Principal Illness Navigation (PIN) represents an important Medicare policy advance, but coverage has not translated reliably into access. PIN addresses a real need: patients with cancer and other serious chronic illnesses often struggle with fragmented communication, scheduling complexity, insurance confusion, caregiver burden, and uncertainty about next steps. Medicare recognizes PIN under Healthcare Common Procedure Coding System (HCPCS) Level II codes G0023 and G0024, with payment established through the Medicare Physician Fee Schedule. Yet the main barriers to PIN implementation are administrative and operational rather than clinical. The billing practitioner must perform an initiating visit and remains responsible for supervision, documentation, and billing, even when auxiliary personnel furnishing navigation are external to the practice. Many private practices and oncology groups lack the infrastructure or patient volume to employ dedicated navigators. Specialized outside navigation organizations may offer a scalable alternative, but contracting, enrollment, and billing remain difficult; reassignment adds further friction when an eligible organization seeks to submit claims and receive Medicare Part B payment. This commentary argues that PIN's implementation challenges reflect not only physician education gaps but also a broader trust problem in the administrative pathway. Historical warnings from the U.S. Department of Health and Human Services Office of Inspector General help explain physician caution. Experience from other Centers for Medicare & Medicaid Services programs, including the Medicare Diabetes Prevention Program and the Guiding an Improved Dementia Experience (GUIDE) Model, shows that CMS can modify delivery rules and formally evaluate implementation when operational barriers emerge. To make PIN function as a real benefit rather than a paper benefit, CMS should provide plain-language guidance, clarify risk boundaries, simplify enrollment and payment pathways, and measure activation, onboarding time, and successful service delivery.
Digital technologies in cancer care, including smartwatches, wearable sensors, and app-based platforms, enable continuous real-time health monitoring. However, many devices are designed for fitness or wellness markets and are not optimised for clinical monitoring of cancer patients. This survey explored the potential role of digital technologies across the cancer pathway and aimed to identify key barriers to adoption. A web-based questionnaire was developed through expert consensus, internally validated, and piloted with five individuals. It was distributed to UK-based healthcare professionals and academics via professional networks and social media. The survey examined: (1) the role of digital technology before, during, and after treatment; (2) technical barriers; and (3) human factors. Quantitative data were analysed descriptively and free-text responses thematically. Eighty-four responses were received (including 28% allied healthcare scientists, 26% nurses, 9% clinicians). 48% had used digital technologies in research and 27% in direct clinical care. Most respondents (95%) believed digital technologies could benefit cancer patients through direct communication with clinical teams (94%), mood monitoring (91%), and vital sign monitoring (87%). Perceived benefits varied across the cancer care pathway: before treatment, providing insight into patients' health (91%); during treatment, monitoring vital signs (96%) and side effects (91%); and after treatment, supporting rehabilitation (94%). Technical barriers included poor integration into clinical systems (66%), limited interoperability (83%), data accuracy concerns (82%), and suboptimal user design (80%). Human factors included the need for long-term support (94%) and digital literacy (92%). Specialist teams were considered most appropriate leads for monitoring during prospective studies (77%) and primary care for long-term follow-up (53%), with patients playing a central role in both scenarios. Digital technologies are viewed as valuable tools across the cancer pathway, but integration, interoperability, design, and human factors must now be addressed to enable effective and equitable clinical adoption.
