Search Results (11,183)

Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo and is diagnosed clinically, yet many patients initially present in primary care. Early identification may optimize referral and management. Objective: To perform a pilot Phase 1 validation of the Benign Paroxysmal Positional Vertigo Screening Questionnaire (BPPV-SQ), a brief screening questionnaire designed for future use in general practice (primary care settings where patients are initially evaluated by general practitioners), assessing its ability to identify BPPV, suggest canal involvement, and support progression to Phase 2 validation. Methods: In this prospective observational study, 108 patients with positional vertigo and no neurological signs were evaluated in a specialist setting. The 7-item dichotomous questionnaire (score 0–3 for diagnostic core) was administered prior to bedside examination, which served as the reference standard. Results: Higher questionnaire scores were associated with an increased probability of confirmed BPPV. Among patients with the maximum score of 3, BPPV was confirmed in 73.5% of cases, with a lateralization concordance of 69.4% between questionnaire responses and specialist diagnosis. In contrast, lower scores (0–1) were associated with a markedly lower rate of confirmed BPPV (14.3%). Conclusions: In this pilot Phase 1 validation, the BPPV-SQ demonstrated score-dependent diagnostic reliability and acceptable lateralization agreement in high-score patients, supporting progression to Phase 2 validation in primary care. Full article

Background: Intensive care units (ICUs) are high-acuity environments that require respiratory therapists (RTs) to maintain vigilance, manage emotions, and make rapid clinical decisions. In such settings, performance stability is critical for patient safety. Although emotional intelligence (EI) and work–life balance (WLB) have been linked to professional outcomes in health care, their independent and direction-specific associations with job performance among ICU respiratory therapists remain underexamined. Methods: A national cross-sectional survey was conducted among respiratory therapists working in ICUs across Saudi Arabia (June 2025–January 2026). EI was measured using the Wong and Law Emotional Intelligence Scale. WLB was assessed using the work interference with personal life (WIPL), personal life interference with work (PLIW), and work–personal life enhancement (WPLE) scales. Job performance was evaluated using the Individual Work Performance Questionnaire. Correlation and multivariable linear regression analyses were performed to estimate independent associations. Results: A total of 392 RTs were included in the final analysis. Higher EI was independently associated with greater task performance (B = 0.21, p < 0.01) and contextual performance (B = 0.30, p < 0.001), and with lower counterproductive work behaviours (B = −0.24, p < 0.001). Among WLB dimensions, PLIW showed the strongest adverse association, predicting lower task performance (B = −0.20, p < 0.05) and higher counterproductive behaviours (B = 0.39, p < 0.001), but was not significantly associated with contextual performance in the fully adjusted model. WPLE demonstrated modest positive associations with performance, whereas WIPL was not significant in adjusted models. Conclusions: Job performance among ICU respiratory therapists is shaped by both emotional regulatory capacity and cross-domain strain. Personal life interference with work emerged as the most influential adverse predictor, whereas EI was associated with constructive performance patterns. Findings should be interpreted in light of the cross-sectional design and self-reported data. Sustaining performance in high-acuity settings requires attention to emotional competencies and structural sources of role conflict alongside clinical expertise. These findings inform workforce strategies to support performance and sustainability in critical care settings. Full article

Background: Schizophrenia in adolescence disrupts neurodevelopment and long-term functioning. While symptom reduction remains a primary treatment goal, quality of life (QoL) represents a critical, patient-centered outcome. Pharmacogenetic variability, particularly in CYP2D6 metabolism of second-generation antipsychotics, may influence tolerability and subjective well-being beyond symptom control. Materials and Methods: Forty-seven adolescents (aged 14–18 years) diagnosed with schizophrenia (DSM-5) were followed in routine clinical care. CYP2D6 genotyping classified patients as normal metabolizers (NM, n = 27) or reduced-function metabolizers (RFM, including intermediate/poor, n = 20). Symptom severity was assessed with PANSS, QoL was assessed with the Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q), and adverse effects (hyperprolactinemia, extrapyramidal symptoms, sedation, metabolic changes) were monitored. Non-parametric tests and multiple linear regression were applied. Results: At 12 months, RFM patients showed significantly higher PANSS scores, markedly more adverse reactions (95% vs. 48.1%), and lower PQ-LES-Q total and domain scores (all p < 0.0001) compared to NM patients. A regression analysis identified the metabolizer status (β = −0.410, p = 0.001), extrapyramidal symptoms (β = −0.248, p = 0.003), sedation (β = −0.193, p = 0.029), and hyperprolactinemia (β = −0.190, p = 0.012) as independent predictors of a reduced QoL, explaining 84% of the variance. The residual symptom severity was not independently associated. Conclusions: In adolescent schizophrenia, the CYP2D6-reduced metabolizer status is the strongest independent predictor of long-term QoL impairment, associated primarily through a substantially higher burden of treatment-related adverse effects (metabolic, endocrine, neurological, and sedative) rather than through persistence of psychotic symptoms alone. These findings support early pharmacogenetic testing to guide individualized dosing and improve tolerability and patient-reported outcomes. Full article

