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We aimed to evaluate the satisfaction of the students of medicine of a session of simulation by role-play having as theme "patient centered approach". We used a self-administered satisfaction questionnaire. Among 221 students, 94.1% qualified the quality of the session as satisfactory: the time allocated to the session (87.8%), the trainers (84.7%), the group size (89.6%) and the general atmosphere (88.2%). They declared that this session helped them to make connections with their previous knowledge (81.5%) and that it completed the practice in internship (83.2%). Our results showed the interest of integrating role-play into the medical education, at least at the end of the first cycle of medical studies. However, improvements of the educational system can be considered. [ABSTRACT FROM AUTHOR]

Background/Objectives: Managing type 2 diabetes mellitus (T2DM) and obesity requires a multidimensional, patient-centered approach including nutritional interventions (NIs) and physical activity. Changes in the gut microbiota (GM) have been linked to obesity and the metabolic alterations typical of T2DM and obesity, and they are strongly influenced by diet. However, few studies have evaluated the effects on the GM of a very-low-calorie ketogenic diet (VLCKD) in patients with T2DM, especially in the mid-term and long-term. This longitudinal study is aimed at evaluating the mid-term and long-term impact of the VLCKD and Mediterranean diet (MD) on the GM and on the anthropometric, metabolic, and lifestyle parameters of 11 patients with T2DM and obesity (diabesity). This study extends previously published results evaluating the short-term (three months) impact of these NIs on the same patients. Methods: At baseline, patients were randomly assigned to either a VLCKD (KETO group) or a Mediterranean diet (MEDI group). After two months, the KETO group gradually shifted to a Mediterranean diet (VLCKD-MD), according to current VLCKD guidelines. From the fourth month until the end of the study both groups followed a similar MD. Previous published results showed that VLCKD had a more beneficial impact than MD on several variables for 3 months of NI. In this study, the analyses were extended until six (T6) and twelve months (T12) of NI by comparing data prospectively and against baseline (T0). The GM analysis was performed through next-generation sequencing. Results: Improvements in anthropometric and metabolic parameters were more pronounced in the KETO group at T6, particularly for body mass index (−5.8 vs. −1.7 kg/m2; p = 0.006) and waist circumference (−15.9 vs. −5.2 cm; p = 0.011). At T6, a significant improvement in HbA1c (6.7% vs. 5.5% p = 0.02) and triglyceride (158 vs. 95 mg/dL p = 0.04) values compared to T0 was observed only in the KETO group, which maintained the results achieved at T3. The VLCKD-MD had a more beneficial impact than the MD on the GM phenotype. A substantial positive modulatory effect was observed especially up to the sixth month of the NI in KETO due to the progressive increase in bacterial markers of human health. After the sixth month, most markers of human health decreased, though they were still increased compared with baseline. Among them, the Verrucomicrobiota phylum was identified as the main biomarker in the KETO group, together with its members Verrucomicrobiae, Akkermansiaceae, Verrucomicrobiales, and Akkermansia at T6 compared with baseline. Conclusions: Both dietary approaches ameliorated health status, but VLCKD, in support of the MD, has shown greater improvements on anthropometric and metabolic parameters, as well as on GM profile, especially up to T6 of NI. [ABSTRACT FROM AUTHOR]

Patient-centered medicine is a relatively new model for planning, implementing, and evaluating healthcare services. It is based on mutually beneficial partnerships between healthcare providers, patients, and their families. However, the existing models of patient-centered healthcare have a number of disadvantages. The article introduces patient-centered healthcare as part of corporate culture adopted by various medical organizations. The authors developed a component model for the empirical study of patient-centered healthcare in terms of corporate culture. It involved five components, i.e., corporate culture, attitude to patient, attitude to work / professional image, adherence to ethical principles, and motivation. The model was tested using assessment methods developed by the authors, as well as using the Questionnaire of Professional Motivation by K. Zamfir as modified by A. A. Rean and the Mouton-Blake Corporate Culture Test. The sample involved 267 medical employees of urban medical organizations, Primorye Region. The respondents demonstrated a general understanding of patient-centered approach, which they interpreted as communication skills with patients. The dominant culture was that of task, which allowed medical staff to achieve their goals through collective decisions and mutual assistance. However, this mutual assistance was mandated to them due to the lack of personnel. The model demonstrated a good potential for yielding psychological and organizational technologies for training, support, and correction of patient-centered issues in medical organizations.

The way we engage with each other in science matters. While some ways of engaging may facilitate interactions, others may hinder them. Trust has been identified as one of the central factors facilitating collaborations between scientific communities and lay communities, and respect has been pointed to as having a central role to play in building and maintaining this trust. But what should respecting others in the interactions between scientific and lay communities involve? What does cultivating respect involve in this context? This paper aims at addressing these questions. In particular, it focuses on the role and nature of respect in the interactions between healthcare providers and patients in order to develop an analysis of the different types of respect and their relative importance in collaborations between scientists and lay publics. Overall, we will argue that understanding the complexity of respect dynamics may help to act appropriately in scientific experts-lay people interactions. [ABSTRACT FROM AUTHOR]

Objective: This retrospective study aimed to address acceptance and long-term adherence to Continuous Positive Airway Pressure (CPAP) treatment among non-responder patients to ImThera THN system who initially declined this therapy. Material and methods: We employed a structured outpatient approach to communicate THN study results, categorize initial CPAP nonadherence reasons, and encourage CPAP trials through tailored appointments. Recorded follow-ups addressed individual concerns, providing medical guidance and acknowledging person-specific challenges. Adherence data were collected using CPAP hour meters at predetermined intervals, following Belgium's social security stipulations. Results: Between July 2014 and October 2016, eleven participants, including one woman, with prior CPAP experience (average 2months) were enrolled. Initial non-adherence was linked to ENT or psychological factors. Ten patients agreed to CPAP trials, where interventions included changing CPAP brand, pressure adjustments, mask changes, and additional measures like cognitive-behavioral therapy and nasal spray. After 1 year, mean adherence was 6.3 ± 2 h/day, and average CPAP usage duration was 8.67 ± 2.13 years. As of November 2023, eight out of eleven patients were still actively using CPAP. Conclusion: In this investigation, we challenged the concept of CPAP non-adherence, highlighting evolving adherence and the significance of continuous monitoring and personalized interventions. Our findings underscore ongoing patient education, multidisciplinary support, and dynamic intervention adaptation for enhanced adherence in challenging patient populations. The results provide insights applicable to non-adherent patients with obstructive sleep apnea, emphasizing the importance of individualized care and sustained engagement for improved CPAP acceptance. [ABSTRACT FROM AUTHOR]