Autistic people represent a substantial and probably under-recognised population within reproductive and maternity services. Maternity care nevertheless continues to rely on neurotypical assumptions about communication, sensory tolerance, pain expression, emotional display, and help-seeking. To map the scope, distribution, and thematic content of literature on autistic people's experiences and support needs across pregnancy, childbirth, postpartum care, and infant feeding, and to identify implications for maternity service design and midwifery practice. A mapping review was conducted using a systematic literature search. The search returned 73 relevant records. After title and abstract screening and focused relevance assessment, 25 papers were included in the final evidence map. Studies were categorized by design, perinatal stage, and thematic focus, and were synthesised narratively. The final map comprised 7 reviews or evidence syntheses, 9 qualitative studies, 4 survey studies, 2 cohort or comparative quantitative studies, and 3 practice-focused or contextual papers. The literature clustered most significantly around pregnancy and childbirth. Across study designs, the most consistent findings concerned sensory overload, communication barriers, poor fit between autistic needs and routine maternity care, unmet support needs, and dissatisfaction with standard care environments. Evidence on clinical outcomes and midwives' own experiences remained limited. Avoidable distress commonly arises from the interaction between autistic sensory and communication needs and inflexible maternity systems. Accessible care requires predictable and multimodal communication, consent-based touch, sensory adjustment, continuity where possible, tailored postnatal and feeding support, and co-designed pathways. Research should now evaluate implementation, sustainability, and outcomes in routine maternity services with autistic people as partners.
Peer recovery support services (PRS) delivered by individuals with lived experience of substance use, are increasingly incorporated into substance use disorder (SUD) care systems to improve care engagement, reduce acute care use, and support recovery. However, existing systematic reviews have focused on substance use outcomes, with limited attention to healthcare utilization, psychosocial functioning, and outcomes across settings, and populations. This systematic review, registered in PROSPERO (CRD42023469279), synthesized peer-reviewed studies from 2003 to 2026 evaluating PRS for individuals with alcohol or drug-related SUD. Using MEDLINE, Embase, PsycINFO, and CINAHL, the review included 53 studies primarily conducted in high-income countries that reported quantitative outcomes across substance use, healthcare utilization, behavioral health, and treatment engagement. Risk of bias was assessed using Cochrane RoB 2, ROBINS-I, and ROBINS-E tools. Overall, evidence was most favorable for selected treatment-linkage and engagement outcomes, whereas findings for substance use, emergency department use, hospitalization, overdose, and mortality were inconsistent. Uncontrolled longitudinal studies frequently reported improvements in depression and anxiety, but no randomized trials evaluated these outcomes, limiting causal inference. Exploratory cross-study patterns suggested that sustained navigation, practical assistance, and repeated peer contact were more often present in programs reporting favorable outcomes; however, these components were not independently evaluated. Substantial heterogeneity, frequent multicomponent interventions, high risk of bias in many nonrandomized studies, and limited long-term and economic data constrain conclusions. Findings support the promise of PRS while underscoring the need for more rigorous comparative studies, cost-effectiveness data, and further research in low- and middle-income countries.
Mobile phones are indispensable clinical tools for healthcare workers (HCWs), yet remain largely unaddressed within infection prevention and control (IPC) frameworks. Repeated handling during patient care combined with inconsistent disinfection may allow these devices to serve as multidrug-resistant (MDR) organism reservoirs contributing to healthcare-associated infections (HAIs). A hospital-based cross-sectional analytical study with an embedded intervention and post-intervention follow-up was conducted at Menoufia University Hospitals, Egypt (2025-2026). Swabs from 300 HCWs' mobile phones across eight clinical areas were processed microbiologically and confirmed by Vitek 2. Antimicrobial susceptibility testing followed the Clinical and Laboratory Standards Institute (CLSI) 2025 guidelines. Bacterial burden was quantified by colony-forming units (CFU; low < 50, moderate 50-200, high > 200). Extended-spectrum β-lactamase (ESBL) and carbapenemase production were phenotypically confirmed, then genotypically characterized by multiplex PCR (blaTEM, blaSHV, blaCTX-M, blaOXA-48, blaNDM, blaIMP, blaVIM, blaKPC). Four decontamination methods were evaluated, and ward-level HAI rates correlated with MDR prevalence. Overall, 270/300 (90.0%) phones were contaminated, and 179/300 (59.6%) carried MDR organisms, with the highest burden in the intensive care unit (ICU). Coagulase-negative staphylococci (CoNS; 29.4%) and S. aureus (25.4%), including methicillin-resistant strains (MRSA), predominated. Among Gram-negative isolates (n = 169), ESBL production was detected in 24.9% and carbapenemase in 13.0%; blaTEM (13.6%) and blaOXA-48 (4.7%) were most prevalent, respectively. Sodium hypochlorite-impregnated wipes achieved the greatest bacterial load reduction (96.5%). Only 9.0% of HCWs reported daily phone disinfection; phone use during invasive procedures was the strongest MDR risk factor (adjusted odds ratio [AOR] 2.9; p < 0.001). At the ward level, MDR prevalence was strongly correlated with HAI rates (r = 0.986; p < 0.001). Post-intervention reductions in contamination (90.0%→78.0%), MDR carriage (59.6%→45.0%), and mean CFU (190.1 ± 80.3→95.5 ± 55.2) were all significant (p < 0.001). HCWs' mobile phones are potential reservoirs of MDR organisms, including clinically important ESKAPE-associated pathogens. Integrating standardized phone hygiene into IPC programs, supported by evidence-based decontamination and molecular surveillance, is warranted, particularly in high-acuity clinical settings.
