Search Results (356)

Background/Objectives: Artificial intelligence (AI) is increasingly applied across spinal pain care, by improving diagnostic accuracy, optimizing clinical workflow, and advancing translational research. However, AI’s role and its integration into rural spine care face challenges. Therefore, the current narrative review synthesizes the role of AI in rural spine care, spanning diagnosis, clinical decision support, imaging, natural-language processing, and remote monitoring. Methods: We searched the peer-reviewed literature on AI in spinal pain care across six databases from inception to June 2026. Results: In the United States, AI models have shown promise in strengthening clinical decision support that assists clinicians in identifying spinal pain disorders and providing evidence-based treatment recommendations; however, most were developed and validated in urban healthcare settings. Additionally, evidence on external validation, dataset representativeness, robustness to incomplete or low-quality data, interoperability, prospective clinical utility, and implementation feasibility in rural spine care remains limited. Therefore, we propose a translational framework in which de-identified data from rural and urban healthcare settings are aggregated, harmonized, and used to develop a multimodal AI model. AI models further require rigorous technical and external validation, prospective validation in rural settings, explainability, and continuous post-implementation monitoring. Despite its benefits, key limitations, including data scarcity and algorithmic bias, are also highlighted. Conclusions: AI has emerged as a promising tool for strengthening clinical decision support in spinal pain disorders in rural settings. The most realistic role of AI in rural settings is not to replace specialist expertise, but to act as one component of a multidisciplinary care team. Full article

Background: Depression is a major health issue among older adults and is frequently accompanied by chronic physical conditions. Conventional care of depression in older adults is delivered through primary care settings and often fails to address the complex interactions between mental health, physical illness, and social determinants of health in this population. Integrated care models, characterized by coordinated, multidisciplinary, and patient-centered approaches, have emerged as a promising strategy for improving depression outcomes in late life. Objective: This scoping review aimed to characterize integrated care models for managing depression in older adults. The review examined the structure and implementation of these models and evaluated depression-related outcomes. Methods: A systematic literature search was conducted in PubMed and Google Scholar. Studies published in English between 2006 and February 2026 were considered. Eligible studies included randomized controlled trials (RCTs), cluster RCTs, and quasi-RCTs that evaluated integrated care interventions targeting depression in adults aged 65 years or older or mixed adult populations that included older adults. One reviewer conducted the search and initial screening, and four additional reviewers evaluated the eligibility of full-text reports and extracted data using a structured template. Results were synthesized descriptively. Results: Seventeen studies met the inclusion criteria. Integrated care interventions were implemented across primary care clinics, community health centers, and home healthcare programs in several countries. Participants commonly had depression alongside chronic medical conditions, including diabetes, hypertension, heart failure, or chronic obstructive pulmonary disease. Integrated care models varied in staffing, therapeutic components, specialist involvement, delivery intensity, and comparator conditions. Most interventions incorporated multidisciplinary care teams; structured symptom monitoring; care coordination; behavioral or psychological interventions; and, in some studies, chronic disease management, social support, or technology-supported follow-up. Thirteen studies reported a favorable depression-related finding at one or more assessment points; however, benefits were not always sustained, and some studies reported null- or comparator-favoring findings. Conclusions: Integrated care for depression in older adults encompasses heterogeneous models implemented across diverse healthcare contexts. Common themes included multidisciplinary collaboration, coordinated follow-up, structured psychological or behavioral treatment, symptom monitoring, and integration of mental and physical health management. Favorable outcomes were reported in most studies, but findings varied by population, setting, comparator, intervention intensity, and follow-up duration. These findings may inform future program design, although the effectiveness of the integrated care models and the independent contribution of individual components remain uncertain. Full article