Benign Prostate Hyperplasia (BPH) significantly impacts men's health and quality of life, with its prevalence rising with age. This review critically examines the cost-effectiveness of pharmacological interventions for BPH to optimize patient outcomes and healthcare resource utilization. This review explores the integration of cost-effectiveness analysis (CEA) into clinical practice, balancing clinical efficacy with economic efficiency in BPH management. We performed a critical literature search, including recent studies on the economic evaluation of BPH treatments, focusing on pharmacotherapies such as alpha-blockers and 5-alpha reductase inhibitors. Additionally, we discussed the concept of CEA and evaluated the role of medicinal reconciliation and the avoidance of polypharmacy in favor of optimal BPH treatment. Cost-effectiveness analysis is crucial for evaluating BPH treatments, with evidence suggesting a shift towards surgical interventions may offer greater long-term economic benefits. However, these models must be applied cautiously, considering clinical evidence and patient preferences to ensure equitable and patient-centric healthcare. [ABSTRACT FROM AUTHOR]

The clinical interview represents a valuable opportunity to enhance the therapeutic alliance and lay the foundation for a successful therapeutic intervention. The article by Singh Ospina et al., published in the Journal of General Internal Medicine in 2019, and the consequent debate, provides an opportunity to reflect on physical therapist-patient interaction during clinical encounters. Despite referring to a clinical setting other than physiotherapy, the study highlights the challenges associated with rigorous time planning for the practitioner but also allows for some valuable recommendations that can foster more effective communication and promote a patient-centered approach. [ABSTRACT FROM AUTHOR]

Purpose of Review: Cancer clinical trials remain highly underrepresented from racial and ethnic minorities. The lack of diversity in clinical trials significantly impacts the generalizability of drug treatments approved for cancer patients. This review intends to discuss recent shifts in cancer clinical trials to increase equitable participation across all patient populations. Recent Findings: Current trends highlight innovative ways to build accessible clinical trials with diverse patient populations in mind. Patient-driven technology in the form of digital health platforms was created to address the gap in financial and non-financial barriers to clinical trial participation. Summary: Recent research sheds light on ways to make clinical trials more accessible to patients. This review will showcase how clinical trial site leaders, coordinators, and sponsors can meet the needs of patients to ensure they can participate in future clinical trials by engaging with community leaders and patient organizations. [ABSTRACT FROM AUTHOR]

Managing the patient's blood and hematopoietic system is like managing any of the other organs and organ systems during patient care. Specialists control the heart, kidneys, endocrine system, etc. and the patient's blood requires similar clinical treatment. The hematopoietic system and its circulatory products are fundamental for the healthy functioning of the human body. In simple terms, Patient Blood Management (PBM) is an organized, patient-centered approach in which the entire healthcare team coordinates efforts to improve outcomes by managing and preserving the patient's own blood. By reducing dependence on blood transfusions, PBM seeks to improve clinical outcomes, reduce the risks and costs associated with transfusions, and improve the safety and quality of patient care. Essentially, the concept of PBM is about the holistic management and preservation of the patient's own blood in the medical and surgical context.

The management of major bleeding is a critical aspect of modern healthcare and it is imperative to emphasize the importance of applying Patient Blood Management (PBM) principles. Although transfusion support remains a vital component of bleeding control, treating severe bleeding goes beyond simply replacing lost blood. A more comprehensive, multidisciplinary approach is essential to optimize patient outcomes and minimize the risks associated with excessive transfusions.

Aims: This review examines the Current State of the Integrated Healthcare approach and assesses the impact of integrated care models on patient health outcomes. Methodology: A systematic review using PubMed database and Google Scholar database. Using period 2019-2023 and keywords Clinical Medicine AND Diagnosis AND Treatment AND Integrated Approach and "integrated care" AND "diagnosis and treatment" AND "clinical medicine" AND "multidisciplinary care" were employed to identify relevant studies from PubMed and Google Scholar. Finally, 18 articles were sampled. Results: The systematic literature review on integrated diagnosis and therapy in clinical medicine shows many study designs and sample sizes. RCTs, the gold standard, are included in the review, along with Prospective Cohort Studies, Retrospective Studies, Cross-Sectional Studies, and Post-hoc Analyses. Some studies have large populations and rich datasets, whereas others have smaller samples. These studies provide varied approaches and timeframes for applying the integrated approach in clinical practice and discuss integrated healthcare approaches that use multidisciplinary teams, innovative technologies, and targeted interventions to treat chronic disorders and multi-morbidities. Integrated healthcare enhances patient outcomes, adherence to recommendations, and quality of life, emphasizing the need for tailored care in modern medicine. Scientific Novelty: Exploring a complex, integrated clinical medicine diagnosis and treatment approach to find patient care solutions. Conclusion: Clinical medicine's integrated diagnosis and treatment strategy is dynamic and promising. It can improve patient care, lower healthcare costs, and improve the quality of life for people with diverse health issues. [ABSTRACT FROM AUTHOR]

