Senologic Hellenic Society

The European Federation of Internal Medicine (EFIM) was founded in 1996 by merging the Association Européenne de Médecine Interne and the Forum of Presidents of National Internal Medicine Societies in Europe, creating aunified platform for continental collaboration among national societies. Today, EFIM represents 48societies from 45countries-over 70,000 internists-making it one of Europe's largest medical federations. Its mission is to promote internal medicine scientifically, ethically, and professionally, centered on education, research, and advancement through research publication, congresses, internist communication, and health expertise. This article examines the present and future of internal medicine in light of EFIM's new policy, "Internal Medicine in the 21st Century: Back to the Future." It offers a critical appraisal of current challenges alongside strengths and opportunities. Internal medicine represents acornerstone of future hospitals and healthcare systems rather than aresidual specialty. Strengthening and standardizing training and granting internists formal leadership in care coordination and education will ensure sustainable, person-centered healthcare.

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.

IntroductionPharmacists are among the most available and frequently consulted healthcare providers supporting older adults. They can actively contribute to thorough geriatric assessments and interventions and are often included in geriatric teams across different care settings. AimThis narrative review aims to compile current knowledge and practical approaches related to pharmacists’ roles in caring for older adults.MethodsWe searched in three databases and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Included studies were randomized clinical trials (RCTs) and systematic reviews, published between the years 2014 and 2024 in any language, reporting on the involvement of pharmacists in geriatric care, their interventions and results.ResultsFrom 306 identified different records, 32 studies were included in the final synthesis. The majority (22; 68.8%) were systematic reviews, ten were RCTs. The studies reported on the role of pharmacists in geriatric care in diverse settings including home, community, outpatient clinics, hospital, long-term care and residential facilities. While interventions were often multifaceted and complex, they more commonly comprised medication reviews and medication reconciliation. Positive outcomes resulting from pharmacists´ interventions were reported in 71.9% of the studies, mostly focused on medication appropriateness, deprescribing, medication safety and effectiveness.ConclusionOur narrative review highlights the growing evidence supporting the integration of pharmacists into geriatric care teams across diverse clinical settings. Despite heterogeneity among studies and limited high-certainty evidence, the findings underscore the potential of pharmacists to contribute meaningfully to person-centred, multidisciplinary care in this vulnerable population.

"Waiting for Godot" is a vivid portrayal done in a theatrical manner of the distorted nature of modern human, social trends, and consciousness. The bewildered and illusory psyche of the 20th century is depicted as dark philosophy. Renowned literary figures such as Albert Camus, Samuel Beckett, and Harold Pinter, amidst the existential wars prevailing in their time, created a new dimension in literature by portraying the true values and contradictions of human life as a literary mirror, thus giving birth to a new style [Absurd Theatre (Absurd Drama)] in literary genre and breaking the illusionary contemplation of speculative mimicry in existentialist and deterministic philosophies. "Waiting for Godot" is an excellent example of absurdism, existentialism, and postmodernism. In these philosophies, reality is often concealed because they believe that reality is merely a specific outcome or experience of actions taken, which does not necessarily align with their principles or beliefs. These philosophies support alternative or skeptical perspectives to either illuminate or obscure reality. "Waiting for Godot" is an excellent example of absurdism, existentialism, and postmodernism. In these philosophies, reality is often concealed because they believe that reality is merely a specific outcome or experience of actions taken, which does not necessarily align with their principles or beliefs. These philosophies support alternative or skeptical perspectives to either illuminate or obscure reality. Where Godot is virtual, imaginary, and symbolic, existing in a deterministic manner throughout the play, devoid of any tangible form of its own.

To explore the challenges and opportunities for the implementation of falls preventive services across Europe. An online cross-sectional survey among healthcare professionals was initiated by the European Geriatric Medicine Society (EuGMS) Special Interest Group on Falls and Fractures containing a Likert scale and multiple-choice questions on education and knowledge, current practices, barriers, and facilitators for falls prevention. Survey participation for healthcare professionals was encouraged by the EuGMS through an email invitation, website banner, and social media. National representatives from 24 countries further promoted it via societies, local networks, and hospital channels. A total of 1669 multidisciplinary healthcare professionals participated from 34 European countries (median 47 years; 75% female; 40.6% physicians (73.3% geriatricians/trainees), 36% physiotherapists, 23.4% other healthcare professionals). Only 26.9% believed their undergraduate education adequately prepared them for clinical practice in this area. A total of 75.8% of respondents reported opportunistically screening older adults for fall risk often or always during consultations. Gait and balance assessment was considered the most important and was the most frequently performed component of the multifactorial fall risk assessment. The top-five barriers were staffing issues, lack of time, older adults' non-adherence to recommended strategies, workload related to falls prevention, and prioritizing other tasks. The top-five facilitators were more time, easy-to-use guidelines, sufficient resources, increased education and training on falls prevention, and increased collaboration. We observed regional and country-level variation in these top barriers and facilitators. This survey highlights the need for improved undergraduate education in falls prevention across Europe. It is essential to educate and engage governmental bodies and insurers to secure their support and prioritization of falls prevention initiatives. Furthermore, enhancing education, addressing older adults' nonadherence, interdisciplinary collaboration and providing easy-to-use guidelines seem crucial for effective implementation. The falls prevention strategy should be tailored to the local context.

