The co-occurrence of mental illness and chronic medical conditions represents a formidable and escalating public health challenge. Patients with these comorbidities experience a synergistic burden of illness, leading to poorer clinical outcomes, reduced quality of life, and significantly increased mortality compared to those with either condition alone. Traditional healthcare systems, historically fragmented into separate silos for physical and mental health, are fundamentally ill-equipped to manage this complex patient population, resulting in care that is inefficient, costly, and often iatrogenic. This comprehensive review synthesizes the current evidence on integrated care models as the superior standard of care for this population. We first examine the profound epidemiological scale and bidirectional pathophysiology of comorbidity, exploring the shared biological mechanisms, including systemic inflammation and hypothalamic-pituitary-adrenal (HPA) axis dysregulation, that link mind and body. We then delineate the severe clinical and economic consequences of fragmented care, including the staggering mortality gap and the pervasive problem of polypharmacy. Subsequently, we outline the foundational components of effective integrated care, such as patient-centered planning, measurement-based care, and comprehensive medication management. A critical analysis of evidence-based models including the Collaborative Care Model (CoCM), the Primary Care Behavioral Health (PCBH) model, and Assertive Community Treatment (ACT) is presented, highlighting their distinct applications across a continuum of patient acuity. Finally, we address key implementation challenges and future directions, emphasizing the critical roles of technology, policy reform, and the transition to value-based payment models. The evidence overwhelmingly indicates that a systemic shift toward integrated, whole-person care is not merely an option but a clinical and fiscal imperative.

This study examines how multidisciplinary collaboration among emergency, clinical, and administrative professionals influences patient outcomes and overall hospital performance. Focusing on real-world interactions in acute care settings, it analyzes communication patterns, decision-making processes, and coordinated workflows that bridge clinical and non-clinical roles. By mapping how emergency physicians, nurses, allied health staff, and administrators share information and align priorities during care transitions, the research identifies which collaborative behaviors are most strongly associated with reduced length of stay, lower readmission rates, and improved patient safety metrics. The study also considers contextual factors—such as staffing levels, electronic health record (EHR) integration, and leadership support—that enable or hinder effective teamwork. Using a mixed-methods design, the study combines quantitative performance indicators with qualitative data from interviews, focus groups, and direct observations to generate a comprehensive picture of interprofessional practice. Statistical analyses correlate specific collaborative interventions (for example, structured handoff protocols or interdisciplinary rounds) with measurable improvements in efficiency and clinical outcomes, while thematic analysis reveals perceived barriers like role ambiguity, time pressure, and cultural silos. The findings aim to inform practical recommendations for training, workflow redesign, and policy changes that strengthen multidisciplinary collaboration and, in turn, enhance hospital resilience, patient experience, and operational sustainability.

Objectives: To conduct a systematic review of existing literature to assess the relationship between obesity and CKD. Methods: A detailed computerized search of relevant databases was conducted to identify studies that met the inclusion criteria. The search encompassed PubMed, SCOPUS, Science Direct, Cochrane Library, and Web of Science to find pertinent research. Results: Our analysis included seven studies with a total of 21,191 obese patients and males comprised less than half of the participants, totaling 6675 (31.5%). The prevalence of CKD among obese individuals ranged from 7% to 48.9%. The results of this systematic review indicate a clear association between obesity and chronic kidney disease (CKD). Across multiple studies, obesity, particularly abdominal obesity, was found to significantly increase the risk of developing and progressing CKD, with higher body mass index (BMI) and waist-to-hip ratio (WHR) correlating with greater renal dysfunction. Key mechanisms involved include renal fat deposition, increased glomerular filtration rate (GFR) decline, and metabolic disturbances. Conclusion: This systematic review provides strong evidence that obesity is a significant risk factor for the development and progression of chronic kidney disease. The reviewed studies highlight the complex interplay between obesity, metabolic dysfunction, and renal impairment, underscoring the need for early identification and management of obesity in patients at risk for CKD.

Given that it influences the therapeutic product's dissolving profile and bioavailability, particle size is a crucial component of contemporary medication quality. Particle size analysis aids in improving drug quality and improving the pharma product development process. In this research, the particle size distribution of Azithromycin oral suspension is determined using an innovative and accurate approach that was established for the purpose of determining the particle size of the suspension. This approach has produced good, repeatable outcomes. The International Conference on Harmonization's Q2 (R1) guidelines were followed in the development and validation of the wet method, which used water as the dispersant. The results showed that the method was robust and reproducible, with the percentage RSD values found within acceptance limit. The approach presented here in is a precise, verified, and efficacious technique for ascertaining the particle size distribution of oral azithromycin suspension. In-depth discussion of the particle size approach is provided to guarantee comprehension of the particle size distribution and the performance of the method across the product's lifetime.

