There is increasing evidence that LGBTQIA+ people are diagnosed with borderline personality disorder (BPD) at higher rates than cisgender and heterosexual populations. Despite this, limited qualitative research has critically examined the social, cultural, institutional, and diagnostic processes that shape these disparities. BPD is a highly stigmatised and contested psychiatric diagnosis, with a long history of debate across disciplines, including psychiatry. Critically unpacking these diagnostic trajectories is essential for understanding how gender and sexual diversity, and LGBTQIA+ people more broadly, are responded to within mental health and social care systems. Drawing on in-depth interviews with 13 LGBTQIA+ individuals who had received a BPD diagnosis, this study is informed by the sociology of diagnosis and queer theory. This framework enables a critical interrogation of how gender and sexual diversity intersect with dominant psychiatric discourses that continue to pathologise non-normative identities, emotional expression and relational practices. Findings are organised around three interrelated themes. First, participants described how limited understanding, validation, and access to LGBTQIA+ -affirming care contributed to experiences of distress that were subsequently interpreted through a diagnostic lens. Second, participants highlighted how BPD diagnostic criteria risk pathologising identity exploration and self-expression that diverge from cisnormative and heteronormative expectations. Third, clinical judgements were frequently shaped by superficial assumptions about appearance, gender expression and sexuality, compounded by limited queer-specific training among practitioners. Collectively, our findings suggest everyday clinical interactions, diagnostic practices and healthcare cultures contribute to the disproportionate application of BPD diagnoses among LGBTQIA+ people. The study underscores the need for further critical research, practitioner education and the resourcing of LGBTQIA+ -affirming mental health services.

Interstitial lung disease (ILD) is one of the most common manifestations of systemic sclerosis (SSc), with most patients requiring treatment with immunosuppressive or anti-fibrotic agents to control ILD progression. Since gastrointestinal (GI) tract complications are widespread in this patient setting, we focused on their prevention and management. We conducted a modified Delphi study following best practices for consensus studies. We involved 20 expert rheumatologists from 8 Italian regions in two online rounds conducted between April and September 2024. An agreement of at least two-thirds of panellists was achieved on most topics explored, including the need for a preliminary evaluation of GI status in patients with SSc-ILD undergoing anti-fibrotic therapy (100% agreement), taking into account the presence of pre-existing diarrhoea (100%), weight loss (95%) and nausea/loss of appetite (100%), the definition of specific tests and exams for these conditions, the need of informing patients on potential GI complications (100%) and nutritional preventive advice (85%), and the monitoring of GI status during anti-fibrotic therapy (100%), at 3-month intervals (75%). Further, dose-reduction of anti-fibrotic therapy and, if needed, temporary discontinuation, was agreed in presence of side effects including diarrhoea (95%) or weight loss (85%). In the presence of nausea or loss of appetite, dose-reduction was also agreed, with no immediate need for drug discontinuation (90%). This study provided a detailed list of expert-based recommendations to guide everyday clinical practice of SSc-ILD, though prospective validation is needed to confirm their effectiveness in preventing and managing GI side effects.

Arthroscopic treatment of TFCC lesions and stabilization of the DRUJ offer a differentiated range of findings-oriented procedures. Theses include central smoothing/partial resection via peripheral capsular sutures to foveal refixation and, in cases of irrepairable damage, anatomical reconstruction of the DRUJ-stabilizing radioulnar ligaments. The Palmer and Atzei classifications are widely used in everyday clinical practice and offer a structured approach to diagnosis and indication, with foveal integrity being the central criterion for DRUJ stability. Medical history, clinical examination, imaging and, in particular, diagnostic arthroscopy ensure precise classification, while standardized follow-up treatment concepts and realistic expectations ensure functional results. The choice of the specific procedure should be injury-specific, patient-related and experience-based.

