Artificial intelligence (AI) is rapidly reshaping clinical education by embedding assessment and feedback into everyday learning activities. Medical students can now use machine learning dashboards, generative AI, large language models, and emerging agentic systems to practice clinical reasoning, communication, and procedural skills while receiving individualized feedback within seconds. However, the availability of more data and more feedback does not necessarily produce better learning. This Viewpoint is intended for clinical educators, assessment leaders, curriculum committees, faculty developers, and institutional leaders who must decide how AI should be used in formative activities without reducing education to automated scoring. AI-assisted formative assessment is defined in this paper as the intentional use of AI tools to generate, organize, and support interpretation of performance information for learning rather than grading. Its distinctive contribution lies in the scale, adaptivity, conversational simulation, pattern detection, and possible autonomy of AI systems. However, AI outputs become formative only when learners and educators interpret them critically, judge their trustworthiness, and translate them into a small number of focused follow-on learning actions. This paper synthesizes the current evidence base while noting that much of it remains early, heterogeneous, and concentrated in short-term or single-setting studies. It examines key risks, including hallucination, automation bias, epistemic overtrust, hidden curricular effects, and broader concerns related to professional identity, power asymmetries, data privacy, and inequitable access. It also presents context-specific implementation examples for preclinical case-based learning, communication and objective structured clinical examination preparation, procedural skill laboratories, clerkship learning, and programmatic assessment portfolios, together with practical implications for faculty development, institutional governance, and phased local implementation. As a Viewpoint rather than an empirical study or systematic review, the framework and examples should be interpreted as evidence-informed design propositions that require local evaluation and validation. Overall, the value of AI-assisted formative assessment depends less on the volume of AI-generated feedback than on educational designs that preserve learner agency, professional judgment, and human accountability.
Myocardial ischemia-reperfusion injury (MIRI) poses diagnostic challenges due to complex histopathological changes. This study aimed to develop an intelligent framework for evaluating MIRI on hematoxylin-eosin-stained slides, to compare major deep learning architectures, and to determine the advantages of transformer models across multiple interventions and time points. A total of 1280 whole-slide images (~62,000 tiles) from public datasets were analyzed across antioxidant, β-blocker, calcium channel blocker, and control groups at 6, 24, and 72 hours. Seven model families (convolutional neural networks, recurrent neural networks, long short-term memory networks, autoencoders, graph convolutional networks, variational autoencoders, and transformers) were trained under unified preprocessing, with generative adversarial networks used exclusively for leakage-free augmentation. Weak supervision used a clustering-constrained attention multiple-instance learning strategy, and segmentation applied a Transformer-UNet. Data were split into 8:1:1 at the subject level, with 5-fold cross-validation. The transformer achieved the best performance (accuracy=0.942; area under the curve=0.982; and F1-score=0.958). Segmentation Dice scores were 0.847 (necrosis) and 0.821 (apoptosis). Predictions strongly agreed with expert measurements (r=0.886; Bland-Altman limits +5% or -5%), and attention maps aligned with necrotic borders and inflammatory foci. Temporal trends matched biological expectations, with the antioxidant group showing the most stable improvement. Transformer-based pathology offers accurate, robust, and interpretable assessment of MIRI and provides a scalable framework for dynamic injury quantification and therapeutic evaluation.
To evaluate ocular blood flow in school-aged children born prematurely, with or without retinopathy of prematurity (ROP), using laser speckle flowgraphy (LSFG), and to determine factors associated with LSFG-derived parameters. This cross-sectional observational study included 123 school-aged preterm children: 54 without ROP, 20 with untreated type 2/mild ROP, and 49 with treated type 1 ROP. All participants underwent ophthalmic examinations and optic nerve head (ONH) perfusion assessments using LSFG. Mean blur rate indices of the entire ONH (MA), vessel area (MV), and tissue area (MT) of the right eye were analysed. Multivariable generalised linear models were used to identify variables associated with LSFG parameters, and Pearson's correlation was used to examine the association between axial length and MT. Children with type 1 ROP had lower MA, MV, and MT than those with type 2/mild ROP, whereas MV was the highest in the type 2/mild ROP group. Type 1 ROP was independently associated with reduced MA and MV in the full cohort. Among children with ROP, anti-vascular endothelial growth factor (VEGF) treatment was associated with lower MA, MV, and MT. Longer axial length correlated with reduced MT in both the full cohort (r = -0.30, p < 0.01) and the ROP subgroup (r = -0.35, p < 0.01). Type 1 ROP was associated with reduced ocular blood flow in school-aged children born preterm. Among eyes with ROP, a history of anti-VEGF treatment was associated with lower MA, MV, and MT, although this may reflect disease severity.
