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Defining health management: A conceptual foundation for excellence through efficiency, sustainability and equity
Get PDFThis is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work
is properly cited, the use is non‐commercial and no modifications or adaptations are made.
© 2025 The Author(s). The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.The practice of healthcare management is essential for the efficient operation of health services, encompassing leadership, management, and direction within healthcare organisations. 'Health management' extends beyond healthcare management by integrating principles of public health and health policy. As health management is commonly practised but not cohesively recognised, the European Health Management Association (EHMA) conducted this study to develop a cohesive definition of health management. Developed through a qualitative methodology comprising focus group discussions and validation through quantitative expert interviews, this study proposed a holistic definition of health management, incorporating social, environmental and economic determinants of health, cross-sector collaboration, and the 'One Health' approach. The publication of this unified definition has important implications for professional training, policy development, and health outcomes. It provides a foundational framework for curricula, informs precise policy formulation, and promotes excellence through health service delivery that reflects efficiency, sustainability, and equity.https://onlinelibrary.wiley.com/doi/full/10.1002/hpm.390
Enhancing the experience and outcomes of children with complex care needs in acute paediatric settings: A realist review protocol
Get PDFIntroduction The number of babies, children and young people with complex care needs (henceforth children with complex care needs (CCCN)) in England has increased in recent decades, and this has also been recognised globally. CCCN may have frequent and lengthy hospital admissions, but during these episodes, their needs are not always met, potentially resulting in suboptimal experiences and outcomes. Despite increased numbers of CCCN accessing acute care and displaying greater complexity, much of the contemporary literature has focused on primary care coordination between health, education and social care. Research specifically focused on CCCN in the acute care setting is largely absent. This realist review aims to understand how optimal experience and outcomes are achieved for CCCN during acute care, in different settings, for whom and why. Methods and analysis This realist review will proceed through six steps: (1) clarifying the scope of the review, (2) searching for evidence, (3) data selection and quality appraisal, (4) data extraction, (5) analysis and synthesis and (6) dissemination. We will search Medline, Cumulated Index in Nursing and Allied Health Literature and PsycINFO, alongside grey literature and other sources and will carry out citation tracking. Patient and public involvement and engagement have aided in the development of this protocol and will be maintained through regular consultations with a stakeholder group throughout the review. The review will result in a programme theory which will include context-mechanism-outcome configurations and provide data to support claims of generative causation. Ethics and dissemination Ethical approval is not required for this review as it does not involve primary research. The programme theory developed will be disseminated through peer-reviewed publications and relevant conferences. It will subsequently inform the development of an intervention to improve acute care for CCCN.https://doi.org/10.1136/bmjopen-2024-09732
Spontaneous Jejunal perforation in coeliac disease: diagnostic dilemma and navigating treatment beyond gluten-free diet in the absence of refractory disease
Get PDFCoeliac disease (CD) is relatively common in the West, affecting up to 1% undergoing serological screening and 0.6% histologically confirmed diagnosis of the population [1]. The pathophysiology involves a complex interplay between genetic susceptibility, environmental, and immunologic factors, resulting in chronic inflammation. 95% of people with CD exhibits the HLA-DQ2 and HLA-DQ8 genes which are crucial for presenting gluten-derived peptides to immune cells. The end result is activation of CD4+ T-helper cells in the lamina propria. These cells release inflammatory cytokines such as interferon-gamma that drive chronic inflammation and ultimately villous atrophy [2]. While treatment is mainly conservative and mandatory avoidance of gluten-containing diet, a small proportion fails to response to this measure, leading to progressive disease and refractory malabsorption. This is called the refractory CD (RCD). Diagnosis of this requires absolute proof that Gluten-Free Diet (GFD) has been adopted for at least 12 months, apart from exclusion of other potential causes that may mimic CD [3]. RCD is categorised into type 1 and type 2, based on the presence of aberrant intraepithelial lymphocytes, with the latter carrying a worse prognosis. Most cases of CD associated Ulcerative Jejunitis (UJ), a chronic immune-mediated deep ulceration within the jejunum is found coexisting with type 2 RCD. Very few presents with UJ alone with no RCD association.https://academic.oup.com/omcr/article/2025/3/omae210/808811
Analysis of outcomes of novel single-branched aortic stent graft for treatment of Type B Aortic Dissection
No full texthttps://www.annalsthoracicsurgery.org/article/S0003-4975(25)00306-6/abstrac
Enteral Tube Nutrition in anorexia nervosa and Atypical Anorexia Nervosa and outcomes: a systematic scoping review
