Search Results (320)

Background: S3-level clinical practice guidelines represent the highest standard of evidence-based healthcare, integrating systematic reviews, formal evidence grading, and structured expert consensus. In periodontology, current S3-level guidelines provide robust recommendations for the management of stage I–III periodontitis. However, increasing clinical complexity, emerging diagnostic technologies, and the need for patient-centred and implementation-oriented care highlight important gaps that warrant further methodological refinement. Objective: This review aims to critically appraise the conceptual foundations, strengths, and limitations of existing S3-level periodontal guidelines and to propose a structured roadmap for the development of next-generation S3 guidance. Methods: A narrative and methodological review was conducted focusing on key European S3-level guidelines in periodontology and endodontics, with emphasis on guideline methodology, evidence grading, outcome prioritization, and consensus processes. Results: Current S3-level periodontal guidelines demonstrate strong methodological rigor but show limited coverage of stage IV periodontitis, peri-implant diseases, and endo–perio lesions. In addition, emerging domains such as biomarker-based diagnostics, artificial intelligence-assisted decision support, and implementation science are not yet systematically integrated. Conclusions: Future S3-level periodontal guidelines should incorporate clinical complexity, patient-reported outcomes, precision diagnostics, digital technologies, and real-world implementation strategies to enhance personalization, transparency, and clinical impact. Full article

Background: Adult females with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are frequently underdiagnosed due to gender bias, overlapping symptoms, and limited awareness among healthcare professionals. The scarcity of research on this subject—particularly in the UK context—underscores the need for further investigation. Accordingly, the aim of this study was to explore the lived experiences of adult females receiving a late diagnosis of ASD and/or ADHD and to identify key barriers within the UK diagnostic pathway. This study addresses a critical knowledge gap by examining the factors contributing to delayed diagnosis within the United Kingdom. Study Design and Method: The study employed a qualitative approach, utilising an anonymous online questionnaire survey comprising nine open-ended questions. Responses were obtained from 52 UK-based females aged 35–65 years who had either received or were awaiting a diagnosis of ASD and/or ADHD. Data were analysed thematically within a constructivist framework. Findings: The analysis revealed three overarching themes: (i) limited understanding and lack of empathy among healthcare professionals, (ii) insufficient post-diagnostic support, with most participants reporting no follow-up care, and (iii) a complex, protracted diagnostic process, often involving waiting periods exceeding three years. Gender bias and frequent misdiagnosis were recurrent issues, contributing to significant psychological distress. These findings underscore the need for systemic reforms and align closely with gaps identified in the existing literature. Conclusions: The findings emphasise the urgent need for gender-sensitive diagnostic frameworks, enhanced professional training, and a person-centred approach to care. Key recommendations include shortening diagnostic waiting times, strengthening healthcare professionals’ knowledge base, and ensuring equitable and consistent post-diagnostic support. Full article

Background and Objectives: Telemedicine has become an essential component of chronic Inflammatory Bowel Disease (IBD) care, yet the factors that shape patient satisfaction with remote consultations remain only partially understood. This study aimed to assess satisfaction with institutional telemedicine services among Italian patients with ulcerative colitis (UC) and Crohn’s disease (CD), and to identify sociodemographic, clinical and organisational predictors to inform more person-centred telehealth models. Materials and Methods: We conducted a prospective, multi-centre, cross-sectional study in three IBD units in northern, central and southern Italy between June and October 2024. Consecutive adult patients who had completed a scheduled, non-emergency telemedicine visit were invited within 24–48 h to complete an online questionnaire including the Italian Telemedicine Satisfaction Questionnaire (I-TSQ), sociodemographic items, IBD-related variables, and telemedicine process indicators (accessibility, technology usability, technical support, time saved). Data were analysed descriptively and with multivariable linear regression to determine independent predictors of satisfaction, adjusting for recruiting centre. Results: A total of 705 patients participated (54.9% UC; 55.3% disease duration > 10 years). Overall, telemedicine satisfaction was high (mean I-TSQ total 57.5 ± 4.9; range 35–70), and all respondents reported reduced indirect costs compared with in-person visits. Greater ease of technology use, more frequent contact with the care team, male sex, older age, and employment were independently associated with higher satisfaction scores. Conversely, first-ever teleconsultations, CD, subcutaneous therapies, more difficult platform access, and the need for technical support were linked to lower satisfaction. Model fit was modest (R² up to 0.20), suggesting the presence of additional unmeasured relational and contextual factors. Conclusions: Telemedicine for IBD is widely accepted in Italy, but satisfaction is strongly conditioned by digital usability, previous experience, and clinical complexity. Tailored telehealth pathways that incorporate user-friendly platforms, proactive technical support, and attention to vulnerable subgroups are needed to translate high satisfaction into sustained, equitable remote care. Full article

