Background Laboratory test overuse is a well-recognized challenge in modern healthcare, contributing to unnecessary costs, inefficient resource utilization, and potential patient harm. Inappropriate repeat testing, particularly outside recommended minimum retesting intervals (MRIs), represents a measurable target and actionable strategy to improve laboratory demand management. This study evaluated MRI compliance across multiple clinical settings and quantified the potential impact of MRI-based hard-stop restrictions. Methodology A retrospective observational study was conducted at a regional healthcare network in Northeast Portugal, including three hospitals and 14 primary care centers. All laboratory requests for 77 biomarkers performed between January 2023 and December 2024 were analyzed. Repeat tests were classified as appropriate or inappropriate based on established MRI recommendations. Patterns were compared across primary care, hospital outpatient, and inpatient/emergency settings. Statistical comparisons were performed using chi-square and z-tests for proportions. Potential cost savings were estimated based on reagent costs. Results Among 3,012,396 tests, 21.4% were performed outside recommended MRI thresholds. Inappropriateness rates were significantly different across care settings (p < 0.001): 6.7% in primary care, 15.4% in hospital outpatient care, and 31.4% in hospital inpatient care. Overutilization was particularly pronounced for frequently requested biomarkers, as 10 of the 11 most frequently prescribed biomarkers showed overall inappropriateness rates ranging from 24.4% to 32.5%. The simulated implementation of MRI-based hard-stop rules was projected to reduce laboratory expenditure by 14.2% (€119,281.93 annually). Notably, 38.5% of the estimated savings were attributable to B-type natriuretic peptide alone. Conclusions Substantial non-compliance with MRI recommendations was identified across all levels of care, particularly in the hospital inpatient setting. These findings highlight the need for targeted laboratory demand management strategies, especially in high-intensity clinical environments. MRI-based interventions, including electronic decision-support tools such as hard-stop policies, may represent effective and sustainable approaches to improve test appropriateness, reduce healthcare costs, and minimize patient harm associated with unnecessary diagnostic cascades.
Geriatric medicine is becoming increasingly more important in the context of demographic change. Older people frequently suffer from multimorbidity, functional impairments and complex psychosocial conditions that are often insufficiently addressed by a purely diagnosis-oriented medical approach. The primary aim of geriatrics is therefore not only the treatment of diseases but also with respect to individual goals, the preservation of independence, quality of life and social participation.This expert paper outlines the current state of geriatric care in Germany, its scientific evidence base and key challenges and future perspectives. Central elements of geriatric complexity medicine include comprehensive geriatric assessment, multiprofessional treatment concepts and cross-sectoral models of care. Numerous studies demonstrate that this approach improves functional outcomes, reduces the risk of long-term care dependency and reduces or shortens hospital stays.Despite established acute geriatric and rehabilitation structures, substantial deficits remain in nationwide access to care, financing, academic integration, research and professional training. Workforce shortages, insufficient outpatient services and the limited integration of geriatric principles into other medical specialties weaken the great opportunity that modern geriatric medicine offers for preventing the need for long-term care. At the same time, digitalization, telemedicine and innovative cross-sectoral care models offer new opportunities for patient-centered geriatric medicine.The authors advocate stronger structural and political support for geriatrics, the expansion of outpatient geriatric centers, financing systems that adequately reflect patient complexity and a stronger integration of geriatrics into research, teaching and medical education including a German Center for Geriatric Medicine with substantial involvement of geriatrics. In this way, geriatrics can make a major contribution to a sustainable, patient-centered and future-oriented healthcare system. Die geriatrische Medizin gewinnt angesichts des demografischen Wandels zunehmend an Bedeutung. Ältere Menschen leiden häufig an Multimorbidität, funktionellen Einschränkungen und komplexen psychosozialen Problemlagen, die durch eine rein diagnoseorientierte Medizin nicht ausreichend berücksichtigt werden. Ziel der Geriatrie ist daher nicht allein die Behandlung einzelner Erkrankungen, sondern, auf Basis individueller Ziele, der Erhalt von Selbstständigkeit, Lebensqualität und gesellschaftlicher Teilhabe.Das vorliegende Expertenpapier beschreibt den aktuellen Stand der geriatrischen Versorgung in Deutschland, ihre wissenschaftliche Evidenz sowie zentrale Herausforderungen und Zukunftsperspektiven. Im Mittelpunkt steht die geriatrische Komplexitätsmedizin mit dem geriatrischen Assessment, multiprofessionellen Behandlungskonzepten und sektorenübergreifenden Versorgungsmodellen. Zahlreiche Studien belegen, dass dadurch funktionelle Fähigkeiten verbessert, Pflegebedürftigkeit reduziert und Krankenhausaufenthalte verringert oder verkürzt werden.Trotz etablierter akutgeriatrischer und rehabilitativer Strukturen bestehen weiterhin erhebliche Defizite in der flächendeckenden Versorgung, der Finanzierung, der universitären Verankerung sowie in Forschung und Weiterbildung. Besonders der Fachkräftemangel, unzureichende ambulante und präventive Angebote und die mangelnde Integration geriatrischer Prinzipien in andere Fachgebiete schwächen die große Chance, die eine moderne Altersmedizin zur Vermeidung von Pflegebedürftigkeit bietet. Gleichzeitig eröffnen Digitalisierung, Telemedizin und innovative sektorenübergreifende Versorgungskonzepte neue Möglichkeiten.Die Autorinnen und Autoren fordern eine strukturelle und politische Förderung der Geriatrie, den Ausbau ambulanter geriatrischer Zentren, eine an Komplexität und Funktionalität orientierte Finanzierung sowie eine intensivere wissenschaftliche und akademische Verankerung, inklusive eines Deutschen Zentrums für Altersmedizin mit starker Beteiligung der Geriatrie. Die Geriatrie kann damit einen entscheidenden Beitrag zu einem nachhaltigen, patientenzentrierten und zukunftsfähigen Gesundheitssystem leisten.