During radiotherapy of non-small-cell lung cancers, changes in radiomics features extracted from cone-beam computed tomography images can serve as unique predictors. For adapting treatment plans or assessing early treatment responses, there is a pressing need to screen cone-beam computed tomography-derived radiomics features for predicting tumour regression volume. Our study enrolled 58 patients with non-small cell lung cancer undergoing radiotherapy, comprising dataset1, and an additional 32 patients who underwent an adaptive treatment approach, forming dataset2. For dataset1 patients, radiomics features were extracted from both the planning computed tomography and the first treatment cone-beam computed tomography. For dataset2 patients, features were also extracted from the replanning computed tomography and the corresponding cone-beam computed tomography after 20 fractions of radiotherapy. By employing correlation coefficient and intraclass correlation coefficient analyses on planning computed tomography and first treatment cone-beam computed tomography features, we identified robust and reproducible features in dataset1 patients. Reproducible delta radiomics features were further selected to characterize feature changes and screen delta radiomics features for tumour regression in dataset2 patients. Lastly, predictive delta radiomics features were screened using least absolute shrinkage and selection operator regression. Based on dataset1, we selected 34 radiomics features. From these, 16 delta radiomics features were further screened using dataset2. The changes observed in these features were consistent across both computed tomography and cone-beam computed tomography images. Specifically, nine features exhibited significant differences (p<0.05) while seven features remained relatively unchanged (p>0.05). Ultimately, four delta radiomics features were identified to classify tumour regression volume with a 30 % threshold for cone-beam computed tomography images. Our study introduces a novel strategy for selecting computed tomography-based cone-beam computed tomography radiomics features, enabling the identification of reliable features for model development. Preliminary findings firstly demonstrate the feasibility of using cone-beam computed tomography-based delta radiomics features to classify tumour regression volume during radiotherapy of non-small-cell lung cancer.
Chimeric antigen receptor T-cell therapy (CAR-T) has revolutionized the treatment of B-cell precursor ALL (B-ALL), but its global availability is limited. This study assessed current access and barriers to CAR-T CD19 therapy for children across Europe. A country questionnaire developed by the European Group for Blood and Marrow Transplantation Pediatric Diseases Working Party, St Jude Children's Research Hospital, and IBFM assessed current access to advanced therapies for B-ALL in Europe using Qualtrics software. Data from 36 WHO-defined European countries (27 high-income, nine upper-middle-income) observed a median of five pediatric hematology-oncology (PHO) centers per country (0.56 PHO centers/1 million inhabitants, range, 0.05-1.83). Hematopoietic stem-cell transplantation (HSCT) facilities were available in 89% of countries (32/36). CAR-T CD19 therapy was available in 72% of countries; however, 25/36 (69%) countries lacked clinical trials or international collaborations for pediatric CAR-T CD19 therapy. Most countries accepted foreign patients, but referrals remained limited, with 1-2 foreign patients treated annually per country. Eighteen countries expressed interest in a referral network, but only six had established mechanisms for domestic or international referrals. Substantial disparities exist in access to advanced therapies for pediatric B-ALL across Europe. Although CAR-T CD19 therapy is available in most countries, gaps in clinical trials, collaborations, and referral systems limit equitable access. Efforts to improve infrastructure and establish referral networks are essential to enhance care for patients with pediatric B-ALL.
