Search Results (7,562)

Background: Improving health-related quality of life (HRQoL) and return to work (RTW) among adults with cancer are central to cancer survivorship care, but the effects of different non-pharmacological interventions remain unclear. We evaluated exercise, psychoeducational, vocational, and multidisciplinary interventions across RTW and overall and domain-specific HRQoL. Methods: PubMed/MEDLINE, Embase, and CENTRAL were searched from inception to 3 June 2026 for randomised controlled trials reporting HRQoL or RTW. Random-effects models were used to pool standardised mean differences (SMDs) for HRQoL and odds ratios (ORs) for RTW. Risk of bias and evidence certainty were assessed using RoB 2 and GRADE. The protocol was registered in PROSPERO (CRD420261432617). Results: Eighty-one randomised controlled trials involving 11,257 participants were included; 67 assessed HRQoL, 17 assessed RTW, and 3 included both outcomes. Of the 67 HRQoL trials, 39 (58%) enrolled exclusively female participants. Compared with usual care, overall HRQoL improved with psychoeducational (SMD, 0.40; 95% CI, 0.16–0.65), exercise (SMD, 0.38; 95% CI, 0.26–0.50), and multidisciplinary interventions (SMD, 0.39; 95% CI, 0.23–0.55), whereas vocational interventions showed no clear benefit (SMD, −0.09; 95% CI, −0.43–0.25). Exercise was associated with improvements across all six evaluable HRQoL domains. Psychoeducational interventions improved emotional and physical functioning, while multidisciplinary interventions produced a small improvement in physical functioning. For RTW, psychoeducational interventions were associated with higher odds of returning to work (OR, 1.41; 95% CI, 1.15–1.73), as were multidisciplinary interventions (OR, 2.26; 95% CI, 1.15–4.48), although the latter estimate was based on only three trials. Exercise interventions also showed a favourable estimate, although the confidence interval included the null (OR, 1.95; 95% CI, 0.99–3.87), whereas vocational interventions showed no clear benefit (OR, 1.29; 95% CI, 0.81--2.08). Conclusions: The effects of non-pharmacological rehabilitation differed by intervention type and recovery outcome. Exercise provided the broadest HRQoL benefits, whereas psychoeducational interventions showed the clearest benefits for emotional functioning and RTW. These findings support goal-directed, needs-based rehabilitation and may inform clinical and policy decisions on the delivery of psychological, physical, and workplace support in cancer survivorship care. Full article

Background: Lifestyle modification is central to type 2 diabetes mellitus (T2DM) management, but adherence is difficult to assess in routine care. We developed a pragmatic Lifestyle Compliance Index (LCI) from routinely collected behavioral variables and examined its cross-sectional associations with cardio-renal-metabolic measures. Objectives: To describe the LCI, compare outcomes across adherence categories, evaluate adjusted associations, and quantify incremental discrimination for prevalent metabolic and renal abnormalities. Methods: Adults with T2DM attending a specialized outpatient diabetes clinic in Romania were assessed using a standardized clinical questionnaire and routine laboratory data. The LCI combined seven binary behaviors and graded physical activity (0–2 points; theoretical range 0–9). Group comparisons, unadjusted bivariate and adjusted multivariable regressions, false discovery rate correction, and stratified five-fold cross-validated logistic models were used. Results: Among 232 participants, 231 had a complete LCI; low, moderate, and high adherence included 84 (36.4%), 94 (40.7%), and 53 (22.9%) participants, respectively. Higher LCI scores were associated with lower adiposity, HbA1c, TyG index, triglycerides, creatinine, and SCORE2-Diabetes risk and with higher eGFR. In models adjusted for age, sex, and diabetes duration, each LCI point was associated with lower odds of obesity (aOR 0.749), elevated TyG index (0.757), albuminuria (0.716), reduced eGFR (0.802), and HbA1c ≥ 7% (0.833). Adding LCI improved cross-validated discrimination most for albuminuria (AUC 0.482 to 0.642), obesity (0.489 to 0.619), and elevated TyG index (0.524 to 0.646). The baseline albuminuria AUC was below chance, and the extended AUC remained modest. Conclusions: In this cross-sectional sample, higher self-reported lifestyle adherence was associated with a more favorable cardio-renal-metabolic profile. The LCI should be considered exploratory until validated against objective measures and tested in larger prospective populations. Full article

