Rare and ultra-rare genetic diseases (GDs) involve complex, multidimensional burdens not fully captured by clinical endpoints, highlighting uncertainties in the availability, scope, and quality of Health-Related Quality-of-life patient-reported outcome measures (HRQoL-PROMs). To identify PROMs developed or validated to assess HRQoL in rare and ultra-rare GDs, map their content using the International Classification of Functioning, Disability and Health (ICF), and evaluate their measurement properties according to COSMIN methodology. Original studies reporting PROM development or measurement properties in rare or ultra-rare GDs were included. PubMed, Embase, PsycINFO, Web of Science, registries, outcome-measure repositories, reference lists, and citation tracking were searched from inception to March 26, 2026, without language restrictions. Study selection, data extraction, and risk-of-bias (RoB) assessment were performed independently. Methodological quality was evaluated using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) RoB checklist. Measurement properties were rated as sufficient, insufficient, indeterminate, or inconsistent, and certainty of evidence was assessed using a modified GRADE approach. PROM content was mapped to ICF components and synthesized narratively; no meta-analysis was conducted due to heterogeneity. Fifty-nine studies were included, covering 45 PROMs across 29 rare or ultra-rare GDs. Instruments were predominantly disease-specific, although generic and adapted measures were also identified. PROMs mainly addressed body functions and activities/participation, while environmental factors, social participation, stigma, and access-to-care domains were consistently underrepresented. Internal consistency and construct validity were most frequently assessed, whereas responsiveness, measurement error, and cross-cultural validity were rarely evaluated. Only three PROMs (HAE-QoL, NF1-AdQoL, EPP-QoL) were classified as COSMIN category A and recommended; most were category B, and five were category C. The evidence is limited and methodologically weak, and many QoL-PROMs fail to capture key multidimensional aspects of QoL; more rigorous, patient-centered, disease-specific development and validation are needed. This review examined questionnaires used to assess health related quality of life in people with rare and ultra-rare genetic diseases. Although 45 PROMs were identified, only three had enough evidence to be recommended. Many questionnaires focused mainly on symptoms and physical functioning, while important aspects such as social participation, stigma, care access, and environmental support were often missing. Future PROMs should be developed with strong patient involvement and validated across age groups, languages, and disease contexts.
Brexucabtagene-autoleucel (brexu-cel) is an anti-CD19 chimeric antigen receptor T-cell (CAR-T) product approved for relapsed/refractory Mantle Cell Lymphoma (MCL) after two prior treatment lines, including Bruton tyrosine kinase inhibitors (BTKi). Patients with high-risk (hr) disease-defined by high-intermediate or high-risk MIPI-c, p53 overexpression, or TP53 alterations-have a poor prognosis, underscoring the need for improved first-line strategies. The European Mantle Cell Lymphoma Network therefore designed a phase II trial to investigate the incorporation of brexu-cel into first-line therapy for hr MCL. CARMAN is a randomized controlled, international, multicenter, open-label phase II trial evaluating efficacy, safety, and tolerability of an abbreviated induction followed by first-line brexu-cel and 6 months Ibrutinib maintenance (Arm A) as compared to standard of care induction and maintenance (Arm B). In Arm A, induction consists of two cycles of ibrutinib plus rituximab (I + R) followed by two cycles of R-CHOP plus ibrutinib (I). R-CHOP + I may be omitted in patients achieving complete or partial remission after two cycles of I + R, who then receive one additional I + R cycle before brexu-cel infusion and I maintenance. Arm B comprises a TRIANGLE-like regimen based on age, fitness, and investigator choice (alternating R-CHOP plus ibrutinib/R-DHAP or IR-bendamustine), followed by IR maintenance. Overall, 150 patients from five European countries are randomized 1:1. The primary endpoint is failure-free survival from randomization, with failure event defined as the earliest of stable disease at the end of induction (Arm B, or Arm A if brexu-cel is not infused) or within 12 weeks from CAR-T-cell infusion (Arm A), disease progression after induction, or death from any cause. Secondary endpoints include efficacy (overall and complete response rates and PET-negative CR rate 6 months from randomization as assessed according to Lugano criteria, molecular remission rate as measured by MRD), safety and tolerability (adverse events graded according to CTCAE), and patient-reported quality of life as measured by the EORTC-QLQ-C30 and EORTC-QLQ-NHL-HG29 questionnaires. When complete, CARMAN will provide important information on efficacy and safety in first-line CAR-T cell therapy in hr MCL and has the potential to prepare a practice changing confirmatory trial for these difficult-to-treat patients. Recruitment is ongoing. EU clinical trial number: 2022-502405-15-00.
