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Search Results (1,282)

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Keywords = patient’s perceived effectiveness

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18 pages, 3385 KB  
Article
A Preliminary Investigation of Thai Clinical Attitudes Towards VR Adoption in Upper-Extremity Rehabilitation: Patient Usability and Clinician Perceived Usefulness
by Sanya Utthayotha and Noppon Choosri
Multimodal Technol. Interact. 2026, 10(7), 70; https://doi.org/10.3390/mti10070070 (registering DOI) - 26 Jun 2026
Abstract
Virtual reality (VR) has shown promising potential for upper-extremity rehabilitation; however, its successful integration into clinical practice depends not only on therapeutic effectiveness but also on the acceptance of the technology by patients and healthcare professionals alike. Despite growing international research in this [...] Read more.
Virtual reality (VR) has shown promising potential for upper-extremity rehabilitation; however, its successful integration into clinical practice depends not only on therapeutic effectiveness but also on the acceptance of the technology by patients and healthcare professionals alike. Despite growing international research in this area, there is limited evidence on clinical attitudes toward VR rehabilitation in Thailand and other middle-income settings. This study investigates Thai patients’ and clinicians’ perceptions of VR for upper-extremity rehabilitation through two complementary studies focusing on perceived usability and usefulness. The first study evaluated the perceived usability of a VR rehabilitation game using the System Usability Scale (SUS) among 40 first-time VR users divided into younger and senior groups. The younger group reported a higher average SUS score (64.6) than the senior group (55.4). While both groups generally perceived VR rehabilitation positively, senior participants expressed greater concern regarding system complexity, consistency, and the need for technical assistance. Nevertheless, the findings indicate that VR remained an acceptable rehabilitation approach even among elderly first-time users in a population with relatively lower technological readiness. The second study explored clinicians’ perceptions of utilizing VR-generated movement data to support rehabilitation decision-making. Five rehabilitation professionals evaluated the potential usefulness of VR data visualizations for diagnosis and treatment monitoring. Clinicians generally perceived VR data as valuable, particularly for tracking rehabilitation progress rather than diagnostic decision-making. Feedback from interviews also highlighted practical considerations for future implementation, including the importance of normative data, simplified visualization formats, and the feasibility of clinical workflows. By combining patient usability perspectives with clinicians’ evaluations of clinical usefulness, this research provides a broader understanding of the factors influencing VR adoption for upper-extremity rehabilitation in Thailand. The findings contribute contextual evidence from an underrepresented healthcare environment and offer insights relevant to the future deployment of VR-assisted rehabilitation systems in similar socio-economic settings. Full article
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12 pages, 605 KB  
Article
Development and Application of Patient-Reported Outcome Measures (PROMs) in Patients on Chronic Home Oxygen Therapy
by Eusebi Chiner, Ignacio Boira, Joaquín Fernández-Serrano, Mónica Llombart, Violeta Esteban, Paula Fernández Martínez, Marian Fernández, Sandra Vañes, Francesco Gigliarano, Sandra Navarro and Sergio García Ferrer
J. Clin. Med. 2026, 15(13), 4948; https://doi.org/10.3390/jcm15134948 (registering DOI) - 25 Jun 2026
Abstract
Background/Objectives: Chronic home oxygen therapy—long-term oxygen therapy (LTOT)—improves survival and quality of life in chronic respiratory failure when used ≥15 h/day, but adherence is frequently suboptimal and specific patient-reported outcome measures (PROMs) are scarce. To develop, validate and apply a specific PROM [...] Read more.
