Clinics and Practice最新文献

{"title":"A Clinical Decision Support System for Post-Surgical Cardiovascular Remote Monitoring.","authors":"Charalampia Pylarinou, Francesk Mulita, Efstratios Koletsis, Vasileios Leivaditis, Elias Liolis, Lefteris Gortzis, Dimosthenis Mavrilas","doi":"10.3390/clinpract16050093","DOIUrl":"10.3390/clinpract16050093","url":null,"abstract":"<p><p><b>Background:</b> Post-surgical cardiovascular monitoring places a heavy information burden on clinical teams, requiring the rapid synthesis of patient history, intraoperative data, monitoring streams, and surgical outcome evidence. Existing clinical decision support systems handle this integration poorly, and most offer little visibility into their reasoning. We present a Retrieval-Augmented Generation (RAG) architecture designed specifically for this domain, with a focus on evidence traceability and practical workflow integration. <b>Methods:</b> We describe a three-layer RAG architecture comprising a retrieval layer that creates 768-dimensional representations of clinical scenarios; an augmentation layer using a stacking ensemble (Random Forest and XGBoost base learners with a logistic-regression meta-learner) to integrate patient-specific data with retrieved evidence and produce calibrated probability estimates; and a generative layer using a fine-tuned BERT classifier together with Gemini 2.5 Pro to synthesise actionable clinical recommendations. Components were prototyped on publicly available, de-identified data from MIMIC-III and the MIMIC-III-Ext-PPG benchmark to verify pipeline integrity. <b>Proposed Evaluation Framework:</b> This paper presents a system architecture rather than a clinically validated implementation. We outline a structured evaluation framework to assess the technical performance and clinical applicability of the RAG architecture, encompassing the technical validation of system components, expert assessment of clinical workflow integration potential, and analysis of interpretability features essential for healthcare deployment. Specific technical targets include retrieval precision >90% for relevant evidence, query response time <3 s, and a clinical appropriateness rating of >85% from expert review. <b>Conclusions:</b> We describe a RAG architecture for post-surgical cardiovascular monitoring in which every recommendation is linked to retrievable source documents, making the reasoning visible and challengeable. A structured evaluation framework is proposed to guide the system towards clinical validation.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13204805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036380","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 Update on Umbilical Cord Abnormalities and Associated Thrombosis: A Systematic Review.","authors":"Marco La Verde, Eleonora Braca, Antonio Cerillo, Maria Fatigati, Pasquale De Franciscis, Davide Pisani, Mario Fordellone, Mariavictoria De Simone, Carlo Pietro Campobasso, Alessandro Feola","doi":"10.3390/clinpract16050092","DOIUrl":"10.3390/clinpract16050092","url":null,"abstract":"<p><p><b>Background and objective</b>: Umbilical cord abnormalities (UCAs) such as hypercoiling, velamentous or marginal cord insertion, or reduced Wharton's jelly are associated with umbilical thrombosis. UCAs increase the risk of vascular obstruction and impaired fetal blood flow, resulting in hypoxia or stillbirth. We examined the association between the UCAs and the umbilical cord thrombosis. <b>Methods</b>: According to PRISMA, five electronic databases (PubMed, Scopus, Embase, Cochrane Library, and Clinicaltrial.gov) were screened. Only studies that analyzed umbilical cord insertion abnormalities and abnormalities of the umbilical cord associated with thrombosis were included in this systematic review. Studies without thrombosis were excluded (PROSPERO ID: CRD420251087525). <b>Results</b>: Only 12 articles out of 1105 screened records satisfied the inclusion criteria, comprising 3 retrospective cohort studies, 3 case series and 6 case reports. The publication years ranged from 1983 to 2025. A total of 126 cases of umbilical vascular thromboembolism (UVTE) were identified, among which 84 cases of UCAs represented by 16 cases of stricture, 14 cases of hypercoiling, 16 cases of too-short cords (≤40 cm), 11 cases of too-long cords (≥70 cm), 5 cases of velamentous or furcate cord insertions, 12 cases of nuchal cord insertions, 13 cases of funistisis, 11 cases of true knots, and 3 cases of Wharton jelly abnormalities. <b>Conclusions</b>: UCAs, including true knots, abnormal coiling, and furcate or velamentous cord insertion, were highly associated with UVTE. Future studies should involve developing standardized criteria for the diagnosis and reporting of UCAs.