Search Results (6,182)

Background: Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic inflammatory rheumatic diseases associated with impaired quality of life, persistent disease burden, and increased healthcare utilization. Treatment adherence and psychosocial factors may influence outcomes, but their longitudinal associations in real-world hospitalized populations remain insufficiently characterized. Methods: We conducted a single-center, retrospective, mid-term longitudinal observational study including 50 adults with RA or AS who experienced repeated hospitalizations over a four-year period. The final dataset comprised 196 hospitalization episodes analyzed as repeated observations nested within individual patients. Disease activity was assessed using DAS28 in RA and ASDAS and/or BASDAI in AS, according to data availability and routine clinical practice. Treatment adherence, quality of life, anxiety, social isolation, patient–provider communication, dietary support, inflammatory markers, and hospitalization-related outcomes were extracted from medical records and structured inpatient assessments. Linear mixed-effects models were used for continuous outcomes, and ordinal mixed-effects models were used for ordered categorical outcomes, with adjustment for age, sex, and time where appropriate. Results: In RA, higher treatment adherence was associated with lower disease activity over time. In AS, comparable associations were not detected, possibly reflecting disease-specific factors, limited variability in adherence, and reduced statistical power in the smaller AS subgroup. Better patient–provider communication was associated with higher adherence and lower anxiety, whereas greater social isolation was associated with poorer quality of life. More favorable dietary support was associated with better adherence, although the magnitude of this association should be interpreted cautiously because of sparse categories and wide confidence intervals. Lower inflammatory burden, particularly lower CRP over time, was associated with lower hospitalization-related costs. Conclusions: In this selected cohort of repeatedly hospitalized patients with RA or AS, treatment adherence, psychosocial factors, and supportive care indicators were associated with clinically relevant longitudinal outcomes. The findings support a multidisciplinary, patient-centered approach to inflammatory rheumatic disease care. However, because of the retrospective design, modest sample size, selected inpatient population, non-standardized assessment of several variables, and possible instability of some ordinal model estimates, the results should be interpreted as exploratory and confirmed in larger prospective cohorts. Full article

Background: Sustainable healthcare in obstetric and maternity nursing emphasizes the provision of high-quality, safe, and environmentally responsible care for women and newborns. Nurses’ knowledge, awareness, and clinical practices are central to the implementation of sustainable approaches, including efficient resource management, evidence-based interventions, and patient education. Evaluating these dimensions is essential for identifying gaps, informing targeted training, and supporting sustainable and effective maternal care aligned with global health goals. Accordingly, this study aimed to assess obstetric and maternity nurses’ knowledge, awareness, and clinical practices related to sustainable healthcare. Method: A cross-sectional study design was employed. A convenience sampling technique was used to recruit obstetric and maternity nurses working in the selected study settings during the data collection period. A total sample of 120 participants was targeted. The study was conducted at Al-Azhar University Hospital in New Damietta and selected Family Medicine Centers in Damietta Governorate, Egypt. Data were collected using a structured, self-administered questionnaire developed specifically for this study to assess eco-conscious nursing practices in obstetrics and gynecology units. The questionnaire included sections addressing demographic and professional characteristics, knowledge and awareness of sustainable healthcare, eco-conscious clinical practices in maternity settings, perceived barriers and institutional support, attitudes and advocacy toward environmental sustainability, procedure- and material-related environmental concerns, and energy and water conservation behaviors. Responses were measured using standardized 5-point Likert and frequency scales, with composite scores calculated to categorize levels of knowledge, practices, and attitudes toward sustainability; higher scores indicated greater knowledge, awareness, and engagement in sustainable practices. Results: Overall, among the 120 nurses, of whom 62 (51.7%) had reported having heard about sustainability and received training about it, whereas 58 (48.3%) had not. Most participants held a bachelor’s degree (n = 54, 45.0%), nearly half had more than 10 years of nursing experience (n = 58, 48.3%), and the largest proportion worked in delivery rooms (n = 53, 44.2%). Regarding knowledge, attitude, and practice, good knowledge was observed in 61 participants (50.8%), good practice in 46 participants (38.3%), and positive attitudes in 108 participants (90.0%). The findings also showed that trained nurses in obstetrics and gynecology units demonstrated significantly higher knowledge, more positive attitudes, and better eco-conscious practices compared to untrained nurses across all domains (p < 0.001). Conclusions: The study demonstrates that maternity nurses showed moderate to high awareness and positive attitudes toward sustainability, while environmentally sustainable practices were less consistently implemented, indicating a clear knowledge–attitude–practice gap. Nurses who received sustainability-related training consistently achieved significantly higher knowledge, attitude, and practice scores than untrained nurses. Full article

