Search Results (685)

Effective risk communication designed for risk management increases concern and motivates action by providing guidance and specific actions that can be taken. When exposures to environmental contaminants or stressors are ubiquitous or pollutant sources are not easily controlled, also decreasing sustainability, risk communication is focused on actions for risk reduction and avoidance. Three recommended practices (use of virtual exemplars, narrative, and social media) are discussed as tactics and platforms to inform public beliefs and behaviors and to encourage adoption of long-term planning goals that avoid the consequences of future risks. These risk communication strategies appeal broadly to lay audiences, are not limited to scientists and science-trained risk communicators, and are consistent with the US EPA’s SALT Framework, a research-based approach with recommended practices to guide risk communication. The overall strategy is to make risk communication more effective by using approaches that are dynamic, interactive, engaging, and relatable. Full article

Background: Survival among children and adolescents and young adults (AYA) with cancer has improved substantially over recent decades; however, dominant survivorship models remain reactive—activated post-treatment and anchored to static exposure- and organ-based screening. This design underuses the anticipatory window at diagnosis and overlooks environmental and social determinants that modulate outcomes across the life course. Methods: We narratively reviewed international frameworks including the Children’s Oncology Group (COG), the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG), the Pan-European Network for Care of Survivors after Childhood and Adolescent Cancer (PanCare) and the National Comprehensive Cancer Network (NCCN), and synthesized evidence on environmental determinants, exposomics, toxicogenomics, and implementation. Building on two decades of real-world practice, we describe the evolution from the Pediatric Environmental History (PEHis) to the Ambiomic Health Compass (AHC), integrating genomic, exposomic, geospatial, clinical, and biomonitoring layers into routine care. In this framework, survivorship is conceptualized as beginning at the time of cancer diagnosis (“day 0”). Results: PEHis operationalizes guideline-based care with structured environmental and social assessment, personalized plans, and community integration, contributing to improved survival, healthier behaviors, reduced treatment-related mortality and stronger oncology–primary-care coordination. AHC extends PEHis with dynamic risk recalibration, contextual alerts, targeted biomonitoring, and toxicogenomic interpretation, enabling anticipatory decisions from day 0. The manuscript summarizes the paradigm shift (current vs. Ambiomic models), the domain-specific expansion over existing guidelines, the core clinical/system tools, and time-bound metrics (12, 24, 60 months) to support implementation and evaluation. Conclusions: Survivorship should move upstream—from late surveillance to ambiomic, exposure-aware care beginning at diagnosis. Integrating advanced exposomics, mutational epidemiology, and explainable analytics can reduce preventable events and chronicity, enhance equity, and align pediatric oncology with planetary health. The PEHis–AHC continuum offers a scalable blueprint for next-generation survivorship programs in Europe and beyond. Ambiomic medicine does not replace precision medicine—it completes and extends it by integrating exposomics, social context, and anticipatory analytics from day 0. Full article

Background/Objectives: Conversations about end-of-life care or advance care planning are often difficult and emotionally challenging to initiate. Tailoring messages to the specific audiences can make these sensitive discussions more manageable and effective. The Evidence-based Model for the Transfer and Exchange of Research Knowledge (EMTReK), compromising six core components (message, stakeholders, processes, context, facilitation, and evaluation) offers a structured framework for research dissemination and knowledge transfer in palliative and long-term care settings. Knowledge translation bridges research and practice, with its effectiveness depending on stakeholder engagement, tailored communication, and systematic application of evidence in policy and practice. This study explores stakeholder perspectives on a dementia care intervention, using EMTReK as an analytical framework to examine how knowledge transfer and exchange (KTE) actions were implemented across long-term care settings. Methods: A qualitative analysis was conducted on primary data comprising case narratives from multinational research groups involved in the “Caregiver Decision Support” (mySupport) study (2019–2023). Teams from Canada, the Czech Republic, Ireland, Italy, the Netherlands, and the United Kingdom evaluated the mySupport intervention through interviews, with analysis guided by components of the EMTReK model. Results: Facilitated Family Care Conferences were found to be effective mechanisms for supporting knowledge transfer and intervention uptake in dementia care across nursing homes in Europe and Canada. Despite challenges posed by the COVID-19 pandemic, Family Care Conferences adapted through stakeholder engagement, interactive learning, and innovative communication methods. Using EMTReK as an analytical framework, the research team identified key elements that contributed to successful implementation, including the importance of flexibility to accommodate local contexts. Conclusions: The transnational application of the EMTReK model for advance care planning in long-term dementia care highlights the importance of tailored, culturally relevant knowledge translation strategies, which, despite challenges from the COVID-19 pandemic, were successfully implemented through local adaptations and diverse dissemination methods, emphasising the need for further research on their impact on resident and family outcomes. Full article

