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Stroke is a leading cause of long-term disability, yet recovery trajectories are highly heterogeneous and difficult to predict at the individual level. Standardised clinical assessments primarily capture task accomplishment under controlled conditions but may overlook changes in movement quality, including the distinction between compensatory strategies and behavioural restitution. Additionally, they provide limited insight into the postural control processes that underlie functional task performance. Recent consensus initiatives emphasised the need for sensitive, functionally relevant measures of balance and mobility after stroke. Integrating routine clinical assessments with a sensor-based approach during functional tasks offers new opportunities to characterise recovery more precisely and to map longitudinal trajectories of poststroke change. Within the European Union-funded TARGET project, the FOSTER study aims to generate multimodal data to support data-driven, individualised prognostic models, so-called virtual twins, for personalised rehabilitation.
FOSTER is a prospective, single-centre observational cohort study at Rehabilitation Hospital Inkendaal (Belgium). We aim to include 100 adults within 8 weeks poststroke, assessed at three to five time points, including an entry assessment after admission and follow-up assessments within predefined windows at approximately 5, 8, 12 and 24 weeks poststroke. The protocol combines synchronised sensor-based measurements during functional tasks (seated reaching, standing reaching and gait initiation) obtained during an exergame, with standardised clinical tests and patient-reported outcome measures (PROMs). Sensors include surface electromyography, inertial measurement units, force plates and markerless motion capture. Sensor-based measurements target movement quality, and anticipatory and reactive postural control during self-initiated functional tasks. Derived outcomes will capture kinetic, kinematic and neuromuscular features of movement strategies, including temporal and asymmetry characteristics. In addition, in-task performance metrics, real-world activity monitoring through accelerometry, standardised clinical assessments and PROMs will be collected to provide a comprehensive, multimodal characterisation of recovery. Linear mixed-effects models will characterise longitudinal trajectories and relationships between clinical and sensor-derived measures.
The FOSTER study was approved by the Ethics Committee of Rehabilitation Hospital Inkendaal (B.U.N. 2024-TEE-002). Participants will be included after providing informed consent. Data are pseudonymised and stored on a General Data Protection Regulation-compliant platform. Findings will be disseminated through peer-reviewed publications, conferences and within the TARGET consortium.
Adolescent obesity is increasing worldwide, and a minority of adolescents are meeting recommended physical activity (PA) and dietary guidelines, particularly among adolescents from low socioeconomic areas. There are limited studies qualitatively investigating the engagement in healthy lifestyle behaviours in this population. Therefore, this study aimed to gain a greater understanding of perceived barriers and facilitators of healthy lifestyle behaviours, specifically PA and dietary behaviours, in this under-represented population.
Eight semistructured qualitative focus groups with 35 adolescents aged 13–15 years old were conducted across four European countries (Spain, the Netherlands, Greece, UK) following the Theory of Planned Behaviour framework which states that individual behavioural intentions are grounded on attitudes, subjective norms and perceived behavioural control. Discussions were centred on adolescents’ PA and healthy eating behaviours and were thematically analysed.
Regarding attitudes, adolescents understood the importance of healthy lifestyle behaviours but often failed to engage in them. Concerning subjective norms, friends and peers were perceived as barriers to PA, except during physical education (PE) classes. Positive relationships between pupils and teachers facilitated PA, and family influence primarily affected dietary behaviours. Regarding perceived behavioural control, the school structures including lack of space and time, as well as limited healthy food options in canteens and the COVID-19 pandemic were barriers to healthy lifestyle behaviours, while mandatory PE classes and school clubs facilitated PA.
In conclusion, despite adolescents recognising the significance of healthy lifestyle behaviours they often fail to engage in them. Their healthy lifestyle behaviours were influenced by their friends, families and teachers. The school structure and the COVID-19 pandemic were considered barriers to healthy lifestyle behaviours among adolescents.
This scoping review intended to map the existing literature on chronic stroke rehabilitation interventions in primary healthcare (PHC) settings, with a particular focus on intervention dosage—frequency, intensity, type and duration—as well as the mode of delivery, which encompasses intervention location, format and provider.
A scoping review was conducted following the guidelines outlined in the Joanna Briggs Institute Manual for Evidence Synthesis.
A comprehensive search of 16 databases was conducted on the EBSCOhost platform on 10 February 2022. A supplementary Google search was conducted to identify grey literature up to 19 November 2022.
Sources published in English between 2010 and 2022 with full-text availability, addressing interventions for chronic stroke survivors delivered by various stakeholders in PHC, community or home-based settings.
Two reviewers independently screened the identified sources to determine eligibility for inclusion. Data were extracted independently, compared between reviewers, analysed and synthesised narratively with descriptive statistics.
