Search Results (456)

Background/Objectives: Focal fibrocartilaginous dysplasia (FFCD) is a rare, benign developmental disorder of the growing skeleton first described 40 years ago. It is characterised by a fibrocartilaginous tether adjacent to the physis, which disrupts symmetrical growth and leads to progressive angular deformity. The aim of this review was to define site-specific clinical patterns and management principles for FFCD to optimise patient outcomes. Methods: We conducted a narrative review of more than four decades of published literature on FFCD. All identified English-language case reports, case series, and review articles were analysed to synthesise evidence on clinical presentation, anatomical location, natural history and treatment strategies. Results: To date, 169 cases have been reported, with approximately two-thirds involving the proximal tibia. Tibial lesions typically present in toddlers as unilateral genu varum and, in most cases, demonstrate spontaneous remodelling and complete resolution. In contrast, femoral and upper-limb lesions rarely resolve spontaneously and often progress, thereby warranting earlier and more invasive management. Radiographic findings are highly characteristic, most commonly showing a cortically based metaphyseal lucency with a sclerotic rim. These features are generally considered sufficient for diagnosis, usually eliminating the need for biopsy. Management has evolved towards a tailored approach, consisting of observation for tibial lesions with potential for spontaneous resolution and timely surgical intervention for femoral or upper-limb lesions at risk of progression or joint compromise. Conclusions: Despite the advances made in recent decades, FFCD remains a distinctive yet heterogeneous condition in paediatric orthopaedics. This narrative review summarises more than four decades of published literature, including case reports, case series, and review articles, with particular attention to site-specific clinical patterns and their implications for optimising management. Full article

Background: Early rehabilitation after pediatric ischemic stroke may support neuroplasticity and improve long-term functional outcomes. However, rehabilitation practices remain heterogeneous, and evidence-based recommendations regarding the optimal timing and intensity of intervention are limited. Objectives: This scoping review aimed to evaluate the available evidence regarding early rehabilitation after pediatric ischemic stroke, identify prognostic factors associated with functional recovery, summarize current therapeutic approaches, and highlight gaps in the existing literature. Eligibility Criteria: Eligible studies included children and adolescents aged 0–18 years diagnosed with ischemic stroke and receiving rehabilitation or therapeutic intervention. Studies addressing the timing, intensity, and effects of physiotherapy, occupational therapy, speech and language therapy, neuropsychological intervention, neuromodulation, or multidisciplinary rehabilitation were considered for inclusion. Sources of Evidence: A structured literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library, and Google Scholar for studies published between 2000 and January 2025. Charting Methods: Data were extracted using a standardized charting form and synthesized narratively because of substantial heterogeneity in study design, populations, interventions, and outcome measures. Results: Twenty-one sources met the inclusion criteria. Direct evidence specifically addressing early rehabilitation after pediatric ischemic stroke was limited and consisted primarily of observational studies. A substantial proportion of the available evidence was indirect, originating from studies of perinatal stroke, unilateral brain injury, cerebral palsy, and related pediatric neurorehabilitation populations, as well as clinical guidelines and expert consensus documents. The available evidence suggests potential benefits across motor, cognitive, communication, and functional domains, although the strength and directness of evidence varied substantially. Several studies identified the early post-stroke period as a potentially important window for neuroplasticity, while family involvement, individualized treatment planning, and interdisciplinary care were consistently highlighted as important components of rehabilitation. Evidence supporting neuromodulation techniques remained preliminary and was largely limited to selected pediatric populations. Conclusions: The available evidence, although heterogeneous and largely indirect, suggests that early coordinated and multidisciplinary rehabilitation may be beneficial in pediatric ischemic stroke care. However, the current evidence base remains limited, and high-quality prospective studies are needed to establish standardized rehabilitation protocols and determine the optimal timing and intensity of therapeutic interventions. Full article