Population aging represents one of the most significant social transformations of our time, with profound implications for health systems, social protection, and intergenerational solidarity. By 2050, 1 in 6 people globally will be aged 60 years or older, with the fastest growth occurring in low- and middle-income countries least prepared to respond. Alongside demographic shifts, sociocultural transitions-urbanization, changing family structures, and increased women's labor participation-are fundamentally altering traditional caregiving arrangements. The COVID-19 pandemic exposed with devastating clarity the consequences of neglected long-term care (LTC) systems. The United Nations has recognized LTC as a global public health priority, establishing it as 1 of 4 action areas under the UN Decade of Healthy Ageing (2021-2030). Building on a decade of normative work-including the LTC System Framework and the LTC Service Package-World Health Organization is now advancing the development of Global Standards for LTC, with a consultation draft released in May 2026 and currently open for public input. The proposed standards address interconnected domains spanning foundational principles; service delivery across home, community, and residential settings; health and care workforce; support for unpaid carers; governance; financing; and quality monitoring. This article describes the strategic approach to strengthening LTC systems globally, presents the evolving Global LTC Standards framework, and outlines pathways for clinicians, researchers, policymakers, and civil society to engage in shaping these standards. The implications extend across practice, policy, and research-offering opportunities to advance quality, equity, and sustainability in LTC worldwide.
Early arterial blood gas abnormalities may aid risk stratification, but the joint prognostic value of early hypoxemia, hypercapnia, and acid-base status remains uncertain in adult ICU admissions requiring invasive mechanical ventilation during the ICU stay. To evaluate associations of first-day oxygenation and carbon dioxide measures with 30-day mortality. We conducted a multicenter retrospective cohort study using a Taiwan critical care registry from 2018 to 2020. Among 11,912 adult ICU admissions with invasive mechanical ventilation during the ICU stay, 4960 had complete first-day arterial blood gas data and interpretable 30-day vital status. Hypoxemia was defined as PaO2/FiO2 <200 mmHg and hypercapnia as PaCO2 >45 mmHg. Multivariable logistic regression adjusted for age, sex, comorbidities, treatment-limitation indicators, and nonrespiratory SOFA score. Additional analyses modeled PaO2/FiO2 and PaCO2 continuously and incorporated pH, severe hypercapnia, palliative care exclusion, and care-unit effects. Overall 30-day mortality was 1141/4960 (23.0%). Compared with the group without a predefined arterial blood gas abnormality, isolated hypoxemia (adjusted odds ratio [aOR], 1.63; 95% CI, 1.33-2.00) and combined hypoxemia-hypercapnia (aOR, 1.67; 95% CI, 1.21-2.32) were associated with higher mortality, whereas isolated hypercapnia was not (aOR, 0.86; 95% CI, 0.54-1.39). As a continuous variable, lower PaO2/FiO2 remained associated with mortality after nonrespiratory SOFA adjustment, whereas PaCO2 did not show a harmful adjusted association. Early hypoxemia carried the most consistent mortality signal. Isolated mild hypercapnia should be interpreted cautiously with pH, severity threshold, and illness-severity context.