In total 34 sources are included in the review, with most (n=28) originating from high-income countries. Interventions predominantly targeted the body function and structure component of the International Classification of Functioning, Disability and Health framework (n=29) through physical exercise (n=21). However, few interventions addressed the activity (n=17) and participation (n=11) components. Contextual factors (n=9) were seldom considered in intervention design. Intervention dosage varied widely. Most interventions were delivered by the multidisciplinary team (n=9) and were provided either at home (n=16) or in the community (n=13). Individual sessions (n=18) were more commonly offered than group sessions (n=8).
The optimal dosage for chronic stroke interventions remains uncertain, and current interventions, along with their modes of delivery, are often misaligned with PHC settings. Further research is essential to establish best practices in both well-resourced and under-resourced environments to address the current evidence gap and to enable the development of effective rehabilitation protocols that meet the needs of chronic stroke survivors and their families in PHC settings.
Weight loss through combined lifestyle interventions (CLIs) can slow down knee osteoarthritis (OA) progression. However, gender-related factors may influence both the implementation of and participation in CLIs. Therefore, the aims were to identify gender-related facilitators and barriers to CLI implementation among healthcare professionals (HCPs) and uptake and adherence among individuals with early-stage knee OA and overweight or obesity.
Semi-structured interviews were conducted in this qualitative study. Thematic analysis, combining inductive and deductive approaches, was performed according to the Consolidated Framework for Implementation Research (CFIR) domains.
HCPs and individuals with knee OA and overweight or obesity were interviewed in Dutch between December 2023 and May 2024.
16 HCPs who referred or delivered a CLI and 23 individuals with knee OA and overweight or obesity who participated in a CLI were purposively recruited. 16 participants identified themselves as women and 7 as men; no other gender identities were reported.
HCPs experienced resistance to CLIs of both men and women. Additionally, HCPs perceived that women were more open and available to participate in CLIs, tended to prioritise others over themselves and often lacked familial support compared with men. Women valued trust, preferred female HCPs and struggled with self-prioritisation. Men were motivated by female HCPs and participants due to their empathy and interaction. Across men and women, barriers included conflicting HCP advice, work stress, caregiving tasks and lack of discipline, while social environment support was a key facilitator.
Addressing gender-related facilitators and barriers in the design and implementation of the CLI may improve long-term engagement and efficacy in individuals with knee OA and overweight or obesity.
Overview of Medical Research in the Netherlands (OMON), managed by the CCMO: NL75367.078.20
Acute, chronic, and hard-to-heal wounds pose a growing challenge due to reduced patient quality-of-life, higher cost and increased hospital admissions. Although there is no gold standard for wound care, there is a trend toward simple, outpatient-compatible treatment options. Acellular dermal fish skin derived from Gadus morhua (Atlantic cod) is a promising alternative. This retrospective study evaluated the surgical procedures and outcomes associated with fish-skin graft transplantation for difficult-to-treat wounds. Forty-four patients (33 male and 11 female; mean age: 72.4 years; mean wound area: 84.5 cm2) were treated with acellular fish skin graft. Wound healing was assessed by photographic documentation, confocal microscopy and clinical evaluation. Patient satisfaction was assessed using a structured questionnaire. A positive effect on wound healing, defined as a reduction in wound size, was observed in 88.6% of cases, with complete wound closure in 45.45% of cases. Most patients reported that the procedure was neither painful nor time-intensive; 95% stated that they would opt for treatment again. Fish skin grafting has also shown beneficial outcomes in complex cases, such as in wounds secondary to pyoderma gangrenosum and wounds with exposed bone. Fish skin graft transplantation represents a safe, well-tolerated and effective option for managing chronic wounds as well as challenging postoperative wounds, such as those at anatomically challenging sites.
To synthesise existing qualitative and conceptual literature on the implementation, ethical considerations and policy implications of Medical Assistance in Dying for Mental Disorder as a Sole Underlying Medical Condition (MAiD MD-SUMC) in Canada and internationally.
A qualitative evidence synthesis using a thematic analysis approach. Empirical, conceptual and policy papers addressing MAiD for mental disorders were identified through major databases and grey literature. Studies were thematically analysed to identify recurring ethical, clinical and policy themes related to eligibility, assessment and implementation.
Data was extracted from a systematic search of Medline and Embase for peer-reviewed studies published from 1974 onwards, supplemented by relevant policy documents and legal cases.
Studies were included if they examined MAiD MD-SUMC and explored ethical, legal or clinical considerations or provided stakeholder perspectives. Exclusion criteria included studies focusing solely on non-psychiatric conditions or not published in English.
Two independent reviewers screened, extracted and analysed data using an iterative thematic synthesis approach. Key themes were identified through consensus discussions.