Pain is a complex experience that encompasses both physical and emotional dimensions. Stomatognathic Pain (SP) affects the anatomical and functional structures of the stomatognathic system, which is involved in essential activities such as mastication, deglutition, and phonation. Consequently, SP can significantly impair patients’ quality of life, affecting physiological, psychological, and social well-being. Precision Medicine (PM) is an emerging patient-centered approach that enables healthcare providers to tailor diagnostic and therapeutic strategies according to each patient’s biochemical, physiological, environmental, and behavioral profile. The aim of this narrative review is to highlight PM tools for the diagnosis and treatment of SP and to explore their contribution to personalized management. A literature search was conducted in the PubMed and Scopus databases using the keywords “orofacial pain”, “stomatognathic pain”, “precision medicine”, “pain management”, “pain assessment”, “pain treatment”, and “patient-centered care”. Current evidence suggests that PM can improve SP management by identifying pathogenic mechanisms, clarifying disease etiology, and integrating advanced molecular and digital technologies. Emerging approaches, including genetic profiling, biomarker analysis, artificial intelligence–based diagnostics, targeted therapies, individualized rehabilitation, and behavioral interventions, may support personalized treatment and facilitate the development of patient-centered care models, ultimately reducing the burden of SP and improving clinical outcomes and quality of life. Full article

Background: In Uganda, COVID-19-related disruptions increased the number of children who missed scheduled routine vaccination (defaulters). Identifying and following up with defaulter children is important for improving vaccination coverage. This paper describes Uganda’s experience in revitalizing community-led defaulter tracking to improve vaccination coverage post-COVID-19 in four purposefully selected districts. Methods: During two 6-month periods in 2022 and 2024, healthcare workers (HCWs) worked with village health teams (VHTs) to review health facility-based immunization registers, identify and track defaulters aged 0 to 59 months. VHTs visited identified defaulters’ homes, reviewed vaccination histories and reminded caregivers to bring defaulters to immunization sites for catch-up vaccination. Results: Overall, 20,922 defaulters were identified by health register review; VHTs located 15,749 (75.3%) through household visits, of whom 3688 (23.4%) were verified as previously vaccinated based on their home-based vaccination records, leaving 12,061 as true defaulters. Among the true defaulters, 9662 (80.1%) received at least one catch-up vaccination after follow-up by the VHT. The most frequently administered catch-up vaccines were measles–rubella first dose (MR1) at 55.4%, followed by diphtheria–tetanus–pertussis third dose (DTP3) at 48.3% and Bacillus Calmette–Guérin (BCG) at 47.4%. Among the 2399 children who remained unvaccinated after follow-up, the most common reasons were relocation outside the original catchment area (49.5%) and caregiver intention to vaccinate later (16.3%). Conclusion: Community-led defaulter tracking was feasible and improved vaccination uptake in post-COVID-19 Uganda. Strengthening the quality and availability of health facility immunization data, along with targeted community engagement, caregiver reminders and integrated vaccination services would improve identification and follow-up of defaulters, reducing population immunity gaps. Full article

