Search Results (415)

Introduction: Improving adult pneumococcal vaccination is a public-health priority in Romania, and evidence regarding patient-level outcomes following different approaches to physician training remains limited. Materials and methods: This non-randomised, multicentre, quasi-experimental implementation study examined patient-level changes across three geographically distinct Romanian settings between August and November 2025. Physicians in Iași and Dolj counties received in-person training combining medical content with communication techniques based on motivational interviewing, whereas physicians in the webinar group received online medical training without a dedicated communication module. Eligible adult patients completed questionnaires before and after counselling and reported whether they had been vaccinated or had scheduled a vaccination appointment. Results: The analysis included 295 questionnaire pairs from patients nested within 29 physicians. Baseline attitudes differed markedly across settings (composite score of 5.64 in the webinar group, 5.29 in Dolj County, and 4.09 in Iași County; p < 0.001), as did strong baseline vaccination intention (75.6%, 48.1%, and 27.2%, respectively). Using a composite score comprising all seven attitude items, with item 7 reverse-coded and vaccination intention analysed separately, the cluster-robust group-by-time model indicated different mean changes between settings (global p = 0.001): +0.28 in the webinar group, +1.02 in Iași, and +0.60 in Dolj. Strong vaccination intention increased within each setting, but the magnitude of change did not differ between settings (group-by-time p = 0.929). The combined self-reported vaccination-or-scheduling outcome was observed in 81.5% of patients in the webinar group, 49.4% in Iași, and 73.3% in Dolj; after adjustment for baseline intention, there was no longer evidence of an overall group difference (p = 0.651). Discussion and conclusions: Because training approach, delivery modality, geographical setting, physician cohort, and patient population were not independently allocated, and because baseline levels differed markedly between settings, the findings should be interpreted as exploratory implementation patterns rather than causal comparative effects. Full article

The NHS-funded Common Ailments Service (CAS) in Wales enables community pharmacists to manage 28 common ailments by providing advice and/or medication free of charge without the need for patients to book an appointment. The aim of this study was to evaluate the patient experience of the CAS using patient reported experience measures (PREMs) and determine the feasibility of digital data capture collected directly from patients through a pharmacist-led manual recruitment model. The study used prospective, primary data collected through an online survey accessible via a Quick Response code and census recruitment. A total of 3660 surveys were included in the analysis, completed between 27 October 2025 and 31 March 2026. Overall experience was rated as excellent by 95.1% of participants. A theory-based framework analysis of 1499 free-text comments across the six domains of healthcare quality confirmed the high standard of care provision, primarily influenced by consultation quality, convenience, accessibility, and short waiting times. It also identified targeted areas for improvement, such as the need for seamless referrals from other areas of primary care and consistent availability of the service across all pharmacies. While digital PREMs captured high-quality insights, the pharmacist-led recruitment model reached a “feasibility ceiling”, with an overall response rate of 3.2%. Full article

Background/Objectives: People with severe mental illness experience high rates of malnutrition and cardiometabolic disease, and hospital food is increasingly regarded as part of clinical care rather than mere catering. Although nutrition is increasingly recognised as a therapeutic component of psychiatric care, little is known about how the professionals closest to nutritional care would design an inpatient meal concept. Methods: We conducted a cross-sectional, anonymous online survey of 26 nutrition professionals working in psychiatric settings in the German-speaking D-A-CH region (Germany, Austria, and Switzerland), who rated the goals, patient needs, dietary forms, meal characteristics, organisational aspects, and barriers relevant to an inpatient meal concept on five-point Likert scales. Free-text responses were analysed thematically. Results: Respondents prioritised eating enjoyment (mean [M] = 4.65) and psychological stability over economic goals, and rated both appetite loss and hyperphagia, together with medication-related metabolic change, as key patient needs. A Mediterranean dietary pattern was clearly the preferred model (M = 4.62), whereas low-carbohydrate options were the least endorsed form (M = 2.65). Interprofessional communication between nursing, kitchen, and dietetics was the highest-rated item overall (M = 4.75), while budget restrictions were seen as the principal barrier. Conclusions: In this small, self-selected expert sample, experts largely converged on a patient-centred, Mediterranean, flexible and choice-based meal concept delivered through strong interprofessional processes, supporting a shift from catering toward nutrition as a therapeutic component of inpatient psychiatry. Full article

