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Öğe Protocol for an umbrella review of systematic reviews evaluating the efficacy of digital health solutions in supporting adult cancer survivorship care(Public Library of Science, 2025) Keane, Danielle; Calbimonte, Jean-Paul; Pawlowska, Ewa; Kassianos, Angelos P.; Medina, Joan C.; Gregorio, Joao; Serra-Blasco, Maria; Celebic, Aleksandar; Meglio, Antonio Di; Asadi-Azarbaijani, Babak; Foster, Claire; Donohoe, Claire L.; Mafra, Allini; Backes, Claudine; Ochoa-Arnedo, Cristian; Gezer, Derya; Bozkul, Gamze; Taşvuran Horata, Emel; Özkan, Esra; Prue, Gillian; İşcan, Gökçe; Dural, Gül; Bahçecioğlu, Gülcan; Ersöğütçü, Filiz; Berzina, Guna; Bektaş, Hicran; Vaz-Luis, Ines; Mlakar, Izidor; Rocha-Gomes, Joao; O'Connor, Mairead; Clara, Maria Ines; Karekla, Maria; Hagen, Marte Hoff; İmançer, Merve Saniye; Çöme, Oğulcan; Mevsim, Vildan; Aksoy, Nilay; Martins, Rui Miguel; Yokuş, Sıdıka Ece; Bayram, Şule Bıyık; Akçakaya Can, Aysun; Brandao, Tania; Saab, Mohamad M.; Bayar Muluk, Nuray; Yıldırım, Zeynep; Podina, Ioana R.; Karadağ, Songül; Erden, Sevilay; Semerci, Remziye; Aydın, Aydanur; Frountzas, Maximos; Üzen Cura, Şengül; Ruveyde, Aydın; Billis, Antonios; Calleja-Agius, Jean; Vojvodic, Katarina; Jaswal, Poonam; Şahin, Eda; Ilgaz, Ayşegül; Pilleron, Sophie; Hegarty, JosephineIntroduction The growing number of people living with, through and beyond cancer poses a new challenge for sustainable survivorship care solutions. Digital health solutions which incorporate various information and communication technologies are reshaping healthcare; offering huge potential to facilitate health promotion, support healthcare efficiencies, improve access to healthcare and positively impact health outcomes. Digital health solutions include websites and mobile applications, health information technologies, telehealth solutions, wearable devices, AI-supported chatbots and other technologically assisted provision of health information, communication and services. The breadth and scope of digital health solutions necessitate a synthesis of evidence on their use in supportive care in cancer. This umbrella review will identify, synthesise, and compare systematic reviews which have evaluated the efficacy or effectiveness of digital solutions for adult cancer survivorship care with a particular focus on surveillance and management of physical effects, psychosocial effects, new cancer/ recurring cancers and supporting health promotion and disease prevention. Methods and analysis An umbrella review of published systematic reviews will be undertaken to explore the types of digital health solutions used, their efficacy or effectiveness as a form of supportive care, and the barriers and enablers associated with their implementation. The umbrella review will be reported according to the Preferred Reporting Items for Overviews of Reviews (PRIOR) checklist. A search will be conducted across key databases. Records will be assessed independently by two review authors for eligibility against predefined criteria and will undergo two stage title, abstract and full text screening. All systematic reviews that meet the inclusion criteria will be assessed for quality using the AMSTAR 2 checklist with quality assessment and data extraction by two reviewers. The degree of publication overlap of primary studies across the included reviews will also be calculated and a mapping of the evidence will also be presented.Öğe A Questionnaire-Based Study on Use of Plants in Diabetic Patients(Marmara Üniversitesi, 2025) Gürdal, Bahar; Toprak, BehiyeObjective: Among patients diagnosed with diabetes mellitus, we aimed to investigate the rates of use of medicinal plants, detailed information on use and purchase, socio-demographic characteristics associated with the tendency to use plants, and the status of reporting to health care professionals. Methods: The study was conducted in family health centers where patients diagnosed with diabetes mellitus visited. A questionnaire form of objective questions was filled for patients. The questionnaire included socio-demographic characteristics (age, gender, education) of the patients, disease condition, medicines used, and whether or not they used plants. If so, more information was obtained on the plants that are the name, used part, preparation method, frequency of administration, the place from which the plants was obtained, the person who advised the product, the knowledge of the physician and his/her attitude about herbals. Results: 100 people (66% women, 34% men) participated in the study between the ages of 24-80, 13% of them have Type 1 and 87% have Type 2 diabetes. Only 11% of patients use plants. Eight plants have been identified. The most commonly used plant (36.36%) is cinnamon. Among the usage of the plants, decoction is placed on the top, with 78%. 62.5% of the patients obtain the plants from herbal shops. Friends or relatives are the primary sources of information regarding medicinal plant use (73%). Conclusion: By increasing the knowledge of physicians about plants, it has been seen that patients can share their usage of plants more easily with physicians.