Search Results (962)

Simulation-based learning experiences (SBLE) are widely used in health professions education to enhance clinical skills, confidence, and decision-making in a safe environment. In Doctor of Physical Therapy (DPT) programs, peer simulation offers a cost-effective alternative to high-fidelity simulation and standardized patients, though its effectiveness across different instructional formats remains underexplored. This study examined the differences in student confidence in outpatient physical therapy between cohorts of students from three educational delivery methods, which included face-to-face (F2F), virtual instruction (VI), and F2F combined with integrated clinical experiences (F2F + ICE), prior to their first clinical experience. Using a three-group comparative design, 107 students across three academic years (2019, 2020, and 2022) completed pre- and post-course surveys assessing confidence in four domains and interest in outpatient care. A two-way ANCOVA, controlling baseline interest, revealed significant differences in confidence across all cohorts between pre- and post-course assessment time periods (p < 0.001), with no significant differences between cohorts under the various delivery formats at post-course assessment. While the F2F + ICE group demonstrated higher baseline confidence, this difference was not found post-course. Findings suggest that peer simulation effectively improves perceived confidence in outpatient physical therapy regardless of delivery mode. These results support the integration of SBLE in DPT curricula to prepare students for clinical practice and highlight the need for further research across multiple programs. Full article

Background/Objectives: Chemsex is defined as the intentional use of psychoactive substances to enhance or prolong sexual activity, predominantly observed among men who have sex with men. It has emerged as a notable behavioral and public health concern due to its association with high-risk sexual practices, psychiatric morbidity, and somatic complications. Despite increasing recognition, global prevalence estimates vary widely (3–52.5%) due to differences in study populations and methodology. Commonly used substances include synthetic cathinones, amphetamines/methamphetamines, MDMA, GHB/GBL, ketamine, alkyl nitrites, and PDE-5 inhibitors. Methods: A narrative review was conducted using PubMed through 11 December 2025. Search terms combined chemsex-related terminology, substance names, and health outcomes. Recent English-language publications (2020–2025) were prioritized. Evidence was synthesized thematically across epidemiology, health complications, motivations, and interventions. Results: Chemsex is strongly associated with unprotected sex, multipartner encounters, and prolonged intercourse, leading to significantly increased rates of HIV, syphilis, gonorrhoea, and chlamydia. Psychiatric complications include depression, anxiety, compulsive sexual behavior, and psychosis, with higher risks in individuals engaging in slamming or polysubstance use. Somatic complications vary by substance and include cardiovascular disease, hyponatremia, rhabdomyolysis, ulcerative cystitis, methemoglobinemia, and overdose. Motivational factors extend beyond sexual enhancement and include minority stress, internalized and externalized stigma, and maladaptive coping mechanisms. Integrated interventions combining harm reduction, cognitive–behavioral therapy, peer-led services, and pharmacotherapy, alongside digital health tools to support PrEP adherence and risk reduction, show promise in mitigating these harms. Conclusions: Chemsex represents a complex interplay of biological, psychological, and sociocultural factors that contribute to elevated STI risk and psychiatric and somatic morbidity. Addressing chemsex requires destigmatized, multidisciplinary approaches that integrate behavioral, pharmacological, and community-based interventions. Digital health innovations can further enhance engagement, risk reduction, and access to timely care. Full article