Background: The patient-centered approach is essential for quality health care and patient safety. Understanding the service user's perspective on the factors maintaining the health problem is crucial for successful treatment, especially for patients who do not recognize their condition as clinically relevant or concerning. Despite the association between intensive use of visual social media and body dissatisfaction and eating disorders, little is known about the meanings users assign to posting or searching for edited photos and the strategies they use to protect themselves from digital risks. Objective: This study aims to examine how young women recovering from eating disorders in Northern Italy perceive the health risks and potential benefits associated with visual social networks (ie, Instagram and Snapchat). The literature has found these platforms to be detrimental to online body comparisons. It also explores the perceived usefulness, willingness, and personal interest in coconstructing social media literacy programs with girls recovering from eating disorders. Methods: A total of 30 semistructured interviews were conducted with adolescent girls aged 14-17 years at the end of their treatment for eating disorders. The following areas of research were addressed: (1) the meanings associated with the use of Instagram and Snapchat; (2) the investment in the photographic dimension and feedback; (3) the impact of visual social networks on body experiences; (4) the potential and risks perceived in their use; (5) the importance of supporting girls undergoing treatment for eating disorders in using social networks; and (6) the usefulness and willingness to co-design social network literacy programs. Content analysis was applied. Results: A total of 7 main contents emerged: active or passive role in using social networks, the impact of online interactions on body image, investment in the photographic dimension, effects on self-representation, perceived risks, self-protective strategies, and potential benefits. The findings highlight a strong awareness of the processes that trigger body comparisons in the virtual context, creating insecurity and worsening the relationship with oneself. The self-protective behaviors identified are the development of critical thinking, the avoidance of sensitive content, increased control over social networking site use, and a certain skepticism toward developing antagonistic ideologies. All these topics were considered fundamental. Conclusions: The findings provide important insights for health professionals working with youth in preparing media literacy programs. These programs aim to reduce potential risks and amplify the positive effects of online resources. They underscore the importance of addressing this issue during hospitalization to develop skills and critical thinking aimed at changing small habits that perpetuate the problem in everyday life. The inherent limitations in current service practices, which may not adequately address individual needs or impact posttreatment life, must also be considered. [ABSTRACT FROM AUTHOR]

3D printers can produce specific medical objects that are tailored to the individual patient's needs, and if they are combined with a personalized orthopedic rehabilitation, it can result in improved functional outcomes. We present a 26-year-old male war victim with multiple injuries in his lower and upper limbs. The use of standard crutches was impossible, so we developed a customized 3D-printed crutch with a relative low cost. The gait and balance scores—as a part of the Tinetti score—improved immediately, and the patient's QUEST 2.0 questionnaire was high after 4 weeks of the crutches use, indicating high patient's satisfaction.

The growing spread of infections caused by multidrug-resistant pathogens makes the need of tailoring antimicrobial therapies by means of a 'patient-centered' approach fundamental. In this scenario, therapeutic drug monitoring (TDM) of emerging antimicrobial candidates may be a valuable approach, but expert interpretation of TDM results should be granted for making them more clinically useful. The MD Clinical Pharmacologist may take over this task since this specialist may couple PK/PD expertise on drugs with a medical background and may provide expert interpretation of TDM results of antimicrobials for tailoring therapy on real-time in each single patient based on specific both drug/pathogen issues and patient issues. This article aims to highlight the main key-points and organizational aspects for implementing a successful TDM-based expert clinical pharmacological advice (ECPA) program for tailoring antimicrobial therapies on real-time in different hospitalized patient special populations. TDM-based ECPA programs lead by the MD Clinical Pharmacologist may represent a way forward for maximizing clinical efficacy and for minimizing the risk of resistance developments and/or toxicity of antimicrobials. Stakeholders should be aware of the fact that this innovative approach may be cost-effective. [ABSTRACT FROM AUTHOR]

Featured Application: The application of this work relates to the use of 3D printing and artificial intelligence as systems to support the personalisation of medical devices, in particular powered upper limb exoskeletons and passive orthoses. The human hand is the most precise and versatile tool that nature has given man, and any deficits in this area affect the functional capabilities and quality of human life. Scientists, engineers and clinicians are constantly looking for solutions in the field of diagnosis, treatment, rehabilitation and care of patients with hand function deficits. One such solution is a hand exoskeleton. In the process of designing and testing the hand exoskeleton, emphasis should be placed on the full usability and comfort of the system; hence, the issues of personalization, matching and testing are crucial for the development of the discussed group of solutions. The aim of this paper is to present the possibilities of personalizing 3D-printed medical devicesbased on our own experience in functional user assessment andthe material selection, design, optimization using artificial intelligence and production and testing of several generations of different upper limb exoskeletons, incorporatingthe considerations of the Medical Device Regulation (MDR), ISO 13485 and ISO 10993 standards.The novelty and possible contribution of the proposed approach consist of the possibilities and limitations of the personalization of the upper limb exoskeleton discussed in the article as well as the directions of further development of significant scientific, technical and clinical importance. [ABSTRACT FROM AUTHOR]

Currently, taking into account the pronounced competition among modern medical organizations, attracting patients and forming a high degree of their loyalty requires significant efforts both in the field of ensuring the quality of medical services provided, and in the field of full implementation of legally enshrined patient rights, compliance with ethical and deontological norms, the formation of effective communication and integration processes between employees of a medical organization and patients and/ or their relatives, and in the context of the activities of a private medical organization, special work is also largely required to optimize the main business processes. All the activities described above are united by the concept of «patient-centered approach».Purpose of the study. To increase the degree of satisfaction of patients with the organization of medical care through the introduction of a patient-centered approach.Materials and methods. This study was undertaken using methods of analysis and synthesis, experiment and sociological measurements (questionnaires, qualitative interviews of 64 patients and 10 employees), included the study and generalization of specialized research and practical experience, work with local regulatory documents.Results. Сomprehensive work on the introduction of patient-centered principles into the activities of a medical organization had a positive impact on both the degree of patient satisfaction with the organization of medical services provided and on the assessment of modified working conditions by employees of a medical organization.Conclusion. Сonstructive optimization of the activities of a medical organization through the introduction of patient-centered principles should be carried out using an integrated approach based on international experience using project management, risk management and patient-orientation methodologies. To determine the main areas of activity and monitor the effectiveness of implemented measures, the most appropriate, relevant tools are internal audit and conducting a patient survey.

