Search Results (909)

Background: Telepharmacy, the provision of patient care services by pharmacists through the use of telecommunications technology, is associated with improved diabetes-related outcomes and access to healthcare. The primary aim of this study was to characterize pharmacists’ interventions at a virtual pharmacist-led diabetes clinic (PLDC). The secondary aim was to assess the feasibility of conducting a future cost-effectiveness study of the PLDCs. Methods: This prospective observational feasibility study was conducted within a pharmacist-led clinic at Seha Virtual Hospital, Riyadh, Saudi Arabia. Two intern pharmacists collected data between 31 July 2024 and 31 January 2025. Results: Seventy-five patients (mean [SD] age 50.47 years [14.95]) attended the clinic. The majority were female (58.7%), had type 2 diabetes (86.6%), and were from outside Riyadh (97.3%). The communication with patients was carried out mainly via telephone (73, 97.3%). The mean consultation duration was 7.64 min (SD = 5.68). A total of 179 interventions were conducted, with a mean number of interventions per patient of 2.5 (median 3, min 0, max 5). The most common intervention was patient education and counseling about their disease and medications. While it was feasible to capture the details of pharmacist interventions and resource use data, incomplete data on patient outcomes presented a challenge. Conclusions: Our detailed documentation of pharmacist–patient encounters revealed the ability of pharmacists to identify and manage the problems of diabetes patients at virtual PLDCs. Our feasibility study identified a few challenges that need to be addressed when designing future cost-effectiveness studies. Full article

The Horizon 2020 EnerMaps project addresses the fragmentation and variable reliability of European energy datasets by developing a reproducible quality control (QC) framework aligned with FAIR principles. This research supports sustainability goals by enabling better decision making in energy management, resource optimization, and sustainable policy development. This study applies this framework to an initial inventory of 50 spatially referenced energy datasets, classifying them into three assessment levels and subjecting each level to progressively deeper checks: expert consultation, metadata verification against a customized “DataCite/schema.org” schema, documentation review, completeness analysis, consistency testing via simple linear regressions, comparative descriptive statistics, and community feedback preparation. The results show that all datasets are findable and accessible, yet critical FAIR attributes remain weak: 68% lack explicit licenses and 96% omit terms-of-use statements; methodology descriptions are present in 77% of cases, while quantitative accuracy information appears in only 43%. Completeness screening reveals that more than half of the datasets exhibit over 20% missing values in one or more key dimensions. Consistency analyses nevertheless indicate statistically significant correlations (p < 0.05) for the majority of paired comparisons, supporting basic reliability. By improving the FAIRness (Findable, Accessible, Interoperable, Reusable) of energy data, this study directly contributes to more effective sustainability assessments and interventions. The proposed QC workflow therefore provides a scalable route to improve the transparency, comparability, and reusability of heterogeneous energy data, and its adoption could accelerate open energy modelling and policy analysis across Europe. Full article

Background/Objectives: Pacific peoples in Aotearoa, New Zealand experience the highest burden of gout globally, yet there is still a lack of awareness and understanding of the disease. A Pacific community group and Pacific health professional network co-designed Pacific gout resources to improve understanding. The aim of this study is to identify and discuss the current state and perceptions of Pacific gout education, and explore health professionals’ views on Pacific co-designed resources and their usefulness in clinical settings. Methods: The Fa’afaletui model was utilised to conduct semi-structured Talanga interviews with 14 health professionals in Auckland, New Zealand who work in primary care clinics. The interview explored their views on providing gout education and on the feasibility of the Pacific co-designed gout resources. Talanga interviews were audio recorded and thematically analysed. Results: Overall, health professionals responded positively to the co-designed resources, identifying the benefits of supporting primary care consultations and improving Pacific patients’ understanding of gout. The key findings were summarised in five main themes: (1) health system barriers to gout education, (2) misleading information, (3) health professionals’ experiences of providing health education, (4) general impressions of Pacific co-designed resources, and (5) the feasibility of Pacific co-designed educational resources in a clinical setting. Conclusions: This study presents the views of health professionals in providing health education related to gout and on the feasibility of Pacific co-designed educational resources. It reinforces the significance of involving communities in the design and implementation of interventions to ensure they are culturally safe, relevant, and have long-term impacts on gout management. Full article