Background: Gorlin–Goltz syndrome is a rare autosomal dominant condition with characteristic craniofacial and odontogenic anomalies. Orofacial alterations in childhood may precede dermatological findings, highlighting the relevance of early orthodontic and functional evaluation. Objective: This case describes a multidisciplinary orthodontic and Home Sleep Apnea Testing (HSAT)-based approach for the assessment of craniofacial morphology and sleep-disordered breathing (SDB) risk in a pediatric patient with Gorlin–Goltz syndrome. Methods: A 12-year-old male with a genetically confirmed PTCH1 mutation underwent digital intraoral scanning, orthodontic evaluation, and SDB screening using the Pediatric Sleep Questionnaire (PSQ). Following a positive screening score, HSAT with the Philips Alice NightOne^® system was performed under specialist supervision. Results: The patient showed recurrent odontogenic cysts, a lateral open bite, and unilateral Class II canine relationship. The PSQ score was 0.579, exceeding the validated cut-off of 0.33 and indicating an elevated SDB risk. HSAT findings were suggestive of mild obstructive sleep apnea based on Respiratory Event Index (REI) values (REI 4.7/h), with an isolated SpO₂ nadir of 77% and a maximum recorded apnea duration of 425 s, warranting cautious specialist interpretation and follow-up assessment. Conclusions: Integrating orthodontic assessment, digital documentation, validated screening tools, and objective HSAT-based evaluation may support the early recognition of functional compromise in syndromic pediatric patients. Positive screening results should prompt specialist referral and objective sleep assessment, while attended polysomnography remains indicated when comprehensive sleep architecture evaluation or definitive characterization is required. Full article

Background and Clinical Significance: Choanal atresia is a rare congenital obstruction of the posterior nasal aperture, with an estimated incidence of one in 5000 to one in 8000 live births. Bilateral disease typically presents as a neonatal emergency, whereas unilateral disease is more frequent and may remain undiagnosed for years or decades, presenting in adolescence or adulthood with chronic unilateral nasal obstruction and ipsilateral mucopurulent rhinorrhoea. Optimal surgical management remains debated, particularly with regard to mucosal-flap reconstruction and the choice of postoperative stent. Case Presentation: A 22-year-old male was referred for chronic left-sided nasal obstruction, persistent ipsilateral mucopurulent rhinorrhoea and reduced ipsilateral olfaction. Nasal endoscopy and high-resolution computed tomography demonstrated an isolated, non-syndromic, mixed bony–membranous left choanal atresia. The patient underwent transnasal endoscopic choanoplasty with posterior septectomy and removal of the atretic plate and posterior vomer. An ipsilateral superiorly based septal mucoperichondrial flap was raised first and later transposed over the sphenoid rostrum; following drilling, the contralateral septal mucosa was approached and incised horizontally to generate a superior and an inferior leaflet, which were rotated to cover the corresponding portions of the residual posterior septal ridge. A bioabsorbable mometasone-furoate-eluting sinus implant (PROPEL^®, Medtronic) was deployed across the neo-choana. The follow-up endoscopy at two months demonstrated a widely patent, well-mucosalized neo-choana with complete resolution of symptoms. Conclusions: Transnasal endoscopic posterior septectomy combined with mucosal-flap reconstruction and a bioabsorbable steroid-eluting stent is a technically feasible and biologically rational approach to adult unilateral CA. To our knowledge, this is among the first reports describing the off-label intraoperative use of a PROPEL^® stent in a young adult with isolated unilateral choanal atresia. Full article

Background: The research question explored in this study revolves around the quantitative evaluation of the carbon footprint of cranioplasty surgery, a neurosurgical intervention meant to reconstruct skull defects. Methods: Following a calculation of the emissions pertaining to Scope 1 to 3 of the Greenhouse Gas (GHG) Protocol, the authors engaged with various stakeholders to identify possible interventions meant to drive the carbon efficiency of a cranioplasty pathway. The service improvement project (SIP) that ensued was aimed at reducing the volume and weight of the packaging materials for cranioplasty shipping boxes, and decreasing the paper consumption relative to the preparation of user manuals without compromising patients’ safety. Results: Our analysis indicates a cumulative carbon footprint of 104.35 kg CO₂e for a single unilateral cranioplasty operation, where packaging corresponds to 6.4% of Scope 3 emissions and 1.41% of its total emissions. Of note, our SIP led to an overall 76.53% decrease in the number of emissions generated by the packaging equivalent required for a unilateral titanium implant. Conclusions: This study demonstrates the effectiveness of a partnership between public institutions and medtech companies in driving carbon net efficiency of a cranioplasty pathway, and we suggest that such approach is scalable to other surgical specialties. Full article

