Search Results (313)

Background: The addition of CD-38 monoclonal antibody daratumumab (DARA) to front-line therapy for newly diagnosed multiple myeloma (NDMM) has improved outcomes. The real-world (RW) adoption of treatments remains inconsistent. We aimed to evaluate the adoption of DARA regimens in the treatment of NDMM. Methods: We conducted a retrospective study at a multi-site academic–community healthcare system from August 2020–September 2023. Patients (n = 414) were ≥18 years with NDMM upon initiating front-line therapy. Results: The median age was 69; most were male (60.6%, n = 251), white (69.1%, n = 286), and non-Hispanic (89.6%, n = 371). At diagnosis, 52.2% (n = 216) had R-ISS stage II, and the performance status was preserved, with 69.3% (n = 287) having ECOG 0–1. The adoption of DARA-based induction was incomplete (53.9%, n = 223) and was higher at the academic myeloma center than the community sites (63.9% vs. 47.7%; p = 0.001). At three months after treatment initiation, patients receiving DARA-based induction achieved deeper responses than those treated without DARA. The distribution of IMWG responses favored the DARA group, with a higher proportion attaining VGPR or better (65.0% [n = 145] vs. 51.3% [n = 98]). Conclusions: DARA-based regimens for NDMM were underutilized and notably less common at community sites. Coordinated implementation strategies at the provider and community levels may narrow adoption gaps and translate trial-proven benefits into routine practice. Full article

Background: Early management of adult burn injuries in resource-constrained environments—such as battlefields and primary care facilities—remains hindered by the absence of standardized, evidence-based protocols. This study aimed to systematically synthesize existing evidence and develop an integrated framework of actionable recommendations to optimize prehospital and early emergency care. Methods: A comprehensive evidence synthesis was conducted across 14 international and domestic bibliographic databases and authoritative repositories. Eligible sources included clinical practice guidelines, expert consensus statements, evidence summaries, and systematic reviews. Literature quality was appraised using validated instruments, and best-practice recommendations were extracted and thematically synthesized across the continuum of early burn care. Results: Fifty-nine high-quality studies yielded 77 recommendations across 13 domains, spanning from scene safety and burn process cessation through airway, breathing, and circulatory management to wound care, infection control, and transfer preparation. An integrated, context-adaptive framework was established to guide resource-calibrated interventions rather than rigid protocol adherence. Conclusions: These findings provide tiered guidance for frontline healthcare providers and inform the development of emergency care standards in resource-limited settings. Future research should prioritize field validation and contextual implementation to address barriers to evidence translation and enhance real-world applicability. Full article

The COVID-19 pandemic placed unprecedented pressure on healthcare systems and frontline professionals, particularly nurses, highlighting the importance of understanding their emotional experiences and coping strategies. This study aimed to explore the emotional experiences and coping strategies of nursing professionals during the first wave of the COVID-19 pandemic in a Spanish regional healthcare setting. A qualitative descriptive phenomenological study was conducted in 2020. Data were collected through semi-structured interviews and written narratives from 36 nursing professionals working in the Riojan Health Service. Three main themes emerged: perceived emotions, stressors, and coping strategies. Nurses reported intense feelings of fear, uncertainty, and frustration, which negatively impacted their mental health and hindered emotional regulation and decision-making. Key stressors included high workload, lack of resources, constant exposure to risk, and rapidly changing clinical situations. Despite these challenges, participants described various coping strategies, such as peer support, professional commitment, and adaptive emotional responses, which helped them manage the situation. The findings describe the emotional impact experienced by nursing professionals during the first months of the COVID-19 pandemic and identify coping strategies used in a specific regional healthcare context in Spain. Full article

Background: Managing occupational stress in healthcare services is critical because frontline workers operate under multiple job demands. Objective: We extend the literature on health psychology and organizational behavior by examining how two types of occupational stress—eustress and psychological distress—impact the performance of frontline healthcare service workers. We also investigate the interactive influence of stress management strategies—savoring and avoidance coping—on the performance effects of occupational stress. Methods: We surveyed 400 frontline healthcare service workers across the globe using MTurk. We used Smart PLS4 to assess our measures and test our hypotheses. Results: Job demands—a higher-order construct comprising workload, role conflict, and work complexity—had a non-significant effect on eustress (β = 0.037, p = 0.596) but a significant positive effect on psychological distress (β = 0.566, p < 0.001). Eustress had a positive effect on employee engagement (β = 0.229, p < 0.001) and savoring (β = 0.437, p < 0.001). Psychological distress had a positive effect on turnover intention (β = 0.275, p < 0.001) and avoidance coping (β = 0.525, p < 0.001). The interaction between savoring and eustress had a negative effect on employee engagement (β = −0.162, p = 0.003). The interaction between avoidance coping and psychological distress had a negative effect on turnover intention (β = −0.058, p = 0.054). Conclusions: Job demands in frontline healthcare services manifest as hindrance stressors that increase workers’ psychological distress. Avoidance coping is an effective strategy for managing psychological distress and reducing workers’ turnover intention. Full article