Background: Migraine is a chronic illness that may impact the daily living and quality of life of affected individuals and might lead to excessive use of antimigraine medications. Quality of life in migraine patients is crucial, as it highlights the significant impact of migraines on daily activities, emotional well-being, and overall health. This study aims to assess the association between medication overuse headache and migraine-specific quality of life in migraine patients. Methods: A cross-sectional study was conducted at a neurology clinic in Riyadh, Saudi Arabia, from April 2025 to October 2025. Data about the quality of life were collected using the Migraine-Specific Quality of Life Questionnaire (MSQ). Medication overuse was identified using the International Classification of Headache Disorders, third edition (ICHD-3) criteria, and migraine severity was classified using the Migraine Symptom Severity Scale. Descriptive statistics were used to describe the study sample. Bivariate tests and multivariable linear regression were used to assess factors associated with MSQ. All statistical analyses were performed using SAS (ver. 9.4). Results: A total of 152 migraine patients were included, of whom 17.1% met the criteria for medication overuse headache (MOH). In bivariate analyses, MOH was significantly associated with lower Migraine-Specific Quality of Life (MSQ) scores across all domains (p < 0.001). Multiple adjusted linear regression confirmed MOH and migraine severity as the factors independently associated with reduced MSQ, with MOH associated with lower RR (β = –11.65), RP (β = –12.84), and EF (β = –16.23) scores (all p < 0.05). Conclusions: Medication overuse headache is common among migraine patients, affecting nearly one in six individuals in this study. It is strongly associated with increased migraine severity and a substantial reduction in quality of life across all domains. These findings highlight the critical need for early identification and appropriate management of medication overuse in clinical practice. Full article

Background/Objectives. Diarrhea-predominant irritable bowel syndrome (IBS-D) significantly affects patients’ quality of life (QoL). However, data on disease severity and its correlation with QoL among Vietnamese patients remain limited. This study aimed to investigate the clinical characteristics, symptom severity, and the relationship between symptom burden and quality of life in patients with IBS-D in Vietnam. Methods. A cross-sectional study was conducted on patients diagnosed with IBS-D based on the Rome IV criteria at an outpatient clinic of a tertiary hospital. Disease severity and QoL were assessed using the IBS Symptom Severity Score (IBS-SSS) and the standardized Vietnamese version of the IBS Quality of Life (IBS-QoL) questionnaire, respectively. Clinical characteristics, comorbidities, and overlap syndromes were also recorded. Results. Among the 123 patients enrolled (mean age 42.6 ± 14.5 years; 55.3% female), the median IBS-SSS score was 175 (interquartile range: 140–225), and the median IBS-QoL score was 72 (interquartile range: 54–85). The prevalence of overlap syndromes was relatively high, with functional dyspepsia accounting for 46.3% and gastroesophageal reflux disease for 8.9%. A moderate inverse correlation was observed between IBS-SSS and IBS-QoL scores (r = −0.494; p < 0.001). Notably, patients with severe IBS (IBS-SSS ≥ 300) had significantly higher rates of smoking (44.4% vs. 13.2%; p = 0.012) and diabetes (22.2% vs. 5.3%; p = 0.047) compared to the non-severe group. Conclusions. IBS-D imposes a substantial symptom burden and significantly reduces the quality of life in Vietnamese patients, particularly among those with severe disease. The high prevalence of overlap syndromes, along with contributing factors like smoking and diabetes, further increase the complexity and severity of the condition. Full article