Introduction: Basedow (Graves’) desease remains the leading cause of hyperthyroidism (40–60%), affecting mainly young women with a prevalence varying according to the iodization of the populations. Methods: Retrospective, descriptive and analytical study, covering 25 years (01/01/1998–31/12/2023) at the Medical Clinic II/CHAN; inclusion of all hyperthyroidism files related to Graves' disease, operative criteria and standardized definitions; descriptive and comparative analysis. Results: Our cohort included 3007 patients, with a female predominance; the most common initial clinical signs were goiter (nearly 89%) and exophthalmos (approximately 69%). Under ATS, a decrease in pulse rate and weight regain were observed at 18 months. Overall outcomes showed failure in 48–49% of cases, remission in nearly 33%, and recurrence around 18%; cardiac complications included cardiothyreosis in nearly 6% and acute thyrotoxic crisis in 0.3%. The worst outcomes were associated with grade 3 goiter, exophthalmos, a consultation time > 12 months and a loading dose > 40 mg/day. Conversely, early initiation of maintenance treatment (<6 months) was associated with more remissions and fewer recurrences. Conclusion: Rapid initiation and reasoned adjustment of ATS, coupled with stratification by severity (goiter, orbitopathy, delay), optimize the response and limit surgery; these levers can be used in resource-constrained systems.

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of global morbidity and mortality, with acute exacerbations (AECOPD) representing the primary driver of healthcare utilization, economic burden, and negative patient outcomes. The conventional management of AECOPD is frequently fragmented, characterized by professional silos that lead to critical communication gaps, medication errors, high hospital readmission rates, and a suboptimal patient experience. This review synthesizes the evidence for a structured, interprofessional collaborative care model as the superior standard of care for patients with AECOPD. The objective is to explore the distinct and synergistic roles of key healthcare professionals across the entire acute care continuum, from pre-hospital response to inpatient management and the critical transition back to the community. This report details the evidence-based contributions of Emergency Medical Services, Nursing Technicians, Radiology Technicians, Respiratory Therapists, the integrated Pharmacy Team (Clinical Pharmacists and Pharmacy Technicians), Social Workers, and Medical Records Technicians, highlighting their crucial interdependencies. The synthesis of current evidence demonstrates that formalized collaborative care models, when supported by robust system-level frameworks such as structured communication protocols and integrated electronic health records, significantly improve clinical outcomes, enhance system efficiency, and elevate patient-reported quality of life. Such integrated models are no longer an ideal but an essential framework for delivering effective, efficient, and patient-centered care for this complex and vulnerable population.

Background: Varenicline represents the most effective first-line pharmacotherapy for smoking cessation, though post-marketing safety concerns historically limited utilisation. Contemporary evidence requires synthesis following resolution of neuropsychiatric safety signals and emerging applications in diverse populations. Objective: To evaluate varenicline efficacy and safety for smoking cessation through systematic review of evidence published January 2020-October 2025. Methods: Comprehensive search across PubMed/MEDLINE, Scopus, Web of Science, and EMBASE identified randomised controlled trials, systematic reviews, and meta-analyses. Two reviewers independently screened records using predefined PICO criteria: adults ≥18 years with current smoking status; varenicline monotherapy at standard dosing; placebo/active comparators; biochemically verified continuous abstinence ≥6 months. Data extraction captured efficacy outcomes, safety profiles, and population-specific effects. Risk of bias assessment employed Cochrane RoB 2 methodology. Results: Database searching retrieved 3,247 records, with 15 studies meeting inclusion criteria after systematic screening. Studies encompassed 8 randomised controlled trials, 4 systematic reviews/meta-analyses, 2 network meta-analyses, and 1 observational study, representing >15,000 participants across diverse populations. Varenicline demonstrated superior efficacy versus placebo across all populations, with 6-month continuous abstinence rates of 22.1% versus 8.9% (OR 3.14, 95% CI 2.21-4.46, p<0.001). Particularly robust effects were observed in cardiovascular disease patients (OR 4.12, 95% CI 2.89-5.87) and dual cigarette-e-cigarette users (OR 4.95, 95% CI 2.29-10.70). Safety analysis across >8,000 participants showed no significant increase in serious adverse events (6.8% vs 5.9% placebo, OR 1.23, 95% CI 0.95-1.59, p=0.11), including neuropsychiatric (OR 1.25, 95% CI 0.73-2.14, p=0.42) and cardiovascular events (OR 1.35, 95% CI 0.71-2.56, p=0.36). Nausea remained the most common adverse effect (28.6% vs 9.2% placebo) but proved dose-dependent and transient. Conclusions: Contemporary evidence strongly supports Varenicline as highly effective and acceptably safe first-line therapy for smoking cessation across diverse adult populations, including those with cardiovascular disease and psychiatric disorders. Historical safety concerns have been definitively resolved, supporting broader clinical implementation within established guidelines.