Öğe Advances in vaccine adjuvant development and future perspectives(Taylor and Francis Ltd., 2025) Sinani, Genada; Şenel, SevdaUse of highly purified antigens to improve vaccine safety has led to reduced immunogenicity and efficacy, resulting in the need for adjuvants to increase and/or modulate the immunogenicity of the vaccine. Despite the need for potent and safe vaccine adjuvants, currently, there are still very few adjuvants in licensed human vaccines. Advances in immunology and molecular biology, especially in the last decade, have allowed researchers to understand better how the adjuvants work and enhance immune responses. While aluminum salts are still the most widely used adjuvants, research has shifted toward the rational design of adjuvant systems containing immunostimulatory molecules. Application of systems biology, which is based on high-throughput technologies using mathematical and computational modeling, has provided a deeper understanding of the biological events elicited by vaccination as well as the influence of other factors such as sex, age, microbiota, genetics and metabolism on the immune response. By this means, it became possible to tailor potential vaccine adjuvants more precisely for a successful vaccine with enhanced efficacy, safety and protection. In this review, after describing the mechanism of action of the adjuvants, current adjuvants in licensed vaccines, as well as those under clinical development will be mentioned in detail. Finally, new approaches in vaccine adjuvant development using systems biology and artificial intelligence will be reviewed, and future directions in vaccine research in regard to efficacy, safety and quality aspects will be discussed.Öğe Formulation Optimization on Semi-Solid NLC Dispersions Containing Antioxidant Herbal Oils: A Novel Approach for Cosmeceuticals(John Wiley and Sons Inc, 2025) Badıllı, Ulya; Çakır, Kerem; Yeğen, Gizem; İnal, Özge; Aksu, BuketSkin aging prevention is increasingly important in cosmetics. Topical application of antioxidants protects the skin against reactive oxygen species (ROS) generated as a result of continuous exposure to UV radiation. Herbal oils offer significant anti-aging potential due to their antioxidant content. Lipid nanoparticles (i.e., SLN and NLC) have been comprehensively evaluated for dermal drug delivery and cosmetic applications since they offer enhanced skin hydration and improved percutaneous penetration. The latest approach for dermal application is the usage of semi-solid lipid nanoparticle dispersions, which offer unique advantages. Semi-solid SLN/NLC dispersions have a suitable consistency for dermal application and can be prepared by a one-step production method without additional excipients. Furthermore, they preserve the colloidal particle size in spite of their semi-solid consistency. Development of novel cosmeceutical semi-solid NLC dispersions containing valuable herbal oils such as pomegranate seed, argan, grape seed, and coconut oils was aimed at in this study. Formulation optimization was performed using a modeling program based on response surface methodology (RSM). Optimum semi-solid NLC formulation (Opt-NLC) was prepared using Compritol 888ATO and argan oil at amounts of 0.8403 and 0.5457 g, respectively. The particle size of the Opt-NLC formulation was found to be 188.6 ± 3.58 nm, which falls within the targeted size range. PDI was also reduced and a more uniform particle size was obtained by optimization. Rheological and mechanical characterization results revealed that Opt-NLC has suitable properties in terms of product performance and consumer compliance. As a result, formulation optimization of semi-solid NLC dispersions containing antioxidant herbal oils was successfully performed using RSM methodology.Öğe Clinical and economic consequences of medication nonadherence: a review of systematic reviews(Frontiers Media, 2025) Achterbosch, Maria; Aksoy, Nilay; Obeng, George D.; Ameyaw, David; Agh, TamasBackground: Medication efficacy observed in clinical trials may differ from its effectiveness during real-world usage. Medication nonadherence is one of the key factors being responsible for this efficacy-effectiveness gap. The World Health Organization estimated that only 50% of chronic medication users is adherent and nonadherence results in both negative health outcomes for the patient and higher societal costs. An overview of the consequences across disease groups may allow some comparison and could contribute to identification of priority clinical areas. Objective: We aimed to provide an overview the impact of nonadherence on clinical and economic outcomes. Method: We narratively reviewed systematic reviews published between 2014 and 2024 on the effect of medication nonadherence on clinical and economic outcomes. Results: Overall, 43 systematic reviews were identified, including over 410 original studies on clinical outcomes and 174 on economic outcomes, covering different clinical areas (e.g., organ transplantation, cardiovascular diseases, diabetes, depression and chronic lung diseases [asthma/COPD]). Beyond diminished treatment effects, medication nonadherence has been associated with elevated mortality, increased healthcare utilization (including hospital admissions), and higher direct (e.g., more healthcare provider visits) and indirect financial cost burden (e.g., work productivity losses due to absenteeism and presenteeism) for patients and society. Conclusion: Medication nonadherence is associated with poor clinical and economic outcomes across disease areas. Given the significant impact of nonadherence, raising awareness among healthcare professionals and policymakers, early stakeholder engagement in intervention design, and eventually implementation of cost-effective interventions on both health policy, system and individual patient level are urgently required.