PURPOSE:To design and implement a structured international quality improvement initiative addressing two critical areas: post-fracture osteoporosis treatment and fall prevention programs. METHODS:We developed a quality improvement initiative using the Plan-Do-Check-Act (PDCA) model across six European orthogeriatric units. After identifying common gaps, the intervention focused on three pillars: (1) education and training of multidisciplinary teams; (2) patient and caregiver engagement through flyers, posters, and videos; and (3) protocol standardization, through the development of Standard Operating Procedures and referral to fall-prevention clinics. Each orthogeriatric team selected a priority area based on local needs. We then collected process and outcome metrics and assessed them within each country's healthcare context. RESULTS:The project led to a set of educational materials and clinical protocols, enhancing training, empowering patients and professionals, and improving service quality. Trained healthcare workers were satisfied with the program, and most of the patients declared themselves to be more informed than before. The development and introduction of an osteoporosis algorithm increased treatment rates significantly in Portugal and Finland. Bone-health and fall-prevention clinics were launched within the geriatric medicine department in Malta and Italy, respectively. CONCLUSION:This low-cost, scalable initiative shows early promise for adaptation across diverse European healthcare systems. The initiative aims to expand to additional orthogeriatric units and to launch a suite of standardized orthogeriatric tools and protocols that could support wider implementation.
Background/objectiveGrowing evidence emerges that Toxoplasma gondii (T. gondii) is associated with mental disorders like anxiety disorders or attention-deficit/hyperactivity disorder (ADHD). In ADHD patients around 25% suffer from comorbid anxiety disorders. As the impact of a latent T. gondii infection on anxiety in adult ADHD remains unknown, this study aims to investigate this relationship.MethodsIn a case-control study, including 140 participants, venous blood samples were taken of 70 adult ADHD patients and 70 controls for serological analysis of markers of infection and inflammation (leukocytes, C-reactive protein, anti-T. gondii immunoglobulin M (IgM) and anti-T. gondii immunoglobulin G (IgG) (seropositivity), IgG titers (serointensity) as well as anti-T. gondii IgG avidity. The influences on state and trait anxiety were explored using the State-Trait-Anxiety Inventory (STAI).ResultsSeropositivity was significantly associated with the leukocyte count in all participants (n = 140, p = 0.004). Moreover, regression analysis revealed a significant association of seropositivity and serointensity with trait anxiety but not with state anxiety: trait anxiety was significantly lower in seropositive ADHD patients compared to seronegative subjects with ADHD (n = 70, p=0.029). In addition, trait anxiety scores decreased in an IgG-dependent manner in all participants (n = 140, p = 0.028) as well as in the ADHD group (n = 70, p = 0.015). Comorbid anxiety disorders in ADHD were not associated with latent T. gondii infection.ConclusionOur data is the first revealing an association between T. gondii and trait anxiety in a serointensity-dependent manner in individuals with ADHD. Further research is needed to clarify the clinical impact of the observed lower trait anxiety in individuals with ADHD and latent T. gondii infection.
BACKGROUND:Obstructive hypertrophic cardiomyopathy (oHCM) is characterized by left ventricular (LV) outflow tract obstruction, which increases afterload and chronically activates the Anrep response, a compensatory (afterload-driven) state of hyperdynamic systole, prolonged systolic ejection time, and increased myocardial workload. We investigated whether the myosin inhibitor mavacamten reverses this state, comparing its effects to the anatomic relief achieved by alcohol septal ablation. METHODS:Thirty-six patients with symptomatic oHCM were treated with mavacamten. Of these, 29 who achieved a resting LV outflow tract gradient <50 mm Hg at 3 months (responders) underwent echocardiography-derived pressure-volume analysis before and after therapy. For comparison, a separate cohort of 13 patients with oHCM underwent identical pressure-volume analysis before and 3 months post-alcohol septal ablation. Anrep-related indices were quantified: afterload (LV end-systolic pressure [LVESP] and effective arterial elastance [Ea]), contractility (end-systolic elastance [Ees] and end-systolic volume at 150 mm Hg [ESV150]), and systolic ejection time. Myocardial workload (stroke work, potential energy, and pressure-volume area) and diastolic function (LV end-diastolic pressure [LVEDP], end-diastolic volume [EDV], and volume at an LVEDP of 15 mm Hg [V15]) were also assessed. RESULTS:At baseline, all patients showed chronic activation of the Anrep response: elevated afterload (high LVESP and Ea), hypercontractility (high Ees and low ESV150), and prolonged systolic ejection time, accompanied by increased mechanical workload (elevated stroke work, potential energy, and pressure-volume area). After 3 months, both mavacamten responders and alcohol septal ablation responders showed comparable ventricular unloading: reductions in afterload and contractility, shortened systolic ejection time, and decreased myocardial workload, all while preserving stroke volume. Diastolic indices improved (increased EDV and V15, and decreased LVEDP). Conversely, in mavacamten nonresponders (persistent LV outflow tract gradient ≥50 mm Hg at 3 months), Anrep-related indices and myocardial workload did not change. CONCLUSIONS:In oHCM, chronic Anrep activation maintains cardiac output against elevated afterload at high energetic cost. Our finding that mavacamten and alcohol septal ablation produce comparable hemodynamic corrections establishes the reversal of this afterload-driven state as a central mechanistic target of therapy in oHCM.
Das Neuroblastom zählt zu den häufigsten soliden Tumoren im Kindesalter. Das klinische Erscheinungsbild reicht von günstigen Verläufen mit spontaner Regression bis hin zu hochaggressiven, metastasierten Tumoren bei Hochrisikopatient_innen. Die Pflege von Kindern mit einem Neuroblastom erfordert ein ganzheitliches Konzept mit dem Fokus auf Symptommanagement, Erfassung und Linderung therapiebedingter Nebenwirkungen, allgemeiner onkologischer Pflege sowie umfassender psychosozialer Begleitung und Edukation der Familien. Pflegende agieren als koordinierende Schlüsselpersonen in einem interprofessionellen Team und müüber hohe fachliche sowie reflektierende Kompetenzen verfügen.
