Search Results (618)

Background/Objectives: Hospital discharge of pediatric hematopoietic stem cell transplant (HSCT) patients is complex and requires multidisciplinary efforts to ensure patients/caregivers are prepared for transition to the outpatient setting. This period is tenuous as patients are medically complex, immunocompromised, and required to take several medications requiring dose titration. Miscommunication or decreased preparedness for discharge can place patients at risk for life-threatening complications. An integrative review was performed to evaluate the current literature on discharge coordination best practices for pediatric HSCT, revealing a scarcity of data. Taking into account this minimal literature and the lack of an established process at our center, this article details the development and implementation of a multidisciplinary care coordination program for pediatric HSCT patients following hospital discharge, aiming to establish a standardized approach and thus improve caregiver readiness for discharge. Methods: A group of physicians, advanced practice nurses, registered nurses, and pharmacists developed a comprehensive approach to pediatric HSCT discharge coordination. Interventions included standardized education, checklist integrated into the electronic medical record, 24 h rooming-in period, and personalized pharmacist follow-up. Surveys were provided to caregivers to assess discharge readiness and ongoing medication adherence. Results: This quality improvement project demonstrated feasibility via successful implementation for 12 patients. Compared to a nine-patient pre-implementation group, there was no statistically significant difference in perceived readiness. Medication adherence was unable to be evaluated. Clinical significance was anecdotally appreciated by the medical care team, with improved organization, collaboration, and communication. Conclusions: A new pediatric HSCT discharge coordination program was created and successfully implemented. More literature on best practices is needed. Full article

Objectives: We aimed to investigate how receiving integrated healthcare services from a case manager via instant messaging affected patients with disabilities. Methods: This database-matched case–control study was conducted at one medical center. Patients with officially certified disabilities were recruited and assigned to either the LINE-based group or the control group, which accessed services in the traditional manner. Their baseline characteristics were collected through chart reviews. Medical service utilization data—including their number of outpatient visits, prescribed medications, and hospitalizations—were obtained at baseline and 3, 6, and 12 months into the intervention. In the LINE group, quality of life, caregiver burden, and perceived social support were also assessed. A repeated-measures ANOVA was used to analyze within- and between-group differences over time. Results: Both the LINE group and the control group contained 66 patients. The number of outpatient visits (p < 0.001) and quantity of medication taken (p = 0.026) were significantly lower in the LINE group than in the control group. Furthermore, the caregiver burden in the LINE group (p = 0.024) was significantly lower 12 months after receiving integrated healthcare services. Conclusions: Providing integrated healthcare services via instant messaging enabled patients with disabilities to access medical services promptly and efficiently, thus enhancing the accessibility of healthcare and improving care for the disabled population. Full article

Background/Objectives: The COVID-19 pandemic presented unprecedented challenges to healthcare systems worldwide, significantly impacting individuals with chronic conditions who depend on continuous medical care. In Romania, the pandemic revealed systemic vulnerabilities, particularly in ensuring access to services for older adults and rural populations. This study aimed to assess perceived barriers to healthcare access and service quality among Romanian patients with chronic diseases and a confirmed history of COVID-19, within the framework of the country’s multi-tiered healthcare system. Methods: A cross-sectional study was conducted between January and March 2025, involving 16 adult participants diagnosed with at least one chronic illness. Data were collected using a 30-item questionnaire administered by the principal investigator after obtaining informed consent. The instrument explored access to services, challenges related to remote consultations, and satisfaction with nursing care. Descriptive and comparative analyses were carried out based on age group and area of residence. Due to the small sample size, the results are considered exploratory and context-specific. Results: Most participants reported disrupted access to healthcare services, especially within public sector facilities. Rural residents experienced longer delays in receiving care than those in urban areas. Digital health tools were perceived as barriers by 75% of respondents aged 60 and above, while younger participants adapted more easily. Overall satisfaction with nursing care was moderate to high (mean score: 3.56/5), with the highest ratings observed among patients aged 30–60 years. Conclusions: This study highlights significant barriers to healthcare access among Romanian patients with chronic illnesses and a confirmed COVID-19 diagnosis during the pandemic. The key challenges included digital exclusion and rural–urban disparities. The findings underscore the need for targeted strategies to enhance digital health literacy, adapt care delivery models, and strengthen healthcare system resilience in future public health emergencies. Full article