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13204851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036345","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":"Digital Access for Screens and Smiles: Telehealth Use and Dental Care Access in the U.S.","authors":"Gulzar Shah, Anjana Kalathimekkattu, Indira Karibayeva, Bobbie J Newell","doi":"10.3390/clinpract16050091","DOIUrl":"10.3390/clinpract16050091","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Cost-related delays hinder access to dental care in the United States, while the growing use of telehealth has an uncertain impact on population-level access to dental services. The study examined factors associated with cost-related delays in dental care among U.S. adults and whether telemedicine use in the past year was associated with these delays. <b>Methods:</b> This cross-sectional study utilized nationally representative data from the 2023 National Health Interview Survey (NHIS) to examine the association between telehealth use and oral health services utilization in the past 12 months. All analyses were performed using R version 4.5.1 within the RStudio IDE (version 2025.09.0+387). <b>Results:</b> Adults who visited a dental provider within the past 12 months had lower odds of cost-related dental care delay, whereas telemedicine users had higher odds of delay. Higher odds of delayed dental care were observed among women, those aged below 65 years, Hispanics, those with poorer health, and those living in the Midwest, South, and West. Education and family income-to-poverty ratio were not significantly associated with delay in the adjusted analysis. <b>Conclusions:</b> Cost-related delays in dental care remain common and reflect persistent sociodemographic inequities and patterns of healthcare engagement. Telemedicine use alone does not appear to contribute to overcoming barriers to dental care access. Policies that reduce financial barriers and connect telehealth encounters with oral health referral pathways may improve equitable access to dental services.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13204784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148035880","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":"Efficacy and Safety of Glycerol Lidocaine Ear Drops in the Non-Antibiotic Treatment of Otitis Externa Symptoms-An Observational Study.","authors":"Maria Sobol, Ewelina Sielska-Badurek, Mariusz Cięciara, Artur Wrzosek, Justyna Tomaszewska, Beata Roman","doi":"10.3390/clinpract16050090","DOIUrl":"10.3390/clinpract16050090","url":null,"abstract":"<p><p><b>Purpose</b>: The aim of this study was to investigate the safety and efficacy, as well as relief of symptoms after regular use, of 0.5% lidocaine hydrochloride solution in anhydrous glycerol (Auridol) in the form of ear drops, in patients with symptoms of otitis externa (OE) in a real-world setting. <b>Methods</b>: This real-world pre-post study included 64 subjects aged 1 to 69 years with symptoms as follow: swelling, pain due to regular exposure to water or caused by frequent use of detergents, pain due to prolonged wearing of earphones, or earwax clogging the external auditory canal. In each subject, following an otoscopic examination and interview given by an ENT, the Auridol treatment was initiated. The product was administered as two drops into the affected ear up to three times daily in patients with symptoms of OE. During each visit, physical and functional symptom were evaluated. In addition, the efficacy of using the product was assessment using a VAS scale. At the end of the study, subjects rated the product according to a Likert scale. <b>Results</b>: A statistically significant reduction in perceived pain was observed at <i>t</i> = 30' as well as <i>t</i> = 3 days after application. For physical symptoms assessed by an ENT, a statistically significant difference was observed between consecutive scores for two of the assessed parameters (redness and swelling.) The product was rated very highly by the subjects. <b>Conclusions</b>: The results suggest that a combination of anhydrous glycerol and 0.5% of lidocaine in the form of ear drops has a positive effect in the treatment of symptoms of OE.