Background/Objectives: Clostridioides difficile colonization is common among hospitalized onco-hematological patients, yet its clinical significance and risk factors in this population remain incompletely characterized. This study aimed to determine the prevalence, risk factors, and genomic characteristics of C. difficile colonization among oncology and hematology inpatients, and to assess its relationship with progression to symptomatic infection. Methods: We conducted a prospective cohort study of patients admitted to the oncology and hematology departments of a tertiary-care hospital in the Canary Islands, Spain, between March and October 2025. Weekly active screening for C. difficile colonization was performed on stool samples throughout hospitalization. Risk factors were assessed using multivariable logistic regression, and whole-genome sequencing was performed on 16 of the 23 recovered isolates (after excluding 3 non-recoverable and 4 contaminated isolates) to characterize sequence types, ribotypes, and antimicrobial resistance determinants. Results: Among 215 patients (262 admission episodes), colonization was detected in 23 episodes (8.8%), with higher rates in oncology (10.9%) than hematology (7.2%; adjusted OR 0.37, 95% CI 0.14–0.96, p = 0.042). Chemotherapy administered during hospitalization was the strongest independent risk factor for colonization (adjusted OR 4.16, 95% CI 1.56–11.10, p = 0.004). Only 4.3% of colonizations were classified as truly community-associated, with 95.7% of patients showing documented healthcare contact. Sequencing of 16 isolates identified nine sequence types, including ST11 (ribotype 078, of zoonotic origin) and rare ribotypes (RT010, RT451); four isolates (36%) exhibited moxifloxacin resistance linked to gyrA/gyrB mutations, while all remained susceptible to vancomycin and metronidazole. No colonized patient progressed to symptomatic infection; the single CDI case in the cohort occurred in a non-colonized patient. Conclusions: These findings support current recommendations against isolating or treating asymptomatically colonized patients, while underscoring the need for continued genomic surveillance and reinforced environmental hygiene and antimicrobial stewardship in this high-risk population. Full article

Background: Driving risk in older adults is multifactorial, and comprehensive on-road assessment is not always feasible in community practice. Although the Driving Risk Checklist-25 (DRCL-25) is easy to administer, interpretation based solely on the total score may obscure the type of driving difficulty. Objective: This study aimed to clarify the latent structure of the DRCL-25 in community-dwelling older adults and to propose a clinically interpretable three-factor solution based on parallel analysis. Methods: A total of 591 community-dwelling older drivers (mean age 75.9 ± 5.5 years), recruited through community-based long-term care prevention health checkups in Akita Prefecture, completed the DRCL-25. Internal consistency was examined using Cronbach’s alpha. The suitability of factor analysis was assessed using the Kaiser–Meyer–Olkin (KMO) statistic and Bartlett’s test of sphericity. The number of factors was examined by parallel analysis (1000 random datasets). Factors were extracted from the Pearson correlation matrix by maximum likelihood (ML) estimation and rotated using varimax rotation; an oblique (Promax) rotation was conducted as a sensitivity analysis. Loadings of |0.30| or greater were used to support interpretation. The three-factor model and the total-score model were compared with respect to their association with mild cognitive impairment (MCI) status, determined using the National Center for Geriatrics and Gerontology Functional Assessment Tool (NCGG-FAT). Results: Internal consistency was acceptable (Cronbach’s alpha = 0.767), the KMO value was 0.808, and Bartlett’s test was significant (χ²(300) = 2249.1, p < 0.001). A three-factor solution, supported by parallel analysis and interpretability, was interpreted as (1) driving burden in complex situations, (2) danger signs noticed by others, and (3) reduced attention and orientation, together explaining 21.2% of total item variance. Factor-specific reliability was acceptable for Factor 1 (α = 0.725) but low for Factor 2 (α = 0.459) and Factor 3 (α = 0.460). Oblique rotation indicated moderate-to-high inter-factor correlations (r = 0.56–0.63). The three-factor model and the total-score model showed comparable association with MCI status (AUC = 0.571 for both; this was a descriptive comparison, and no formal statistical test of the AUC difference was performed). Conclusions: The DRCL-25 showed an interpretable, although moderately inter-correlated, three-factor structure. Given its modest explained variance, the low reliability of two of the three factors, and the absence of incremental predictive validity over the total score, this structure should be regarded as provisional and hypothesis-generating, providing a conceptual and communicative framework rather than a validated basis for clinical decision-making at this stage. Full article