This scoping review aimed to map and synthesize the scientific evidence on how lifestyle factors and quality of life are associated with the onset and progression of non-carious diseases (NCDs) in young and adult populations, identifying patterns, methodological characteristics, and gaps in the existing literature. A systematic literature search was conducted across PubMed, Embase, Scopus, and Web of Science databases to retrieve studies evaluating the influence of lifestyle habits and quality of life indicators on NCDs development and worsening. Most included studies were conducted in Brazil, with cross-sectional designs being the most prevalent. The main modulating factors identified included gastroesophageal reflux, post-bariatric conditions, smoking, bruxism, and anxiety. The results were summarized through a descriptive narrative synthesis. Considerable methodological heterogeneity was observed, particularly due to the absence of standardized protocols for NCDs assessment. Methodological quality was also evaluated to contextualize the robustness of the available evidence. Overall, lifestyle and quality of life factors play an important role in the progression of NCDs, underscoring the need for their integration into diagnostic and therapeutic planning. Further clinical studies are warranted to deepen the understanding of the relationship between NCDs and broader health domains, with particular attention to early oral aging syndrome (EOAS). Full article

Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains among the most complex procedures in interventional cardiology, with variable technical success and heterogeneous long-term outcomes. Conventional angiographic scores such as J-CTO and PROGRESS-CTO provide only modest predictive accuracy and neglect critical patient and operator-related factors. Artificial intelligence (AI) and machine learning (ML) have emerged as transformative tools, capable of integrating multimodal data and offering enhanced diagnostic, procedural, and prognostic insights. Methods: We performed a structured narrative review of the literature between January 2010 and September 2025 using PubMed, Scopus, and Web of Science. Eligible studies were peer-reviewed original research, reviews, or meta-analyses addressing AI/ML applications in CTO PCI across imaging, procedural planning, and prognostic modeling. A total of 330 records were screened, and 33 studies met the inclusion criteria for qualitative synthesis. Results: AI applications in diagnostic imaging achieved high accuracy, with deep learning on coronary CT angiography yielding AUCs up to 0.87 for CTO detection, and IVUS/OCT segmentation demonstrating reproducibility > 95% compared with expert analysis. In procedural prediction, ML algorithms (XGBoost, LightGBM, CatBoost) outperformed traditional scores, achieving AUCs of 0.73–0.82 versus 0.62–0.70 for J-CTO/PROGRESS-CTO. Prognostic models, particularly CatBoost and neural networks, achieved AUCs of 0.83–0.84 for 5-year mortality in large registries (n ≈ 3200), surpassing regression-based methods. Importantly, comorbidities and functional status emerged as stronger predictors than procedural strategy. Future Directions: AI integration holds promise for real-time guidance in the catheterization laboratory, robotics-assisted PCI, federated learning to overcome data privacy barriers, and multimodality fusion incorporating imaging, clinical, and patient-reported outcomes. However, clinical adoption requires prospective multicenter validation, harmonization of endpoints, bias mitigation, and regulatory oversight. Conclusions: AI represents a paradigm shift in CTO PCI, providing superior accuracy over conventional risk models and enabling patient-centered risk prediction. With continued advances in federated learning, multimodality integration, and explainable AI, translation from research to routine practice appears within reach. Full article