The National Special Pathogens System (NSPS) stratifies U.S. healthcare facilities by their readiness level to care for patients with high-consequence infectious diseases (HCIDs). While NSPS Level 1 and 2 facilities possess advanced biocontainment capabilities to care for patients for the duration of their illness, most U.S. hospitals fall under a NSPS Level 3 or 4 designation, with limited resources to manage patients with a suspected or confirmed HCID. However, emerging zoonotic threats like H5N1 underscore the need to bolster HCID preparedness across all NSPS Levels. Beginning in March 2024, the U.S. H5N1 outbreak has primarily impacted wild bird flocks, poultry, and cattle, along with some human infections. The continuation of this outbreak in wild and domesticated animals increases the likelihood of further human spillover and eventual viral evolution in human hosts. At the frontlines, rural farming communities are likely to be most affected, with potential outbreaks exacerbated by a lack of accessible NSPS Level 1, 2, or 3 facilities in these regions. Thus, strengthening the HCID preparedness of local NSPS Level 4 facilities is critical to preventing transmission, minimizing societal disruption, protecting communities and the healthcare workforce, along with ensuring an equitable, coordinated response to future emerging infectious disease threats. This manuscript explores the financial, societal and health system impacts of HCID outbreaks to delineate the necessity of strengthening the preparedness of NSPS Level 4 facilities. Full article

This study investigates the impact of different types of personal protective equipment (PPE), specifically Powered Air-Purifying Respirators (PAPRs) and traditional N95 masks with face shields, on the physiological stress responses of healthcare workers (HWs) during the COVID-19 pandemic. Utilizing an interventional randomized crossover trial design, the research encompasses a simulation phase with ten participants followed by field testing involving thirty frontline healthcare professionals in a tertiary-care hospital setting. Heart rate (HR) and movement data were collected through smartwatches, while trained observers recorded the duration and nature of various activities undertaken during simulations. Data analysis employed statistical techniques, including Principal Component Analysis (PCA) and t-Distributed Stochastic Neighbor Embedding (t-SNE), to explore potential correlations between PPE type, HR, and movement. Clustering validation measures such as the Calinski–Harabasz, Davies–Bouldin, and Silhouette scores were applied to evaluate the difference between each type of PPE. The results indicated no significant differentiation in HR responses between the two PPE types. However, because HR may lack the sensitivity to fully capture variations in cognitive load or stress, these findings should be interpreted as an exploratory baseline. Additionally, no clear distinctions were observed regarding individual user responses or the activities performed, even when considering movement data. Although the findings imply non-inferiority of the examined PPE, future research including heart rate variability as a more comprehensive indicator of stress would be informative. This research contributes valuable insights into PPE selection and its implications for healthcare worker performance and well-being in high-stress environments, ultimately aiming to inform guidelines and training programs to enhance healthcare delivery during infectious disease outbreaks. Full article

Background: During the COVID-19 pandemic, fever clinic nurses under closed-loop management faced high occupational stress and strict isolation, which may impair sleep quality. However, evidence in this population remains limited. This study investigated the sleep quality of fever clinic nurses during closed-loop COVID-19 management and identified associated factors. Methods: A sequential explanatory mixed-methods design approach was employed. Quantitative data were collected using the Pittsburgh Sleep Quality Index (PSQI) and Nurses’ Psychological Capital Scale from 33 front-line nurses, acknowledging the limited sample size. Semi-structured in-depth interviews were conducted with six nurses to provide qualitative insights. Results: The mean PSQI score was 8.16 ± 4.25, indicating moderate sleep disturbances among nurses. Factors associated with sleep quality included demographic and occupational factors (e.g., night shifts, work pressure) and psychological capital (self-efficacy, resilience, hope, and optimism). Qualitative analysis identified three themes: the impact of personal circumstances on sleep quality, psychological pressures during closed-loop management, and the role of self-regulation in coping. Conclusions: During the closed-loop management for COVID-19 pandemic prevention and control, the sleep quality of nurses in fever clinics was poor. This study identified personal circumstances, work pressure, and psychological capital as potential factors associated with sleep quality, suggesting that further research is needed to develop and test targeted interventions. These findings provide preliminary evidence that may inform future management strategies, but do not support definitive intervention recommendations. Full article