Background/Objectives: Multilevel lumbar spinal stenosis (MLSS) is frequently encountered in patients undergoing surgery for lumbar spinal stenosis, yet the optimal extent of decompression remains debated. While multilevel decompression (MLD) may address all radiological stenotic levels, it may also increase surgical invasiveness and operative time. Minimally invasive endoscopic techniques such as unilateral biportal endoscopy (UBE) allow for targeted decompression and facilitate staged surgical strategies. The aim of this study was to evaluate the clinical outcomes of selective single-level decompression (SLD) using UBE in patients presenting with MLSS. Methods: This retrospective monocentric observational study included consecutive adult patients with MLSS who underwent decompression using UBE between December 2022 and July 2025. MLSS was defined as the presence of at least two lumbar levels with Schizas grade B or higher stenosis. Patients undergoing prior lumbar surgery or presenting with non-degenerative pathology were excluded. Patients underwent either SLD targeting the symptom-driving level or MLD, depending on the surgical strategy. Patient-reported outcomes included the Oswestry Disability Index (ODI), lumbar visual analog scale (LVAS), and radicular visual analog scale (RVAS). Results: Among 305 patients operated on for lumbar spinal stenosis, 83 (27%) presented with MLSS and were included in the study. Seventy-four patients (89%) underwent initial SLD and nine (11%) underwent MLD. Among patients treated with SLD, 9 (12%) required a second decompression during follow-up, whereas 65 patients (88%) achieved favorable outcomes without further surgery. Across the entire cohort, ODI, LVAS, and RVAS improved significantly after surgery. Operative time was significantly longer in the MLD group (122 ± 28.1 min vs. 58.1 ± 12.0 min; p < 0.001). These findings support the feasibility of a symptom-driven selective decompression strategy for MLSS using UBE. In our cohort, most patients experienced meaningful functional improvement after SLD without requiring additional surgery. Although a staged approach may necessitate secondary intervention in a minority of patients, selective decompression may help limit surgical extent in carefully selected patients while preserving favorable clinical outcomes. Conclusions: Selective SLD using UBE was associated with significant clinical improvement in most patients with MLSS while reducing operative time and surgical extent. A stepwise strategy targeting the dominant symptomatic level may represent a feasible minimally invasive approach for selected patients with MLSS. Prospective studies are needed to confirm these findings. Full article

Background/Objectives: Severe brain injury (SBI) in very preterm infants includes heterogeneous lesions with distinct timing, burden and outcomes. We used cranial ultrasound (CUS) to describe SBI entity, documented timing, three-domain burden, deaths following documented withdrawal, withholding or non-escalation of life-sustaining treatment for poor neurological prognosis (neuro-WWLST), and survivor outcomes. Methods: Retrospective single-center cohort (1991–2020) of 2841 very preterm infants (<32 weeks’ gestation and/or birth weight ≤ 1500 g) with complete CUS within 48 h after birth. CUS was summarized by four windows, three domains—parenchymal lesion, intraventricular hemorrhage (IVH) and ventriculomegaly—and three mutually exclusive entities: periventricular hemorrhagic infarction (PVHI), cystic periventricular leukomalacia (cPVL and grade 3 IVH without PVHI/cPVL (IVH3 entity). Cross-outcome analyses used common maximal-burden CUS. Results: SBI occurred in 286/2841 infants (10.1%) and neuro-WWLST death in 45/2841 infants (1.6%); 43/45 occurred within SBI, and 43/89 SBI deaths (48.3%) followed documented neuro-WWLST. Using common maximal-burden CUS, severe three-domain involvement was more frequent among neuro-WWLST deaths than survivors (37.2% vs. 8.6%). Among SBI survivors with follow-up, cerebral palsy (CP) occurred in 87/176 (49.4%) and clinically classified school-age cognitive sequelae in 50/155 (32.3%). Outcomes varied by entity, with mainly ambulatory unilateral CP after PVHI, more frequent non-ambulatory bilateral CP after cPVL, and a heterogeneous IVH3 profile. Severe three-domain involvement identified a small subgroup with higher outcome burden, but outcomes were not deterministic. Conclusions: A structured, descriptive CUS approach separating lesion entity, documented timing and multidomain burden may support transparent cohort-level description of SBI trajectories, documented neuro-WWLST deaths and survivor outcomes. Full article