Chronic diseases represent one of the most complex, costly, and significant challenges for healthcare systems. The increase in chronic conditions and multimorbidity, together with the growing demand for continuity of care makes the vulnerability of the hospital-to-community transition increasingly evident. This phase is often characterized by delays, fragmented services, and insufficient support for patients and caregivers, leading to higher rates of early readmission and substantial clinical, social, and economic impacts. This paper was developed through a narrative synthesis of international and national literature on continuity of care, integrated models, and nurse-led experiences. Based on this synthesis, an integrated six-phase nursing model is proposed, combining predictive assessment tools and telemedicine to enhance early risk identification, proactive discharge planning, and post-discharge follow-up. Evidence indicates that nurse-led interventions supported by digital solutions can reduce inappropriate hospital days, decrease hospital readmissions, and improve patient and caregiver satisfaction. The integration of predictive tools and telemedicine solutions, coordinated by nurse case managers, represents a promising strategy to strengthen continuity of care and the sustainability of the healthcare system, and the proposed conceptual model highlights practical implications while outlining future research directions for empirical validation and large-scale implementation. Full article

Background/Objectives: Adult spinal deformity (ASD) is increasingly prevalent due to an ageing population and is associated with significant pain, disability, and reduced quality of life. While surgery is often considered for severe deformities, many patients are either unsuitable for major corrective procedures or prefer conservative care. This narrative review synthesizes the current evidence on nonoperative management strategies for ASD. Methods: A literature search on the PubMed and Cochrane databases identified relevant studies published up to 25 October 2025. Medical Subject Headings and keywords related to nonsurgical ASD management were used. Eligible studies included nonsurgical series with a minimum of 12 months’ follow-up, while case reports were excluded. Results: Seven studies met our inclusion criteria: three on bracing, three on physiotherapy and combined physical and cognitive rehabilitation programmes, and one on transforaminal epidural steroid injections (ESIs). Bracing was effective in slowing the curve progression rate. One study showed that the progression rate decreased from 1.47°/year to 0.24° for degenerative scoliosis (p < 0.0001) and from 0.70°/year to 0.24° for idiopathic scoliosis (p = 0.03). Another study showed that there was no statistically significant difference in the Cobb angle or anticipated worsening when comparing the initial measurement with the final control after treatment (p = 0.973). Finally, a third study reported reduced back pain, with Roland–Morris scores improving from 3.3 to 2.0 (p < 0.001) at 18 months. Physiotherapy and multidisciplinary rehabilitation programmes appeared to be effective in significantly reducing pain and disability levels. One study found that Oswestry Disability Index (ODI) scores improved from 39.5 to 31.8 (p < 0.001), while back pain, measured using the Numeric Pain Rating Scale (NPRS), improved from 58.4 to 42.1 (p < 0.001), with 51% achieving minimal clinically important change (MCIC). Another study reported ODI reductions from 38 to 17.6 and pain scores from 6.5 to 2.2 (p < 0.001), while in a third study, the “Koshimagari Exercise” programme yielded MCIDs in the ODI for 42% of patients. Finally, ESIs provided significant pain relief for at least a month in over half of the patients with degenerative scoliosis and radiculopathy, with diminishing effects throughout the first 2 years. More specifically, 37.2% of patients had a successful outcome at one year post-injection and 27.3% at 2 years (p < 0.01). Conclusions: Our study suggests that bracing, physiotherapy, and multidisciplinary rehabilitation programmes, as well as ESIs, can serve as effective short term alternatives for patients with ASD who are either unsuitable for surgery or do not wish to pursue it. As such, this review provides valuable evidence-based insights that can guide clinicians in developing a treatment plan and lay the foundations for establishing a novel pathway for this specific subgroup of patients with ASD. Full article