Anxiety, depression, and stress are prevalent psychosocial manifestations in Long COVID, and understanding their global impact can guide safe, effective, and evidence-based interventions. This study reviewed the literature to analyze the prevalence indicators and predictors of anxiety, depression, or stress experienced by adults and older adults with Long COVID. This systematic prevalence review was conducted using the databases MEDLINE via PubMed^®, CINAHL-EBSCO, Web of Science, Scopus, EMBASE, LILACS, and BDENF. Observational studies that assessed anxiety, depression, or perceived stress in adults and older adults with Long COVID were included, with no restrictions on time or language. Two reviewers independently conducted the selection process. Full texts were analyzed for their eligibility potential. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Studies. Ten observational studies with moderate methodological quality were included. Anxiety and depression were the most prevalent psychosocial symptoms in Long COVID, reported in mild, moderate, and severe cases of COVID-19 infection. Prevalence rates reached up to 47.8% for anxiety, 37.3% for depression, and 23% for stress. The combined analysis revealed a pooled prevalence of 15.3% (95% CI: 10.8% to 20.2%). Being female, having pre-existing mental disorders or associated clinical comorbidities, experiencing severe infection in the acute phase, and receiving intensive care were predictors of greater mental burden. The experience of anxiety, depression, and stress in prolonged COVID-19 was reported in countries with different income levels and was disproportionately experienced, especially by women and individuals with associated clinical conditions or psychopathological comorbidities. Full article

Background/Objectives: The high sensitivity of paediatric nurses directly influences the quality of nursing care provided to patients. The purpose of this study is to present the most frequent issues faced by paediatric nurses in their everyday work and their responses to difficult situations at work, define the actions applied when a difficult situation occurs, and assess the level of stress and other factors influencing the level of stress experienced by paediatric nurses. Methods: This study was conducted using an original survey form and a standardised psychological questionnaire based on the Perceived Stress Scale (PSS-10) for paediatric nurses. Results: The study involved 416 paediatric nurses and indicated a medium level of stress among the nurses. The median stress level, calculated as the sum of answers to questions based on the PSS-10, was 18 (16.0 ÷ 20.0), and the mean was 17.9 (min–max = 1–30). The median Sten score was 6 (5.0 ÷ 7.0), and the mean Sten score was 5.94 (min–max = 2–9). Nurses aged 21–30 years, who live in a city, have a Bachelor of Science in Nursing or a Master of Science in Nursing, and work ≥ 61 h a week and 161–250 h a month experience a higher level of stress. Factors such as choosing which child to help first, spending a great deal of time filling out medical documentation, obtaining a sick child’s consent to perform nursing procedures which the child does not understand, involving the minor in decision-making, impolite or offensive behaviour from a sick child or their parents, ineffective nursing and treatment methods, providing care against the opinion/views of a sick child or their parents, difficulties in or a lack of understanding of the situation of a sick child and their family, performing nursing procedures that can cause the child pain, and the inability to fulfil a sick child’s request increase the level of stress experienced by paediatric nurses. When a difficult situation occurs at work occurs, the nurses usually meet and talk about the situation with someone close (72.4%) or engage in other activities to avoid thinking about the situation (66.6%). They consult a psychologist/psychotherapist very rarely (9.6%) and a psychiatrist extremely rarely (4.6%). Conclusions: Polish paediatric nurses were found to experience a medium level of stress. Since paediatric nurses are exposed to stress, providing them with psychological care is important. The level of perceived stress is dependent on the nurse’s age, place of residence, and education, as well as weekly and monthly working durations. Paediatric nurses experience many difficult situations in their everyday work that influence their stress levels. Management should pay special attention to difficult workplace situations faced by paediatric nurses and implement regular actions to reduce the levels of stress experienced. Full article