Background/Objectives: Timely access to protein substitutes and special low-protein foods (SLPFs) is fundamental to maintaining dietary adherence and metabolic control in phenylketonuria (PKU). Disruptions within the prescription pathway may compromise the continuity of medical nutrition supply, with potential consequences for patient outcomes and health service efficiency. This study aimed to identify the most frequently reported prescription-related challenges from the perspective of UK industry stakeholders and to outline their implications for the care and dietetic practice of individuals with PKU. Methods: A structured questionnaire was distributed by the National Society for Phenylketonuria to industry representatives involved in supplying Advisory Committee on Borderline Substances (ACBS) approved protein substitutes and special low-protein foods (SPLFs). Anonymised responses were analysed descriptively to identify the types, frequency, and impact of prescription-related issues. Results: Forty-four prescribing and supply incidents were reported by specialist nutrition manufacturers and suppliers. Reported incidents affected both paediatric (54%) and adult (46%) patients, with protein substitutes accounting for the largest proportion of prescribing and supply issues (48%), followed by SLPFs (27%) and combined product issues (25%). Most reported barriers originated within primary care, particularly general practitioner (GP) practices (61%), followed by community pharmacies (21%). Thematic analysis identified five key areas of difficulty: GP prescribing barriers, prescribing errors, pharmacy and wholesaler procurement problems, supply chain and distribution challenges, and communication and care coordination failures. These challenges affected continuity of dietary treatment, increased the burden on patients, carers and healthcare professionals, generated additional financial costs, and highlighted wider inefficiencies within the prescribing and supply pathway. Fewer than half of the reported incidents were resolved (41%). Conclusions: Addressing these system-level barriers through improved prescribing processes, clearer communication pathways, and better coordination between stakeholders may enhance continuity of dietary treatment, reduce burden on patients and healthcare professionals, and support more efficient delivery of specialist nutritional care for individuals with PKU. Full article

Background/Objectives: Timely access to protein substitutes and special low-protein foods (SLPFs) is essential for effective dietary management of phenylketonuria (PKU). As key healthcare professionals responsible for coordinating and delivering nutritional therapy, metabolic dietitians are directly involved in managing prescription-related issues that may arise within the access pathway. This study aimed to identify the main prescription-related barriers experienced by metabolic dietitians in the UK and to explore their implications for patient care, clinical workload, and the delivery of specialist PKU services. Methods: A structured questionnaire was distributed by the National Society for Phenylketonuria to dietitians involved in the care for individuals with PKU in the UK. Anonymised responses were analysed descriptively to identify the types, frequency, and impact of prescription-related issues. Results: A total of 448 responses were received from metabolic dietitians across the UK reporting prescription-related problems affecting dietary products. Most reported incidents involved children (306/446; 68.6%). Among responses specifying the affected product category (n = 443), SLPFs accounted for most reported problems (261/443; 58.9%), followed by protein substitutes (120/443; 27.1%) and finally combined protein substitute and SLPF issues (62/443; 14.0%). Qualitative analysis identified barriers across all stages of the prescribing pathway, with issues primarily relating to GP prescribing processes, home delivery and supply, pharmacy services, and broader administrative and system-related factors. These disruptions affected continuity of dietary management and metabolic care, with reported consequences including reduced access to prescribed dietary products, difficulties maintaining dietary adherence, increased patient and family burden, anxiety and frustration, and a substantial hidden workload for metabolic dietetic services. Conclusions: Prescription-related problems represented a significant barrier to timely access to essential medical foods for individuals with PKU in the UK. The findings highlight challenges across the prescribing and supply pathway that compromise access to both protein substitutes and SLPFs, impose additional burdens on patients and families, and increase workload for specialist metabolic dietetic services. Addressing these system-level barriers, alongside strengthening communication, coordination, and prescribing processes across stakeholders, may improve continuity of dietary treatment and enable more efficient delivery of specialist metabolic care. Full article