Background: Music therapy is a non-pharmacological psychosocial intervention that is increasingly recognised for its role in supporting older adults in acute hospital settings. Engagement with music, whether through passive listening, preferred recorded music, live music, or creative music therapy, has been linked to improvements in behavioural, cognitive, and emotional outcomes during episodes of delirium. Although there are reviews on non-pharmacological approaches to delirium, few have focused specifically on music therapy within acute hospital environments. Methods: This scoping review examined the evidence relating to music-based interventions for older adults who are experiencing delirium or who are at risk of delirium in acute care settings. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR). Four electronic databases were searched systematically, namely, CINAHL, Medline, PsycINFO and Embase. Results: Seven primary research studies published between 2004 and 2024 met the inclusion criteria. A narrative synthesis approach was used to summarise the data. Three themes were identified. The first relates to the extent to which music therapy may reduce the incidence or severity of delirium or other related behaviours in acute hospital settings. The second relates to the potential for music-based interventions to support clinical practice by improving interaction between patients and staff and reducing distress during recovery and enhancing physical recovery. The third relates to the impact of music therapy on emotional regulation, engagement, cooperation with care, and overall patient experience. Conclusion: Music therapy shows promise as a person-centred, safe, and low-cost intervention that may enhance wellbeing and support delirium care for older adults in acute hospital settings. Further high-quality studies are needed to strengthen the evidence base and guide practice. Full article

Background: Treatment nonadherence in oncology is common. Surveys often miss why patients do not follow recommendations. We synthesised Natural Language Processing (NLP) studies, mainly sentiment analysis, of patient-generated content (social media, forums, blogs, review sites, and survey free text) to identify communication and relationship factors linked to nonadherence and concordance. Methods: We conducted a scoping review (PRISMA-ScR). Searches of PubMed, CINAHL, and Scopus from 2013 to 15 June 2024 identified eligible studies. We included 25 studies. Data were charted by source, cancer type, NLP technique, and adherence/concordance indicators, then synthesised via discourse analysis and narrative synthesis. Results: Four themes emerged: (1) unmet emotional needs; (2) suboptimal information and communication; (3) unclear concordance within person-centred care; and (4) misinformation dynamics and perceived clinician bias. Sentiment analysis helped identify emotions and information gaps that surveys often miss. Conclusions: Patient-voice data suggest practical actions for nursing, including routine distress screening, teach-back, misinformation countermeasures, and explicit concordance checks to improve adherence and shared decision making. Registration: Not registered. Full article

Background: Effectively managing pain in adults remains challenging, particularly in individuals with cognitive impairment or communication difficulties. Digital technologies, including artificial intelligence (AI)-enabled facial recognition and mobile applications, are emerging as innovative tools to improve the objectivity and consistency of pain evaluation. This scoping review aimed to map the current evidence on digital pain-assessment tools used with adult and older populations, focusing on validity, reliability, usability, and contributions to person-centred care. Methods: The review followed the Joanna Briggs Institute methodology and Arksey and O’Malley framework and was reported in accordance with PRISMA-ScR guidelines. Systematic searches were conducted in PubMed, CINAHL Complete, Medline (ALL), and PsycINFO for English-language studies published from 2010 onwards. Eligible studies included adults (≥18 years) using digital tools for pain assessment. Data extraction and synthesis were performed using Covidence, and findings were analyzed thematically. Results: Of 1160 records screened, ten studies met inclusion criteria. Most research was quantitative and conducted in high-income clinical settings. Five tools were identified: ePAT/PainChek^®, Painimation, PainCAS, Pain Clinical Assessment System, and Active Appearance Model. Four key themes emerged: (1) Validity and Reliability of Digital Pain Assessment Tools; (2) Comprehensive Pain Evaluation Across Contexts (Rest vs. Movement); (3) Usability and Integration into Clinical Practice; (4) Enabling Person-Centred Pain Management and Future Directions. Conclusions: Emerging evidence suggests that facial-recognition-based digital pain-assessment tools may demonstrate acceptable psychometric performance and usability within dementia care settings in high-income countries. However, evidence relating to broader adult populations, diverse care contexts, and low-resource settings remains limited, highlighting important gaps for future research. Full article