Sacroiliac joint (SIJ) disruption alters posterior pelvic ring stability and can produce abnormal sacral stress redistribution; the symmetry of sacral load transfer following different fixation strategies remains controversial. This study compared sacral stress patterns under unilateral and bilateral SIJ instability for three fixation constructs using a three-dimensional finite element (FE) model. A lumbosacral–pelvic FE model was reconstructed from computed tomography data of a healthy adult and validated against previously published pelvic biomechanical data. SIJ instability was simulated by reducing the friction coefficient to represent ligamentous failure. Three fixation constructs were analyzed: anterior plate combined with posterior screw fixation (Model 1), spinopelvic fixation (Model 2), and hybrid fixation (Model 3). A 750 N axial compressive load was applied to simulate static standing. Peak sacral von Mises stress, stress amplification factors (SAFs), and left–right asymmetry ratios were computed and compared with the intact reference. Model 1 produced the highest sacral stress amplification (SAF = 3.46 under unilateral instability; peak stress 265.40 MPa). Model 2 reduced peak sacral stress (125.66 MPa under bilateral instability; SAF = 1.64), but values remained above the intact-model baseline. Model 3 yielded sacral stress closest to the intact condition under bilateral instability (81.64 MPa; SAF = 1.06), with near-symmetric load distribution in the bilateral injury configuration. Fixation topology strongly influenced sacral load transfer: hybrid fixation (Model 3) produced sacral stress magnitudes closest to the intact model, particularly under bilateral instability, whereas spinopelvic fixation (Model 2) showed more consistent left–right symmetry under unilateral injury. No single construct was superior across all symmetry-related outcomes. Hybrid stabilization may provide a biomechanically balanced approach to highly unstable posterior pelvic ring injuries under the simulated static axial-loading conditions. Full article

Background/Objectives: To investigate the prevalence and associated factors of postoperative radiculitis in patients treated with Anterior Lumbar Interbody Fusion (ALIF) in L4–L5 or L5–S1 utilizing lumbopelvic sagittal parameters and ideal alignment values calculated with GAP score components. Methods: A retrospective review using Natural Language Processing (NLP) for automated data extraction from clinical notes was conducted. 61 adult patients were included in the analysis. Postoperative radiculitis was defined as the new onset of unilateral or bilateral pain in the L4–S1 radicular territory with preserved motor function. Clinical parameters (Oswestry Disability Index), radiographic parameters (lumbopelvic sagittal alignment using GAP score components), and surgical factors (cage size and disc height modification) were evaluated and subsequently entered into a multivariable logistic regression analysis. Results: Postoperative radiculitis occurred in 29.5% of patients, with symptoms primarily manifesting within the first six weeks following surgery and lasting up to six months. Patients in the Pain group showed notable differences in pre- and postoperative GAP score parameters, specifically higher values for relative lumbar lordosis (RLL) and relative pelvic version (RPV). Furthermore, multivariable logistic regression identified postoperative RLL and the anterior disc height (ADH) ratio to be independently associated with the development of radiculitis. Conclusions: Excessive disc space enlargement during ALIF is associated with a higher likelihood of postoperative radiculitis, particularly in patients with pre-existing near-ideal lumbar alignment. To mitigate this iatrogenic complication in this group, the degree of correction must be individualized. This tailored approach should incorporate parameters from the GAP score and a careful assessment of the relationship between the anterior disc height and the vertebral body. Full article

Objectives: A comprehensive diagnosis and treatment were carried out in 104 newborns, including 48 children diagnosed with unilateral cleft lip and palate (UCLP) and 56 patients diagnosed with bilateral cleft lip and palate (BCLP). The control group consisted of 116 medical records and diagnostic models of jaws from newborns with UCLP/BCLP, which were analysed before and after orthodontic correction using a removable facebow with headgear attachment. Methods: All newborns (n = 104) underwent orthodontic correction to reposition of the alveolar process fragments in UCLP and intermaxillary bone in BCLP using mini-implants and elastic traction devices/springs, followed by primary cheiloplasty. Cheiloplasty was performed one month after fragment alignment had been achieved. Results: Statistical analysis showed that orthodontic correction using mini-implants and elastic traction was highly effective. In the UCLP group, normalised alignment of alveolar fragments was achieved in 97.9% of cases (p = 0.0000000016); in the BCLP group, normalised positioning of the intermaxillary bone was observed in 96.42% (p = 0.00000000007). A direct comparison between the treatment and control groups revealed consistent significance across all diastasis measurements, supporting the clinical advantage of fixed orthodontic approaches. Conclusions: The clinical data and statistical analysis indicate that the fixed orthodontic appliance combined with mini-implants and elastic traction is effective. This approach normalises alveolar and intermaxillary positioning and provides optimal preoperative conditions for primary cheiloplasty and subsequent uranoplasty. It also shortens rehabilitation duration and leads to stable aesthetic and functional results. Full article