Physicians are entering practice in healthcare systems shaped by consolidation, corporatization, administrative complexity, and rising burnout. These pressures are especially relevant in psychiatry and child and adolescent psychiatry, where clinicians must navigate fragmented systems, multidisciplinary teams, reimbursement constraints, and organizational decisions that directly affect patient care. However, most graduate medical education programs provide limited formal training in leadership, hospital administration, finance, governance, or systems-level decision-making. This editorial argues that leadership development and hospital administration exposure should be integrated into residency and fellowship training as core educational experiences. Drawing on a trainee's psychiatry hospital administration elective at a large nonprofit psychiatric health system, it illustrates how exposure to executive leadership meetings, quality and safety committees, operational dashboards, strategic planning, service line decisions, and electronic health record implementation can help trainees understand how health systems function and where physicians can meaningfully intervene. For psychiatrists and child psychiatrists, leadership training is not only preparation for formal administrative roles. It is central to effective clinical practice, team coordination, patient advocacy, and professional sustainability. A tiered model that provides foundational leadership exposure for all trainees, with advanced elective pathways for interested residents and fellows, may help prepare physicians to engage constructively with modern health systems. Embedding leadership curricula and hospital administration electives into graduate medical education can strengthen physician agency and prepare the next generation to shape, rather than simply endure, the systems in which they practice.
The sustainable development of a modern healthcare system relies not only on the provision of basic healthcare services but also on a stable reserve of future healthcare professionals. Medical students constitute an important source of the future healthcare workforce, and their career construction may influence the long-term stability of healthcare service provision. However, from the perspective of public health workforce development, existing empirical studies have primarily focused on external incentives, while relatively limited attention has been paid to the psychological factors shaping medical students' career construction. This study examined the relationship between occupational calling and career construction among medical students and further tested the mediating roles of teacher-student interaction and meaning in life. A cross-sectional questionnaire survey was conducted among medical students from an undergraduate university and a vocational college in Zhuhai, China. After excluding invalid responses with missing or abnormal age information, 532 valid questionnaires were included in the final analysis. Validated scales were used to measure occupational calling, teacher-student interaction, meaning in life, career construction, and self-efficacy. The results showed that occupational calling significantly predicted teacher-student interaction, meaning in life, and career construction. Teacher-student interaction has a positive predictive effect on meaning in life and career construction. At the same time, the mediating analysis indicates that teacher-student interaction and meaning in life exert significant mediating effects, jointly influencing the relationship between occupational calling and career construction. These findings suggest that strengthening occupational calling, improving teacher-student interactions, and enhancing meaning in life are crucial for cultivating public health professionals and promoting career construction among medical students. Therefore, medical education should not only focus on increasing the number of future healthcare professionals but also strive to support their career development and foster their long-term commitment to serving the healthcare system.