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13206003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036031","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":"Development of a Core Set of Nursing-Sensitive Patient Outcomes in Intensive Care Units: A Delphi Consensus Study.","authors":"Luciano Cellura, Anna Maria Grugnetti, Stefano Gabriele Scaglia, Attilio Quaini, Silvia Natoli, Giuseppina Grugnetti","doi":"10.3390/clinpract16050089","DOIUrl":"10.3390/clinpract16050089","url":null,"abstract":"<p><p><b>Introduction/Aim</b>: Nursing care constitutes a fundamental determinant of patient outcomes in intensive care units (ICUs); however, the absence of standardised nursing-sensitive indicators constrains the objective evaluation of care quality within this setting. The present study aimed to develop an evidence-informed core set of nursing-sensitive patient outcomes (NSPOs) specific to intensive care nursing. <b>Methods</b>: A Delphi consensus study was conducted between September 2023 and February 2025 at the IRCCS Policlinico San Matteo Foundation, Pavia, Italy. The process comprised a preliminary scoping review, followed by two iterative Delphi rounds and a final consensus meeting aimed at refining conceptual domains without modifying item ratings. Thirty-eight ICU nurses evaluated 35 evidence-based NSPOs using a five-point Likert scale. Consensus was defined a priori as ≥75% agreement (scores 4-5), with a minimum response rate of ≥80%. Reliability was assessed using a two-way random-effects Intraclass Correlation Coefficient (ICC). <b>Results</b>: Fifteen NSPOs achieved the predefined consensus threshold and demonstrated moderate-to-excellent reliability (ICC = 0.65-0.85). The validated core set was organised into four domains-safety, clinical, functional, and perceptual-reflecting both preventive-technical and holistic dimensions of ICU nursing care. <b>Conclusions</b>: This study produced the first ICU-specific evidence-based NSPO core set in Italy, providing a measurable and reproducible framework to support systematic outcome monitoring, and quality improvement in critical care practice.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13206322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148035671","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":"Clinical and Histopathological Profile of Adults with Celiac Disease at Diagnosis and on a Gluten-Free Diet: A Cross-Sectional Observational Study.","authors":"Elena Maria Domsa, Ioana Para, Adela Viviana Sitar Taut, Teodora Atena Pop, Elena Ofelia Mosteanu, Laura Elena Gligor, Mihaela Elvira Cîmpianu, Antonia Gabriela Nitescu, Viorel Lucian Marina, Bogdan Nicolae Mucea, Vasile Andreica","doi":"10.3390/clinpract16050088","DOIUrl":"10.3390/clinpract16050088","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Celiac disease (CD) is a chronic immune-mediated enteropathy triggered by gluten ingestion in genetically predisposed individuals, with a highly heterogeneous clinical presentation encompassing both intestinal and extraintestinal manifestations. Despite growing clinical awareness, diagnostic delay remains a significant challenge, and the evolution of clinical and histopathological features following gluten-free diet (GFD) initiation remains incompletely characterized. This study aimed to compare the clinical, serological, and histopathological profile of adults with newly diagnosed CD and those maintained on a long-term GFD. <b>Methods:</b> This prospective observational study enrolled 50 adult patients with biopsy-confirmed CD: 16 at the time of diagnosis (gluten-consuming) and 34 on a GFD for at least one year. All participants underwent standardized clinical assessment, serological testing (IgA anti-tissue transglutaminase [tTG] and/or IgA anti-endomysial antibodies [EMAs]), upper digestive endoscopy with duodenal biopsies graded according to the Marsh-Oberhuber classification, and evaluation for <i>Helicobacter pylori</i> co-infection. Between-group comparisons were performed using the Mann-Whitney U test, Fisher's exact test, and chi-square test, as appropriate. <b>Results:</b> Newly diagnosed patients exhibited a significantly longer median duration from symptom onset to diagnosis compared to the GFD group (<i>p</i> = 0.03). Histopathological severity was greater in the newly diagnosed group, with more advanced Marsh-Oberhuber grades (<i>p</i> = 0.03). Among individual symptoms, bloating was significantly more frequent in newly diagnosed patients (<i>p</i> = 0.02). Notably, thrombocytosis was identified significantly more often in the newly diagnosed group compared to GFD patients (<i>p</i> = 0.02), representing a potentially underrecognized extraintestinal marker of active CD. Overall rates of intestinal and extraintestinal manifestations and CD-specific seropositivity did not differ significantly between groups. <b>Conclusions:</b> The clinical and histopathological profile of adults with celiac disease differs meaningfully between the time of diagnosis and during GFD adherence. Bloating and thrombocytosis were significantly more prevalent at diagnosis, with thrombocytosis emerging as a potentially underrecognized marker of active disease. Conversely, several manifestations persisted despite dietary treatment, underscoring the heterogeneous nature of CD across its clinical course. These findings may support earlier disease recognition and more individualized follow-up strategies in routine clinical practice.