Öğe UHPLC-DAD method development and validation for simultaneous quantification of 7 phenolic compounds in dietary supplements of sage capsules(Marmara University, 2025) Gözet, Tuba; Alkhidhri, AtharThe content of the dietary supplements of capsules generated from extracts of medicinal plants in terms of bioactive compounds may not be known. The aim of this study is to do method development and validation for quantification of the phenolic compounds (chlorogenic acid, caffeic acid, syringic acid, p-coumaric acid, ferulic acid luteolin-7-o-glucoside, and rosmarinic acid) in capsules of dietary sage (Salvia officinalis) supplements by ultra-high-performance liquid chromatography with diode array detector (UHPLC-DAD) to facilitate the quality control. Mobile phase gradient method is optimized in reverse UHPLC mode using aqueous acetonitrile as the mobile and C18 (50*2.1 mm, 1.8 µm) as the stationary phase. Quantitation was done by signal specific integration using diode array detector (DAD). Total run time is 18 minutes. Separation of the phenolic compounds were at 35 °C by employing gradient elution of water: trifluoroacetic acid (100:0.1, v/v) and acetonitrile: water: trifluoroacetic acid (95:5:0.1, v/v/v) as mobile phase A and B, respectively at a flow rate of 0.5 ml/min. The method showed good linearity with correlation coefficient (r2) that varied between 0.9993 and 0.9997. Limit of detection (LOD) and limit of quantification (LOQ) values were 1.97-18.77 and 6.58-62.56 mg/ml, respectively. Recovery (%) were between 90% and 114% for capsule matrix for all compounds at all levels except for ferulic acid and luteolin-7-o-glucoside. The method is suitable for application in quality control laboratories because of the short run time and simultaneous analysis of phenolic compounds in dietary supplements of sage capsules.Öğe Evaluating the Antibiofilm Effects of Antibiotics on Staphylococcus Species from Pediatric Hematology-Oncology Patients(2025) Vatansever, Cansu; Aksoy, Nilay; Adaklı Aksoy, Başak; Fışgın, TunçBiofilms are microbial communities and occur on different medical devices such as catheters. The formation of bacterial biofilms on medical devices leads to indwelling medical device-related infections. Since biofilm bacteria are more resistant to antibiotics than planktonic bacteria, using these antibiotics in indwelling medical device-related infections causes recurrence of infections, treatment failure, and death. Minimum inhibitory concentration (MIC) is an important reference in treating acute infections caused by planktonic bacteria. However, MIC is ineffective in indwelling medical device-related infections caused by biofilm bacteria. The study aims to demonstrate the necessity and development of effective and standard methods such as minimum biofilm prevention concentration, minimum biofilm inhibitory concentration, and minimum biofilm eradication concentration in the case of indwelling medical device-related infection. The study was conducted with 10 isolates of Staphylococcus species from patients who developed infections in the Pediatric Hematology-Oncology Department at Medical Park Bahcelievler Hospital. According to the study results, even if planktonic bacteria are sensitive to antibiotics, they can become resistant to this antibiotic when they are in a biofilm (p < 0.05, Crosstab). Also, inhibiting the growth of planktonic bacteria does not prevent biofilm formation. The study additionally revealed that inhibiting and eradicating biofilm is more difficult than preventing biofilm formation (p < 0.05).Öğe Optimizing stress ulcer prophylaxis practices and reducing associated costs in intensive care units: a non-randomized controlled study(2025) Ayhan, Yunus Emre; Eskidemir, Güneş; Koçoğlu Kınal, Ayşe Gül; Aksoy, NilayObjective: This study evaluated the use of stress ulcer prophylaxis (SUP), assessed the costs associated with inappropriate use, and highlighted the impact of clinical pharmacists on improving adherence to the SUP guidelines. Method: A prospective, non-randomized controlled study was carried out in two intensive care units (ICUs) of a training and research hospital between 1 June 2023 and 1 December 2023. Routine care services were provided for the observation group (OG) patients. In the guideline group (GG) patients, SUP management and routine care were performed according to ASHP guidelines. The physician and clinical pharmacist jointly evaluated the patients to determine the suitability of their SUP indications. Adherence rates to ASHP guidelines and the costs associated with nonadherence were evaluated. Results: A total of 196 patients