Search Results (5,890)

Background: Effective nurse–patient communication is fundamental to quality care delivery, yet language barriers pose significant challenges in multicultural healthcare environments. In Saudi Arabia’s diverse healthcare landscape, nurses frequently encounter patients who do not speak Arabic, potentially compromising care quality and patient safety. Objective: To explore multilevel factors influencing communication between Saudi nurses and non-Arabic-speaking patients, using Bronfenbrenner’s ecological systems theory as a conceptual framework. Design: A qualitative descriptive study employing semi-structured interviews analyzed through reflexive thematic analysis. Setting: Four healthcare facilities (two governmental and two private hospitals) across Saudi Arabia. Participants: Eighteen Saudi registered nurses with experience caring for non-Arabic-speaking patients, recruited through purposive sampling. Methods: Semi-structured interviews (n = 18) were conducted in Arabic or English between November 2025 and February 2026. Data were analyzed using Braun and Clarke’s reflexive thematic analysis, organized within Bronfenbrenner’s ecological levels. Collaborative reflexive coding and member-checking with six participants supported analytical rigor. Results: Five main themes emerged: (1) Individual-level competencies and preparedness (microsystem), (2) Interpersonal dynamics and cultural sensitivity (microsystem), (3) Unit-level resources and organizational support (mesosystem), (4) Institutional policies and language services (exosystem), and (5) Healthcare system and societal influences (macrosystem). Participants identified language proficiency gaps, cultural misunderstandings, inadequate interpreter services, and systemic barriers as primary challenges affecting communication quality. Conclusions: Communication between Saudi nurses and non-Arabic-speaking patients is influenced by complex, interconnected factors across multiple ecological levels. Interventions should address individual competency development, organizational support systems, and policy-level changes to ensure equitable, safe, and effective communication for all patients. Full article

Background: Telehealth acceptance for chronic low back pain (CLBP) remains unclear. It may depend on patients’ knowledge, attitudes, barriers, and health factors. This study assessed telehealth physical therapy’s acceptability for CLBP by examining willingness, knowledge, attitudes, and barriers, and comparing willingness among healthcare professionals. Methods: This study included 309 adults with CLBP. The Telemedicine Perception Questionnaire (TMPQ) assesses perceptions and barriers. Participants rated telehealth willingness and completed the PROMIS-29 for health factors. The descriptive statistics summarized the characteristics. The Friedman test was used to compare professional willingness, t-tests were used to examine sex differences, Pearson’s correlation was used to assess PROMIS-29 and telehealth willingness, and multivariate regression was used to identify the related variables. Results: The participants had an average age of 26.06 years, and 90% were female. Willingness varied (p < 0.001), being highest among dietitians (3.86 ± 1.15), lowest in physical therapists (3.52 ± 1.13). Males reported more telehealth barriers (p = 0.043), and females had higher anxiety, depression, fatigue, and pain scores (p < 0.05). Willingness to use telehealth physical therapy correlated with physical function (r = 0.319). The knowledge score was most strongly correlated with physical function (r = 0.368). Regression analysis showed that knowledge (B = 0.057, p = 0.011) and attitude (B = 0.063, p < 0.001) predicted greater telehealth willingness, with the model explaining moderate proportion of the variance in willingness to use telehealth physical therapy (R² = 0.381; adjusted R² = 0.370). Conclusions: Telehealth physical therapy was moderately acceptable in adults with CLBP. Knowledge and acceptance increased the willingness to use telehealth services. Higher knowledge of telehealth and more positive attitudes were associated with a greater willingness to use telehealth physical therapy. These findings suggest that patient education and clear orientation to telehealth procedures may support readiness for telehealth-based physical therapy. However, the strong predominance of female participants (90%) and the self-selected online sample should be considered when interpreting the findings, as these factors may limit generalizability to the broader CLBP population. Full article