Patient education is an integral part of physiotherapy practice. The use of patient education and the adoption of a patient-centered approach to education has not been examined in a European setting. To explore the frequency and perceived importance of patient education practices of physiotherapists in Iceland. A convergent mixed methods study design was utilized. A cross-sectional, web-based survey was completed by 216 physiotherapists (35.1% response rate). Transformed qualitative data played a secondary role to quantitative results measuring frequencies of use and perceived importance of a spectrum of patient education practices. Providing exercise and diagnostic information had the highest rated frequency and importance. Advising on social support and having the patient explain why their home exercises were important were rated lowest. A large difference was reported between frequency and importance when collaborating with patients on goal-setting. Therapists reported delivering education through discussions and physical demonstrations, while relying on visual cues and return demonstrations to evaluate education effectiveness. Patient-specific education, including preferred learning style, was not always considered. The highest-rated barriers to patient education were patient characteristics that were psychosocial in nature. Results regarding readiness for education indicated needs to assess patient motivation while managing external barriers. The results indicate that physiotherapists engage in a wide variety of patient education activities that they consider important. Barriers to patient education identified by therapists may be managed by further skill development in a collaborative patient-centered approach to patient education. [ABSTRACT FROM AUTHOR]

Background: Promptly identifying individuals with addictive disorders reduces mortality and morbidity and improves quality of life. Although screening in primary care with the Screening, Brief Intervention and Referral Treatment strategy has been recommended since 2008, it remains underutilized. This may be due to barriers including lack of time, patient reluctance or perhaps the timing and approach for discussing addiction with their patients. Objective: This study aims to explore and cross-analyze patient and addiction specialist experiences and opinions about early addictive disorder screening in primary care to identify interaction-related screening obstacles. Design and participants: Qualitative study with purposive maximum variation sampling among nine addiction specialists and eight individuals with addiction disorders conducted between April 2017 and November 2019 in Val-de-Loire, France. Main Measures: Using a grounded theory approach, verbatim data was collected from face-to-face interviews with addiction specialists and individuals with addiction disorders. These interviews explored their opinions and experiences with addiction screening in primary care. Initially, two independent investigators analyzed the coded verbatim according to the data triangulation principle. Secondly, convergences and divergences between addiction specialist and addict verbatim categories were identified, analyzed, and conceptualized. Key Results: Four main interaction-related obstacles to early addictive disorder screening in primary care were identified and conceptualized: the new concepts of shared self-censorship and the patient's personal red line, issues not addressed during consultations, and opposition between how physicians and patients would like to approach addictive disorder screening. Conclusions: To continue analysis of addictive disorder screening dynamics, further studies to examine the perspectives of all those involved in primary care are required. The information revealed from these studies will provide ideas to help patients and caregivers start discussing addiction and to help implement a collaborative team-based care approach. Trial registration: This study is registered with the Commission Nationale de l'Informatique et des Libertés (CNIL) under No. 2017–093. [ABSTRACT FROM AUTHOR]

Modifications to the Healthcare Providers Patient-Activation Scale (HP-PAS), which evaluates attitudes toward the importance of using a patient-centered approach (PCA), are required. Content validity and reliabilities of a scale developed from the HP-PAS to evaluate self-reported adherence to patient-centered physical therapy were preliminarily investigated. A total of 86 Japanese physical therapists completed the validity assessments in an anonymous survey. Among them, 53 completed the reliability assessments in a named survey. The HP-PAS was modified to mark the most suitable frequency for each item, creating an 11-point scale. For the validity assessments, the participants assigned each item to a therapist-centered approach or PCA using a 5-point scale. Content validity was considered when the proportion of scores 4 and 5 ("possibly" or "definitely" a PCA) with respect to the total number of scores was > 50%. Ceiling and flooring effects were considered when the response proportions of scores of 10 and 0, respectively, on an 11-point scale were > 20%. Items with an intraclass correlation coefficient (ICC) < 0.4 in the test–retest reliability from the item list were excluded. Of the 20 items, 6 were excluded, developing a 14-item self-reported adherence to a patient-centered physical therapy scale (SAPCPTS), which exhibited good internal consistency (Cronbach's α = 0.95, 95% confident intervals [CIs] = 0.93–0.96) and test–retest reliability (ICC = 0.84, 95% CIs = 0.75–0.91). This study identified that the 14-item SAPCPTS demonstrated preliminary evidence of content validity and reliability. [ABSTRACT FROM AUTHOR]

Background: Among cardiovascular diseases, adult patients with congenital heart disease represent a population that has been continuously increasing, which is mainly due to improvement of the pathophysiological framing, including the development of surgical and reanimation techniques. However, approximately 20% of these patients will require surgery in adulthood and 40% of these cases will necessitate reintervention for residual defects or sequelae of childhood surgery. In this field, cardiac rehabilitation (CR) in the postsurgical phase has an important impact on the patient by improving psychophysical and clinical recovery in reducing fatigue and dyspnea to ultimately increase survival. In this context, compliance with the rehabilitation program is a key element for the therapeutic benefits of the program. The increase of mobile health care devices and software has greatly extended self-care capabilities across the spectrum of health care activities. Moreover, the possibility of telemonitoring the progress of this self-care provides elements of empowerment and awareness of one's state of health. As a branch of telehealth, CR can be optimized and facilitated using remote telemedicine devices., Objective: The principal goal of the Innovation in Postoperative Rehabilitation Training and Monitoring (IPOTERI) study is to design, realize, and test a composite and integrated system for postsurgical rehabilitation therapies at home specialized for cardiac surgery. The secondary aims are to implement the system in a "real-life" context of postcardiac surgical rehabilitation, and to create a data set and a data collection methodology to prototype data analytics algorithms and artificial intelligence techniques for customizing the rehabilitation pathway., Methods: The IPOTERI method consists of a telemonitoring platform that guarantees continuity of postoperative care, an intelligent home station based on an Android app for the patient with a user-friendly interface to record vital signals (electrocardiogram, blood pressure, oxygen saturation, and body weight) and access the planning of rehabilitation activities, and a decision support system that communicates with hospital medical records to transmit alerts and specific support information for the formulation and updating of the treatment and care plan., Results: The pilot test started in June 2023 (protocol number 20406/2021) including 50 patients who will be monitored for 12-14 weeks using the developed platform, as described in the Procedures subsection of the Methods section., Conclusions: The IPOTERI approach, based on the processing of data recorded during the monitoring of telemedicine devices used at home during the postsurgical rehabilitation of a cardiac patient, together with clinical data from the perioperative and postoperative periods could have positive effects on adherence to the rehabilitation program and clinical improvement as well as result in overall improvement of quality of life., International Registered Report Identifier (irrid): DERR1-10.2196/47951., (©Francesca Mastorci, Maria Francesca Lodovica Lazzeri, Lamia Ait-Ali, Paolo Marcheschi, Paola Quadrelli, Massimiliano Mariani, Rafik Margaryan, Wanda Pennè, Marco Savino, Giuseppe Prencipe, Alina Sirbu, Paolo Ferragina, Corrado Priami, Alessandro Tommasi, Cesare Zavattari, Pierluigi Festa, Stefano Dalmiani, Alessandro Pingitore. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 22.01.2025.)