Background/Objectives: Contemporary periodontal therapy is increasingly guided by evidence-based clinical protocols, particularly the European Federation of Periodontology (EFP) S3 Clinical Practice Guidelines. The present study aimed to assess dentists' perceptions regarding modern periodontal therapy and to perform a preliminary psychometric evaluation of a newly developed questionnaire. Methods: A cross-sectional questionnaire-based study was conducted among 109 dental practitioners. The questionnaire evaluated perceptions regarding non-surgical periodontal therapy, surgical periodontal therapy, and the comparative role of both therapeutic approaches. Descriptive statistical analysis, internal consistency analysis using Cronbach's Alpha, Intraclass Correlation Coefficient (ICC), repeated measures ANOVA, and exploratory factor analysis (Principal Component Analysis-PCA) with Varimax rotation were performed to evaluate the psychometric properties of the instrument. Results: The questionnaire demonstrated good internal consistency, with Cronbach's Alpha values ranging from 0.77 to 0.86. ICC analysis confirmed satisfactory reliability. Respondents showed favorable attitudes toward evidence-based periodontal management, supporting non-surgical therapy as first-line treatment and the staged integration of surgical approaches in complex cases. Exploratory factor analysis identified a coherent factorial structure, with four components explaining 73.94% of the total variance. Conclusions: The questionnaire showed good psychometric properties, supporting its potential utility as a reliable and useful instrument for evaluating professional attitudes and clinical decision-making in periodontology.
Prostate MRI has become a key tool in the detection, localization, and staging of prostate cancer, as well as in active surveillance. Despite its diagnostic value, conventional PI-RADS v2.1-compliant protocols can exceed 30 min, with T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) accounting for much of the scan time. Prolonged acquisitions have important clinical consequences, including increased patient motion, reduced image quality, compromised patient comfort, and limited scanner throughput, at a time when demand for prostate MRI has increased markedly. This review provides radiologists with a practical overview of modern acceleration strategies for prostate MRI that may reduce acquisition time while preserving PI-RADS v2.1 diagnostic requirements. We examine innovations in T2WI and DWI acquisition, including deep learning reconstruction, optimized 2D fast spin-echo sequences, near-isotropic 3D T2WI, synthetic high b-value DWI, and deep learning phase correction. In selected, locally validated implementations, accelerated prostate MRI may be performed more efficiently while retaining the PI-RADS-required sequence components. The strength of evidence varies across techniques. Among the approaches discussed, deep learning reconstruction for accelerated 2D T2-weighted imaging has the most mature supporting clinical evidence. Deep learning phase correction for DWI and use of near-isotropic 3D T2WI as a potential alternative to routine multiplanar 2D T2WI are newer approaches that require further validation before they can be broadly relied upon. Widespread implementation requires standardized local validation, ADC reproducibility assessment, and multicenter evaluation across vendors and field strengths. When carefully implemented, accelerated prostate MRI protocols can improve patient experience, reduce motion artifacts, and expand access to high-quality prostate MRI without sacrificing diagnostic reliability.
Background/Objectives: Work-related musculoskeletal disorders (WMSDs) and occupational stress substantially affect workforce health and productivity. This systematic review aimed to synthesize evidence regarding the effectiveness of the Pilates method as a biopsychosocial intervention for employees, examining its impact on physical, psychological, and occupational outcomes. Methods: A systematic search was conducted across major electronic databases and search engines (PubMed, Scopus, Web of Science, PEDro, and Google Scholar) following PRISMA 2020 guidelines. The review protocol was prospectively registered in PROSPERO (CRD420261390771). Eligible studies included randomized controlled trials, quasi-experimental, and observational designs involving employees participating in Pilates programs. Outcomes were categorized into three domains: physical health, mental well-being, and occupational performance. Results: Twenty-three studies (n = 1179 participants) met the inclusion criteria. The evidence indicates that Pilates may reduce pain intensity and disability in workers with chronic low back or neck pain, with moderate certainty based on randomized controlled trials. Improvements in psychological outcomes, including anxiety and job-related stress, were also reported, although the certainty of evidence was lower. Occupational benefits included enhanced job satisfaction and, in limited cases, favorable cost-utility findings. Conclusions: Pilates appears to be a feasible multidimensional intervention for workplace health, with potential benefits across physical and psychosocial domains. Further high-quality trials are needed to clarify long-term effects, economic impact, and optimal implementation strategies within occupational settings.