Background: Prevalence of dyspepsia varied worldwide, including in India. Studies from India reported a prevalence between 14.9 to 30.4%. Risk factors associated with dyspepsia are Helicobacter pylori infection, predominantly vegetarianism, smoking, and tobacco chewing. Most of the studies have not evaluated patients with dyspepsia using esophagogastroduodenoscopy. There is a scarcity of literature estimating the prevalence from India’s rural population. The present study is designed to estimate the prevalence of dyspepsia, study the associated risk factors including dietary factors, and evaluate using esophagogastroduodenoscopy. Methods: It is a community-based cross-sectional study carried out using Rome III criteria. Multi-staged sampling was done and data was collected by house-to-house survey. The subjects with dyspepsia were mobilized to undergo esophagogastroduodenoscopy. The data were analyzed using SPSS and a two-tailed p-value < 0.05 was considered significant. Results: Prevalence of dyspepsia in the rural community was found to be 29.6%. In univariate model, associated risk factors of dyspepsia were older age group, predominantly vegetarian diet, regular tea intake, chewing tobacco, smoking, and gudakhu use. In multivariate analysis, only smoking tobacco was found to be significantly associated. Endoscopic evaluation revealed 56% had functional dyspepsia. Abnormal findings reported were esophagitis (26%), antral gastritis (9%), antral ulcer (7%), and inflammatory esophageal polyp (2%). Conclusion: Dyspepsia is a very common disease in Odisha with the majority diagnosed with functional dyspepsia. Smoking tobacco was found to be an independent risk factor for dyspepsia. Further studies using Rome IV criteria are recommended.

In contemporary healthcare, technology plays a pivotal role in enhancing patient care through interprofessional collaboration. By integrating diverse expertise from various healthcare disciplines, teams can leverage cutting-edge technologies such as electronic health records (EHRs), telemedicine platforms, and artificial intelligence (AI) diagnostic tools to improve safety and efficiency. These technologies facilitate seamless communication among healthcare professionals, ensuring that patient information is shared promptly and accurately. For instance, when nurses, physicians, and pharmacists collaborate using a shared EHR system, they can quickly access comprehensive patient histories and medication lists, reducing the risk of errors and enhancing decision-making. This collaborative approach not only safeguards patient well-being but also streamlines workflows, allowing healthcare teams to allocate time more effectively. Moreover, the integration of technology in patient care fosters a culture of continuous improvement, where interprofessional collaboration can lead to better health outcomes. Utilizing telehealth services, healthcare professionals from various specialties can connect remotely to discuss complex cases, enabling a holistic view of patient needs. This level of collaboration is crucial in addressing chronic conditions and managing transitional care, where multiple healthcare providers must work together to coordinate treatment plans. As teams utilize data analytics and AI-driven tools to identify trends and measure performance outcomes, they can make data-informed decisions that enhance both quality of care and patient satisfaction. Thus, embracing technology while promoting interprofessional collaboration stands as a powerful strategy to elevate patient care efficacy, safety, and overall health outcomes.

Diabetic retinopathy (DR) is fundamentally a neurovascular complication initiated and propelled by chronic hyperglycemia. DR represents a significant and escalating public health crisis, inextricably linked to the global diabetes pandemic. Traditional, fragmented healthcare delivery models poorly manage it. In response, integrated care has emerged as a person-centered, holistic framework designed to address these complex, interconnected needs. This narrative review synthesizes the evidence on integrated care for the diabetic patients. It explores the core components and theoretical underpinnings of integrated care, provides a typology of prominent models across primary care, hospital, community, and transitional care settings, and evaluates their evidence-based impact. The analysis covers rising global prevalence of diabetes and its complications creates a problem that standard care methods cannot be met by traditional models of care. Structured, tech-enabled teamwork is the cornerstone of a sustainable, egalitarian, and successful strategy to prevent vision loss from diabetic retinopathy. A comprehensive toolkit for system redesign is provided by the care paradigms examined here, ranging from the proactive coordination of the Patient-Centered Medical Home to the co-located expertise of Integrated Practice Units and the broad reach of teleretinal screening. With the help of data analytics and artificial intelligence, these models will be intelligently integrated to provide more proactive, individualized, and patient-centered care, which will define the future of DR management. The healthcare community may strive to guarantee that no one loses their valuable sight due to a complication that is nearly completely preventable with the correct system in place by adopting this multidisciplinary viewpoint.