Background/Objectives: Chronic home oxygen therapy—long-term oxygen therapy (LTOT)—improves survival and quality of life in chronic respiratory failure when used ≥15 h/day, but adherence is frequently suboptimal and specific patient-reported outcome measures (PROMs) are scarce. To develop, validate and apply a specific PROM for patients on LTOT. Methods: A prospective observational cohort study was conducted at San Juan de Alicante University Hospital (April 2024–December 2025) following a four-stage process: conceptual framework definition and expert workshop, content validation and item reduction, cognitive interviews with pilot reliability testing (n = 25), and field application to 120 consecutive chronic LTOT users. The LTOT-PROM was designed to capture the patient-perceived impact attributable to LTOT during the previous 4 weeks. Internal consistency was assessed with Cronbach’s α and test–retest reproducibility with the intraclass correlation coefficient (ICC). Results: The final instrument comprises 15 scored items in two dimensions—Daily Activity (9 items) and Adverse Effects (6 items)—plus one ambulatory-only mobility item excluded from the total score. Cronbach’s α was 0.814 (95% CI 0.681–0.906) for Daily Activity, 0.743 (95% CI 0.548–0.872) for Adverse Effects and 0.808 (95% CI 0.677–0.902) for the total scale; total ICC(A,1) was 0.890 (95% CI 0.767–0.950). Among the 120 patients (62 men, 58 women; mean age 78 ± 13 years; mean therapy duration 40 ± 32 months), 68% reported reduced effort for daily activities, 66% reported a reduction in dyspnoea and 67% reported improved self-confidence; 49% reported morning airway dryness and 7% abandoned the equipment due to nasal dryness or rhinitis. Conclusions: The LTOT-PROM is a brief, reliable and reproducible oxygen-specific instrument for assessing the recent patient-perceived impact of LTOT in routine clinical practice. Further studies should evaluate structural validity, external validity and the relationship between LTOT-PROM scores and objective adherence measures. The construct was predefined as the patient-perceived impact attributable to LTOT during a standardised 4-week recall window, and cognitive interviews confirmed that respondents interpreted the items as experienced benefit/burden during that period rather than as week-to-week symptom change. Full article
(This article belongs to the Special Issue Chronic Lung Conditions: Integrative Approaches to Long-Term Care)
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21 pages, 873 KB  
Review
Assessing Quality of Life in Genetic Cardiomyopathies: A Scoping Review
by Lucrezia Tomberli, Fausto Barlocco, Annariina Koivu, Jari Hyttinen, Iacopo Olivotto and Enrica Ciucci
Int. J. Environ. Res. Public Health 2026, 23(7), 833; https://doi.org/10.3390/ijerph23070833 (registering DOI) - 25 Jun 2026
Abstract
Genetic cardiomyopathies (GCMs) are chronic heart muscle disorders requiring lifelong monitoring and treatment. Although quality of life (QoL) and health-related quality of life (HRQoL) are increasingly recognized as important outcomes in cardiomyopathy care, their conceptualization and measurement remain inconsistent. This scoping review aims [...] Read more.
Genetic cardiomyopathies (GCMs) are chronic heart muscle disorders requiring lifelong monitoring and treatment. Although quality of life (QoL) and health-related quality of life (HRQoL) are increasingly recognized as important outcomes in cardiomyopathy care, their conceptualization and measurement remain inconsistent. This scoping review aims to (a) identify the tools most commonly used to assess QoL and HRQoL in adults with genetic cardiomyopathies and (b) map the thematic areas of existing studies, including symptom burden, psychological distress, diagnostic challenges, and the impact of medical and psychological interventions. PubMed, Scopus, and PsycINFO were systematically searched, and the final search was completed in November 2025. Seventeen peer-reviewed studies met the inclusion criteria and were included in this scoping review. The review followed the PRISMA extension for Scoping Reviews and included both quantitative, qualitative and mixed-methods designs. Most studies employed standardized tools such as EQ-5D (N = 5), SF-36/SF36v2 (N = 5), and the Kansas City Cardiomyopathy Questionnaire (N = 3), while others included the Minnesota Living with Heart Failure Questionnaire (N = 2) and disease-specific or ad hoc measures. The most frequently investigated themes included impairments in physical functioning, emotional well-being, symptom burden, psychological distress, and social participation. Several studies showed that patients’ perceived QoL was more closely associated with symptom burden and psychological adjustment than with objective clinical indicators alone. Clinical interventions showed mixed or limited effects on QoL and HRQoL outcomes, even when clinical parameters improved. Qualitative research further emphasized the lived experiences of patients and families, highlighting unmet needs in care. Less commonly addressed findings concerned caregiver perspectives, patient–provider communication, treatment adherence, socioeconomic disadvantage, healthcare costs, productivity loss, and the experiences of patients with rarer cardiomyopathy-related conditions. The results highlight how QoL and HRQoL are central but still inconsistently assessed outcomes in cardiomyopathy research. This review calls for greater conceptual clarity between QoL and HRQoL, greater standardization in measurement tools, broader inclusion of psychosocial variables, and more patient-centred research approaches to better support individuals living with cardiomyopathies. Full article
(This article belongs to the Section Behavioral and Mental Health)
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29 pages, 308 KB  
Article
Facilitators and Barriers to Implementing Evidence-Based Clean Intermittent Catheterization After Radical Hysterectomy: A Mixed-Methods Study
by Lu Xing, Biru Luo, Yuqing Song, Huaping Fu, Wen Zhao and Xue Deng
J. Clin. Med. 2026, 15(13), 4925; https://doi.org/10.3390/jcm15134925 (registering DOI) - 24 Jun 2026
Abstract
Objective: To analyze the perceived facilitators and barriers promoting and hindering the clinical application of the best evidence of clean intermittent catheterization (CIC) in patients after radical hysterectomy (RH). Methods: This study employed a convergent parallel mixed-methods design. Participants included patients undergoing CIC [...] Read more.