Background/Objectives: The application of artificial intelligence (AI) in the healthcare field continues to deepen, with the development paradigm gradually shifting from technology-driven innovation to design-driven innovation towards “human-centered artificial intelligence (HCAI).” This aims to bridge the potential of AI technology with actual clinical needs and improve the quality and accessibility of healthcare services. However, it still faces challenges such as insufficient integration of theoretical frameworks, complex implementation challenges, and an imperfect ethical governance mechanism. Methods: This article presents a systematic narrative review about the philosophical and ethical foundations of HCAI related literature, analyzes the specific clinical application models recorded in the literature, integrates key theories related to implementation science, human–machine collaboration, and explainable AI(XAI), and constructs a multidimensional comprehensive analysis framework for HCAI in the medical field. Results: The study shows that design-driven innovation is the key to bridging the gap between the potential of AI technology and practical medical applications; the successful implementation of “human-centered artificial intelligence” relies on interdisciplinary collaboration, stakeholder co-creation, and ethical considerations throughout the entire lifecycle; Among them, human-centered design ensures that technology meets real needs; Implementation Science guarantees innovation can effectively integrate into complex medical environments; explainable AI technology is the cornerstone of establishing clinical trust; the strategic governance framework sets boundaries and tracks for the healthy development of the entire ecosystem. Conclusions: Beyond summarizing existing research findings, this study proposes targeted design frameworks and trade-off strategies for key technical and practical dilemmas of HCAI. It also clarifies the contextual boundaries of existing empirical results, provides a differentiated operational path for the implementation of HCAI, as well as a clear direction and important reference for academic research and future practical applications of human-centered AI medicine. Full article

Smart Hospitals integrated within 6G edge networks aim to enhance hospital connectivity and operational efficiency by enabling intelligent and personalized e-health services and applications while optimizing resource utilization and maintaining a high degree of autonomy. Nevertheless, the interconnectivity and 6G integration, which comprise core components of Smart Hospitals, are susceptible to a wide range of security threats, posing significant risks to the confidentiality, integrity, and availability of hospital data and operations. Given that security is a critical concern for Smart Hospitals, there is an urgent need to develop novel security mechanisms to safeguard these environments within 6G edge networks. In particular, this work highlights how defining 6G characteristics, such as Ultra-Reliable Low-Latency Communications, massive IoMT connectivity, distributed edge intelligence, and AI-native network operation, not only enable next-generation hospital services but also reshape the security and privacy threat landscape and the requirements of mitigation mechanisms. In this context, the first essential step is to comprehensively understand both existing and emerging threats targeting Smart Hospitals in the 6G edge network ecosystem. Therefore, this article provides a categorization of security and privacy attacks based on their primary targets. Moreover, it presents a survey of mitigation techniques derived from recent literature, specifically designed to counter threats facing Smart Hospitals in 6G edge networks. The intent is to establish a foundation that supports ongoing research towards the development of effective, 6G-aware security countermeasures capable of protecting Smart Hospitals under the stringent latency, scalability, and reliability requirements of future healthcare environments. Full article

Hybrid healthcare integrates digital and in-person services across care delivery and governance, becoming central to modern health systems. Driven by technological advances and the COVID-19 pandemic, it reshapes care pathways, workforce organisation, and system management. Hybrid models can improve outcomes while reducing staff and administrative burdens. This paper presents a consortium-based exploratory review to conceptualise hybrid healthcare and define its core domains. Using qualitative analysis and two AI-focused case studies, it identifies five interrelated domains: operations, care pathways, education, governance, and data-driven personalised care. Findings, including evidence from Czechia, offer a practical framework for analysing hybrid healthcare transformation. Full article

Background: Tanzania’s national family planning standards mandate that healthcare providers deliver objective, comprehensive, and client-focused contraception information to enable informed choice. Despite these initiatives, evidence indicates contraceptive uptake in Tanzania is low (38%), with a growing rate of discontinuation at 34%. Therefore, this study aimed to explore women’s experiences of contraceptive counseling, with a particular focus on how information provided by healthcare providers influences informed contraceptive choice in Moshi Municipality, Tanzania. Methods: Semi-structured qualitative interviews were carried out with 15 women attending family planning clinics for contraceptive counseling at the two selected public health facilities in Moshi Municipality. Purposive sampling was used. Reflexive thematic analysis described by Braun and Clarke was employed. Results: Three main themes and eight sub-themes emerged. The main themes were information and communication gaps, provider interaction and autonomy, and social networks and structural influence. The sub-themes were insufficient and unclear information; myths and misconceptions; limited visual aids and practical demonstrations; respectful and friendly services; time given by the provider; provider-led choice, influence by peer stories and fear; and accessibility of the services and environment. Participants experienced limited discussion of available contraceptive methods and limited use of visual aids for thorough explanation to enable women to make an informed choice and consistent use of contraceptive methods. Conclusions: The findings highlight that women’s experiences with contraceptive counseling for informed contraceptive choice are diverse, including both positive and negative aspects. Respectful and friendly approaches and a supportive service environment are important; however, they are insufficient on their own to ensure informed contraceptive choice. Quality information from the healthcare provider that is clear, complete, accurate, and comprehensive is central to the counseling process. The integration of these factors is essential to empower women to make informed contraceptive choices that align with their reproductive intentions. Full article