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Globally, mental health disorders are on the rise in response to both natural and man-made crises. Especially in low and middle-income countries (LMICs) like Ethiopia, this is further stretching the already limited mental health facilities, necessitating an innovative solution to the challenges it presents. With the primary goal of examining methods to enhance the quality and accessibility of mental health care in Ethiopia, the Center for International Health at the University hospital of Ludwig Maximilian University Munich (CIHLMU), the International Network for Cooperation in Mental Health (i.nez), and Saint Paul's Hospital Millennium Medical College (SPHMMC) collaborated to organize this 2024 conference, which was held in Addis Ababa, Ethiopia. The conference focused on three key themes: (Theme I) rehabilitation and recovery, (Theme II) a One Health approach to conflict response, and (Theme III) innovative strategies for mental health recovery. The event featured a number of presentations, panel discussions, and networking opportunities bringing together important stakeholders, including representatives from ministries, professional associations, government and non-government service providers, service users, caregivers of individuals with mental health conditions and journalists. A central takeaway from the conference was the urgent need for multi-sectoral collaboration to enhance mental health services and ensure more accessible, high-quality care across Ethiopia.
The primary care system (PCS) is an essential national health infrastructure defined by the delivery of comprehensive, integrated, and accessible services that serve as the patient's first and sustained point of contact with the healthcare system. A comparative review was performed through searches of PubMed, KoreaMed, and J-STAGE databases using terms including "primary care," "general practitioner," "family physician," "gatekeeping," "Korea," and "Japan." Gray literature from the Japan Medical Association, Korea Medical Association, and OECD (Organisation for Economic Co-operation and Development) was also reviewed. Clinical case examples from one author's practice were included to illustrate real-world general practitioner (GP) challenges. Both Japan and South Korea feature universal health insurance but differ substantially in physician training pathways, gatekeeping enforcement, and community care integration. Japan is transitioning toward a kakaritsuke-i (registered home doctor) model with a nascent GP specialty board, whereas South Korea relies primarily on specialist-led private clinics for primary care delivery. International evidence suggests that structured, continuous family physician (FP) training is associated with improved chronic disease management, preventive care utilization, and patient satisfaction. Strengthening South Korea's PCS requires a clearly defined mandatory FP residency framework, reinforced gatekeeping mechanisms, and greater investment in community-based integrated care. Japan's ongoing reforms offer a useful regional comparator, while international FP models provide a proven evidence base for structural improvement.
Although applications in the field of Robotic Technologies for Older Adults' Healthcare are becoming increasingly widespread, existing research has largely focused on specific application scenarios, and a comprehensive understanding of the global research landscape, knowledge structure, thematic evolution, and future trends remains limited. This review aimed to conduct a bibliometric analysis and visualization of the field of Robotic Technologies for Older Adults' Healthcare, revealing the research landscape, research hotspots, thematic evolution, and future development trends in this field. This review adopted the bibliometric analysis method. The Web of Science Core Collection was selected as the core database, covering the period from January 2015 to July 2026, and literature screening was conducted following the PRISMA guidelines. Conduct bibliometric analysis using R Bibliometrix, VOSviewer, and CiteSpace, including publication trends, citation analysis, collaboration networks, keyword co-occurrence, topic clustering, and outlier detection. Meanwhile, the PubMed database was additionally included to assist in validating the results of the bibliometric analysis. This research field has developed rapidly since 2016. Among them, China has the highest number of publications, while the United Kingdom has the highest average citation impact, indicating a discrepancy between research output and academic influence. International Journal of Social Robotics ranked first in both the number of publications and total citations, while BMJ Open had the highest average citations per article. Most core research institutions were concentrated in Japan, showing the characteristic of regional concentration in this research field. Core authors formed several research groups (such as Yu, Bevilacqua, and Rigaud), but extensive international collaboration has not yet been formed. Robotic Technologies for Older Adults' Healthcare is gradually forming a knowledge system integrating technology development, healthcare applications, and evidence-based development. Three hotspot themes were further identified, including Intelligent Assistive Robots, Healthcare, Rehabilitation, and Wellness for the Aging Population, and Trend Forecasting. Among the burst keywords, "PARO," "Gait," and "Deep Learning" indicate that robotic technologies are focusing on older adults' social companionship, physical function recovery, and personalized health management, representing the frontier hotspots in this field. In the future, AI technologies, multimodal intelligent interaction, personalized health management, and cross-disciplinary collaborative innovation may become the key driving forces for the continuous development of this field, promoting the translation of clinical effectiveness in the field of Robotic Technologies for Older Adults' Healthcare. This review provides a comprehensive knowledge map of Robotic Technologies for Older Adults' Healthcare and offers evidence-based insights for medical researchers and policymakers regarding future technological developments and clinical translation.