Background: As ageing populations grow, the prevalence of dementia and pre-dementia conditions is rising. Emerging approaches to neurorehabilitation emphasize not only performance-based outcomes but also holistic, experiential, and person-centred aspects of care. The extended mind thesis further highlights the potential role of external tools in supporting impaired cognitive functions. Within this ecological and experiential perspective, Social Assistive Robotics (SAR) may offer a multidimensional approach to address cognitive, emotional, and social needs in neurocognitive disorders. Objective: To synthesize current evidence on the effects of robotic interventions within an enactive framework integrating mind, body, environment, and technology. Methods: A systematic search was conducted in PubMed, Ovid Medline, Scopus, ScienceDirect, Springer, Wiley, IEEE Xplore, ACM Digital Library, and the Cochrane Library. Due to heterogeneity among included studies, an umbrella review was performed using vote-counting by direction of effect as a non-quantitative synthesis method. Methodological rigour followed JBI and Cochrane guidelines. Results: Sixteen reviews were included. The strongest and most consistent benefits emerged for affective outcomes, particularly emotional response and social interaction p = 0.007 (two-sided). Conversely, outcomes related to cognition, anxiety, agitation, depression, and quality of life showed mixed or non-significant effects, while neuropsychiatric symptoms demonstrated no benefit. Conclusions: Discrepancies across reviews seem driven by methodological limitations in primary studies, limiting interpretability. The strength of this umbrella review lies in identifying systematic gaps that can guide future research. With stronger evidence, integrating SAR into experiential neurorehabilitation may offer a promising avenue for holistic, ecologically grounded care that extends beyond traditional task-based performance. Trial Registration: PROSPERO CRD420251165419. Full article

On behalf of Cell Therapy Transplant Canada (CTTC), we are pleased to present the Abstracts of the CTTC 2024 Annual Conference. The conference was held on 1–3 May 2024 in beautiful Victoria, British Columbia, at the Victoria Conference Centre, and attracted 293 in-person delegates and five virtual attendees. Several plenary sessions were held on topics such as gene therapy for hemoglobin disorders, optimizing donor selection, graft-versus-host disease (GvHD) strategies, collaborative care, survivorship, graft failure, and CAR-T therapy. Poster authors presented their work during a lively and engaging networking reception on Thursday, 2 May, and oral abstract authors were featured during the oral abstract session in the afternoon of Friday, 3 May 2024. Forty-nine (49) abstracts were selected for presentation as posters and six (6) as oral presentations. Abstracts were submitted within four categories: (1) Basic/Translational Sciences, (2) Clinical Trials/Observations, (3) Laboratory/Quality, and (4) Pharmacy/Nursing/Other Transplant Support. The top six (6) abstract authors were invited to give an oral presentation, and the top four (4) poster abstracts were selected to receive an award. All of these were marked as “Award Recipient” within the relevant category. Three abstracts were determined by the peer review panel to be inappropriate for this conference and were not invited to present at the conference, and two authors withdrew their abstract; therefore, five abstract numbers are missing from the list. We congratulate all the 2024 abstract presenters on their research and contributions to the field. Full article