Background: The financial burden of diagnostic testing for obstructive sleep apnea (OSA) represents a substantial barrier to treatment initiation, with cost-related access disparities disproportionately affecting the low-income and underinsured population. Home sleep testing (HST) offers a cost-effective diagnostic alternative, yet economic patterns across provider types remain unclear. This study assessed whether board-certified sleep medicine provider (BCSMP) status is associated with differences in provider-billed HST charges and evaluated how organizational and payment contexts influence these charges. Methods: A retrospective cross-sectional analysis was conducted using 2019 data from Optum’s de-identified Clinformatics^® Data Mart Database (N = 61,531 adult HST claims). The main exposure was provider status (BCSMP vs. non-BCSMP). The outcome was total provider-requested charge per HST procedure. Generalized Linear Models with a gamma distribution estimated adjusted charge differences, controlling for organizational context, place of service, and payer type. Results: BCSMP encounters had significantly lower adjusted mean HST charges than non-BCSMPs (mean difference: −$78.04; 95% CI: −$89.06 to −$67.02; p < 0.001). Individual practitioners charged $168.48 less than hospital-affiliated providers, while group practices and other facilities charged more (all p < 0.001). Fee-for-service arrangements were associated with lower charges than commercial and Medicare Advantage plans (p < 0.001). Conclusions: Board-certified sleep medicine providers and individual practice settings were associated with lower billed charges for home sleep testing; however, these findings do not necessarily reflect actual cost reduction. To translate these baseline charge differences into equitable clinical protocols and healthcare policies, future research must analyze negotiated reimbursement rates, billing structures, and practice environments to determine how these cost parameters impact the overall cost of an OSA diagnosis. Full article

Background/Objectives: This cross-sectional observational study investigated factors associated with emergency room (ER) utilization for dental pain in a rural inland region of Portugal. The main objective was to examine the relationship between access to dental care, sociodemographic characteristics, oral health behaviors, and clinical outcomes with the use of emergency room services for dental problems. Methods: The study sample comprised 423 participants from the districts of Bragança and Vinhais, in Trás-os-Montes, aged 4 to 90 years, who attended their first dental medicine consultation. Participants completed a structured questionnaire addressing sociodemographic characteristics, general health, oral health behaviors, and dental prosthetic use, and underwent oral examination for assessment of the Decayed, Missing, and Filled Teeth (DMFT) index. Associations with reported ER utilization due to toothache were analyzed using Fisher’s exact test and the Mann–Whitney U test. Results: Overall, 28.4% of participants reported having visited the ER due to dental pain, and most cases were managed with medication followed by discharge. ER utilization was significantly associated with behavioral risk factors such as smoking, as well as poorer oral hygiene practices, including less frequent tooth brushing. In addition, participants who sought ER care presented higher DMFT scores, indicating a greater burden of untreated dental decay and tooth loss. Conclusions: These findings suggest that limited preventive dental care and unfavorable oral health behaviors are associated with to avoidable ER visits for dental pain in rural settings. This study reinforces the need to strengthen access to preventive oral health services and to advance the integration of dental care into Portugal’s National Health Service (SNS), particularly in underserved inland regions. Full article

The rapid advancement of laboratory automation, robotics, and digital technologies has significantly transformed laboratory medicine worldwide, improving efficiency, diagnostic accuracy, and quality management. However, the adoption of these technologies in developing countries such as Indonesia remains uneven and is influenced by infrastructural, financial, regulatory, and workforce-related challenges. This structured narrative review aimed to critically examine the current landscape of laboratory automation and robotics in Indonesia, with particular emphasis on implementation challenges, workforce transformation among medical laboratory scientists (Ahli Teknologi Laboratorium Medik, ATLM), and pathways toward equitable integration. Studies published between 2015 and 2025 were identified through PubMed, Scopus, and Google Scholar, complemented by Indonesian regulatory documents, professional guidelines, and relevant grey literature. The review was informed by PRISMA principles and synthesized narratively to explore technological developments, operational impacts, policy contexts, and implementation barriers relevant to Indonesian laboratory systems. The findings indicate that automation and robotics offer substantial benefits, including improved turnaround time, enhanced quality assurance, reduced laboratory errors, and greater operational efficiency. Nevertheless, significant barriers persist, particularly disparities in digital infrastructure, financial constraints, limited workforce readiness, and the absence of comprehensive implementation frameworks. The review further highlights that automation is reshaping rather than replacing the role of ATLM, shifting professional responsibilities toward digital competency, automation oversight, data interpretation, and quality management. Achieving sustainable laboratory automation in Indonesia therefore requires an equity-centered and systems-oriented approach involving regulatory strengthening, workforce development, infrastructure investment, and multi-stakeholder collaboration. With strategic planning and policy alignment, laboratory automation and robotics hold considerable potential to modernize laboratory services and support Indonesia’s broader healthcare transformation agenda. Full article