Objective: To analyze the perceived facilitators and barriers promoting and hindering the clinical application of the best evidence of clean intermittent catheterization (CIC) in patients after radical hysterectomy (RH). Methods: This study employed a convergent parallel mixed-methods design. Participants included patients undergoing CIC after RH, medical and nursing practitioners and managers in the gynecological department and outpatient clinics at a tertiary-level women’s and children’s hospital in Chengdu. They were included in both components separately. Interview data were managed using Nvivo 11.0 software and analyzed through directed content analysis. Quantitative data were analyzed using SPSS 29.0 statistical software. Results: A questionnaire survey was conducted among 156 healthcare providers and 300 patients. Qualitative interviews were conducted with 11 healthcare workers and 12 patients. At the evidence itself level, evidence meeting clinical needs and evidence lacking practical applicability, respectively, promoted and hindered clinical implementation of the best evidence. At the potential adopters’ level, healthcare professionals’ insufficient professional competence, low willingness to promote implementation, numerous concerns, and lack of autonomy and awareness regarding the importance of the task were significant barriers, but they maintained an overall positive attitude toward the application. At the practical environment level, patient-related perceived barriers predominantly hindered evidence implementation. Additionally, a supportive practice atmosphere, economic feasibility, and talent development opportunities served as key facilitators. However, existing nursing practice content and workflows directly impacted evidence adoption. Conclusions: The promotion and barriers to the clinical application of the best evidence for CIC in RH postoperative patients are multifaceted. Targeted intervention strategies must be developed to facilitate the effective translation of evidence into clinical practice. Full article
(This article belongs to the Section Nephrology & Urology)
10 pages, 402 KB  
Opinion
Melatonin in Clinical Practice: Grey Zones Between Chronobiology, Insomnia and Consumer Supplementation
by Alexandros Kalkanis, Aliki Karkala and Athanasia Pataka
Clocks & Sleep 2026, 8(3), 38; https://doi.org/10.3390/clockssleep8030038 (registering DOI) - 24 Jun 2026
Abstract
Melatonin occupies a paradoxical position in contemporary sleep medicine: despite its physiological role as a regulator of circadian timing, it is frequently used and perceived as a nonspecific “natural” hypnotic. Although melatonin demonstrates modest benefits for sleep initiation and clearer efficacy in circadian [...] Read more.
Melatonin occupies a paradoxical position in contemporary sleep medicine: despite its physiological role as a regulator of circadian timing, it is frequently used and perceived as a nonspecific “natural” hypnotic. Although melatonin demonstrates modest benefits for sleep initiation and clearer efficacy in circadian rhythm sleep–wake disorders, its clinical use is often undermined by diagnostic imprecision, inappropriate dosing, mistimed administration, inconsistent formulations, and inadequate patient counseling. Circadian disorders can be misclassified as primary insomnia, leading to symptomatic treatment approaches that fail to address the underlying phase misalignment. At the same time, supraphysiological doses and reflexive bedtime administration have become normalized despite evidence that melatonin acts primarily as a chronobiotic whose effects depend more on timing than dose. Regulatory inconsistencies and substantial variability in over-the-counter preparations further complicate safe and reproducible use. These factors contribute to avoidable treatment failure, inaccurate labeling of nonresponse, and persistent misconceptions regarding melatonin’s mechanism of action. Therefore, melatonin should be approached as a pharmacological intervention requiring the same diagnostic rigor, individualized dosing, and longitudinal assessment expected of other sleep therapeutics, particularly when integrated with behavioral and circadian interventions. Full article
(This article belongs to the Section Disorders)
14 pages, 543 KB  
Article
“It’s Not Just a System Error”: A Qualitative Study of Nurses’ Perspectives on Medication Safety in Saudi Hospitals
by Mukhlid Alshammari
Healthcare 2026, 14(13), 1840; https://doi.org/10.3390/healthcare14131840 (registering DOI) - 24 Jun 2026
Abstract
Background: Medication errors remain a major threat to patient safety in acute care settings worldwide and are associated with preventable morbidity, mortality, and increased healthcare costs. Nurses play a critical role in identifying, intercepting, and preventing medication-related harm. However, limited qualitative evidence has [...] Read more.