This article analyses the Italian Legislative Delegation Bill of 4 September 2025 (DDL 2025), which proposes the recontextualization of healthcare liability through the introduction of Article 590-septies into the Italian Criminal Code (c.p.) and the amendment of Article 590-sexies c.p. and of Articles 5 and 7 of the Gelli-Bianco Act (Law No. 24/2017). The study examines the extent to which the reform, if enacted, would produce a shift of criminal negligence liability from the individual frontline clinician towards the apex management figures of healthcare organizations—at both the corporate and hospital levels—and under what conditions such a shift would be compatible with the constitutional principle of personal criminal responsibility (Art. 27 Const.) and with the evidentiary criteria for criminally relevant omission. Adopting a doctrinal and jurisprudential analysis approach, the study formulates a falsifiable hypothesis, accompanied by four ex post verifiability indicators observable over a five-year time horizon following the possible entry into force of the provision. The analysis demonstrates how the DDL 2025 would recontextualize the notion of culpa—encompassing imperizia (lack of skill), negligenza (negligence), and imprudenza (imprudence), functionally comparable to forms of criminal negligence in common law systems—by linking fault assessment to contextual factors such as organizational deficiencies and resource scarcity. This approach would adopt a deflationary framework, establishing a distinction between avoidable human error and errors caused by systemic dysfunctions and foreshadowing a potential shift of liability towards apex management, who are required to ensure organizational models adequate to patient safety. This orientation, far from constituting a doctrinal novelty, would formalize ex lege a trajectory already established in civil and criminal case law of the Court of Cassation (Cass. No. 6386/2023, “Travaglino”), further intersecting with the administrative liability regime for organizations under Legislative Decree 231/2001. Significant interpretive challenges remain, related to the application of criminal liability criteria to the omissive conduct of healthcare managers, as well as to the contrasting international evidence on the behavioural effectiveness of medical liability reforms. The redefinition of top-management liability would therefore be configured not merely as a tool for the protection of the individual professional but as a derived constitutional guarantee of the right to health and the safety of care, pursued through formalized risk governance, the integration of incident reporting and organizational audit systems, the transition towards Enterprise Risk Management models, and the traceability of apex decision-making processes. Examples drawn from other European jurisdictions illustrate the heterogeneity of legal approaches to medical fault and frame the Italian proposal as a context-specific solution that nonetheless could contribute to the international debate on institutional and organizational accountability for patient safety. Full article

Background: The need for palliative care (PC) is increasing globally. As frontline healthcare workers, nurses play a pivotal role in providing PC to end-of-life (EOL) patients. Therefore, undergraduate nursing students must be adequately prepared to provide evidence-based, compassionate, and comprehensive care to patients during their terminal phase of life. Herein, we aimed to assess the knowledge and attitudes of Saudi undergraduate nursing students toward palliative and EOL care. Methods: This was a cross-sectional, correlational study conducted on 147 undergraduate nursing students from various regions of Saudi Arabia. The participants completed the Palliative Care Quiz for Nurses (PCQN) and Frommelt Attitudes Toward Care of the Dying-Form B scale (FATCOD-B) to assess their knowledge and attitudes toward EOL care, respectively. Results: Higher PCQN scores were significantly associated with higher FATCOD-B scores, suggesting that nursing students with higher levels of PC knowledge had more positive attitudes toward EOL care (r = 0.205, p = 0.013). Additionally, PC knowledge and formal PC education significantly predicted nursing students’ attitudes toward EOL care (β = 0.187, p < 0.05; β = −0.185, p < 0.05, respectively). The model explained 7.6% of the variance in nursing students’ attitudes toward EOL care (R² = 0.076, p < 0.01). Conclusions: PC education remains inadequately integrated into undergraduate nursing curricula worldwide, despite nurses being at the forefront of EOL care. Embedding PC concepts early in nursing programs is crucial to build a workforce capable of meeting growing EOL care demands with genuine knowledge and confidence. Full article

