Search Results (1,029)

Background: Effective communication improves patient satisfaction and reduces stress for both patients and physicians. Surveys consistently highlight the importance of strong communication skills among physicians, especially in oncologic settings. Yet, communication training is neither ubiquitous nor standardized in medical studies or residency, and physicians report that this task represents a burden for them. Given the limited data addressing the observations and expectations of patients with gynecologic malignancies when receiving bad news, this survey aimed to assess their perspective on this topic. Methods: We examined throughout an anonymous questionnaire how patients with gynecological and breast cancer experienced the delivery of bad news. Data were collected in Germany from July 2024 to September 2025. The questionnaire was available online and in paper form in four languages (German, English, Turkish, Arabic), with the purpose of recording culture-specific data. Results: A total of 249 patients completed the survey. Regarding the overall need for improvement in delivering bad news, 222 women (94.5%) declared that improvement was necessary, with 92 (39.1%) of them indicating that substantial improvement was required. While 67.9% of patients were content with the physician’s professional competence, 30.5% stated a lack of empathy, and 32.9% stated insufficient time for conversation. When comparing satisfied and dissatisfied patients, significant differences were observed across several aspects, such as consultation length, nonverbal communication, calmness of the setting, stress level after the conversation, and the offer to bring a trusted person or arrange a follow-up conversation. Conclusions: This patient survey highlights a persistent gap between patients’ expectations and physicians’ performance when it comes to delivering bad news. The findings underline the urgent need for the implementation of systematic training programs and structured communication protocols in gynecologic oncology. Full article

Background: The use of contraceptive methods is a key component of public health and reproductive health, contributing to family planning, maternal well-being, and social stability. However, contraceptive use is often influenced by the availability and continuity of medical counseling. Limited evidence exists on how regular specialist counseling affects informed contraceptive use in real-world community settings. Methods: A cross-sectional study was conducted between January 2025 and January 2026 using a structured questionnaire. A total of 2400 participants aged 18–55 years were included. The study population was divided into two groups: 1000 women who had been regular patients or receiving consultation for at least one year at the Gynecology and Endocrinology Department of the General Hospital in Ferizaj, and 1400 community participants who had not received regular medical counseling related to reproductive health during the previous year. Data were analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression. Results: The prevalence of current contraceptive use was significantly higher among women receiving regular medical counseling compared with those without regular consultations (72.4% vs. 41.8%; p < 0.001). Modern contraceptive methods were more frequently used in the counseled group, including oral hormonal contraceptives (38.5%), intrauterine devices (21.4%), and implants (7.8%), whereas condom use (49.3%) and traditional methods (18.4%) predominated among participants without counseling (p < 0.001). Use of contraceptives based on medical recommendation was reported by 81.2% of counseled women compared to 29.6% in the non-counseled group (p < 0.001). Long-term contraceptive use (≥12 months) was significantly more common among counseled participants (64.9% vs. 33.5%; p < 0.001). After adjustment for age, education, and marital status, regular medical counseling was independently associated with higher odds of modern contraceptive use (OR = 3.62; 95% CI: 3.01–4.35; p < 0.001). Conclusions: Regular medical counseling by gynecologists and endocrinologists is strongly associated with informed, consistent, and modern contraceptive use among adults aged 18–55 years. These findings underscore the importance of strengthening structured counseling services as an integral component of public health strategies aimed at improving reproductive health outcomes. Full article