Background/Objectives: Fibromyalgia is a painful syndrome with biopsychosocial components that predominantly affects middle-aged women. This study aimed to evaluate changes in sleep quality and quality of life following intravenous (IV) lidocaine treatment in patients with fibromyalgia (FM). Methods: This retrospective observational study included patients diagnosed with fibromyalgia who underwent intravenous lidocaine treatment at a tertiary pain clinic between June 2023 and June 2024 and had a Pittsburgh Sleep Quality Index (PSQI) score > 5. The patients’ demographic data, Fibromyalgia Impact Questionnaire (FIQ) scores at baseline and at 1 and 3 months post-treatment, Numerical Rating Scale (NRS-11) scores, Short Form-12 (SF-12) mental and physical component scores (MCS-12, PCS-12), and PSQI scores were recorded. Results: Overall, 51 patients were included. 92.2% of the patients were women, with a mean age of 41.6 ± 9.5 years. Statistically significant reductions in NRS-11, FIQ, and PSQI scores and increases in SF-12 component scores were observed at 1 and 3 months compared with baseline (p < 0.001). Negative correlations were found between NRS-11 and PCS-12 and MCS-12, and a positive correlation was found between FIQ and PSQI. Sleep quality showed a marked improvement at 1 month; however, attenuation of this benefit was observed at the 3-month follow-up. Conclusions: Sleep quality appeared to be associated with short-term functional outcomes, whereas pain intensity was associated with mid-term clinical status in patients with fibromyalgia. Prospective randomized controlled trials are required to confirm these findings and to determine optimal dosing and treatment schedules. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is increasingly observed in patients undergoing supracricoid laryngeal surgery; however, the impact of postoperative anatomical changes on sleep-disordered breathing remains insufficiently characterized. This pilot study aimed to assess the incidence and severity of OSA after Open Partial Horizontal Laryngectomy type II (OPHL II) and to evaluate correlations between polysomnographic parameters and radiologic measurements of the neolarynx. Methods: A prospective observational cohort study was conducted on ten patients who underwent OPHL II between 2019 and 2024 and were evaluated at least one year postoperatively. The sample size was determined using a conservative estimate appropriate for a pilot prospective study, which required a long postoperative follow-up period of at least one year. All patients completed Stop-Bang, Berlin, and Epworth questionnaires and underwent overnight polysomnography. Cervical CT scans were used to measure airway length to the vocal cords (ALVC), supralaryngeal tract horizontal (SVTH) and vertical (SVTV) segments, and the base-of-tongue–to–cervical-body distance (BTCB). Results: OSA was detected in all patients: 40% mild, 30% moderate, and 30% severe. Mean AHI was 25.5 ± 18.9 events/h, and OSA severity strongly correlated with AHI (rho = 0.94; p < 0.0001). Among radiologic parameters, SVTV showed a positive correlation with OSA severity (rho = 0.82; p = 0.0035), while BTCB demonstrated a significant negative correlation (rho = −0.71; p = 0.0207). No significant associations were found for ALVC or SVTH. Conclusions: Supracricoid laryngectomy produces anatomical changes that predispose patients to OSA. Radiologic metrics—particularly SVTV and BTCB—appear to be meaningful predictors of OSA severity. A multidisciplinary approach is essential for early diagnosis and management. Due to the small number of patients enrolled larger multicenter studies are needed to confirm these findings and define radiologic criteria associated with postoperative OSA. Full article

Nurses are healthcare professionals who can play a leading role in preventing antimicrobial resistance, given their direct assistance to patients. For this reason, in-depth university training is desirable. This study was conducted to detect possible weak points in the university training about an important public health topic represented by general knowledge about antibiotics and antibiotic resistance. We carried out a survey on Knowledge, Attitudes, and Practices of students attending the Nursing Sciences course at the University of Messina, Italy, by administering an online standardised questionnaire that included general and specific questions about antibiotics and antibiotic resistance. General and specific scores were calculated. Some gaps were found about the knowledge of antibiotics (mean score: 3.6/4) and, especially, antibiotic resistance (mean score: 3.2/5). As expected, most of the incorrect answers to both antibiotic and antibiotic-resistance knowledge were given by students in the first year, but some gaps were also found among students in the last year. Given the growing role nurses can play in combating antibiotic resistance, these findings point to a possible information gap in the study course and highlight the need to enhance the current university training programmes with activities designed to increase knowledge on these important public health issues. Full article