Aim: This study aimed to evaluate self-reported digital health literacy levels and work engagement among nurses in the United Arab Emirates (UAE), while also examining associations with demographic factors and the interplay between digital health literacy and work engagement. Background: The integration of digital technologies into healthcare has transformed patient care, clinical practice, and administration. Nurses, as frontline practitioners, play a crucial role in utilizing digital tools to enhance patient interactions and navigate complex healthcare systems. Methods: Between May and August of 2024, 364 nurses in the United Arab Emirates participated in a cross-sectional design study. A standardized 21-item self-reported Digital Health Literacy questionnaire and a 9-item Utrecht Work Engagement Scale were administered. Descriptive statistics were used, with t-tests, ANOVA, correlations, and multiple linear regression applied. Results: The average score for self-reported digital health literacy (3.05 ± 0.57) and work engagement (4.83 ± 1.13) was high. Gender, age, work experience, and education level showed varying patterns of association with self-reported DHL and work engagement across total and subscale scores. Education level was significantly associated with self-reported DHL but not with work engagement. The overall work engagement score and its subscales were positively correlated with self-reported DHL. Conclusions: Our findings provide a robust basis for subsequent research on DHL and work engagement. These findings support the relevance of self-reported DHL as a factor associated with nurses’ work engagement in digitally intensive healthcare settings. The study reveals that nurses reported high levels of digital health literacy and work engagement. Full article

Background: Healthcare systems globally continue to experience persistent workforce and system-level challenges as increased workloads, lasting wellbeing impacts, and retention issues remain following the pandemic. To inform strategies and interventions to address these issues, this paper explored the workplace experiences of Victorian (Australia) frontline healthcare workers with parenting responsibilities during the COVID-19 pandemic. Methods: A total of 39 frontline healthcare workers from a large metropolitan hospital were interviewed between October 2020 and February 2021. Reflexive thematic analysis was used to analyse transcripts. Results: Three superordinate themes and five subordinate themes were identified. Themes highlighted the significant pressure that rapid workplace changes placed on healthcare staff and leaders, affecting their physical, mental, and relational health. Support from peers and supervisors was protective, though this increased demands on supervisors themselves. While many staff reported pride in their work, some experienced reduced career satisfaction and concerns about lasting psychological impacts. Conclusions: This study identifies how workplace supports operate through communication transparency, leadership capacity, and protected peer-support space, translating to organisational priorities for the post-pandemic workforce. In the context of ongoing workforce shortages and heightened demands post-pandemic, these findings underscore the importance of strengthening leadership capacity, embedding sustainable workplace supports, and addressing the psychological needs of healthcare staff. Such system-level responses are essential for pandemic recovery, improving workforce retention and staff wellbeing in the modern healthcare environment. Full article

Background: The importance of evidence-based practice (EBP) is well recognized, yet its implementation remains challenging across healthcare systems, especially in low- and middle-income countries, where resource constraints, workforce turnover, and organizational barriers can hinder practice change. The traditional approach to implementation has focused on training, guidelines, and leadership support; however, these strategies do not always sustain frontline staff engagement. Objective: This descriptive case study examined how social movement strategies supported a multi-year EBP implementation initiative within a Philippine academic–clinical partnership. Methods: Program documents, training records, implementation reports, curriculum materials, and internal records of guideline-related activities were reviewed. Data were organized using the Social Movement Action Framework, with attention to preconditions for change, social movement mechanisms, and implementation outcomes. Results: The initiative included champion training, guideline integration, awareness activities, academic–clinical collaboration, and practice-focused implementation efforts related to breastfeeding, vascular access device management, and pressure injury prevention. These activities provided observable process indicators of stakeholder engagement, shared ownership, and continued use of guideline-informed practices. Conclusions: Social movement strategies may offer a useful complementary lens for understanding how EBP implementation gains momentum in real-world healthcare settings. Additional studies should explore their relationship to implementation outcomes and clinical care processes. Full article

