Clinics and Practice最新文献

{"title":"Patterns of Detecting Substances of Abuse in a Large Series of Patients in Spain During 2021-2025.","authors":"Carmen Lara-Apolinario, Cesar Martinez-Carral, Desiree Fischetti, Adexe J Fulgencio-González, Casimira Domínguez, Pedro C Lara","doi":"10.3390/clinpract16090173","DOIUrl":"10.3390/clinpract16090173","url":null,"abstract":"<p><strong>Aim: </strong>This study was conducted to assess, for the first time, patterns in common drugs of abuse detected in urine samples from a large series of patients treated at a tertiary university hospital and the role of age and sex in these patterns.</p><p><strong>Methods: </strong>This study included samples from all patients analyzed at the Dr. Negrín University Hospital Laboratory from January 2021 to December 2025 with positive immunoassay test results for at least one of the following substances of abuse: cannabis, cocaine, amphetamine/methamphetamine, or opioids. The samples were anonymized, and only the patient's sex and date of birth were included in the analysis.</p><p><strong>Results: </strong>In total, there were 5019 positive results for at least one of the substances screened (cannabis, opioids, amphetamine, or cocaine). Women represented only 28.2% of all patients with a positive test (<i>p</i> < 0.0001). Substance positivity was strongly influenced by age. Cannabis positivity was observed in 2989 cases (59.9%) and was very high in the younger age groups, consistently declining towards age 65 (94% for <18 years vs. 16.2% for >65 years) (<i>p</i> < 0.0001). In contrast, amphetamine (15.9%) and opioid (13.9%) use rose consistently from 7.5% and 0.7%, respectively, among patients aged <18 years, to 61.3% and 23.1%, respectively, in the >65 age group (<i>p</i> < 0.0001). Cocaine positivity (45.6%) was very low at early ages (5.4% for <18 years group), increased in middle age (62%: 36-55 years group), and decreased in older age (11.9% for >65 years group) (<i>p</i> < 0.0001).</p><p><strong>Conclusions: </strong>With more than five thousand samples analyzed, our study sheds light on the profile of substance abuse in a large population of patients attending a university hospital. Our results can help to better adjust preventive political actions and medical care, in the context of substance abuse.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paget-Schrotter Syndrome in the Primary Care Setting: A Case Report and Scoping Review of Clinical Presentation and Diagnostic Delay.","authors":"Mohammed Hteit, Raein Ghazvinian, Mohammed Abdulrasak","doi":"10.3390/clinpract16090172","DOIUrl":"10.3390/clinpract16090172","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Paget-Schrotter syndrome (PSS), or primary axillary-subclavian vein thrombosis, is an uncommon but clinically important form of upper extremity deep vein thrombosis. It often affects young, physically active patients and may initially be interpreted as a musculoskeletal disorder. This scoping review, combined with a contemporary primary care case, aimed to map the reported clinical presentation, diagnostic delay, and initial misdiagnosis of classic PSS. <b>Methods:</b> The review was conducted using the Arksey and O'Malley framework and reported in accordance with the PRISMA extension for scoping reviews (PRISMA-ScR). PubMed was searched for English-language publications from 1 January 2000 to 1 March 2026. Eligible reports described effort-induced thrombosis involving the axillary and/or subclavian venous segment. Secondary upper extremity deep vein thrombosis, non-effort thrombosis, pseudo-PSS, isolated distal venous thrombosis, and reports without extractable patient-level presentation data were excluded. Data were charted descriptively. <b>Results:</b> Among 1954 screened records, 143 studies met inclusion criteria and contributed 165 published patients. Together with the present case, the synthesis included 166 patients. Median age was 28 years, and 73.5% were male. Arm swelling (95.2%), pain (80.1%), cyanosis or discoloration (69.9%), and venous distension (70.5%) were the most frequent presenting features. Diagnostic delay was reported in 27.3% of patients with reported data, whereas initial misdiagnosis was reported in 21.7% of included patients. Musculoskeletal injury or muscle strain was the most common initial misdiagnosis, accounting for 66.7% of misdiagnosed cases. Pulmonary embolism was reported in 24.7% of patients, although this reported frequency is likely influenced by case-report publication bias, selective imaging, and preferential reporting of more severe presentations, and should not be interpreted as a population-level risk estimate. <b>Conclusions:</b> PSS should be considered in young or otherwise low-risk patients with unilateral arm swelling after strenuous or repetitive upper extremity activity. Greater awareness of this clinical presentation in primary care and general emergency settings may reduce diagnostic delay and post-thrombotic morbidity.