Persistent postconcussion symptoms (PPCSs) represent a complex phenomenon following mild traumatic brain injury (mTBI), and this phenomenon is characterized by a diverse range of symptoms that greatly impact daily functioning, including the ability to engage in physical, cognitive, and social activities. Effective rehabilitation strategies and a nuanced understanding of brain function and patient perception remain insufficiently explored in adults with PPCSs. This study aims to assess the physiological and neurofunctional effects of targeted physical exercise carried out as a graded subsymptomatic aerobic exercise program. Furthermore, the project seeks to alleviate the complex symptomatology and perception of PPCSs through the planned intervention. In addition, the study aims to obtain feedback from patients and researchers involved in this interprofessional project and to conduct a comprehensive 360-degree evaluation combining subjective and objective data in order to obtain novel insights into the symptom complexity of PPCSs, ultimately paving the way for future strategic initiatives in mTBI treatment. This randomized controlled trial enrolled 70 patients with PPCSs. The patients were randomized in a 1:1 ratio to either a control group or a training group. Patients in the control group maintained their usual activities and care. Patients in the training group underwent a 12-week tailored aerobic exercise program designed to stay below symptom-provocation thresholds, using the Buffalo Concussion Bike Test (BCBT) as the assessment instrument. The study consisted of qualitative patient interviews, physical tests, exercise evaluations, neurofunctional and structural magnetic resonance imaging (MRI) scans, and process evaluations. MRI assessed neurophysiological changes, including blood-brain barrier integrity and cerebral metabolism. The primary outcome is improvement in physical performance on the BCBT. The secondary outcomes are symptom severity, neurophysiological function, and quality of life. The study will incorporate a multimodal approach, combining subjective patient reports with objective clinical and neuroimaging data, enabling the interdisciplinary research group to perform comprehensive evaluations of the complexity of PPCSs. Study funding was awarded in December 2022. Enrollment and randomization of 70 patients were completed in March 2025. The 12-week postintervention assessments concluded in August 2025. Data analysis is ongoing and expected to conclude in 2026. The results will be published in separate manuscripts in 2027. This study is innovative in its approach to patients with PPCSs, focusing on the effect of an individualized exercise regimen and exploring the neurofunctional underpinnings of symptom improvements as well as the patient perceptions of dealing with PPCSs. The findings are anticipated to contribute greatly to the field of PPCS management, potentially transforming current rehabilitation practices.
Cognitive impairment (CI) is a significant burden for patients with multiple sclerosis (MS). However crucial its assessment is, longitudinal measurement of cognitive performance is susceptible to learning effect, making the results of repeated evaluations difficult to interpret. Reliable change index (RCI) and standardized regression based norms (SRB) are accepted statistical methods to assess the reliability of a difference score between two observations. Thus, our aims were to provide RCIs and SRBs for all three subtests of the Brief International Cognitive Assessment for MS (BICAMS) battery and to measure the prevalence of true cognitive worsening and improvement. We retrospectively evaluated the first interim analysis data of the longitudinal follow-up or our BICAMS prevalence study-cohort after 1-year. We analyzed the data of 242 MS patients. We calculated both the RCIs and the SRBs for all three subtests of the BICAMS battery. According to the RCI, 5.4%, 6.9% and 14.6% worsened while 12.3%, 34.3% and 10.6% improved on the SDMT, BVMT-R and CVLT-II respectively. In case of SRB method, 3.8%, 8.3% and 19.7% worsened while 3.8%, 7.6% and 0.0% improved. The κ values revealed a mild-to-moderate agreement (κ=0.391-0.540; p<0.001). In case of the BVMT-R and the CVLT-II assessments the baseline scores influenced this outcome significantly (BVMT-R: OR: 1.068; 90%CI: 1.001-1.138; CVLT-II: OR: 1.096; 90%CI: 1.041-1.153). Comparing the methods, RCI seems to be better in cases with already established CI, while SRB, the more complex method, seemingly detects change better in cognitively intact patients.