Background: Medication errors remain a major threat to patient safety in acute care settings worldwide and are associated with preventable morbidity, mortality, and increased healthcare costs. Nurses play a critical role in identifying, intercepting, and preventing medication-related harm. However, limited qualitative evidence has explored nurses’ perspectives on medication safety within the Saudi Arabian healthcare context. This study explored nurses’ experiences of medication safety, perceived systemic challenges, and strategies for error prevention in Saudi hospitals. Methods: A qualitative descriptive design was employed. Fourteen (n = 14) nurses from two major referral hospitals in Saudi Arabia participated in semi-structured face-to-face interviews. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke’s six-phase thematic analysis framework. Results: Five overarching themes were identified: (1) Communication gaps; (2) Medication processes; (3) Technology and safety; (4) Workload and staffing; and (5) Staff competence. Participants described how communication failures, staffing pressures, workflow interruptions, and documentation ambiguities compromised medication safety. While barcode systems and EHRs were perceived as valuable safeguards, participants emphasized that their effectiveness depended on staff vigilance, adequate training, and supportive workplace cultures. Conclusions: Medication safety is a dynamic socio-technical process shaped by communication, competence, staffing capacity, and human interaction with technology. Improving safety requires integrated organizational strategies that combine workforce investment, structured communication practices, continuous professional education, and non-punitive incident reporting cultures. These findings provide practical insights for healthcare leaders seeking to strengthen medication safety systems in Saudi Arabia and comparable settings. Full article
23 pages, 422 KB  
Article
Identity Transformation and the Role of Accountability in Recovery from Problematic Pornography Use: A Phenomenological-Hermeneutical Study
by Luís Lorente-Corral, David Sancho-Cantus, Samuel Asensio, Cristina Cunha-Pérez and Jorge Casaña-Mohedo
J. Clin. Med. 2026, 15(12), 4845; https://doi.org/10.3390/jcm15124845 (registering DOI) - 22 Jun 2026
Viewed by 88
Abstract
Background: Problematic pornography use (PPU) has emerged as a clinically significant phenomenon with severe repercussions for mental health and interpersonal relationships. Despite advances in prevalence studies, a gap remains in understanding the subjective processes of recovery and personal transformation. Objective: To [...] Read more.
Background: Problematic pornography use (PPU) has emerged as a clinically significant phenomenon with severe repercussions for mental health and interpersonal relationships. Despite advances in prevalence studies, a gap remains in understanding the subjective processes of recovery and personal transformation. Objective: To describe the lived experience of individuals in recovery from PPU and compulsive sexual behavior and to analyze the perceived factors and dynamics of group support within their process of change. Methods: A qualitative study was conducted following Van Manen’s phenomenological-hermeneutical approach. In-depth semi-structured interviews were held with 27 individuals (26 men, 1 woman) engaged in structured recovery. Data analysis was performed through thematic analysis supported by ATLAS.ti Scientific Software Development GmbH, 2026. Results: A structured trajectory was identified across three phases: personal collapse, group engagement, and transformative mechanisms. Accountability emerged as a salient perceived mechanism of change, fostering sincerity (35.7%) and relapse prevention (19.1%). The “mirror effect” and “rational hope” within the support group facilitate a profound identity shift from a “spoiled identity” to a state of personal authenticity. Conclusions: For individuals engaged in structured support groups, recovery from PPU transcends mere abstinence, requiring a profound identity transformation facilitated by collective connection and honesty. These findings suggest the potential utility of integrating group-based accountability into therapeutic interventions for behavioral addictions tailored to the patient’s experiential profile. Full article
(This article belongs to the Special Issue Current Therapeutic Approaches to Addictive Disorders)
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37 pages, 458 KB  
Article
Ventilator-Associated Pneumonia (VAP) Prevention Bundle: A Multicenter Cross-Sectional Saudi Study to Assess Knowledge, Adherence, and Perceived Barriers Among ICU Practitioners in Hail Region
by Ashwaq Abdullah Alanezi, Waleed E. Elawamy, Huda Khalaf Alshammri, Eman Ali Elkordy and Ahmed E. Taha
Pathogens 2026, 15(6), 656; https://doi.org/10.3390/pathogens15060656 (registering DOI) - 22 Jun 2026
Viewed by 190
Abstract
Ventilator-associated pneumonia (VAP) is linked to high mortality rates, especially in developing countries. This cross-sectional survey study was conducted across three central hospitals in the Hail region of Saudi Arabia, King Salman Specialist Hospital, Hail General Hospital, and King Khalid Hospital, to assess [...] Read more.