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections remain a significant public health concern. Achieving the World Health Organization (WHO) elimination targets by 2030 requires more effective detection strategies than risk factor-based screening. This study evaluates an opportunistic screening program implemented in Primary Care, incorporating an automated diagnostic and referral pathway. Prospective study of universal HBsAg and anti-HCV screening conducted in a Primary Care center in Barcelona. Adults requiring a blood test for any reason between February 2023 and February 2025 were included. Positive cases were directly referred to the Hepatology Department through an automated care pathway. A total of 3,103 individuals were screened (41% male; mean age 51 years). The prevalence of anti-HCV positivity was 2.0%, with 0.35% having active infection; 82% of viremic patients initiated antiviral treatment. HBsAg prevalence was 0.8%, and 92% of referred cases attended specialist care; 17% initiated treatment. A higher number of risk factors was associated with anti-HCV positivity, whereas no predictors of HBsAg positivity were identified. Notably, 45% of patients with detectable HCV RNA and 44% of HBsAg-positive individuals had neither recognized risk factors nor elevated ALT levels. Automated opportunistic screening in Primary Care is feasible and effective, identifying HBV and HCV infections that would likely remain undetected using risk factor-based screening strategies. This integrated approach may contribute substantially to the micro-elimination of viral hepatitis.
Infectious Diseases require rapid decisions based on heterogeneous and evolving clinical data. At the same time, the shortage of infectious diseases specialists continues to widen the gap between demand for expertise and its availability. Artificial intelligence (AI) has emerged as a potential support tool, although its role in routine care remains uncertain. To review current and emerging applications of AI in infectious disease decision-making and to examine their clinical relevance, limitations, and implementation challenges. Recent literature was identified through searches of PubMed/MEDLINE, Scopus, Web of Science and Google Scholar, complemented by manual screening of references from relevant articles on AI applications in infectious diseases. AI applications in infectious diseases span three main areas of clinical decision-making. Large language models can assist with knowledge retrieval and support routine diagnostic and management questions. Machine learning models are primarily used for risk stratification, identifying patients at risk of clinical deterioration, antimicrobial resistance, or infection recurrence, with potential implications for triage and early intervention. AI-supported therapeutic tools focus on empiric antibiotic selection, antimicrobial stewardship, and dose optimization. AI is best viewed as a decision-support layer that may extend specialist expertise and improve consistency of care. Its clinical adoption, however, depends on external validation across settings, integration within existing workflows, and continued clinician oversight.
The Emergency Department (ED) frequently cares for patients with heart failure (HF). There is a paucity of literature evaluating the effect of Palliative Care (PC) on ED utilization amongst patients with HF. Evaluate the effects of early PC consults on subsequent ED utilization after discharge for patients with HF. We evaluated Veterans admitted to Veterans Administration (VA) hospitals for HF exacerbation between 2010 and 2024. We compared early versus standard versus no PC. Early PC is defined as completion of consultation within 24 h of ED presentation. Standard PC is defined as PC involvement after 24 h of presentation. Our primary outcome is defined as ED visit or rehospitalization within 180 d of discharge. Among 126,775 HF Veterans with 207,364 ED visits, 1669 (0.8%) veterans received early PC, 7101 (3.4%) received standard PC and 198,594 (95.8%) received no PC. Proportional hazard modeling with facility fixed effects and competing risk adjustment found that early PC regardless of timing was associated with a significant reduction in time to ED use or readmission compared to those without PC. Patients admitted with diagnosis of HF exacerbation have less subsequent ED utilization when receiving PC. This presents a unique opportunity for ED initiated PC involvement for a patient cohort known to have high hospital resource utilization.