Everyday complaints (EDCs) in veterinary practice are frequently under-measured signals of quality and client experience. A practical framework to quantify and use these complaints is presented. It highlights that most published veterinary data describe formal legal or disciplinary cases, while routine concerns about fees, communication, outcomes, and service are rarely captured systematically and lack benchmarks linked to the workload of each practice. Drawing on veterinary mediation reports and human healthcare complaint taxonomies, the paper identifies key obstacles: unclear definitions, under-capture of informal complaints, absence of denominators, and failure to distinguish severity levels. To address this, the manuscript defines EDCs as any owner-initiated dissatisfaction requiring staff time (excluding legal/insurance cases) and outlines a form to log each episode with standardized fields such as category, channel, service area, severity, and resolution. It suggests veterinary clinics build internal baselines over at least 12 months, use run or control charts to detect meaningful shifts and treat both unexpectedly high and near-zero complaint rates as prompts for closer review, so veterinary hospitals can turn everyday complaints into structured inputs for quality improvement rather than purely reputational threats. Full article

Medical image transmission across cloud-enabled healthcare networks has become increasingly common in modern telemedicine systems. However, existing approaches suffer from increased computational overhead, inadequate resistance against statistical attacks, poor reconstruction quality and so on. Hence, an efficient secure medical image transmission framework that integrates compression and encryption is needed. This work presents a ‘denoising-compression-encryption’ framework, which integrates Huang’s Block Truncation Coding (HBTC) with Gauss-iterated map with Inertia Weight-based Chimp Optimization Algorithm (GIW-CHO) optimized Elliptic Curve Cryptography (ECC) and termed as ‘OKBECC’. Initially, the images are denoised for intensity stabilization and then HBTC is employed to binarize and decorrelate the images. Finally, encryption is performed by ECC using the keys optimized by GIW-CHO algorithm. HBTC greatly influences the interpixel-correlation and histogram structure by reducing the entropy to approximately one before encryption, which makes it unpredictable. GIW-CHO helps explore larger key space and provides stronger optimal keys, which helps in attaining better quality of reconstructed image. The proposed work is tested across different image modalities including X-ray, ultrasound, Magnetic Resonant Imaging (MRI), Computed Tomography (CT) and histopathology upon standard performance measures. The proposed OKBECC shows an average NPCR, UACI and cipher entropy of about 99.6%, 33.4% and 7.99 bits, respectively, which outperforms multiple existing algorithms. In addition, the image reconstruction quality is proven with PSNR of about 68 dBs, which is clinically acceptable. Full article

Background: Artificial intelligence (AI) is increasingly used in nephrology, including rehabilitation planning for patients with chronic kidney disease (CKD). However, most AI systems are predominantly trained on English-language data, which may influence the quality and clinical relevance of the generated recommendations. Objective: To evaluate the impact of query language on the quality and clinical applicability of AI-generated exercise programs for CKD patients undergoing renal replacement therapy. Methods: We conducted a structured qualitative comparison using predefined evaluation criteria based on KDIGO and ERA rehabilitation guidelines. Outputs were assessed for structure, clinical detail, safety framing, and adaptability. Identical prompts were formulated in Ukrainian and English. Generated exercise programs were assessed for alignment with international guidelines (KDIGO, ERA), level of clinical detail, progression, safety considerations, and adaptability. Results: All AI systems produced safe exercise programs incorporating aerobic, resistance, flexibility, and relaxation components. However, significant differences were observed depending on the query language. Ukrainian-language outputs were simpler and focused on general well-being, with limited progression and monitoring. In contrast, English-language outputs demonstrated greater clinical depth, including structured progression, intradialytic adaptations, and the use of validated monitoring tools (e.g., Borg RPE scale). Copilot provided the highest clinical precision, ChatGPT delivered structured programs, and Gemini emphasized safety and motivation. English-language prompts produced more detailed and guideline-aligned outputs, whereas Ukrainian-language prompts generated simpler, wellness-oriented recommendations. Conclusions: Query language influences the structure and clinical completeness of AI-generated rehabilitation programs. English-language prompts currently yield more detailed and guideline-aligned outputs. Further multilingual model development is needed. English-language queries currently yield more clinically robust outputs. Development of multilingual AI systems and standardized prompt frameworks is essential to ensure equitable access to AI-assisted healthcare. Full article