Background: Acute sore throat (pharyngitis) accounts for 10–30% of ambulatory visits annually. Bacterial etiology, primarily Group A Streptococcus, is confirmed in only 20–34% of cases, and inappropriate antibiotic administration remains frequent, contributing to antimicrobial resistance. Community pharmacists play a key role in symptomatic management and stewardship, but real-world practices remain underexplored. Methods: A 16-item online questionnaire surveyed 629 Italian community pharmacists via professional networks, covering demographics, diagnostic tools, symptom assessment, treatment preferences, and follow-up. Responses were analyzed using descriptive statistics and interpreted within a multidisciplinary expert framework. Results: Italian community pharmacists (n = 629), predominantly mid-career and experienced individuals, prioritize targeted symptom questioning (flu-like signs (59.96%), fever (48.73%), pain intensity (49.64%)) and medical referral over formal diagnostic tools like the Centor criteria (unused in 53.66% of cases). A total of 46.74% report performing a Strep A test in fewer than 20% of patients. Topical sprays (83.33%) and lozenges (44.69%), especially containing flurbiprofen (94.19%), dominate recommendations, followed by systemic analgesics (45.79%). For mild cases, anti-inflammatory/analgesic sprays/lozenges (35.42%) and antiseptic lozenges (35.61%) dominate, while in severe cases, drugs with anti-inflammatory or analgesic effects are often preferred (72.47%). Most pharmacists request a follow-up (73.22%). Conclusions: Italian community pharmacists report a predominantly topical-first approach focused on symptomatic treatment and referral when appropriate. Diagnostic gaps and inconsistent follow-up represent actionable targets. The findings inform training outputs prioritizing simplified triage, expanded symptom checklists, spray/lozenge optimization, and 3–5-day call-backs. This work aims to promote pharmacists’ antimicrobial stewardship to reduce antibiotic use while enhancing patient-centred sore throat care in Italy’s pharmacy network. Full article

Background: Medication errors committed by informal caregivers of older adults represent a significant risk to patient safety, particularly in the context of population aging and increasing therapeutic complexity. Community pharmacies could play a key role in detecting and preventing them; furthermore, pharmacy location (urban, town, or rural settings) role in medication errors remains underexplored. Objective: To analyze the types and frequency of caregiver-related medication errors observed by community pharmacists and to determine if differences exist according to pharmacy location. Methods: A cross-sectional study was conducted using an online self-reported questionnaire by pharmacists, technicians, and assistants working in the Region of Murcia, Spain. The questionnaire assessed types of medication errors observed, factors associated, preventive strategies, professional attitudes, and strategies at home. Descriptive statistics were calculated, and associations between pharmacy location and categorical variables were evaluated using Pearson’s chi-square (χ²) test or Fisher–Freeman–Halton exact tests. Statistical significance was set at p < 0.05. Results: A total of 148 professionals participated, including 109 pharmacists (73.6%), 24 pharmacy technicians (16.2%) and 15 pharmacy assistants (10.1%). According to pharmacy location, 74 participants worked in urban pharmacies (50.0%), 63 in town pharmacies (42.6%) and 11 in rural pharmacies (7.4%). The most frequently reported medication errors were incorrect administration time (n = 91, 61.5%), omission errors (n = 87, 58.8%) and dosing errors. (n = 80, 54.1%). Treatment complexity and polypharmacy were identified as the main contributing factors. Most preventive strategies and professional practices showed no statistically significant differences detected for most preventive strategies and reported professional practices across settings. However, moderate associations were found regarding the perceived frequency of medication and prescribing errors in rural settings reporting lower frequencies. However, findings involving the rural subgroup should be interpreted cautiously due to a limited sample size. Conclusions: Community pharmacy professionals demonstrate a consistent and proactive role in detecting and preventing caregiver-related medication errors across urban, town, and rural settings. Although geographic location has limited influence on most professional practices, rural pharmacies may assume an expanded role in patient and caregiver support. Standardized prevention strategies could be implemented broadly, with additional adaptations for rural contexts. Full article