T1 colorectal cancer presents a management challenge because a minority of lesions harbour lymph node metastasis (LNM), while T1N-positive disease may demonstrate favourable survival compared with some locally advanced node-negative tumours. This narrative review examines determinants of nodal metastasis in T1 colorectal cancer and considers how these features may inform risk-adapted management. This narrative review was conducted across two databases (MEDLINE and Embase), prioritising studies that used standardised definitions, including International Tumour Budding Consensus Conference (ITBCC) criteria for tumour budding and D2-40 or elastin staining for lymphovascular invasion. The most consistent predictors of lymph node metastasis are lymphovascular invasion and high-grade tumour budding, with poor differentiation and submucosal invasion depth adding to risk. Non-granular pseudo-depressed lateral spreading tumours and depressed lesions appear to signal covert submucosal invasion, indirectly increasing nodal risk. Evidence for tumour site, sex, molecular subtype, and lymphatic vessel distribution remains inconsistent or exploratory. Survival for T1N-positive disease is generally favourable compared with high-risk stage II disease, although comparisons are confounded by nodal burden, stage migration, treatment era, and adjuvant chemotherapy. A structured pathology report incorporating lymphovascular invasion, tumour budding, grade, depth, margin status, and morphology may support balanced decisions regarding completion surgery and adjuvant therapy while avoiding overtreatment.
To describe contemporary trends in kidney stone disease (KSD)-related inpatient episodes, procedures, and costs in England and Scotland, with emphasis on post-coronavirus disease 2019 (COVID-19) service recovery, socioeconomic variation in Scotland, comparison with other urological procedures, and 10-year healthcare demand and cost projections. Retrospective descriptive analyses were conducted using English Hospital Episode Statistics (2020-2025) and Public Health Scotland data (2019-2024). KSD-related finished consultant inpatient episodes and procedures were identified using the International Statistical Classification of Diseases and Related Health Problems 10th Revision and Operation and Procedures fourth edition codes, respectively. Procedures were categorised as extracorporeal shockwave lithotripsy, ureterorenoscopy (URS), percutaneous nephrolithotomy, or open. Trends were compared with uro-oncological resections and benign prostate obstruction procedures. Socioeconomic variation was assessed using the Scottish Index of Multiple Deprivation. The 10-year healthcare demand and cost projections, accounting for National Health Service (NHS) cost uplift factors, were modelled using historical data. The COVID-19 pandemic disproportionately reduced KSD-associated activity compared with procedures for bladder and kidney cancer. Although volumes now exceed pre-pandemic levels, inpatient episodes remain below baseline and waiting times remain prolonged. Between 2020 and 2025, inpatient episodes increased by 27.4% in England and 17% in Scotland, with URS accounting for >50% of interventions. KSD procedural volumes are comparable to the combined volume of uro-oncological resections and benign prostatic obstruction procedures. In Scotland, 44% of procedures were performed in the two most deprived socioeconomic quintiles versus 37% in the two least deprived. In England, KSD-associated episodes are projected to increase by 33% to 111 907 (95% confidence interval 96 057-130 373) by 2034-2035, with an estimated cumulative NHS cost of £1.82 billion over the next decade. Kidney stone disease exacts a growing burden on healthcare services with incomplete recovery of inpatient care following the COVID-19 pandemic, socioeconomic disparities, and rising healthcare demand. These findings can inform service planning and prioritise evaluation of strategies to improve efficiency, equity, and prevention.