As population aging accelerates, the demand for high-quality end-of-life (EOL) care continues to rise. However, a substantial proportion of patients with terminal cancer still experience death in acute-care hospitals without adequate palliative care. Consultative palliative care (CPC) represents a feasible model for delivering palliative care without requiring dedicated inpatient units, yet evidence evaluating its clinical impact remains limited. In this study, we developed a structured hospital-based CPC model tailored to the Korean healthcare system, the Korea Holistic Optimized Palliative care for End-of-life (K-HOPE) model, and prospectively evaluated its clinical impact. K-HOPE was delivered by an interdisciplinary CPC team in a tertiary hospital. Unmet needs were assessed using the Integrated Palliative care Outcome Scale (IPOS), and longitudinal changes were analyzed using mixed-effects models for repeated measures. Among patients who died during hospitalization, quality of death was evaluated using the Good Death Scale (GDS). A total of 84 patients with terminal cancer received K-HOPE. The total IPOS score significantly decreased over time (β = −10.4, 95% CI −12.8 to −8.0; p < 0.001), indicating reduced overall burden and unmet needs. Significant improvements were observed in psychological distress (p = 0.010) and communication and information needs (p < 0.001), whereas changes in physical symptoms and practical concerns were not statistically significant. Among 22 patients who died during hospitalization, 59.1% achieved a good quality of death (GDS ≥ 12). Longer duration of CPC involvement was significantly associated with higher quality of death and remained an independent predictor in multivariable analysis. These findings suggest that the K-HOPE CPC model improves communication and overall EOL care experiences among hospitalized patients with terminal cancer, indicating that meaningful improvements in EOL care can occur even during short periods of CPC involvement. Structured CPC integrated into routine oncology practice represents a feasible strategy for improving EOL care in tertiary hospitals, and a standardized CPC framework may enhance the consistency and reproducibility of care delivery within the Korean healthcare system. Full article

Background/Objectives: Time-constrained consultations in high-volume settings can crowd out patient-centered communication, while AI-generated advice may face algorithm aversion when it lacks a humanistic dimension. This study examined whether a brief narrative-based prompt could improve coded patient-facing communication features in an LLM relative to both clinicians and an unprompted model on authentic patient queries. Methods: We conducted a three-condition comparative evaluation using a stratified sample of 1000 de-identified MedDialog-CN consultations (2016–2020). For each consultation, the same patient query was used to generate (i) a zero-shot GPT-o3-mini response and (ii) a narrative-prompted GPT-o3-mini response; the original physician reply served as the human baseline. Responses were annotated with a pre-specified schema operationalizing four communication dimensions—Storytelling, Empathy, Personalization, and Clarity—with expert adjudication. Frequency-based indicators were summarized as mean events per consultation, and binary indicators as proportions; secondary checks captured unwarranted certainty and risk-relevant language. Results: Narrative prompting shifted coded patient-facing communication from sparse and selectively deployed (clinicians and zero-shot AI) to more routine and standardized. Across the reported communication measures, the prompted model showed the most favorable overall pattern, with higher narrative-device use, empathic support, contextual tailoring, and terminology explanation, alongside more frequent consideration of patient preferences and markedly higher rates of emotion–symptom linkage and the presence of a patient-centered narrative framework. Conclusions: Narrative prompting may offer a lightweight and potentially scalable strategy for improving patient-facing communication in Chinese asynchronous, text-based online consultations. An important next step is calibration: humanistic cues should be delivered selectively and safely so that responses remain credible, locally feasible, and cognitively manageable. Full article

Background: The integration of artificial intelligence (AI) into lung cancer screening offers significant potential; however, public adoption of AI-assisted lung cancer screening remains inconsistent and poorly understood. A robust understanding of the psychological and social determinants underlying adoption is critical to inform evidence-based implementation strategies. Objective: This study aims to identify the key factors that influence the public’s Behavioral Intention (BI) to adopt AI-assisted lung cancer screening. We built on the Unified Theory of Acceptance and Use of Technology (UTAUT) and integrated Doctor–Patient Trust and Perceived Risk into the framework to examine the associations between these medically specific factors, together with traditional adoption variables, and the public’s BI. Methods: A cross-sectional survey was conducted among 971 residents in China from September to November 2025. Based on the extended UTAUT, a measurement instrument was developed and refined through expert consultations and pilot testing. Exploratory factor analysis (EFA) was performed to validate the questionnaire’s construct validity. Hypothesis testing was then carried out via Partial Least Squares Structural Equation Modeling (PLS-SEM) to evaluate the measurement model and examine the structural relationships among latent constructs. Results: EFA results indicated a seven-factor structure (KMO = 0.897, p < 0.001). The structural model accounted for 35.0% of the variance in BI. Social Influence (β = 0.292, p < 0.001), Facilitating Conditions (β = 0.156, p < 0.001), Performance Expectancy (β = 0.101, p = 0.004), Doctor–Patient Trust (β = 0.107, p = 0.002) were positively associated with BI, while Perceived Risk (β = −0.106, p < 0.001) showed a negative association. Furthermore, Doctor–Patient Trust was significantly and negatively associated with Perceived Risk (β = −0.168, p < 0.001), suggesting a potential mediating pathway from trust to intention (Indirect Effect = 0.018, p = 0.003). Conclusions: Adoption of AI-assisted lung cancer screening appears to be associated not only with perceived utility but also with trust in medical professionals and Perceived Risk. These findings suggest the importance of integrating technological innovation with strategic public education and tailored communication strategies to foster its adoption. Public health interventions should leverage physician endorsements and promote AI awareness to support informed, trust-based engagement with AI technologies. Full article