Effective communication and team non-technical skills are key points for patient safety in anesthesia and intensive care. Named caps have been proposed as a strategy to enhance team efficiency. However, evidence regarding their impact on objectively assessed team performance remains limited. We conducted a prospective, single center, randomized, experimental study in a high-fidelity simulation setting (SimHU, Nîmes). Anesthesia and intensive care residents, young doctors, and paramedics participated in simulated critical scenarios, alternating between sessions with and without named caps. The primary objective was to compare team performance, assessed by observers using the TEAM score. The secondary objectives were self-reported measures of entitativity, team cohesion and inclusion of self in the group. A total of 112 participants across 32 simulation sessions were included, which were assessed by 19 instructors. TEAM scores were significantly higher in the named cap group compared to the control group: the 44 points TEAM score (37 ± 7 vs. 33 ± 7; p = 0.026) and the total score (45 ± 8 vs. 40 ± 9; p = 0.020). Subjective perceptions of entitativity and team cohesion did not differ significantly. Named caps were associated with higher team performance in a simulated environment. Their impact on perceived team cohesion and entitativity was not statistically significant under simulation conditions. Further research in clinical settings is needed to determine whether named caps improve teamwork and patient safety.
This German multicenter study aimed to analyze the efficacy of telephone-assisted self-help (TASH) and changes during subsequent adaptive treatment in children with mild-to-moderate ADHD. Participants were children (6;0-11;11 years) with mild-to-moderate ADHD. Study Step 1 comprised a randomized waitlist-controlled trial on the efficacy of three-month, parent-directed TASH. Depending on their response to TASH, in Step 2, children were assigned to booster TASH (full response), behavior therapy (partial response), or pharmacotherapy plus behavior therapy or counseling (non-response) for six months. The primary outcome was the change in blinded-clinician-rated ADHD symptoms; for subsequent changes (Step 2), we considered semi-blinded ratings. The primary analyses were by intention-to-treat. Of the 163 included children (77.9% boys), 80 were randomized to TASH and 83 to the waitlist control group. Following TASH, 12 children (8.8%) were classified as full responders, 40 (29.2%) as partial responders, and 85 (62.0%) as non-responders. An analysis of covariance did not yield an effect of TASH on the primary outcome (mean between-group difference = 0.00 ± 0.07, 95% CI[- 0.14, 0.13]; p = 0.95; d = -0.01, 95% CI[- 0.37, 0.34]). During Step 2, full responders demonstrated a stable symptom level (piecewise mixed-effects model for repeated measures; d = - 0.07, 95% CI[- 0.61, 0.47], p = 0.80), partial responders a small increase in ADHD symptoms (d = 0.29, 95% CI[0.00, 0.59], p = 0.05), and non-responders a large decrease (d = - 1.00, 95% CI[- 1.27, - 0.73], p < 0.001). TASH is not effective in reducing blinded-clinician-rated ADHD symptoms in children with mild-to-moderate ADHD. Based on the changes within the response groups during Step 2, hypotheses are generated for adaptive treatment after TASH. Trial registration German Clinical Trials Register (DRKS): DRKS0000897; URL: https://drks.de/search/de/trial/DRKS00008973/details ; registered on December 18th 2015.
Impaired cerebral blood flow in preterm neonates is a risk factor for developing brain injury. High-frame-rate (HFR) ultrasound (US) imaging using plane-wave transmissions enables spectral Doppler-based flow analysis in all imaging pixels with high spatiotemporal resolution and sensitivity, potentially providing a better indicator of neonatal cerebral blood flow. The aim was to investigate the feasibility of HFR US in measuring cerebral blood flow velocities in the periventricular zone of newborn infants. Secondary aims: (i) differentiate between venous and arterial flow, (ii) investigate the impact of unilateral brain injury on blood flow and (iii) examine the influence of patient variables on HFR results. In a prospective cohort study, 2-D HFR US imaging data in (pre)term infants were recorded with a custom HFR mode on a Zonare ZS3 system with a high-frequency linear probe (L20-5). Data were analyzed offline to calculate peak systolic velocity (PSV), end diastolic velocity, resistivity index and the new flow index (FI), defined as the average PSV across all blood flow pixels within a region of interest. HFR US was performed in 81 patients (118 HFR recordings) of which 72 recordings were excluded due to technical limitations or insufficient image quality. In the remaining 46 recordings, arterial and venous flow could be reliably distinguished. In neonates with unilateral intracranial pathology (n = 12), the median FI was higher on the affected side (1.62, IQR 1.48-1.79) compared to the contralateral side (1.41, IQR 1.33-1.50; p = 0.002). Across all recordings, FI showed no significant correlation with birth weight (ρ = 0.11, p = 0.42), post-menstrual age (ρ = 0.07, p = 0.56), z-scores or mean airway pressure in ventilated infants. Obtaining qualitative and quantitative flow indices with HFR US imaging is feasible in a population of neonates. HFR-derived perfusion indices may play an important role in understanding and preventing neonatal brain injury.