Background: Managing urinary calculi during a multiple gestation pregnancy presents significant clinical challenges, which require rigorous care to prevent adverse maternal and fetal outcomes. This report aims to offer clinical nursing references by summarizing the management of a complex pregnancy complicated by ureteral calculi and thyrotoxicosis. Case Presentation: A patient with a twin gestation complicated by a ureteral calculus and thyrotoxicosis was managed with nurse-led continuous care within a physician-directed multidisciplinary framework. During hospitalization, interdisciplinary medical and nursing teams continuously monitored maternal and fetal vital signs to establish individualized surgical and nursing regimens. Post-discharge integrated care was delivered via online and offline follow-up, incorporating collaborative assessments from the obstetrics, endocrinology, and psychology departments, alongside multidimensional physical care and targeted psychological counseling. Conclusions: With standardized treatment and continuous nursing intervention, the patient delivered healthy boy-girl twins by caesarean section at 37 weeks of gestation, followed by successful ureteroscopic lithotripsy and uncomplicated hospital discharge. This case illustrates a feasible approach to nurse-led continuous care within a physician-directed multidisciplinary framework for complex, high-risk pregnancies. As this is a single case, the findings should be interpreted cautiously and require further validation. Full article

Background/Objectives: Children and adolescents living with HIV (ALHIV) are among the most vulnerable groups affected by HIV and AIDS. Their vulnerability exposes them to several challenges, such as HIV-related stigma and/or interrupted academic activities due to health-related complications. Since they are still minors who cannot independently make decisions regarding their own lives, most of the challenges extend to their caregivers, who sometimes provide care and support under difficult psychological, social, and economic conditions. This study aimed to explore the lived experiences and challenges of primary caregivers caring for ALHIV in Gauteng Province of South Africa. Methods: A qualitative exploratory design with phenomenological orientation was adopted. Eight primary caregivers of ALHIV were purposively sampled and interviewed using individual face-to-face semi-structured interviews. Data was analysed thematically according to the eight steps of Tesch’s qualitative analysis framework. Since it involved human participants, this study was subjected to ethical clearance by the Research Ethics Committee of the University of South Africa, which imposed conditions for upholding ethical principles such as informed consent and confidentiality. Results: Primary caregivers encounter challenges such as regular monitoring of ALHIV who are always sick, treatment adherence monitoring, behavioural management, financial strain, stigma and discrimination, lack of proper nutrition and managing adolescents’ academic difficulties. These challenges require support from multidisciplinary team members which include nurses because they play a crucial role in supporting treatment adherence among ALHIV and in strengthening the capacity of primary caregivers to provide effective treatment support. Conclusions: It is essential to adopt an integrated approach to psychosocial, as well as financial support interventions targeting primary caregivers. Full article

Background/Objectives: Bone is the third most common site of solid-tumor metastasis, and surgical management spans a wide spectrum from observation to curative en bloc resection in selected patients. 18F-FDG PET/CT has been reported to alter oncologic management in 20% to 45% of patients across diverse settings, yet its specific impact on surgical decision-making within a multidisciplinary orthopedic oncology board (MOOB) reassessment and the predictors of decision change remain undefined. Methods: We retrospectively analyzed consecutive patients with histopathologically confirmed bone metastases evaluated at a tertiary-care MOOB between February 2023 and February 2026. For each patient, the surgical plan was recorded twice: first by the orthopedic team based on available conventional imaging (radiography, computed tomography, magnetic resonance imaging) and then as the final PET/CT-informed MOOB review. This design evaluates changes in decision-making intent after PET/CT-informed multidisciplinary reassessment, rather than the isolated causal effect of PET/CT or actual surgical implementation. Surgical plans were categorized as no surgery, palliative stabilization, palliative resection, or curative-intent resection, and changes were classified as no change, escalation, de-escalation, or cancellation. Results: Among 73 patients (mean age 64.7 ± 12.1 years; 53.4% male), the most frequent primaries were lung (37.0%), breast (21.9%), and renal cell carcinoma (13.7%). Following PET/CT-informed MOOB reassessment, the intended surgical plan changed in 53.4% of cases (p < 0.001), comprising surgery cancellation (27.4%), escalation (17.8%), and de-escalation (8.2%). Patients directed to no surgery increased fourfold (6.8% to 28.8%), and curative resection emerged as a post-reassessment recommendation (0% to 10.9%). SUVmax did not predict overall decision change, but higher SUVmax was associated with cancellation/de-escalation in the directional analysis. In exploratory multivariable analysis, polymetastatic disease (OR 0.051; 95% CI 0.005 to 0.547; p = 0.014), long-bone diaphyseal location (OR 0.133; p = 0.006), and higher Eastern Cooperative Oncology Group (ECOG) performance score (OR 2.109 per point; p = 0.018) independently predicted decision change. Conclusions: PET/CT-informed MOOB reassessment was associated with substantial changes in intended surgical strategy for metastatic bone disease. The findings support careful multidisciplinary integration of metabolic imaging, metastatic burden, anatomic location, and performance status, but should be regarded as hypothesis-generating until validated prospectively with data on treatment delivery and downstream outcomes. Full article