were included in the study: 121 in the OG and 75 in the GG. A total of 54.6% of the patients were male, and the reason for hospitalization was mainly surgery (52.6%). SUP use was higher in OG (100%) than in GG (42.6%) (p < 0.001). The indication rate according to the ASHP guidelines was significantly higher in the GG group (100%) than in the OG group (54.5%) (p < 0.001). Dosage form adherence was significantly lower in the OG (0%) than in the GG (100%) (p < 0.001). The costs associated with proton pump inhibitor use for inappropriate indications and incorrect dosage forms were $60 versus $0 (p < 0.001) and $321 versus $0 (p < 0.001) in OG and GG, respectively. Overall, cost savings of $327 were achieved in the GG group. Conclusion: Inappropriate SUP use is common in the ICUs. Adequate adherence to guidelines and proactive involvement of clinical pharmacists may reduce inappropriate SUP in ICUs and the associated costs.Öğe Barriers to healthcare access and continuity of care among Ukrainian war refugees in Europe: findings from the RefuHealthAccess study(2025) Kardas, Przemyslaw; Mogilevkina, Iryna; Aksoy, Nilay; Agh, Tamas; Garuoliene, Kristina; Lomnytska, Marta; Istomina, Natalja; Urbanavice, Rita; Wettermark, Björn; Khanyk, NataliiaIntroduction: The Russian invasion of Ukraine displaced over 14 million people. By 2024, around 6 million Ukrainian refugees settled in Europe under the EU Temporary Protection Directive, providing permit of residence, work and health care. This influx strained European healthcare systems, particularly in addressing acute injuries. As the stay of refugees in EU countries prolongs, the management of chronic conditions becomes increasingly important. However, there is limited information available about Ukrainian refugees' access to various healthcare services. Aim: The aim of this study was to evaluate perceived accessibility of healthcare services in Europe for Ukrainian war refugees and to identify barriers to healthcare access, in order to inform improvements in healthcare provision. Methods: A cross-sectional online survey was conducted across Europe from July 2023 to April 2024, targeting adult Ukrainian war refugees. Survey explored areas defined as key health care needs. Descriptive, parametric and non-parametric statistical analysis methods were employed in data analysis. Results: Of 659 respondents, 550 (83.4%) were included in the final analysis due to having reported need to use healthcare services in the past year. The most prevalent needs included dental care (82.9%), prescription medication (81.6%), care for acute (78.4%), and chronic conditions (64.0%). Perceived access to care varied across services, with vaccinations rated highest, while chronic condition care rated lowest. Around ¼ of respondents reported that they had to temporarily return to Ukraine for services not available in the countries where they stayed, these being mostly dental and gynaecologic care. The most prevalent barriers reported were long waiting times (64.2%), information barriers (55.5%), and high service costs (49.1%). Discussion: The survey identified several barriers in the access to healthcare system for Ukrainians, particularly for chronic conditions care. Some barriers may be subjective, relating to limited access to information. However, others point to potential shortcomings within national healthcare systems, suggesting areas that require further review and improvement. Conclusions: Addressing language barriers, improving information dissemination, and enhancing chronic condition management were identified as crucial for improving healthcare access for Ukrainian war refugees. Coordinated strategies are needed to support refugees and ensure the sustainability of host healthcare systems.Öğe Online simulation versus traditional classroom learnings in clinical pharmacy education: effect on students' knowledge, satisfaction and self-confidence(BioMed Central, 2025) Selçuk, Aysu; Öztürk, Nur; Önal, Nurbanu; Bozkır, Asuman; Aksoy, NilayBackground: Over the course of the past few years, the area of medical education has experienced a substantial movement towards the establishment of online learning platforms and resources. This study aimed to to evaluate the efficacy of an online simulation learning intervention, MyDispense®, compared to traditional classroom learning in terms of enhancing knowledge, satisfaction, and self-confidence among participants. Methods: A multicentre randomized controlled study was conducted among pharmacy students who were assigned either intervention MyDispense® or control traditional classroom learning groups. They were eligible if they previously had experience with online simulation learning. A previously validated questioner were used to measure the outcome of knowledge, satisfaction and self-confidence. Results: Both the intervention and control groups revealed significant improvement in knowledge, the P value for pre-post knowledge scores for each group was < 0,001. Despite these internal improvements, this study's findings showed no statistically significant differences (p > 0.05) between the intervention and control groups on knowledge gain, satisfaction, or self-confidence. This represents comparable outcomes irrespective of the group's exposure to intervention. Conclusion: The study evaluated the efficacy of online simulation learning intervention MyDispense® in comparison to traditional classroom learning. While both strategies effectively improved knowledge, satisfaction, and self-confidence, the findings demonstrated that the online simulation yielded equivalent learning benefits. MyDispense® could be an alternative to traditional education in situations where face to face learning is not feasible, with comparable learning outcomes. Clinical trial number: not applicable.