Background/Objectives: Private dental markets operating under fee-for-service arrangements lack the structural accountability mechanisms that typically drive quality governance adoption in publicly funded systems. In Romania, where no private dental office currently holds formal accreditation, accreditation-seeking reflects a genuine behavioral choice rather than a regulatory compliance. This study examined whether financing structure and Professional Governance behavior operate as distinct determinants of accreditation-seeking intention among private dental practitioners and which pathway offers a more tractable entry point for quality policy intervention. Methods: A cross-sectional survey was conducted among 98 licensed private dental practitioners in Romania (November 2025-January 2026). Three domain composites were derived from a 31-item de novo instrument anchored in JCI, ANMCS, and EN ISO 9001:2015 standards: Professional Governance, Patient Rights and Ethics, and Patient Safety Behaviors. The financing profile was operationalized as engagement with the national public insurance system (CNAS). Binary logistic regression modeled high accreditation-seeking intention (Q31 ≥ 4) against standardized domain scores and financing engagement, with bootstrap confidence intervals from 2000 replicates. Results: Two predictors independently and significantly predicted high accreditation-seeking intention. CNAS engagement showed the strongest association (OR = 5.05, 95% bootstrap CI [1.87-17.91], and p = 0.003), while the Professional Governance score remained independently associated (OR = 2.68, 95% bootstrap CI [1.63-5.63], and p = 0.003). The Patient Rights and Ethics score was not significant. Practitioners actively exploring CNAS contracting showed the highest accreditation-seeking intention (exceeding that of established contractors), suggesting a possible transitional accountability dynamic during financing transition, though this interpretation requires prospective longitudinal validation. Model performance was good (AUC = 0.788; Nagelkerke R2 = 0.339). Conclusions: Both financing engagement and governance behavior predicted accreditation-seeking intention after mutual adjustment, representing distinct pathways to voluntary quality adoption in private dental practice. Policy interventions aligned with entry into public contracting and with practice-level governance development are more likely to support accreditation uptake than normative appeals to professional ethics alone.
The aim of this paper is to present the current status, challenges, and development directions of obstetrics and gynecology residency training in the Southern Great Plain region, in the context of the ongoing transformation of the Hungarian healthcare system. Obstetrics and gynecology represent one of the most complex fields of clinical medicine, where decision-making, ethical sensitivity, psychological resilience, and technical proficiency together define professional competence. Over the past decade, Hungarian postgraduate medical education has undergone significant reforms: the introduction of the healthcare service relationship, the elimination of informal gratuities, and the implementation of a competency-based educational framework have resulted in a more transparent and objective system. This paper draws attention to regional residency data, presenting trends in trainee distribution, the main structural elements of the program, and key areas of modernization - including digitalization, simulation-based training, the strengthening of research activity, and international mobility. The authors emphasize that high-quality residency training program requires structured competency assessment, modern infrastructure, the integration of international experience, and adequate mental support for trainees. The obstetrician-gynecologist of the future should not only be technically proficient but also reflective, empathetic, and responsible - a physician whose training is built on both professional excellence and the preservation of humanistic values and vocation. Orv Hetil. 2026; 167(29): 1159-1163. A jelen közlemény célja, hogy bemutassa a Dél-Alföld régió szülész-nőgyógyász rezidens képzésének aktuális helyzetét, kihívásait és fejlesztési irányait a hazai egészségügyi rendszer átalakulásának összefüggésében. A szülészet-nőgyógyászat szakképzése a klinikai orvoslás egyik legösszetettebb területe, ahol a döntéshozatal, az etikai érzékenység, a pszichés teherbírás és a technikai felkészültség egysége határozza meg a szakmai kompetenciát. Az elmúlt évtizedben a magyar szakorvosképzés jelentős reformokon ment keresztül: az egészségügyi szolgálati jogviszony, a hálapénz megszüntetése és a kompetenciaalapú oktatási struktúra bevezetése átláthatóbb, objektívebb rendszert eredményezett. A közlemény a Dél-Alföld régió rezidensképzésének adataira épül, bemutatva a rezidensek eloszlásának trendjeit, a képzési struktúra fő elemeit, valamint a modernizáció kulcsterületeit – a digitalizációt, a szimulációs oktatást, a tudományos tevékenység erősödését és a nemzetközi mobilitást. A szerzők kiemelik, hogy a minőségi szakorvosképzés alapfeltétele a strukturált kompetenciaértékelés, a korszerű infrastruktúra, a nemzetközi tapasztalatok beépítése és a rezidensek mentális támogatása. A jövő szülész-nőgyógyásza nem csupán technikailag felkészült, hanem gondolkodó, empatikus és felelősségteljes gyógyító, akinek képzése a szakmai kiválóság mellett az emberi hivatástudat megőrzésére is épül. Orv Hetil. 2026; 167(29): 1159–1163.