Healthcare quality systems have evolved from narrow inspection and compliance mechanisms into broader, multi-level architectures that combine standards, measurement, organizational learning, patient safety, equity and patient-reported outcomes. Yet the field remains fragmented, with substantial variation in how quality is defined, measured and operationalized across countries and healthcare settings. This narrative review synthesizes major international quality systems and frameworks used in healthcare delivery, examines principal methods for evaluating and improving quality, and critically discusses organizational and policy conditions associated with successful implementation. A purposive review of the seminal conceptual literature and authoritative documents from major international organizations was undertaken to identify cross-cutting themes relevant to hospitals, ambulatory care and health systems. The review shows that influential approaches—including the World Health Organization’s quality and patient safety frameworks, Joint Commission International accreditation, NCQA/HEDIS, the EFQM model, ISO-based management systems, AHRQ quality indicators and OECD performance initiatives such as PaRIS—should be viewed as complementary rather than competing models. Their effectiveness depends less on formal adoption alone than on leadership commitment, workforce engagement, data infrastructure, patient involvement and alignment with financing and regulation. Evidence is strongest for gains in standardization, safety processes, teamwork and selected efficiency outcomes; direct causal effects on patient outcomes remain less consistent, particularly when quality systems become compliance-driven or are insufficiently adapted to local context. Future healthcare quality systems should integrate equity, digital interoperability, AI-enabled learning capabilities, patient-reported measures and continuous improvement while reducing measurement burden and indicator proliferation. Full article

Web-based repeated-measures cohorts enable remote, scalable, and temporally structured monitoring of health-related outcomes in naturalistic settings. This paper presents the DiCoBENE study, a web-based cohort of healthcare-track university students, and reports evidence-informed instrument selection together with protocol features and pilot baseline findings. A structured review was used to inform the web-based administration of patient-reported outcome measures (PROMs) covering sleep quality, perceived stress, anxiety symptoms, depressive symptoms, and quality of life. In the pilot baseline sample, 442 students constituted the analytic dataset and 370–372 completed the core PROM battery, depending on the instrument. Poor sleep quality, anxiety symptoms, depressive symptoms, and perceived stress were common. Internal consistency was good to excellent for the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire 9-item depression module (PHQ-9), and the 10-item Perceived Stress Scale (PSS-10), and moderate for the Pittsburgh Sleep Quality Index (PSQI). Exploratory multivariate analyses, including latent profile analysis, principal component analysis, and partial-correlation network analysis, suggested that baseline heterogeneity was more parsimoniously summarized as a graded multidimensional burden continuum than as sharply separated phenotypes. Taken together, these findings position DiCoBENE as a methodologically explicit framework for web-based repeated outcome assessment in student well-being research. Full article