Background: A woman’s childbirth experience is important to her health and family well-being. Evidence-based intrapartum care may support a positive experience. When resources are constrained, identifying services that are most strongly associated with childbirth experience may help inform quality-improvement priorities. This study aimed to explore priority intrapartum services associated with women’s experience following vaginal birth. Methods: A multicenter cross-sectional study was conducted in mainland China. A total of 498 postpartum women from ten tertiary facilities were involved. Data were collected through retrospective review of medical records and self-administered questionnaires completed by postpartum women. A self-designed questionnaire was used to collect general information and information on intrapartum services, and the Childbirth Experience Questionnaire was used to assess childbirth experiences. Random forest and Bayesian network analysis were used to examine associations and identify potentially high-priority services. Results: Childbirth experience scores ranged from 27 to 76, with a mean of 61.29. In bootstrap analyses of the random forest model, coefficient of variation for variable-importance estimates ranged from 5.1% to 32.3%. The Bayesian network contained seven structurally compact communities, five of which were closely associated with childbirth-experience outcomes; hospital type was an important connecting node between intrapartum services and childbirth experience. Among the top ten factors associated with the overall childbirth experience, several intrapartum services stood out. These included the type, initiation time, and duration of skin-to-skin contact; the number of evidence-based services received during the first and second stages of labour; and the use of pain-relief methods. Conclusions: Receiving a broader range of evidence-based intrapartum services, longer uninterrupted skin-to-skin contact and access to pain-relief options were associated with more positive childbirth experience scores. Full article

Background/Objectives: Hematopoietic cell transplantation (HCT) is increasingly used to treat malignant and non-malignant hematologic diseases and is associated with complex physical, psychological, and informational needs. Nurses play a central role in HCT care; however, the range, characteristics, and reported outcomes of nurse-led interventions have not been comprehensively synthesized. This review aimed to identify the types and outcomes of nurse-led interventions in adult HCT recipients and highlight gaps in evidence. Methods: The review was initially registered as a systematic review and was refined to a scoping review before final synthesis because of substantial heterogeneity in the available evidence. Studies involving adults undergoing or having received HCT were included if they evaluated interventions initiated, delivered, or coordinated by nurses and reported at least one clinical or patient-reported outcome. Multiple databases and grey literature (2015–2025) were searched. Study selection and data charting were performed independently by two reviewers. Methodological quality was assessed using the Mixed Methods Appraisal Tool, and findings were synthesized narratively. Results: Ten studies met the inclusion criteria, mostly from high-income countries. Nurse-led interventions included pre-transplant preparation, education, symptom management, physical activity and nutrition support, psychosocial care, navigation, survivorship follow-up, and advance care planning. Several studies reported improvements in self-efficacy, physical activity, symptom burden, and advance care planning documentation; however, findings for overall quality of life, infection rates, and long-term recovery were limited or inconclusive. Conclusions: Evidence on nurse-led interventions across the HCT trajectory remains limited. The mapped studies provide promising preliminary findings in selected outcome domains but are insufficient to establish intervention effectiveness. Future research should develop and evaluate rigorously designed, adequately powered, longitudinal, and multicomponent nurse-led interventions, including in resource-limited settings. Full article