Autism spectrum disorder (ASD) not only affects a person's social communication and behaviors, but also has an impact on their parents, who encounter different challenges during caregiving. Interventions developed for parents of children with ASD often focus on improving child outcomes and seldom consider the well-being of parents and families. Interventions leveraging mindfulness-based approaches have been developed to support parents of children with ASD, but the costs, inflexibility, and scarcity of resources may limit their accessibility. App-based interventions can be an accessible, scalable, and economical way of providing interventions at a primary health care level. The aim of this study was to develop an evidence-based digital intervention that complements existing, overloaded psychiatric services, to provide mindfulness-based psychoeducation for parents of children with ASD to improve their mental well-being. The app development process follows the systematic approach of intervention mapping. Needs assessment was first conducted through semistructured qualitative interviews with health care professionals. Performance and change objectives were specified; theory-based and practical application methods were selected, followed by the design of the curriculum for a structured intervention. A pilot waitlist randomized controlled trial was conducted to evaluate the feasibility, acceptability, and preliminary efficacy of the app with parents of children with ASD recruited from a tertiary child psychiatric service in Hong Kong. The resulting intervention, the TRIP app, is a 6-week structured intervention consisting of 6 sessions per week (each session lasting 15-20 minutes), covering topics on ASD parenting skills and mindfulness practices. The six weekly themes include (1) cultivating curiosity in parenting, (2) mindfulness of the breath and body, (3) management of core and associated features of ASD, (4) managing conflicts and setting boundaries, (5) perspective taking, and (6) cultivating self-compassion. The curriculum was designed to target the determinants of parental stress, including parents' knowledge, skills, emotions, and attitudes. App content and features were designed to incorporate behavioral change techniques, social cognitive theory, and elaboration likelihood model, to enhance efficacy and promote long-term usage. The app was found to be feasible and acceptable in the pilot randomized controlled trial (n=40), with greater long-term usage among parents of children on the waiting list who were yet to receive diagnostic assessment and clinical management, when compared with parents of children who have already been receiving clinical care. The TRIP app was developed based on knowledge and expertise across psychiatry, public health, behavioral science, and implementation science. It caters to the unmet needs for improving caregiver well-being in the holistic care model for families of children with ASD. The clinical efficacy of the TRIP app is yet to be evaluated through clinical trials.
Preoperative visualisation tools may support patient education and shared decision-making by helping patients understand anticipated postoperative outcomes. This scoping review asked: in preoperative doctor-patient shared decision-making for elective surgery, what patient-facing visualisation tools have been reported to depict anticipated changes in patient's anatomy; in which surgical contexts have they been used; how have they been incorporated into decision-making; and what outcomes have been evaluated? A scoping review was conducted following JBI methodology and PRISMA-ScR guidelines. PubMed, EMBASE, Scopus, CINAHL, Web of Science, and Cochrane Library were searched for studies published from 1 January 2020-27 March 2025, using search terms derived from the research question, to identify studies that used visualisation tools during preoperative doctor-patient shared decision-making to depict postoperative changes in appearance, anatomy, or physical function. Extracted data included study characteristics, tool features, surgical context, shared decision-making application, and objective or patient-reported outcome measures related to use of the visualisation tool. A descriptive numerical summary and narrative synthesis were performed. The search identified 22,384 records, of which eight studies met the inclusion criteria. Seven studies concerned breast-related procedures, including breast augmentation (n = 5) and breast-conserving surgery (n = 2); one study concerned high tibial osteotomy. Five different visualisation systems were described, most commonly the Vectra 3D platform (n = 4). Across studies, patients reported better understanding of anticipated outcomes, improved communication with clinicians, and, in some cases, greater decisional confidence. Formal assessments of simulation accuracy were uncommon and limited to breast augmentation, where reported accuracy was generally high. Published evidence on patient-facing visualisation tools for surgical shared decision-making remains limited and concentrated in breast surgery. Future efforts should develop accessible, validated visualisation tools across broader surgical fields and evaluate their effects on comprehension, expectation-setting, communication, decisional confidence, and technical accuracy.