Introduction: In our everyday clinical dental practice at the Clinic for Removable Dentistry at the University Dental Clinical Centre "St. Panteleimon" – Skopje, R.N.Macedonia total removable dentures are manufactured with respect to the prosthetic principles. Purpose: The purpose of this article is to represent a rare case of individually designed total removable dentures with patients’ inclusion in the decision for aesthetics. Material and methods: A 70 year old patient came at the Clinic for Removable Dentistry at the University Dental Clinical Centre "St. Panteleimon" – Skopje, R.N.Macedonia, with a request to change his old worn-out dentures. At the clinical objective measurements his vertical height has been decreased, and he had problem with mastication. Increase of the vertical dimension was recreated, with specific request for the color, shape and length of the new set of acrylic teeth of the patient. Results and Discussion: The internet is approachable to our patients so they can have an option to choose a variety of teeth that suit them, however with respect to the dental prosthetic principles. Finlay Sutton with his technician Rowan are in favor of individually designed dentures using dental photographs of patients in their youth. Their work is in correlation with our article where we use two different sets of acrylic teeth. Conclusion: The participance of the patient in choosing the proper shape, length and color (colors) of the acrylic teeth can be helpful in recreating the lost intermaxillary relations in the patients’ mouth.

The field of mental-health care continues to face the challenge of translating conceptual approaches into the idiographic reality of everyday clinical practice. For any framework to be both meaningful and useful to individual cases, it must account for the contextual, interconnected, temporal, and granular nature of such problems and prioritize clinical utility by design. In this narrative review, we aim to bridge this gap by proposing a workable framework building on these premises. Our proposal centers on the concept of “problem-sustaining patterns,” which aligns with the ongoing trend toward complexity thinking while offering sufficient clinical utility in practice. We advocate for a collaborative approach in which professionals and help-seeking individuals co-construct these models. Furthermore, we discuss the need for new digital tools to facilitate the procedural steps while also enabling development of generative models as clinical decision-making support tools, which could significantly enhance the feasibility of embracing complexity in clinical practice.

Out-toeing gait in children, commonly referred to by parents as “duck feet,” is a very frequent reason for paediatric consultation. This expression often leads to the suspicion of a foot problem, while in most cases the condition is benign and related to normal growth. In everyday clinical practice, out-toeing is usually the result of a physiological variation in femoral torsion that tends to resolve spontaneously over time. The foot, which is often blamed, is generally structurally normal and simply adapts distally. Misinterpretation may lead to unnecessary concern and inappropriate treatment. The article offers a practical and straightforward approach to out-toeing gait in childhood and aims to help clinicians distinguish normal variants from conditions that deserve further evaluation. In most children, careful observation over time and clear communication with parents are the most effective strategies.

Heart failure remains one of the leading causes of cardiovascular morbidity and mortality, impairing the quality of life. Based on randomized, controlled clinical trials, SGLT2 inhibitors significantly improve outcomes and reduce symptoms. However, real-world evidence is essential to better assess their effectiveness and safety in everyday clinical practice. To evaluate the effects of empagliflozin therapy on the quality of life and functional status, as well as to assess its safety profile in the Hungarian cohort of the international Emp-Activity study, covering the full spectrum of heart failure. This prospective, non-interventional, multicenter, observational study involved symptomatic heart failure patients enrolled from 11 Hungarian centers. A total of 106 patients were enrolled, of whom 101 were assigned to the empagliflozin cohort and 5 to the non-empagliflozin cohort. Patients received empagliflozin as part of routine heart failure therapy and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) at baseline and after 24 weeks. Functional status was assessed using the New York Heart Association (NYHA) classification. 101 patients were enrolled to the empagliflozin cohort (median age 69 years, 28.7% female), primarily in NYHA class II and III. Among them, 57% had HFrEF, 19% HFmrEF, and 22% HFpEF. The most frequent etiology was ischemic heart disease (42%). The most common comorbidities included hypertension (58%), atrial fibrillation (33%), diabetes mellitus (26%), and hyperlipidemia (25%). A significant improvement was observed in the KCCQ-12 overall score (74.3 ± 19.5 vs. 67.1 ± 19.5, p<0.01), with clinically meaningful improvement (≥5-point increment) in 53% of patients. The NYHA class improved significantly. Systolic blood pressure decreased (131 ± 16 mmHg vs. 127 ± 17 mmHg, p = 0.02), while diastolic blood pressure, serum creatinine, and potassium levels remained stable during the 24-week follow-up. In Hungarian patients with heart failure, 24-week empagliflozin treatment resulted in significant improvements in the quality of life and functional capacity, while being well tolerated. These findings support the effectiveness and safety of empagliflozin in routine clinical practice across the full spectrum of heart failure. Orv Hetil. 2026; 167(7): 257-264.