Background: Artificial intelligence (AI) has emerged as a transformative tool in medicine, leveraging rapid analysis of large datasets to accelerate diagnosis, enhance clinical decision-making, and improve clinical workflows. This is highly relevant in stroke care given the time-sensitive nature of the disease process. This review evaluates the current landscape of evidence-based medicine utilizing AI in stroke, with emphasis on its use in phases of clinical care across the stroke continuum, including pre-hospital, acute, and recovery phases. This offers a comprehensive understanding of the current state of AI in both practice and literature. Methods: A review of major databases was conducted, identifying peer-reviewed literature evaluating the use of AI and its level of evidence across the stroke continuum. Given the heterogeneity of study designs, interventions, and outcome metrics spanning multiple disciplines, findings were synthesized narratively. Results: Across all phases of care, there remain no randomized controlled trials (RCTs) evaluating patient-level outcome data using AI (Level A). In the pre-hospital phase of care, AI has been used to identify stroke symptoms and assist EMS routing/training but presently remains limited to research. AI is most studied in the acute phase of care, representing the only phase to achieve commercial application in imaging detection and telestroke assistance, supported by non-randomized evidence (Level B-NR). In the recovery phase, AI may enhance wearable technologies, tele-rehabilitation, and robotics/brain–computer interfaces, with early RCTs (Level B-R) supporting the latter two, representing the strongest evidence for AI in stroke care to date. Conclusions: Despite the potential for AI to transform all phases of care across the stroke continuum, major challenges remain, including transparency, generalizability, equity, and the need for externally validated clinical studies. Full article

Background/Objectives: The incorporation of peer support within mental health services has shown benefits for service users’ recovery and engagement, yet implementation is often hindered by role ambiguity and limited institutional recognition. The aim of this study is to explore the experiences of workers in a programme that provides peer support within a personal assistance model. The focus is on how they perceive the shaping of their professional role and their integration within care teams, rather than on evaluating service outcomes or effectiveness. Methods: An interpretive qualitative methodology with an exploratory approach was used. The study was conducted in a single organisational setting and focused on the self-reported experiences of personal assistants. Fieldwork was conducted in 2025 with ten personal assistants. Data were obtained through individual semi-structured interviews and one focus group with the same participants. A thematic content analysis combining inductive and deductive coding strategies was conducted using MAXQDA (version 24.11). Results: Findings indicate that the Personal Assistant role was perceived as reducing some of the ambiguity commonly associated with peer support, due to a clearer contractual framework and a more explicit delineation of functions. However, tensions persisted in relation to its hybrid professional identity, experiences of task overload, and ongoing gaps in coordination with traditional professional roles. Key facilitators included institutional support, accessible coordination, a supportive culture of care, and informal peer networks. Perceived benefits were reported for service users, including increased trust, hope, and autonomy, as well as for assistants, who described enhanced professional purpose and progress in their own recovery, alongside risks of emotional strain. Conclusions: Analysing the perspective of participants, the personal assistance model may represent a promising framework for the professionalisation of peer support through functional clarity, continuous supervision, and recognition of experiential knowledge. Further progress requires strengthening internal communication, expanding training opportunities, and enhancing the structural participation of personal assistants in decision-making. The study contributes an exploratory qualitative perspective to the growing literature on integrating lived-experience professionals into mental health services. Full article

In contemporary education, schools are increasingly expected to foster students’ subjective well-being alongside academic achievement, as both are recognized as mutually reinforcing conditions for learning, success, and long-term outcomes. This study presents Appwel, a scalable instrument assessing pupils’ self-reported school experiences. It contains 21 statements rated on a 5-point Likert scale. Appwel was developed through a sequential three-phase process. First a Delphi study (N = 40) identified key concepts, which informed questionnaire development. Second, an exploratory factor analysis in a large, voluntary sample of Flemish secondary school students (N = 44,870) examined the underlying structure. Third, a confirmatory factor analysis in an independent student sample (N = 56,624) provided initial evidence of validity and reliability for a four-factor model with satisfactory fit and internal consistency across gender and grade. The final structure comprised class climate and engagement, peer relationships, academic self-concept, and authenticity and support, offering a practically applicable framework for monitoring students’ school well-being. Grounded in internationally established models of school well-being, Appwel is context-specific to the adolescent school setting; however, its theoretically informed format allows for careful adaptation and future examination of its applicability across different educational, cultural, and longitudinal contexts. Full article

