Search Results (392)

Introduction: Choosing the optimal inhaler is crucial for effective management of asthma and COPD. Preferences and experiences may differ between patients and healthcare providers. The NEXThaler^®, a dry powder inhaler (DPI), was developed to simplify inhalation and improve patient satisfaction. Aim: This survey examined factors influencing inhaler selection and compared perceptions of NEXThaler^® with currently used or prescribed inhalers (CUI/CPI) among patients, general practitioners (GPs), and specialists. Methods: A cross-sectional survey was conducted in Poland among 96 patients with asthma or COPD and 151 physicians (70 GPs, 81 specialists). Participants assessed inhaler attributes using MaxDiff scaling and rated their CUI/CPI and NEXThaler^® on a Likert scale to evaluate usability and satisfaction. Results: Both patients and physicians prioritized ease of inhalation and confidence in administering the correct dose. Patients rated these highest (means 11.09; 95% CI 10.16–12.02 and 9.83; 95% CI 8.87–10.79), similar to physicians (12.35; 95% CI 11.76–12.94 and 15.41; 95% CI 14.78–16.04). Device size and clarity of instructions had a minimal impact on inhaler choice (patients: 3.44; 95% CI, 2.93–3.95 and 3.64; 95% CI, 2.82–4.46; physicians: 0.91; 95% CI, 0.58–1.24 and 1.60; 95% CI, 1.28–1.92). For CPI, specialists rated devices higher than GPs in terms of quality, feedback systems, clarity of manuals, and confidence that patients use the inhaler correctly (p < 0.05). For NEXThaler^®, both groups gave comparable, high scores (median 5 [4–5]; p > 0.05). Patients rated NEXThaler^® higher than their CUI for innovation, ease of use, dose counter, and feedback features (p < 0.001). Overall, 79% of healthcare providers and 71% of patients preferred NEXThaler^®. Conclusions: Both patients and healthcare providers evaluated NEXThaler^® positively, particularly regarding usability and dose control. However, the results also highlight ongoing gaps in inhaler-related knowledge and confidence, especially in primary care, emphasizing the need for continued education and collaborative training to improve the effectiveness of inhalation therapy. Full article

Artificial intelligence (AI) is profoundly transforming medicine and healthcare, evolving from analytical tools aimed at automating specific tasks to integrated components of complex socio-technical systems. This work presents a conceptual and theoretical review proposing the Model–Context–Relation (M–C–R) framework to interpret how the effectiveness of Artificial Intelligence (AI) in medicine and healthcare emerges from the dynamic alignment among algorithmic, contextual, and relational dimensions. No new patient-level data were generated or analyzed. Through a qualitative conceptual framework analysis, the study integrates theoretical, regulatory, and applicative perspectives, drawing on the Revision of the Semiological Paradigm developed by the Palermo School, as well as on major international guidelines (WHO, European AI Act, FDA). The results indicate that AI-supported processes have been reported in the literature to improve clinical accuracy and workflow efficiency when appropriately integrated, yet its value depends on contextual adaptation and human supervision rather than on algorithmic performance alone. When properly integrated, AI functions as a digital semiotic extension of clinical reasoning and may enhance the physician’s interpretative capacity without replacing it. The M–C–R framework enables understanding of how performance, ethical reliability, and organizational sustainability emerge from the alignment between the technical model, the context of use, and relational trust. In this perspective, AI is conceptualized not as a decision-maker but as an adaptive cognitive partner, fostering a reflective, transparent, and person-centered medicine. The proposed approach supports the design of sustainable and ethically responsible AI systems within a Medicine of Complexity, in which human and artificial intelligence co-evolve to strengthen knowledge, accountability, and equity in healthcare systems. Full article

The fast advancement of artificial intelligence presents ethical challenges that exceed the scope of traditional moral theories. This paper proposes a value-centered framework for AI ethics grounded in axiology, which distinguishes intrinsic values like dignity and fairness from instrumental ones such as accuracy and efficiency. This distinction supports ethical pluralism and contextual sensitivity. Using Multi-Criteria Decision Analysis (MCDA), the framework translates values into structured evaluations, enabling transparent trade-offs. A healthcare case study illustrates how ethical outcomes vary across physician, patient, and public health perspectives. The results highlight the limitations of single-theory approaches and emphasize the need for adaptable models that reflect diverse stakeholder values. By linking philosophical inquiry with governance initiatives like Responsible Artificial Intelligence (AI) and Digital Humanism, the framework offers actionable design criteria for inclusive and context-aware AI development. Full article