Ventilator-associated pneumonia (VAP) is linked to high mortality rates, especially in developing countries. This cross-sectional survey study was conducted across three central hospitals in the Hail region of Saudi Arabia, King Salman Specialist Hospital, Hail General Hospital, and King Khalid Hospital, to assess the knowledge and adherence of intensive care unit (ICU) healthcare practitioners to the ventilator bundle (VB) for VAP prevention. It also looked at the practitioners’ perceived barriers to effective VB deployment. The study (n = 86) revealed significant disparities in VAP prevention knowledge across educational levels regarding the recommended degree of head-of-bed (HOB) elevation (p < 0.001), the use of endotracheal tubes with extra lumens for subglottic drainage (p < 0.001), and the protective effects of 0.12% chlorhexidine gluconate antiseptic oral rinse (p = 0.019). Professional experience significantly influenced knowledge of non-standard VB components (p < 0.001), the recommended frequency of awakening and spontaneous breathing trials (SBTs) (p < 0.001), and knowledge of extra-lumen tubes (p = 0.038) and kinetic beds vs. standard beds (p = 0.005). Significant differences were found between professional categories regarding knowledge of hand hygiene performance (p = 0.032), the correct degree of HOB elevation (p = 0.007), and patient positioning (semi-recumbent vs. supine) (p = 0.023). Years of experience significantly impacted reported compliance with institutional VB (p = 0.013), adherence to oral care protocols (p = 0.035), and the assessment of sedation depth (p = 0.002). While basic measures like HOB elevation practice and DVT prophylaxis showed universal reported compliance (100%), significant performance gaps were identified in more complex tasks, such as interrupting continuous sedative infusions and performing SBTs as recommended (p < 0.001), particularly among novice practitioners. The primary implementation barrier preventing full compliance with the VB was identified as educational deficit, which was prioritized as the most important area for quality improvement, highlighting the need for targeted training for newly hired ICU staff. Full article
18 pages, 630 KB  
Article
Determinants of Patients’ Intention to Use Remote Monitoring Service for Cardiac Implantable Electronic Devices: An Extended Technology Acceptance Model Study in Taiwan
by Teh-Kuang Sun and Shu-Hui Chuang
Healthcare 2026, 14(12), 1802; https://doi.org/10.3390/healthcare14121802 (registering DOI) - 22 Jun 2026
Viewed by 80
Abstract
Background/Objectives: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has been associated with potential clinical and economic benefits; however, its adoption among patients remains limited in some healthcare settings. This study examined patients’ intention to use RM services by applying an [...] Read more.
Background/Objectives: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has been associated with potential clinical and economic benefits; however, its adoption among patients remains limited in some healthcare settings. This study examined patients’ intention to use RM services by applying an extended Technology Acceptance Model (TAM) that incorporates perceived effectiveness (PE), perceived barriers (PB), perceived threat (PT), and economic considerations, as well as the influence of socioeconomic factors. Methods: A cross-sectional survey was conducted among 104 patients with CIEDs in Taiwan using validated questionnaires. Structural equation modeling (SEM) was employed to examine the relationships among the proposed constructs. The association between intention to use and actual service utilization was explored. The correlations between sociodemographic factors and the constructs were analyzed using analysis of variance (ANOVA). Results: SEM showed that perceived effectiveness (PE), perceived usefulness (PU) and perceived ease of use (PEOU) were significantly associated with intention to use RM services, with economic considerations also having a significant contribution. Intention to use RM services further predicted actual adoption. However, PB and PT did not moderate these relationships. Sociodemographic factors influenced RM acceptance, with younger, more educated, employed, higher-income, and professionally employed patients reporting stronger perceptions and greater intention to use RM. Conclusions: This study reinforces the TAM framework in the context of health-related technology adoption. Overall, the adoption of RM services is complex and shaped by psychological, economic, and demographic factors, highlighting the need for user-friendly design, targeted education on clinical benefits, and flexible pricing and reimbursement strategies to improve equitable and sustained use. Full article
(This article belongs to the Section Digital Health Technologies)
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16 pages, 577 KB  
Article
Pain as an Exploratory Marker of Rehabilitation Engagement After ACL Reconstruction: Combined Ligament Injuries and Digital Disengagement in a Sensor-Based Monitoring Cohort
by Andreas Kopf, Wolfgang Hitzl, Christoph Bauer, Maximilian Willauschus, Johannes Rüther, Niklas Engel, Sophie Pennekamp, Lotta Hielscher, Vincent Franke, Hermann-Josef Bail and Markus Gesslein
J. Clin. Med. 2026, 15(12), 4709; https://doi.org/10.3390/jcm15124709 - 17 Jun 2026
Viewed by 158
Abstract
Background/Objectives: To analyse postoperative pain trajectories after anterior cruciate ligament (ACL) reconstruction using data from a digital rehabilitation system, and to determine (i) whether combined ligament injuries are perceived as more painful than isolated ACL tears, (ii) which patient characteristics are associated with [...] Read more.