Background: Ethical competencies dealing with decision-making for clinicians involved in artificially administered nutrition and hydration (AANH) have not been defined in the literature. Although clinical assessments identify nutrition needs and appropriate routes of nutrition administration, an assessment of the ethical, cultural, and spiritual implications of the medical nutrition therapy may be overlooked., Methods: Eleven competency statements were developed by members of two international sections of the American Society for Parenteral and Enteral Nutrition. This descriptive cross-sectional survey study was conducted to measure the importance of the competency statements to the membership of two sections using a five-point Likert scale of 1-5 (1-low to 5-high)., Results: A total of 113 responses (12.5% response rate) were obtained predominantly from physicians and dietitians from 25 countries. There was a wide range of world regions of the 49% respondents outside of the United States. Means and SDs were calculated for agreement with the 11 competency statements with overall means ranging from 4.32 to 4.67. Most of the participants cared for adult/older adult patients (63.7%) exclusively, and 12.4% cared for pediatric/neonate patients exclusively; the remainder (23.9%) cared for both populations. Respondents reported they were either experienced, competent, or expert (88.6%) in dealing with ethical issues related to AANH., Conclusion: This international interdisciplinary group agreed that the integration of ethical, cultural, and spiritual competencies into clinical decision-making regarding artificially AANH is important., (© 2024 American Society for Parenteral and Enteral Nutrition.)

Little is known about patients' postoperative emotional and social functioning and preferences for recovery settings. This qualitative study explores patients' perspectives on factors influencing postoperative recovery, including the proportion of time recovering at home (home time) and unmet information needs. Semistructured interviews were conducted between September and December 2020 with veteran patients aged 65 y or older who underwent surgery at a single hospital. A purposeful sampling strategy was used to identify patients with a broad representation of major operations and various amounts of home time. One-hour interviews were audio-recorded, transcribed verbatim, and anonymized for analysis. A rigorous team-based in-depth thematic analysis was performed. Validation techniques to enhance the quality and credibility of the study included triangulation, independent coding, and search for disconfirming evidence. Twelve patients were interviewed (11 [91.7%] males; mean (standard deviation) age, 72.3 [4.8] y). Five factors that influenced the recovery process emerged: (1) professional support services, (2) informal caregiver support, (3) environment for recovery, (4) individual traits, and (5) physical and functional impairments. The analysis also elucidated four unmet information needs regarding recovery: (1) personalized and detailed information, (2) anticipated recovery time, (3) possible complications, and (4) comprehensive information about discharge location options. The study demonstrated that patients recovering from surgery require wide-ranging levels of support to meet their unique needs and preferences. Patients value easy-to-understand and personalized information about recovery from providers. These findings may be helpful to develop strategies that better support patients in their postoperative recovery and post–acute care transition pathways. [ABSTRACT FROM AUTHOR]

Complex disorders usually affect multiple symptom domains measured by several outcomes. The importance of these outcomes is often different among patients. Current approaches integrate multiple outcomes without considering patient preferences at the individual level. In this article, we propose a new composite Desirability of Outcome Ranking (DOOR) that integrates individual level ranking of outcome importance and define a winning probability measuring the overall treatment effect. Stratified randomization can be performed based on the participants' baseline outcome rankings. A Wilcoxon-Mann-Whitney U-statistic is used to average the pairwise DOOR between one treated and one control patient, considering the difference in these patients' ranking of outcome importance. We use both theoretical and empirical methods to examine the statistical properties of our method and to compare with conventional approaches. We conclude that the proposed composite DOOR properly reflects patient-level preferences and can be used in pivotal trials or comparative effectiveness trials for a patient-centered evaluation of overall treatment benefits. [ABSTRACT FROM AUTHOR]

The human hand is the most precise and versatile tool that nature has given man, and any deficits in this area affect the functional capabilities and quality of human life. Scientists, engineers and clinicians are constantly looking for solutions in the field of diagnosis, treatment, rehabilitation and care of patients with hand function deficits. One such solution is a hand exoskeleton. In the process of designing and testing the hand exoskeleton, emphasis should be placed on the full usability and comfort of the system; hence, the issues of personalization, matching and testing are crucial for the development of the discussed group of solutions. The aim of this paper is to present the possibilities of personalizing 3D-printed medical devicesbased on our own experience in functional user assessment andthe material selection, design, optimization using artificial intelligence and production and testing of several generations of different upper limb exoskeletons, incorporatingthe considerations of the Medical Device Regulation (MDR), ISO 13485 and ISO 10993 standards.The novelty and possible contribution of the proposed approach consist of the possibilities and limitations of the personalization of the upper limb exoskeleton discussed in the article as well as the directions of further development of significant scientific, technical and clinical importance.

Efrat Neter,1 Lea Glass-Marmor,2 Loren Haiien,2 Ariel Miller2,3 1Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel; 2Multiple Sclerosis Center & Department of Neurology, Carmel Medical Center, Haifa, Israel; 3Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, IsraelCorrespondence: Efrat NeterDepartment of Behavioral Sciences, Ruppin Academic Center, 3 Bait, Emeq Hefer, 4025000, IsraelTel +972-54-6462677Fax +972-9-8983043Email neter@ruppin.ac.ilBackground: As the number of treatment options for multiple sclerosis (MS) has expanded, alignment between physician and patient on effects of medication has emerged as important for medication persistence/discontinuation.Objective: To evaluate physician–patient agreement levels on medication effect and health status.Methods: Persons with MS (PwMS) (n=71) participated in a cross-sectional study collecting their satisfaction (using the Treatment Satisfaction Questionnaire for Medication), intention to dis/continue treatment and global health perception; physicians assessed response to medication and global health status.Results: Concordance between PwMS’ assessment of medication effectiveness and physician’s assessment on response to medication, health status and EDSS were rs= 0.50, rs= 0.57 and rs= − 0.58, respectively.Conclusion: The significant concordance attests to physician–patient effective communication and may contribute to improved medication adherence.Keywords: concordance, disease-modifying therapy, patient-centered approach, multiple sclerosis, patient-reported outcomes, participatory medicine

