Metropolitan Hospital

The ongoing digital transformation is reshaping organizational and care delivery models in cardiology, positioning telemedicine as a pivotal tool to address increasing clinical and demographic complexity. This ANMCO position paper presents a comprehensive and critical overview of telemedicine applications in cardiovascular care, with a focus on its role in strengthening hospital-community integration, its deployment within hospital-based healthcare systems, and the associated regulatory and operational frameworks. The analysis encompasses the management of chronic cardiovascular conditions, such as heart failure and atrial fibrillation, through telemonitoring, telecontrol, televisit, and teleconsultation. Additionally, it explores the use of digital technologies in post-myocardial infarction follow-up, oral anticoagulation management, preoperative assessment, and care for elderly patients. The position paper also highlights the challenges and opportunities linked to digital infrastructure, interoperability, data protection, and healthcare professional training.

Purpose Public art is a vital contributor to urban placemaking and provides numerous economic, social and cultural benefits. Main streets are hubs of urban activity and are often managed by organizations, such as Business Improvement Areas (BIAs), that install and manage public art. The purpose of this study, therefore, is to explore the impact of public art within main streets and the value of resources for stakeholders to evaluate these impacts, in addition to building a framework to inform the development of evaluation tools and techniques targeted to main street organizations. Design/methodology/approach This qualitative exploratory study involved a thematic analysis of semi-structured key informant interviews with 10 main street representatives based in Toronto, Canada, as well as a content analysis of BIA websites. Findings This research corroborates previous literature on the economic, social and cultural impacts of public art, which often focuses on public art in cities and large urban areas, and demonstrates that many of these impacts also apply to the hyper-local context of main streets. Additionally, main street stakeholders have a need for resources to aid in evaluating and disseminating these impacts to assist with improved decision-making, securing funding and garnering support for public art projects. Originality/value This study explores the impacts of public art within the context of main streets and puts forth a public art impact matrix for main streets informed by literature and interview findings, as a foundational framework to further the development of resources to evaluate the impacts of public art in main street communities.

Abstract Background Identifying pathogenic/likely pathogenic variants in high-risk cancer genes is key to cancer risk management.Prophylactic surgeries like RRM and RRSO are guideline-recommended options. This study aims to provide real-world evidence on their clinical implementation. Methods Between 2020 and 2025, 203 women referred for genetic testing at Genekor Medical S.A., were detected with P/LP variants in cancer susceptibility genes, for which risk-reducing surgical options are either recommended or considered for discussion. Referring clinicians were invited to complete a questionnaire to assess whether prophylactic surgical options had been discussed, if the patients had agreed to undergo such procedures, and whether the surgeries have already been performed or postponed. Results Among the individuals referred for genetic testing, 168(83%) were referred following a cancer diagnosis, while 35(17%) were unaffected individuals referred due to a family history. 153 individuals (76%) harbored BRCA1/2, 31(15%) harbored PALB2, PTEN, TP53 and 19 (9%) harbored BRIP1,RAD51C, RAD51D P/LP variants. RRSO was discussed with 78/153 (51%) of BRCA1/2 carriers and agreed in 60/78 (77%) cases. Addition of hysterectomy to RRSO was discussed in 16/78 (21%) of cases and agreed in 10/16 (63%). RRM was discussed with 113/203 (56%) of patients and agreed in 73/113(65%). In PALB2, PTEN, TP53 carriers, RRM was discussed in 21/31 (68%) cases, and accepted in 9/21 (43%), while in 5 cases both RRM/RRSO were discussed with 3 women agreeing. Finally, for 19 BRIP1,RAD51C, RAD51D carriers, in 9 cases the physician discussed RRSO as an option, with the examinees agreeing in 7 of them and in 5 cases RRM was discussed with agreement to proceed in 2 of them. In all cases, 22 individuals although agreed to proceed with RRM and/or RRSO, decided to postpone the procedure. Conclusions This study highlights the high awareness and acceptance of surgical management demonstrating the adherence to the recommendations. Age under 35 years and receiving therapy at the time of genetic testing were significant factors in lowering risk reduction RRSO and hysterectomy performance rates. Stage IV cancer was the main reason for not discussing surgical intervention. Citation Format: K. Papazisis, M. Paraskeva, S. Giassas, M. Skondra, R. Iosifidou, C. Tolis, G. Kesisis, E. Zairi, V. Venizelos, C. Markopoulos, I. Natsiopoulos, E. Bleka, I. Xanthakis, A. Ananiadis, D. Matheos, D. Stefanou, A. Adamidis, A. Meintani, G. Kapetsis, D. Bouzarelou, E. Papadopoulou, G. Nasioulas. High-risk cancer susceptibility genes mutation carriers’ compliance with surgical risk reduction for breast and ovarian cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-05-05.