Background/Objectives: To analyse postoperative pain trajectories after anterior cruciate ligament (ACL) reconstruction using data from a digital rehabilitation system, and to determine (i) whether combined ligament injuries are perceived as more painful than isolated ACL tears, (ii) which patient characteristics are associated with clinically relevant pain (visual analogue scale [VAS] > 5), and (iii) whether higher early pain is associated with later discontinuation of digital monitoring. Methods: This retrospective cohort study used routine data recorded by a validated sensor-based home rehabilitation system in patients after ACL reconstruction. This approach has previously been used to analyse functional recovery trajectories. All patients with ACL-related indications who performed at least one postoperative test were included and classified into four groups: isolated ACL rupture, ACL + meniscus, ACL + collateral ligament, and ACL + collateral ligament + meniscus. Pain during exercises and tests was recorded on a 0–10 VAS. High pain was defined as VAS > 5. Group comparison between indication types, anthropometric and activity-related variables and the proportion of high-pain events were performed using chi-square tests. Early pain (first postoperative month) was analysed in relation to the presence of later tests (≥3 months) to explore associations with discontinuation of digital monitoring. Results: Combined ligament injuries showed a significantly higher proportion of high-pain events during rehabilitation compared with isolated ACL ruptures (5.8% vs. 2.4%, overall p < 0.001). In particular, combined ligament injuries with ACL + collateral ligament rupture were associated with a greater share of VAS > 5 ratings in the early rehabilitation phases. No relevant association was observed between sex or BMI category and the occurrence of high pain, while age group showed an overall association without a consistent directional pattern. Sport activity level showed a strong relationship with high pain (p < 0.001). Early pain demonstrated a small but statistically significant negative correlation with later test participation (r = −0.15, approximately 2% of variance, p = 0.0076); however, this association was attenuated and no longer statistically significant when analysed using mixed-effects models accounting for within-patient clustering, indicating that patients with higher early pain tended to discontinue digital monitoring. Conclusions: Digital routine data after ACL reconstruction suggest that (i) combined ACL–collateral ligament injuries are perceived as more painful than isolated ACL tears, (ii) high postoperative pain is more closely related to activity level and injury pattern than to sex or BMI, while age group shows an overall but non-directional association, and (iii) higher early pain shows a weak bivariate correlation with digital disengagement that was not confirmed in mixed-effects models. Pain is therefore an exploratory marker warranting further investigation, rather than a confirmed independent predictor of adherence in app-based rehabilitation. Full article
(This article belongs to the Section Orthopedics)
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12 pages, 721 KB  
Article
Differences in Micronutrient Knowledge, Beliefs, and Supplementation Practices Between Pregnant Women and Healthcare Providers: A Cross-Sectional Study
by Anna Elisabeth Hentrich, Dörthe Brüggmann, Samira Catharina Hoock, Lukas Jennewein, Frank Louwen and Eileen Deuster
Nutrients 2026, 18(12), 1934; https://doi.org/10.3390/nu18121934 (registering DOI) - 15 Jun 2026
Viewed by 167
Abstract
Background/Objectives: Adequate micronutrient intake during pregnancy is critical for fetal development, yet whether pregnant women and healthcare professionals share consistent knowledge, beliefs, and supplementation practices remains poorly characterized. Methods: Two parallel cross-sectional surveys using identical core items were conducted at a German tertiary [...] Read more.
Background/Objectives: Adequate micronutrient intake during pregnancy is critical for fetal development, yet whether pregnant women and healthcare professionals share consistent knowledge, beliefs, and supplementation practices remains poorly characterized. Methods: Two parallel cross-sectional surveys using identical core items were conducted at a German tertiary care center between April and November 2024. Pregnant women (n = 132) and healthcare professionals who initiated the survey (n = 105) completed anonymous QR-code-based questionnaires assessing micronutrient-related knowledge, perceived dietary adequacy, and supplementation practices or recommendation patterns. Comparative analyses were restricted to fully completed healthcare professional questionnaires (n = 80). Group differences were analyzed using chi-square or Fisher’s exact tests. Results: Healthcare professionals demonstrated higher knowledge levels across most micronutrients. Knowledge gaps were most pronounced for vitamin B12, with 53.0% of pregnant women unable to identify any fetal effect compared with 20.0% of providers (p < 0.001). Beliefs about dietary sufficiency were broadly aligned for folic acid (p = 0.452) and vitamin D (p > 0.999), but diverged markedly for vitamin B12, where 79.2% of providers considered dietary intake alone adequate compared with 47.3% of pregnant women (p < 0.001). Substantial differences were observed between patient-reported supplementation practices and provider-reported recommendation patterns: Vitamin B12 (70.0% vs. 3.8%), vitamin D (76.2% vs. 41.3%), omega-3 fatty acids (76.2% vs. 47.5%), and folic acid (98.5% vs. 81.3%; all p < 0.001). The internet was the most frequently cited information source among pregnant women (89.4%), while healthcare professionals reported using both scientific literature (75.0%) and internet-based resources (76.3%), the latter primarily for accessing professional and scientific information. Conclusions: Substantial patient–provider differences in micronutrient knowledge, beliefs, and supplementation practices persist even within a highly educated population at a tertiary care center. These findings suggest potential differences between patient-reported supplementation behavior and provider-reported recommendation practices, particularly for vitamin B12 and vitamin D. These findings suggest that more structured communication regarding micronutrient supplementation during pregnancy is needed. Full article
(This article belongs to the Special Issue Optimizing Maternal Nutrition for Maternal Health and Infant Outcomes)
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22 pages, 1008 KB  
Systematic Review
Identifying Clinical Managers’ Leadership Competencies: A Systematic Review and Cross-Frameworks Mapping Using the CLCF
by Ali Maashi and Julie Davies
Healthcare 2026, 14(12), 1720; https://doi.org/10.3390/healthcare14121720 - 15 Jun 2026
Viewed by 191
Abstract
Background/Objectives: Effective clinical leadership is a critical driver of healthcare quality, patient safety, and organisational performance. However, evidence on the leadership competencies of healthcare professionals in formal management roles remains fragmented. It is dispersed across professional groups, healthcare contexts, and conceptual frameworks, limiting [...] Read more.