Background: Unilateral progressive condylar growth (UPCG) represents a complex clinical condition characterized by abnormal enlargement of the mandibular condyle, leading to progressive facial asymmetry and functional impairment. Objectives: The aim of this review is to analyze the biological, clinical, and therapeutic factors guiding condylectomy, assess the current role and scope of proportional condylectomy, and propose an algorithm to guide its indication in patients with UPCG. Methods: A narrative review was conducted to analyze the biological, clinical, and therapeutic factors involved in the indication for condylectomy in patients with progressive unilateral condylar growth. Studies including patients diagnosed with unilateral condylar hyperplasia or condylar osteochondroma who underwent surgical treatment were considered to evaluate clinical indications, timing of intervention, and outcomes. Special attention was given to the concept of proportional condylectomy. Results: Current evidence indicates that early intervention may control disease progression, reduce the severity of residual deformity, and minimize the need for secondary orthognathic surgery. The integration of clinical findings, three-dimensional imaging, and patient-specific factors is essential for appropriate treatment planning. Conclusions: Based on these considerations, a structured clinical algorithm is proposed to guide decision-making in patients with unilateral progressive condylar growth. This approach supports individualized treatment strategies aimed at optimizing functional and esthetic outcomes. Full article

Background: Severe jaw atrophy (Cawood and Howell Class V–VI) often renders conventional endosseous implantation unfeasible due to the lack of medullary bone and vascularization. This study presents a digital workflow for customized subperiosteal implants designed to eliminate bone segmentation errors and ensure optimal passive fit. Methods: Two clinical cases of severe atrophy—a full-arch maxillary rehabilitation and a unilateral partial rehabilitation—were treated using a prosthetic-driven CAD/CAM workflow. Key innovations included densitometric mapping using Hounsfield Units (HU) to identify high-mineralization zones (+1200 to +1800 HU) for strategic screw fixation. Intraoperatively, cobalt–chrome osteoplasty guides and PMMA check-templates were utilized to validate bone segmentation accuracy in vivo and regularize the cortical base. Results: The protocol achieved high precision with a monitored alignment deviation of 0.2 mm. At the 2-year follow-up, clinical and radiographic evaluations (CBCT) confirmed the total absence of gaps at the bone–implant interface. No signs of peri-implantitis, osteolysis, or progressive bone loss were observed, and soft tissues remained stable and healthy. Discussion: Success was driven by the rigorous management of the bone–implant interface and the use of preparatory surgical devices to bridge the gap between digital planning and surgical reality. The mechanical stability achieved through divergent fixation vectors prevented stress shielding by converting shear forces into compression, stimulating basal bone density according to Wolff’s Law. Conclusions: The standardized digital workflow and the use of preparatory surgical devices in this preliminary study showed that complex rehabilitations can be performed with favorable short-term outcomes. While this approach reduces surgical time and biological stress, further prospective studies are required to confirm its clinical predictability and define next-generation subperiosteal implants as a valid alternative for the management of severely atrophic cases. Full article

Objective: This study aimed to compare the clinical and radiological outcomes between microscopic and unilateral biportal endoscopic (UBE) posterior cervical foraminotomy (PCF). Methods: This study included 73 patients who underwent microscopic PCF (n = 40) or UBE PCF (n = 33) for single-level cervical foraminal disc herniation or stenosis between January 2018 and December 2021. Clinical outcomes were measured using the Visual Analog Scale (VAS) and Neck Disability Index (NDI). Radiologic outcomes were evaluated with cervical range of motion (ROM) using computed tomography and flexion-extension dynamic radiography. Results: The mean follow-up period for microscopic and UBE PCF was 33.0 ± 7.6 months and 29.9 ± 5.9 months, respectively. The postoperative neck VAS until postoperative 2 weeks was significantly lower in the UBE PCF group than in the microscopic PCF group (p < 0.05). The estimated blood loss and operative time were significantly lower in the UBE PCF group than in the microscopic PCF group, while the length of hospital stay was numerically shorter but did not reach statistical significance. The two groups had no significant difference in the NDI on the preoperative and postoperative 3 months. The recurrence occurred in 1 patient (2.5%) of the microscopic PCF group and 1 patient (3%) of the UBE PCF group. The revision surgery was performed in 2 patients (5%) of the microscopic PCF group and in 1 patient of the UBE PCF group. There were no significant differences in motion and instability between the two groups. Conclusions: Both microscopic and UBE PCF are effective and safe procedures for treating cervical radiculopathy due to cervical foraminal disc herniation or stenosis. The UBE approach may provide advantages mainly in early postoperative recovery, including lower early postoperative neck pain, while long-term clinical and radiologic outcomes appear comparable to those of microscopic PCF. Full article