This qualitative study incorporates caregiver perspectives to identify their (1) experiences with medical and educational supports for their children with chronic TBI following inpatient rehabilitation and across the recovery trajectory and (2) recommendations to improve service provision for young people with TBI. Nineteen caregivers of children with complicated-mild-to-severe TBI participated in semi-structured virtual interviews. Participants were from a large Midwestern U.S. city. Researchers used reflexive thematic analysis, incorporating an experiential orientation and a deductive approach. Standards for Reporting Qualitative Research guided this process. Children were an average of 5.2 years post-injury, and age at injury ranged from 2.6 to 18.0 years, providing depth of caregiver experiences discussed in interviews. Four primary themes were identified: (1) TBI leads to lasting changes in the child, (2) the healthcare environment is overwhelming, (3) TBI forces a shift in caregiver responsibilities, and (4) school challenges persist over time. Caregivers generated concrete, experience-based recommendations, highlighting the need for increased support, resources, and education in specific areas following pediatric TBI. By centering caregiver voices across recovery, this study underscores their unique expertise in identifying system-level gaps and informing the development of interventions, services, and policies that better support children with TBI and their families over time. Full article

Background: Micromanagement is an extensively prevalent yet relatively under-theorized management process in healthcare organizations. This narrative review synthesizes the literature on micromanagement and related leadership practices in healthcare, focusing on its antecedents, manifestations, consequences, and mitigation strategies. Methods: A structured literature search was conducted on 10 May 2024 across eight electronic databases. Eligible studies included qualitative, quantitative, mixed-methods, and applied studies published between 2003 and 2024. The main outcomes were the underlying causes and behavioral measures of micromanagement, examined directly, or closely related constructs such as excessive supervision, reduced autonomy, authoritarian leadership, toxic leadership, and controlling managerial behavior. The secondary outcomes involved organizational and patient-related effects and their respective interventions. Results: A total of twelve studies were selected. The identified antecedents of micromanagement were authoritarian leadership styles, autocratic and toxic leadership personality traits, overly intrusive supervisory practices, poor employee empowerment, complicated regulation, unclear definition of professional roles, and inherent structural challenges. Micromanagement behavior was seen in authoritative decision-making, transactional supervision, systematic reduction in employee autonomy, and institutionalized distrust. The consequences recorded include high levels of occupational stress, poor organizational productivity, poor quality of healthcare services, high employee turnover rates, and psychological problems. Conclusions: This review represents a preliminary conceptual synthesis of the literature that addresses micromanagement in healthcare. The evidence base is inconsistent, with many studies focusing on constructs that relate to micromanagement while not studying it directly. In future research, validated tools to assess micromanagement should be designed, as well as leadership interventions that benefit both workplace and patient outcomes. Full article

Youth substance abuse represents a complex social and security problem which cannot be adequately captured solely through crime statistics. In the context of the Slovak Republic, there is a lack of systematic research linking healthcare data on intoxications with criminological indicators, which limits the effective design of preventive measures. The research analyses substance abuse (according to ICD 10 F10–F19) among youth in the NUTS 3 regions of the Slovak Republic during 2019–2024 and their descriptive association with drug-related crime. Analysis is based on data provided by public administration entities—the National Health Information Centre of the Slovak Republic (data on youth hospitalisation), the Operational Centre of the Emergency Medical Service of the Slovak Republic (data on EMS call-outs) and the Ministry of Interior of the Slovak Republic (data on crime). The provided data represent the whole population of the Slovak Republic. To enable comparison between datasets, two standardised indices are constructed: an EMS index representing a number of EMS call-outs and urgent hospitalisations per 100,000 inhabitants of the respective youth age group and a crime index representing a number of drug-related criminal offences per 100,000 total regional inhabitants. A total of 4486 emergency interventions with F10–F19 diagnoses were identified, with the highest proportion being disorders caused by alcohol (F10), more common among juveniles (14–17) than in minors (6–13). The analysis identifies a moderate positive association between the regional EMS index for F10 and F11–F19 diagnoses (correl youth = 0.66; correl juveniles = 0.55) and a weak negative association between the F11–F19 EMS index and the drug-related crime index (correl youth = −0.28; correl minors = −0.52). The Pearson correlation coefficients are reported as descriptive indicators. Formal statistical inference was not the aim of this study. The findings suggest that crime statistics alone inadequately reflect the health risks of youth substance abuse, underscoring the need to link healthcare, criminological, and demographic data and to develop regionally targeted prevention. Full article