In Australia, nearly 400,000 people live in residential aged care, of those, 40% experience a hospital admission annually. High-quality care transitions are crucial for ensuring safe and effective continuity of care. Ineffective information sharing increases risks of harm for already vulnerable consumers, contributing to adverse health outcomes, creating care delays and causing distress to individuals moving between care settings. This study aimed to co-design, pilot and evaluate the implementation of a comprehensive discharge documentation and medication package aligned with the electronic medical record to support quality care transitions between hospital and residential aged care. Mixed-methods, participatory action approach, incorporating workshops, surveys, and interviews. Ten RNs from four residential aged care sites participated, and ten hospital-to-residential aged care transitions were evaluated. 80% (n = 8) stated the discharge package met the standard for providing comprehensive care, and 100% (n = 10) identified improved medication safety. Three themes were identified from the interviews: 1) Enhancing system improvements supports more effective care transitions; 2) Effective cross-sector information sharing depends on well-defined and replicable processes; 3) Historical standards drive lower expectations. This participatory action research co-designed an effective discharge package for hospital-to-residential aged care. Developed by a nurse-led multidisciplinary team, this work established a strategy that supports patient safety, quality information sharing, and is aligned with hospital and residential aged care standards. Based on the difficulties of effective communication, the use of the documentation package demonstrates an effective tool to support information sharing processes between hospital and residential aged care.
Underserved pregnant individuals experience high risk for weight gain outside clinical guidelines and adverse perinatal outcomes. The Women, Infants, and Children (WIC) federal program assists underserved pregnant individuals with supplemental nutrition. WIC is positioned to disseminate interventions promoting recommended gestational weight gain, increasing access to efficacious programs and complementing clinical care. Pregnant WIC participants were randomly assigned (2019-2023) to a co-developed multicomponent e-health intervention for gestational weight gain management or usual care between 10 and 16 weeks gestation. The primary outcome (analyzed 2025) was gestational weight gain guideline attainment. Secondary weight outcomes included study-observed weight gain, weekly weight gain, deviation from guidelines, fat mass gain, and change in energy balance behaviors. Adverse perinatal outcomes were exploratory. Pregnant participants (n=351; 57% non-Hispanic Black) were enrolled (179 Intervention; 172 Usual Care) across 31 WIC clinics. The incidence of guideline attainment was not different between groups (both groups 17%; adjusted odds ratio, 1.05; 95% CI, 0.55 to 2.01; P=0.89). Study-observed weight gain (adjusted mean difference, -1.4 kg; 95% CI, -2.8 to -0.1; P=0.04), rate of weight gain (-0.07 kg/wk; 95% CI, -0.13 to -0.01; P=0.02), deviation from guidelines (-0.05 kg/wk; 95% CI, -0.10 to -0.00; P=0.03), and fat mass gain (-1.3 kg; 95% CI, -2.1 to -0.6; P<0.001) were lower in the Intervention Group compared to Usual Care. Change in energy intake was lower in the Intervention Group (306 kcals/day; 95% CI, -500 to -112; P=0.002). There were 43 cases (9% Intervention, 16% Usual Care) of preterm birth and 30 NICU admissions (7% Intervention, 11% Usual Care). A remotely delivered lifestyle intervention concomitant with WIC care reduced gestational weight and fat mass gain. This approach demonstrates the potential for scalable interventions integrated into existing public health systems to expand access and inform public health strategies targeting maternal health disparities. Trial registration: This study is registered at www. gov NCT04028843.