Introduction: The application of information and communication tools in healthcare is becoming increasingly widespread and is obtaining promising results. However, their use by informal caregivers is not adequately elucidated. Objective: The aim was to analyze the opinions, perceptions, and attitudes of informal caregivers of stroke patients concerning the use of Stroke-CareApp (Version 1), a smartphone application (app) designed exclusively for this population. Methods: A qualitative study was conducted using a phenomenological approach. Five caregivers used Stroke-CareApp, an app designed as a meeting place for peers, with information about the disease and access to healthcare professionals. Results: The discourses obtained from the interviews were analyzed, and the resulting codes were divided into eight categories: impact on the caregiver, coping with caregiving, involvement in caregiving, steps toward recovery in the absence of the caregiver, relevance for the caregiver, facilitating factors for the use of the app, source of consultation when in doubt and reliability of the information, and limitations in the use of the app. Conclusions: Although caregivers consider the app a beneficial intervention for them, it is important to note that it is a complementary alternative to other interventions, and one must be patient and perseverant during the initial months to achieve optimal adherence. Full article

Background: Exercise rehabilitation is a crucial component of stroke recovery, particularly for patients transitioning to home or community settings. However, there is currently a lack of self-reported scales designed to measure the level of engagement in exercise rehabilitation among patients with stroke. Objective: To develop and validate psychometric properties of the Engagement in Exercise Rehabilitation Scale for patients with stroke. Methods: The initial item pool was extracted from a literature review and a semi-structured interview with patients with stroke. The development and refinement of the items underwent expert consultation and cognitive interviews with patients with stroke. The items primarily covered patients’ perceptions, emotional attitudes, and specific engagement behaviors regarding exercise rehabilitation in home or community settings. A total of 260 patients with stroke were selected to test the reliability and validity. The psychometric proprieties test included construct validity, content validity, criterion-related validity, exploratory factor analysis, internal consistency reliability, test–retest reliability, and split-half reliability. Results: The final version of the Engagement in Exercise Rehabilitation Scale comprised 20 items. The scale’s content validity index was determined to be 0.976, while the item-content validity indices ranged from 0.833 to 1.000. Results from exploratory factor analysis indicated that this scale is unidimensional, with a cumulative variance contribution rate of 79.3%. The test–retest reliability of the scale was found to be 0.879, its split-half reliability was measured at 0.980, and its Cronbach’s α coefficient was calculated to be 0.986. Conclusion: The Engagement in Exercise Rehabilitation Scale for patients with stroke demonstrates accepted reliability and validity. The accuracy and generalizability of this scale necessitate further validation through additional large-sample studies involving diverse populations across multiple centers. Full article

Large language models (LLMs) have become extensively used among users across diverse settings. Yet, with the complex nature of these large-scale artificial intelligence (AI) systems, leveraging their capabilities effectively is yet to be explored. In this study, we looked at the types of communication errors that occur in interactions between humans and ChatGPT-3.5 in Arabic. A corpus of six Arabic-language consultations was collected from an online mental health support forum. For each consultation, the researchers provided the user’s Arabic queries to ChatGPT-3.5 and analyzed the system’s responses. The study identified 102 communication errors, mostly grammatical and repetitions. Other errors involved contradictions, ambiguous language, ignoring questions, and lacking sociality. By examining the patterns and types of communication errors observed in ChatGPT’s responses, the study is expected to provide insights into the challenges and limitations of current conversational AI systems, particularly in the context of sensitive domains like mental health support. Full article

Telemedicine has transformed obstetrics and gynecology (OB/GYN), accelerated by the COVID-19 pandemic. This study aims to synthesize evidence on the adoption, effectiveness, barriers, and technological innovations of telemedicine in OB/GYN across diverse healthcare settings. This scoping review synthesized 63 peer-reviewed studies (2010–2023) using PRISMA-ScR guidelines to map global applications, outcomes, and challenges. Key modalities included synchronous consultations, remote monitoring, AI-assisted triage, tele-supervision, and asynchronous communication. Results demonstrated improved access to routine care and mental health support, with outcomes for low-risk pregnancies comparable to in-person services. Adoption surged >500% during pandemic peaks, stabilizing at 9–12% of services in high-income countries. However, significant disparities persisted: 43% of rural Sub-Saharan clinics lacked stable internet, while socioeconomic, linguistic, and cultural barriers disproportionately affected vulnerable populations (e.g., non-English-speaking, transgender, and refugee patients). Providers reported utility but also screen fatigue (41–68%) and diagnostic uncertainty. Critical barriers included fragmented policies, reimbursement variability, data privacy concerns, and limited evidence from conflict-affected regions. Sustainable integration requires equity-centered design, robust policy frameworks, rigorous longitudinal evaluation, and ethically validated AI to address clinical complexity and systemic gaps. Full article