Background: Fear of falling is common in older adults with type 2 diabetes mellitus (T2DM), particularly in those with balance and mobility impairment. The Falls Efficacy Scale—International (FES-I) is widely used to quantify concern about falling but requires local validation. We aimed to validate the Romanian version of the FES-I in older adults with T2DM. Methods: In this validation study, 124 consecutive outpatients with T2DM aged > 60 years completed the Romanian FES-I at baseline (v1) and at one-month follow-up (v2). Internal consistency was assessed with Cronbach’s alpha and item–total correlations. Test–retest reliability was evaluated using intraclass correlation coefficient (ICC) and the Bland–Altman agreement. Construct validity was examined by correlations with the Fear-of-Falling Questionnaire—Revised (FFQ-R), Berg Balance Scale (BBS), Timed Up and Go (TUG), and single-leg stance (SLS). Discriminative performance was assessed via ROC analyses. Results: Mean FES-I scores were 30.8 ± 11.4 (v1) and 31.1 ± 11.6 (v2). Internal consistency (Cronbach’s alpha 0.945–0.947) and test–retest reliability (ICC 0.972; 95% CI 0.956–0.983) were excellent, with minimal bias. FES-I correlated strongly with FFQ-R (rho = 0.787) and moderately with function (BBS rho = −0.631; TUG rho = 0.547; SLS rho = −0.498; all p < 0.001). Discrimination was good for BBS (AUROC = 0.779) and TUG (AUROC = 0.800). Conclusions: The Romanian FES-I demonstrates excellent reliability and good validity in older adults with T2DM, with low measurement error and clinically interpretable change thresholds. It can be used for fear-of-falling quantification in routine care and research, including longitudinal monitoring and evaluation of interventions in Romanian patients with diabetes. Full article

Background: Digitalization and artificial intelligence-supported clinical decision support systems (AI-DSS), defined here as tools that generate patient-specific alerts, risk estimates, prioritization prompts, documentation suggestions, or related recommendation outputs intended to support rather than replace professional nursing judgment, can improve clinical decision-making, yet they may also amplify technostress and burnout, with downstream effects on missed nursing care and implementation readiness. Methods: We surveyed 239 registered nurses from a tertiary-care hospital in Timișoara, Romania (January–March 2025), including critical care (n = 60) and general wards (n = 179). Measures included a 15-item technostress scale, eHEALS, Maslach Burnout Inventory–Human Services Survey (MBI-HSS), Safety Attitudes Questionnaire (SAQ) teamwork and safety climate subscales, a 10-item missed nursing care inventory, and a six-item AI-DSS acceptance scale reflecting perceived usefulness, trust, and stated willingness to use such tools if available as an attitudinal readiness outcome rather than as routine observed use. Multivariable regression, exploratory mediation models, cluster analysis, and exploratory ROC analysis were performed. Results: Higher technostress was associated with higher emotional exhaustion (r = 0.52) and more missed care (r = 0.41), whereas eHealth literacy correlated with higher AI-DSS acceptance (r = 0.35) and lower technostress (r = −0.34). In adjusted models, technostress (per 10 points) was associated with higher missed care (β = 0.28, p < 0.001) (equivalent to 0.14 points per 5-point increase) and higher odds of low AI-DSS acceptance (OR = 1.38, p = 0.001), while eHealth literacy was associated with lower odds of low acceptance (OR = 0.71 per 5 points, p < 0.001). Burnout and the safety climate statistically accounted for approximately 35% of the technostress–missed care association. Three workflow phenotypes were identified, with the high-strain/low-literacy cluster showing the most missed care (3.5 ± 1.8) and the lowest AI acceptance (19.7 ± 5.2). An exploratory in-sample ROC model for intention to leave achieved an AUC of 0.82. Conclusions: Higher technostress clustered with worse nurse well-being, more care omissions, and lower AI-DSS acceptance, whereas eHealth literacy appeared protective. Interventions combining digital skills support, usability-focused redesign, and a stronger safety climate may reduce missed care and support safer AI implementation. Full article