Objectives: To synthesize current evidence and emerging data on systemic treatment strategies for early-stage and locally advanced human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC), with emphasis on treatment de-escalation and the integration of immunotherapy. Data Sources: We searched PubMed/MEDLINE, Scopus, and EMBASE for English-language studies published from 2010 to 2025 using terms related to HPV-positive disease, oropharyngeal carcinoma, de-escalation, chemoradiation, and immunotherapy. Review Methods: Peer-reviewed clinical trials, meta-analyses, and key translational studies addressing systemic therapy, biomarkers, and immunotherapeutic strategies in HPV-positive OPSCC were included. Emphasis was placed on phase II–III trials evaluating cisplatin-sparing regimens, cetuximab substitution, radiation dose reduction, and early-phase immunotherapy combinations. Evidence was synthesized qualitatively. Results: Cisplatin-based concurrent chemoradiation remains the standard of care for locally advanced HPV-positive OPSCC. De-intensification trials suggest that reduced-intensity regimens may be feasible in carefully selected low-risk patients; however, replacing cisplatin with cetuximab results in inferior survival. PD-1 inhibitors (e.g., pembrolizumab, nivolumab) provide durable responses in recurrent/metastatic disease and are under active evaluation in earlier stages and in combination with therapeutic vaccines, bispecific antibodies, and viral-vector platforms. Conclusions: Systemic therapy for HPV-positive OPSCC is moving toward biomarker-informed personalization. Cisplatin-based chemoradiation remains the curative backbone, while rational de-escalation and immunotherapy integration may preserve high cure rates while reducing long-term toxicity. Ongoing phase III trials will clarify which patient subsets are most suitable for de-intensified or immunotherapeutic approaches, guiding future standards of care. Full article

Gender incongruence significantly impacts the family system, yet the subjective experiences of caregivers remain relatively underexplored. This narrative review synthesizes contemporary evidence regarding psychological distress, emotional burden, and quality of life among caregivers of transgender and gender-diverse individuals. A targeted literature search of PubMed, Scopus, PsycInfo, and Google Scholar (2015–2025) was conducted, identifying 16 studies for thematic synthesis. Results indicate that caregivers consistently report elevated emotional distress, characterized by chronic anxiety, hypervigilance, and ambiguous loss. This burden is primarily driven by prolonged exposure to uncertainty, the weight of complex medical decision-making—particularly regarding fertility and hormone therapy—and vicarious minority stress stemming from social stigma and systemic barriers. Notably, distress is often intensified by sociopolitical climates rather than the transition process itself. Conversely, access to peer support networks, healthcare relationships, and engagement in advocacy emerged as vital protective factors facilitating resilience and adaptive meaning-making. We can conclude that caregiver well-being is a multifaceted process deeply embedded in social and institutional contexts. These findings underscore the necessity of integrated, family-centered medical-psychological models that explicitly support caregivers to ensure more equitable and effective gender-affirming care pathways. Full article