This research examines the connection between leadership and sustainable development, emphasizing how community involvement moderates it. It seeks to analyze the impact of leadership styles on sustainable development practices in three distinct cultural and economic contexts: Pakistan, India, and Taiwan. The study participants include managers, entrepreneurs, and consultants. A quantitative research methodology, which included questionnaires and statistical analysis, was used to collect data from business professionals in these three nations. This study considers the viewpoints of both general business leaders and the insights provided by small and medium-sized enterprises, which play a crucial role in driving economic growth in these areas. For example, 99% of Pakistan’s enterprises are small and medium-sized enterprises. However, due to financial constraints, small and medium-sized enterprises face obstacles such as limited innovative capacity. Small and medium-sized enterprises are vital to economic growth in Taiwan and India as well. Small and medium-sized enterprises generate many jobs and contribute substantially to GDP. Effective leadership is critical for promoting sustainability goals, as the findings show that leadership benefits sustainable development projects (H1). Sustainable development outcomes are greatly improved when the community is actively involved (H2), further demonstrating the significance of community involvement as a key component of effective sustainability measures. Contrary to expectations (H3), community involvement did not moderate the relationship between leadership and sustainable development as hypothesized; rather, it appeared as an independent factor that positively influenced sustainability outcomes. The findings highlight the broad relevance of effective leadership practices in various socioeconomic contexts. This study offers valuable insights for policymakers seeking to promote sustainable growth by emphasizing the importance of effective leadership practices and active community engagement within small and medium-sized enterprises. Full article

Background/Objectives: The middle-income countries (MICs) in the Middle East and North Africa (MENA) region face multifaceted challenges—including fiscal constraints, conflict, and vaccine hesitancy—that impede the timely introduction of critical vaccines. This study examines the status, barriers, and facilitators to introducing three critical vaccines—human papillomavirus vaccine (HPV), pneumococcal conjugate vaccine (PCV), and rotavirus vaccine (RV)—across seven MENA MICs, to identify actionable solutions to enhance vaccine uptake and immunisation coverage. Methods: Using the READ methodology (ready materials, extract, analyse, and distil data), this review systematically analysed policy documents, reports, and the literature on the introduction of HPV, PCV, and RV vaccines in seven MENA MICs. A data extraction framework was designed to capture the status of vaccine introduction and barriers and facilitators to introduction. Findings and data gaps were validated with stakeholder consultations. Results: Of the seven study countries, progress in introducing PCV and RV has been uneven across the region (five countries have introduced PCV, four have introduced RV, and only a single country has introduced HPV at time of writing), hindered by vaccine hesitancy, fiscal challenges, and insufficient epidemiological data. Morocco is the only country to introduce all three vaccines, while Egypt has yet to introduce any. Other common barriers include the impact of conflict and displacement on healthcare infrastructure, delayed introduction due to the 2020 COVID-19 pandemic, and limited local production facilities and regional cooperation. In addition, not all countries eligible for Gavi MICs support have applied. These findings provide a roadmap for policymakers to accelerate equitable vaccine introduction in the MENA region. Conclusions: Targeted efforts, such as addressing fiscal constraints, improving local manufacturing, tackling gender barriers, and fostering public trust, paired with regional collaboration, can help bridge gaps and ensure no community is left behind in preventing vaccine-preventable diseases. Full article

