Search Results (33)

Safeguarding patient and personnel safety and improving care quality has emerged as a critical priority for healthcare systems globally. In response to persistent challenges in healthcare delivery, many countries have adopted clinical governance frameworks and organisational learning processes to strengthen accountability and promote continuous improvement. Robust clinical governance frameworks provide the processes and accountability measures necessary to foster a culture of knowledge-sharing and evidence-based decision-making, all of which are key characteristics of a learning organisation. This study seeks to investigate the role of clinical governance in improving hospital performance through three interconnected sub-studies. The first sub-study will explore how non-clinical managers in selected public sector hospitals leverage clinical governance to improve hospital performance. The second sub-study will evaluate the impact of clinical governance interventions on clinical outcomes and identify opportunities for organisational learning within these hospitals. The third sub-study will serve as an embedded experimental component, monitoring changes in complaint resolution indicators before and after interventions to assess improvements in clinical governance through both intra- and inter-hospital comparisons. Qualitative data will be analysed using NVivo version 15, with inductive thematic analysis employed to uncover emergent patterns and interpretive themes. Full article

The digital transformation of public services has led to a surge in the volume and complexity of informatics-related complaints, often marked by ambiguous language, inconsistent terminology, and fragmented reporting. Conventional keyword-based approaches are inadequate for detecting semantically similar issues expressed in diverse ways. This study proposes an AI-powered framework that employs BERT-based sentence embeddings, semantic clustering, and classification algorithms, structured under the CRISP-DM methodology, to standardize and automate complaint analysis. Leveraging real-world interaction logs from a public sector agency, the system harmonizes heterogeneous complaint narratives, uncovers latent issue patterns, and enables early detection of technical and usability problems. The approach is deployed through a real-time dashboard, transforming complaint handling from a reactive to a proactive process. Experimental results show a 27% reduction in repeated complaint categories and a 32% increase in classification efficiency. The study also addresses ethical concerns, including data governance, bias mitigation, and model transparency. This work advances citizen-centric service delivery by demonstrating the scalable application of AI in public sector informatics. Full article

Background/Objectives: Breast implants are widely used in reconstructive surgeries, as well as in cosmetic procedures, to enhance or restore breast shape and volume. With advances in techniques and materials, these devices have become safer and more effective over the years. Nevertheless, complications such as capsular contracture, rupture, infections, or other types of malignancies (BIA-SCC). This study evaluated the postmarketing safety and performance of implants via technovigilance data and a review of scientific studies. Methods: The research analyzed publications from the BVS, PubMed, Embase, and ClinicalTrials databases from between 2007 and 2023 (15 years), in addition to reports registered in the Notivisa system during the same period. Results: A total of 113 studies were identified, 15 of which were selected for the final analysis, which revealed that capsular contracture, seroma, infection, and rupture were the most common complications. In the Notivisa system, 786 reports were found, including 397 technical complaints and 389 adverse events, with pain, infections, and lymphoma among the most frequently reported issues. Conclusions: These findings highlight the importance of continuous surveillance to identify risks and promote improvements in the quality and safety of breast implants, ensuring patient well-being. As a practical contribution, a clinical decision-making algorithm was proposed to support healthcare professionals in the early identification and management of implant-related complications. Full article

Urban free-roaming cats present challenges like noise, urination, defecation, property damage, public health risks, and wildlife predation. Traditional enforcement methods, such as containment laws and impounding, are ineffective, especially in low-income areas, where many free-roaming cats live. These cats are often cared for by “semi-owners”, who feed them without formal ownership. Financial barriers to sterilization for owned and semi-owned cats in these areas result in unplanned litters, sustaining the free-roaming population and burdening local authorities and animal welfare organizations. Cats causing complaints are frequently impounded and euthanized, affecting the mental health of veterinary, shelter, and council staff. This paper critiques punitive, compliance-driven strategies and highlights the success of assistive Community Cat Programs offering free sterilization, microchipping, and registration. In Banyule, Victoria, such a program reduced cat impoundments by 66%, euthanasia by 82%, and complaints by 36% between 2013 and 2021. Two other programs in large cities and rural towns in NSW and a rural town in Queensland have now reported similar results. Based on the One Welfare framework, these programs address the interconnectedness of animal welfare, human well-being, and environmental health. By removing financial barriers, they build trust between authorities and caregivers, improving compliance and welfare for cats, communities, and wildlife. However, following the loss of key program staff and the reintroduction of financial barriers in Banyule, cat intake rose by 140% between 2022 and 2024, demonstrating the detrimental impact of financial barriers and punitive approaches. This underscores the importance of sustained, community-based solutions and legislative reforms that prioritize humane, barrier-free strategies. Understanding the critical success factors for Community Cat Programs is essential for effective cat management. Full article