Ketosis is a major metabolic disorder that significantly impacts dairy cow health, welfare, and farm profitability, posing challenges to both farmers and veterinarians. This opinion paper, derived from expert panel discussions and a review of the scientific literature, provides a comprehensive, proactive approach to modern ketosis management. It addresses the critical need for increased farmer awareness, emphasizing the veterinarians’ involvement as consultants and data interpreters and equipping them with essential skills in data analysis, communication, and farmer education. This paper also details a practical toolbox of diagnostic, therapeutic, management, and preventive strategies, including precision technologies and welfare-enhancing practices, to optimize metabolic health, enhance productivity, and ensure the long-term sustainability of dairy farming. This expert consensus translates scientific knowledge into practical on-farm actions, empowering farmers with risk-based insights and equipping veterinarians with tools and strategies for success. Ultimately, the consensus of our opinion paper reflects an industry-wide transition toward absolute transparency in diagnostic reporting, based on reliable data that creates an indispensable foundation for evidence-based ketosis management. Full article

Background/Objectives: An 8-kg, 16-month-old child was brought to the emergency department of a regional community hospital with shallow respirations. Due to her pallor and the diluted appearance of the first blood sample, the emergency physician suspected sepsis associated with severe anemia. Her first laboratory results revealed a hemoglobin of 1.7 g/dL. Subsequent laboratory data revealed positive fibrin split products and hypofibrinogenemia with reticulocytosis. Because this regional community hospital did not have a pediatric intensivist, the emergency physician instead consulted a neonatal intensivist for guidance. Methods: A femoral intraosseous line was placed to allow aggressive massive transfusion. After consultation with the neonatal intensivist, packed red blood cells were transfused at a rate of 30 mL/kg/h. After transfusion, the patient became agitated and required repeated paralytic, sedative, and analgesic boluses of succinylcholine, ketamine, midazolam, dexmedetomidine, and fentanyl, with fentanyl and dexmedetomidine drips. The patient arrived at a tertiary care center 13 h after admission. Results: At the tertiary care center, the patient was weaned off the drips and was theorized to have secondary autoimmune hemolytic anemia due to sepsis after positive direct and indirect Coombs test. She was treated with a course of antibiotics, including cefepime and vancomycin, without steroids or immunotherapy. Five months later, her hemoglobin had returned to 12.1 g/dL, and she tested negative on direct and indirect Coombs test. Conclusions: This case highlights the importance of collaboration between and within departments to successfully manage pediatric hemostatic resuscitation. Full article

Despite the aim of municipal boundaries re-demarcation to improve capacity, functionality, economic viability, and service delivery in South African municipalities, it often leads to community unrest, protests, and violent confrontations. This article examines socio-political factors that contribute to the ongoing disputes in Vuwani and Malamulele communities, Limpopo, South Africa, and their implications for social cohesion and local governance in a post-apartheid context. Semi-structured interviews were conducted with 52 community members and other stakeholders who are directly involved in or affected by the disputes. Guided by territoriality theory, through thematic analysis, the study findings reveal that re-demarcation disputes are intertwined with political interests, differentiated ethnic and cultural identities, inadequate community consultation, and governance power imbalances. By situating Vuwani and Malamulele communities within wider debates on municipal border disputes, this study calls for an inclusive, transparent, and culturally sensitive approach to the implementation of municipal boundary changes. This is crucial for building united, peaceful, and sustainable communities, and for local government to regain public trust in post-apartheid South Africa. Full article

This article reports on action research which sought the perspectives of South Sudanese families and communities about their experiences and understanding of child protection. The research was grounded in cycles of interviews, consultation, and participation observation with a total of ninety-seven participants which included South Sudanese leaders and families in Australia and in Uganda. The resulting data offers a layered insight into the pressures families navigate and the strengths on which they draw to keep children connected to community and culture in Australia and the importance they place on community led approaches in which protection and safety are understood as collective responsibilities. The findings show that the collective strengths they highlight are often misunderstood within Western child protection systems. The paper concludes that meaningful partnership and developmental ways of working are essential for building trust and designing approaches that keep children safe within culture. Full article