Abstract Introduction The Comprehensive Geriatric Assessment (CGA) is the gold standard for managing frailty in older adults, with strong support in the literature. However, gaps remain in the evaluation of electronic CGA’s (eCGA’s) and standardised implementation. The Frailty Intervention Team at Sandwell and West Birmingham delivers multidisciplinary care via CGA, but prior to intervention, assessments were often incomplete, with baseline compliance at just 23%. This was largely due to the absence of a user-friendly, embedded electronic solution. Method A root cause analysis identified key barriers to CGA completion. A three-month baseline audit established a 23% completion rate. In response, an electronic CGA (eCGA) was developed with key stakeholders, including the electronic patient record (EPR) provider. The eCGA launched on 1st March 2024 alongside structured team training. CGA ‘champions’ supported its adoption throughout the team. A target compliance level of 80% was set. Results Post-implementation (Phase 2) audit data show a 76%* completion rate, an increase of 53% from baseline. The number of CGAs reviewed in both baseline and follow-up audits remained consistent to ensure data reliability. Early findings indicate successful uptake and improved compliance with CGA delivery. Conclusion The introduction of a digital CGA significantly improved compliance and standardised practice within the frailty team. The eCGA is now embedded into routine care. Phase 3, a follow-up audit planned 12–18 months post-implementation, will assess sustainability. Additional benefits include improved usability, digital integration, and future potential for dashboard-based compliance tracking. *Final audit figures to be confirmed prior to BGS Autumn Meeting.

Introduction: The proportion of elderly patients with IBD is steadily increasing due to the aging population and improved survival. Patients in this age group present specificities in diagnosis and treatment, particularly regarding the use of biological agents, where immunosenescence, multimorbidity, and polypharmacy affect the precise assessment of benefit and risk. Aim: This systematic review, which was conducted in accordance with the PRISMA 2020 statement, aims to synthesize available data on the epidemiology, clinical characteristics, and therapeutic management of IBD in the elderly, with emphasis on the most recent data and practical guidelines for the use of biological therapies. Methods: A systematic search of PubMed, Scopus, and Embase was conducted. A total of 40 studies were included, comprising 5 randomized controlled trials, 15 prospective cohort studies, and 20 retrospective observational studies. Eligible studies included randomized controlled trials, observational cohort studies, and population-based analyses. Given substantial clinical and methodological heterogeneity, findings were synthesized narratively. Data on demographics, disease phenotype, comorbidities, and treatment outcomes were extracted and analyzed. In addition, a narrative synthesis of major randomized trials of biologic therapies, recent guidelines, and data from prospective studies and patient registries was performed with a focus on safety and real-world outcomes in the elderly. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and the Cochrane Risk of Bias tool. Results: The majority of included studies (85%) were found to have a low to moderate risk of bias, providing a reliable basis for the synthesis. Data show an increasing incidence of IBD in the elderly, often with a milder clinical course and a higher ratio of UC to CD. Multimorbidity and polypharmacy are significant challenges that increase the risk of adverse events. Although classic therapies remain effective, in many cases, a lower threshold is required to initiate advanced therapies, such as biologic agents. Anti-tumor necrosis factor (anti-TNF) agents, as well as biologics with alternative mechanisms of action such as vedolizumab (α4β7 integrin antagonist) and ustekinumab (interleukin-12/23 inhibitor), represent key therapeutic options in elderly patients with IBD. These biologic factors have efficacy comparable to that in younger patients and are considered attractive options due to reduced systemic immunosuppression and favorable safety profiles. JAK inhibitors are a practical option but are associated with an increased thromboembolic risk and require careful patient selection. Older age is associated with higher absolute rates of serious infections, hospitalizations, and, in some series, mortality. Individualized decision-making, including frailty assessment, vaccination coverage, infection control, and dose adjustments based on renal and hepatic function, is essential for optimal care. Conclusions: IBD in the elderly is a distinct clinical entity with unique challenges in diagnosis and management. A multidisciplinary approach and individualized treatment strategies are essential to ensure the balance between disease control and minimizing the risks associated with comorbidity and polypharmacy. Further research, including specifically designed clinical trials, is needed to optimize treatment and outcomes in this unique patient group.