Background/Objectives: To report patients’ perspectives on the impact of adult-onset Still’s disease (AOSD) on their health-related quality of life (HRQoL), work productivity and the effect of coronavirus (COVID)-19, using data from the PRO-AOSD (patient-reported outcomes adult-onset Still’s disease) survey in Germany. Methods: The PRO-AOSD survey comprised blinded patient and physician surveys. An additional post-hoc analysis was performed to determine the relationship between HRQoL and disease activity (defined per C-reactive protein and Physician’s Global Assessment data). The following outcomes were reported: patients’ perspectives on the impact of AOSD on their physical and mental HRQoL and work productivity, outcomes for patients with active versus inactive disease, and the effect of COVID-19 on their general health and work productivity. Results: Adult patients with AOSD were recruited from 19 centers in Germany. A total of 124 patients were included: 59.7% (74/124) were female, and the mean age of diagnosis was 38.2 years. Reported HRQoL was impaired in almost all domains, especially physical health. For the 58 patients whose data enabled categorization into active (31.0%, 18/58) versus inactive disease (69.0%, 40/58), patients with active disease reported significantly worse outcomes in the following (p < 0.001): likelihood of perceiving their health as excellent or similar to other people’s health, severity of pain in the past month, and the ability to complete strenuous activities. Although all patients were of working age, not all were employed (60.5%, 75/124). Many patients felt that compared to their peers, they were more burdened by the COVID-19 pandemic (33.9%) and were more afraid of contracting COVID-19 (49.2%). Conclusions: Patients with AOSD suffered from impaired HRQoL, which was worsened by active disease and the COVID-19 pandemic. Full article

Background and objectives: Numerous studies and meta-analyses have established the efficacy of telemonitoring for blood pressure and other components of metabolic syndrome in improving disease management. Nevertheless, the adoption of telemonitoring technologies is often hindered by personal, technological, and systemic barriers. In Slovakia, where patient–physician contact rates are high, there is limited research on patients’ perspectives regarding telemedicine adoption for cardiovascular risk management. The objective of this study was to examine patients’ perspectives on and perceived obstacles to the use of telemonitoring for arterial hypertension and dyslipidemia in Slovakia. Methods: This cross-sectional, questionnaire-based survey targeted a cohort of 18,053 patients. The survey instrument was designed to gather data on several key areas: patient demographic characteristics, blood pressure measurement habits, the utilization of smart technologies, perceived benefits and barriers to telemonitoring, and patients’ knowledge of their lipid profiles and cardiovascular risk factors. Statistical analysis included chi-square tests, ANOVA, and effect size calculations with 95% confidence intervals (CI). Results: A total of 1787 patient responses (9.9%) were collected. Among the respondents, 67.4% (n = 1204) had arterial hypertension, while 7.9% (n = 95) were on non-pharmacological therapy. Only 21.2% (n = 255) of hypertensive patients measured their blood pressure daily, with a significantly higher proportion of men than women (28.6% vs. 12.7%, p = 0.011, Cohen’s d = 0.42). The most frequent users of blood pressure monitoring were in the 31–45 age group (p = 0.001, η² = 0.08). A total of 19.4% (n = 347) of respondents used wearable devices, and 6.3% (n = 113) used blood pressure monitors connected to an application. Smart technology use was significantly more common in the 31–45 age group (p = 0.01, Cramer’s V = 0.15). Moderate interest in telemedicine was expressed by 69.8% (n = 1247) of respondents, though only 27.4% (n = 490) showed strong interest. The majority of patients (73.8%, n = 1319) did not know their LDL-C levels, and 45.7% (n = 817) of those who did had elevated levels. Conclusions: The findings suggest that while interest in telemedicine methods for the management of arterial hypertension and dyslipidemia exists among Slovak patients, it is more moderate than initially assumed. Importantly, expressed willingness to participate in a study should not be directly equated with readiness to adopt new technologies in daily practice. Successful integration of telemonitoring into the Slovak healthcare system will therefore require not only patient engagement but also active support from healthcare providers to overcome practical and motivational barriers. These findings highlight the need for targeted implementation strategies that address the specific barriers identified in the Central and Eastern European healthcare context. Full article