Background/Objectives: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by fluctuating symptoms, long-term medication use, bodily uncertainty, and complex self-management demands. These features can make patients’ experiences difficult to narrate, recognize, and integrate into everyday life. This study aimed to explore how Chinese women living with SLE use visual narratives to make sense of illness disruption, treatment burden, identity changes, and relational experience. Methods: This qualitative study used Virtual Photovoice, an online visual method in which participants generate and discuss photographs about lived experience, with eight Chinese women living with SLE. Data included participant-generated photographs, brief captions, SHOWeD-based written reflections structured around prompts that move from image description to broader reflection, and transcripts from three online Photovoice workshops. The data were analyzed using reflexive thematic analysis within a participatory-informed Virtual Photovoice design, informed by illness narrative theory. Results: Four themes were developed: Invisible Battlefield, Masks and Boundaries, Anchors of Order, and Longing to Be Seen. Participants used photographs and accompanying accounts to give form to fatigue, pain, and bodily uncertainty; negotiate the boundaries between concealment and disclosure; transform medication routines, dietary practices, and illness-related objects into anchors of order and agency; and contrast embodied relational support with clinical encounters experienced as distant or indicator-centered. Conclusions: The findings show how visual illness narratives can support meaning-making, self-recognition, and reflection on patient-centered communication among women living with SLE. Virtual Photovoice offers a narrative and participatory-informed approach for understanding psychological, embodied, and relational dimensions of chronic illness that are often difficult to express through routine clinical or everyday language. Full article

Background: Dental anxiety constitutes a prevalent barrier to oral healthcare utilization, yet patient-centered data on its prevalence, symptom profile, and preferred management strategies remain scarce in Romanian adult populations. Objectives: This study aimed to assess the prevalence and demographic correlates of self-reported dental anxiety, identify the most anxiety-provoking procedures, evaluate the perceived efficacy of anxiety-reduction strategies, and characterize patient preferences for improved anxiety management in the dental setting. Methods: A cross-sectional observational study was conducted using an anonymous 18-item online questionnaire (Google Forms) among 223 Romanian adults (≥18 years), recruited via convenience sampling between May and June 2025. Descriptive statistics, Pearson’s chi-square tests, Fisher’s exact test, Cramér’s V, and ordinal logistic regression (proportional odds model) were applied (Python 3.11; pandas, scipy, statsmodels). Results: Any degree of self-reported pre-procedural anxiety was endorsed by 60.5% of respondents, with 11.7% reporting moderate-to-severe levels. In the fully adjusted multivariable model (Model 2), female sex (OR = 1.80, 95% CI: 1.04–3.14, p = 0.037) and chronic medical conditions (OR = 3.84, 95% CI: 1.21–12.20, p = 0.022) were independent predictors of higher anxiety severity, although the chronic disease estimate was based on a small subgroup (n = 13) and its wide confidence interval indicates limited precision. Tooth extractions (49.8%) and periodontal surgery (39.5%) were the most anxiety-provoking procedures. Despite this high prevalence of self-reported anxiety, 66.4% of participants had never employed any coping strategy. Detailed procedural explanations provided by the clinician were consistently identified as the dominant patient-preferred intervention across four independent survey items (endorsed by 24.7–77.6% of respondents). A highly significant association was observed between anxiety status and perceived inadequacy of staff anxiety management (χ² = 22.406, p < 0.001). Conclusions: Self-reported dental anxiety affects the majority of this Romanian adult sample, with communication-based strategies representing the primary patient-centered priority. These findings support integrating structured communication training and standardized anxiety screening into routine dental practice. Full article