The incidence of neoplastic disorders worldwide has steadily increased, and Romania is no exception, showing a substantial rise in active oncologic surveillance cases. Family physicians are essential to the multidisciplinary team, providing screening, early diagnosis, care during and after cancer treatment, comorbidity management, and palliative care. Primary prevention through lifestyle behavioral changes and early detection in the asymptomatic phase remain the most effective strategies to reduce cancer morbidity and mortality. However, structural barriers within the Romanian primary healthcare system, specifically fragmented digital infrastructure, administrative workloads and limited patient health literacy, frequently restrict these preventive activities. The aim of this narrative review is to analyze cancer prevention and management within Romania’s current demographic and socio-economic context, comparing the national system to models from the UK, the Netherlands, and Spain. The analysis highlights operational gaps, including low breast, cervical, and colorectal screening uptake in Romania. We concluded that optimizing patient care requires transitioning to an integrated pathway, supported by practical reforms like digital fast-track scheduling modules managed directly by family physicians. Full article

Aerospace engineering applications typically entail complex high-performance systems with sustainable safety. They are usually designed by multidisciplinary development teams where collaboration efficiency is undermined by the diversity of views (models) provided by the disciplines involved. This produces design deadlocks (augmenting risks and costs) when crosschecking modeling representations to assess the impact of different models on each other to maintain system integrity. This paper presents details of the design process of a planetary rover in which diverse stakeholders deal with distinct aspects of the above space ground vehicle. It includes preliminary results from requirements analysis and system design that are used to interlink system models for an autonomous model crosschecking design process. The approach reduces collaborative design efforts by enabling multiple developers to minimize potential design inconsistencies by cross-relating their system models. Concluding remarks and future research are also presented. Full article

Introduction: Stroke remains a leading cause of mortality and long-term disability worldwide. Coordinated care delivered through protocol-driven multidisciplinary teams enables rapid diagnosis and treatment, both of which are essential for improving clinical outcomes. Objective: Our objective was to analyze care strategies in the emergency management of acute ischemic stroke, focusing on treatment times and influencing factors, interventions implemented in emergency settings and their impact on clinical outcomes, and the contribution of healthcare professionals to optimizing stroke care. Methods: A systematic review was conducted in accordance with the PRISMA 2020 Statement. Current evidence published between 2021 and 2026 was retrieved from five databases: PubMed, Web of Science, Scopus, Cochrane Library, and SciELO. Eligibility criteria were applied, and methodological quality and risk of bias were assessed using validated appraisal tools. Results: Fourteen studies involving a total of 6384 patients were included. Factors such as healthcare system reorganization, multidisciplinary teamwork, early protocol activation, and the use of stroke-specific triage scales significantly influenced treatment times. Coordinated and protocolized care pathways, together with evidence-based clinical interventions, were consistently associated with higher thrombolysis rates and shorter treatment times, while improvements in neurological and functional recovery were reported in several, but not all, studies. The integration of specialized stroke professionals and structured emergency care processes contributed to reducing treatment delays and improving patient outcomes. Conclusions: Critical treatment times in acute ischemic stroke are influenced by multiple factors, and targeted organizational and clinical strategies can accelerate diagnosis and treatment. Although improvements in clinical outcomes were not consistently demonstrated across all included studies, the available evidence consistently supports protocol-driven multidisciplinary emergency care as an effective strategy for reducing treatment delays and optimizing acute ischemic stroke management. Full article

