of their perceived behavioral control, its indirect measure was weak to moderately negative, with a mean total perceived behavioral control of −80.78 ± 59.21 in a possible range of −231 to 231. Conclusions: The findings suggest that students’ perceptions of mixed social pressure and the presence of barriers or obstacles to collaboration may negatively impact their perceived ease and willingness to collaborate, even despite their initially positive attitudes towards it. Full article

Community-based medical rehabilitation encompasses diverse programs that cater to patients outside of inpatient settings, such as home rehabilitation, day rehabilitation centers, and ambulatory clinics. While inpatient rehabilitation principles are widely standardized, outpatient programs display significant variability influenced by healthcare models, local environments, economic constraints, and available resources. This narrative review aims to explore and synthesize the various models of non-inpatient rehabilitation services, evaluating their effectiveness, cost-efficiency, and patient satisfaction. The review also seeks to identify optimal practices and strategies to enhance community-based rehabilitation, alleviate the burden on inpatient facilities, and improve patient outcomes through multidisciplinary and patient-centered approaches. Additionally, the study examines the critical role of a professional program coordinator and the importance of effective clinical communication in outpatient rehabilitation. A comprehensive search of peer-reviewed literature was conducted across multiple databases, focusing on studies that examined community-based rehabilitation models. The findings suggest that community-based rehabilitation programs are generally more cost-effective than inpatient programs, with their success being heavily dependent on the intensity and timing of interventions. Multidisciplinary approaches and high-intensity rehabilitation have shown promise in improving patient quality of life, though their effectiveness varies by condition. Despite limited research, the involvement of a Physical and Rehabilitation Medicine (PRM) physician as a program coordinator appears vital for ensuring continuity of care. Moreover, effective clinical communication is essential, impacting all aspects of patient care and interprofessional collaboration, with continuous adaptation required to meet the evolving needs of diverse patient populations. Full article

Gross anatomy provides essential knowledge about the structure and function of the human body. Understanding human anatomy requires specific skills from physiotherapy students to comprehend and memorize the location and relationships of anatomical structures. This review aims to summarize the current evidence on teaching methodologies in anatomy education for undergraduate physiotherapy students. A scoping review was conducted consulting the PubMed, EBSCO, SCOPUS, and Web of Science databases. By analyzing ten studies involving over 1380 students, we identified four primary pedagogical approaches: the use of technological tools, combined traditional methods (such as dissections and radiological imaging), interprofessional education, and the innovative use of animal dissections. The findings highlight that hands-on, practical activities, especially those integrating technology (e.g., virtual reality and interactive quizzes), significantly enhance student engagement and knowledge retention. Collaborative learning through interprofessional education was found to foster a deeper understanding of anatomical concepts and improve teamwork skills, which are crucial for clinical practice. Additionally, the inclusion of traditional methods like dissections and radiological imaging, when paired with modern tools, offers a comprehensive approach that bridges theoretical knowledge with practical application. The use of animal dissections also emerged as an innovative strategy to enhance anatomical comprehension. In conclusion, the literature underscores the importance of adopting diverse and innovative teaching strategies in gross anatomy education for physiotherapy students. Such approaches not only enrich the learning experience but also ensure that students are well prepared for the demands of professional practice. Full article

Recently, there has been a remarkable move towards interprofessional collaboration in response to the COVID-19 pandemic and the care of comorbidities. In Germany, there has been a gradual increase in interprofessional learning in medical and pharmacy education, aiming to enhance patient care. To adapt the pharmacy curriculum for collaborative practice between pharmacy and medical students, we developed an immersive interprofessional collaboration course for pharmacy students using adult and pediatric high-fidelity simulators (HFS) to assess and train medication consultation skills. In a randomized controlled trial, we investigated whether interprofessional training between pharmacy and medical students results in differences in pharmacy students’ performance of medication therapy consultation compared to the case of mono-professional training of pharmacy students only. Before and after inter/mono-professional training, each pharmacy student performed an objective structured clinical examination (OSCE) and completed a self-assessment questionnaire. Additionally, an attitude survey towards interprofessional learning was completed by pharmacy and medical students at the end of the training. As expected, interprofessional as well as mono-professional training showed a statistically significant increase in medication consultation skills. Of importance, the performance in the interprofessional training group was significantly better than in the mono-professional group, particularly in drug therapy counselling and consultation behaviors. There was a significant difference between the intervention and control groups in self-assessment scores, and all study participants had positive attitudes toward interprofessional collaboration and training. Therefore, interprofessional training using HFS has been shown to appropriately train pharmacy students for collaborative practice and consultation skills. Full article