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13604958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of the COVID-19 Pandemic on Myocardial Infarction Care in Kosovo.","authors":"Zarife Rexhaj, Besfort Kryeziu, Premtim Rashiti, Pranvera Ibrahimi, Arlind Batalli, Afrim Poniku, Margaritë Gjoka, Michael Henein, Shpend Elezi, Gani Bajraktari","doi":"10.3390/clinpract16090171","DOIUrl":"10.3390/clinpract16090171","url":null,"abstract":"<p><p><b>Background and Aim:</b> Studies worldwide have documented a reduction in acute myocardial infarction (AMI) admissions during the COVID-19 pandemic. We aimed to assess AMI admissions, management, and in-hospital outcomes in Kosovo during the pandemic period. <b>Methods:</b> We conducted a retrospective single-centre study including all consecutive AMI admissions from 1 January 2018 to 31 December 2020 at the Clinic of Cardiology, University Clinical Centre of Kosovo, the only public tertiary primary percutaneous coronary intervention (PCI) centre in the country. The pre-pandemic (PP) period was defined as 1 January 2018-12 March 2020 and the ongoing pandemic (OP) period as 13 March-31 December 2020. Demographic, clinical, laboratory, angiographic, and outcome data were collected. In-hospital mortality was defined as death between admission and discharge. Interrupted time-series analyses were performed. <b>Results:</b> A total of 898 AMI patients were admitted during OP and 2955 during PP. Daily admissions decreased from 3.8/day to 3.05/day (<i>p</i> < 0.001). OP patients were younger, more often hypertensive and smokers, and more frequently male. Coronary angiography (81% vs. 76%, <i>p</i> = 0.001) and PCI (66% vs. 60%, <i>p</i> = 0.001) were more frequent during OP, while in-hospital mortality remained unchanged. Time-series analysis showed a sharp fall in admissions at OP (β = -12.66, <i>p</i> < 0.001) with gradual recovery, alongside an increase in PCI use (β = 0.184, <i>p</i> < 0.001) and stable mortality. The proportion of ST-segment elevation (STEMI) cases increased significantly during the pandemic period. Compared with the pandemic period, admission during the pre-pandemic period was associated with lower odds of undergoing PCI (aOR 0.81, 95% CI 0.69-0.95), while age ≥ 65 reduced the likelihood of PCI. <b>Conclusions:</b> AMI hospitalizations in Kosovo declined significantly during the COVID-19 pandemic. The pandemic cohort was younger, with the profile of admitted patients shifting toward younger age, male sex, and STEMI presentation. Despite fewer admissions, PCI use increased, while no statistically significant difference in in-hospital mortality was observed between the two periods. These findings describe changes in treatment patterns and short-term in-hospital outcomes during the pandemic but should not be interpreted as evidence of equivalent overall quality of AMI care.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Micro-Expression Decoder: A Preliminary Mixed-Methods Evaluation of Training in Subtle Facial and Non-Verbal Cue Recognition in Final-Year Medical Students.","authors":"Hashira Syed, Katerina Sini, Andreas Conte, Austen El-Osta, Azeem Majeed, Waseem Jerjes","doi":"10.3390/clinpract16090170","DOIUrl":"10.3390/clinpract16090170","url":null,"abstract":"<p><p><b>Background</b>/<b>Objectives:</b> Subtle facial and interactional cues may prompt clinicians to explore possible anxiety, confusion or hesitation, but they do not establish a patient's internal state. The Micro-Expression Decoder (MED) links cue recognition with tentative interpretation, direct checking and communication adaptation. <b>Methods:</b> This preliminary, uncontrolled, single-group pre-post convergent mixed-methods evaluation involved 60 final-year medical students from three London medical schools. Ten groups of six completed a 270 min simulation-based programme comprising conceptual teaching, video observation, standardised-patient encounters, feedback and reflection. Study-specific self-ratings and a parallel-form recognition task were completed before teaching and immediately after the instructional and simulation components, before the final