Background/Objectives: Effective clinical leadership is a critical driver of healthcare quality, patient safety, and organisational performance. However, evidence on the leadership competencies of healthcare professionals in formal management roles remains fragmented. It is dispersed across professional groups, healthcare contexts, and conceptual frameworks, limiting opportunities for synthesis and cumulative knowledge development. This systematic review examined three questions: how clinical managers perceive their leadership competency; what challenges they encounter in exercising leadership roles; and what development mechanisms the literature identifies. Methods: A systematic review was conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD420261305279). Four databases were searched: Ovid MEDLINE, CINAHL, EMCARE, and Web of Science from January 2010 to February 2026. Two reviewers independently screened studies; methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Reported competencies were mapped to the five domains of the Clinical Leadership Competency Framework (CLCF) using narrative integrative synthesis. Results: Forty-nine studies were included across quantitative, qualitative, and mixed-methods designs from 24 countries. Competencies in the Working with Others and Demonstrating Personal Qualities domains were reported as strengths across the largest number of included studies. Competencies in Managing Services, Improving Services, and Setting Direction were reported as areas of weakness or developmental need across multiple studies. Leadership challenges included inadequate preparation, role ambiguity, limited authority, and organisational constraints. Development needs spanned formal training, strategic competency building, mentoring, and sustained organisational support. Conclusions: Clinical leadership competency is unevenly distributed across CLCF domains. This pattern reflects not only individual developmental gaps but also the organisational and contextual conditions that shape how leadership is enacted in practice. The findings support a contextual-relational model of clinical leadership. Both individual capability and enabling organisational conditions must be addressed to strengthen leadership effectiveness across healthcare systems. Full article
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24 pages, 311 KB  
Article
Utilising Teledentistry for Interdisciplinary Oral Assessment in Older Patients: An International Cross-Sectional Survey
by Panagiota Chatzidou, Olga Naka, John Fanourgiakis, Eftychia Tsanana, Christos Armeniakos, Lisa Christina Pezarou, Aggelos Sfyrakis and Vassiliki Anastasiadou
Dent. J. 2026, 14(6), 367; https://doi.org/10.3390/dj14060367 - 15 Jun 2026
Viewed by 245
Abstract
Background/Objective: The increasing global population of older adults presents significant challenges for oral healthcare, particularly regarding the management of chronic conditions and prosthetic rehabilitation. Teledentistry, combined with intraoral scanning, offers a promising solution to enhance access, interdisciplinary collaboration, and clinical outcomes in [...] Read more.
Background/Objective: The increasing global population of older adults presents significant challenges for oral healthcare, particularly regarding the management of chronic conditions and prosthetic rehabilitation. Teledentistry, combined with intraoral scanning, offers a promising solution to enhance access, interdisciplinary collaboration, and clinical outcomes in geriatric populations. This study aimed to evaluate the utilisation of intraoral digital scanning within teledentistry for interdisciplinary oral assessment of older patients. Specifically, it investigated current clinical practices, collaboration among healthcare professionals, and perceptions regarding the effectiveness, challenges, and future potential of teledentistry in prosthodontic care. Methods: An analytical cross-sectional survey was conducted among 84 healthcare professionals, including dentists, prosthodontists, and postgraduate students, recruited via an international network. Participants completed a 40-item electronic questionnaire covering demographics, clinical practice, digital technology use, interdisciplinary collaboration, and attitudes toward research and innovation. Descriptive statistics summarised responses, and inferential analyses, including chi-square tests and Spearman correlations, examined associations between career stage, technology adoption, and interdisciplinary practices. Results: Early-career professionals demonstrated the highest adoption of intraoral scanning (76.3%), while mid-career adoption was lowest (28.6%). Sustained usage significantly increased after one year of adoption (93.8%). While 91.7% of respondents valued interdisciplinary care, active collaboration remained limited. Cost, technical barriers, and training gaps were identified as primary obstacles. Professionals perceived intraoral scanning as beneficial for prosthodontic outcomes and chronic inflammation management, though adoption was influenced by experience, systemic factors, and financial support. Conclusions: Teledentistry integrated with intraoral scanning has substantial potential to improve geriatric oral healthcare. Successful implementation depends on structured training, financial investment, and promotion of interdisciplinary collaboration. Future longitudinal and multicenter studies are warranted to evaluate clinical, economic, and patient-centred outcomes, supporting sustainable digital transformation in geriatric dental care. Full article
19 pages, 616 KB  
Article
Impact of a Training Intervention on the Prevention of Aggressions in Nursing Students: A Pre–Post Study
by Chaxiraxi Bacallado-Rodríguez, Francisco Javier Castro-Molina, Jesús Manuel García-Acosta, Silvia Elisa Razetto-Ramos, Federico David Bacallado-Rodríguez and José Ángel Rodríguez-Gómez
Healthcare 2026, 14(12), 1704; https://doi.org/10.3390/healthcare14121704 - 15 Jun 2026
Viewed by 191
Abstract
Background: Violence against healthcare professionals constitutes a global and persistent problem, with significant consequences for professionals’ physical and mental health, organisational climate, and the quality of care provided to patients. Objective: To evaluate the impact of a training activity on the prevention and [...] Read more.