Background: Eye-tracking (ET) devices are gaining attention in technology-based paediatric rehabilitation through their intrinsic ability to assess patients’ engagement and visual attention within motivating, technology-based environments. We conducted a systematic review of available evidence from 2004 to 2025 on the implementation of ET in rehabilitative trainings targeting paediatric populations with neurological and neurodevelopmental disorders. This paper aims to outline the rehabilitative outcomes pursued in the clinical populations considered. Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three electronic databases (PubMed, Web of Science, and Scopus) were consulted to summarise the state of the art of the last 20 years. Selected articles were categorised according to the type of treated disorder and the rehabilitated function. Results: ET devices have been increasingly integrated into paediatric rehabilitation with promising results across multiple neurodevelopmental conditions (e.g., ASD, ADHD, cerebral palsy). These systems have proven effective not only in training gaze control, but also in enhancing executive functions, social cognition, communication, and participation. Furthermore, they promote personalised and data-driven solutions and support high levels of engagement, feasibility, and user satisfaction. Conclusions: ET represents a promising frontier for paediatric rehabilitation, addressing various neurodevelopmental disorders. The gaze-contingent protocols employed have demonstrated potential effects in promoting adaptive behaviour across multiple developmental areas. Further research is warranted to provide shared guidance and to strengthen practice recommendations. Full article

The use of telemedicine by the Ultra-Orthodox (UO) population in Israel presents challenges due to unique cultural characteristics, including limited internet use for religious ideological reasons and lower levels of digital literacy. This cross-sectional survey examines the rate of telemedicine use in the UO society in Israel according to religious groups, factors, attitudes and barriers associated with telemedicine use. The study included 1460 adult UO participants using quota by gender, and religiosity groups. The participants underwent a phone interview assessing telemedicine use (defined as at least one monthly phone/video call/e-mail correspondence with a medical professional, during the last year), attitudes, and perceived barriers. In total, 39% of participants used telemedicine and 42% performed one or more administrative actions. Phone consultations were the most common mode of communication with healthcare providers. The main barrier to using telemedicine was religious-ideological. Multiple logistic regression revealed that female sex, participants aged 30–44, married status, above-average income, frequent family physician visits, and internet use significantly associated with telemedicine use. Compared to <30, adults aged 60+ years use less telemedicine (OR 0.52, 95% CI 0.32–0.86). These findings indicate telemedicine use within the UO population, though substantial cultural barriers remain, and may assist policymakers in expanding its implementation. Full article

Toponyms, i.e., place names, are fundamental for reconstructing the diachronic development of communities without written records, encoding unique historical and cultural data of any civilisation; however, they are vulnerable to loss as languages decline. This also happens for the scarcely documented language Kula (or Tanglapui), a Papuan Alor-Pantar language (Trans-New Guinea macro-family) from Eastern Alor, Southeastern Indonesia (Alor-Pantar Archipelago, Timor area). The spatial knowledge encapsulated in Kula toponyms has been critically threatened by resettlement since the 1960s, alongside its declining daily usage. To preserve this heritage, this article presents a systemised dataset of Kula place names derived from oral traditions, documented for the first time during fieldwork between 2023 and 2026. Data collection followed established language documentation methodologies, utilising semi-structured interviews and community verification with elder native speakers and local consultants to ensure adherence to ethical standards and cultural accuracy of recording practices. The dataset comprises 31 entries of place names, each detailing toponymic variants, glosses/folk etymologies, associated natural resources, stories/historical elements, settlement type, location, habitation status, and internal and external tribal links when information is available. This paper fills a critical gap in Timor-Alor-Pantar linguistics, offering an open-access resource for reconstructing migration patterns and preserving the Kula people’s collective memory against accelerating language endangerment. Full article