Background: An outbreak of Marburg virus in Jinka Town, Southern Ethiopia, has raised significant concern regarding the potential spreading of disease throughout the country. Healthcare workers play a crucial role in early prevention and control of such an outbreak. However, the knowledge, attitudes, and preparedness of healthcare workers regarding Marburg virus disease have not been assessed yet, despite these factors being critical for early prevention and control of an outbreak. This study aimed to assess the knowledge, attitude, and preparedness regarding Marburg virus disease among healthcare workers in Awi Zone public hospitals, northwest Ethiopia, in 2026. Methods: An institutional-based cross-sectional study was conducted among healthcare workers in Awi Zone public hospitals from 26 December 2025 to 10 January 2026. A simple random sampling technique was used to select 394 participants. The data were collected using a pre-tested, structured self-administered questionnaire. The data were entered into Epi-data version 4.6 and analyzed using SPSS version 25. Results: A total of 394 healthcare workers participated in this study. The mean age of the participants was 32.9 ± 4.87 years. The study revealed that 47.7% (95% CI: 42.78–52.62%) and 61.2% (95% CI: 56.4–66%) of participants had good knowledge and a positive attitude towards Marburg virus disease, respectively. However, only 20.3% (95% CI: 16.34–24.26%) demonstrated good preparedness for the Marburg virus outbreak. Conclusions: The study revealed that the majority of healthcare workers had positive attitudes and suboptimal knowledge but critically low preparedness regarding Marburg virus disease prevention and control in Awi Zone public hospitals, northwest Ethiopia. Hence, healthcare workers who are frontline staff for outbreak prevention and control, Awi zone health departments and hospital administrators should be provided with targeted training preparation, training for implementing emergency preparedness plans, and essential infection prevention protocols to improve readiness for a potential outbreak. Full article

The coronavirus (COVID-19) pandemic necessitated unprecedented regulatory responses that enabled rapid therapeutic deployment. The integrated medico-legal framework—comprising the FD&C Act Section 564 (Emergency Use Authorization/EUA), PREP Act (liability immunity), and CICP (injury compensation)—facilitated emergency response while protecting all stakeholders. This normative legal and policy analysis examines nirmatrelvir/ritonavir (Paxlovid) as a case study, integrating emerging pharmacokinetic evidence demonstrating its passage across the blood–brain and blood–placenta barriers. The EUA-PREP-CICP framework achieved notable results: nirmatrelvir/ritonavir’s authorization enabled deployment approximately 1 year after trials began, demonstrating an 89% reduction in the risk of hospitalization or death and potentially preventing thousands of hospitalizations. The PREP Act enabled focused pharmaceutical development and protected frontline healthcare workers during the crisis, though access barriers and transparency concerns remain areas warranting ongoing attention. The CICP provided administrative compensation for qualifying injuries, with acknowledged limitations in filing timelines and causation standards. Pharmacokinetic studies published after authorization revealed biological barrier crossing, representing normal scientific progress through continued investigation. The EUA-PREP-CICP nexus functioned as an integrated system: EUA enabled rapid evidence-based access, PREP immunity facilitated development and deployment, and CICP provided injury remedy. Based on this experience, this study proposes targeted enhancements to further strengthen this framework: systematic post-authorization surveillance timelines, enhanced special population monitoring through registries, modest procedural refinements to CICP, and improved surveillance infrastructure. These evidence-based improvements would build on the framework’s demonstrated strengths, optimizing performance for future emergencies while preserving the essential functions that helped address the COVID-19 pandemic. Full article

Background/Objectives: The COVID-19 pandemic exerted unprecedented pressure on healthcare professionals and systems worldwide. To manage this increased demand, hospitals extended working hours, resulting in increased strain on workers and impacting their professional well-being. Simultaneously, the numerous deaths due to illness meant that healthcare professionals did not have sufficient time to process grief, which may have led to unresolved grief and other mental health problems. The aim of this study was to understand the experiences of loss and grief and their repercussions on Brazilian healthcare professionals working on the front lines during the COVID-19 pandemic. Methods: This qualitative study followed Charmaz’s constructivist grounded theory. The study used the COREQ checklist. Between August 2024 and January 2025, 24 healthcare professionals who worked on the front lines during the COVID-19 pandemic were interviewed via telephone. Participants were primarily female (n = 14) with a mean age of 42 years (SD = 9.13). Interviews were audio-recorded and transcribed. Results: The core phenomenon that emerged from the analytical process is “between exhaustion and resilience in a war-like scenario: challenges and opportunities in the care provided by frontline professionals during the COVID-19 pandemic”. This main axis was anchored in three categories: (1) adversities imposed by COVID-19 on the functioning of health services; (2) witnessing sudden deaths and the physical absence of families; (3) reconstruction of meanings and personal and professional growth. Conclusions: The experience of grief was intensified by the peculiarities permeating the death process in the pandemic context and the modification of farewell moments. The study exposes a need for training programs focused on medical, nursing, psychological, and other areas of care education that involve not only understanding clinical issues but also recognizing loss and grief as an integral part of care processes. Importantly, legislators should allocate additional resources to services that provide psychological support to healthcare professionals, in order to promote their adaptive coping. Full article