Background/Objectives: Dietary supplement (DS) use has become increasingly prevalent among adult athletes worldwide and carries both potential benefits and risks. This study aimed to examine the prevalence and perspectives of DS use among adult athletes attending fitness centers in Saudi Arabia. Methods: A cross-sectional study was carried out between November and December 2024 using self-administered online questionnaires distributed through a convenience sampling method utilizing social media platforms. All adult athletes aged 18 and above currently residing in Saudi Arabia were included. Results: Results indicate that 73.9% of athletes use DS, primarily to address self-reported perceived vitamin/mineral deficiencies (62.0%) and to enhance energy availability (45.8%). The most frequently reported DS used by the responded were vitamins and minerals (77.3%), followed by fish oils (57.3%) and proteins (42.7%). The predominant adverse effects reported were changes in urine color (27.4%) and frequent urination (18.0%). Most supplements were consumed orally (78.4%), once daily (40.7%), or according to individual needs (26.7%), with dosage most often determined by a physician or pharmacist (35.1%). The mean perception score of DS effects on health outcomes was 3.69 ± 0.98, with a significant association with age (p = 0.041). Conclusions: This study highlights the increasing reliance on DS among athletes in Saudi Arabia, highlighting the need for public health interventions that promote safe and informed use of DS. While our study’s use of convenience sampling may limit their generalizability, the findings still provide important insights into current practices and perceptions. Future research should focus on regulatory measures and educational campaigns to mitigate risks and optimize benefits. Our results have significant implications for public health policy and practice. Full article

Objective: This study evaluated the cost-effectiveness of sacituzumab govitecan (SG) compared with single-agent chemotherapy of the physician’s choice (TPC) from the perspective of Taiwan’s National Health Insurance. Methods: A partitioned survival model was developed to assess outcomes in patients with metastatic triple-negative breast cancer (mTNBC). Clinical data were derived from the ASCENT trial, while direct medical costs were obtained from Taiwan’s National Health Insurance Administration (NHIA). Utility values were taken from published literature. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses were performed to examine parameter uncertainty and test the robustness of the results. Results: In the base-case analysis, SG was associated with an incremental cost of USD 121,836 per QALY gained—exceeding Taiwan’s willingness-to-pay (WTP) threshold of USD 102,120. One-way sensitivity analyses indicated that SG drug cost was the primary driver of ICER variability. Probabilistic sensitivity analysis showed that reducing the price of SG by 50% increased the likelihood of cost-effectiveness. Conclusions: From the NHIA perspective, SG is not cost-effective for patients with advanced or metastatic TNBC at its current price. Substantial price reductions would be required for SG to become cost-effective under the WTP threshold of USD 102,120 per QALY. Full article

Background: Ethical dilemmas and the moral distress they generate are central challenges in healthcare practice and professional identity formation. While moral reasoning has been widely studied, comparative evidence on how medical students and practicing physicians approach ethical dilemmas remains scarce in Eastern Europe. Methods: A total of 244 participants (51 senior medical students and 193 physicians) completed an adapted version of the Defining Issues Test, version 2 (DIT-2). Three classical dilemmas were assessed: end-of-life decision-making, access to life-saving medication, and the reintegration of a fugitive. Responses were analyzed through descriptive statistics and chi-square tests to identify differences in decision choices and underlying reasoning. Results: Physicians consistently endorsed conventional, law-based reasoning, emphasizing legality and professional codes, while medical students demonstrated greater variability, indecision, and openness to compassion-driven justifications. In the “Jan and the Drug” and “Fugitive” dilemmas, significant between-group differences highlighted tensions between legality, empathy, and justice (p < 0.01). These differences in reasoning indicate differing vulnerabilities to moral distress, especially when legal and compassionate perspectives conflict. Conclusions: The findings reveal distinct patterns of moral reasoning that reflect different levels of vulnerability to moral distress in healthcare contexts. Integrating structured ethics training and reflective dialogue into both undergraduate and continuing medical education could mitigate moral distress by fostering a balance between justice, compassion, and professional responsibility. Full article

Background: Clinician empathy is associated with family satisfaction and reduced anxiety, but quantitative data from the parents’ perspective in pediatric psychiatry are limited. Objective: To assess parent-perceived physician empathy in pediatric psychiatry consultations and explore its associations with clinical and demographic factors. Methods: Cross-sectional, consecutive sample of parents attending an outpatient pediatric psychiatry clinic (n = 163 parents). A 10-item behavioral empathy scale (range 10–40) was used. Analyses included reliability testing, group comparisons, correlations, OLS regression, and exploratory PCA. Results: The mean total empathy score was 34.5 (SD 4.2); most parents rated physicians as highly empathic (65%). Parents of children with ASD reported lower empathy compared to those with anxiety/depression. Empathy increased modestly with child age and was associated with a calmer state at the end of the visit. PCA suggested exploratory evidence of potential subdimensions, including child-centered communication and listening/facilitation. Conclusions: Parent-perceived empathy in this sample was generally high; however, behaviors that directly involve and facilitate the child (listening, encouraging questions) may need strengthening, particularly for children with ASD. Results should be interpreted in light of the single-center design, the absence of a recorded participation rate, parent-proxy reporting, and the exploratory nature of the PCA. Full article