Background and Objectives: Airway management and ventilation during laryngotracheal surgery represent some of the most challenging tasks in anesthesiology. The shared airway between the surgeon and anesthesiologist requires continuous coordination to ensure optimal oxygenation while maintaining an unobstructed surgical field. Materials and Methods: This narrative review is based on a comprehensive literature search of PubMed, Embase, Scopus, and Google Scholar, covering all publications from inception to 30 June 2025. The literature search was performed using a defined Boolean strategy and explicit inclusion/exclusion criteria, focusing on adult human subjects. The search included combinations of the terms “laryngotracheal surgery,” “airway management,” “ventilation strategies,” “jet ventilation,” “Tritube,” and “Flow Controlled Ventilation.” Only English-language studies focused on human subjects were included. Results: Traditional ventilation strategies, such as apneic oxygenation and jet ventilation, remain widely used but present limitations in terms of gas exchange efficiency, risk of barotrauma, and surgical interference. In recent years, new devices and ventilation modes—particularly the Tritube^® combined with Flow-Controlled Ventilation—have emerged as promising alternatives. These approaches allow continuous ventilation with minimal airway diameter, improving surgical access and patient safety. FCV’s potential to optimize gas exchange and reduce mechanical power is physiologically compelling, but its supporting evidence remains limited and heterogeneous, primarily consisting of small, single-center studies and case series. Conclusions: Optimal airway and ventilation management in laryngotracheal surgery requires individualized planning, technical expertise, and close interdisciplinary communication. This approach must integrate objective neuromuscular monitoring to ensure patient safety and include a comprehensive strategy for safe postoperative airway management and extubation. While emerging technologies have significantly expanded available options, their successful application depends on training, experience, and appropriate case selection. Further high-quality clinical studies are needed to standardize protocols and validate long-term outcomes of these innovative ventilation strategies. Full article

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) in adults is frequently accompanied by psychiatric comorbidities that worsen outcomes and complicate treatment. Pharmacological management is central in care, yet its impact on co-occurring disorders remains uncertain. This systematic review evaluated the effectiveness of commonly prescribed medications for adult ADHD (methylphenidate, atomoxetine, bupropion, and lisdexamfetamine) on comorbid mood, anxiety, personality, and substance use disorders. Tricyclic antidepressants were also included in the search strategy; however, no eligible adult studies assessing imipramine or desipramine in patients with ADHD and psychiatric comorbidity were identified. Methods: A systematic search of the literature was conducted to identify studies examining these medications in adults with ADHD and at least one psychiatric comorbidity. Eligible studies reported clinical outcomes for both ADHD symptoms and the co-occurring disorder. Data were extracted and narratively synthesized, with particular attention paid to treatment effects and sources of heterogeneity. Results: Across the included studies, pharmacological treatments consistently improved core ADHD symptomatology. Their effects on psychiatric comorbidity were more variable. Some evidence suggested beneficial outcomes for selected anxiety disorder subtypes and for features of Cluster B personality disorders, possibly related to reductions in emotional dysregulation and impulsivity. Findings regarding substance use disorders were mixed: several studies reported reduced craving or substance use, but long-term stabilization was inconsistent. Marked heterogeneity in study design, populations, and outcome measures limited comparability. Conclusions: Current pharmacological treatments for adult ADHD show reliable efficacy for core symptoms but inconsistent benefits across comorbid psychiatric conditions. While targeted improvements may occur in specific domains, the evidence base is insufficient to define optimal long-term strategies for adults with ADHD and complex comorbidity. Rigorous, longitudinal studies are needed to clarify medication effects on distinct comorbid profiles and to inform integrated treatment planning. Full article

Background/Objectives: As the primary cause of cancer-related death globally, lung cancer highlights the critical need for early identification, precise staging, and individualized treatment planning. By enabling automated diagnosis, staging, and prognostic evaluation, recent developments in artificial intelligence (AI) and machine learning (ML) have completely changed the treatment of lung cancer. The goal of this narrative review is to compile the most recent data on uses of AI and ML throughout the lung cancer care continuum. Methods: A comprehensive literature search was conducted across major scientific databases to identify peer-reviewed studies focused on AI-based imaging, detection, and prognostic modeling in lung cancer. Studies were categorized into three thematic domains: (1) detection and screening, (2) staging and diagnosis, and (3) risk prediction and prognosis. Results: Convolutional neural networks (CNNs), in particular, have shown significant sensitivity and specificity in nodule recognition, segmentation, and false-positive reduction. Radiomics-based models and other multimodal frameworks combining imaging and clinical data have great promise for forecasting treatment outcomes and survival rates. The accuracy of non-small-cell lung cancer (NSCLC) staging, lymph node evaluation, and malignancy classification were regularly improved by AI algorithms, frequently matching or exceeding radiologist performance. Conclusions: There are still issues with data heterogeneity, interpretability, repeatability, and clinical acceptability despite significant advancements. Standardized datasets, ethical AI implementation, and transparent model evaluation should be the top priorities for future initiatives. AI and ML have revolutionary potential for intelligent, personalized, and real-time lung cancer treatment by connecting computational innovation with precision oncology. Full article