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13206299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036387","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":"Prognostic Significance of Dynamic Free T3 Changes in Critically Ill Patients.","authors":"Yakup Özgüngör, Burak Emre Gilik, Emre Karagöz, Hicret Yeniay, Mensure Çakırgöz, Özlem Melis Korkmaz Özgüngör, İhsan Birol, Sıla Seven","doi":"10.3390/clinpract16050087","DOIUrl":"10.3390/clinpract16050087","url":null,"abstract":"<p><p><b>Background:</b> Non-thyroidal illness syndrome is frequent in critically ill patients, but the prognostic value of dynamic changes in thyroid function tests remains unclear. This study evaluated whether serial measurements of thyroid-stimulating hormone (TSH) and free triiodothyronine (FT3) provide additional predictive value for 30-day mortality beyond conventional severity scores in ICU patients. <b>Methods:</b> This single-center retrospective observational study included 74 adult patients treated for ≥72 h in a general ICU who had TSH and FT3 measured within 24 h of admission and repeated at 48-72 h. Patients aged 18 years or above admitted to the intensive care unit were included in the study. Demographic characteristics, comorbidities, APACHE II, SOFA, modified NUTRIC (mNUTRIC) scores, and routine laboratory data (including albumin, CRP, and lactate) were recorded. The primary outcome was 30-day mortality. Between-group comparisons were performed using t-tests, Mann-Whitney U, and Chi-square tests. Variables significant in univariate analyses were entered into binary logistic regression models, and predictive performance was assessed using receiver operating characteristic (ROC) curves and the Youden index. <b>Results:</b> The mean age was 68.7 ± 14.7 years, and 41.9% (<i>n</i> = 31) of the patients died within 30 days. Non-survivors had higher APACHE II, SOFA, and mNUTRIC scores and lower albumin, lymphocyte count, and second FT3 levels compared with survivors (all <i>p</i> ≤ 0.003). Baseline FT3 and TSH were not associated with mortality, whereas both the subsequent FT3 measurements and the ΔT3 (variance in former to latter FT3) were remarkably predictive. The latter FT3 < 1.63 pg/mL produced an AUC of 0.835 (sensitivity: 77%, specificity: 74%), and a ΔT3 log ratio threshold of -0.09 (≈20% early FT3 decline) produced an AUC of 0.835 (sensitivity: 71%, specificity: 81%). The APACHE II + ΔT3 (numeric) model showed the best discrimination (AUC: 0.921; sensitivity: 87.1%, specificity: 81.4%), outperforming APACHE II alone (AUC: 0.861). <b>Conclusions:</b> In critically ill adult patients, dynamic T3 kinetics-particularly premature decline in FT3 within the first 72 h-provide incremental prognostic value for 30-day mortality beyond APACHE II. Serial FT3 monitoring may help identify high-risk patients whose endocrine adaptation to critical illness is failing.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13206466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036011","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":"Steroid Refractory and Plasma Exchange Partially Responsive Longitudinally Extensive Transverse Myelitis Due to Tumor Necrosis Factor-Alpha (Etanercept): A Case Report.","authors":"Jelena Stojsavljevic, Rafael R Perez, Emilia Petcu, Celestine Odenigbo, Cristian Madrid, Igor Dumic, Charles W Nordstrom","doi":"10.3390/clinpract16050086","DOIUrl":"10.3390/clinpract16050086","url":null,"abstract":"<p><p><b>Background:</b> Acute transverse myelitis (ATM) is an inflammatory disorder of the spinal cord with heterogeneous etiologies, including autoimmune, infectious, paraneoplastic, and drug-induced causes. Tumor necrosis factor-alpha (TNF-α) inhibitors have been infrequently associated with inflammatory central nervous system events, including transverse myelitis. TNF-inhibitor-associated myelitis typically presents with short-segment lesions, a normal brain MRI, and partial responsiveness to corticosteroids. Longitudinally extensive transverse myelitis (LETM) and steroid-refractory cases are uncommon. <b>Case Presentation:</b> A 39-year-old woman with psoriatic arthritis treated with etanercept for two years presented with subacute progressive bilateral lower-extremity sensory loss and weakness. MRI revealed a T2 hyperintense spinal cord lesion extending from T11 to L1 with gadolinium enhancement, consistent with transverse myelitis, while brain MRI was normal. Cerebrospinal fluid analysis showed lymphocytic pleocytosis, elevated protein, oligoclonal bands, and increased kappa free light chains. Extensive infectious, metabolic, paraneoplastic, and autoimmune