Individuals with atherosclerotic cardiovascular disease (ASCVD) often have a high burden of comorbidities. Social determinants of health (SDOH) may complicate adherence to treatment in these patients. This study assessed the association of comorbidities and SDOH among individuals with ASCVD. Cross-sectional data from the 2016 to 2019 Behavioral Risk Factor Surveillance System, a nationally representative US telephone-based survey of adults ages ≥18 years, were used. Cardiovascular comorbidities included hypertension, hyperlipidemia, diabetes mellitus, current cigarette smoking, and chronic kidney disease. Non-cardiovascular comorbidities included chronic obstructive pulmonary disease, asthma, arthritis, cancer, and depression. SDOH associated with being at or above the 75th percentile of comorbidity burden were analyzed using multivariable adjusted logistic regression models. The study population included 387,044 individuals, 9% of whom had ASCVD. The mean (SD) numbers of total, cardiovascular, and non-cardiovascular comorbidities were 1.97 (1.27), 1.28 (0.74), 0.69 (0.91) among those without ASCVD and 3.28 (1.62), 1.73 (0.91), and 1.54 (1.22) among those with ASCVD, respectively (P < 0.001 for all comparisons). Female gender, household income ≤$75,000, being unemployed, and difficulty accessing health care were significantly associated with a higher burden of comorbidities among those with ASCVD. The mean (SD) numbers of comorbidities for those with 0, 1, 2, and ≥3 of the aforementioned SDOH were 2.89 (1.45), 2.86 (1.47), 3.39 (1.58), and 4.01 (1.73), respectively (P < 0.001). Among persons with ASCVD, the burden of cardiovascular and non-cardiovascular comorbidities is directly proportional to SDOH in any given individual. Clinicians should address SDOH when managing high-risk individuals. [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) remains the leading cause of disability worldwide. A better understanding of the beliefs regarding LBP and impact of LBP on the individual is important in order to improve outcomes. Although personal experiences of LBP have traditionally been explored through qualitative studies, social media allows access to data from a large, heterogonous, and geographically distributed population, which is not possible using traditional qualitative or quantitative methods. As data on social media sites are collected in an unsolicited manner, individuals are more likely to express their views and emotions freely and in an unconstrained manner as compared to traditional data collection methods. Thus, content analysis of social media provides a novel approach to understanding how problems such as LBP are perceived by those who experience it and its impact.Objective: The objective of this study was to identify contextual variables of the LBP experience from a first-person perspective to provide insights into individuals' beliefs and perceptions.Methods: We analyzed 896,867 cleaned tweets about LBP between January 1, 2014, and December 31, 2018. We tested and compared latent Dirichlet allocation (LDA), Dirichlet multinomial mixture (DMM), GPU-DMM, biterm topic model, and nonnegative matrix factorization for identifying topics associated with tweets. A coherence score was determined to identify the best model. Two domain experts independently performed qualitative content analysis of the topics with the strongest coherence score and grouped them into contextual categories. The experts met and reconciled any differences and developed the final labels.Results: LDA outperformed all other algorithms, resulting in the highest coherence score. The best model was LDA with 60 topics, with a coherence score of 0.562. The 60 topics were grouped into 19 contextual categories. "Emotion and beliefs" had the largest proportion of total tweets (157,563/896,867, 17.6%), followed by "physical activity" (124,251/896,867, 13.85%) and "daily life" (80,730/896,867, 9%), while "food and drink," "weather," and "not being understood" had the smallest proportions (11,551/896,867, 1.29%; 10,109/896,867, 1.13%; and 9180/896,867, 1.02%, respectively). Of the 11 topics within "emotion and beliefs," 113,562/157,563 (72%) had negative sentiment.Conclusions: The content analysis of tweets in the area of LBP identified common themes that are consistent with findings from conventional qualitative studies but provide a more granular view of individuals' perspectives related to LBP. This understanding has the potential to assist with developing more effective and personalized models of care to improve outcomes in those with LBP. [ABSTRACT FROM AUTHOR]

The objective of this research study was to investigate the effect of patient-centered robot-assisted intervention for upper limb function improvement in stroke patients. Design: A double-blind randomized controlled trial. Intervention: Subjectively preferred areas of need for performing daily activities were identified by pre-interviewing and applied as target goals in the experimental group using a robotic device. Control-1 underwent a program focused on the robot system involving movements of upper limb joints. Control-2 participated in a conventional rehabilitation program. Methods: Forty-five participants engaged in 60 min of daily therapy, five times weekly for 3 weeks. The experimental group used the Canadian occupational performance measure (COPM) to identify subjectively preferred "patient-centered" focus needed areas to perform robotic device aided daily activities. Control-1 used a robot device-focused rehabilitation involving upper limb joint movements. Control-2 participated in conventional rehabilitation. Pre-post intervention measurements of hand, grip, power, and upper limb ROM were acquired by FMA-UE, MFT, and K-MBI. Results: A significant increase of function in the experimental group was observed in each subclass of function and activities of daily living (ADL) performance. Control-1 showed an increase in function without ADL improvement. Control-2 showed an increase in ADL and proximal areas of upper limb function without an increase in other areas. Conclusion: The "patient-centered" approach significantly improved upper limb function and ADL performance compared to "robot-centered" rehabilitation. Further studies are warranted to confirm these results and for generalizability in clinical application. [ABSTRACT FROM AUTHOR]

Patient portals have helped accelerate patient engagement in treatment. Patient understanding of radiology reports has become a necessity, and we are working to design a patient-friendly radiology report that can be easily understood. We have based the design of this new radiology report on the results of a previous study that examined patient desires and needs by exploring their questions posted on online discussion forums. The current design was tested by presenting it in two groups, a control group, and an intervention group. In our evaluation, we relied on the following five concepts: understanding (quiz), cosmetics appearance, perceived ease of use, acceptance, and preference. The results showed that the new design outperformed the current design in all five concepts with an overall of (P <.00). Based on these results, we have determined that the radiology report should include both an image and notes section, and the design can be applied to all types of radiological examinations using various imaging devices. We believe this design will be an important building block in facilitating patient understanding of radiology reports. [ABSTRACT FROM AUTHOR]

The literature review confirms the benefits of applying the person-centered approach. This study explores how GPs involve their patients in decision-making and what is the relationship with individual and professional factors. The SDM-Q-Doc Bulgarian tool was applied to 319 randomly selected GPs. The results have shown that GPs in Bulgaria apply to a large extent the shared decision-making approach in their daily practice. The mean level of shared decision-making of GPs has been assessed as 82%. It has been found that women, as well as GPs with longer work experience, are more likely to discuss the follow-up therapy with their patients. Family doctors' satisfaction has been directly related to the degree of patient-centeredness. [ABSTRACT FROM AUTHOR]