debrief. Standardised-patient ratings were obtained during the first and final simulated encounters. There was no control group or follow-up. <b>Results:</b> Recognition confidence increased from 2.7 to 4.3 (mean change 1.6, 95% CI 1.39-1.81; dz = 1.98), interpretation confidence from 3.0 to 4.5 (dz = 2.01), standardised-patient-rated attentiveness from 3.2 to 4.6 (dz = 2.02), and satisfaction from 3.5 to 4.8 (dz = 1.94). Anxiety recognition increased from 25/60 (41.7%) to 55/60 (91.7%), and confusion recognition from 29/60 (48.3%) to 52/60 (86.7%). Qualitative accounts described earlier noticing, clarification and checking, alongside difficulty distinguishing cues, distraction, cultural variation and over-interpretation. Nineteen students increased confidence without categorical improvement in anxiety or confusion recognition. <b>Conclusions:</b> MED was associated with immediate improvement across study-specific outcomes in simulation. The uncontrolled design, immediate assessment, investigator-developed measures, expectancy effects and ceiling in post-training satisfaction preclude conclusions about causality, retention, real-patient benefit, empathy or clinical competence.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with Prolonged Hospitalisation in Women with Breast Cancer: Evidence from a Large German Multicentre Study.","authors":"Lisa Cordes, Karel Kostev, Matthias Kalder","doi":"10.3390/clinpract16090169","DOIUrl":"10.3390/clinpract16090169","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background/Objectives&lt;/b&gt;: Breast cancer is the most common malignancy among women worldwide and poses a significant burden on healthcare systems. Despite evidence that treatment type is associated with hospital length of stay (LOS), current Germany-wide data on this topic are lacking. The present study aims to identify clinical and procedural factors associated with prolonged hospitalisation in women hospitalised for breast cancer in Germany. &lt;b&gt;Methods&lt;/b&gt;: This multicentre cross-sectional study analysed anonymised inpatient data from 38 German hospitals (IQVIA database), including 16,062 female breast cancer hospitalisation episodes (inpatient cases; patient-level linkage was not possible due to anonymisation, so these may not represent 16,062 distinct women) treated between January 2019 and December 2024. The primary outcome was LOS; prolonged hospitalisation was defined as LOS &gt; 7 days (75th percentile). Comorbidities were assessed using individual comorbidity categories defined according to the Elixhauser classification (retained at ≥1% prevalence). The primary multivariable analysis was restricted to characteristics documented independently of the in-hospital course (age, tumour site, metastatic status, chronic comorbidities). In-hospital complications, procedures, and diagnoses of ambiguous timing were analysed separately as secondary, descriptive associations. LOS was modelled using negative binomial regression (Poisson regression as a sensitivity analysis) and prolonged LOS using logistic regression, both with hospital-clustered robust (sandwich) standard errors. &lt;b&gt;Results&lt;/b&gt;: The overall median LOS was 4 days (IQR 3-7); 19.3% of hospitalisation episodes were prolonged. In the primary analysis, longer LOS was associated with age &gt; 70 years (RR 1.14; 95% CI 1.08-1.20), distant metastases (RR 1.76; 95% CI 1.51-2.04), lymph node metastases (RR 1.09; 95% CI 1.05-1.12), congestive heart failure (RR 1.44; 95% CI 1.31-1.59), anaemia (RR 1.41; 95% CI 1.14-1.75) and depression (RR 1.14; 95% CI 1.03-1.26). In the secondary descriptive analysis, in-hospital complications showed the strongest associations with longer LOS, particularly postoperative infection (RR 2.28), wound disruption (RR 1.92) and pneumonia (RR 1.45). Breast-conserving surgery and partial breast resection were associated with shorter LOS, while mastectomy, blood transfusions, and complex intensive care were associated with prolonged stays; the small inpatient radiotherapy subgroup (1.9%) most likely reflects a highly selected, predominantly palliative population rather than an association attributable to radiotherapy itself. &lt;b&gt;Conclusions&lt;/b&gt;: Prolonged hospitalisation was associated with older age, documented lymph node and distant metastases, and chronic somatic comorbidities including congestive heart failure, anaemia, chronic kidney disease and depression, and, in secondary descriptive analyses, with perioperative complications and intensive procedures. The strong","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent Pleomorphic Adenoma of the Palate: A Case Report.","authors":"Evangelos Kostares, Stavroula Diamantopoulou, Ourania Schoinohoriti, Georgia Kostare, Ioli Artopoulou, Georgios Mitsopoulos, Christos Perisanidis","doi":"10.3390/clinpract16090168","DOIUrl":"10.3390/clinpract16090168","url":null,"abstract":"<p><p><b>Background:</b> Pleomorphic adenoma is the most common benign salivary-gland neoplasm and frequently affects the minor salivary glands of the palate. Although surgical excision is generally curative, incomplete encapsulation, pseudopod-like extensions, and microscopic tumor deposits may contribute to recurrence, which can occur many years after initial treatment. Recurrent palatal pleomorphic adenoma is uncommon and may present diagnostic and reconstructive challenges. <b>Case Presentation:</b> A 64-year-old man was referred with a painless, slowly enlarging recurrent mass of the right posterior hard palate, six years after excision of a pleomorphic adenoma at another institution. Magnetic resonance imaging and contrast-enhanced computed tomography demonstrated a well-defined enhancing palatal lesion measuring approximately 2.1 × 1.9 × 1.9 cm on MRI and 1.8 × 2.2 × 1.9 on CT, without adjacent maxillary bone destruction or cervical lymphadenopathy. An incisional biopsy was consistent with pleomorphic adenoma. Wide local excision was performed, including the tumor, surrounding palatal soft tissue, and underlying periosteum. The resulting defect was reconstructed using a facial artery musculomucosal flap. The postoperative course was uneventful, with satisfactory flap healing and preservation of speech and swallowing. At six months of follow-up, there was no clinical evidence of recurrence or functional impairment. <b>Conclusions:</b> Recurrent pleomorphic adenoma of the palate may develop several years after primary treatment. Complete surgical excision with tumor-free margins and appropriate reconstruction is essential. Long-term clinical follow-up is recommended because late recurrence and, rarely, malignant transformation may occur.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Care Prescribing Patterns for Benzodiazepines and Z-Drugs, and Evidence Gaps Concerning Hydroxyzine and Seasonality: A Systematic Review.","authors":"Małgorzata Romaszko, Anita Nowacka, Michał Majewski","doi":"10.3390/clinpract16090166","DOIUrl":"10.3390/clinpract16090166","url":null,"abstract":"<p><p><b>Introduction:</b> Medications with sedative and hypnotic properties, such as benzodiazepines, the so-called 'Z-drugs', and hydroxyzine, are used in primary care. However, data regarding their prescribing patterns, particularly in the context of seasonality, remain limited. <b>Aim:</b> This review aims to assess the current knowledge regarding primary care prescribing patterns for medications with potential sedative and hypnotic effects, with particular emphasis on benzodiazepines, 'Z-drugs', and hydroxyzine. <b>Material and Methods:</b> The systematic review was conducted following the PRISMA guidelines. The PubMed, Web of Science and Scopus databases were searched. Fourteen original English-language publications from 2015 to 2026, which focused on the primary care prescription of selected groups of medications with hypnotic properties, were included. <b>Results:</b> Most of the studies included concerned benzodiazepines, with inconsistent prescribing patterns. Some studies reported a decrease in the rate of their prescription, whilst others indicated an increase, particularly among older people and patients with multimorbidity. Data concerning 'Z-drugs' were less extensive and showed heterogeneous prescribing trends across countries and study periods. Overall, the findings indicate substantial international variability in hypnotic prescribing in primary care. Evidence regarding hydroxyzine prescribing was particularly limited, with only one study specifically examining its prescribing patterns in primary care. Data on the seasonal prescribing patterns for all groups of medications were limited. <b>Conclusions:</b> Prescription of medications with sedative and hypnotic properties remains an important part of primary healthcare practice. Yet, significant research gaps remain regarding hydroxyzine prescribing and the seasonal variation in hypnotic and sedative prescribing.