Background: Cervical osteochondromas invading the vertebral canal are rare but may cause spinal cord compression requiring surgical resection. Conventional open laminectomy may disrupt posterior stabilizing structures and potentially increase the risk of postoperative cervical deformity. This technical note describes a contralateral-structure-preserving endoscopic technique for cervical osteochondroma resection. Methods: A 25-year-old man with multiple hereditary exostosis presented with neck pain, mild numbness, and a positive Lhermitte’s sign. Computed tomography and magnetic resonance imaging revealed a 9 × 6 × 10 mm osteochondroma originating from the base of the C3 spinous process and extending into the vertebral canal with spinal cord compression and cord signal change. Preoperative clinical assessment included a Visual Analog Scale (VAS) for neck pain of 6/10, a modified Japanese Orthopedic Association (mJOA) score of 16/18, a Neck Disability Index (NDI) of 30%, and Nurick grade 1. The lesion was treated using unilateral biportal endoscopic spine surgery through a partial unilateral laminectomy and sublaminar endoscopic corridor, aiming for en bloc resection while preserving the contralateral lamina, posterior ligamentous complex, and posterior tension band. Continuous intraoperative neurophysiological monitoring (SSEP and MEP) was used throughout the procedure. Results: The osteochondroma was completely resected en bloc using a diamond burr and Kerrison rongeur. Histopathological examination confirmed osteochondroma, and negative margins were identified without residual tumor. The patient’s symptoms resolved completely without postoperative complications, and he was discharged on postoperative day 3. At the 18-month clinical and radiological follow-up, the patient remained symptom-free, with VAS improved to 1–2/10, mJOA improved to 18/18, NDI improved to 4%, and Nurick grade improved to 0, with partial regression of the cord signal change and no evidence of tumor recurrence on follow-up imaging. Cervical lordosis was maintained at the immediate postoperative timepoint. Conclusions: Contralateral-structure-preserving endoscopic resection may represent a potential minimally invasive alternative to conventional wide laminectomy or fusion-based approaches in carefully selected cases of benign cervical osteochondroma. Larger comparative studies with long-term follow-up are required to confirm the potential biomechanical and clinical benefits of this approach. Full article

Background/Objectives: Older adults with cancer in the postoperative environment face complex vulnerability, exacerbated by the frailty of ageing and the aggressiveness of surgical treatment. In this highly demanding context, nurses play a crucial role as patient advocates. However, there is a knowledge gap regarding how advocacy is perceived and experienced by the nurse-patient dyad. This qualitative study aims to explain the practice of advocacy by comparing the perspectives of nurses and patients in order to construct part of a substantive theory on the subject. Methods: The Grounded Theory methodological approach was adopted. The sample included 6 specialist nurses and 10 older cancer patients from the ICU. Data collection consisted of participant observation and semi-structured interviews with both groups of participants. The analysis followed the constant comparison method, using MAXQDA software (version 24.10.0; VERBI Software; Berlin, Germany), allowing for the systematic and comparative identification of codes and categories from the two data sources. Results: The core process, defined as The Advocacy-Adjustment Dyad, reveals how older adult cancer patients navigate critical care through a symbiotic interplay of coping and support. Patients autonomously deploy Internal Adjustment mechanisms namely, Shielding the Emotional Self, to mitigate disease stress. Concurrently, the nurse operationalizes the Dynamic Expert Nurse Advocacy Cycle through a Therapeutic Alliance that prioritizes the patient’s best interest, integrates the Family as an anchor, and ensures a meaningful understanding of information. This dyadic interaction transforms the ICU from a purely technological setting into a therapeutic space, ensuring the Preservation of Personhood and the safeguarding of the patient’s self-determination. Conclusions: This study is pioneering in integrating the patient’s voice into the construction of a theory on advocacy in critical care, demonstrating that its effectiveness is a process of mutual interaction and not merely a unilateral function of the nurse. The findings emphasise the need to actively include the patient’s perspective in training and policy, offering valuable implications for optimizing older adult-centered care. Full article