圣文森特医院

Chronic kidney disease (CKD) complicates insulin dosing and increases glycaemic instability in diabetes. We aimed to compare feasibility, safety and efficacy of automated insulin delivery (AID) with usual care in people with diabetes and advanced CKD. We conducted a prospective, open-label, randomised crossover trial at five tertiary hospitals in Australia and one tertiary centre in Denmark. Adults aged ≥18 years with type 1 diabetes or insulin-treated type 2 diabetes and advanced CKD (stage 3b or higher, including dialysis) were eligible. Participants were randomly assigned in a 1:1 sequence to receive either AID followed by usual care with real-time continuous glucose monitoring (CGM), or the reverse sequence, each for 8 weeks. Allocation was generated centrally using computerised randomisation. Due to the nature of the intervention, participants and clinicians were aware of treatment assignment. The primary outcome was percentage time in range (3.9–10.0 mmol/l) during the final 3 weeks of each treatment period. Forty participants (24 type 1 diabetes, 16 type 2 diabetes; median [IQR] age 60 [55, 69] years; HbA1c 64 [54, 73] mmol/mol [8.0

To map and characterise major transnational initiatives in education and training in geriatrics, and to explore complementarities to support a more coherent and equitable global framework. Multiple transnational programmes operate across a wide spectrum of structures, educational approaches, and content, reflecting diverse regional priorities and stages of development. Coordinated collaboration amongst initiatives is essential to build global capacity, promote equity, and ensure sustainability in geriatrics education and workforce development. To map and characterise major transnational initiatives in geriatrics education and training, and explore complementarities as a basis for a more integrated and equitable global framework. A mapping exercise and expert consultation were undertaken by the European Geriatric Medicine Society (EuGMS) Special Interest Group on Education and Training between January and October 2025, including a meeting of international experts during the Twenty-First EuGMS Congress in Reykjavík. Eligible initiatives operated across national borders with an explicit mandate in education and training related to geriatrics and were not confined to a specific topic or subspecialty. Each initiative was profiled by scope, target audience, and contributions, and classified within a three-tier framework: (1) foundational capacity-building, (2) professional and interprofessional development, and (3) leadership and specialist advancement. Seventeen initiatives were identified. Tier 1 included the International Federation on Ageing (IFA), International Institute on Ageing, United Nations–Malta (INIA), PAHO’s ACAPEM (Basic), ASEAN’s Centre for Active Ageing and Innovation (ASEAN–ACAI), IAGG’s e-Training in Gerontology and Geriatrics (e-TRIGGER) programmes, WHO’s Integrated Care for Older People (WHO ICOPE approach), and AfriAGE. Tier 2 included the IAGG, EuGMS, EICA, PROGRAMMING CA2112, Victorian Geriatric Medicine Training Programme (VGMTP), and ACAPEM (Intermediate); and Tier 3 was represented by leadership academies (EAMA, ALMA, MEAMA/MENAAA, and AAMA), and UEMS–GMS. Collectively, these programmes form a considerably disjointed but potentially complementary global ecosystem for geriatrics education. Greater mutual awareness and alignment, anchored in equity and interprofessional inclusion, could enhance efficiency and sustainability in developing the global geriatrics workforce.