Background: The year 2025 witnessed paradigm-shifting advances in gynecologic oncology, with pivotal clinical trial results redefining therapeutic standards across cervical, ovarian, endometrial, and vulvar cancers. Objectives: This systematic review aimed to comprehensively identify, synthesize, and critically evaluate pivotal phase II and III randomized controlled trials and major studies presented at the major annual meetings, alongside significant peer-reviewed publications from 2025 that introduce innovative therapeutic strategies across gynecologic malignancies. Methods: Conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, this review involved exhaustive searches of electronic databases (PubMed/MEDLINE, Embase), conference proceedings (ASCO 2025, ESMO 2025), and major oncology journals for records from January to December 2025. Inclusion criteria encompassed: (1) Phase II or III randomized controlled trials (RCTs) and (2) Non-randomized studies (including phase I and II trials), reporting on novel therapeutic approaches in gynecologic oncology. All studies were required to report primary survival endpoints (overall survival or progression-free survival) or key efficacy outcomes. Study selection, data extraction, and methodological quality assessment were performed independently by two reviewers, with disagreements resolved through consensus or third-party adjudication. Results: From 1842 records, 23 studies met inclusion criteria (17 phase-III RCTs and 6 non-phase III RCTs/early-phase studies), distributed as follows: cervical cancer (9 studies, 39%), ovarian cancer (9 studies, 39%), endometrial cancer (4 studies, 17.5%), and vulvar cancer (1 study, 4.5%). The major advances identified include: (1) In cervical cancer, the KEYNOTE-A18 trial established pembrolizumab combined with chemoradiotherapy as a new standard for high-risk locally advanced disease, while the PHENIX trial validated sentinel lymph node biopsy as a safe surgical de-escalation strategy. (2) In ovarian cancer, the ENGOT-ov65/KEYNOTE-B96 trial demonstrated the first statistically significant overall survival improvement with an immune checkpoint inhibitor in platinum-resistant recurrent disease, establishing pembrolizumab plus weekly paclitaxel as a new standard of care. Novel therapeutic mechanisms, including glucocorticoid receptor modulation (ROSELLA trial) and cadherin-6-targeted antibody-drug conjugates (REJOICE-Ovarian01), showed remarkable efficacy. (3) In endometrial cancer, updated analyses from NRG GY018 and RUBY trials solidified the role of first-line immuno-chemotherapy, with differential benefits according to mismatch repair status. (4) In vulvar cancer, a pivotal phase II study demonstrated meaningful clinical activity of anti-PD-1 therapy in advanced disease. (5) The extensive circulating tumor DNA analysis from the CALLA trial provided crucial insights into biomarker dynamics in cervical cancer. Conclusions: The convergence of high-impact data from 2025 established multiple new standards of care, emphasizing biomarker-driven approaches, immunotherapy integration across disease stages, and novel mechanisms to overcome resistance, while highlighting challenges in treatment sequencing and global access. Full article

The management of rheumatoid arthritis (RA) has undergone several practice-defining evolutions, beginning with the approval of low-dose methotrexate and continuing through the introduction of numerous disease-modifying antirheumatic drugs (DMARDs). With increasing capability to target pro-inflammatory pathways, successive therapeutics have carried the promise of improved disease control for patients with RA; however, many patients still fail to meet treatment objectives, leading to the recognition of clinical phenotypes that remain therapeutically challenging under the current treat-to-target standard of care, including preclinical inflammatory arthritis, late-onset RA, and treatment-resistant RA. Precision medicine approaches are beginning to characterize the pathogenesis of RA in such populations, and to inform effective tailoring of DMARD therapy to individual patients. Simultaneously, observational data derived from clinical practice are increasingly being used to understand the risks and benefits of long-term DMARD therapy under real-world conditions of use, with registries and other observational sources confirming long-term effectiveness, revising safety profiles, and estimating the costs of treatment for approved therapies. Together, these strategies offer opportunities to address unmet needs in the care of patients with RA. In this review of peer-reviewed clinical and translational research in RA, we identify several clinical phenotypes that demonstrate inadequate response to guideline-directed therapy and review frontiers in clinical research in RA emerging over the last decade, highlighting the use of precision medicine and real-world evidence-based approaches to advance individualized, patient-centered care. Full article