Accreditation is widely used to improve healthcare quality and patient safety; however, staff experiences during accreditation preparation and survey activities remain inadequately understood, particularly in Middle Eastern healthcare settings. The objective of this study was to examine healthcare staff experiences during Joint Commission International (JCI) accreditation and identify organizational factors associated with positive accreditation experiences and perceived outcomes. A cross-sectional survey was conducted among clinical and nonclinical staff at a tertiary academic medical center in Dubai, United Arab Emirates, following a JCI accreditation survey. Descriptive statistics, bivariate analyses, and multivariable logistic regression were used to evaluate associations between organizational factors and staff-reported experiences. A total of 304 staff responses were analyzed. Overall perceptions of accreditation were highly favorable, with more than 90% of respondents reporting positive perceptions of patient safety, quality of care, teamwork, and leadership engagement. Leadership engagement (adjusted odds ratio [AOR] 2.45), perceived improvements in patient safety (AOR 2.89), and quality of care (AOR 2.63) were independently associated with positive accreditation experiences. Workload manageability (AOR 0.61) and psychological safety (AOR 0.68) were negatively associated with positive experience. Nurses and allied health professionals reported more favorable perceptions than physicians, although differences were small. Qualitative findings highlighted the need for continuous readiness, protected time for accreditation activities, improved coordination, and ongoing training. Healthcare staff generally perceived JCI accreditation positively and associated it with improvements in patient safety and quality of care. Leadership engagement emerged as a key facilitator of positive accreditation experiences, whereas workload burden and psychological safety represented important challenges. Organizations implementing accreditation programs should prioritize continuous readiness, workforce support, psychological safety, and targeted physician engagement strategies to sustain accreditation benefits.
Skin-related neglected tropical diseases (skin NTDs) remain visible markers of health-system inequity. The World Health Organization (WHO) road map for neglected tropical diseases 2021-2030, its 2022 strategic framework for skin NTDs, and the WHO Global Report on Neglected Tropical Diseases 2025 already establish integration, primary-care mainstreaming, and improved access to diagnostics and medicines as global priorities. Drawing on Workshop 1 of the 4th International League of Dermatological Societies (ILDS) World Skin Summit, this viewpoint positions the Cape Town Action Plan not as a competing policy framework, but as an implementation compact for translating existing commitments into locally owned service readiness, accountable delivery, and measurable follow-through.
Hemangiosarcomas are heterogeneous malignancies possibly originating in any part of the body, rare in humans. The web of causation of human hemangiosarcomas remains poorly understood, to date, except for subsets of cases which have been recognized in a well-defined causal correlation to vinyl chloride or to ionizing radiation. In 2005, the International Agency for Research on Cancer ranked formaldehyde as a human carcinogen, causally related to both nasopharyngeal cancers and acute non-lymphocytic leukemias; at the time, the evidence in favor of a causal relationship of formaldehyde to sinonasal cancers was stated as "limited". In 2024, an umbrella review reported a significantly increased risk for sinonasal cancers among formaldehyde-exposed workers. A sinonasal hemangiosarcoma affecting an Italian male born in 1957, diagnosed in 2022, was reported to the Italian National Registry of Sino-Nasal Cancers (ReNaTuNS); the patient's occupational history revealed a remote exposure to formaldehyde, used as a disinfectant, when breeding farm animals, from 1967 to 1976. No previous reporting has been found about a possible association between formaldehyde and sinonasal non-epithelial cancers. Formaldehyde is, in our opinion, a suitable candidate to be considered for playing a causal role in the causation of the neoplasm; formal studies are required to test the hypothesis.
To present an integrated, evidence-based view of current rhinoplasty practices, emphasizing patient safety, functional preservation, and interdisciplinary collaboration. We reviewed the literature published between 2019 and 2025, including systematic reviews, meta-analyses, and official documents from the International Society of Aesthetic Plastic Surgery (ISAPS) covering functional, structural, and preservation approaches. Studies regarding the pre-, intra-, and postoperative phases were analyzed to identify associations with patient safety and satisfaction. A global shift from reductive techniques to structural and preservation approaches prioritizing anatomical respect and functional integrity was observed. Evidence supports team planning, psychological screening, and standardized protocols applied across the operative pathway to reduce complications. In addition, technological advances have improved predictability and surgical training. Despite advances, substantial variability in techniques and protocols persists, underscoring the need to strengthen a shared culture of safety through standardized perioperative workflows, structured documentation, and validated outcome assessment, rather than standardizing operative techniques. Rhinoplasty should combine esthetic precision with preservation of nasal function and ethical responsibility. Establishing a global culture of safety requires more than protocols; it demands empathy, collaboration, and the surgeon's active role as a technical and ethical mediator at all stages of care. While not an official ISAPS guideline, this article offers a critical reflection on current evidence and discussions within the ISAPS Patient Safety Committee. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .
Many real-world patients with advanced biliary tract cancer (BTC) are excluded by TOPAZ-1 criteria; this study assessed cisplatin and gemcitabine plus durvalumab (CGD) efficacy and safety in these patients. Data from 1358 patients with advanced BTC treated with first-line CGD across 55 international centers were retrospectively analyzed. Patients were classified as TOPAZ-1-in (meeting all inclusion criteria) or TOPAZ-1-out (meeting ≥ 1 exclusion criterion). Primary endpoints were overall survival (OS) and progression-free survival (PFS); secondary endpoints included objective response rate (ORR), disease control rate (DCR), and safety. Furthermore, OS and PFS of the TOPAZ-1-out cohort were compared with reconstructed survival data from the phase III trial. 912 (67.1%) patients were classified as TOPAZ-1-in, and 446 (32.9%) as TOPAZ-1-out. After a median follow-up of 14.5 months (95% CI: 13.7-36.5), OS was 16.1 months in TOPAZ-1-in and 12.5 months in TOPAZ-1-out (HR 0.69, 95% CI: 14.6-16.5, p = 0.0001); PFS was 8.2 versus 6.5 months (HR 0.73, 95% CI: 7.1-8.1, p < 0.0001). Median OS in the TOPAZ-1-out cohort (12.5 months) was nearly identical to the phase III trial experimental arm (12.9 months; HR 1.15, p = 0.13); for PFS the HR was 1.12 (95% CI 0.93-1.42; p = 0.09). Among TOPAZ-1-out patients, active infection, elevated bilirubin, and ECOG PS > 1 were linked to poorer OS, while no detrimental impact emerged for ALT/AST abnormalities, corticosteroid use, renal or hematologic parameters, or prior surgery within 6 months, suggesting treatment effectiveness was broadly maintained across clinical subgroups. Furthermore, TOPAZ-1-out patients experienced no significant increase in adverse events compared with the TOPAZ-1-in group. Real-world data suggest CGD may be effective in TOPAZ-1-out patients, with no evident increase in toxicity, supporting the potential expanded use of the regimen in clinical practice.
Little is known about how stigma is perceived within psychiatric genetics, a field increasingly central to public discussions about heredity, neurodiversity, and psychiatric risk. Understanding how stigma is perceived and experienced by psychiatric geneticists is important for guiding responsible communication and future stigma-reduction efforts. The International Society of Psychiatric Genetics (ISPG) Stigma Reduction Special Interest Group surveyed members' experiences and perceptions of mental health-related stigma (122 responses; response rate = 11.3%). Two-thirds believed that psychiatric genetics research reduces stigma, and there was a general consensus that researchers should consider stigma-related impacts when communicating research findings. Almost half of respondents perceived public stigma toward the field, and one-third reported avoiding certain research projects due to stigma-related concerns. Among respondents with a mental health diagnosis, 51% described selective disclosure at work shaped by fears of judgment or career impact. Respondents reported the persistence of stigmatizing attitudes within workplaces, despite reporting perceptions of meaningful cultural improvements in recent years. This first empirical assessment of stigma among psychiatric genetics professionals provides several key action points for the field: (1) developing stigma-sensitive research communication guidelines, (2) explicitly include individuals with lived experience, (3) reconsidering mentoring and hiring practices, and (4) evaluating organizational stigma-reducing efforts.
Potentially toxic elements pollution in marine environments is intensifying under anthropogenic activities and climate-driven changes, yet the interactive effects of multiple stressors on metal bioaccumulation, ecosystem health, and human risk remain inadequately synthesized. This review aims to quantitatively integrate multi-stressor interactions involving ocean warming, acidification, and eutrophication with potentially toxic elements dynamics across coastal, estuarine, and open ocean systems. Following PRISMA guidelines, 154 peer-reviewed studies from 652 screened records were synthesized to establish a comprehensive, evidence-based framework for predictive risk assessment. This review indicates that multi-stressor conditions fundamentally alter speciation and bioavailability of mercury (Hg), cadmium (Cd), lead (Pb), arsenic (As), and chromium (Cr), producing synergistic and other non-additive effects that amplify biomagnification. Methylmercury (MeHg) exhibits the strongest trophic magnification, with factors reaching 11.1 in polar shelf ecosystems, while cadmium and lead show biodilution yet elevated tissue burdens in benthic organisms under combined warming and acidification. Arsenic speciation shifts toward more toxic inorganic forms under acidification, and chromium bioavailability increases with pH-dependent redox changes. Sublethal effects, including reproductive impairment, oxidative stress, and metabolic disruption, cascade to population declines and impaired ecosystem functions, with early life stages exhibiting up to 40% greater sensitivity under combined exposures. Human health risk assessments reveal that seafood-consuming populations face elevated risks, with hazard quotients for mercury exceeding one in high-consumption groups, lifetime cancer risks from arsenic and cadmium surpassing safe thresholds, and lead and chromium contributing to cardiovascular and renal toxicities. These findings suggest that current regulatory thresholds, which overlook interactive effects and additive toxicities, systematically underestimate cumulative threats in a changing ocean, necessitating urgent adoption of integrated, climate-aware frameworks aligned with international instruments such as the Minamata Convention on Mercury to protect marine ecosystems and human health.