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Intrathecal Analgesia in Robotic Surgery (IARS) Study: Real-World Associations with Intraoperative Opioid Exposure, Fluid Administration, and Postoperative Pain-Free Recovery.","authors":"Antonio Romanelli, Antonella Langone, Angela Rosaria Caccavale, Alberto D'Amicantonio, Mariafidelia Ferrara, Renato Gammaldi","doi":"10.3390/clinpract16090167","DOIUrl":"10.3390/clinpract16090167","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Subarachnoid analgesia (SA) is increasingly used as an adjunct to general anesthesia in robotic ERAS pathways, but the contribution of the intrathecal local anesthetic, as distinct from that of the intrathecal opioids, has not been isolated. <b>Methods:</b> This study comprised a single-center retrospective cohort of adults undergoing elective robotic surgery (May 2024-July 2025). The exposure was the intrathecal regimen, serving as mutually exclusive categories. The primary outcome was intraoperative opioid exposure (model-derived area under the concentration-time curve per hour, AUC/h); secondary outcomes were standardized intraoperative fluid administration and a stringent pain-free 48 h course (NRS = 0 throughout). Multivariable Gamma and logistic models were supplemented by provider-adjusted mixed-effects analyses, E-values, and a model-free robustness analysis. <b>Results:</b> Of 207 patients, 83.1% received SA; all were given intrathecal morphine and 62.3% levobupivacaine. Compared with no SA, morphine alone was not associated with AUC/h (+14.0%; 95% CI, -0.9 to +31.1), whereas all levobupivacaine-containing regimens were: -36.4% (IM + L5), -24.3% (IM + L5 + S3), and -44.8% (IM + L10 + S3); overall <i>p</i> < 0.001. Algebraically equivalent component reparameterization attributed this to levobupivacaine dose (-44.3% at 5 mg; -59.3% at 10 mg). Remifentanil was used in 98.7%, 88.6%, and 10.0% of patients receiving 0, 5, and 10 mg, respectively. Fluid administration was lower with IM + L5 (-24.9%) and IM + L10 + S3 (-31.0%) after adjustment, but was not with levobupivacaine-graded unadjustment. SA was associated with a pain-free course (adjusted OR, 3.33; 95% CI, 1.06-11.79), an estimate not robust to minimal unmeasured confounding. <b>Conclusions:</b> Levobupivacaine-containing regimens were consistently associated with lower intraoperative opioid exposure, but regimen and opioid strategy were chosen jointly by the same clinician; therefore, these associations between strategies are specific to the delivery context of this study. The fluid and pain-free findings are hypothesis-generating. Trials should vary the local anesthetic dose independently of intrathecal opioids.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality Assurance in Laparoscopic Gynecological Training: A Narrative Review of Standards with a Multicenter Expert Perspective on Pathways Toward Effective Education and Care.","authors":"Vlad Iustin Tica, Liliana Steriu, Dragos Brezeanu, Andrei A Tica, Ana-Maria Brezeanu, Diana Badiu, Roxana Penciu, Silvia Onuc, Irina Tica, Maya Sophie de Wilde","doi":"10.3390/clinpract16090165","DOIUrl":"10.3390/clinpract16090165","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Quality assurance (QA) is a cornerstone of safe and effective postgraduate training in gynecological laparoscopic surgery, where clinical outcomes depend on procedural complexity, equipment sophistication, and the coordinated competence of an entire surgical team. This article is a narrative review of the conceptual, professional, and regulatory foundations of QA in healthcare education, complemented by a structured synthesis of the collective teaching and clinical experience of the author group. It is not an empirical study, and the sections that follow present a conceptual mapping supported by expert perspective rather than original outcome data. &lt;b&gt;Methods:&lt;/b&gt; Sources were identified through targeted searches of PubMed/MEDLINE and Google Scholar, supplemented by hand-searching of policy and curriculum documents issued by professional bodies and by backward citation tracking, without date restriction. Approximately 480 records were screened at title and abstract level, 112 were assessed as full text, and 41 sources were retained against predefined inclusion and exclusion criteria, with five further sources added during peer review. In a second and separate step, the ten co-authors, who hold teaching and supervisory roles in gynecological laparoscopy across academic centers in Romania and Germany, each completed the same six-item written prompt on training provision, trainer development, trainee assessment, and institutional QA practice; responses were coded thematically by two authors independently and consolidated into explicit points of convergence