Universal fall risk screening as a first step to address falls has been endorsed in primary care but remains challenging due to competing clinical priorities and insufficient training. We studied the impact of our geriatric continuing medical education program, the Geriatric Mini-Fellowship (GMF), on the uptake of fall risk screening in primary care over a 5-year period. We hypothesized that primary care providers (PCP) with exposure to the GMF program would be more likely to implement fall risk screening than PCPs without direct or indirect program exposure. We identified 133,068 patients ≥ 65 years of age who received care at primary care clinics in a large health system. Each year, we retrospectively assigned patients to one of three groups based on their provider's exposure to the GMF program. Groups included patients seen by: GMF providers who completed GMF training. GMF-influenced providers who practiced at a clinic with at least one GMF provider. Usual care providers who neither completed GMF training nor worked at a clinic with a GMF provider. We described fall risk screening rates and patterns using multivariate models to estimate the predicted probability and odds of being screened each year based on a provider's training exposure. GMF providers were associated with a greater predicted probability of screening patients for fall risk compared to usual care providers each year. Differences in predicted probabilities between GMF providers and usual care with bootstrapped confidence intervals favored GMF providers. Further, this screening advantage increased over time (2019: 5.8%, 2023: 12%). Our data supports intensive fall risk education on screening through a geriatrics training program to implement sustained fall risk screening in primary care. Screening is the first step in identifying high-risk patients, which can enable assessment of modifiable risk factors and lead to targeted interventions.
This study aimed to evaluate the effect of an Intervention Food for Special Medical Purposes (FSMP) on the nutritional status and muscle function of middle-aged and older adults at risk of malnutrition. A multicenter, randomized, active-controlled, parallel-group study. Two clinical centers located in China. 135 adults aged 45-80 years at risk of malnutrition (Mini Nutritional Assessment [MNA] score ≤ 23.5). Participants were randomized to one of three groups for a 12-week nutritional intervention: Intervention FSMP (one daily sachet of a novel high-protein FSMP plus dietetic counseling); Active Control (one daily sachet of an established FSMP plus dietetic counseling); and Control (dietetic counseling alone). The primary outcome was the change in MNA score. Secondary outcomes were body weight, handgrip strength, calf and mid-upper arm circumferences, and SARC-F score. Linear mixed-effects models showed significant group-by-time interactions for MNA score, body weight, BMI, handgrip strength, and calf circumference. At week 12, both FSMP groups demonstrated greater improvements in MNA score compared with Control (Intervention FSMP: adjusted difference 2.3, 95% CI 1.4-3.2; Active Control: adjusted difference 3.1, 95% CI 2.2-4.0; both P < 0.001). The between-FSMP comparison for MNA was not statistically significant (adjusted difference -0.8, 95% CI -1.7 to 0.1; P = 0.087). The Intervention FSMP group showed greater gains in body weight than Control (adjusted difference 1.2 kg, 95% CI 0.8-1.7; P < 0.001). Compared with Control, handgrip strength improved in both FSMP groups (adjusted differences 2.2-3.0 kg for left hand and 2.8 kg for right hand; all P < 0.001). Across groups, no significant differences were noted in adverse events and gastrointestinal tolerability. Targeted 12-week nutritional intervention with a high-protein FSMP was associated with improvements in nutritional status and handgrip strength in adults at risk of malnutrition.
Multiple Sclerosis is a neurodegenerative disease frequently associated with gait impairments that can emerge early and progressively worsen, substantially affecting mobility and independence. The Expanded Disability Status Scale (EDSS) is widely used to quantify overall disability in people with multiple sclerosis. However, gait alterations may present as specific spatiotemporal and kinematic changes that are not explicitly described by the EDSS scoring criteria. In this context, quantitative gait analysis can provide complementary information on motor function. This study investigates the feasibility of a markerless, single-camera two-dimensional video-based approach to extract quantitative gait parameters in people with multiple sclerosis and to examine whether these measures scale with overall disability level as indexed by scores on the Expanded Disability Status Scale. Twenty people with multiple sclerosis were recorded while walking at a comfortable pace using a standard video camera. Spatiotemporal parameters and lower-limb elevation angles (thigh, shank, and foot) were extracted using the position of the keypoints obtained with a pose estimation algorithm. Associations between these measures and disability scores were assessed. Results showed a significant reduction in normalized stride length and stride time with increasing disability level. In addition, the range of motion of shank and foot elevation angles exhibited strong associations with disability scores. These findings suggest that the range of motion of lower-limb elevation angles, particularly at distal segments, might provide sensitive indicators of disability-related gait impairment. The proposed two-dimensional video-based method offers a low-cost, non-invasive, and unconstrained tool for objective gait assessment in people with multiple sclerosis.