This study thoroughly examines the environmental challenges faced by Malaysian industries in adhering to industrial effluent regulations, addressing the question: what are the obstacles to compliance from the industry’s perspective? This study focuses on eight industries known for low environmental compliance over a seven-year period. Interviews with 13 stakeholders with combined operational experience of over 200 years were conducted to uncover barriers to compliance from the industry’s viewpoint. Key challenges identified include costs, employee attitudes, technology, management support, public complaints, and jurisdictional issues. The responses highlighted the complexity of compliance issues, ranging from divergent to unified viewpoints. According to respondents, enhancing compliance hinges on behavioral changes driven by awareness, incentives, enforcement, guidance, industry ratings, management commitment, and public disclosure of emissions data. This approach provides fresh practical insights that contribute to policy development, insights not previously documented in the literature. This study underscores the government’s crucial role in regulation adherence and the need to analyze barriers and explore alternative approaches. Understanding industry perspectives and strategies for continuous improvement is imperative. Therefore, analyzing current challenges and adopting adaptive measures are essential steps towards achieving self-compliance, continuous improvement, and ensuring environmental sustainability. Full article

This paper presents a new decision support method aimed at prioritizing processing for an intelligent road problem reporting service. The proposed method uses advanced georeferencing technology to extract the longitude and latitude coordinates in the metadata of photos taken with the smartphone application to capture the complaint scene. This method not only maps out the processing times, but also applies a spatiotemporal clustering technique to link the complaint types and locations with the actual complaint processing times. A validation study of the frequency of reported locations per priority reveals that the complaint-processing prioritization method developed in this study aligns realistically with actual field complaint processing. Furthermore, recognizing the significance of location in processing complaints, the georeferencing technique appears suitable for identifying complaint locations for each report and incorporating this into the decision-making framework. Full article

Water quality in rural areas of developing countries is a notable problem. In this article, drinking water quality from eleven villages in the Pavlodar and the Akmola region of Kazakhstan was analyzed. Questionnaires of village respondents and chemical components of drinking water were analyzed to identify the quality of drinking water. In each of the villages, the chemical content varied depending on the source of drinking water. In the rural Pavlodar region, we observed that some cations and anions exceed the MPC. Respondents’ perceptions of water quality are associated with water sources and physical components. For example, respondents’ satisfaction by inside tap of central water systems’ water was high, the answers of those whose water source was private wells showed more mixed satisfaction levels. The drinking water physical quality indicators are closely related to water mineralization and general hardness. The total microbial count of drinking water has a significant relationship with respondents’ complaints about unpleasant taste, odor, and salinity. The relationship between perceived and physical water quality is a critical aspect of water resource management. By bridging the gap between scientific assessments and public perceptions, we can enhance public health, build trust in water management systems, and promote sustainability of water use. Full article

Background: Alternative Disputes Resolution (ADR) systems are becoming increasingly important tools in recent years for the management and resolution of health responsibility cases, but their dissemination and efficiency are still poorly described. The purpose of this paper is to present an ADR system in the autonomous province of Bolzano: the Conciliation Commission. Methods: systematic collection of all claims of the South Tyrol Sanitary Service that were dealt with in the Conciliation Commission from 1 January 2012 to 31 December 2022. Results: closing times of the applications received turn out to be less than a year in 63.8% of the cases, with a number of cases managed rather stably in the time, even if minimal if compared to the number of complaints received to the South Tirol Health Service. Only 5.3% of the application continued the legal process before a civil court. Conclusions: the Conciliation Commission of South Tirol appears to be an excellent instrument for the resolution of disputes in the healthcare field, with rapid resolution times and little to zero costs for the healthcare company, a public health institution. Despite its effectiveness, it seems to be a tool that is still little-known in South Tyrol. Full article