BackgroundTelehealth holds the potential to expand healthcare access for people who use drugs (PWUD). However, limited data exist on their digital infrastructure access, a prerequisite for telehealth participation. We studied digital healthcare accessibility among PWUD.MethodsWe employed respondent-driven sampling to recruit 162 PWUD in Athens, Greece to assess current internet and computer access and telemedicine experience via a structured questionnaire. Participants were at least 18 years with an injection drug use (IDU) history. We utilized logistic regression to evaluate sociodemographic associations.ResultsParticipants’ mean (SD) age was 45.9 (8.8) years, 84.0% were male, 90.1% Greek, 77.8% reported IDU within the past year, 85.2% were not linked to opioid treatment, and 50.0% were experiencing homelessness. Only 1.9% had telemedicine experience. Internet and computer access were reported by 66.0% and 31.5%, respectively. Most (77.9%) used mobile phones for internet access. Compared to participants with secure housing, those experiencing homelessness reported decreased internet (50.6% vs. 81.5%, p < 0.001) and computer access (11.1% vs. 51.9%, p < 0.001). Multivariable analyses revealed that older age (per 1-year increase: OR = 0.94, 95% CI [0.89, 0.99], p = 0.03)), IDU within the past year (0.29 [0.10, 0.88], p = 0.03), and homelessness (0.29, [0.13, 0.65], p = 0.003) were associated with lower odds of internet access.ConclusionsTwo-thirds of PWUD accessed the internet, mainly via mobile phones, while only one-third gained access through a computer. Very few PWUD used telemedicine. Homelessness, recent IDU, and older age may further limit digital infrastructure access and should be considered when designing equitable digital healthcare solutions for PWUD.Trial registrationRegistered on ClinicalTrials.gov (ID: NCT05794984, Protocol: STUDY00007088, Date: 2023-04-03)

To the best of our knowledge, most platforms or apps that geovisualize archaeological excavations are limited to displaying the excavated areas and providing a brief description and interpretation of the remains. Even though the validity of this information is not in question, there are usually no details available to the end user nor is the information in any way connected to the relevant excavation data. As Huvila and Huggett point out, the limiting factor in such cases is the insufficient understanding of the archaeological remains and the poor level of documentation. As a result, the end user is effectively a passive recipient of a digested knowledge without being able to access the source of that knowledge.

A major aim of evolutionary biology is to understand why patterns of genomic diversity vary within taxa and space. Large-scale genomic studies of widespread species are useful for studying how environment and demography shape patterns of genomic divergence. Here, we describe one of the most geographically comprehensive surveys of genomic variation in a wild vertebrate to date; the great tit (Parus major) HapMap project. We screened ca 500,000 SNP markers across 647 individuals from 29 populations, spanning ~30 degrees of latitude and 40 degrees of longitude - almost the entire geographical range of the European subspecies. Genome-wide variation was consistent with a recent colonisation across Europe from a South-East European refugium, with bottlenecks and reduced genetic diversity in island populations. Differentiation across the genome was highly heterogeneous, with clear 'islands of differentiation', even among populations with very low levels of genome-wide differentiation. Low local recombination rates were a strong predictor of high local genomic differentiation (FST), especially in island and peripheral mainland populations, suggesting that the interplay between genetic drift and recombination causes highly heterogeneous differentiation landscapes. We also detected genomic outlier regions that were confined to one or more peripheral great tit populations, probably as a result of recent directional selection at the species' range edges. Haplotype-based measures of selection were related to recombination rate, albeit less strongly, and highlighted population-specific sweeps that likely resulted from positive selection. Our study highlights how comprehensive screens of genomic variation in wild organisms can provide unique insights into spatio-temporal evolutionary dynamics.

In this editorial, we comment on the article entitled "Advances and key focus areas in gastric cancer immunotherapy: A comprehensive scientometric and clinical trial review (1999-2023)," which was published in the recent issue of the World Journal of Gastroenterology. We focused on the results of the authors' bibliometric analysis concerning gastric cancer immunotherapy, which they analyzed in depth by compiling the relevant publications of the last 20 years. Before that, we briefly describe the most recent data concerning the epidemiological parameters of gastric cancer (GC) in different countries, attempting to give an interpretation based on the etiological factors involved in the etiopathogenesis of the neoplasm. We then briefly discuss the conservative treatment (chemotherapy) of the various forms of this malignant neoplasm. We describe the treatment of resectable tumors, locally advanced neoplasms, and unresectable (advanced) cases. Special attention is given to modern therapeutic approaches with emphasis on immunotherapy, which seems to be the future of GC treatment, especially in combination with chemotherapy. There is also a thorough analysis of the results of the study under review in terms of the number of scientific publications, the countries in which the studies were conducted, the authors, and the scientific centers of origin, as well as the clinical studies in progress. Finally, an attempt is made to draw some con-clusions and to point out possible future directions.