Background: In contemporary society, marked by rapid transformations in the sphere of communication and social interaction, social networks have gone beyond the role of simple communication platforms, becoming places where identities are formed, cultural norms are negotiated and self-perceptions are shaped. This reality has generated a growing interest in studying the relationship between the digital environment and health behaviors, especially among young people, a social category extremely receptive to visual and normative influences promoted online. Methods: A cross-sectional study was conducted among students enrolled in different kinds of faculties and specialties. An online questionnaire was distributed to gather socio-demographic, academic and medical data along with lifestyle and health-related behaviors. Several psychometric instruments were used: Health Behaviour Scale (HBS) to measure various dimensions of health-related actions, Bergen Social Media Addiction Scale (BSMAS) to screen for addictive or problematic social media use, Social Media Disorder Scale (SMDS) to measure the problematic social media use among adolescents, Body Appreciation Scale–2 (BAS-2) to evaluate measure of one’s acceptance, favorable opinions and respect of their own body, and Dutch Eating Behavior Questionnaire (DEBQ) to identify the psychological motives behind overeating. Results: More than 70% of students declared that they had their first smartphone before the age of 12 and 65% of students had screentime higher than 3 h per day during the weekdays, with a small increase during the weekends. Women scored higher than men in emotional eating (food consumption in response to negative emotions), and external eating (response to food stimuli in the environment, independent of hunger). Respondents from rural areas showed a significantly lower level of respect and acceptance of their own body and higher risk for Social Media Disorder compared to participants from urban areas. Important statistical correlation has been identified among the variables of the research. Social media addiction was associated with higher emotional eating both directly and indirectly, via lower body appreciation. The analysis also indicated that it does not show a direct relationship with restrictive eating behaviors; rather, its association with restrained eating is fully mediated by the individual’s body appreciation. Conclusions: The use of social platforms is a challenging process, with a great impact on psychological and emotional balance of young people. Even if the study identified a normative use among young people with a high education level, the risks factors should be taken into consideration when dealing with screentime, psychological and mental health and the risk for addiction. Full article

Background: As Information and Communication Technology (ICT) advances, the healthcare market is shifting toward a consumer-centered paradigm. This study analyzes the structural relationships between medical information quality, medical service quality, and Technology Acceptance Model (TAM) variables to determine their impact on patient satisfaction and revisit intentions in a general hospital context. Methods: An online survey was conducted with 376 consumers who had experience using general hospitals in South Korea between June and December 2024. Data were analyzed using structural equation modeling (SEM) with SPSS 29.0 and AMOS 29.0. Ethical measures, including informed consent and anonymity, were strictly followed. Results: Findings indicate that among medical information quality factors, accuracy significantly enhanced perceived usefulness, while timeliness positively influenced perceived ease of use. Regarding medical service quality, both accessibility and responsiveness significantly improved both usefulness and ease of use, with responsiveness being the most powerful predictor of ease of use (β = 0.655). While both TAM variables significantly increased patient satisfaction, only perceived ease of use and satisfaction directly drove revisit intentions; perceived usefulness influenced revisit intention only through the mediation of satisfaction. Conclusions: Patient satisfaction is a paramount factor directly influencing loyalty. Healthcare administrators should prioritize the accuracy and timeliness of digital health information while improving service responsiveness to enhance long-term hospital competitiveness in the proactive consumer era. Full article