The phase III VELOUR trial demonstrated improved outcomes with aflibercept plus FOLFIRI in patients with metastatic colorectal cancer previously treated with oxaliplatin-based regimens. We retrospectively evaluated the prognostic and predictive impact of RAS/BRAF mutations, intrinsic consensus molecular subtype (iCMS), and tumour sidedness in 439 profiled patients. Targeted sequencing identified RAS mutations in 57.5% and BRAF mutations in 10.0% of evaluable tumours; 34.2% of tumours with complete genotyping were RAS/BRAF wild-type. Transcriptomic profiling classified 66.5% of tumours as iCMS2 and 33.5% as iCMS3. RAS/BRAF wild-type tumours showed numerically improved overall survival (OS) and progression-free survival (PFS) with aflibercept, whereas no clear benefit was observed in RAS-mutant tumours. iCMS subtyping was strongly prognostic, with iCMS2 patients demonstrating longer OS and PFS than iCMS3 (OS HR 0.57, 95%CI 0.45-0.72; PFS HR 0.70, 95%CI 0.56-0.88). Exploratory integrated analyses suggested OS benefit in RAS/BRAF wild-type iCMS2 tumours (HR 0.56, 95%CI 0.33-0.96) and a significant PFS advantage in bevacizumab-pretreated iCMS3 tumours (HR 0.41, 95%CI 0.20-0.85, q = 0.032). Right-sided tumours were associated with poorer OS, but no significant treatment interaction was observed. These findings support integrating genomic and transcriptomic biomarkers to refine patient selection for anti-VEGF therapy, warranting validation in prospective studies. ClinicalTrials.gov number: NCT00561470, registered 15 November 2007.

Background: Inflammatory Bowel Disease (IBD) involves a complex interplay between immune dysregulation and intestinal barrier failure. Traditional views focused on individual cell death pathways, but the emerging concept of PANoptosis—a coordinated inflammatory cell death involving apoptosis, necroptosis, and pyroptosis—offers a more holistic understanding of IBD pathogenesis. Objective: This review evaluates the role of PANoptosis in IBD, identifies key molecular triggers (such as the ZBP1-ADAR1 axis), and discusses the therapeutic potential of targeting this process. Methods: We analyzed recent literature and clinical trial data regarding programmed cell death (PCD) inhibitors and natural compounds in IBD models. Results: Preclinical data suggest that targeting PANoptotic regulators like RIPK1 and ZBP1 can restore barrier integrity. However, clinical translation remains challenging; for instance, while targeting pyroptosis via IL-1/IL-18 (Anakinra) showed promise in theory, clinical results in IBD have been disappointing. Furthermore, RIPK1 inhibitors such as GSK2982772 have failed to meet primary endpoints in Phase 2 trials. Conclusions: PANoptosis is a “hot” therapeutic target, but successful treatment likely requires combination therapies or “PANoptosome” specific modulators rather than single-pathway inhibition.

Accurate monitoring of bone regeneration and fracture healing is essential for optimizing orthopedic outcomes and guiding timely clinical interventions. While radiography, computed tomography (CT), and magnetic resonance imaging (MRI) remain standard tools, their limitations, particularly in detecting early biological activity and evaluating healing around implants, have prompted exploration of advanced imaging techniques. This narrative review was conducted through a structured search of PubMed, Scopus, and Web of Science databases for studies published between 2000 and 2025 using predefined keywords related to bone healing and imaging. Peer-reviewed original studies, systematic reviews, and clinically relevant preclinical research focusing on radiological assessment of fracture healing were included, while non-English articles, conference abstracts, and non-peer-reviewed sources were excluded. Study quality and potential sources of bias were appraised based on clarity of methodology, imaging reproducibility, and applicability to clinical practice. Recent innovations, such as high-resolution and functional MRI, quantitative CT (qCT), hybrid positron emission tomography (PET) imaging, and advanced ultrasound modalities, provide deeper insights into trabecular microarchitecture, perfusion, and osteoblastic activity. Metabolic PET tracers, radiomics, artificial intelligence (AI), and 3D printing further enhance diagnostic precision and support personalized treatment planning. Despite their promise, these modalities face challenges including high cost, limited accessibility, lack of standardization, and the need for robust clinical validation. This review summarizes the current radiological landscape, highlights emerging opportunities, and outlines future steps required for integrating advanced imaging tools into routine orthopedic practice.