Advanced methods for analyzing data are in high demand as the volume of high-dimensional data used in healthcare services increases, particularly for the early detection and management of Chronic Kidney Disease (CKD). False diagnosis and treatment of CKD have been rendered more challenging by the complicated nature and the several features detected in these collections of data. Optimizing the diagnostic result depends significantly on the efficient analysis and processing of such complex data. Recent healthcare data analysis tools, including the Feature Selection Model (FSM), face challenges when processing large volumes of historical data with numerous features. Overfitting, a result of the Curse of Dimensionality (CoD), diminishes the accuracy of algorithms developed using conventional methods. Less-than-optimal feature selection (FS) and reduced Classification Accuracy (CA) have also resulted from the failure of multiple modern methods to address the fuzziness and uncertainty inherent in healthcare data features. The current study introduces the Enhanced Fuzzy Joint Mutual Information-Cuckoo Search Algorithm-Genetic Algorithm (EFJMI + CSA-GA) integrated FSM to address the earlier faults. The method defined here integrates EFJMI's fuzzy data processing methods with the Cuckoo Search Algorithm-Genetic Algorithm (CSA-GA) optimization. Applying the University of California Repository's CKD data collection, the EFJMI + CSA-GA was developed. This model has been able to minimize the complete feature set by 62%, which is related to the size of the features. The experimental results from clinical tests using many classification algorithms validate that the FSM-recommended Recurrent Neural Network (RNN) classifier performs effectively. It performs similarly to other FSMs, achieving 99.71% CA, 99.81% sensitivity, and 99.58% specificity.
Modern medical education requires innovative, learner-centered strategies to cultivate essential professional attributes like empathy, communication, and ethical reasoning. While the Attitude, Ethics, and Communication (AETCOM) curriculum is mandated in India, traditional lecture-based methods often struggle to engage students in the practical application of these affective-domain competencies. This study evaluated the impact of a gamified, online escape room on the engagement and learning of first-year medical students regarding AETCOM Modules 1.2 and 1.3. A prospective interventional study was conducted with 180 students consenting first-year MBBS. Participants collaborated in small groups to navigate a 30-minute digital escape room featuring four sequential levels of increasing complexity, focused on patient perspectives, doctor-patient relationships, and ethical dilemmas. Effectiveness was measured using Kirkpatrick's Level 1 (Reaction) via a 23-item Likert-scale and Level 2 (Learning) through pre- and post-intervention assessments. Qualitative data were analyzed using thematic analysis. Quantitative analysis revealed a statistically significant improvement in assessment scores (p < 0.001), with mean scores rising from 13.89 + 3.14 to 14.48 + 3.14. Students reported high levels of satisfaction (mean = 4.24) and perceived the activity as highly relevant to clinical practice (mean = 4.27). Thematic analysis identified three core strengths: enhanced teamwork and collaboration, high levels of interactivity and engagement, and the stimulation of critical thinking and problem-solving skills. Online escape rooms serve as a scalable and effective pedagogical tool for teaching foundational professional competencies. By bridging cognitive and affective learning domains, this gamified approach fosters emotional investment and collaborative learning, better preparing early-phase medical students for the complexities of patient-centered care. Modern doctors need more than just medical knowledge; they must master “soft skills” like empathy, clear communication, and ethical decision-making. While these topics are a mandatory part of medical training in India, students often find traditional lectures uninspiring. Our team wanted to see if a digital “escape room” could make learning these vital professional values more engaging and effective for new students. We designed an online game for 180 first-year medical students. Working in small teams, students solved puzzles based on real-world clinical scenarios, such as understanding a patient’s emotions and navigating ethical dilemmas. We measured success through before-and-after tests and student feedback. Students significantly improved their test scores after playing the game. Furthermore, they gave the activity high ratings, specifically noting that it felt directly relevant to their future work as physicians. These findings show that gamified tools like escape rooms are powerful and scalable ways to teach complex human values. By putting students in a high-pressure, collaborative environment, we helped them internalize the importance of teamwork and patient-centered care. This approach offers a modern alternative to traditional teaching, better preparing the next generation of doctors for the emotional and ethical realities of healthcare.