Öğe Chemotherapy-related cognitive impairment and kidney dysfunction(2025) Simeoni, Mariadelina; Mulholland, Michele M.; Workeneh, Biruh T.; Capasso, Anna; Capasso, Anna; Hafez, Gaye; Liabeuf, Sophie; Malyszko, Jolanta; Mani, Laila-Yasmin; Trevisani, Francesco; De, Ananya; Wagner, Carsten A.; Massy, Ziad A.; Unwin, Robert; Capasso, Giovambattista; CONNECT Action (Cognitive Decline in Nephro-Neurology European Cooperative Target) collaboratorsCancer and kidney diseases (KD) intersect in many ways resulting in worse outcomes. Both conditions are correlated with cognitive impairment, which can be exacerbated in cancer patients by known effects of many antineoplastic drugs on cognition, leading to a phenomenon known as chemotherapy-related cognitive impairment (CRCI). This manifests as poor attention span, disturbed short-term memory, and general mental sluggishness. This literature review explores CRCI and investigates the potential impact of KD on this phenomenon. Additionally, we highlight the shared pathogenetic mechanisms (including neurotoxicity, neuroinflammation, oxidative stress, vascular disease, electrolyte, and acid-base imbalances), clinical presentation and imaging findings between cognitive impairment in KD and CRCI. The disruption of the blood-brain barrier might be a key mechanism for increased brain permeability to anticancer drugs in nephropathic patients with cancer. Based on existing knowledge, we found a potential for heightened neurotoxicity of antineoplastic drugs and a synergistic potentiation of cognitive impairment in cancer patients with KD. However, further translational research is urgently required to validate this hypothesis.Öğe Big databases and biobanks for studying the links between CKD, cognitive impairment, and dementia(2025) Zoccali, Carmine; Mallamaci, Frances; Rosenberg, Kerry; Unwin, Robert; Silva, Pedro Imenez; Simeoni, Maria Adelina; Hafez, Gaye; Capasso, Giovambattista; Nitsch, Dorothea; CONNECT Action (Cognitive Decline in Nephro-Neurology European Cooperative Target) collaboratorsResearch on cognitive function in individuals with chronic kidney disease (CKD) is critical due to the significant public health challenge posed by both CKD and cognitive impairment. CKD affects approximately 10-15% of the adult population, with higher prevalence in the elderly, who are already at increased risk for cognitive decline. Cognitive impairment is notably higher in CKD patients, particularly those with severe stages of the disease, and progresses more rapidly in those on dialysis. This review explores how data from large biobank studies such as the Alzheimer's Disease Neuroimaging Initiative, UK Biobank, and others could be used to enhance understanding the progression and interplay between CKD and cognitive decline. Each of these data sources has specific strengths and limitations. Strengths include large sample sizes and longitudinal data across different groups, and in different settings. Addressing limitations leads to challenges in dealing with heterogeneous data collection methods, and addressing missing data, which requires the use of sophisticated statistical techniques. Combining data from multiple databases can mitigate individual study limitations, particularly via the 'epidemiological triangulation' concept. Using such data appropriately holds immense potential to better understand the pathobiology underlying CKD and cognitive impairment. Addressing the inherent challenges with a clear strategy is crucial for advancing our understanding and improving the lives of those affected by both CKD and cognitive impairment.Öğe Genetic and circulating biomarkers of cognitive dysfunction and dementia in CKD(2025) Zoccali, Carmine; Mallamaci, Francesca; Wagner, Carsten A.; Unwin, Robert; Nedergaard, Maiken; Hafez, Gaye; Malyszko, Jolanta; Pepin, Marion; Massy, Ziad; Paolisso, Giuseppe; Remuzzi, Giuseppe; Capasso, Giovambattista B.; CONNECT Action (Cognitive Decline in Nephro-Neurology European Cooperative Target) collaboratorsChronic kidney disease (CKD) is commonly accompanied by cognitive dysfunction and dementia, which, in turn, increase the risk of hospitalization, cardiovascular events and death. Over the last 30 years, only four studies focused on genetic markers of cognitive impairment in CKD and kidney failure (KF), indicating a significant gap in research. These studies suggest potential genetic predispositions to cognitive decline in CKD patients but also underscore the necessity for more comprehensive studies. Seventeen reports have established connections between cognitive function and kidney disease markers such as estimated glomerular filtration rate (eGFR), Cystatin C and albuminuria. A rapid eGFR decline has been associated with cognitive deterioration and vascular dementia, and mild to moderate eGFR reductions with diminished executive function in elderly men. Various biomarkers have been associated to Alzheimer’s disease or dementia in CKD and KF. These include amyloid beta and phosphorylated tau proteins, uremic toxins, gut microbiota, metabolic indicators, hypertension, endothelial dysfunction, vitamins and inflammation. However, the causal relevance of these associations remains unclear. Overall, the available evidence points to a complex interplay between the different biomarkers and cognitive health in CKD patients, underscoring the need for more research to elucidate these relationships.