Background/Objectives: Family physicians are key stakeholders in the implementation of cancer prevention strategies, including risk factor assessment, lifestyle counseling, and early detection. Despite this, integration of personalized prevention into routine practice remains limited. This study aimed to explore family physicians’ perspectives on barriers, training needs, and collaboration opportunities in cancer prevention. Methods: A mixed-methods study was conducted using an exploratory sequential design. The qualitative phase involved semi-structured interviews with 12 family physicians from the North-West Region of Romania. Thematic analysis was employed to identify main challenges and opportunities. Findings informed the development of a structured online survey completed by 50 family physicians. Descriptive and comparative statistical analyses were applied to assess trends and subgroup differences. Results: Interviews and survey data revealed multiple barriers to cancer prevention in primary care: insufficient consultation time, limited access to diagnostic tools, administrative workload, and low patient health literacy. Physicians reported moderate familiarity with personalized prevention but expressed strong interest in further training, particularly through flexible and interactive learning formats. Collaboration with cancer centers was considered suboptimal; participants emphasized the need for streamlined referral pathways and improved communication. Conclusions: The study highlights systemic and educational gaps affecting cancer prevention efforts in family medicine. Tailored training programs, digital integration with cancer centers, and targeted policy adjustments are needed to enhance prevention capacity within primary care. Full article

Background/Objectives: This study aims to report and compare data from the PRO-AOSD (patient-reported outcomes adult-onset Still’s disease) survey in patients with AOSD from the perspective of patients and their treating physicians. Methods: PRO-AOSD comprised blinded patient and physician surveys. The surveys were designed to assess perceived symptoms and physical impairment. Outcomes reported here include patient demographics; physicians’ assessment of the patient’s health state; physician-reported laboratory findings; pain; disease activity; symptoms; physicians’ treatment goals; and the impact of lifestyle factors on disease improvement. Results: Adult patients with AOSD were recruited from 19 centers in Germany. A total of 124 patients were included, with 74 (59.7%) females; the mean age was 45.5 years. The mean time from first symptom to diagnosis was 2 years, and the mean time was 7 years from diagnosis to survey completion (N = 123). Of 107 patients, most (81.3%) had inactive disease defined by CRP levels. At the time of the survey, around two-thirds of patients were receiving biologic therapy, with 84.1% (69/82) reporting an improvement in symptoms. Many patients had previously received antibiotics (47.6% [n = 58] and 30.4% [n = 37], per patient and physician reports, respectively). Persistent symptoms were reported more frequently by patients than by physicians, including back pain (39.5%), fatigue and weakness (38.7%), and joint inflammation (27.4%). Physicians classified 35.5% of patients as symptom-free. Patients reported exercise as having a positive impact on symptoms (52.4%), while stress (74.2%) and sleep deprivation (62.9%) were reported to worsen symptoms. Targeting systemic manifestations, such as the absence of fever (58.1%, n = 72), was considered the most important treatment goal by physicians. Conclusions: Data from PRO-AOSD highlight distinct differences between patients’ and physicians’ interpretations of the same cases of AOSD. Prior Presentation: These data were presented at the German Congress of Rheumatology (DGRh; 30 August–2 September 2023; Leipzig, Germany). Full article

Background: Shared Decision-Making (SDM) is important for patient-centred care, especially in areas such as gynaecological oncology where treatment decisions are often multifaceted. This study aimed to implement and measure SDM in a gynaecological oncology outpatient clinic, specifically assessing the impact of the BRAN (Benefits, Risks, Alternatives, Nothing) tool on patient and physician perceptions. Methods: A two-phased prospective observational and survey mixed-methodology study was conducted at the tertiary Northern Gynaecological Oncology Centre (NGOC) outpatient clinic in Gateshead, United Kingdom, from October 2023 to November 2024. SDM champions provided staff training. Patient and physician perspectives were measured using the nine-item Shared Decision Making Questionnaire (SDM-Q-9). Phase one was a baseline assessment; phase two involved the implementation of BRAN posters and leaflets. Statistical analyses included the Mann–Whitney U Test and Fisher’s Exact Test. A post-implementation online staff survey was conducted. Results: A total of 207 patients and 13 physicians participated: 107 patients and 13 physicians in phase one and 100 patients and 12 physicians in phase two. Whilst no statistically significant difference in patients’ perceptions of SDM was found between phases (p = 0.73), physicians’ perceptions showed a statistically significant improvement after BRAN tool implementation (p < 0.01). The staff survey results indicated that 84% observed increased patient involvement, and 92% agreed that SDM helped achieve consultation goals. Conclusions: The implementation of SDM at the NGOC led to a statistically significant improvement in the subjective use of SDM by physicians’, despite no significant change in patients’ perceptions, possibly due to high baseline levels. Staff reported increased patient engagement and improved consultation styles. These findings support implementing SDM in gynaecological oncology outpatient settings Full article