IntroductionBreastfeeding in women living with HIV remains controversial despite effective antiretroviral therapy (ART), as a small residual transmission risk persists even with viral suppression, leading to divergent global recommendations.MethodsWe performed a narrative review and policy analysis of randomized trials, international guidelines, and national recommendations (2010-2025), focusing on breastfeeding policies, maternal ART, infant prophylaxis, and monitoring strategies across settings.ResultsEvidence from resource-limited settings shows maternal ART during breastfeeding reduces transmission and improves HIV-free survival, supporting WHO recommendations for breastfeeding with ART and infant prophylaxis. In high-income countries, breastfeeding is often discouraged due to safe alternatives, though some guidelines now allow it under strict viral suppression and close monitoring. Observational studies suggest transmission is rare when suppression is maintained.ConclusionsDifferences in guidance mainly reflect risk tolerance and ethics rather than evidence. Breastfeeding may be considered a conditional option within structured clinical pathways. Breastfeeding for women living with HIV remains a complex topic, even in the era of modern HIV treatment. Medicines called antiretroviral therapy (ART) can reduce the amount of virus in the body to very low levels, which greatly lowers the risk of passing HIV to a baby during breastfeeding. However, a very small risk may still remain. We reviewed scientific studies and national and international recommendations published between 2010 and 2025. We found that advice on breastfeeding differs depending on the country. In many low- and middle-income countries, breastfeeding is recommended when the mother takes ART and the baby receives preventive treatment, because breastfeeding has important health benefits and safe alternatives may not be available. In these settings, studies show that HIV transmission during breastfeeding is rare when treatment is properly followed. In many high-income countries, breastfeeding has traditionally been discouraged for women living with HIV because safe alternatives like formula feeding are readily available. However, some recent guidelines now allow breastfeeding in specific situations, especially when the mother has a fully suppressed viral load and is closely monitored by healthcare providers. Overall, differences in recommendations are not mainly due to differences in scientific evidence, but rather to differences in healthcare resources, access to safe feeding options, and how much risk different health systems are willing to accept. With careful medical follow-up, breastfeeding may be possible as part of individualized care for some women living with HIV.
Modern health systems generate, store, and analyze unprecedented biological information, yet translating it into coherent longitudinal care remains difficult. Fragmentation across encounters, specialties, organizations, and digital systems contributes to delayed diagnosis, inconsistent interpretation, and management misaligned with patients' health-related context. This paper introduces Clinical Coherence as a framework for understanding how clinically meaningful knowledge is integrated and preserved within health systems. Clinical Coherence is defined as the capacity to maintain a consistent representation of a patient's condition over time through integration of biological knowledge, Clinical Phenomenological Data, and interpretive clinical judgment. Clinical Phenomenological Data refers to structured representations of integrated life experiences relevant to health and wellbeing, including symptoms, function, uncertainty, family systems, spiritual or existential concerns, treatment burden, and signals that shape illness perception and management. These forms of knowledge are vulnerable to fragmentation as care becomes distributed across organizational and technological boundaries. Drawing on healthcare quality, continuity of care, patient-centered medicine, Narrative Medicine, complexity science, knowledge management, and clinical governance, Clinical Coherence is conceptualized as an emergent systems property rather than an attribute of an individual clinician, encounter, or technology. Duty of Care Governance is presented as the architecture through which knowledge is preserved through sensing, responsibility, escalation, and feedback. Primary Ovarian Insufficiency serves as a sentinel condition showing how fragmentation across domains can undermine care despite biomedical knowledge. As digital health and artificial intelligence reshape healthcare, Clinical Coherence offers a framework for evaluating whether systems preserve the conditions through which information becomes knowledge and understanding becomes care.
The additional qualifications "Special Orthopaedic Surgery" and "Special Trauma Surgery" are well-established and recognised credentials for specialised care within the field of orthopaedics and trauma surgery. However, given the increasing prevalence of subspecialised care structures, the question arises as to whether the content and requirements of these additional qualifications remain up to date and relevant to clinical practice.The aim of this study was to conduct a systematic analysis of the content and requirements based on the Model Training Regulations (MWBO) of the German Medical Association (BÄK) from 2003 and 2018, as well as the current training regulations (WBO) of all regional medical chambers (LÄK). The number and types of required surgical procedures were examined, along with their distribution across subspecialised areas such as endoprosthetics, spine surgery, shoulder and elbow surgery, and foot and ankle surgery.The analysis reveals a general reduction in the total number of required surgical procedures in both additional qualifications and considerable harmonisation of requirements across regional chambers. In the "Special