Öğe Cognitive impairment in kidney transplanted patients(2025) Malyszko, Jolanta; Golenia, Aleksandra; Farisco, Michele; Lo Re, Vincenzina; Klimkowicz-Mrowiec, Aleksandra; Capasso, Giovambattista; Goumenos, Dimitris; Rroji, Merita; Figurek, Andreja; Hafez, Gaye; CONNECT Action (Cognitive Decline in Nephro-Neurology European Cooperative Target) collaboratorsChronic kidney disease affects almost all of the organs. Recently, more attention has been paid to the kidney and the central nervous system connections. In patients on kidney replacement therapy, including kidney transplantation, there is an increased prevalence of cognitive impairment, and depression and other neurological complications, such as cerebrovascular disorders and movement disorders. Kidney transplant recipients need an assessment for the risk factors and the pattern of cognitive impairment (memory, attention and executive function decline). This enables an accurate diagnosis to be made at an earlier stage. Partial post-transplant cognitive impairment recovery is also important. Finally, doctors and patients alike face numerous ethical concerns and challenges regarding the transplantation of kidneys and other solid organs. In this review, we examined some key issues regarding cognitive impairment in kidney transplant patients. We focused on the mechanism of cognitive impairment in kidney transplant recipients, patterns of cognitive impairment; evaluation of patients with cognitive impairment for kidney transplantation, the potential impact of cognitive impairment on waitlisted and transplanted patients on patient care, non-pharmacological interventions and unmet medical needs, psychological and ethical issues in kidney transplantation, and unmet needs. As cognitive impairment in kidney transplant recipients is an underestimated, underrecognized but clinically relevant problem, screening for cognitive function before and after kidney transplantation would be worth considering in standard routine practice.Öğe Medication adherence in the curricula of future European physicians, pharmacists and nurses - a cross-sectional survey(2025) Gottlieb, Hanna; Seghers, Laura; Leiva-Fernandez, Francisca; Ghiciuc, Cristina Mihaela; Hafez, Gaye; Herdeiro, Maria Teresa; Petrovic, Ana Tomas; Novais, Teddy; Schneider, Marie P.; Dima, Alexandra; Ekenberg, Marie; Wettermark, Björn; European Network to Advance Best Practices Technology on Medication Adherence (ENABLE)Aim: Many patients are not taking their medicines. It has substantial negative medical and economic consequences for patients and healthcare systems but there is limited knowledge on how medication adherence is integrated in medical education. This study seeks to investigate to what extent students in medicine, pharmacy and nursing in Europe are taught about medication adherence. Methods: A cross-sectional online survey was distributed to 731 persons teaching relevant courses across 142 European universities between February and June 2024. The survey addressed definitions of adherence and The ABC Taxonomy; methods to support adherence, methods to identify and monitor non-adherence; consequences and outcomes of non-adherence, and methods applied in teaching. They were also asked to provide links to their curricula. Responses from quantitative questions were analyzed descriptively. Word frequency and qualitative thematic analysis was used for the curricula inventory and analysis of free-text answers, respectively. Results: In total, 212 participants from 114 universities in 34 countries completed the survey. Respondents agreed to similar level on the need to enhance medication adherence teaching, with 72% in pharmacy, 71% medical, and 59% agreement in nursing education. The most taught topic across educations was the clinical impact of non-adherence, according to 89% in pharmacy, 84% medical, and 76% in nursing education. The ABC Taxonomy was taught in more than half of all pharmacy (73%), nursing (60%) and medical education (52%). In the qualitative analysis of free text-answers respondents emphasized the value of early, mixed method teaching. They reported a lack of guidance in teaching medication adherence, causing inconsistency in the educational quality and depth. Time constraints were highlighted as a significant challenge, while interprofessional collaboration and use of medication adherence technologies were seen as opportunities, though not widely implemented in teaching. The curricula inventory showed a substantial variance in how medication adherence content was described. Conclusion: There is a lack of consistent teaching on medication adherence in Europe, underlining the necessity to establish a unified curriculum incorporating the ABC taxonomy, and to include a more patient-centred approach to support medication adherence.