and divergence. &lt;b&gt;Results:&lt;/b&gt; We describe how QA principles, originally articulated in general quality-management and health-promotion literature, have been adapted by professional and regulatory bodies, including the European Board and College of Obstetrics and Gynecology (EBCOG), European Society for Gynecological Endoscopy (ESGE), American Society for Gastrointestinal Endoscopy (ASGE), and the UK General Medical Council, into concrete standards for training providers, trainers, and trainees. We outline the structures used to monitor and audit training quality, including Kirkpatrick's four-level evaluation model and periodic institutional review cycles, alongside documentation and certification pathways such as the Gynecological Endoscopic Surgical Education and Assessment (GESEA) program, with governance and financing as cross-cutting determinants of sustainability. The author synthesis converged on a consistent gap between documented standards and their routine enforcement and diverged on whether external review and formal certification should become mandatory. &lt;b&gt;Conclusions:&lt;/b&gt; The conceptual architecture of QA in gynecological laparoscopy is coherent and broadly fit for purpose, but we identified no study linking the implementation of a specific QA standard to measurable gains in trainee competency or patient outcomes in this field. Proposals for harmonized, outc","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Alternative Biventricular Tracking Approach for Assessment of Right Ventricular Strain in Cardiac Amyloidosis.","authors":"Marina Leitman, Vladimir Tyomkin, Shmuel Fuchs","doi":"10.3390/clinpract16090164","DOIUrl":"10.3390/clinpract16090164","url":null,"abstract":"<p><p><b>Background:</b> Cardiac amyloidosis is characterized by progressive myocardial infiltration leading to ventricular dysfunction. While left ventricular strain assessment is well established, evaluation of right ventricular (RV) mechanics remains challenging because of the ventricle's complex geometry and limitations of conventional speckle-tracking methods. We aimed to evaluate an alternative approach for RV strain assessment based on a continuous biventricular tracking pathway within the apical four-chamber view. <b>Methods:</b> We retrospectively studied 32 patients with cardiac amyloidosis and 32 age-, sex-, rhythm-, and ejection fraction-matched controls. RV free-wall longitudinal strain was measured using a novel investigational biventricular tracking approach from the basal RV free wall through the apex to the basal lateral left ventricular wall and compared with conventional RV strain. Investigational biventricular strain (BVS) was also obtained automatically as a surrogate marker of global ventricular function. Reproducibility was assessed in a subset of 20 patients using intraclass correlation coefficients (ICC), coefficient of variation (CV), and Bland-Altman analysis. <b>Results:</b> Investigational RV free-wall strain was significantly reduced in patients with cardiac amyloidosis compared with controls (-15.3 ± 4.1% vs. -21.2 ± 5.4%, <i>p</i> < 0.001). Compared with conventional RV strain, the investigational biventricular tracking approach yielded more negative global RV strain values in both patients with amyloidosis (-15.3 ± 4.1% vs. -13.8 ± 4.8%, <i>p</i> = 0.003) and controls (-21.2 ± 5.4% vs. -17.4 ± 5.8%, <i>p</i> < 0.001). The greatest differences were observed at the apical RV segment. Bland-Altman analysis demonstrated a mean bias of -2.64 percentage points with 95% limits of agreement from -8.41 to +3.12 percentage points. A significant regional deformation pattern along the investigational tracking contour was observed in patients with cardiac amyloidosis (<i>p</i> < 0.001), whereas no significant regional variation was observed in controls. BVS correlated strongly with LV global longitudinal strain (r = 0.83 in amyloidosis; r = 0.58 in controls; r = 0.84 overall; all <i>p</i> < 0.001). Inter- and intra-observer reproducibility of investigational RV free-wall strain was excellent (ICC 0.976 and 0.985, respectively). <b>Conclusions:</b> The investigational biventricular tracking approach is a feasible and highly reproducible method for assessing ventricular longitudinal deformation using a single continuous contour. It provides complementary information while remaining an exploratory investigational technique. Further studies are required to validate its anatomical specificity, clinical applicability, and prognostic value.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}