Cognitive ability has been linked to posttraumatic stress disorder (PTSD) vulnerability and may influence trauma-focused treatment response, yet its role in youth Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) outcomes remains unclear. Clarifying this issue is relevant for equitable access to evidence-based care. We examined whether formally assessed IQ was associated with PTSD symptom change from pre- to post-treatment based on youth and caregiver reports and with treatment dropout in children and adolescents undergoing TF-CBT after abuse or neglect. Data came from N = 320 youth aged 5-21 years from a randomized clinical effectiveness trial. Intelligence quotient (IQ) was assessed with standardized tests, PTSD symptoms with the Child and Adolescent Trauma Screen (CATS-2), and dropout was defined as not completing therapy as intended. Symptom change was calculated as post- (T1) minus pre-treatment (T0) and evaluated separately for youth and caregiver reports. Regression models included age, gender, baseline PTSD severity, and treatment satisfaction assessed after treatment as an additional model variable. Mean IQ was M = 97.41 (SD = 13.19, range = 51-138). PTSD severity was high at baseline (M = 34.21, SD = 8.09) and decreased substantially (ΔCATS-2T1 ₋ T0 youth report: M = -17.54, SD = 12.34; Cohen's d paired = 1.42). IQ showed small but significant negative correlations with symptom change in youth reports (r = -.14, p = .040) and caregiver reports (r = -.17, p = .018), indicating greater symptom reductions at higher IQ. In regressions, IQ was not a significant predictor in the youth-report model (β = -.10, p = .077), while a small effect remained in the caregiver-report model (β = -.15, p = .011). Baseline PTSD severity and post-treatment satisfaction showed more consistent associations with symptom reduction. Dropout was 29.1%. IQ neither differed between completers and dropouts nor was associated with dropout in logistic regression (OR = 0.99, p = .536), whereas higher post-treatment satisfaction was associated with lower dropout risk. TF-CBT was associated with substantial symptom reductions across the observed IQ range, suggesting its suitability for routine care without excluding youth solely on the basis of cognitive ability. Baseline severity and treatment satisfaction at post-treatment showed stronger associations with symptom change and dropout than IQ. Trial registration The BESTFORCAN study was registered in the German Clinical Trial Registry (DRKS00020516) on 12 February 2020.
Oxidative-stress-related diseases generate elevated levels of hydrogen peroxide (H2O2) and other redox-active species in exhaled breath condensate (EBC), offering a promising avenue for non-invasive disease assessment. Despite its diagnostic potential, clinical translation of EBC redox species detection has been constrained by bulky analyzers, labor-intensive operation, and limited sensitivity. By harnessing the redox potential, we present a Redox-mediated Optochemical Plasmonic Sensing (ROPS) system, an ultrasensitive platform that enables real-time, easy-to-use, point-of-care quantitative analysis of H2O2-equivalent reducing capacity in EBC. By coupling H2O2-triggered gold nanoparticle growth on a phase-modulated plasmonic sensor, the ROPS system based on the phase-modulated interferometry achieved a detection limit of 1.19 pM and a wide dynamic range across 4 orders of magnitude. Moreover, the ROPS system demonstrated excellent reusability, maintaining stable H2O2 sensing performance over 40 reuse cycles. To enable point-of-care applications, we further developed a handheld high-efficiency EBC sampler, which harvested exhaled condensate at 2.49 μL/s and enabled an EBC-ROPS sampling-to-biosensing workflow down to 15 min. Clinical evaluation using EBC samples from lung and esophageal cancer patients and matched controls confirmed reliable quantification of trace H2O2-equivalent Au(III)-reducing capacity in complex EBC matrices, highlighting the potential of the integrated ROPS platform as a practical tool for point-of-care and non-invasive oxidative stress-related disease assessment.