Öğe Cognitive impairment in CKD patients: a guidance document by the CONNECT network(2025) Bolignano, Davide; Simeoni, Mariadelina; Hafez, Gaye; Pepin, Marion; Gallo, Antonio; Altieri, Manuela; Liabeuf, Sophie; Giannakou, Konstantinos; De, Ananya; Capasso, GiovambattistaCognitive impairment is a prevalent and debilitating complication in patients with chronic kidney disease (CKD). This position paper, developed by the Cognitive Decline in Nephro-Neurology: European Cooperative Target network, provides guidance on the epidemiology, risk factors, pathophysiology, diagnosis and clinical management of CKD-related cognitive impairment. Cognitive impairment is significantly more common in CKD patients compared with the general population, particularly those undergoing haemodialysis. The development of cognitive impairment is influenced by a complex interplay of factors, including uraemic neurotoxins, electrolytes and acid-base disorders, anaemia, vascular damage, metabolic disturbances and comorbidities like diabetes and hypertension. Effective screening and diagnostic strategies are essential for early identification of cognitive impairment utilizing cognitive assessment tools, neuroimaging and circulating biomarkers. The impact of various drug classes, including antiplatelet therapy, oral anticoagulants, lipid-lowering treatments and antihypertensive drugs, on cognitive function is evaluated. Management strategies encompass pharmacological and non-pharmacological interventions, with recommendations for optimizing cognitive function while managing CKD-related complications. This guidance highlights the importance of addressing cognitive impairment in CKD patients through early detection, careful medication management and tailored therapeutic strategies to improve patient outcomes.Öğe Cholinergic system in patients with chronic kidney disease: cognitive and renal implications(2025) Xu, Hong; Eriksdotter, Maria; Hafez, Gaye; Sumonto, Mitra; Bruchfeld, Annette; Pesic, Vesna; Unwin, Robert; Wagner, Carden A.; Massy, Carsten; Massy, Ziad A.; Zoccali, Carmine; Pepin, Marion; Capasso, Giovambattista; Liabeuf, Sophie; CONNECT Action (Cognitive Decline in Nephro-Neurology European Cooperative Target)Cholinergic synapses are widespread throughout the human central nervous system. Their high density in the thalamus, neocortex, limbic system, and striatum suggests that cholinergic transmission plays a vital role in memory, attention, learning and other higher cognitive functions. As a result, the brain's cholinergic system occupies a central position in research on normal cognition and age-related cognitive decline, including dementias such as Alzheimer's disease. In addition to its role in the brain, neuronal cholinergic pathways are essential for the physiological regulation of bodily organs, including the kidneys, through the parasympathetic branch of the peripheral nervous system. Chronic kidney disease (CKD) is a non-communicable disease with a global prevalence of approximately 10%. Cognitive impairment is common among patients with CKD, with reported prevalence rates ranging from 30% to 60%, depending on definitions and assessment methods used. Given the importance of the cholinergic system in cognitive processes, it may be a key area of focus for evaluating cognitive function in this population. In this current narrative review, we will first examine evidence linking the cholinergic system to cognitive functions; with a specific focus on drugs that affect this system. we will then discuss the potential implications of cholinergic function in patients with CKD.Öğe The interface of depression and diabetes: treatment considerations(2025) Fanelli, Giuseppe; Raschi, Emanuel; Hafez, Gaye; Matura, Silke; Schiweck, Carmen; Poluzzi, Elisabetta; Lunghi, CarlottaThis state-of-the-art review explores the relationship between depression and diabetes, highlighting the two-way influences that make treatment challenging and worsen the outcomes of both conditions. Depression and diabetes often co-occur and share genetic, lifestyle, and psychosocial risk factors. Lifestyle elements such as diet, physical activity, and sleep patterns play a role on the development and management of both conditions, highlighting the need for integrated treatment strategies. The evidence suggests that traditional management strategies focusing on either condition in isolation fall short of addressing the intertwined nature of diabetes and depression. Instead, integrated care models encompassing psychological support and medical management are recommended to improve treatment efficacy and patient adherence. Such models require collaboration across multiple healthcare disciplines, including endocrinology, psychiatry, and primary care, to offer a holistic approach to patient care. This review also identifies significant patient-related barriers to effective management, such as stigma, psychological resistance, and health literacy, which need to be addressed through patient-centered education and support systems. Future directions for research include longitudinal studies in diverse populations to further elucidate causal relationships and the exploration of novel therapeutic targets, as well as the effectiveness of healthcare models aimed at preventing the onset of one condition in individuals diagnosed with the other.