Background/Objectives: Inborn errors of metabolism (IEM) are chronic, life-threatening genetic disorders with a significant cumulative prevalence worldwide. Advances in early diagnosis and treatment have significantly increased life expectancy, underscoring the need for specialised adult care units and the establishment of structured transition programmes from paediatric to adult services. We hereby present a functional transition model for IEM patients and share our implementation experience. Methods: Initiated in 2012, the partnership between the paediatric Hospital Sant Joan de Déu (HSJD) and the adult-care centre at Hospital Clinic of Barcelona (HCB) culminated in 2019 with the transference of the first IEM patients under the structured A10! Programme. This model is structured around the transition units of paediatric and adult centres to guarantee communication and functional management. Regular monthly meetings at each centre and joint quarterly sessions allowed for protocol harmonisation and personalised care planning. Coordinated engagement of the multidisciplinary health care teams with patients and families smoothed the transfer process. Results: Between 2019 and 2024, 94 IEM patients were successfully transferred. Diagnoses included intermediary metabolism defects (71.23%), lipid metabolism and transport disorders (4.25%), heterocyclic compound metabolism (2.12%), complex molecules and organelle dysfunction (6.37%), cofactor and mineral metabolism (2.12%), signalling defects (5.31%), and unclassified cases (8.51% of rare disorders, maybe non-IEM). Transition formats included 21 in-person joint visits in HSJD, 37 remote transitions during the COVID-19 pandemic, and 36 streamlined transfers via standardised protocols. Sessions, trainings, and meetings allowed the exchange of patients’ needs and protocols. Conclusions: The successful transference of IEM patients requires structured programmes with interdisciplinary paediatric and adult teams, joining efforts with the patient, families, and caregivers. Communication between paediatric and adult transition units is essential to promote continuity of care and patient empowerment. While constantly updated, this model has proven effective, gaining positive evaluations from healthcare professionals and patients alike, representing a scalable framework for lifelong management of IEM in adult care settings. Full article

Background/Objectives: Turnover intention among intensive care unit (ICU) nurses remains consistently higher than that observed in other clinical departments. A weakened professional identity and exposure to ethically challenging situations may further intensify nurses’ intention to leave. This study aimed to examine the influence of moral distress, person-centred care, and nursing professional pride on turnover intention among ICU nurses in South Korea. Methods: A descriptive cross-sectional design was employed using a convenience sample of 203 ICU nurses from three general hospitals in South Korea. Data were obtained between 26 September and 31 October 2024 and analysed using IBM SPSS Statistics for Windows, version 29.0.2.0, with t-tests, one-way analysis of variance, Pearson’s correlation coefficients, and stepwise multiple regression analysis. Results: Two subdomains of nursing professional pride—role satisfaction and willingness to stay—along with gender (male) and the futile care subdomain of moral distress were the main factors influencing turnover intention. These variables collectively explained 24.9% of the variance in turnover intention (F = 17.78, p < 0.001). Conclusions: Strengthening nursing professional pride—particularly role satisfaction and willingness to stay—and reducing futile care-related moral distress may help lower ICU nurses’ turnover intention. Organisational strategies, including ethical management programmes and supportive policies, are recommended to enhance nursing professional pride, alleviate moral distress, and promote long-term nurse retention. Full article

This narrative review explores how specialised clinical competencies and artificial intelligence (AI) technologies converge in the context of perioperative care, with a focus on their combined potential to improve patient safety. Considering the growing complexity of surgical care and rising demands on healthcare professionals, the study aims to understand how human expertise and digital tools can complement each other in this high-stakes environment. Methods: A narrative review methodology was adopted to integrate insights from diverse sources, including empirical studies, policy documents, and expert analyses published over the last decade. Findings reveal that AI can support clinical decision-making, streamline workflows, and enable earlier identification of complications across all perioperative phases. These technologies enhance, rather than replace, the roles of nurses, anesthetists, and surgeons. However, their effective use depends on critical factors such as digital literacy, interdisciplinary collaboration, and ethical awareness. Issues related to data privacy, algorithmic bias, and unequal access to technology highlight the need for thoughtful, inclusive implementation. The future of perioperative care will likely depend on hybrid models where human judgment and AI-based tools are integrated in ways that uphold safety, equity, and person-centred values. Full article

Aim: The aim of this study was to explore the experiences and challenges faced by informal caregivers of people with Alzheimer’s, including the social and emotional aspects of their caregiving role. Methods: A descriptive qualitative study was conducted using one focus group discussion and eleven semi-structured interviews with informal caregivers of individuals diagnosed with Alzheimer’s disease. The data collected were analyzed through thematic analysis using ATLAS.ti qualitative software version 23. Results: The results reveal two themes: (1) “Life centred on compassionate care for the other person”, which reflects the role performed from a perspective of emotional and compassionate commitment to those in need of care, and (2) “Abandonment by caregivers”, which expresses the emotional cost associated with caregiving. Conclusions: Informal caregivers of people with Alzheimer’s disease undertake their roles guided by compassion, which involves substantial personal sacrifice. This commitment often leads to self-abandonment, impacting their emotional and physical health, social relationships, and personal aspirations. It is therefore crucial to implement psychosocial interventions grounded in compassion and to strengthen both formal and informal social support systems for caregivers. Full article