Background and Objectives: Potentially inappropriate medication (PIM) use is associated with adverse clinical outcomes in older adults. Several explicit screening tools are available for identifying PIMs, but Romanian data regarding the application of updated criteria remain limited. This study aimed to assess PIM identification according to the STOPP v3, Beers, EU(7)-PIM criteria and PRISCUS v2, to compare PIM counts and PIM presence across criteria, and to explore associations between PIM counts and selected patient characteristics. Materials and Methods: A retrospective observational study with a cross-sectional design was conducted in a single family medicine practice in Iasi, Romania, including 100 patients aged ≥ 65 years with at least one chronic condition and receiving at least two medications. Medications documented between January and June 2024 were assessed using the four explicit PIM criteria. One-way ANOVA with Bonferroni correction, repeated-measures ANOVA, agreement analyses, and Poisson regression models were used to examine differences between criteria and associations with patient characteristics, multimorbidity, and medication burden. Results: Mean PIM counts ranged from 0.75 for PRISCUS to 1.31 for STOPP. At least one PIM was identified in 73% of participants according to STOPP, 62% according to Beers, 60% according to EU(7)-PIM, and 53% according to PRISCUS. STOPP identified significantly more PIMs than each of the other three criteria (p < 0.001), while pairwise kappa coefficients ranged from 0.506 to 0.777. Among the 16 one-way ANOVA comparisons, only the association between obesity and EU(7)-PIM counts remained significant after Bonferroni correction (p < 0.001). In adjusted Poisson models, medication burden was associated with PIM counts according to STOPP (p < 0.001), Beers (p = 0.016), and EU(7)-PIM (p = 0.018). Obesity remained associated with EU(7)-PIM counts (p = 0.001), multimorbidity with STOPP PIM counts (p = 0.049), and sex with PRISCUS PIM counts (p = 0.030). Age, type 2 diabetes mellitus, and dyslipidemia were not independently associated with PIM counts. Conclusions: PIM identification varied according to the explicit criteria applied, with STOPP identifying the highest mean PIM count. Medication burden was the factor most consistently associated with PIM counts in adjusted analyses, while other patient characteristics showed criterion-specific associations. Given the small sample, single-practice setting, and non-probability sampling approach, these findings should be considered exploratory and require confirmation in larger, multicenter primary care studies. Full article

Background: Patient-centered care (PCC) is central to diabetes management; unfortunately, evidence concerning its relationship with patient-reported outcome measures (PROM) in primary healthcare facilities in Jeddah is limited. This study examined the association between validated PCC scores and patient-reported outcomes and explored how PCC domains could be interpreted through four ethical principles. Methods: A cross-sectional survey was conducted on 594 adults with diabetes recruited from 47 primary care facilities between July and August 2023. The primary exposure was the validated 36-item, eight-domain PCC total score, while the primary outcome was a study-specific core PROM composite. Satisfaction and patient-reported experience measure (PREM) scores were measured as secondary measures. Statistical analysis was completed through multivariable ordinary least-squares regression with HC3 heteroscedasticity-robust standard errors adjusted for sociodemographic and health characteristics, while the four author-defined ethical groupings were examined exploratorily. Results: Among 594 adults with diabetes who completed the study, the mean PCC was 76.91 (SD 17.01), core PROM was 63.51 (SD 16.85), satisfaction was 81.41 (SD 19.30), and PREM was 77.27 (SD 20.45). PCC correlated with core PROM (r = 0.437), satisfaction (r = 0.251), and PREM (r = 0.239). In the primary adjusted model (n = 591), PCC remained positively associated with core PROM (B = 0.433, 95% CI [0.359, 0.507], p < 0.001). Female sex and severe self-rated health were associated with lower PROM scores, whereas older age and type 2 diabetes were associated with higher scores. The model explained 27.0% of PROM variance. Conclusions: Higher PCC was independently associated with better PREM. The ethical mapping provides a potentially useful interpretive framework but requires independent psychometric validation. Full article