Elder abuse is an increasingly common problem in modern society, in the context of rapid population aging. Despite increasing awareness, this phenomenon remains heavily underreported, and effective interventions are yet to be made, thus leading to significant medical, social, and legal implications. The purpose of this review is to present an updated situation of the depths of elder abuse, presenting its prevalence both at the global and European level, the two main environments in which it is the most common (community and institutional settings), different forms of abuse, risk factors, and consequences for each one of them, as well as medico-legal aspects on the matter. A narrative review was conducted based on PubMed/MEDLINE, Scopus, and Web of Science databases, in association with data presented in reports from international organizations. The review included only articles published in English, in peer-reviewed journals, addressing elder abuse in adults aged 60 years and older, and those that didn’t respect the criteria were excluded. Elder abuse comes in different forms, most of the time overlapping, with psychological abuse being the most prevalent. Each one of them has its own risk factors and specific consequences, but all of them will eventually lead to increased morbidity, accelerated cognitive impairment, and functional decline. In community settings, the elders usually experience abuse related to dependency on the family and social isolation, while in institutional settings, abuse is frequently associated with understaffing and inadequate care. From a forensic perspective, functional and cognitive decline complicate the proper documentation of the abuse. Thus, the role of the physician in providing legal support to the victim is essential. Elder abuse continues to be heavily overlooked, losing sight of the fact that its consequences extend beyond immediate physical harm, affecting the general physical and mental health of the victims. A possible solution to this problem is envisioned, with the purpose of raising awareness of this situation and contributing to a change in the perspective from which society looks at the elderly. Full article

The number of older women imprisoned is increasing around the world, leading to an increased demand on health and social care services within prisons. Imprisoned women are considered older by age 50 as they experience a disproportionate burden of cancer and disease. Access to prison cancer screening programmes in prison should mirror access in the community; however, this is not always the case. The purpose of this scoping review is to systematically review the literature relating to enablers and barriers of cancer screening programmes in imprisoned older women. We performed a scoping review using the Arksey and O’Malley framework. Twelve studies were identified. Locations of studies varied across high-income countries. Enablers and barriers were identified within operational, personal, and accessibility categories. To improve mortality relating to cancer diagnosis it is vital that older imprisoned women are supported to access cancer screening. It was identified that older imprisoned women have different needs to other prison populations, and the barriers and enablers identified relate to staffing, communication, peer support, and processes to improve the experience of the older prison population. There is limited research in this area, and older women are a minority in a marginalized prison population. More research is needed to ensure the appropriate and effective development of cancer screening services. Full article

Background/Objectives: Self-care is a cornerstone of healthy aging and chronic disease management; however, evidence on the most effective intervention models for improving quality of life in older adults with chronic non-communicable diseases (NCDs) remains fragmented. This review aimed to evaluate the effectiveness of self-care interventions in promoting quality of life and health outcomes in older adults with NCDs. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251040613). Randomized and non-randomized clinical trials published between 2019 and 2024 were retrieved from Scopus, Web of Science, and EBSCOhost. Eligible studies included adults aged ≥60 years with NCDs receiving self-care interventions. Data extraction and risk of bias assessment were independently performed using Joanna Briggs Institute tools. Results: Twenty-nine studies involving 7241 older adults were included. Self-care interventions comprised nurse-led educational programs, digital health strategies, community- and peer-based approaches, and person-centered care models. Multicomponent and continuous interventions demonstrated consistent improvements in physical and psychological domains of quality of life, self-efficacy, autonomy, symptom management, and treatment adherence. Digital interventions enhanced monitoring and engagement, although their effectiveness varied according to sensory and health literacy limitations. Conclusions: Structured, person-centered, and nurse-led self-care interventions are effective in improving quality of life and autonomy among older adults with NCDs. These findings support their integration into primary and community-based care, reinforcing their relevance for clinical practice, care planning, and the development of assistive and educational strategies in aging care. Full article

Canada’s ageing population continues to grow rapidly and significantly more diverse, which will require unique health and home service needs. The COVID-19 pandemic exacerbated existing challenges in Canada’s healthcare system and demonstrated the need for long-term care (LTC). Semi-structured interviews were conducted with 17 decision makers, managers, and leaders in long-term ethnically focused facility care. Braun & Clarke’s six-stage process of thematic analysis was applied using an iterative, deductive approach to examine the experiences of stakeholders involved in the operational, managerial, financial, and clinical aspects of an ethnicity-focused LTC. Findings highlighted salient characteristics of impactful ethnicity-focused care and factors were uniquely shaped by the delivery of culturally specific care. Key subthemes included social isolation and emotional impact, operational and logistic difficulties during COVID-19, mitigation measures implemented in response, and the social, behavioural, and health benefits observed among seniors living in these LTC homes. Participants identified political and economic constraints (e.g., provincial funding) to establishing ethnicity-focused care homes but proposed several solutions and highlighted potential benefits that could support successful implementation. Analysis of experiences of operational challenges in safely and adequately running ethnicity-focused LTC reinforces the value of ethnicity-focused LTC during times of crisis such as the COVID-19 pandemic, as they provide a culturally safe and familiar space with preventive measures applied in a timely manner for seniors to engage with their peers in an environment that meets their health needs, ensuring safety standards. Full article