The increasing incidence of cancer in sub-Saharan Africa, particularly in Côte d'Ivoire with 17,300 new cases reported in 2020, has motived improvements in patient care, marked by the establishment of a National Centre for Medical Oncology and Radiotherapy. This study aimed to evaluate compliance with international standards regarding the safe handling of cytotoxic drugs, which pose risks to healthcare personnel, patients, and the environment. The methodology encompassed all stages of the anticancer drug management circuit. Failure modes in management that could lead to risks, particularly during the handling of anticancer drugs, were analyzed using the Failure Mode, Effects, and Criticality Analysis (FMECA) method. These failure modes or non-compliant practices were previously identified using the Cyto-SAT tool, which is adapted for evaluating anticancer drug handling practices in low- and middle-income countries. The median compliance rate with good practices was 69%. Among all identified or potential failures, 61 risks were identified. Regarding processes directly involving pharmaceutical activities, specifically logistics and preparation, 21 risks were prioritized. Twenty-seven actions were defined to control them. During the study, the rate of safe practices at the CNRAO was higher than the average rate in low-income countries and that of middle-income countries. For a new centre, the CNRAO shows promising results. It is essential to continue and improve the implementation of safe handling practices to protect both patients and healthcare staff.

Post-cardiac arrest care represents a critical link in the chain of survival, yet outcomes for patients who achieve return of spontaneous circulation (ROSC) remain suboptimal. The period following ROSC is characterized by the complex, multisystem pathophysiology of post-cardiac arrest syndrome (PCAS), which includes profound brain injury, myocardial dysfunction, and a systemic ischemia-reperfusion response. Improving survival and neurological function requires a shift from a series of isolated interventions to a comprehensive, structured, and multidisciplinary system of care that spans the entire patient journey from the pre-hospital environment to the intensive care unit (ICU) and beyond. This review examines the integrated protocols that define modern post-cardiac arrest management. It details the continuum of care, beginning with pre-hospital stabilization and transitioning to in-hospital therapeutic strategies, including targeted temperature management (TTM), hemodynamic optimization, and neurological protection. A central focus is placed on elucidating the distinct and interdependent roles of a broad multidisciplinary team, encompassing not only direct clinical providers such as Paramedics, Nursing Specialists, and Respiratory Therapists, but also the essential technical and administrative personnel who form the operational backbone of this system. The specific contributions of Radiologic Technologists, Biomedical Technicians and Specialists, Nursing Technicians, Unit Coordinators, and Medical Secretaries are analyzed to demonstrate how their functions are integral to the consistent and reliable implementation of evidence-based guidelines. The review further explores the communication strategies and systemic protocols that orchestrate this complex collaboration, addresses common implementation challenges, and surveys the future landscape of post-cardiac arrest care, including emerging technologies and evolving therapeutic paradigms. The central thesis is that optimal patient outcomes are not merely a function of clinical expertise but are fundamentally dependent on the seamless integration of this entire multidisciplinary ensemble.

The FiLaC™ (Fistula Laser Closure) technique has emerged as a valuable sphincter-preserving option for the treatment of cryptogenic anal fistulas, combining efficacy with functional safety. This retrospective study was conducted at the Hepato-Gastroenterology and Proctology Department of Ibn Sina University Hospital, Rabat, between January 2023 and January 2025. Twenty-five patients with cryptogenic anal fistulas underwent treatment using the FiLaC™ procedure, following initial drainage with a seton. Fistulas secondary to Crohn’s disease, tuberculosis, or malignancy were excluded. Cure was defined as complete closure of the fistulous tract and both orifices without recurrence during 24 months of follow-up. The mean age was 45.3 years, with a slight male predominance. Transsphincteric fistulas were the most frequent (44%), and the overall success rate reached 84%, without any case of postoperative incontinence. Univariate analysis showed that a short fistulous tract and a small internal opening were associated with better outcomes (p = 0.036 and p = 0.042, respectively). In multivariate analysis, only the short fistula tract remained a significant independent predictor of success (p = 0.04; OR = 5.12). Recurrent cases were successfully managed with a second FiLaC™ session. The technique was well tolerated and reproducible, with mean energy delivery of 699 Joules and an average fiber withdrawal time of 61.6 seconds. These results confirm that FiLaC™ is a minimally invasive and reliable technique for the management of cryptogenic anal fistulas, offering a high healing rate and optimal preservation of continence. The short length of the fistulous tract appears to be the most decisive predictive factor of long-term success.