Orthopaedic Surgery" qualification, up to 49% of procedures involve endoprosthetics, particularly of the lower extremity. In contrast, subspecialised fields such as shoulder and elbow or foot and ankle surgery are underrepresented, despite their growing importance in clinical practice. Furthermore, modern minimally invasive techniques such as arthroscopy are still scarcely addressed.To address the gap between training content and the realities of clinical care-and to ensure high-quality training and long-term healthcare provision-reform of the current training regulations is needed. The Introduction of defined subspecialty tracks, such as shoulder and elbow surgery or foot and ankle surgery, could offer more differentiated and practice-oriented training, and help to ensure high-quality patient care in the future. Die Zusatzweiterbildungen „Spezielle Orthopädische Chirurgie“ und „Spezielle Unfallchirurgie“ gelten als etablierte und anerkannte Qualifikationen für die spezialisierte Versorgung innerhalb der Orthopädie und Unfallchirurgie (O&U). Angesichts zunehmend subspezialisierter Versorgungsstrukturen stellt sich jedoch die Frage nach der Aktualität und Praxisrelevanz der inhaltlichen Anforderungen dieser Zusatzqualifikationen.Ziel dieser Arbeit war eine systematische Analyse der Inhalte und Anforderungen auf Basis der Musterweiterbildungsordnungen (MWBO) der Bundesärztekammer (BÄK) von 2003 und 2018 sowie der aktuellen Weiterbildungsordnungen (WBO) aller Landesärztekammern (LÄK). Untersucht wurden sowohl Anzahl und Art der geforderten operativen Eingriffe als auch deren Verteilung auf subspezialisierte Themenbereiche wie die Endoprothetik, Wirbelsäulenchirurgie, Schulter- und Ellenbogenchirurgie sowie Fuß- und Sprunggelenkchirurgie.Die Analyse zeigt eine allgemeine Reduktion der geforderten operativen Eingriffe in beiden Zusatzweiterbildungen sowie eine weitgehende Vereinheitlichung der Anforderungen zwischen den LÄKs. In der Zusatzweiterbildung „Spezielle Orthopädische Chirurgie“ entfallen bis zu 49% der Eingriffe auf die Endoprothetik – insbesondere an der unteren Extremität. Demgegenüber sind subspezialisierte Bereiche wie Schulter- und Ellenbogenchirurgie oder Fuß- und Sprunggelenkchirurgie unterrepräsentiert, obwohl diese in der klinischen Praxis zunehmend an Bedeutung gewinnen. Auch moderne minimalinvasive Verfahren wie die Arthroskopie finden bislang kaum Berücksichtigung.Um die Diskrepanz zwischen den Weiterbildungsinhalten und der Versorgungsrealität zu verringern und sowohl die Qualität der Weiterbildung als auch die Versorgungssicherheit nachhaltig zu stärken, ist eine inhaltliche Reform der Weiterbildungsordnungen erforderlich. Die Einführung definierter Schwerpunkte – etwa in der Schulter- und Ellenbogenchirurgie oder der Fuß- und Sprunggelenkchirurgie – könnte eine differenziertere und praxisnähere Qualifikation ermöglichen und so zur langfristigen Sicherstellung einer qualitativ hochwertigen Patientenversorgung beitragen.
Virtual clinics have become essential in modern healthcare delivery, especially following the COVID-19 pandemic. In Saudi Arabia, the Ministry of Health has expanded telemedicine services to enhance accessibility and efficiency. However, limited research has examined user perceptions within the city of Jeddah. This study was conducted in the city of Jeddah, Saudi Arabia, among patients attending Ministry of Health primary health care centers offering virtual family medicine services. A cross-sectional qualitative design was employed using semi-structured interviews and a structured survey (N = 318). Descriptive statistics and thematic content analysis were applied. Key themes were triangulated with participant demographics and service usage patterns. Participants expressed appreciation for the convenience and time-saving aspects of virtual clinics. Nonetheless, concerns were raised regarding diagnostic accuracy, communication barriers, and the absence of physical examination. Gender differences and prior exposure to telehealth significantly influenced preference, with males showing higher favorability toward in-person consultations. Providers emphasized the need for better training and integration of virtual tools. The transition toward virtual healthcare requires not only technological adoption but also attention to user trust and satisfaction. Enhancing digital literacy, addressing infrastructure gaps, and offering hybrid models may optimize the effectiveness and acceptance of virtual care in the Hail region.
Artificial intelligence (AI)-driven histopathological image analysis has shown significant advantages for disease diagnosis, prognosis, and treatment planning, and it is receiving growing attention in modern healthcare. Due to the gigapixel size of whole slide images (WSIs), multiple instance learning (MIL) methods are widely employed in their analysis. Existing MIL approaches primarily rely on either instance-level or bag-level supervision, each facing challenges related to noisy pseudo-labels and suboptimal feature aggregation, respectively. In this paper, we present a novel MIL method for WSI analysis, termed CIB-MIL, which integrates collaborative instance-level and bag-level supervision. We introduce a label disambiguation module within the instance-level supervision channel that employs a noisy-label learning strategy to refine instance pseudo-labels and mitigate the impact of noisy labels. Additionally, we propose a collaborative supervision framework that promotes communication and interaction between the attention mechanism in the bag-level supervision channel and the pseudo-label mechanism in the instance-level supervision channel, enabling cooperative optimization of supervision in both channels. Extensive experiments conducted on five datasets, including three public datasets and two in-house datasets, demonstrate the state-of-the-art performance of CIB-MIL. The code is available at https://github.com/TencentAILabHealthcare/CIB-MIL.