Assistive technologies are increasingly promoted to mitigate age-related declines in cognitive and physical function. Given high levels of sedentary behaviour in older adult care-home residents, technologies promoting physical activity may be beneficial. However, there is little evidence concerning their implementation, evaluation, use, and effects in care-home settings. This evidence gap is particularly notable in terms of the perspectives and experiences of care-home staff. This narrative reflects on insights gained from exploring key feasibility factors related to delivering an immersive cycling intervention in residential care homes from the perspective of care-home staff. Contemporaneous field notes, conversations with care-home managers and staff, and a discussion group involving six care-home staff and one care-home management group representative, as part of a workshop event, identified that standard research timescales and designs may be unsuitable for this research type, highlighting the need for comprehensive community engagement. Cultural and sector-wide considerations of risk and sensitivity to staffing and wider resource pressures are needed to determine optimal technology implementation and use. While assistive physical activity-focused technologies have potential benefits for adult care-home residents, especially those with cognitive impairment, their implementation and use in research and practice require careful planning. Flexible data collection and research designs that capture implementation processes and how participants’ use varies in dynamic contexts are required. Technologies that require high levels of staff supervision are often impractical. Implications for researchers, developers, and care-home operators are discussed with respect to improved informed decision-making and implementation. Full article

Introduction: Nutrition plays a fundamental role in sports performance by influencing energy availability, recovery, and training adaptation. In recent years, different dietary strategies have gained popularity among athletes, although the evidence supporting their efficacy is inconsistent. Objective: This consensus document, developed under the auspices of the Spanish Society of Nutrition, aims to provide a critical overview of the most relevant nutritional strategies currently used in sports and to offer evidence-based practical recommendations for both professional and recreational athletes, coaches, and health professionals. Methods: A narrative review was conducted following standardized scientific procedures by a multidisciplinary panel of experts. The analyzed strategies included high-carbohydrate, low-carbohydrate, ketogenic, intermittent fasting, plant-based, Paleolithic, and carbohydrate periodization diets. Each strategy was assessed based on its physiological rationale, evidence of performance in endurance, strength/power, sprint, aesthetic, weight category, and team sports, practical applications, and potential risks. Results: The available evidence shows that no single dietary strategy can be universally recommended for all athletes. High carbohydrate availability remains the most consistent approach for sustaining performance in endurance and high-intensity efforts. Low-carbohydrate and ketogenic diets enhance fat oxidation but often compromise exercise economy at competitive intensity levels. Intermittent fasting may improve body composition and metabolic health; however, it requires careful adaptation. Well-planned plant-based diets can support performance, although attention to certain nutrients (e.g., B12, iron, and omega-3) is essential. Paleolithic diets improve metabolic parameters but show limited direct evidence of athletic performance. Carbohydrate periodization is a promising tool for combining metabolic adaptations with competitive demands. Conclusions: Nutritional strategies should be individualized according to the athlete’s sport, training phase, and personal context. Professional guidance is crucial for minimizing risks and optimizing benefits. Further well-designed, long-term studies on athletes are needed to resolve the current controversies. Full article