Objectives: Personalized medicine is gaining rapid attention over the current drug prescription approach of ‘one-size-fits-all’. Three-dimensional (3D) printing is one such product development technique that has the potential to transform the pharmaceutical and biomedical sectors. Methods: To establish the future of 3D printing in mainstream pharmacy practice, initially, pharmaceutical preclinical and clinical scientific databases (peer-reviewed articles, patents, and marketed products) over the past 10 years were critically scrutinized. Additionally, to provide context, we developed a hypothetical case study illustrating the capabilities of the 3D printing super-compounding pharmacy in personalized patient care, emphasizing the critical role of pharmacists in this process. Results: Acknowledging the potential of 3D printing in pharmacy practice, this review effectively summarizes the advances and opportunities of pharmaceutically feasible 3D printing methods, as well as the challenges in translating this technology into a future super-compounding pharmacy facility. Furthermore, the review highlights the promising capabilities of such pharmaceutical 3D printers in enabling on-site printing of 3D medicines tailored to individual needs, which may range from dose adjustments to multidrug single tablets (polypills). Conclusions: We believe that 3D printing technology has the potential to revolutionize precision and personalized medication approaches in pharmacy practice, which will significantly benefit patient healthcare outcomes. Additionally, the adoption of such technology in pharmacies will lead to a reinvention of the role of pharmacists, thereby creating more job opportunities. Ultimately, 3D printing will create a new paradigm of super-compounding pharmacy practice, providing a new sense of excitement for those looking to enter the pharmacy profession. Full article

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide. This increases the demand for real-world evidence to complement findings from randomized controlled trials. The German IQVIA Disease Analyzer (DA) database, which is populated with anonymized electronic medical records from general practitioners and specialists, has become an increasingly valuable source for cardiovascular research. Over the past two decades, and especially between 2020 and 2025, numerous epidemiological studies have used this database to explore associations between cardiovascular risk factors, comorbidities, therapeutic patterns, and cardiovascular outcomes in large, broadly representative outpatient populations. This review synthesizes evidence from 13 selected DA-based studies examining atrial fibrillation, heart failure, cardiometabolic disease, lipid management, non-alcoholic fatty liver disease (NAFLD)–related cardiovascular risks, cerebrovascular complications, COVID-19-associated vascular events, and modifiable behavioral and anthropometric factors. These studies were selected based on predefined criteria including cardiovascular relevance, methodological rigor, large sample size, and representativeness of key disease domains across the 2000–2025 period. Eligible studies were identified through targeted searches of peer-reviewed literature using the German IQVIA Disease Analyzer database and were selected to reflect major cardiovascular disease domains, risk factors, and therapeutic areas. Across disease domains, the reviewed studies consistently demonstrate the DA database’s capacity to identify reproducible associations between cardiometabolic risk factors, comorbidities, and cardiovascular outcomes in routine outpatient care. While causal inference is not possible, the database enables the identification of clinically meaningful associations that inform hypothesis generation, help quantify disease burden, and highlight gaps in prevention or treatment. The database’s strengths include large sample sizes (often exceeding 100,000 patients), long follow-up periods, and high external validity, while limitations relate to coding accuracy, residual confounding, and the absence of detailed clinical measures. Collectively, the evidence underscores the importance of the DA database as a crucial platform for real-world cardiovascular research. Full article