Leiomyomas remain highly prevalent by midlife, with persistent racial disparities in age at onset and tumor burden. Although they are traditionally expected to regress after menopause, longitudinal data demonstrate variable behavior, with many leiomyomas persisting, some regressing modestly, and a subset continuing to grow. This structured, nonsystematic review of the contemporary literature was conducted using PubMed and Embase, supplemented by guideline and reference review, with the objective of guiding the evaluation and management of uterine leiomyomas across the menopausal transition. In perimenopausal and postmenopausal patients, abnormal uterine bleeding and pelvic pain require systematic evaluation to exclude endometrial pathology and alternative causes. Transvaginal ultrasonography with structured assessment provides the foundation for evaluation, and magnetic resonance imaging serves as an adjunct when findings are indeterminate or clinical concern is elevated. No single imaging feature reliably distinguishes benign leiomyoma from leiomyosarcoma, and the prevalence of unsuspected leiomyosarcoma at surgery remains low, increasing with age. Management should be individualized and symptom driven, incorporating patient age, comorbidities, hormonal exposures, imaging findings, and preferences, with expectant management appropriate for asymptomatic patients and intervention reserved for refractory symptoms or diagnostic uncertainty.
Recent evidence links adiposity with the risk of severe infections, but whether muscle strength may also be an independent risk factor is less studied. We investigated the association between handgrip strength and risk of common infections and sepsis and explored potential mediation by plasma proteomic biomarkers. We analyzed data from 405,451 UK Biobank participants and replicated the main findings in 4474 Chinese adults from the Hong Kong Osteoporosis Study (HKOS). Baseline handgrip strength was measured by a dynamometer. Cox models were used to estimate its association with incidence of pneumonia, urinary tract infection (UTI), skin infection, and sepsis, adjusting for sociodemographic, lifestyle, and health-related factors. Mediation analyses were performed using 2912 plasma proteins in a UK Biobank subsample (n = 42,414) to identify biological pathways. In UK Biobank (median follow-up 13.6-15.3 years), lower handgrip strength was associated with significantly increased risk of pneumonia (hazard ratio per 5-kg decrement=1.10; 95% CI=1.09-1.11), UTI (1.10; 1.09-1.11), skin infection (1.05; 1.04-1.05), and sepsis (1.08; 1.07-1.10). Associations were largely consistent in HKOS, and the relative risks associated with low grip strength were generally most pronounced in underweight individuals. GDF15 and PLAUR were identified as the most important proteins which mediated 12-14% of these associations. Low handgrip strength is associated with increased risks of common infections and sepsis, particularly in underweight individuals, with partial mediation by proteins related to inflammation and immune-related pathways. Handgrip strength assessment may provide prognostic value beyond body mass index for clinical risk stratification.
Assessments of chimeric antigen receptor (CAR) T-cell pharmacokinetics by flow cytometry (FC) and a droplet digital PCR (ddPCR) assay were compared in adult patients with relapsed/refractory B-cell acute lymphoblastic leukemia following treatment with obecabtagene autoleucel (obe-cel) in the Phase Ib/II FELIX study (NCT04404660). CAR T-cell persistence and B-cell aplasia (BCA) were then correlated with event-free survival (EFS). Peripheral blood (PB) samples collected from 127 obe-cel-infused patients were tested by FC and ddPCR. The Spearman correlation coefficient was used to measure the correlation between the number of CAR T-positive cells by FC and ddPCR. The impact of CAR T-cell persistence and BCA (B-cells <20 cells/µL by FC in PB) on EFS was assessed using Cox proportional hazards regression. ddPCR was observed to statistically correlate with both the surface (0.60, P < 0.0001) and intracellular FC assays (0.74, P < 0.0001). A higher sensitivity for detecting CAR T-cell positive samples was observed with ddPCR, with 58.8% and 41.3% of samples negative by surface and intracellular FC, respectively, being positive by ddPCR. Loss of CAR T-cell persistence (HR: 2.7; 95% CI: 1.4-5.4), and to a lesser degree B-cell recovery (HR: 1.7; 95% CI: 0.7-3.8), as time-dependent variables and at Month 3, were associated with poorer EFS. ddPCR demonstrated enhanced sensitivity over FC methods for detection of obe-cel persistence. Additionally, ongoing persistence and BCA were associated with longer EFS and may be taken into consideration, together with clinical parameters, in informing decision making.