Background/Objectives: Oral health and diabetes are closely linked through shared inflammatory, behavioral, and socioeconomic factors. This study examined the determinants of oral health outcomes and oral-health-related quality of life (OHRQoL) in Romanian diabetic patients using Andersen’s Behavioral Model. Methods: A cross-sectional study was conducted in early 2025 among 79 diabetic patients at a public clinic in Western Romania. Data were collected through questionnaires, clinical oral exams, and the OHIP-14 instrument. Variables were analyzed using Andersen’s Behavioral Model and standard statistical tests, including regression and correlation analyses. Results: Participants had a mean age of 61.2 years; 86.1% had type 2 diabetes and 13.9% type 1. Over 49% reported gingival bleeding, and 38% experienced dental sensitivity. Regression analysis identified limited awareness (OR = 2.21, p = 0.033) and low income (OR = 1.89, p = 0.041) as significant predictors of periodontal symptoms. OHIP-14 scores were weakly correlated with glycemic control (r = 0.17) and dental sensitivity (r = 0.16) but not with objective periodontal parameters. Rural residence, lower education levels, and poor awareness were associated with reduced service utilization and poorer perceived oral health. Conclusions: This study highlights the impact of behavioral, clinical, and socioeconomic factors on oral condition and OHRQoL. Oral health should be integrated into chronic disease care, with prevention-focused strategies aimed at improving access and reducing disparities, especially in older and rural populations. Full article

Neurobehavioral comorbidities in dogs with idiopathic epilepsy (IE) are increasingly recognized, yet their phenotypic variability and clinical implications remain poorly understood. This study aimed to identify behavioral changes following seizure onset and to explore the feasibility of stratifying patients based on neurobehavioral profiles. Seventy client-owned dogs with IE were enrolled and grouped according to treatment: 29 had drug-resistant epilepsy (DRE), 29 were drug-sensitive (DSE), and 12 remained untreated. Owners completed a modified version of the C-BARQ questionnaire, assessing behaviors before and after seizure onset. Nearly one-third of behavioral items showed significant changes, particularly in attachment and attention-seeking behaviors, separation-related behaviors, eating behavior, and signs of cognitive decline such as reduced trainability and dementia-like signs. Principal component analysis followed by cluster analysis revealed two distinct neurobehavioral profiles: Cognitive and Emotional. The Cognitive cluster was associated with a higher total questionnaire score, poorer seizure control (predominantly DRE), and lower owner-perceived quality of life. In contrast, the Emotional cluster was more frequently observed in dogs with DSE or no treatment and was associated with higher quality of life scores. These findings support the clinical relevance of behavioral stratification in canine epilepsy and underscore the need for individualized, multimodal approaches to improve patient care. Full article

Background/Objectives: This study aims to explore how gender influences the role of informal caregivers aged 65 years, considering the increasing involvement of men in caregiving due to longer life expectancy and societal norms. Methods: A two-year cross-sectional study was conducted in the Valencian Community, Spain, involving informal caregivers of 65 years of age and older who provided home-based care for dependent individuals with chronic conditions. The participants were recruited through public health schools, carers’ associations, and clinical consultations. The caregivers completed a comprehensive semi-structured interview, which included items from the Zarit Brief Scale (seven items) to assess caregiver burden and questions about their caregiving responsibilities, training, and experience, as well as the self-perceived frequency of medication errors. Results: A sample of 80 caregivers over 65 years old was analyzed, including 23 men (28.8%) and 57 women (71.2%). Male caregivers were significantly less experienced (mean = 3.1 years, SD = 5.9) compared to female caregivers (mean = 10.1 years, SD = 13.0; p = 0.004). Men reported lower emotional and physical burdens than women (p-value = 0.003), as reflected in the Zarit scores. Caregiving performance, measured by self-reported errors, was comparable between genders. Conclusions: This study explores the growing role of older male caregivers, highlighting their lower experience and training compared to those of women but similar caregiving performance and lower burden. Additionally, trained caregivers demonstrated significantly lower odds of experiencing burden, underscoring the importance of training as a modifiable factor. The findings emphasize the need for gender-sensitive support and tailored training programs to address disparities, reduce caregiver burden, and enhance caregiving quality and equity. Full article

Clinical practice guidelines (CPGs) are essential for current medical professions since they prevent clinical practice from being based on personal opinions, bias, or individual experience. CPGs are technologies used to govern clinical practice because they guide decision making considering the best available evidence and patients’ values and preferences. In Colombia, studies associated with CPGs and medical professions are scarce; the few available have considered CPGs as a tool for standardization, improving health care efficiency, and quality, and have identified barriers against their implementation. Studies from the medical humanities, sociology, and medical philosophy perspectives are nonexistent. The objective of this study was to analyze the way in which 311 physicians perceive CPGs, the difficulties associated with implementation, the way in which CPGs set and condition individual and collective professional autonomy, and its effect on patient–physician relationships. Our findings revealed that CPGs may be understood as tools used to govern medical judgment and the medical professions with limited implementation in the Colombian health system, but which have become significant mechanisms placing medicine close to the highest scientific, professional, and ethical standards. Full article