Background/Objectives: Family meetings (FMs) are clinical encounters in a structured space between the patient, family members, and care teams. Healthcare professionals (HPs) often lack formal training in conducting FMs. The scoping review aims to provide an overview of the available research evidence on FMs’ education for HPs. Methods: We searched MEDLINE, Embase, CINAHL, PsycINFO, and Scopus. The PCC (Population-Concept-Context) framework was used to define inclusion criteria: educational intervention on FMs aimed at HPs in all settings of care and students of medicine and nursing sciences treating adult patients with oncological and non-oncological diseases. Results: The search retrieved 1017 articles, of which 26 were eligible. The training had as its primary aims the development of communication skills and curriculum development/evaluation. For the most part, palliative care physicians served as trainers, while medical students and residents represented a major part of trainees, underscoring a focus on early-career learners. FM training is mainly provided in the American countries and intensive care settings. Role-play or simulation was the most common teaching method. Pre- and post-interventional designs were the most common, with few studies incorporating longitudinal follow-up to assess skill retention. Quantitative and qualitative methodologies were used to evaluate interventions. Conclusions: The training topics are related to advanced communication, but there is a lack of an interprofessional perspective and long-term assessment of the skills learned. It is necessary to consider different family types as subjects of communication. Full article

Guidelines on fertility preservation (FP) have been developed to help young women preserve their fertility, which may have been impaired due to cancer. Nevertheless, the correct management of oncological patients of childbearing age remains controversial, especially regarding gynecological malignancies. For this reason, we explored the current knowledge, attitudes, and clinical practices of physicians towards the challenges of FP in this population. A specially developed questionnaire on fertility-related issues in patients with gynecological cancer was administered via email to 167 people, representing 167 centers of the Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO) group. A total of 56 physicians, who represented 56 out of these 167 centers, responded to our survey (response rate: 33.5%). Approximately half of these physicians stated that they had adequate knowledge about the use of gonadotropin-releasing analog (GnRHa) injections (n = 30; 53.6%), the cryopreservation of oocytes (n = 25; 44.6%), and the cryopreservation of ovarian tissue (n = 27; 48.2%) in patients with gynecological tumors. Meanwhile, regarding (borderline) ovarian tumors, endometrial or cervical cancer, and genetic mutation carriers, attitudes varied substantially. In conclusion, the results of our survey highlight the different perspectives on controversial topics among physicians directly involved in the treatment of these tumors. These findings also demonstrate the lack of evidence on these issues to adequately counsel this specific patient population. Full article

Premature infants are an especially vulnerable group that often needs extended intensive care. Prematurity naturally hampers the development of the immune system, significantly increasing the risk of infections. In the Neonatal Intensive Care Unit (NICU), antibiotic treatment is often a crucial, life-saving measure. For parents, the birth of a very preterm infant (before 32 weeks of gestation) turns what should be a happy event into a period filled with deep uncertainty and distress. Maintaining hope amid these difficulties relies heavily on maintaining regular communication with and trusting the medical team. Clinical realities in the NICU include a high risk of infection that requires multiple medications, including antibiotics. There is an inverse relationship between gestational age and pharmaceutical exposure. Parents worry about the amount of medication their child receives and the potential long-term effects on development. Over the past thirty years, initiatives such as antimicrobial stewardship programs have worked to reduce antibiotic use and treatment duration in the NICU, emphasizing proper care for premature infants worldwide. This article examines the ethical landscape from the perspectives of three primary stakeholders: parents, healthcare providers, and regulatory bodies. The key ethical question is whether these groups achieve meaningful cooperation or if institutional and professional priorities overshadow clinical practice. In the NICU, decision-making responsibility mainly lies with the medical team, as parents often have limited influence over treatment decisions, and regulatory oversight usually occurs indirectly. This concentration of authority underscores the complex and critical nature of neonatal intensive care. Full article