The sustained improvement in cancer survival has highlighted the growing impact of cardiovascular toxicity related to anticancer therapies, which has become a leading cause of non-cancer morbidity and mortality. This position statement aims to provide a practical and standardized framework for the comprehensive management of cardiotoxicity in oncology patients from the perspective of Primary Care (PC) in Spain, acknowledging its pivotal role in prevention, early detection, risk stratification, and long-term follow-up. The document reviews the main forms of cardiovascular toxicity associated with systemic anticancer therapies, as well as local treatments such as thoracic radiotherapy, incorporating current definitions and recommendations from European and international guidelines. A structured model based on the oncology care continuum is proposed, encompassing the initial phase, active treatment, and survivorship, allowing cardiovascular surveillance to be tailored according to baseline risk, type of treatment, and clinical evolution. Special emphasis is placed on early cardiovascular risk assessment, proactive optimization of cardiovascular risk factors and comorbidities, and the establishment of clear referral and coordination pathways between PC, Oncology, Hematology and Cardiology. The central role of PC in the follow-up of long-term cancer survivors is also highlighted, as this growing population remains at risk of late cardiovascular complications that may persist or increase over time. This position statement seeks to promote coordinated, equitable, and patient-centered care, reducing clinical variability and improving cardiovascular outcomes and quality of life for oncology patients within the National Health System.
Depression and anxiety are often undetected and untreated in individuals with multiple sclerosis (MS), despite a high prevalence of these conditions in this population. This study evaluated the clinical utility, diagnostic accuracy, and acceptability of depression and anxiety screeners and their integration into routine MS clinic appointments. Participants with MS (N = 207; age M = 47.3 ± 12.7 years, 77.3% female) were enrolled in this cross-sectional study conducted at an MS clinic in Melbourne, Australia. Consenting participants completed the Patient Reported Questionnaire-9 (PHQ-9) and the Depression, Anxiety and Stress Scale-21 (DASS-21) via an electronic tablet in the clinic waiting room or online for telehealth appointments, and underwent a Structured Clinical Interview for DSM-5 major depressive disorder and generalised anxiety disorder. Sensitivity, specificity, internal consistency, and patient comfort were assessed. The PHQ-9 and DASS-21 depression subscales demonstrated excellent internal consistency (α=0.90-.93) and good diagnostic performance. For anxiety, DASS subscales showed moderate validity, with the stress subscale outperforming the anxiety subscale. Participants rated screening as highly acceptable (mean comfort score=7.7/10). Among people with MS, self-administered depression and anxiety screening tools are valid and acceptable for routine use at MS clinic appointments. Tablet and online survey administration provide scalable options for integrating mental health assessment into standard care.