Background: Thymosin alpha 1 (Tα1, thymalfasin) is a thymus-derived immunomodulatory peptide investigated as an adjunctive therapy in cancer care. Although studied across malignancies, its evidence landscape has not been systematically mapped. This scoping review characterized treatment contexts, intervention patterns, outcome domains, and safety reporting of clinical studies evaluating Tα1 in patients with cancer. Methods: PubMed, Embase, and CENTRAL were searched for clinical studies of Tα1 in patients with cancer published from January 2016 to March 2026. Eligible studies included randomized controlled trials, non-randomized studies, observational studies, and case-based reports. Data on study characteristics, cancer type, intervention features, comparators, outcomes, and adverse-event reporting were charted and synthesized descriptively. Results: Twenty-six clinical publications were included. Most were conducted in China, and retrospective observational studies and case reports predominated. Hepatobiliary, thoracic, and gastrointestinal cancers were the most frequently studied clusters. Classical Tα1 was administered mainly by subcutaneous injection, most commonly at 1.6 mg, and used primarily as an adjunct to chemotherapy, radiotherapy, chemoradiotherapy, targeted therapy, immune checkpoint inhibitors, or postoperative and supportive care. Outcomes included tumor response, survival, recurrence, immune and inflammatory markers, treatment-related toxicity, functional status, and quality of life. Several studies reported favorable clinical, immune-related, or treatment-tolerance signals, but heterogeneity limited comparability. Safety reporting was inconsistent. One case described severe multisystem immune-related toxicity during combination treatment without establishing Tα1-specific causality. Conclusions: Tα1 has been investigated mainly as an adjunctive immunomodulatory strategy in cancer care. Prospective controlled studies with standardized dosing, defined treatment contexts, consistent outcomes, and systematic harms reporting are needed. Full article

Background: Diabetes self-management is essential for type 2 diabetes care, but cross-sectional associations may be distorted when questionnaire scores are incorrectly derived or converted into arbitrary categories. We evaluated clinical and sociodemographic correlates of the continuous Diabetes Self-Management Questionnaire (DSMQ) total score in a secondary analysis of an outpatient clinical database. Methods: The analysis included 262 adults with type 2 diabetes recruited between 1 November 2025 and 1 May 2026. DSMQ total and subscale scores were independently recalculated from the 16 item-level responses using the published scoring algorithm. The primary analysis retained the DSMQ score as a continuous outcome. The database provided a participant-level count of documented glucose measurements > 250 mg/dL. This operational count was not treated as a standardized clinical event or severity category; individual measurement timestamps, participant-specific observation duration, and the total number of glucose measurements were unavailable. Results: The recalculated DSMQ score was 5.26 ± 2.35 (median 5.10; interquartile range 3.12–7.08). Among 261 participants with an interpretable sex code, 144 (55.2%) were women. In univariable analyses, lower DSMQ scores were concurrently associated with longer diabetes duration, a higher recorded severe-hyperglycemia count, higher HbA1c, and higher fasting glucose. In the adjusted model (n = 261), the recorded severe-hyperglycemia count remained negatively associated with DSMQ score (adjusted coefficient −0.412 points per recorded episode; 95% confidence interval −0.621 to −0.203; p < 0.001). Individualized versus hospital-based education was not independently associated with the corrected score. A beta-regression sensitivity analysis produced a concordant direction of association (coefficient −0.152 on the logit mean scale; p < 0.001). The linear model explained 17.2% of observed variance (adjusted R² = 0.136), with an optimism-corrected R² of 0.099. Conclusions: The recorded severe-hyperglycemia count was a concurrent correlate of lower DSMQ score. Because the study is cross-sectional and glucose-measurement counts were preaggregated without observation-time or monitoring-frequency data, the findings do not establish temporal direction, causality, or individual-level clinical prediction. Item-level score verification and continuous-outcome analysis materially changed the interpretation of the dataset. Full article