Emphasis has increasingly been placed on expanding medical generalism in response to an ageing population and the rising prevalence of multimorbidity. While the ability to manage complex, undifferentiated illness across multiple conditions is undeniably important, modern healthcare is simultaneously becoming more technologically advanced and clinically specialised. Breakthroughs in diagnostics, therapeutics and procedural medicine demand deep, focused expertise to deliver safe and effective care, particularly for high-risk patients. Rather than viewing generalism and specialism as competing models, healthcare systems must recognise them as complementary. Generalists are essential for holistic assessment, coordination and continuity, while specialists provide advanced interventions and nuanced disease-specific management. In an era defined by both multimorbidity and rapid medical innovation, the central challenge is not to prioritise one approach over the other, but to strike an appropriate balance which ensures that patients receive the right expertise at the right time.
Cognitive impairment associated with schizophrenia (CIAS) has a substantial impact on people living with the condition. We aimed to update a 2012 conceptual model of CIAS with consideration of lived experience using insights from multinational cohorts of healthcare stakeholders and people living with schizophrenia. To update the 2012 conceptual model, we used insights from a targeted literature review, concept elicitation interviews with adults living with schizophrenia (n = 26) and healthcare stakeholders (n = 83), 3 patient advisory boards (n = 32), and clinical trial exit interviews of participants (n = 37) from the CONNEX-X clinical trial. Six relevant articles were identified that reported 52 CIAS signs and symptoms and 33 impacts of CIAS. CIAS domains highlighted in the concept elicitation interviews as affecting participants' lives included attention (92% of participants), social cognition (84%), processing speed (80%), and memory (76%). Advisory board participants reported impacts of CIAS on daily life and independent living, including career goals and relationships. CONNEX-X exit interviewees reported memory problems (51% of participants), difficulties in learning new things (46%), and concentration difficulties (43%). These insights were used to expand the CIAS model and provide more nuance and granularity. The findings of this study highlight the substantial burden of CIAS on the daily lives of people living with schizophrenia and the impact on their quality of life. A modern CIAS conceptual model is important for the assessment of cognitive impairment in both clinical trials and clinical practice.
HIV has become a manageable chronic condition, one of the major successes of modern medicine. People living with HIV can now expect near-normal life expectancy with effective treatment, yet important challenges remain. Comorbidities, prevention of new infections, and the persistence of stigma continue to affect outcomes. Addressing these issues requires coordinated care, with general practice, hospital services, and specialist HIV teams working closely together. This article aims to support healthcare professionals by summarising current best practice in treatment, outlining advances in prevention and early diagnosis, and exploring how stigma can be reduced both within healthcare and in the wider community. These efforts are essential if the UK is to meet its goal of ending new HIV transmissions by 2030.
A physician's death represents a critical point of tension between the values of modern medicine and the ethical limits of care. This review article analyzes how physicians face their own end of life and the type of care they receive compared with the general population. A narrative review of literature published between 2014 and 2025 was conducted using PubMed, Scopus, and SciELO databases with the MeSH and DeCS descriptors: "Terminal care", "Palliative care", "Attitude to death", "Health personnel", "Right to die". Findings show that although physicians express a preference for a dignified death with therapeutic proportionality and symptom control, many still die under highly technological and interventionist schemes. Mexico lacks systematic data documenting how its physicians die, revealing a gap between ethical intention and institutional practice. This analysis proposes developing a observational study to characterize therapeutic intensity, respect for autonomy, and the moral distress experienced by healthcare teams as bioethical and occupational issues within the health system. La muerte del médico representa un punto de máxima tensión entre los valores de la medicina moderna y los límites éticos del cuidado. Este artículo de revisión analiza cómo los médicos enfrentan el final de su propia vida y qué cuidados reciben en comparación con la población general. Se realizó una revisión narrativa de la literatura publicada entre 2014 y 2025 en las bases de datos PubMed, Scopus y SciELO, utilizando los descriptores MeSH y DeCS: “Cuidados al final de la vida”, “Cuidados paliativos”, “Actitud ante la muerte”, “Personal de salud” y “Derecho a morir”. Los hallazgos muestran que, aunque los médicos expresan preferencia por una muerte digna, con proporcionalidad terapéutica y control sintomático, muchos continúan falleciendo bajo esquemas de alta intervención tecnológica. México carece de registros clínicos que documenten cómo mueren sus médicos, lo que revela una brecha entre la intención ética y la práctica institucional. Este análisis propone desarrollar un estudio observacional que caracterice la intensidad terapéutica, el respeto a la autonomía y el sufrimiento moral del equipo tratante como problemas bioéticos y ocupacionales dentro del sistema de salud.