This paper studies the health consequences of administrative centralization in healthcare, focusing on the consolidation of Local Health Authorities (LHAs) within the Italian National Health Service. This type of reform fits within a broader set of cost-containment efforts aimed at reducing administrative expenditures and exploiting economies of scale. In the Italian case, the reform centralized governance and expanded the scale of health administration, creating authorities with substantially larger catchment areas and shifting decision-making to more heterogeneous jurisdictions. Such changes may affect the responsiveness of healthcare provision to local needs, the coordination of service delivery, and access to care. Using an event-study Difference-in-Differences design, we estimate the policy's impact on municipal mortality rates, accounting for heterogeneous treatment effects and co-occurring fiscal adjustment policies. We find a significant increase in mortality starting four years after implementation, with an average treatment effect on the treated of 2.1%. The effects are concentrated in municipalities belonging to absorbed LHAs and in those exposed to mergers involving relatively large pre-reform LHAs and substantial post-merger expansions in catchment areas; they are also unevenly distributed, creating new vulnerable areas. Welfare estimates based on life-years lost indicate that the monetary costs of increased mortality exceed plausible administrative savings by roughly an order of magnitude.
The global population is ageing at an unprecedented rate, creating substantial pressures on healthcare systems to deliver personalised, proactive, and cost-effective care for older adults. Digital twin (DT) technology, where dynamic virtual replicas of physical entities are continuously updated through real-time data, has emerged as a transformative tool in precision medicine. Despite its growing application across clinical specialties, its specific utility within geriatrics and gerontology remains underexplored in the academic literature. This narrative review aims to synthesise existing evidence on the applications of digital twin technology in geriatric and gerontological care, examine associated challenges and identify future research priorities. A narrative review methodology was employed, with a systematic search of PubMed, Scopus, Web of Science, and IEEE Xplore databases covering publications from January 2014 to December 2025. Studies were selected based on relevance to digital twins, ageing populations, or geriatric clinical domains, with data synthesised thematically. Digital twins demonstrate significant potential benefit across multiple geriatric domains, with use in cardiovascular monitoring, fall prevention, dementia management, polypharmacy optimisation, and chronic disease self-management. Key enablers include advances in Internet of Things (IoT), artificial intelligence, and electronic health records. Persistent challenges include data privacy concerns, interoperability deficits, computational costs, and ethical questions surrounding autonomy and consent in cognitively impaired populations. Digital twin technology holds considerable promise for revolutionising geriatric and gerontological care, by enabling hyper-personalised clinical decision-making, predictive risk management, and remote patient monitoring. Translating this potential into practice requires focused investment in regulatory frameworks, equitable access infrastructure, and interdisciplinary collaboration. Future research should prioritise standardisation, caregiver integration, and longitudinal validation studies within older adult populations.
Emergency room (ER) visits in older adults are associated with increased morbidity and mortality. The World Health Organization's Integrated Care for Older People (ICOPE) framework assesses intrinsic capacity (IC), but the association between IC impairments and ER visit risk remains underexplored. This study examined whether IC impairments were associated with ER visits among community-dwelling older adults. This retrospective cohort study used Taiwan's Integrated Care for Older People (ICOPE) database linked to National Health Insurance claims and the Death Registry. A total of 244,899 adults aged ≥65 years were followed from 2022 to 2023. Six IC domains (cognition, mobility, vitality, vision, hearing, and psychological well-being) were assessed. IC impairment severity was categorized as low (0 impairments), moderate (1-2 impairments), or high (≥3 impairments). Latent class analysis (LCA) identified IC impairment patterns. Poisson regression estimated rate ratios (RRs), adjusting for confounders. Over 213,528 person-years, 96,889 ER visits occurred (453.75/1,000 person-years). Impairments in all six IC domains were significantly associated with higher ER visit risk, with malnutrition showing the strongest association (aRR = 1.27, 95% CI: 1.24-1.31). Greater IC impairment severity was associated with higher ER visit risk. Five IC impairment patterns were identified, and the "impairments in all domains" group had the highest risk (aRR = 1.47, 95% CI: 1.41-1.54). IC impairments, particularly greater impairment severity, were associated with a higher risk of ER visits. Routine ICOPE assessment in community and primary care settings may help identify at-risk older adults early and guide targeted, integrated interventions, with closer follow-up for those with multiple impairments.