Background Chronic musculoskeletal pain, particularly in patients with obesity, poses significant challenges due to increased pain sensitivity, reduced mobility, and systemic inflammation. Obesity aggravates mechanical constraints on the joints and increases systemic inflammation, exacerbating certain medical conditions and making conventional therapeutic approaches less likely to succeed. Conventional therapies often show limited efficacy, necessitating innovative approaches. Objective This pilot study evaluated the short-term effectiveness of a mindfulness and motor imagery-based intervention delivered via an app (SAS YUZIT), on the pain, functionality, and quality of life of patients with obesity and chronic knee pain. Methods A prospective, single-center study was conducted over 1 month by including 30 patients (BMI >30 kg/m2) experiencing chronic knee pain (≥3 months) who did not need surgery. Patients underwent two video-guided motor imagery sessions, focusing on neuromuscular reactivation. Functional scores, including the Single Assessment Numeric Evaluation (SANE) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and 36-Item Short Form Health Survey (SF-36) score, were assessed before and after intervention. Paired t tests were used to analyze score improvements, with P<.05 deemed significant. Results Significant improvements were observed across all parameters. The mean overall SANE score improved by 51% (P<.001). The minimal clinically important difference was therefore approximately 6.7 points. The observed mean improvement (25 points) exceeded this threshold by more than threefold, indicating a clinically meaningful improvement in functional status. The mean (SD) KOOS score increased by 56% (P<.001) from 40.89 (16.7) to 63.79 (14.6). The mean (SD) SF-36 scores showed substantial enhancements in both physical (from 39.7 [20.8] to 65.9 [18.8]; +66%; P<.001) and mental components (from 47.2 [23.1] to 64 [21]; +36%; P<.001). Patient satisfaction with this method was rated 4.5/5, and no adverse effects were reported. Conclusions Video-guided motor imagery demonstrated significant efficacy in reducing pain and improving the functionality and quality of life of patients with obesity and chronic knee pain. By targeting central neuromuscular circuits through guided visualization exercises, this non-invasive intervention addresses central activation dysfunction, a proposed novel concept in neuromuscular disorders that originates from hypotheses derived from clinical observations. This interesting concept requires further exploration to ensure its neurophysiological validation through future studies with larger sample sizes, control groups, and long-term follow-ups, all of which could explore CAD as a therapeutic target.

Health service transitions of child, adolescent, and young adult cancer survivors between paediatric and adult cancer care services are pervasively fragmented, resulting in poor coordination, reduced satisfaction, and adverse outcomes for cancer survivors and significant others (e.g., caregivers and family members). Numerous trials and clinical guidelines have been developed to support care transitions, but their convergence, divergence, and methodological quality remain unclear. To advance clinical practice and quality research about care transitions, a synthesis of trials and guidelines on child, adolescent, and young adult care transition across age-appropriate cancer services is required to inform future research, practice, guideline, and policy development. A systematic review (CRD420251029796) was conducted. Studies were identified from searches of six bibliographic databases, four trial registers, and grey literature. Inclusion criteria focused on clinical guidelines or trials published between January 2020 and April 2025 that addressed age-related transitional cancer care. A total of 3706 records were identified. After screening, 18 records met the inclusion criteria: 10 clinical guidelines, 4 completed trials, and 4 ongoing trials with registrations. While general recommendations between guidelines were consistent, they diverged in detail relating to their local contexts. Only two ongoing trials, and no completed studies, included independent control groups. Completed trials were limited and highly variable in approach, components, and outcome measures, suggesting regionally specific guidelines enhance relevance, applicability, and transition practices. Future research should develop core outcome sets for care transition trials to facilitate comparison of outcomes and should develop robust study designs, including control groups.

OBJECTIVES:Systemic sclerosis-associated heart involvement (SHI) is an enigmatic disease manifestation associated with high mortality. The Scleroderma Clinical Trials Consortium (SCTC) Cardiac Working Group developed SHI classification criteria to enable systematic investigation of this condition. METHODS:An international, interdisciplinary working group was assembled. Using consensus methods and existing literature, provisional SHI classification criteria items were developed. Continuous consensus exercises and a discrete choice experiment were performed to reduce items and derive individual item weights. The sensitivity and specificity of the classification criteria were tested in an independent cohort (n = 168) of SHI (cases) and non-SSc heart disease (controls). RESULTS:The working group agreed that the SCTC SHI Classification Criteria should identify the direct effects of SSc on the heart and exclude the complications of other SSc manifestations or cardiac comorbidities. The final classification criteria include 23 items measuring cardiac fibrosis, inflammation, arrhythmias and small vessel vasculopathy. No single item is pathognomonic for SHI, with a requirement for the presence of abnormalities across multiple histopathological, imaging, serological, and imaging domains to be present to secure a diagnosis. A classification criteria score of ≥11 identified SHI with a sensitivity of 78% and specificity of 96%, with an area under the curve of 0.87 (0.80-0.93). This threshold correctly identified >90% of cases of SHI. CONCLUSION:The newly derived SCTC SHI Classification Criteria have high sensitivity and specificity for SHI. Application of these criteria will enable standardized classification of patients in studies to facilitate future investigation of this important disease manifestation.