Over the past decade, telehealth provision of care has become increasingly common. This shift away from in-person clinics may impact the experience of medical learners and the preceptors who train them. This study aimed to measure and compare obstetrics and gynecology resident physicians’ perceived quality of educational feedback during telemedicine compared to in-person clinical encounters. This prospective observational study recruited residents enrolled in a family planning clinical rotation at an academic residency program. After every in-person and telemedicine clinic session from January 2021 to February 2022, participating residents were sent a link to a 3 min survey via text message. Ordinal regression modeling was used to compare Likert responses between the telehealth and in-person clinical settings. All nine residents enrolled in the clinical rotation chose to participate in this study and responded to 114 of 132 survey prompts (86%). Participants positively rated the feedback they received during all clinic sessions. When comparing the two clinic experiences, there was no statistically significant difference in perceived quality of feedback or satisfaction with feedback. Residents’ perception of educational feedback during telemedicine clinic is at least similar for most measures and superior for contraception counseling when compared to an in-person clinic. Full article

Background/Objectives: The availability of accessible health information outside of traditional healthcare settings has transformed patient engagement in shared decision-making (SDM) with healthcare providers. However, the challenge of navigating misinformation complicates SDM, highlighting the critical role of trust, especially when patient-achieved information conflicts with professional advice. This study examines the association between patients’ health information behavior (HIB) and SDM, emphasizing the role of patients’ trust in healthcare providers. Methods: Utilizing data from the Health Information National Trends Survey (HINTS), this research explores how trust mediates the relationship between HIB and SDM. We conducted factor analysis, mediation analysis, and moderated mediation analysis to assess our hypotheses. Results: Factor analysis identified two main HIB dimensions: emotional responses and utilization of social media. Emotional responses positively influenced SDM, enhancing trust and decision-making involvement. In contrast, utilization of social media negatively influenced SDM through decreased trust. Mediation analysis confirmed trust in physicians as a crucial mediator, particularly when emotional responses foster trust and engagement. Moderated mediation showed that high healthcare quality amplified the positive mediation effects of trust, underscoring its role in effective SDM. Conclusions: This study highlights the significant role of trust in enhancing patient engagement in SDM through HIB. High perceived healthcare quality also strengthens trust, improving SDM outcomes. The study contributes to the literature by providing a comprehensive analysis of the interplay between HIB, trust, and SDM, suggesting that enhancing patient-centered care requires fostering trusted patient–physician relationships. Full article

Background/Objectives: Understanding environmental experiences in residential dementia care is crucial for enhancing care practices, training, and policy. The environment’s role in dementia care is complex. Allied health and nursing professionals must consider environmental aspects concerning care for individuals with dementia. This study investigates how employed caregivers experience and perceive environmental influences in residential dementia care. Methods: In September 2024, we systematically searched PubMed, CINAHL, and PsycINFO for qualitative studies, adhering to SRQR guidelines. The CASP tool was used to assess study quality, ensuring rigor and reliability in selection. The meta-synthesis is registered with Prospero: CRD42024598962. A template analysis was conducted to structure emerging themes. Results: Fifteen studies met the inclusion criteria. Key themes included: 1. Working Environment: Informed understandings—capturing caregivers’ perceptions of organisational structures and support. 2. Lived Environment: Stability and Clarity—highlighting the impact of relational and social dynamics on caregiving; and 3. Physical and Built Environment: Impact on Overall Care Experience—looking at the role of space and design in facilitating effective dementia care. Following this, more subthemes emerged, resulting in the final template. Conclusions: The key gaps included understanding the existing strengths of practice, differences in job roles, funding, the role of Employed Caregivers, and Employed Caregivers’ personhood. Emphasising evidence-based practice and clearly defining job roles may improve decision-making and collaboration. It is essential to identify funding gaps and provide clear guidelines and training to ensure equitable care and maximise the contributions of Employed Caregivers working with nurses and allied health professionals. Recognising Employed Caregivers’ personhood could enhance job satisfaction and reduce burnout. Policies should address these gaps by providing training to clarify roles and enhance skills. A supportive, person-centred workplace may improve satisfaction and care outcomes. Future research should evaluate these aspects and continue to identify the best practices. Full article