Get PDF© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Background: Anorexia nervosa and atypical anorexia nervosa require refeeding as a core part of their treatment, and enteral tube nutrition (ETN) may be needed in some individuals either to supplement or replace oral nutrition. This scoping review aimed to explore outcomes associated with phases of ETN, including initial nutrition, transition from enteral nutrition to oral intake, and to overall nutrition; Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist was used. A systematic search was performed using the Ovid and the Web of Science databases, using relevant search terms identifying 37 studies to be included in the review. Quantitative and qualitative data were synthesised and presented; Results: ETN resulted in similar or higher weight gain than oral nutrition. Refeeding syndrome parameters were comparable between ETN and oral nutrition with some indication that prophylactic phosphate supported mitigation of hypophosphataemia. Global psychological parameters related to the eating disorder improved with nutrition; however, there was an indication that weight and shape concerns did not improve during this period. There was a lack of evidence related to transition from ETN to oral intake. Qualitative data indicated meanings attached to the tube, suggesting that additional support may be needed for the transition away from the tube. Furthermore, consideration may be required to support individuals in mitigating trauma related to ETN under restraint; Conclusions: ETN, when required, is a viable alternative to oral intake. Results indicated the need for further research, especially in the transition from ETN to oral intake with regard to strategies of transition and support, and outcomes related to these strategies.https://www.mdpi.com/2072-6643/17/3/42
Effect of proximal blood flow arrest during endovascular thrombectomy (ProFATE): A multicenter, blinded-end point, randomized clinical trial
Get PDFBACKGROUND: The effect of temporary blood flow arrest during endovascular thrombectomy for acute ischemic stroke is uncertain due to the lack of evidence from randomized controlled trials. We aimed to investigate whether temporary blood flow arrest during endovascular thrombectomy using a balloon guide catheter improves intracranial vessel recanalization compared with nonflow arrest. METHOD(S): The ProFATE trial (Proximal Blood Flow Arrest During Endovascular Thrombectomy) was a multicenter, randomized, participant- and outcome-blinded trial at 4 thrombectomy centers in the United Kingdom. Adults with acute ischemic stroke due to anterior circulation large vessel occlusion were randomly assigned (1:1) by a central, Web-based program with a minimization algorithm to undergo thrombectomy with temporary proximal blood flow arrest or nonflow arrest during each attempt. The primary outcome was the proportion of participants achieving near-complete/complete vessel recanalization (expanded Thrombolysis in Cerebral Infarction score of 2c or 3) at the end of the thrombectomy procedure, adjudicated by a blinded independent imaging core laboratory. Analyses were performed on the intention-to-treat population, adjusted for age, IV thrombolysis, onset-to-randomization time, Alberta Stroke Program Early CT Score, occlusion site, randomization site, and National Institutes of Health Stroke Scale. RESULT(S): Between October 10, 2021, and June 27, 2023, we recruited 134 participants, of whom 131 participants (mean age, 75 years; 62 47%] women and 69 53%] men) were included in the final analysis. Sixty-six participants were allocated to the temporary blood flow arrest group and 65 to the nonflow arrest group. The proportion of participants with an expanded Thrombolysis in Cerebral Infarction 2c/3 score at the end of the endovascular procedure was 74.4% (49/66) in the flow arrest group and 70.8% (46/65) in the nonflow arrest group (adjusted odds ratio, 1.07 95% CI, 0.45-2.55]; P=0.88). Among the prespecified secondary efficacy outcomes, a lower rate of emboli to a new vascular territory occurred in the blood flow arrest group compared with the nonflow arrest group (1.5% versus 12.3%; adjusted odds ratio, =0.04 95% CI, 0.01-0.53]; P=0.014) and a higher rate of complete recanalization (expanded Thrombolysis in Cerebral Infarction score, 3) after the first attempt in the flow arrest group versus the nonflow arrest group (33.0% versus 15.3%; adjusted odds ratio, =3.80 95% CI, 1.40-10.01]; P=0.007). No between-group differences were identified for the remaining procedural or clinical efficacy (modified Rankin Scale at 90 days) or safety outcomes (worsening of the stroke severity at 24 hours, adverse events, symptomatic intracranial hemorrhage, or mortality). CONCLUSION(S): Among patients presenting with anterior circulation large vessel occlusion acute ischemic stroke, temporary proximal blood flow arrest during endovascular thrombectomy, compared with nonflow arrest, did not significantly improve the near-complete/complete vessel recanalization (expanded Thrombolysis in Cerebral Infarction score, 2c-3) at the end of the procedure. Larger randomized controlled trials are warranted to confirm or refute a clinically significant treatment effect of temporary flow arrest on the functional outcome following endovascular thrombectomy.Copyright © 2024 The Authors.https://doi.org/10.1161/strokeaha.124.04971
Dermatological assessment: history-taking and examination
No full textNurses of all disciplines will find dermatological complaints one of the most common presentations in their practice. This article looks at effective techniques when assessing dermatological conditions. Skin problems are common, affecting up to one-third of the population during their lifetime, and they are frequently encountered by advanced clinical practitioners (ACPs) in both primary and secondary care settings. Despite the prevalence of dermatological presentations, ACPs often feel unprepared to conduct a thorough dermatological history and examination. This article aims to provide guidance to trainees and qualified ACPs, whether in acute hospital settings or primary care, to perform dermatological assessments and examinations systematically. This is the first article in a two-part series on dermatological assessment.https://www.magonlinelibrary.com/doi/abs/10.12968/pnur.2025.36.2.5
Diagnosis of Shock States
No full textShock is a common and deadly illness with a dynamic course over time. Echocardiography is an essential diagnostic tool in the management of shock. Each phase of shock management requires a specific approach with different echocardiographic goals. The initial goal of echocardiography is to diagnose the cause of shock, followed by treatment optimization, stabilization, and deescalation. The initial examination is rapid and based on the recognition of patterns (low mean systemic pressure, left and right heart failure, tamponade, and catastrophic valve failure) using a qualitative 2-dimensional examination with selected Doppler techniques. Subsequent examinations are often more detailed, semiquantitative, and quantitative.https://www.criticalcare.theclinics.com/article/S0749-0704(25)00020-X/abstrac
Gut Microbiota Modulation in Type 2 Diabetes and Cardiometabolic Risk: A Systematic Review.