Background and Clinical Significance: Familial short stature is a common reason for referral in clinical genetics. While often attributed to a single genetic cause, genetic heterogeneity can complicate diagnosis and management. This report describes a family in which three distinct pathogenic variants in SHOX, PDE4D and ACAN caused overlapping phenotypes of familial short stature. Case Presentation: Clinical, radiological and molecular data were collected retrospectively at the Reference Centre for Constitutional Bone Diseases at Montpellier University Hospital. Targeted gene panels, whole genome sequencing and Sanger sequencing were employed to identify pathogenic variants. Variant interpretation followed the guidelines of the American College of Medical Genetics. A pathogenic SHOX variant (c.452G>A; p.Ser151Asn) was identified in the proband and her mother, which is consistent with dyschondrosteosis. A de novo PDE4D variant (c.671C>T; p.Thr224Ile) was identified in a cousin presenting with syndromic acrodysostosis. An ACAN splice variant (c.6833-1G>A) was detected in several family members and is associated with short stature and skeletal anomalies. An individual carrying both the SHOX and ACAN variants exhibited a more severe phenotype, suggesting an additive effect. Conclusions: This case study highlights the importance of systematic molecular investigations in families with overlapping yet heterogeneous phenotypes. Comprehensive genetic familial analysis enables personalized care and accurate genetic counselling, particularly when multiple diagnoses coexist. A family history should not preclude molecular testing, since similar phenotypes can result from different genetic causes. Full article

Background/Objectives: Health literacy (HL) plays a fundamental role in maternal and neonatal outcomes by influencing women’s ability to access, understand, and apply health information during pregnancy. However, evidence regarding the determinants of HL among pregnant women remains limited, particularly within the Spanish context. This study aimed to assess HL levels among pregnant women and to examine their association with personal, socioeconomic, and health-related factors. Methods: A cross-sectional study was conducted between January 2023 and February 2024 across nine primary care centres within the Vigo Health Area (Spain), including 182 pregnant women receiving prenatal care. HL was measured using the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16). Sociodemographic, obstetric, and health-related variables were collected through structured interviews. Descriptive and inferential analyses were performed to explore associations between HL and the selected variables. Results: Limited HL was observed in 35.7% of participants. A significant association was found between HL and family income (p = 0.037), with limited HL being more frequent among women with a monthly family income below €2000. No associations were identified with other sociodemographic or health-related variables. Thirty-nine per cent of participants visited hospital emergency services on two or more occasions, mostly without admission. The main source of information was healthcare professionals, although Internet use was also relevant. Conclusions: The prevalence of limited HL was lower than that reported in other national studies, although inequalities related to family income persisted. These findings highlight the need to incorporate systematic, HL-tailored strategies into prenatal care, based on prior HL assessment, to promote informed decision-making and improve maternal and neonatal outcomes. Full article

Background: The aged care sector in Australia is increasingly focused on a personalised care approach which prioritises dignity and respect for older adults. With a growing ageing population, we are also seeing more complexity in health needs and palliative care. Allied health professionals are skilled in the delivery of care that fosters independence and quality of life as health deteriorates. However, in the recent aged care reform, there has been concern that allied health are not clearly recognised for their role in aged and palliative care. Methods: Qualitative study using semi-structured interviews with aged care service providers and allied health peak body representatives and clinicians to understand the perceived impact of aged care reforms in Australia on allied health workforce. Guided by a constructivist epistemology, reflexive thematic analysis was used to understand key themes. Results: Eight interviews were conducted, yielding one key theme and three sub themes. These were person-centred palliative care, advocates, location of care matters, and funding model, with the key theme of the funding model intersecting with all other themes. Conclusions: The issue of recognising allied health best practice in aged and palliative care is multifactorial. At the heart of the problem appears to be how well recognised allied health disciplines are for the value of their contribution, and constraints imposed by funding models and sector priorities on the sufficient input of the full scope of practice. Without a sufficient and skilled workforce supported to enact their full scope, the ability to deliver a personalised care approach and outcomes for our ageing population will suffer. Full article