Background: Violence against healthcare professionals constitutes a global and persistent problem, with significant consequences for professionals’ physical and mental health, organisational climate, and the quality of care provided to patients. Objective: To evaluate the impact of a training activity on the prevention and management of aggression in healthcare settings among fourth-year undergraduate nursing students. Materials and Methods: The study was conducted at the Nuestra Señora de Candelaria School of Nursing, University of La Laguna. An intervention study with a quasi-experimental design without a control group was conducted through the implementation of a training workshop. A pre- and post-intervention questionnaire was administered to a sample of 59 fourth-year nursing students. In addition, two questionnaires were distributed at the end of the session to assess satisfaction with the training received and students’ self-perceived acquisition of knowledge. This research complied with the TREND statement. Results: Descriptive analysis showed higher post-test scores than pre-test scores. The Wilcoxon test indicated a statistically significant difference between the pre-test and post-test scores. Mean knowledge scores increased from 3.16 to 7.58 following the intervention, with a statistically significant difference (p < 0.001) and a very large effect size (r = 0.87). Conclusions: The training workshop was associated with a significant immediate improvement in knowledge, high levels of satisfaction, and enhanced self-perceived learning. Full article
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19 pages, 633 KB  
Article
Teleophthalmology and Teleglaucoma in Clinical Practice: Attitudes of Ophthalmologists in Bulgaria
by Stanka Uzunova, Rumyana Stoyanova, Marin Atanassov, Angel Atanasov and Kristina Kilova
Healthcare 2026, 14(12), 1696; https://doi.org/10.3390/healthcare14121696 - 13 Jun 2026
Viewed by 204
Abstract
Background: Over the past two decades, teleophthalmology has become an effective approach for glaucoma screening and follow-up, with its adoption markedly accelerated by the COVID-19 pandemic. Objectives: The aim of the present study was to explore and analyze the attitudes of ophthalmologists in [...] Read more.
Background: Over the past two decades, teleophthalmology has become an effective approach for glaucoma screening and follow-up, with its adoption markedly accelerated by the COVID-19 pandemic. Objectives: The aim of the present study was to explore and analyze the attitudes of ophthalmologists in Bulgaria toward the application of teleglaucoma, digital communication, and artificial intelligence in clinical practice. Methods: A cross-sectional survey study was conducted among 113 ophthalmologists between September 2024 and March 2025, representing 10.5% of all licensed ophthalmologists in Bulgaria (n = 1074). Results: Age, professional experience, and specialization influenced the level of involvement in managing glaucoma patients. The level of awareness regarding the term ‘teleophthalmology’ was higher among respondents with a specialization in ophthalmology and those holding a doctoral degree (p = 0.001). Among the ophthalmologists surveyed, 35.4% (n = 40) provided teleophthalmology services, while an additional 19.5% (n = 22) reported no prior provision of such services but planned to do so in the future. The most preferred method for conducting teleophthalmology consultations was telephone communication (n = 27; 67.5%), followed by communication via Skype, Viber, or Messenger (n = 23; 57.5%). Physicians with longer professional experience more frequently conducted remote consultations with patients they already knew (p = 0.006). A substantial proportion of respondents (85.0%, n = 96) expressed willingness to participate in training related to contemporary trends and the provision of remote medical services. More than half of respondents expressed positive attitudes toward the use of artificial intelligence in ophthalmology, although practical implementation remained limited. Conclusions: The present study outlined the current landscape of attitudes among ophthalmologists in Bulgaria toward teleglaucoma, digital communication, and the use of artificial intelligence in clinical practice. The findings indicated a moderately positive yet cautious stance—remote services were perceived primarily as complementary tools, particularly for the follow-up of previously known patients and for real-time collaboration between specialists. Full article
(This article belongs to the Section Digital Health Technologies)
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