Current agentic AI frameworks such as LangGraph and AutoGen simulate autonomy via sequential prompt chaining but lack true multi-agent coordination architectures. These systems conflate semantic reasoning with orchestration, requiring LLMs at every coordination step and limiting scalability. By contrast, TB-CSPN (Topic-Based Communication Space Petri Net) is a hybrid formal architecture that fundamentally separates semantic processing from coordination logic. Unlike traditional Petri net applications, where the entire system state is encoded within the network structure, TB-CSPN uses Petri nets exclusively for coordination workflow modeling, letting communication and interaction between agents drive semantically rich, topic-based representations. At the same time, unlike first-generation agentic frameworks, here LLMs are confined to topic extraction, with business logic coordination implemented by structured token communication. This hybrid architectural separation preserves human strategic oversight (as supervisors) while delegating consultant and worker roles to LLMs and specialized AI agents, avoiding the state-space explosion typical of monolithic formal systems. Our empirical evaluation shows that TB-CSPN achieves 62.5% faster processing, 66.7% fewer LLM API calls, and 167% higher throughput compared to LangGraph-style orchestration, without sacrificing reliability. Scaling experiments with 10–100 agents reveal sub-linear memory growth (10× efficiency improvement), directly contradicting traditional Petri Net scalability concerns through our semantic-coordination-based architectural separation. These performance gains arise from the hybrid design, where coordination patterns remain constant while semantic spaces scale independently. TB-CSPN demonstrates that efficient agentic AI emerges not by over-relying on modern AI components but by embedding them strategically within a hybrid architecture that combines formal coordination guarantees with semantic flexibility. Our implementation and evaluation methodology are openly available, inviting community validation and extension of these principles. Full article

DIALOGUE (DIagnostic AI Learning through Objective Guided User Experience) is a generative artificial intelligence (GenAI)-based training program designed to enhance diagnostic communication skills in medical students. In this single-arm pre–post study, we evaluated whether DIALOGUE could improve students’ ability to disclose a type 2 diabetes mellitus (T2DM) diagnosis with clarity, structure, and empathy. Thirty clinical-phase students completed two pre-test virtual encounters with an AI-simulated patient (ChatGPT, GPT-4o), scored by blinded raters using an eight-domain rubric. Participants then engaged in ten asynchronous GenAI scenarios with automated natural-language feedback. Seven days later, they completed two post-test consultations with human standardized patients, again evaluated with the same rubric. Mean total performance increased by 36.7 points (95% CI: 31.4–42.1; p < 0.001), and the proportion of high-performing students rose from 0% to 70%. Gains were significant across all domains, most notably in opening the encounter, closure, and diabetes specific explanation. Multiple regression showed that lower baseline empathy (β = −0.41, p = 0.005) and higher digital self-efficacy (β = 0.35, p = 0.016) independently predicted greater improvement; gender had only a marginal effect. Cluster analysis revealed three learner profiles, with the highest-gain group characterized by low empathy and high digital self-efficacy. Inter-rater reliability was excellent (ICC ≈ 0.90). These findings provide empirical evidence that GenAI-mediated training can meaningfully enhance diagnostic communication and may serve as a scalable, individualized adjunct to conventional medical education. Full article

The social acceptance of Renewable Energy Sources (RESs) is a decisive factor in the successful implementation of clean energy projects. This study explores the attitudes, demographic profiles, and common misconceptions of citizens in the Region of Epirus, Greece, toward photovoltaic and wind energy installations. Special attention is given to the role of education, age, and access to information—as well as spatial factors such as visual exposure—in shaping public perceptions and influencing acceptance of RES deployment. A structured questionnaire was administered to 320 participants across urban and rural areas, with subdivision between regions with and without visual exposure to RES infrastructure. Findings indicate that urban residents exhibit greater acceptance of RES, while rural inhabitants—especially those in proximity to installations—express skepticism, often grounded in esthetic concerns or perceived procedural injustice. Misinformation and lack of knowledge dominate in areas without visual contact. Statistical analysis confirms that younger and more educated participants are more supportive and environmentally aware. The study highlights the importance of targeted educational interventions, transparent consultation, and spatially sensitive communication strategies in fostering constructive engagement with renewable energy projects. The case of Epirus underscores the need for inclusive, place-based policies to bridge the social acceptance gap and support the national energy transition. Full article