Öğe Clinical research framework proposal for ketogenic metabolic therapy in glioblastoma(2024) Duraj, Tomas; Kalamian, Miriam; Zuccoli, Giulio; Maroon, Joseph C.; D'Agostino, Dominic P.; Scheck, Adrienne C.; Poff, Angela; Winter, Sebastian F.; Hu, Jethro; Klement, Rainer J.; Hickson, Alicia; Lee, Derek C.; Cooper, Isabella; Kofler, Barbara; Schwartz, Kenneth A.; Phillips, Matthew C. L.; Champ, Colin E.; Zupec-Kania, Beth; Tan-Shalaby, Jocelyn; Serfaty, Fabiano M.; Omene, Egiroh; Arismendi-Morillo, Gabriel; Kiebish, Mİchael; Cheng, Rİchard; El-Sakka, Ahmed M.; Pflueger, Axel; Mathews, Edward H.; Worden, Donese; Shi, Hanping; Cincione, Raffaele Ivan; Spinosa, Jean Pierre; Slocum, Abdul Kadir; İyikesici, Mehmet Salih; Yanagisawa, Atsuo; Pilkington, Geoffrey J.; Chaffee, Anthony; Abdel-Hadi, Wafaa; Elsamman, Amr K.; Klein, Pavel; Hagihara, Keisuke; Clemens, Zsofia; Yu, George W.; Evangeliou, Athanasios E.; Nathan, Janak K.; Smith, Kris; Fortin, David; Dietrich, Jorg; Mokherjee, Purna; Seyfried, Thomas N.Glioblastoma (GBM) is the most aggressive primary brain tumor in adults, with a universally lethal prognosis despite maximal standard therapies. Here, we present a consensus treatment protocol based on the metabolic requirements of GBM cells for the two major fermentable fuels: glucose and glutamine. Glucose is a source of carbon and ATP synthesis for tumor growth through glycolysis, while glutamine provides nitrogen, carbon, and ATP synthesis through glutaminolysis. As no tumor can grow without anabolic substrates or energy, the simultaneous targeting of glycolysis and glutaminolysis is expected to reduce the proliferation of most if not all GBM cells. Ketogenic metabolic therapy (KMT) leverages diet-drug combinations that inhibit glycolysis, glutaminolysis, and growth signaling while shifting energy metabolism to therapeutic ketosis. The glucose-ketone index (GKI) is a standardized biomarker for assessing biological compliance, ideally via real-time monitoring. KMT aims to increase substrate competition and normalize the tumor microenvironment through GKI-adjusted ketogenic diets, calorie restriction, and fasting, while also targeting glycolytic and glutaminolytic flux using specific metabolic inhibitors. Non-fermentable fuels, such as ketone bodies, fatty acids, or lactate, are comparatively less efficient in supporting the long-term bioenergetic and biosynthetic demands of cancer cell proliferation. The proposed strategy may be implemented as a synergistic metabolic priming baseline in GBM as well as other tumors driven by glycolysis and glutaminolysis, regardless of their residual mitochondrial function. Suggested best practices are provided to guide future KMT research in metabolic oncology, offering a shared, evidence-driven framework for observational and interventional studies.Öğe Antioxidant, anti-tyrosinase activities and characterization of phenolic compounds for some plants from the Marmara Region, Türkiye(2024) Meriç, Zehra İlke; Nath, Ebru Özdemir; Doğan, Ahmet; Bitiş, LeylaIn this study, antioxidant, anti-tyrosinase, and sun protection factor (SPF) values of 26 extracts obtained from 24 plants naturally grown in the Marmara Region were investigated, and phenolic compound characterization of 8 active plants was performed. All of the plants mentioned in this study have been evaluated for their Sun Protection Factor (SPF) values for the first time, as well as 3 of them evaluated for antioxidant activity and 15 of them evaluated for tyrosinase inhibition for the first time. The results showed that the plant extracts generally exhibited high antioxidant activities. In terms of DPPH radical scavenging activity, Cota tinctoria (L.) J. Gay exhibited a very close IC50 value (0.038 mg/mL) to the standard compounds, ascorbic acid and quercetin. Plantago major L. subsp. intermedia (Gilib.) Lange demonstrated the highest CUPRAC radical scavenging activity (0.187 mM ascorbic acid equivalent). Hypericum perforatum L. was determined to have the highest total phenolic content (0.268 mg GAE g/extract). Among the plant extracts, Sambucus ebulus L. fruit extract exhibited the highest tyrosinase inhibition (IC50 0.08 mg/mL), showing a similar effect to the standard compound kojic acid. The extract with the highest SPF value was calculated Inula oculuschristi L. extract, with a value of 28.55. The phenolic compound analysis of eight plants, which have been determined to exhibit high efficacy in both antioxidant activities and tyrosinase inhibition, was conducted. Some of phenolic compounds obtained from these eight plants were novel for these species. According to the experiments conducted in this study, Euphorbia helioscopia has high potential as natural sources of antioxidants and skin whiteners.