Strategic competition in health service markets requires managers to make pricing, marketing, and investment decisions under uncertainty, yet educational programs in healthcare management and dietetics lack experiential tools for teaching these competencies within a game-theoretic framework. This study develops and computationally validates SY142-Game-Theory-1, a computational simulation framework that models strategic competition between two asymmetric healthy living centers as a 36-month repeated Prisoner’s Dilemma, integrating demand decomposition, net present value analysis, employee satisfaction dynamics with burnout thresholds, reputation feedback, and stochastic shock events. The simulation produces a valid and distinctly asymmetric Prisoner’s Dilemma structure in which the established provider faces the classical temptation to defect while the new entrant’s rational incentive aligns with cooperation; Axelrod-style tournaments across 22 strategies (96,800 simulations) identify Forgiving Tit-for-Tat as the top-performing strategy; Monte Carlo validation (n = 1000) confirms a statistically significant cooperation premium of 24.1% over Nash equilibrium; and sensitivity analyses across four parameters demonstrate robustness of all qualitative findings. The open-source framework bridges game theory, simulation-based learning, and health service management education, providing a computationally validated foundation for teaching strategic decision-making in competitive healthcare environments, with empirical evaluation of learning outcomes reserved for future work. Full article

Background/Objectives: Nursing home residents were among the most vulnerable populations during the COVID-19 pandemic, facing strict restrictive measures, limited access to medical services, and significant psychological consequences derived from institutional confinement. Despite the magnitude of these impacts, the perspective of residents themselves remain underrepresented in the qualitative literature, particularly in the Spanish context. The aim of this study was to analyze and describe the perspectives of residents in a nursing home regarding the restrictive measures adopted by the facility and their access to medical services during the COVID-19. Methods: An exploratory qualitative study was conducted with 24 residents of a nursing home in Cáceres, Spain. Data were collected through in-depth interviews and field notes, and analyze using inductive thematic analysis following Braun and Clarke’s framework. Results: Two main themes were identified: Necessary to feel safe, but unpleasant: accepting the restrictive measures (Accepting the measures; and Better safe, even if unpleasant) and Barriers to healthcare: abandonment, fear, and age-based exclusion (Neglect and abandonment by healthcare system; The residence as a “bubble” and fear of hospital transfer; and Not treated because of our age). Conclusions: The findings highlight the complexity of the experiences of older adults in residential care during the COVID-19 pandemic and underscore the urgent need to balance health protection with psychological well-being, dignity, and the rights of older people in future emergency responses. Full article

Background: Malocclusion has important functional, esthetic, and psychosocial consequences; however, access to orthodontic treatment remains uneven and strongly influenced by socio-economic factors. While these disparities are well documented internationally, evidence from Romania remains limited. This study aimed to evaluate the influence of socio-economic factors on orthodontic treatment initiation within the Romanian population. Methods: A cross-sectional questionnaire-based study was conducted in 2025 using an online survey distributed through social media and community networks. A total of 285 adults were included. Data were analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression. Results: Overall, 56.5% of respondents reported having undergone orthodontic treatment. Age and self-perceived information level were significantly associated with treatment initiation in the multivariable model. Participants older than 30 years were significantly less likely to have undergone orthodontic treatment compared with those aged 18–30 years (OR = 0.28, 95% CI: 0.12–0.62, p = 0.002). Higher levels of self-perceived information were associated with a greater likelihood of having undergone orthodontic treatment (OR = 0.75, 95% CI: 0.59–0.96, p = 0.020). Income and area of residence were not significantly associated with treatment initiation. However, respondents with lower income levels were significantly more likely to perceive treatment cost as a barrier to orthodontic care. Conclusions: Within this surveyed sample, age and self-perceived information level were independently associated with orthodontic treatment initiation. Although income was not associated with treatment uptake, financial cost remained an important perceived barrier, particularly among lower-income respondents. Given the convenience sampling strategy and limited representativeness of the sample, the findings should be interpreted as exploratory and require confirmation in larger population-based studies. Full article