This study aimed to systematically analyze the developmental trajectory, research landscape, and thematic evolution of tauopathy research from 2003 to 2025 using bibliometric methods. A total of 6752 publications retrieved from the Web of Science Core Collection (WoSCC) were analyzed using the R package bibliometrix and VOSviewer to construct bibliometric networks, including co-authorship, co-citation, and keyword co-occurrence analyses. Scimago Graphica was used to visualize international collaboration patterns. The annual number of publications on tauopathy increased markedly during the period 2003-2025, reflecting sustained global research interest. The United States was the leading contributor in both publication output and citation impact, while the University of Pennsylvania emerged as a key institution. Among individual researchers, the most productive authors and influential scholars were identified through publication output and citation-based metrics. Citation analysis highlighted the enduring impact of highly cited studies, particularly those establishing key biomarker frameworks for Alzheimer's disease research.Keyword-based analysis further revealed a shift from traditional mechanistic studies toward more integrative research themes, such as tau-amyloid-β interactions, neurodegeneration, and glial involvement, alongside continued interest in tau-targeted therapeutic strategies. This bibliometric analysis provides a quantitative and structured overview of the global tauopathy research landscape. Beyond confirming established patterns, it captures the dynamic evolution of research priorities and identifies emerging directions, offering a data-driven basis for future investigations.
Chronic environmental contamination is a prevalent environmental justice issue. Few studies have considered that such exposures may be a source of collective trauma - shared negative mental health outcomes that persist across decades and generations. An observational survey (N = 363) in the predominantly low-income Latine community on the Tucson International Airport Area Superfund site used community-engaged door-to-door and social media recruitment to compare those potentially exposed to historical contamination to non-exposed residents on mental health outcomes. Potential mediators (e.g. health concerns) and moderators (e.g. racial-ethnic identity) were also assessed. Analyses revealed elevated post-traumatic stress in the exposed group which was mediated by material (e.g. health concerns), social (e.g. environmental justice concerns), and "lifescape" (e.g. shattered assumptions about the world) impacts. We argue that contamination may indeed be a source of collective trauma based on our review of the literature. Community-engaged research should continue documenting and intervening on the collective trauma of contamination.
The global demographic shift toward an aging population necessitates a critical transformation in healthcare, particularly within Physical and Rehabilitation Medicine (PRM). Older adults frequently present with complex geriatric syndromes, such as frailty, sarcopenia, and cognitive impairment, that demand specialized, multidisciplinary rehabilitation strategies. The present global survey conducted by the International Society of Physical and Rehabilitation Medicine (ISPRM) Special Interest Group (SIG) in Geriatric Rehabilitation identifies systemic and educational gaps in the current PRM landscape. Despite a high clinical caseload of older adults, the majority of PRM practitioners report inadequate residency training in geriatric competencies and cite workforce shortages as primary barriers to care. This article discusses the perspectives and future steps required to elevate geriatric rehabilitation, emphasizing the urgent need for structured academic programs.
To examine how clinical goal-setting is used in routine audiological practice and the extent to which practice aligns with evidence-informed elements of person-centred goal-setting. Multi-method exploratory study comprising semi-structured interviews, in-clinic observations, and an international online survey. Survey responses from 97 hearing health professionals from 16 countries; interview transcripts from eight audiologists; observations from 12 adult hearing assessment appointments conducted by four audiologists. Goal-setting was widely endorsed as best practice in audiological rehabilitation, with the Client Oriented Scale of Improvement commonly used to structure discussions. However, findings identified several convergent barriers to effective goal-setting: clients were not consistently active partners and were often unaware of formal goals; clinicians reported difficulty eliciting specific, personally meaningful goals, particularly with communication or cognitive barriers; time pressure constrained goal discussions; structured tools to support goal elicitation and client access to goals were limited; goals were frequently documented but not used as an ongoing rehabilitation focus. Goal-setting in audiology is practised frequently but appears to be enacted inconsistently as an iterative rehabilitation process. Strengthening client ownership, goal specificity, strategy planning, and structured review would likely improve its clinical utility.