Online patient education materials (OPEMs) are increasingly relied upon by patients seeking information on breast reconstruction. However, the readability, quality, and cultural inclusivity of these resources remain unclear. Following PRISMA guidelines, a systematic review and meta-analysis of OPEMs related to breast reconstruction was conducted across PubMed, Embase, and Scopus through April 2025. Eligible studies evaluated websites, videos, or AI-generated materials for readability [Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Scores (FRES), and SMOG], quality (DISCERN), or usability [Patient Education Materials Assessment Tool (PEMAT)]. Data were pooled using random-effects models. Studies lacking quantitative data were synthesized thematically. Twenty studies encompassing 1634 OPEMs (1038 websites and 596 videos) were included. Meta-analyses revealed that most materials required a high reading level: FKGL mean=12.68, SMOG=12.29, and FRES=42.39, all indicating difficult-to-college-level text. DISCERN quality scores averaged 2.72/5, with wide variability across sources. PEMAT scores indicated suboptimal usability: understandability=61.9% and actionability=21.9%. Thematic analysis highlighted deficiencies in risk disclosure, citation use, language accessibility, and racial/ethnic representation. Non-English materials and social media content were especially limited in cultural sensitivity and depth. OPEMs in breast reconstruction are often inaccessible, incomplete, and insufficiently actionable. Content from academic or institutional sources generally outperforms patient-generated and AI-based materials but still falls short of re--ed standards. There is an urgent need for coordinated evidence-based guidelines to improve digital patient education in reconstructive surgery.
Electroconvulsive therapy (ECT) is an effective treatment for severe and treatment-resistant bipolar depression, yet intracranial vascular malformations such as cerebral cavernous malformations raise safety concerns due to transient ECT-induced increases in blood pressure and intracranial pressure, potentially elevating the risk of hemorrhage. We report a case of a woman in her mid-60s with treatment-resistant bipolar depression and severe symptom burden (MADRS 45; HAMD-17 35; HAMD-21 39) in whom brain MRI incidentally revealed a 6×4 mm cavernous hemangioma in the left precentral gyrus without signs of prior hemorrhage. Following interdisciplinary consultation with neurosurgery and anesthesiology, an index course of ECT was initiated with careful hemodynamic monitoring and pharmacological blood pressure control. The patient received 16 sessions; initial bifrontal stimulation yielded insufficient seizure quality despite maximal stimulus intensity, prompting a switch to right unilateral electrode placement, which produced adequate seizures. Hypertensive peaks up to 210/150 mmHg were successfully managed with metoprolol and intravenous urapidil. Apart from transient anisocoria after the first session with unremarkable cranial CT findings, no neurological complications occurred. Depressive symptoms markedly improved by the end of treatment (MADRS 12; HAMD-17 15; HAMD-21 17). This case suggests that ECT can be performed safely and effectively in patients with cerebral cavernous hemangioma when multidisciplinary assessment and targeted hemodynamic management are implemented, and that the combination of metoprolol and urapidil may represent a useful strategy to mitigate blood pressure surges during ECT.
Falls are highly prevalent after stroke. Although trunk control is critical for dynamic stability during walking, the contribution of upper body (head, neck, thorax, spine) kinematics to fall risk discrimination and prediction remains unknown. This study examined whether trunk kinematics during walking differentiate people with stroke (PwS) with high versus low fall-risk and whether these measures improve fall risk classification. Fifty sub-acute PwS from a public 3D gait dataset were analysed. Participants walked barefoot at self-selected speed while full-body kinematics were recorded (Vicon®). Fall risk was classified with the Tinetti Performance-Oriented Mobility Assessment (≤18/28 = high risk). Sagittal and frontal upper body kinematics and thoraco-pelvic coordination (continuous relative phase, CRP) were computed. Group differences were tested using ANCOVA adjusted for age and walking speed. Linear discriminant analysis assessed fall risk prediction using walking speed alone and combined with trunk kinematics. Participants were classified as high (n = 22) and low (n = 28) fall risk. High-risk PwS showed significantly greater mean and maximal sagittal spinal flexion, greater maximal frontal head angle, and lower mean and maximal CRP indicating reduced thoraco-pelvic dissociation. Sagittal head and neck kinematics did not differ. Walking speed alone yielded an AUC of 0.83. Adding maximal sagittal spine angle improved AUC to 0.87 and specificity (0.75-0.88) without affecting sensitivity. High fall risk PwS showed greater trunk flexion, reduced thoraco-pelvic coordination, and greater frontal plane head angle during walking. Walking speed alone strongly predicted fall risk, while adding trunk kinematics improved specificity without affecting sensitivity.