Pediatric spine surgery is a high complexity procedure that can carry risks ranging from pain to neurological damage, and even death. This comprehensive mini review explores current best practice obtaining valid and meaningful informed consent (IC) prior to pediatric spinal surgery, including modalities that support effective comprehension and understanding. An evaluation of the literature was performed to explore understanding of surgical IC by patients or their guardians and the role of multimedia tools as a possible facilitator. The evidence discussed throughout this review, based on legal and ethical perspectives, reveals challenges faced by patients and guardians in achieving comprehension and understanding, especially when facing stressful medical situations. In this context, the introduction of multimedia tools emerges as a patient-centered strategy to help improve comprehension and decrease pre-operative uncertainty. This review highlights the need for a tailored approach in obtaining IC for pediatric patients and suggests a potential role of shared decision-making (SDM) in the surgical discussion process., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Rosa Filezio, Sharma, Thull-Freedman, Ferri-de-Barros and Santana.)

Introduction Transition is the process of preparing an adolescent or young adult for the adult model of care. Poor transitions have been linked to increased medical utilization and poorer kidney outcomes. There are limited studies evaluating predictors of transition readiness or interventions in pediatric patients with chronic kidney disease (CKD). Methods We enrolled 42 non-dialysis, non-transplant patients with CKD stage 2 or higher and 14 years and older receiving care in our pediatric nephrology clinic. Data collected included demographics, clinical information, and transition readiness as measured by the Transition Readiness Assessment Questionnaire (TRAQ). Patients were provided with a structured, remote curriculum with resources that addressed areas of need. Patients were followed every three to six months. Repeat TRAQ questionnaires were administered six months after enrollment. Results Our study found that younger age and male gender were risk factors for poor transition. Age was consistently a positive predictor of higher TRAQ scores in the medication, appointment, and total score domains (p < 0.05). Male gender was a risk factor for lower TRAQ scores in the appointment and communication domains (p < 0.05). Additionally, our curriculum was effective at improving scores across all TRAQ domains, with an average increase of about 25% in six months. There was no difference in patients who had a three-month follow-up as compared to a six-month follow-up (p > 0.05). Conclusion Our study finds that younger age and male gender are risk factors for poor transition. Additionally, a structured, remote curriculum is effective at improving transition readiness., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Colorado Multiple Institutional Review Board issued approval 21-4622. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Chan et al.)

Background: Good physician-patient communication is an important aspect of patient-centered care and contributes to positive health outcomes, however, there is a lack of standard European Union (EU) communication training policies for physicians. This study explores the barriers to good communication for both physicians and patients across four EU countries as part of the EU-funded project, Health Communication Training for Health Professionals – H-COM. Method: Focus groups were conducted with 31 patients and 38 physicians from Germany, Greece, Spain, and Cyprus. Two separate discussion guides were constructed for each target group around three themes: perceptions of, barriers to, and needs for health communication. Thematic analysis was used. Results: Commonalities and differences between countries and target groups were identified, with participants discussing attitudinal, emotional, educational, and systemic barriers to good communication. Participants indicated a significant gap in health communication knowledge, skills, and training for physicians, with regional differences. Conclusion: The results imply that there is a need for EU-wide communication training for physicians that would be best addressed by common themes and tailoring to specific regional differences. The results also imply that effective training should encompass a blend of theory and practical methods, and should be delivered via an e-learning platform for maximum accessibility. Training programs that adhere to these suggestions can begin to address the gaps in patient-centered care in the EU. [ABSTRACT FROM AUTHOR]

The Shared Decision Making Questionnaire (SDM-Q) is a self-reported questionnaire, one of the most frequently ap-plied instruments for assessing patients' involvement in decision-making process. The aim of current study was the translation and linguistic validation of the physician version of a shared decision making questionnaire SDM-Q-DOC in the Bulgarian language. The translation procedure of the tool was done according to the established rules. We recommend the wide use of SDM-Q-Doc-Bulgarian version in general practice, targeting the implementation of shared decision-making and related to that improvement in efficiency and quality of care in Bulgaria. [ABSTRACT FROM AUTHOR]

The patient-centered approach combines a quality care and structured education at the individual, professional and organizational levels, and helps patients with chronic illnesses to become an active part in clinician-patient consultation. In Bulgaria, the incidence of diabetes mellitus is increasing epidemically, with a tendency to reach 14% in 2025. The implementation of a patient-centered approach in daily practice will help to fully understand the individual living with chronic disease like type 2 diabetes mellitus (T2DM). The patient-centered model involves the integration of different specialists to join forces to improve the quality of care and quality of life of patients with diabetes mellitus. The aim of the study was to define the determinants of quality of life and individual characteristics in patients with T2DM, influencing the effective implementation of a patient-centered approach in outpatient practice. [ABSTRACT FROM AUTHOR]

Both research and care have focused on first episodes of psychosis (FEPs) as a way to address the issue of early stages of schizophrenia and to reduce the duration of untreated psychosis. The objective of this study was to explore specifically the lived experience of FEP from the point of view of patients and their families by applying a metasynthetic approach, including a systematic review of the literature and analyses of qualitative studies on the subject. This metasynthesis follows thematic synthesis procedures. Four databases were systematically searched for qualitative studies reporting FEP from the patient or family's perspective. Article quality was assessed with the Critical Appraisal Skills Program. Thematic analysis was used to identify key themes and synthesize them. Thirty-eight articles were included, covering data from 554 participants (378 patients and 176 relatives). Three themes emerged from the analyses: (1) When and how does a FEP start? (2) What are its negative and positive aspects? (3) How do patients and families recount FEPs? Our results found important discrepancies between the experiences of patients and those of their families, especially regarding positive aspects. In light of the confusion reported by patients and notable in our results, we also discuss the gap between the name, FEP, and the lived experience of patients and family members in order to explore its practical implications. [ABSTRACT FROM AUTHOR]