Residential green space is an important component of urban green space and one of the major indicators for evaluating the quality of a residential community. Traditional indicators such as the green space ratio only consider the relationship between green space area and total area of the residential community while ignoring the difference in the amount of green space enjoyed by household residents in high-rise and low-rise buildings. Therefore, it is meaningful to estimate household green space and its spatial distribution in residential communities. However, there are frequent difficulties in obtaining specific green space area and household number through ground surveys or consulting with property management units. In this study, taking a composite residential community in Chongqing, China, as the study site, we first employed a five-lens drone to capture its oblique RGB images and generated the DOM (Digital Orthophoto Map). Subsequently, the green space area and distribution in the entire residential community were extracted from the DOM using VDVI (Visible Difference Vegetation Index). The YOLACT (You Only Look At Coefficients) instance segmentation model was used to recognize balconies from the facade images of high-rise buildings to determine their household numbers. Finally, the average green space per household in the entire residential community was calculated to be 67.82 m², and those in the high-rise and low-rise building zones were 51.28 m² and 300 m², respectively. Compared with the green space ratios of 65.5% and 50%, household green space more truly reflected the actual green space occupation in high- and low-rise building zones. Full article

Aims/Background: Polypharmacy, or the concurrent intake of five or more medications, is a significant issue in clinical practice, particularly in multimorbid elderly individuals. Despite its importance for patient safety, medical education often lacks systematic training in recognising and managing polypharmacy within the framework of patient-centred care. We investigated the impact of a structured learning intervention introducing polypharmacy as a chronic condition, assessing whether it enhances medical students’ diagnostic competence, confidence, and interprofessional collaboration. Methods: A prospective cohort study was conducted with 50 final-year medical students who received a three-phase educational intervention. Phase 1 was interactive workshops on the principles of polypharmacy, its dangers, and diagnostic tools. Phase 2 involved simulated patient consultations and medication review exercises with pharmacists. Phase 3 involved reflection through debriefing sessions, reflective diaries, and standardised patient feedback. Student knowledge, confidence, and attitudes towards polypharmacy management were assessed using pre- and post-intervention questionnaires. Quantitative data were analysed through paired t-tests, and qualitative data were analysed thematically from reflective diaries. Results: Students demonstrated considerable improvement after the intervention in identifying symptoms of polypharmacy, suggesting deprescribing strategies, and working in multidisciplinary teams. Confidence in prioritising polypharmacy as a primary diagnostic problem increased from 32% to 86% (p < 0.01), and knowledge of diagnostic tools increased from 3.1 ± 0.6 to 4.7 ± 0.3 (p < 0.01). Standardised patients felt communication and patient-centredness had improved, with satisfaction scores increasing from 3.5 ± 0.8 to 4.8 ± 0.4 (p < 0.01). Reflective diaries indicated a shift towards more holistic thinking regarding medication burden. The small sample size limits the generalisability of the results. Conclusions: Teaching polypharmacy as a chronic condition in medical school enhances diagnostic competence, interprofessional teamwork, and patient safety. Education is a structured way of integrating the management of polypharmacy into routine clinical practice. This model provides valuable insights for designing medical curricula. Future research must assess the impact of such training on patient outcomes and clinical decision-making in the long term. Full article

The renovation of old urban residential areas is and will continue to be an important part of urban renewal in China. The renovation of existing old urban residential areas focuses more on the physical level of renovation and pays insufficient attention to the improvement of collaborative community governance. However, collaborative community governance is the key to sustainable renovation. This study aims to explore the formation mechanism of multiple subjects’ collaborative governance in the renovation of old urban residential areas. A general collaborative governance theoretical framework was adopted and adjusted by innovatively introducing the improvement of collaborative community governance in old urban residential areas as an important variable in collaborative results. Data were collected through 853 questionnaires in 16 provinces across China and analyzed using Structural Equation Modeling. Data analysis reveals the following conclusions: (1) institution design and the collaborative process have significant positive impacts on collaborative results, while facilitative leadership has a negative impact; (2) the collaborative process is an important mediating variable on collaborative results; (3) government departments’ and residents’ self-governing organizations play important roles in improving collaborative community governance. Face-to-face dialogue and consultation, information disclosure and transparency, and reaching an intermediate consensus are important mediator variables. The research results provide theoretical support and practical suggestions for promoting the improvement of multiple-subject collaboration through old urban residential area renovation. Full article