Background/Objectives: Dementia involves progressive cognitive and functional deterioration that leads to dependence and overload on family caregivers. This overload has a negative impact on the physical, mental, emotional, and occupational health of caregivers, leading to occupational imbalance and problems arising from an inadequate distribution of time devoted to caregiving. This project aims to evaluate the effects of the technology-based CAREFIT programme, structured around physical activity interventions, education, and psychoemotional and social support, on the health-related quality of life and emotional well-being of informal caregivers. Methods: The experimental group will develop the intervention programme, which will last 8 weeks and combine educational activities, physical activities, and psychoemotional and social support. Before beginning the intervention, the entire experimental group will receive a training session and educational materials on how to access and use the platform. The CAREFIT platform will consist of two educational sessions and two weekly physical sessions, combined with psychoemotional and social support activities that participants must complete. Initial, final, and follow-up evaluations will be conducted. The HRQoL and psychoemotional health (stress, anxiety, depression, and perceived social support and burden) of caregivers of people with dementia will be the main outcome measures. The effects of the intervention on the study variables will be assessed using a repeated-measures analysis of variance (ANOVA). Conclusions: The proposed protocol for the CAREFIT programme represents an innovative and multidisciplinary initiative that leverages a digital platform to promote the well-being of informal caregivers of people with dementia. This approach combines health literacy and strengthened psychoemotional and social support. Through this integration, the goal is to reduce the levels of burden, stress, anxiety, and depression among primary caregivers, while strengthening their self-care capabilities and social support networks. Full article

Background: Patient education (PE) is an integral part of treatment from taking charge to the care, assistance, and rehabilitation of the patient, and consists of structured, organised actions, the orientation of which is aimed at finding solutions supported by scientific evidence. Aim: This prospective, descriptive, exploratory, single-centre pilot study aimed to evaluate the effectiveness of a PE intervention for oncological patients with entero-urostomies and their caregivers through the measurement of quality of life, perceived needs, and caregiver burden. Methods: This study was conducted in a National Cancer Institute between 22 December 2022 and 31 March 2023, and it was organised into three specific therapeutic education event days relative to the real needs measured by the patients and caregivers before it. Results: Our results seem to suggest that the PE intervention in entero-urostomy patients improves their quality-of-life levels, while caregivers’ perceived emotional burden levels are reduced. Conclusions: Targeted and individualised PE interventions positively affect self-care and quality of life in patients with an entero-urostomy and the emotional burden perceived by caregivers. Full article

Background/Objectives: Rare diseases are predominantly genetic in etiology and characterized by a prolonged ‘diagnostic odyssey’. Advances in genetic testing (GT) have helped shorten the time to diagnosis for rare/undiagnosed conditions. We aimed to synthesize the evidence on psychosocial factors related to GT for rare diseases to inform more person-centered approaches to care. Methods: We conducted a systematic literature search in six databases using structured terms (September 2024). Retrieved articles underwent independent dual review. Data were extracted and collated in tables for analysis. Thematic analysis was used to identify promoters/barriers to GT for patients and families. Findings were validated by a patient advocate and were reported using PRISMA-ScR guidelines. Synthesized findings were mapped to the Theory of Planned Behavior to inform intervention development. Results: Of 1730 retrieved articles, 32 were included for data extraction/synthesis. Studies employed qualitative (n = 19), quantitative (n = 10), and mixed-methods (n = 3) approaches. Nearly all (29/32, 91%) were non-interventional, reporting on decision-making cognitions/processes (19/32, 59%), attitudes/preferences (15/32, 47%), psychosocial impact (6/32, 19%), and knowledge/awareness (4/32, 8%) of pre-conception/prenatal/diagnostic GT and carrier screening. Promoters included understanding GT, ending the diagnostic odyssey, actionable outcomes, personal/family history, altruism, and reproductive decision-making. Barriers included logistical (e.g., distance, cost), psychological burden, perceived lack of benefit, and discrimination/social stigma concerns. Conclusions: Some psychosocial factors related to GT for rare diseases overlap with those in literature on GT for common conditions. Identified factors represent targets for theory-informed, person-centered interventions to support high-quality GT decisions that are informed and aligned with patient/family values and preferences. Full article