Background: Patients with cystic fibrosis frequently require repeated courses of intravenous antibiotic therapy, resulting in cumulative vascular injury, progressive depletion of peripheral venous access, and increasing complexity in long-term vascular access management. Integrating structured vascular access planning into multidisciplinary care pathways has become increasingly important for preserving venous capital, optimising vascular access decision-making, and ensuring continuity of care. Objective: To describe the development and implementation of an Advanced Practice Nursing-led multidisciplinary vascular access care pathway for patients with cystic fibrosis requiring prolonged intravenous therapy. Methods: A practice-based descriptive analysis of a multidisciplinary vascular access pathway was conducted, incorporating ultrasound vascular assessment, structured clinical decision-making, and coordinated care across the Emergency Department, Cystic Fibrosis Unit, Vascular Access and Infusion Team, Hospital Pharmacy Service, and Hospital-at-Home Programme. An illustrative patient example was used to demonstrate pathway implementation in routine clinical practice. Results: Pathway implementation illustrated the feasibility of integrating ultrasound-guided vascular assessment, evidence-informed selection of vascular access devices, and coordinated home-based intravenous therapy within a multidisciplinary care model. Ultrasound-guided vascular assessment identified a suitable upper-arm basilic vein despite severe peripheral venous depletion. An Advanced Practice Nurse successfully performed ultrasound-guided midline catheter insertion, achieving first-attempt cannulation and no immediate complications. The illustrative patient completed four weeks of home-based intravenous antibiotic therapy without observed catheter-related infection, thrombosis, occlusion, catheter dysfunction, or unplanned hospital readmissions. The patient reported satisfaction with the treatment experience and the ability to maintain daily activities throughout treatment. Conclusions: This study describes and clinically contextualises an APN-led multidisciplinary vascular access care pathway for patients with cystic fibrosis requiring prolonged intravenous therapy. The illustrative patient demonstrated the feasibility of applying the pathway in routine clinical practice. Further prospective multicentre studies are required to evaluate its effectiveness, safety, reproducibility, and broader applicability. Full article

Background: Prehabilitation has become an essential component of perioperative care in colorectal surgery, aiming to improve postoperative outcomes through multimodal interventions. However, its real-world implementation remains heterogeneous. This study aimed to evaluate the degree of implementation and variability of prehabilitation programs across colorectal surgery units in Spain. Methods: A national multicenter cross-sectional survey (VAPPER Survey) was conducted among colorectal surgery units. The questionnaire included 83 items addressing organizational structure, nutritional assessment, frailty screening, and multidisciplinary collaboration. Data were analyzed descriptively and expressed as frequencies and percentages. Results: A total of 104 hospitals participated. Prehabilitation programs were present in 79% (n = 82) of centers, while 21% (n = 22) reported no program. Nutritional screening was not performed in 21% (n = 22) of hospitals. Among those performing screening, MUST was the most frequently used tool (68%, n = 56), although considerable variability existed. Systematic use of GLIM criteria was reported in only 24% (n = 20), whereas 35% (n = 28) did not use GLIM and 41% (n = 34) applied it selectively. Frailty screening in patients ≥70 years was absent in 54% (n = 44) of centers, and geriatric involvement was limited and non-standardized. Conclusions: Prehabilitation is widely implemented in Spain but remains highly heterogeneous across all dimensions. The most relevant deficits are concentrated in systematic nutritional assessment, malnutrition diagnosis using standardized criteria, geriatric integration, and psychological support. Standardization of protocols, strengthening of multidisciplinary teams, and enhanced training in perioperative nutrition are priorities for optimizing outcomes in colorectal surgery. Full article