Background: Peer-assisted learning (PAL) is used in medical education. Its impact in basic medical sciences remains unexplored, namely considering the perspectives of all the populations involved: students, undergraduate teaching assistants (UTAs), and faculty members. We evaluated the educational impact of a PAL programme in Histology and Embryology in a medical course at the Faculty of Medicine of the University of Porto (FMUP). Methods: A cross-sectional convergent mixed-methods study was conducted in the Histology and Embryology course. Tailored online questionnaires comprising Likert-type items and open-ended questions were replied to by students attending theoretical–practical classes with UTAs, the UTAs, and the professors. Internal consistency was assessed using Cronbach’s alpha. Students’ theoretical–practical examination scores were compared between classes with and without UTAs using the Mann–Whitney U test, and effect size (r) was calculated to estimate the magnitude of differences observed. Results: Students (n = 190) reported highly positive perceptions regarding the creation of a more approachable learning environment, clarification of doubts, and identification of histological structures and strongly recommended the extension of UTAs to other courses of the medical school. UTAs (n = 17) described gains in disciplinary understanding, broader perspectives on the medical curriculum, communication and public-speaking skills, teamwork, leadership, self-confidence, and interest in academic careers. Professors (n = 6) valued PAL for improving individual support, facilitating time management, and contributing to UTA training, while highlighting the need for structured pedagogical preparation. Students attending classes with UTAs achieved significantly higher theoretical–practical examination scores (p = 0.04; effect size r = 0.12). Conclusions: PAL was perceived as highly beneficial by all groups involved in the project, enhancing the learning environment, supporting knowledge consolidation, and developing pedagogical and interpersonal skills. A grade analysis indicated that PAL was associated with improved academic performance. These findings reinforce the value of integrating PAL initiatives into preclinical medical education while highlighting the importance of sustained tutor preparation and supervision. Full article

Background/Objectives: Pharmacists play a key role in managing urinary tract infection (UTI) symptoms by providing medications, self-care advice, and over-the-counter treatments, while referring patients to a doctor when necessary. This study aimed to examine the practices of community pharmacists in managing UTI symptoms and to gain insight into their attitudes toward antibiotic use for this condition. Methods: A cross-sectional study was conducted among community pharmacists in Serbia using a previously validated online questionnaire, assessed for content and face validity and pilot-tested among pharmacists. Results: A total of 430 community pharmacists participated in the study. Patients more often consulted pharmacists before visiting a doctor than after (median 5 vs. 3 per week; p < 0.001). For uncomplicated UTIs, pharmacists primarily recommended increased fluid intake (92.8%), herbal teas (94.7%), and food supplements (85.6%), whereas for complicated UTIs, most referred patients to a doctor (95.4%). Attitudes, perceived competence, and support for over-the-counter antibiotic availability were significantly associated with gender, years of experience, and specialization. Pharmacists who agreed that antibiotics are the most effective treatment for uncomplicated urinary tract infections were more likely to refer patients to a doctor (p < 0.01). Conclusions: Pharmacists are frequently consulted for UTI management and emphasize non-antibiotic approaches for uncomplicated cases. Their attitudes influence counseling practices, highlighting the need for standardized UTI counseling services, antimicrobial stewardship education, and structured communication training to support appropriate antibiotic use. Full article

Family health history (FHH) is an important tool for cancer risk assessment, yet its clinical utility is undermined by incomplete data, particularly among historically marginalized communities whose family records have been systematically disrupted by slavery, forced displacement, and undocumented status. I conducted a cross-sectional online survey of 1885 US adults affected by cancer to examine associations between genealogy engagement and FHH confidence and to assess variation across sociodemographic subgroups. Genealogy research was the single strongest modifiable predictor of FHH confidence, with participants reporting genealogy research more than twice as likely to report high confidence compared to those who did not (OR = 2.07, 95% CI 1.72–2.50), a relationship that persisted after full adjustment for age, sex, race, income, and education. Despite comparable rates of genealogy engagement, Black and Hispanic respondents reported substantially lower FHH confidence than White respondents. These findings suggest that while interest in genealogy is already widespread and self-motivated in the population, current clinical tools for FHH collection are inadequate to leverage this interest equitably. Next-generation FHH tools should be designed to reflect the dynamic, collaborative features of genealogy platforms rather than static medical forms, and their development must be grounded in community-centered design principles that prioritize populations for whom incomplete family history poses an added burden. Full article