The twentieth century marked a golden age for endocrinology, particularly in the methods used to treat type 1 diabetes mellitus. One of the most significant advancements during this period was the development of the insulin pump. This technology, which initially adhered to the original principles and goals of diabetes management, has undergone a remarkable evolution. The transition from large, impractical devices that were suitable only for research in clinical settings, and often associated with complications, to portable, user-friendly, and safe devices has been substantial. This evolution has facilitated the integration of insulin pumps into everyday clinical practice. A detailed examination of the journey from the first prototype of the insulin pump to the models developed by the early 1990s illustrates how researchers overcame numerous challenges. Their efforts laid the groundwork for contemporary understandings of pump insulin therapy and the realization of the aspiration for an artificial pancreas.

The article addresses risks of violating criminal law for physicians, illustrated by examples relating to physicians' documentation duties as well as their obligation to obtain proper informed consent prior to surgical procedures. Such "administrative" activities are easily forgotten in everyday clinical practice or neglected in favor of direct patient care. If atreatment error occurs-potentially resulting, in the worst-case scenario, in the patient's death-and the public prosecutor becomes aware of it, they are obliged to initiate an investigation. In order to assess responsibility, aformal criminal investigation against all physicians involved in the patient's treatment is normally opened initially, which often entails significant psychological stress. Using illustrative examples, risk-prone scenarios are presented, and ways to avoid criminally relevant conduct are outlined.

Cushing's disease caused by an ectopic sphenoid pituitary macroadenoma: a major interdisciplinary challenge in everyday clinical practice.

Electroencephalography (EEG) is a crucial diagnostic tool in epilepsy, providing high temporal resolution for detecting epileptic seizures and interictal discharges. Despite its significance, EEG analysis faces challenges such as susceptibility to artifacts, individual variability, and the need for specialized expertise. In recent years, the rapid and intensive development of artificial intelligence (AI), in particular machine learning and deep learning methods, has shown that their application in EEG analysis can be useful in everyday clinical practice. The integration of artificial intelligence offers promising solutions to enhance EEG interpretation, automate routine analysis, and improve diagnostic accuracy. Machine learning algorithms, particularly convolutional neural networks, have demonstrated expertise-level performance in classifying EEG signals and predicting seizures, reducing clinician workload and increasing efficiency. AI applications extend to wearable devices and implantable systems for continuous seizure monitoring and personalized therapy. However, challenges remain, including data quality, noise interference, privacy concerns, and the translation of research models into clinical practice. Future developments should focus on refining AI systems, improving dataset quality, and ensuring accessibility to enhance the diagnosis and management of epilepsy. Methodology: For the purpose of this paper, electronic databases such as Scopus, Google Scholar, and PubMed were searched. The literature search covered publications released primarily between 2016 and 2025, with particular emphasis on studies published within the last decade, reflecting the dynamic development of artificial intelligence methods in EEG analysis. A literature review was conducted using the following keywords: electroencephalography (EEG), epilepsy diagnosis, Artificial Intelligence (AI), seizure detection, deep learning, machine learning, automated EEG analysis, neuroimaging. Original research studies, case reports, and review articles were utilized. The search was limited to publications in Polish and English.