Proactive mental health consultation–liaison (C-L) services in neonatal intensive care units (NICUs) are increasingly recognized as essential to infant health and family functioning, yet there is limited guidance on how to develop sustainable and effective programs in real-world clinical settings. This paper describes the development, implementation, and iterative refinement of a NICU mental health C-L program using a learning health system (LHS) framework. Grounded in a theory-driven model that conceptualizes the infant as the identified patient, the program was designed to target proximal mechanisms influencing infant regulation, parent–infant interaction, and medical course. Consistent with LHS principles, program elements were introduced incrementally and refined through embedded data collection, rapid feedback loops, and multidisciplinary team learning. Data sources emphasized feasibility, reach, implementation processes, and acceptability rather than hypothesis-driven outcome testing. Over six years, this approach supported the expansion of multiple integrated service components, including dyadic intervention services, parent mental health screening and referral pathways, unit-wide family engagement initiatives, and neurobehavioral care practices. Rather than presenting a fixed protocol, this paper offers a replicable framework for developing NICU mental health C-L services that balances developmental theory, implementation realities, and sustainability. The LHS approach provides a pragmatic roadmap for NICUs seeking to build or refine mental health services in contexts characterized by clinical complexity, evolving evidence, and system-level constraints. Full article

Objectives: Timely diagnosis, efficient patient journey, and well-coordinated multidisciplinary care are essential foundations for optimizing treatment outcomes in urothelial carcinoma. This study aims to identify key organizational characteristics and development areas within the patient journey of urothelial carcinoma (UC) in Bulgaria, with a particular focus on the role of multidisciplinary teams (MDTs), referral patterns, and the timeliness of therapeutic decision-making. Methods: This study employed a structured survey and in-depth interviews with 30 leading Bulgarian oncologists across different medical facilities specialized in the treatment of urothelial carcinoma. The survey was developed according to international best practices and included seven key domains: patient flow, quality of life, health outcomes, patient perception of satisfaction, symptom impact, unmet needs, and trends and changes in therapy. Quantitative survey data were analyzed using descriptive statistics and cross-tabulations, while qualitative interview data were analyzed using thematic analysis to identify key patterns and challenges. Results: Most patients entered the care pathway at early disease stages. Referrals were primarily initiated by urologists (71%), while multidisciplinary team involvement was reported in all participating centers, although organizational practices varied. Treatment was initiated within 1–2 weeks following diagnosis in 69% of cases, and follow-up was predominantly conducted through scheduled clinical visits (81%). Respondents identified coordination between healthcare facilities, reduction in waiting times, and improved access to diagnostic tools as the most important areas of progress and ongoing development within urothelial carcinoma care. Conclusions: The findings highlight several areas within the urothelial carcinoma patient journey where coordination can be further strengthened, particularly in relation to MDT engagement, meeting regularity, referral pathways, and follow-up practices. Strengthening multidisciplinary collaboration and implementing integrated care pathways may support further improvements in coordination and consistency of care. Full article

Providing care for effective management of tuberculosis (TB) and diabetes mellitus (DM) is a challenge, particularly in resource-limited settings. This study assessed factors affecting the provision of care for patients with TB-DM in Addis Ababa, Ethiopia, using the six elements of the SELFIE—Sustainable intEgrated chronic care modeLs for FinancIng and performancE framework. A health facility-based cross-sectional study was conducted with randomly selected patients with TB-DM multi-morbidity. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 27. Logistic regression was employed to identify factors influencing TB-DM care provision. A total of 357 respondents participated, with a response rate of 96.5%. The mean age of the respondents was 49.8 years. Only 13.4% of patients received good TB-DM services. Key factors influencing TB-DM care were (a) insufficient counseling on the proper use of medication (AOR = 2.6, CI: 1.1–6.6, p = 0.035) and the risk of TB for DM patients (AOR = 10, CI: 3.7–27, p < 0.001), (b) leadership and governance including supportive leadership for TB-DM care (77.1%), organized TB-DM care (62.5%), the presence of a care policy (77.1%), and continuity of care (58.3%), (c) workforce factors such as the presence of a multidisciplinary team (60.4%), TB-DM service coordinator (58.3%), HCWs with adequate knowledge (87.5%), (d) costs of health services are fair (75%) and (e) lack of technologies such as EMR (88%) and lack of medical products to treat TB-DM (64.7%) delays care for TB-DM. Most TB-DM patients in Addis Ababa had limited access to care. The continuous monitoring of services can facilitate the identification of care gaps, thereby guiding the implementation of improved interventions. Full article