Background: Unsafe care remains a major global health challenge, contributing to millions of preventable deaths and ranking among the top ten causes of mortality and disability worldwide. The World Health Organization’s Global Patient Safety Action Plan 2021–2030 emphasizes the need for strong leadership and system-wide engagement to eliminate avoidable harm. As the largest component of the global healthcare workforce, nurses—especially those in management roles—are essential to achieving these goals. Objective: This narrative review synthesizes global evidence on how nursing management practices, particularly leadership, staffing, and safety culture, influence patient safety outcomes across diverse health systems. Methods: A purposive narrative review was conducted using PubMed, CINAHL, Scopus, and Web of Science databases. Peer-reviewed studies and organizational reports published between 2020 and 2025 were evaluated. A thematic synthesis approach was used to identify patterns related to leadership style, staffing ratios, workplace conditions, and organizational resilience. Quality appraisal followed adapted Critical Appraisal Skills Programme (CASP) and Joanna Briggs Institute (JBI) guidance. Results: A total of 37 peer-reviewed empirical studies were included in the narrative synthesis, along with key global policy and foundational framework documents used to contextualize findings. Evidence consistently demonstrated that transformational leadership, adequate nurse staffing, positive safety culture, and organizational learning structures are strongly associated with improved patient outcomes, reduced errors, and enhanced workforce well-being. Most studies exhibited moderate to high methodological rigor. Conclusions: Nursing management plays a decisive role in advancing global patient safety. Policies that strengthen leadership capacity, ensure safe staffing, promote just culture, and support nurse well-being are critical to achieving WHO’s 2030 safety objectives. Empowering nurse leaders across all regions is essential for building safer, more resilient health systems. Full article

Temporary anchorage devices (TADs) have become integral in contemporary orthodontic biomechanics, providing reliable skeletal anchorage independent of dental support or patient compliance. This narrative review synthesizes the current evidence regarding TADs classification, design parameters, biomechanical principles, clinical insertion protocols, complication management, and technological innovations. We reviewed foundational literature and recent clinical studies with emphasis on factors affecting primary and secondary stability, including insertion torque, angulation, cortical bone characteristics, and soft-tissue considerations. Self-drilling techniques are generally preferred for maxillary sites, while pre-drilling remains indicated in dense mandibular bone to reduce thermal risk and torque overload. Clinical success is optimized when insertion torque is maintained between 5 and 10 N·cm and site-specific anatomy is respected. Reported survival rates exceed 85–95% when proper protocols are followed. While TADs are associated with relatively low complication rates, failures are usually early and linked to excessive torque, poor hygiene, or inflammation. New technologies such as cone-beam computed tomography-guided placement, 3D-printed surgical guides, and AI-based planning tools offer promising avenues for safer and more individualized treatment. In conclusion, TADs represent a predictable and versatile option for skeletal anchorage in orthodontics, provided that mechanical design, biological adaptation, and clinical handling are coherently integrated into patient-specific strategies. Full article

Background: The management of complex hepato-pancreato-biliary (HPB) pathologies demands exceptional surgical precision. Traditional two-dimensional imaging has limitations in depicting intricate anatomical relationships, potentially complicating preoperative planning. This review explores the synergistic application of three-dimensional (3D) reconstruction and artificial intelligence (AI) to support surgical decision-making in complex HPB cases. Methods: This narrative review synthesized the existing literature on the applications, benefits, limitations, and implementation challenges of 3D reconstruction and AI technologies in HPB surgery. Results: The literature suggests that 3D reconstruction provides patient-specific, interactive models that significantly improve surgeons’ understanding of tumor resectability and vascular anatomy, contributing to reduced operative time and blood loss. Building upon this, AI algorithms can automate image segmentation for 3D modeling, enhance diagnostic accuracy, and offer predictive analytics for postoperative complications, such as liver failure. By analyzing large datasets, AI can identify subtle risk factors to guide clinical decision-making. Conclusions: The convergence of 3D visualization and AI-driven analytics is contributing to an emerging paradigm shift in HPB surgery. This combination may foster a more personalized, precise, and data-informed surgical approach, particularly in anatomically complex or high-risk cases. However, current evidence is heterogeneous and largely observational, underscoring the need for prospective multicenter validation before routine implementation. Full article