Multiple myeloma (MM) is a heterogeneous cancer that remains incurable. After treatment, the presence of residual myeloma clonal cells, or minimal residual disease (MRD), leads to tumor recurrence (relapse) and treatment failure (refractory disease). Strong clinical evidence indicates MRD is a surrogate marker of survival in patients with MM and is of important prognostic value in disease management. MRD status is dynamic and longitudinal changes in MRD status have different clinical implications. For example, sustained MRD negativity (undetectable MRD) has been associated with greatly improved survival outcomes, whereas the loss of MRD negativity is associated with disease progression. Although research on the prognostic impact of MRD dynamics in real world clinical practice is ongoing, several major concerns remain to be addressed before implementing the monitoring of MRD dynamics and MRD-guided therapeutic decision making in everyday clinical practice in the management of MM. In this review, we discuss the prognostic and clinical value of MRD dynamics, the evidence from literature for MRD-guided clinical decision making, and the challenges around implementing monitoring of MRD dynamics into clinical practice.

Background and purpose Musculoskeletal disorders are a leading cause of disability worldwide, for which person-centred education is recommended as a first-line approach. However, novice physiotherapists often face greater challenges in delivering patient education, and limited understanding exists regarding how it is enacted in everyday clinical practice. This study aimed to explore how Portuguese novice physiotherapists enact patient education during musculoskeletal sessions and how they rationalise their educational practices. Methods An ethnographic study was conducted, involving video-based observations of musculoskeletal treatment sessions delivered by novice physiotherapists, followed by video-elicitation interviews. Data were analysed using a deductive, data-driven content analysis approach. Results Eight novice physiotherapists (≤5 years of professional experience) participated. Educational practices were categorised into three types of therapeutic relationship: activity-passivity, guidance-cooperation, and mutual participation. Most participants demonstrated characteristics of more than one type across interactions; although, a dominant type could be identified for each physiotherapist. Overall, practices tended to cluster towards activity–passivity and guidance–cooperation, with fewer instances of mutual participation. Conclusion The findings suggest that patient education delivered by Portuguese novice physiotherapists remains largely physiotherapist-centred, with limited enactment of shared decision-making and patient autonomy. These results highlight the need for educational and mentorship strategies that better support novice physiotherapists in translating person-centred principles into routine musculoskeletal practice.

Background/Objectives: Peripheral venous cannulation is one of the most frequently performed invasive procedures in adult patients and is often associated with procedural pain. Despite the availability of various pain-reduction strategies, analgesia during cannulation is not consistently implemented in routine clinical practice. The aim of this review was to identify local pharmacological interventions recommended for reducing procedural pain during peripheral venous cannulation, to assess their clinical effectiveness, and to determine which interventions may be feasibly incorporated into everyday clinical practice. Methods: A literature review was conducted including randomized controlled trials, prospective studies, and meta-analyses involving adult patients undergoing peripheral venous cannulation. Outcomes of interest included procedural pain intensity, clinical effectiveness of pharmacological interventions, and their impact on additional outcomes such as patient satisfaction, anxiety, and safety. Results: Peripheral venous cannulation was most commonly associated with moderate-intensity pain. The use of local pharmacological interventions-particularly vapocoolant sprays and topical local anesthetics in cream or patch form-resulted in a significant reduction in pain intensity compared with placebo or no intervention. Several studies also reported improved patient satisfaction and a favorable safety profile of the analyzed interventions. Conclusions: Current evidence indicates that local pharmacological interventions are effective and safe in reducing pain associated with peripheral venous cannulation and may represent a valuable component of patient-centered clinical care. In addition to summarizing clinical effectiveness, this review highlights practical and organizational factors influencing the implementation of pharmacological pain-reducing interventions in routine nursing practice.