Background: Intermediate-high and high-risk pulmonary embolism (PE) are associated with substantial mortality despite anticoagulation. While reperfusion therapies may improve outcomes, real-world evidence comparing treatment strategies and identifying predictors of mid-term mortality remains limited. We aimed to evaluate predictors of 90-day mortality and the impact of reperfusion therapy in patients with intermediate-high and high-risk PE managed within a multidisciplinary Pulmonary Embolism Response Team (PERT). Methods: This retrospective cohort study included 114 consecutive patients with intermediate-high or high-risk acute PE admitted to a tertiary referral center between October 2023 and December 2024. Risk stratification was performed according to ESC guidelines, and simplified Pulmonary Embolism Severity Index (sPESI) scores were calculated. Treatment strategies included anticoagulation alone or reperfusion therapy (systemic thrombolysis or catheter-directed therapy). The primary endpoint was all-cause 90-day mortality. Multivariate logistic regression was performed to identify independent predictors of mortality. Results: The mean age was 68 ± 16 years, and 88% had at least one comorbidity. Reperfusion therapy was administered to 27% of patients. Mortality rates were 1% at 24 h, 6% at 7 days, 17% at 30 days, and 25% at 90 days. In multivariate analysis, hemoglobin ≤ 11.7 g/dL (OR 5.06, 95% CI 1.58–16.17, p = 0.006), sPESI > 2 (OR 4.86, 95% CI 1.49–15.84, p = 0.009), prior stroke (OR 11.59, 95% CI 2.08–64.51, p = 0.005), and high 30-day mortality risk classification (OR 14.14, 95% CI 1.19–167.89, p = 0.036) were independent predictors of mortality. Reperfusion therapy was independently associated with a significant reduction in 90-day mortality (OR 0.05, 95% CI 0.003–0.65, p = 0.022). The regression model demonstrated good explanatory power (Nagelkerke R² = 0.487). Conclusions: In this real-world cohort of intermediate-high and high-risk PE, reperfusion therapy was independently associated with lower 90-day mortality and low bleeding risk. In addition to established predictors, sPESI retained strong prognostic value beyond its traditional 30-day timeframe. These findings support risk-adapted reperfusion strategies guided by multidisciplinary teams and reinforce the role of integrated clinical risk assessment in optimizing outcomes. Full article

Background: Chemotherapy-induced alopecia (CIA) significantly impacts patient quality of life (QoL). Scalp cooling therapy (SCT) is effective, but its success in clinical settings remains variable. Objective: To evaluate the association between a refined multidisciplinary team-based approach, integrating appearance care professionals, and SCT efficacy in breast cancer patients. Methods: This retrospective before–after single-institution study compared SCT outcomes before (Group A, n = 66) and after (Group B, n = 79) implementing a refined care model among patients who completed their full planned chemotherapy courses. The baseline characteristics were comparable except for a significantly higher proportion of patients starting a weekly regimen in Group B (54.4% vs. 30.3%, p = 0.004). The model featured enhanced staff training, a specialized hair/scalp charting system, and task-sharing between nurses and integrated certified hairdressers. The primary endpoint was the number of cycles with Grade 2 or higher alopecia (CTCAE v5.0). Results: The refined approach was associated with improved scalp cooling outcomes. The percentage of patients with Grade 2+ alopecia at treatment completion decreased from 53.0% in Group A to 32.9% in Group B (p = 0.015). The overall proportion of time spent with Grade 2+ alopecia fell from 17.3% to 6.5% (p < 0.001). In the ddAC f/b wPTX regimen, the median number of Grade 2+ cycles reduced from 10.0 to 4.0 (p = 0.033). While the wPTX f/b ddAC regimen showed a numerical reduction (1.0 vs. 0.0 cycles), it did not reach statistical significance (p = 0.326). Conclusions: The refined multidisciplinary approach, including the integration of appearance care professionals, was associated with improved scalp cooling outcomes and lower median cycle numbers across regimens. Although these findings may be partly influenced by the baseline imbalance in chemotherapy regimens, this comprehensive team-based care model offers a feasible strategy for enhancing patient support in oncology settings. Full article