This study investigated family language policies (FLP) in the current context of the Macao Special Administrative Region (Macao SAR). It explored family language ideologies, management strategies, and intergenerational practices through questionnaires, semi-structured interviews, and participant observations. The findings indicate that Macao permanent residents’ families take Cantonese Chinese as the primary medium of communication and cultural identity. Simultaneously, Mandarin and English are often valued for their roles in academic and professional advancement. Portuguese exhibits a trend of marginalization, despite remaining one of the official languages of the Macao SAR. As for other dialects, they may be used in family conversations but are not considered important languages. Beyond this hierarchy of language values, the researchers also revealed that the FLP of Macao’s permanent residents’ families tends to be driven by both experience and foresight, enabling family members to engage in effective consultation on language choice and language learning. Regarding language practice, children’s multilingual fluency is significantly better than that of their parents. The dominant family language tendency does not influence the consensus of multilingualism and allows code-mixing to appear in conversations. In this article, FLP in Macao families is found to be shaped by both experiential knowledge and future-oriented practical considerations, while also reflecting parents’ affective concerns and responses to broader structural pressures. All these factors together form a decision-making system. In this system, both emotion and reason play their roles simultaneously. If a hierarchical distinction must be made, the rational recognition of the diverse characteristics of the linguistic environment and the dominant status of the main language will be primary. Full article

Background: This paper addresses the need to clarify and highlight the vital roles non-state actors play in strengthening the disaster management ecosystem, drawing on knowledge and experience across sectors and entities. The objective is to underscore the irreplaceable roles of non-state actors in disaster response and the need for shared capacities through the coordination, adoption, and application of agreed-upon protocols across actors and contexts. The research’s ultimate goal is to provide policymakers, crisis managers, non-state actors, and volunteer coordinators with a comprehensive overview of the functional areas, competencies, and capacities of civic organisations across all phases of disaster management. Integrating these organisations into existing governmental crisis management systems offers an opportunity to enhance community resources and capacities through unified communication and interoperability protocols based on existing technical and ethical standards. Methods: The research reviews academic literature, legal and policy frameworks, and grey literature, including recommendations and experiences documented in a repository of 140 CORDIS EU-funded initiatives that illustrate expert and institutional opinions on disaster management. The manuscript also relies on secondary data analyses presenting the opinions collected from 50 participants in an interactive group exercise on the role of non-state actors and volunteers. It further draws on aggregated knowledge from nine consultative workshops involving 20 civic and governmental organisations, synthesising practices, formal standards, robust coordination frameworks, and command-and-control system rules into an innovative voluntary disaster response protocol for non-state actors and volunteers. The findings demonstrate the value of non-state actors in disaster management and how gaps in their engagement can create opportunities to strengthen the disaster management ecosystem by enhancing the cohesion of capacities and resources. Compared with international standards (INSARAG, etc.), a protocol incorporating technical and integrity norms in an accessible, adaptable format emphasises the importance of integrating non-state actors into the formal disaster crisis management system. Conclusions: Establishing a set of standards for coordinated awareness and response, facilitated by continuous communication of roles and competencies among disaster responders at both local and international levels, is essential for the sustainable mitigation of negative impacts before, during, and after emergencies or catastrophic events. Full article

Background: Research in pelvic floor muscle-related symptoms (PFM-related symptoms) in Saudi Arabia remains limited. Clearer identification of symptom burden and its predictors is needed to guide physiotherapy strategies for prevention and management. Objective: We aimed to determine the prevalence of PFM-related symptoms among adult Saudi men and identify behavioral and lifestyle predictors associated with symptom burden. Methods: A community-based cross-sectional survey was conducted among 458 men aged >18 years from the Al-Baha region of Saudi Arabia. PFM-related symptoms were assessed using five items adapted from the Pelvic Floor Distress Inventory-20 (PFDI-20), their impact using five items from the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and urinary incontinence using the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF). Data were analyzed with descriptive statistics, correlation analysis, one-way ANOVA, and binary logistic regression. Results: Urinary incontinence was reported by 14% (86% reported none), but 19% disclosed regular “preventive” voiding. Symptom incidence increased with age (p < 0.001). Logistic regression identified smoking (OR = 1.34, p = 0.029) and preventive voiding (OR = 1.54, p = 0.002) as significant predictors of greater symptom burden. Conclusions: These results highlight the need for physiotherapy-led strategies in primary care, prioritizing smoking-cessation support and structured bladder training, with escalation when required. Prospective studies are needed to confirm temporality and to develop a practical rehabilitation pathway for men. Full article