Background and Objectives: Gastrointestinal (GI) endoscopy requires safe and effective sedation. Remimazolam, an ultra-short-acting benzodiazepine, may offer advantages over traditional sedatives like midazolam and propofol, including rapid onset, short half-life, and a favorable safety profile. This study evaluates the feasibility, safety, and patient satisfaction of continuous remimazolam infusion administered by trained gastroenterologists for GI endoscopy. Materials and Methods: This prospective registry included patients with ASA physical status I and II undergoing standard endoscopic procedures. Continuous remimazolam sedation was administered, with boluses given as needed. Vital signs were monitored, and patient satisfaction was assessed before and after the procedure using standardized questionnaires. Results: A total of 159 procedures were performed in 141 patients. Sedation was successful in all patients, with a mean induction dose of 7.1 mg and total infusion of 15.1 mg. Recovery time averaged 3.3 min. Adverse events, including transient hypotension and hypoxia, occurred in 11.3% of patients but were easily managed. Most patients (97%) reported sufficient comfort, with an average satisfaction score of 8.1/10. Conclusions: Continuous remimazolam infusion administered by trained gastroenterologists is a safe and effective alternative to traditional propofol sedation for GI endoscopy. It offers stable sedation, rapid recovery and high patient satisfaction, potentially reducing anesthesiology workload and improving procedural efficiency. Further studies are needed to confirm these findings in broader patient populations. Full article

Background: The metamorphopsia questionnaire (MeMoQ) is an established patient-reported outcome measure (PROM) in the context of macular disease. However, its performance has not been proved in those being treated for various macular conditions with intravitreal anti-vascular endothelial growth factor (Anti-VEGF). The objective was to eliminate misfitting items, enhance measurement precision, and ensure optimal response categorisation. Methods: Rasch analysis was performed iteratively on 2286 responses from patients with macular diseases being treated with Anti-VEGF to optimise the MeMoQ. Fit statistics, reliability indices, person and item separation measures, and principal component analysis (PCA) of residuals were assessed to determine the optimal model. This study was conducted in an outpatient clinic specialising in retinal diseases in Hywel Dda University Health Board. Results: Misfitting items were removed in successive iterations, leading to optimised category probability curves and stable fit statistics for the MeMoQ. The resulting model for all responses included two final items, with person separation remaining inadequate reducing from 1.23 to 1.12 and reliability from 0.60 to 0.56. Category probability curves demonstrated good ordering of response variables with Andrich thresholds separated by >1.2 logits. In the subgroups of neovascular age-related macular degeneration and diabetic macular oedema person separation remained below two and reliability remained low. Conclusions: Rasch analysis demonstrated that the MeMoQ was not a valid or reliable PROM in this patient population. Therefore, the MeMoQ may not provide a reliable index of patient’s perception and visual experience when undergoing Anti-VEGF treatment. Full article

Background: Long COVID presents a novel and emerging public health challenge. As the first point of contact, general practitioners (GPs) play a key role in diagnosing and coordinating the care of patients presenting with post-acute sequelae of COVID-19 (PASC), despite a lack of experience. This study aimed to identify the main difficulties encountered by GPs in Franche-Comté, France, in managing adult outpatients with long COVID. Methods: We conducted a cross-sectional survey using an anonymous online questionnaire, which contained 21 questions and was distributed to GPs in Franche-Comté, France. The survey assessed definition, diagnostic and therapeutic challenges in managing long COVID. Results: Among the 410 questionnaires distributed, 90 general practitioners (GPs) responded (response rate: 21.9%). The mean age of participants was 34 ± 10 years, and 64.4% were women (n = 58). Regarding knowledge of long COVID, three participants (3.3%) did not recognize it as a distinct clinical entity, while more than half (58.9%, n = 53) reported insufficient knowledge. The main challenges identified were therapeutic management (76.7%, n = 69) and diagnosis (75.6%, n = 68). Only 4.5% of respondents (n = 4) reported no difficulty in defining post-acute sequelae of SARS-CoV-2 infection (PASC). The most frequently reported diagnostic difficulty was distinguishing long COVID from differential diagnoses (93.3%, n = 83/89), particularly fibromyalgia (94.3%, n = 83/88). Only 37.1% of participants (n = 33/89) reported actively following up patients with PASC. During initial management, the main challenge was the difficulty in objectively assessing patients’ complaints using available diagnostic tools (80.7%, n = 67/83). Additionally, a large majority of GPs reported difficulties in addressing patients’ questions (86.7%, n = 72/83) and managing associated anxiety disorders (75.9%, n = 63/83). Conclusions: These findings highlight the immediate need to enhance GP training in Franche-Comté, France, in dealing with long COVID. Improvements such as harmonizing long COVID definitions, testing diagnoses, and strengthening interdisciplinary coordination are essential to provide coherent and patient-centered care for this disease. Full article