Background: The European Society of Cardiology (ESC) published the first guidelines on cardio-oncology in 2022. Implementing the 272 proposed recommendations into everyday clinical practice has become a mandatory challenge for countries belonging to the ESC community. Methods: The study aimed to assess cardio-oncology knowledge and the degree of implementation of ESC guidelines among cardiologists registered with the Heart Failure Association of the Polish Cardiac Society and oncologists from the Polish Society of Clinical Oncology. Physicians were invited via email and voluntarily chose to participate by completing a 20-question questionnaire. Results: Among the 104 respondents, half (50%) were cardiologists, and the majority (80%) had more than ten years of clinical experience. A total of 38.8% of specialists practiced outpatient medicine, while 41.7% worked in academic centres. The majority (58.3%) consult fewer than ten cardio-oncology patients per week, with less than 8% of specialists having the greatest experience (>25 consultations per week). Most physicians were familiar with the ESC guidelines on cardio-oncology. Cardiologists more frequently indicated heart failure as the main problem in cancer patients (OR = 5.82; 95% CI: 2.08-16.22; p = 0.0007), ordered echocardiography and ECG together with cardiovascular risk factors control (OR = 4.01; 95% CI: 1.74-9.25; p = 0.001) during long-term follow-up, chose angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) combined with calcium channel blocker (CCB) for treating hypertension (OR = 3.9; 95% CI: 1.56-9.75; p = 0.003), and rarely monitored lipid profile based on the type of cancer therapy (OR = 0.09; 95% CI: 0.03-0.26; p = 0.000009). Oncologists more often observed cardiovascular issues in lung cancer (OR = 3.78; 95% CI: 1.58-9.05; p = 0.002), recognized venous thromboembolism as the most common problem in cardio-oncology (OR = 6.52; 95% CI: 2.7-15.73; p = 0.00002), opted for ACEI/ARB monotherapy in the management of high blood pressure (OR = 11.76; 95% CI: 2.49-55.54; p = 0.002), and significantly more often chose low-molecular-weight heparin in the treatment of asymptomatic incidental pulmonary embolism (OR = 5.93; 95% CI: 2.47-14.24; p = 0.00006). Conclusions: The understanding of cardio-oncology varies significantly between cardiologists and oncologists. Although the survey was conducted only in one country (Poland), its results may serve as a reference point for structural reforms with building implementation strategies of ESC guidelines in daily practice in other countries.

AI in critical care: A roadmap to the future.

Impact on slow-flow/no-reflow of intravascular ultrasound-guided primary percutaneous coronary intervention in ST-elevation myocardial infarction

Nurses' role in deprescribing for older adults: A scoping review.

Mythic Origins of a Medical Milestone: Revisiting the Story of Blood Transfusion.

Allergen immunotherapy (AIT) is the only intervention capable of modifying the natural history of allergic diseases. The evidence supporting its effectiveness comes from two distinct but complementary methodological approaches: randomized controlled trials (RCTs), traditionally considered the gold standard for establishing causality, and real-world evidence (RWE), which reflects everyday clinical practice. The tension between these two paradigms is methodological, ethical, and political. Critically examine the epistemological foundations, limitations, and strengths of RCTs and RWE in evaluating AIT, exploring the ethical implications and influence of the pharmaceutical industry in the construction of clinical evidence. Narrative and reflective review of methodological and bioethical literature on RCTs and RWE, with a focus on AIT studies. The analysis considers internal and external validity, generalizability, data governance, conflicts of interest, and regulatory implications. RCTs offer internally valid estimates of effectiveness, but these are difficult to generalize; RWE captures the complexity of clinical practice but is vulnerable to confounding and bias. The ethical dimensions differ: RCTs raise issues of equivalence and informed consent, while RWE raises issues of privacy and secondary use of data. The industry utilizes considerable influence on both paradigms, contributing to systematic distortions of the evidence. Neither RCTs nor RWE, taken in isolation, provide a sufficient picture of the efficacy and safety of AIT. Only an integrated approach, combining methodological rigor and pragmatic relevance, accompanied by independent monitoring of conflicts of interest and greater transparency, can support truly evidence-based medicine.