testing, including aquaporin-4 and MOG antibodies, was negative. Despite high-dose intravenous corticosteroids and the discontinuation of etanercept, the patient experienced clinical worsening with lesion expansion, meeting criteria for LETM, and developed urinary retention. She subsequently underwent plasma exchange, resulting in radiologic improvement and moderate clinical recovery. <b>Conclusions:</b> This case highlights an atypical presentation of TNF-inhibitor-associated myelitis characterized by a biphasic course, longitudinally extensive spinal cord involvement, steroid refractoriness, and responsiveness to plasma exchange. These features suggest either an unusually severe TNF-inhibitor-related inflammatory phenotype or a TNF-inhibitor-triggered antibody-mediated demyelinating process. Reports of TNF-inhibitor-associated myelitis evolving into longitudinally extensive, steroid-refractory disease remain limited, and this presentation may broaden the recognized clinical spectrum of TNF-α-related CNS inflammatory events. Close neurologic follow-up and heightened awareness of severe CNS complications associated with TNF-α inhibitors are warranted.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13206227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036003","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":"Correction: Lago et al. Serotonin-Norepinephrine Reuptake Inhibitors in Fibromyalgia Management: An Integrative Literature Review of Clinical Evidence. <i>Clin. Pract.</i> 2026, <i>16</i>, 68.","authors":"Isabella Oliveira do Lago, Bruna Moura Medina Diniz, Daniela Vieira Buchaim, Rogerio Leone Buchaim","doi":"10.3390/clinpract16050084","DOIUrl":"10.3390/clinpract16050084","url":null,"abstract":"<p><p>In the original publication [...].</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13204707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148035662","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":"Efficacy of Combining Kegel Exercises with EMS-Based Pelvic Floor Muscle Electrostimulation in Postmenopausal Women with Involuntary Urinary Leakage.","authors":"Lucian Șerbănescu, Sebastian Mirea, Paris Ionescu, Ionuț Iorga, Traian-Virgiliu Surdu, Vadym Rotar, Stere Popescu, Elena Mocanu, Luana Alexandrescu, Cosmin Nișcoveanu, Radu-Andrei Baz","doi":"10.3390/clinpract16050085","DOIUrl":"10.3390/clinpract16050085","url":null,"abstract":"<p><strong>Background/objectives: </strong>Urinary incontinence (UI) is a frequent condition in postmenopausal women and is associated with a substantial negative impact on quality of life. Conservative management can include pelvic floor muscle training (PFMT) and high-intensity focused electromagnetic stimulation (HIFEM); however, data regarding the potential benefit of combining these modalities remain limited. This study aimed to evaluate whether the addition of a structured Kegel exercise program to EMSELLA-based electromagnetic stimulation is associated with enhanced clinical outcomes in postmenopausal women with urinary incontinence.</p><p><strong>Methods: </strong>This prospective comparative study included 99 postmenopausal women with stress, urgency, or mixed urinary incontinence and an International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) score ≥ 6. Participants received either EMSELLA therapy alone (Group A, n = 49) or EMSELLA combined with a standardized Kegel exercise program (Group B, n = 50) over a three-month period. Symptom severity was assessed at baseline and at three months using the ICIQ-UI SF. Between-group comparisons were performed using analysis of covariance, adjusting for baseline scores.</p><p><strong>Results: </strong>Both therapeutic approaches were associated with clinically meaningful improvement in urinary incontinence symptoms. After adjustment for baseline severity, lower follow-up ICIQ-UI SF scores, greater mean symptom reduction, and higher response rates were observed in the combined-therapy group. Across all menopausal-duration subgroups, outcomes consistently favored the association of EMSELLA therapy with Kegel exercises. No treatment-related adverse events were reported.</p><p><strong>Conclusions: </strong>The association of EMSELLA electromagnetic stimulation with a structured Kegel exercise program was associated with greater symptom improvement than electromagnetic stimulation alone, suggesting an additive therapeutic effect of voluntary pelvic floor muscle training. This combined conservative approach was well tolerated and may represent a useful management strategy for postmenopausal urinary incontinence.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13206572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148035982","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}