Background: Although the concepts of meteoropathy and meteosensitivity are not included in official classifications, such as the ICD-11 or DSM-5, they are increasingly being studied as potential symptom complexes linking weather variability to health status. The METEO-Q questionnaire, originally developed in Italy, has been adapted in Japan and Turkey, where it has demonstrated satisfactory reliability parameters, although the authors emphasized the need for further verification of the tool’s temporal stability. The present study aimed to adapt METEO-Q to the Polish language and conduct a critical assessment of its factor structure, measurement invariance, and validity in clinical groups. Methods: This cross-sectional study involved 1128 adults: healthy individuals (n = 711), cardiac outpatients (n = 194), and subclinical group with diagnosed mental disorders (n = 223). Data from healthy participants were divided into a training sample (n = 426) for exploratory factor analysis (EFA) and a test sample (n = 285) for confirmatory factor analysis (CFA). Measurement invariance was assessed in the clinical groups. Validity was verified through correlations with a list of 21 symptoms and measures of anxiety and worry about climate change. Results: A two-factor model (meteoropathy and meteosensitivity) was better fitted to the data than a one-factor model, which is consistent with findings from Italian, Japanese, and Turkish studies. However, absolute fit indices in the test sample indicated significant model misfit [CFA: χ² (43) = 210.192, p < 0.001, RMSEA = 0.120, CFI = 0.927], suggesting the presence of local errors in the tool’s structure. The reliability of the subscales was high (α from 0.86 to 0.93). Multi-group analyses suggested metric and scalar invariance. Patients with mental disorders obtained the highest scores, while cardiac outpatients reported a lower level of meteoropathy (M = 6.13) than healthy individuals (M = 7.24). Conclusions: METEO-Q demonstrates a stable two-factor structure and high internal consistency. The obtained RMSEA index (0.12), although indicative of some misfit, is similar to results obtained in other adaptations, such as the Japanese (RMSEA = 0.10) and the Turkish (RMSEA = 0.11), which suggests it is a consistent feature of this tool across different cultural contexts. Accordingly, the instrument is suitable for research purposes; however, its clinical application requires considerable caution and further work to optimize the model. Full article

Background: Patients undergoing dental treatment often experience psychological distress and social discomfort, yet longitudinal data on these changes are limited. Existing studies rely on cross-sectional designs or lengthy tools, reducing feasibility in routine practice. This study explored psychological and social trajectories during dental care, highlighting challenges and implications for patient wellbeing and care delivery. Methods: A prospective cohort study with repeated measures across three dental visits (V1–V3) was conducted. Participants completed a 21-item binary (yes/no) questionnaire assessing psychological (Q1–Q6) and social dimensions (Q7–Q14 at all visits; extended social domain Q7–Q21 at V2–V3). Composite scores were calculated, and longitudinal changes were analyzed using generalized estimating equations or mixed-effects models. Item-level trajectories were examined with multiple comparison adjustments. Results: Of 120 enrolled patients, 100 completed all visits. Psychological well-being consistently improved, while social outcomes showed more complex, domain-specific patterns. Item-level analyses revealed gains in appearance and satisfaction, whereas stigma, fear, and social integration remained relatively stable, underscoring the need to monitor multiple psychosocial dimensions. Conclusions: Psychosocial monitoring during dental care is feasible and potentially beneficial. The 21-item questionnaire was practical and well-accepted, with composite scores serving as simple indicators for tracking patient wellbeing and supporting a holistic, patient-centered approach. Further validation in larger and more diverse populations is needed. Full article