Background: Online communities such as Reddit can reveal critical information needs (CINs) among people who discuss opioid use for chronic or acute pain under conditions of stigma and uncertainty. Methods: We used a mixed-method design to analyze 3428 unique Reddit posts from 1 January to 31 December 2022. Sentence-BERT embeddings and K-means clustering identified eight dominant themes, followed by qualitative analysis of a random subsample of 400 posts. Results: The most prevalent theme was seeking alternatives to opioids for pain relief (28.00%), followed by medications for chronic pain (19.84%) and kratom use experiences (14.64%). Qualitative findings showed recurrent concerns about addiction, stigma in clinical encounters, withdrawal, treatment access, and peer-to-peer discussion of kratom, tianeptine, cannabis, and other substitute substances. Conclusions: The study suggests an unmet need for accessible, nonstigmatizing, and clinically grounded information on pain management, tapering, and lower-risk alternatives to opioid use. These results have implications for addiction prevention, harm reduction, and patient-facing communication strategies for clinical practice and community health. Full article

Purpose-aware AI systems are increasingly deployed in safety-critical, multi-agent, and human-facing environments, where they must transform heterogeneous data into timely, explainable, and goal-aligned decisions under uncertainty. Existing architectures often couple perception, reasoning, communication, and security only at the pipeline level. This creates a research gap in unified semantic transformation, purpose-oriented judgment, bounded imperfection handling, and semantic self-protection. To address this gap, this paper proposes a DIKWP+BUG semantic–cognitive reference architecture for artificial-consciousness-oriented computing, without claiming definitive artificial consciousness. The architecture represents cognition through the Data–Information–Knowledge–Wisdom–Purpose (DIKWP) model and uses BUG theory to model bounded approximation, incomplete evidence, and confidence miscalibration in cross-dimensional reasoning. The model is mapped to an Artificial Consciousness Processing Unit (ACPU) reference substrate, an Artificial Consciousness Operating System (ACOS), a DIKWP semantic communication subsystem, and a concept–semantic fused security subsystem. The components are implemented through runtime emulation and evaluated in smart-city governance, autonomous-driving, and medical-triage simulations. Compared with selected baselines, the prototype increased cognitive throughput from $4.5\mathrm{k}$ to $7.8\mathrm{k}$ logged events, reduced perception–action latency from $340\mathrm{ms}$ to $120\mathrm{ms}$, reduced CPU utilization from $95\%$ to $68\%$, lowered smart-city congestion duration by $30\%$, improved emergency response time by approximately $40\%$, achieved 0 collisions versus approximately $2/10$ baseline IoV runs, and improved medical-triage accuracy from $85\%$ to $92\%$. These online-runtime results provide initial feasibility evidence under controlled simulation conditions; they do not include offline model-preparation costs and therefore should not be interpreted as end-to-end lifecycle speedups. Matched-compute ablation, statistical benchmarking, hardware prototyping, and real-world validation remain future work. Full article

Background/Objectives: Medication-related harm is a leading global patient safety challenge, yet patients’ lived experiences of medication safety remain underexplored in Central and Eastern European healthcare systems, where structural constraints significantly shape everyday medication use. Methods: This study provides an in-depth qualitative analysis of Hungarian patients’ online narratives, building on a prior netnographic mixed-methods study. Using grounded theory-informed principles and a patient-centred medication safety framework, we inductively analysed 5174 publicly accessible Hungarian-language comments posted on health forums and social media platforms between August 2020 and August 2023. The COM-B model was applied as a secondary lens to map findings onto modifiable behavioural determinants. Results: Access to services and communication emerged as the dominant medication safety concerns. Patients reported long waiting times, limited rural emergency services, and brief consultations leading to delayed or inadequate treatment. Communication gaps included insufficient information on medication duration, side effects, and follow-up, as well as conflicting advice from multiple sources, all of which eroded trust and prompted treatment discontinuation or reliance on informal online communities. Community pharmacists were largely absent from patients’ mental models of care, representing a significant missed opportunity given their accessibility. Less frequently mentioned were medication shortages, healthcare professional workload, and systemic safety culture. Conclusions: Clear, respectful communication and timely access to care are central to medication safety from the patient perspective. Netnography combined with a grounded theory-informed methodology offers a valuable approach for capturing authentic patient perspectives in structurally burdened healthcare systems, with findings relevant beyond the Hungarian context. Full article