Background: Physical inactivity and sedentary behaviour are major public health concerns associated with an increased risk of non-communicable diseases, reduced quality of life, and substantial healthcare burden. In recent years, technology-based interventions, including wearable devices, mobile health applications, artificial intelligence-driven systems, and adaptive digital platforms, have been increasingly adopted to promote physical activity and reduce sedentary time in adult populations. However, the evidence remains fragmented across intervention types, behavioural targets, and population groups. The aim of this scoping review was to map the recent literature on digital interventions designed to promote active lifestyles in adults, with a specific focus on their reported impact on physical activity promotion and sedentary behaviour reduction. Methods: This scoping review was conducted in accordance with the PRISMA-ScR guidelines. A literature search was performed in PubMed and Scopus using a predefined search strategy combining terms related to digital technologies, physical activity, sedentary behaviour, and adult populations. Studies published in English between 2022 and 2026 were considered. After removal of duplicates and screening of titles and abstracts, full texts were assessed according to predefined eligibility criteria. Data were charted descriptively and synthesised narratively to identify the main intervention models and emerging research trends. Results: The search identified 887 records, of which 35 studies were included in the final synthesis. The literature included was grouped into four broad categories: wearable devices and mHealth tools for monitoring and goal-setting; adaptive interventions based on Just-In-Time Adaptive Interventions, artificial intelligence, and gamification; advanced technologies such as Internet of Things systems and exoskeleton-based approaches; and hybrid interventions combining digital tools with human support or environmental modifications. Overall, technology-based interventions were generally associated with increases in step count, moderate-to-vigorous physical activity, and adherence to movement-related behaviours. In contrast, their effectiveness in reducing sedentary behaviour was less consistent and appeared to depend more strongly on context-sensitive prompting, posture-focused strategies, and multicomponent or hybrid intervention models. Conclusions: Digital health interventions represent a promising strategy for promoting physical activity in adults, but their impact on sedentary behaviour reduction remains more limited and heterogeneous. The findings suggest that simply increasing exercise is not sufficient to address prolonged sitting and that more tailored, adaptive, and context-aware approaches are needed. Future research should prioritise methodological standardisation, longer follow-up periods, and interventions specifically designed to interrupt sedentary time across different adult populations. Full article

Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related mortality worldwide. Despite established guidelines recommending semiannual surveillance for high-risk patients, real-world adherence remains inconsistent. Gaps in healthcare personnel knowledge and care coordination are recognized contributors to this implementation failure. Methods: Under IRB approval, a quality improvement project using the Plan-Do-Study-Act (PDSA) framework was conducted in an ambulatory liver clinic in the southwestern United States. One PDSA cycle was completed. Retrospective and prospective chart reviews (n = 50 charts each) were conducted to assess HCC surveillance ordering and scheduling rates. Thirty healthcare personnel completed investigator-developed pre- and postintervention surveys measuring knowledge and perceptions. Intervention: A structured educational session grounded in current American Association for the Study of Liver Diseases (AASLD) surveillance guidelines was delivered to the full interdisciplinary clinic team, incorporating clinic-specific compliance data and role-specific coordination responsibilities. Results: Knowledge scores improved significantly from a mean of 41.67% to 95.33% (t [29] = −20.27, p < 0.001, d = 3.70). Perception scores improved (Wilcoxon z = −4.30, p < 0.001). Surveillance ordering increased from 88% to 94% and scheduling from 60% to 80%. Conclusions: A single structured educational PDSA cycle was associated with significant improvements in healthcare personnel knowledge and perceptions and with improved ordering and scheduling of HCC surveillance imaging. Postintervention imaging completion and result review rates were not assessed within the available follow-up period. Run chart monitoring of surveillance metrics across subsequent PDSA cycles is planned to evaluate sustainment and guide iterative improvement. 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

Background/Objectives: Growing concern about narcissistic traits in younger generations and their effects on empathy, communication, and mental health underscores the need for focused research on medical students as future healthcare professionals. Medical training carries a substantial psychological burden that can compromise students’ well-being, professional development, and the future quality of patient care. Personality traits, including grandiose and vulnerable narcissistic dimensions, may shape susceptibility to such psychological distress. Therefore, this study aimed to examine narcissistic traits and their associations with psychological distress among Croatian medical students across study years and trait levels. Methods: In this cross-sectional study, 413 medical students from the University of Split completed self-administered questionnaires during mandatory classes. Narcissistic traits were assessed using the Pathological Narcissism Inventory (PNI) and psychological distress was measured with the Brief Symptom Inventory (BSI). High pathological narcissistic traits were operationally defined as scores within the highest quartile. Statistical analyses included correlation, comparative, and regression analyses. Results: Overall, pathological narcissistic traits were expressed at low to moderate levels and did not differ across academic years. High narcissistic traits were identified in 35% of students, with 15% exhibiting elevated levels of both grandiose and vulnerable dimensions, suggesting an overlap between the two dimensions. Gender differences emerged across both narcissistic dimensions, with women scoring higher on vulnerable and men scoring higher on grandiose narcissism. One-quarter of students met the criteria for clinically significant psychological distress, which was more prevalent in the earlier years of study. High levels of pathological narcissistic traits, particularly vulnerable traits, were significantly associated with clinically significant distress and elevated symptoms across nearly all BSI domains, most notably interpersonal sensitivity and paranoid ideation. Despite this burden, only a minority of distressed students reported seeking psychological help. Conclusions: Elevated pathological narcissistic traits are significantly associated with psychological distress in medical students. The high prevalence of distress, combined with low help-seeking rates, underscores the need for early identification strategies and structured mental health support within medical education. Addressing personality-related vulnerability factors may improve student well-being, enhance professional development, and, ultimately, elevate the quality of healthcare delivery. Full article