Mammalian Na⁺/Ca²⁺ exchangers (NCXs) mediate inward (Ca²⁺-exit) or outward (Ca²⁺-entry) currents (I_NCX), with the peak current (I_peak) declining to the steady-state current (I_ss). The Ca²⁺-, ATP-, and PIP₂-dependent activation of cardiac (NCX1.1) inward I_NCX has been previously documented. To investigate possible interactions among regulatory modes, we examined the effects of ATP and PIP₂ on outward I_NCX when the CBD1 and CBD2 domains of NCX1.4 (brain variant) are Ca²⁺-occupied and -unoccupied. At nominally zero cytosolic Ca²⁺, ATP and PIP₂ significantly reduced the outward I_peak amplitude. While increasing cytosolic Ca²⁺ increased I_peak and I_ss/I_peak, consistent with CBD1- and CBD2-dependent regulation, no significant effects of ATP or PIP₂ were detected at 0.1–10 μM cytosolic Ca²⁺. These observations indicate distinct responses under the Ca²⁺ conditions examined and warrant direct mechanistic investigation. Although we observed opposing effects of ATP and PIP₂ on inward (in NCX1.1) and outward (in NCX1.4) currents using different patch-clamp configurations and protocols, the data collectively suggest that Ca²⁺, ATP, and PIP₂ regulatory modes may operate differently on the forward and reverse modes in NCX1.1 and NCX1.4 variants. Given the important physiological implications across distinct cell types (e.g., cardiomyocytes, neurons, glia, and kidney), careful investigation is needed to resolve how distinct regulatory modes affect the forward and reverse modes of mammalian NCX variants. Full article

Background/Objectives: Pancreatic cancer (PC) is characterized by poor survival and a substantial psychological burden. Growing evidence suggests that individuals diagnosed with PC are at an increased risk of suicide. This systematic review aimed to synthesize the available evidence on suicide risk among patients with PC and to identify factors associated with increased vulnerability. Methods: Following the PRISMA 2020 guidelines, a systematic review of the PubMed/MEDLINE and Scopus databases was conducted in August 2026. Of the 1015 records initially identified, 23 studies published between 2010 and July 2026 were included. Eligible studies specifically examined suicide risk among patients with PC using registry-based, administrative, or death certificate data. Risk of bias was assessed using the ROBINS-E tool. Results: Most included studies reported a higher suicide risk among patients with PC compared with the general population and, in many analyses, compared with patients with other cancer types. Large population-based studies generally reported standardized mortality ratios of approximately 2 to 11, although substantially higher estimates were observed in selected populations and specific subgroups. Suicide risk was particularly elevated during the early post-diagnosis period (with several studies identifying the greatest excess risk within the first two months following diagnosis), remained elevated throughout the first year and gradually declined thereafter. Male sex emerged as the most consistently demonstrated risk factor for suicide, while associations with unmarried status were observed across several studies but were derived largely from partially overlapping SEER-based cohorts. Additional evidence suggests a potential role for social vulnerability and poor prognostic factors. Conclusions: Despite the predominantly observational nature of the available evidence, the consistency of the findings highlights the importance of increased awareness of suicide vulnerability among patients with PC and supports consideration of psychosocial assessment and mental health support within routine pancreatic cancer care. Future prospective studies are needed to better characterize high-risk patients and to inform targeted suicide prevention strategies. Full article

Artificial intelligence (AI) is moving rapidly from retrospective prediction and image analysis into treatment selection, operative planning, intraoperative guidance, and postoperative prognostication in cardiothoracic surgery. This transition raises an ethical problem that cannot be resolved by model accuracy alone: when an algorithm begins to shape a high-stakes clinical decision, the distribution of knowledge, authority, and responsibility also changes. This review synthesizes cardiothoracic and closely related medical evidence available through August 2026, with emphasis on quantitative performance, human–AI interaction, bias, patient autonomy, and liability. The available evidence is simultaneously encouraging and cautionary. Machine-learning approaches can improve predictive performance and AI-assisted thoracic planning can reduce errors and increase procedural consistency; however, these gains have not consistently translated into superior patient outcomes. Human–AI studies similarly demonstrate that improved accuracy may coexist with automation bias and overacceptance of algorithmic recommendations. Evidence of demographic performance disparities and limitations in the representativeness of training and validation datasets further raises concerns regarding fairness and equitable access to care. On this basis, we argue that cardiothoracic AI should be governed according to the level of decision influence rather than by technology type alone. We distinguish non-delegable professional duties, distributed system responsibilities, and non-transferable patient authority, and propose an Ethical Heart Team Framework for converting algorithmic output into ethically defensible clinical action. Full article