Get PDFCardiometabolic complications related to type 2 diabetes mellitus (T2DM) are often due to changes in the gut microbiota. The review analyzed studies looking at the effects of probiotics, prebiotics, high-fiber diets, and fecal microbiota transplantation (FMT) on glucose levels and heart and metabolic health in individuals either having T2DM or being at risk. The review followed the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. The literature was searched using text terms and controlled vocabulary, employing Boolean operators "AND," "OR," and various combinations across PubMed, Embase, and the Cochrane Library. Open-access, full-text English papers from 2005 to 2025, including those authored by people, were searched. The quality was assessed using the Risk of Bias 2.0 (RoB 2.0) tool, and the evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Fifteen randomized controlled trials (RCTs) were analyzed for methodological quality, with three categorized as having a high risk of bias (RoB). The GRADE tool categorized two high RoB RCTs as "low quality." However, two RCTs had low RoB and were classified as "high quality." Ten RCTs had uncertain RoB, lowering the evidence by one point to "moderate quality." A comprehensive review of RCTs was conducted to assess outcomes related to glycemic parameters (e.g., glycated hemoglobin (HbA1c), fasting glucose), lipid profiles, inflammatory markers, anthropometric measures, and gut microbiota composition. Interventions included probiotic and prebiotic supplementation, high-fiber or Mediterranean-style diets, and FMT. Probiotic yogurt containing Lactobacillus acidophilus and Bifidobacterium lactis significantly improved lipid profiles by reducing low-density lipoprotein cholesterol (LDL-C) and total cholesterol. High-fiber diets consistently lowered fasting blood glucose, HbA1c, triglycerides, and LDL-C while elevating high-density lipoprotein cholesterol (HDL-C) and beneficial short-chain fatty acid (SCFA)-producing bacteria. Anti-inflammatory effects were observed across interventions, notably with probiotics and polyphenol-rich Mediterranean diets, which reduced tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and other inflammatory cytokines. The Green-Mediterranean diet significantly improved weight, insulin resistance, and Framingham risk scores. Novel mechanisms involving SCFAs and bile acid metabolism were also identified as key modulators of host metabolic response. Microbiota-based interventions offer promising avenues for glycemic control and cardiometabolic risk reduction in patients with T2DM
MicroRNA-Based Markers of Oral Tongue Squamous Cell Carcinoma and Buccal Squamous Cell Carcinoma
No full textBackground Oral cancers, including oral tongue squamous cell carcinoma (OTSCC) and buccal squamous cell carcinoma (BSCC), are known to be widespread and can progress aggressively within the oral cavity. Objective The primary aim of this study is to identify microRNA (miRNA)-based markers for OTSCC and BSCC. Materials and methods This observational study was conducted at Northampton General Hospital from January 2024 to December 2024. A total of 150 patients were recruited, and clinical and demographic data were collected, including age, gender, smoking and alcohol consumption history, tumor stage, and grade. Patients were randomly assigned to either the OTSCC or BSCC group using a computer-generated random sequence. Tumor tissue samples from both groups were obtained through biopsy or surgical resection for miRNA analysis. Results Data were collected from 150 patients, with a mean age of 55.4 years, slightly higher in the BSCC group. Males comprised 60% of the cohort, and smoking history was more prevalent in BSCC (73.3%) than in OTSCC (66.7%). Advanced tumor stages (III-IV) were predominant in both groups (61.3% overall), while comorbidities and a family history of cancer were observed in 36.7% and 22.0% of patients, respectively. MiR-21 demonstrated high diagnostic accuracy (area under the curve >0.90) and was independently associated with poor survival outcomes in both cancer types (p < 0.001). Functional analyses linked these miRNAs to key oncogenic pathways, including cell proliferation and metastasis. Conclusions miRNA-based markers, particularly miR-21, show significant potential for enhancing the diagnosis and prognosis of OTSCC and BSCC. Further studies are required to validate these findings and investigate their therapeutic applications.https://www.cureus.com/articles/337402-microrna-based-markers-of-oral-tongue-squamous-cell-carcinoma-and-buccal-squamous-cell-carcinoma#!