Abstract Background The research program CARPEM (cancer research and personalized medicine) brings together the expertise of researchers and hospital-based oncologists to develop translational research in the context of personalized or “precision” medicine for cancer. There is recognition that patient involvement can help to take into account their needs and priorities in the development of this emerging practice but there is currently no consensus about how this can be achieved. In this study, we developed an empirical ethical research action aiming to improve patient representatives’ involvement in the development of the translational research program together with health professionals. The aim is to promote common understanding and sharing of knowledge between all parties and to establish a long-term partnership integrating patient’s expectations. Methods Two distinct committees were settled in CARPEM: an “Expert Committee”, gathering healthcare and research professionals, and a “Patient Committee”, gathering patients and patient representatives. A multidisciplinary team trained in medical ethics research ensured communication between the two committees as well as analysis of discussions, minutes and outputs from all stakeholders. Results The results highlight the efficiency of the transfer of knowledge between interested parties. Patient representatives and professionals were able to identify new ethical challenges and co-elaborate new procedures to gather information and consent forms for adapting to practices and recommendations developed during the process. Moreover, included patient representatives became full partners and participated in the transfer of knowledge to the public via conferences and publications. Conclusions Empirical ethical research based on a patient-centered approach could help in establishing a fair model for coordination and support actions during cancer research, striking a balance between the regulatory framework, researcher needs and patient expectations. Our approach addresses the concept of translational ethics as a way to handle the main remaining gap between combining care and research activities in the medical pathway and the existing framework.

Background: According to the latest Guidelines from the World Health Organization, there is an increasing need for patient-centered tuberculosis disease management given the socio-economic factors influencing the tuberculosis epidemic. In the present study, we aimed to study TB in Barcelona city from an anthropological point of view and to devise a series of specific proposals to implement a patient-centered approach in our setting.Methods: We carried out a qualitative study using an anthropological approach in Barcelona in the period between November 2017 and November 2018 and proposed specific interventions based on our observations.Results: In practice, in our environment (a low-incidence European country where tuberculosis tends to present in patients with multiple social problems), and despite the goodwill of the care teams, there are no established and stable circuits, or specific tools to ensure that this is done routinely. Based on our observations, we have devised a series of specific proposals to implement a patient-centered approach. With these interventions we aim to (a) directly ameliorate TB patients well-being in any diagnostic/healthcare management center and (b) at more general level, to increase TB detection and treatment adherence.Conclusions: The patient-centered TB management recommended by the WHO might be essential for patients' well-being, but there is a lack of circuits or working protocols that ensure its implementation in a regulated manner. In the present manuscript we explain the various concrete measures that we propose in our region and which could be put into practice in other cities or geographic regions with similar epidemiological characteristics.

Background: The enhanced recovery after surgery (ERAS®) is a multimodal perioperative care pathway designed to reduce surgical stress and ultimately improve patient recovery and outcome. It can require significant resources but with proven benefits. The main goal of this study was to perform a diagnostic assessment of perioperative practice in a local colorectal surgical center., Methods: 93 patients who underwent elective colorectal surgery from January to December 2022 were analyzed. Preadmission, preoperative, and postoperative data of all patients were collected in a database developed by the researchers, according to ERAS® guidelines. Descriptive statistics were employed to summarize demographic and clinical characteristics. Chi-square and T-test were performed to identify possible associations between categorical variables and postoperative complications., Results: Overall analysis showed deficient preoperative patient optimization, especially regarding nutritional counseling and supplementation, smoking and alcohol cessation, anemia treatment (9%), and pre-anesthetic medication (42%). Removal of invasive devices was significantly delayed (removal of urinary catheter average on the fourthday and surgical drain average on the fifth day) in the postoperatively period and oral intake (average onset on the sixth day). Both contribute to hospital length of stay (mean of 13 days) and a significant number of complications., Conclusion: The results lead us to an individual and multidisciplinary reflection on current practices and outcomes. ERAS® program, already adopted by many centers, could have a positive impact on the immediate postoperative recovery of colorectal patients in Funchal Central Hospital and implementation seems necessary., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Rodrigues et al.)

Background: The low participation rate in cardiac rehabilitation programs is the major reason for rehospitalization, morbidity, and mortality. Home-based cardiac rehabilitation by technological means is an essential component of a "patient-centered" approach, which is capable of enhancing the participation rate in rehabilitation programs. Introduction: The aim of this research was to examine attitudes, perceptions, and behavioral intentions toward remote digital cardiac rehabilitation (RDCR) with respect to factors such as age, education, smoking, exercise habits, technological illiteracy, and mobile phone behavior. Materials and Methods: This was a cross-sectional study of 200 adult patients discharged from a hospital after an acute coronary syndrome, cardiac surgery, or percutaneous coronary intervention. All patients answered an anonymous Technology Usage Questionnaire, which examined the relationship between their willingness to participate in the RDCR program and various parameters. The surveys were distributed and completed between July 2017 and November 2017 at the Sheba Medical Center in Israel. Results: Overall, 83% of all participants were interested in participating in the RDCR program. Those with heart failure had a greater interest in the program (100%; p < 0.05), whereas patients after coronary bypass surgery had a lesser interest (71.1%; p < 0.05). The level of attitude toward healthy lifestyle was found to be a significant predictor of willingness to participate in RDCR (odds ratio 2.26; p = 0.01). Sociodemographic characteristics, lifestyle, habits, technological knowledge, age, and gender were not found as significant predictors of interest in RDCR. Conclusions: The RDCR program was acceptable to most cardiac patients, including the elderly population, and could be a potential solution for patients who avoid traditional rehabilitation programs in medical centers. [ABSTRACT FROM AUTHOR]

As a result of the ongoing 2019 coronavirus disease (COVID-19) pandemic, the medical and dental services across the world have to tackle unprecedented situations, providing essential care and professional support. The global health care crisis caused directly by the vast number of severe COVID-19 cases, and indirectly by reduced access to health care, as well as by limited secondary care provision, had a major impact on specialist services, and subsequently the deterioration of medical and dental conditions, particularly in vulnerable persons. In particular, at present, special care dentistry seems to play a unique role, dealing with a wide range of patients with underlying medical conditions and co-morbidities, phobic individuals, and persons with learning/physical disabilities. The effective adaptation of health services to the current new reality, based on an empathetic approach and recent guidelines, would allow us to maintain an adequate care provision, minimizing the long-term impact of the pandemic.