The synthesis identified four major themes: (1) Irremediability and treatment resistance—persistent uncertainty regarding when mental disorders can be considered irremediable. (2) Capacity and vulnerability—ongoing debate about assessing capacity amid fluctuating symptoms and social influences. (3) Ethical and policy considerations—divergent interpretations of autonomy, justice and safeguards highlighting the need for standardised criteria. (4) Public and professional perspectives—public and family support for inclusion, although clinician hesitancy exists.
The evidence supports a thoughtful, structured approach to potential implementation of MAiD MD-SUMC in Canada. Future priorities include refining criteria for irremediability, standardising capacity assessments, addressing disorder-specific complexities and strengthening mental health infrastructure. Continued research, engagement and transparent policy dialogue will be essential to ensure that any expansion of MAiD upholds ethical integrity, protects vulnerable persons and maintains public trust.
The multifaceted responsibilities borne by clinical facilitators can impose a significant strain on their mental and emotional health and well-being. Within nursing and other healthcare professions, the responsibilities of clinical facilitators extend beyond conventional clinical duties to encompass supervising, facilitating, assessing, and supporting students as they transition into professional nursing practice. There is a need for insights into the well-being of clinical facilitators in the face of demanding work conditions, limited resources, and the emotional toll of patient care. This article critically reviews the literature to determine the current state of mental well-being among clinical facilitators in undergraduate health professions education and how they should be supported.
A scoping review guided the study using the Population, Context, Concept framework with a search string incorporating associated Boolean operators. 233 records were retrieved from eight databases and reviewed according to the inclusion and exclusion criteria. A total of 13 full-text articles were found to be eligible for extraction and analysis.
Major findings resulted in thematising mental health issue characteristics according to high and low job demands and burnout. Literature outlined the causes of mental health issues, including lack of recognition and appreciation, work performance, teaching and learning practices, student characteristics, support structures, and the environment. Recommendations included training, appropriate support systems, workload, guidelines, monitoring, community of practice, and research-oriented support.
Educational institutions must move beyond ad hoc support and implement integrated, strategic initiatives grounded in the principles of the Job-Demand-Control model. Future research should focus on developing and rigorously evaluating multifaceted intervention programmes that address these systemic factors. By investing in the well-being of clinical facilitators, institutions ultimately invest in the quality of future healthcare providers and the safety of the patients they will serve.
This article sets the tone for factors to consider and provides recommendations for educational institutions to better support the mental well-being of clinical facilitators.
by Nikola Lübbering, Alexander Krogmann, Felix Jansen, Eicke Latz, Georg Nickenig, Sebastian Zimmer
BackgroundAtherosclerosis is a chronic inflammatory disease driven by endothelial dysfunction, cholesterol accumulation, and immune activation leading to thrombosis and vascular stenosis. While LDL-lowering therapies are firmly established, targeting the underlying inflammation is still an emerging strategy. Cholesterol crystals (CC) contribute to inflammation by activating the NLRP3 inflammasome in monocytes and promoting disease progression. Cyclodextrin (CD), an FDA-approved drug carrier, has shown atheroprotective effects by enhancing cholesterol metabolism and reducing inflammation in preclinical models. This study investigated whether CC-uptake in human monocytes, a prerequisite for inflammasome activation, is also influenced by CD pretreatment.
MethodsHuman peripheral mononuclear cells were isolated from whole blood samples provided by 76 patients undergoing coronary angiography at the University Hospital Bonn between November 2017 and February 2018. After separation, peripheral mononuclear cells were stimulated with 2-Hydroxypropyl-γ-Cyclodextrin and CC. CC-uptake by monocytes was analyzed using flow cytometry.
ResultsCC-uptake by monocytes varied greatly between patients (8–37%), with lower uptake observed in patients with elevated leukocytes (p = 0.0058) and diabetes mellitus (p = 0.0448). CD-pretreatment significantly reduced CC-uptake (20.1% ± 0.8% vs. 15.0% ± 0.6%, p p = 0.0316), requirement for percutaneous coronary intervention (PCI) (p = 0.0030), and elevated leucocyte levels (p = 0.0135) had lower CCΔCD, suggesting a link between systemic inflammation and attenuated CD efficacy.
ConclusionWe demonstrated that CD significantly reduced CC-uptake in patients undergoing coronary angiography, which supports its role in inhibiting CC-phagocytosis and promoting cholesterol efflux. Interestingly, patient response to CD varied, with those exhibiting greater systemic inflammation or CAD showing a less pronounced reduction in CC-uptake. Our findings provide insight into the atheroprotective mechanisms of CD and suggest its potential utility in evaluating individual cardiovascular risk and monitoring CD-based therapeutic interventions in humans.
FreshRSS 