Background/Objectives: Health systems in many countries are increasingly turning to task shifting, task sharing and broader skill-mix solutions to address staff shortages and unequal access to care, particularly in rural regions. This article summarizes how different healthcare systems introduce intersecting competencies through new professional roles, the expansion of the scope of existing professions, and the transfer of selected tasks between them. The aim was also to indicate which strategies may be relevant for the Polish context. Methods: A literature review was carried out using PubMed and Embase (14 February–9 March 2025). Publications from 2010 to 2024 in English or Polish were included. The study was designed as a narrative review supported by a structured literature search. Publications and policy documents relevant to skill-mix strategies were identified through a concept-driven process and incorporated into a thematic synthesis. Results: Countries that introduced new professional roles reported better access to care and more continuity for patients. Expanding the scope of nurses, physiotherapists and pharmacists often helped reduce the workload of doctors and, in some places, also supported better treatment results or smoother work in facilities. At the same time, there were clear challenges: unclear role boundaries, gaps in training, extra workload and limited organizational support. These issues were particularly visible in rural areas, where staff shortages are the most severe. Conclusions: Skill-mix strategies can support healthcare systems by improving access and the overall quality of care. However, their success depends on clear regulations, adequate preparation and acceptance among health workers. Although many solutions are promising, further research is needed to better assess their long-term effects and usefulness in medical deserts. Full article

Background and Objectives: Young women treated for breast cancer often face persistent sexual and reproductive challenges post-treatment, which frequently remain unaddressed during routine follow-up. This study evaluated health-related quality of life (HRQoL), sexual health, and fertility-related counselling in breast cancer survivors younger than 40 years. Materials and Methods: We performed a single-centre cross-sectional study including 65 women with non-metastatic breast cancer (at least 12 months post-primary treatment). Patients completed the EORTC QLQ-C30 and SHQ-22 questionnaires, along with a pilot-tested 7-item fertility preservation survey. Data were analyzed using descriptive statistics and non-parametric tests to compare treatment subgroups (e.g., endocrine therapy vs. others). Results: Overall quality-of-life scores were relatively preserved (median 66.67), with high functional scores. However, patients reported symptomatic distress, particularly fatigue and insomnia (both median 33.33). Sexual health was significantly impacted: communication with healthcare professionals was the most impaired domain (median score 100), followed by low libido (66.7) and vaginal dryness (66.7). Women receiving endocrine therapy reported significantly lower functional scores and a higher symptom burden compared to those not on endocrine treatment (p < 0.05). While 60% of patients received fertility information, only 16.9% underwent preservation procedures. Notably, a significant association was observed between reproductive health actions and sexual behaviour; women who had undergone fertility preservation procedures reported higher levels of sexual activity (p = 0.015). Conclusions: Despite relatively preserved functional status, young breast cancer survivors face significant symptomatic and sexual challenges. The profound lack of communication regarding sexual health and the gaps in fertility counselling highlight the need for a more integrative, multidisciplinary approach in survivorship care. Full article