Primary cardiac tumours are relatively uncommon (75% are benign). Across the other 25%, representing malignant neoplasia, sarcomas account for 75–95%, and primary cardiac intimal sarcoma (PCIS) is one of the rarest findings. We aimed to present a comprehensive review and practical considerations from a multidisciplinary perspective with regard to the most recent published data in the specific domain of PCIS. We covered the issues of awareness amid daily practice clinical presentation to ultra-qualified management in order to achieve an adequate diagnosis and prompt intervention, also emphasizing the core role of MDM2 immunostaining and MDM2 genetic analysis. An additional base for practical points was provided by a novel on-point clinical vignette with MDM2-positive status. According to our methods (PubMed database search of full-length, English publications from January 2021 to March 2023), we identified three studies and 23 single case reports represented by 22 adults (male-to-female ratio of 1.2; male population with an average age of 53.75 years, range: 35–81; woman mean age of 55.5 years, range: 34–70) and a 4-year-old child. The tumour-related clinical picture was recognized in a matter of one day to ten months on first admission. These non-specific data (with a very low index of suspicion) included heart failure at least NYHA class II, mitral regurgitation and pulmonary hypertension, acute myocardial infarction, ischemic stroke, obstructive shock, and paroxysmal atrial fibrillation. Awareness might come from other complaints such as (most common) dyspnoea, palpitation, chest pressure, cough, asthenia, sudden fatigue, weakness, malaise, anorexia, weight loss, headache, hyperhidrosis, night sweats, and epigastric pain. Two individuals were initially misdiagnosed as having endocarditis. A history of prior treated non-cardiac malignancy was registered in 3/23 subjects. Distant metastasis as the first step of detection (n = 2/23; specifically, brain and intestinal) or during follow-up (n = 6/23; namely, intestinal, brain and bone, in two cases for each, and adrenal) required additional imagery tools (26% of the patients had distant metastasis). Transoesophageal echocardiography, computed tomography (CT), magnetic resonance imagery, and even ¹⁸F-FDG positronic emission tomography-CT (which shows hypermetabolic lesions in PCIS) represent the basis of multimodal tools of investigation. Tumour size varied from 3 cm to ≥9 cm (average largest diameter of 5.5 cm). The most frequent sites were the left atrium followed by the right ventricle and the right atrium. Post-operatory histological confirmation was provided in 20/23 cases and, upon tumour biopsy, in 3/23 of them. The post-surgery maximum free-disease interval was 8 years, the fatal outcome was at the earliest two weeks since initial admission. MDM2 analysis was provided in 7/23 subjects in terms of MDM2-positive status (two out of three subjects) at immunohistochemistry and MDM2 amplification (four out of five subjects) at genetic analysis. Additionally, another three studies addressed PCISs, and two of them offered specific MDM2/MDM2 assays (n = 35 patients with PCISs); among the provided data, we mention that one cohort (n = 20) identified a rate of 55% with regard to MDM2 amplification in intimal sarcomas, and this correlated with a myxoid pattern; another cohort (n = 15) showed that MDM2-positive had a better prognostic than MDM2-negative immunostaining. To summarize, MDM2 amplification and co-amplification, for example, with MDM4, CDK4, HMGA3, CCND3, PDGFRA, TERT, KIT, CCND3, and HDAC9, might improve the diagnosis of PCIS in addition to MDM2 immunostaining since 10–20% of these tumours are MDM2-negative. Further studies are necessary to highlight MDM2 applicability as a prognostic factor and as an element to be taken into account amid multi-layered management in an otherwise very aggressive malignancy. Full article

In addition to motor symptoms, neurocognitive impairment (NCI) affects patients with prodromal Parkinson’s disease (PD). NCI in PD ranges from subjective cognitive complaints to dementia. The purpose of this review is to present the available evidence of NCI in PD and highlight the heterogeneity of NCI phenotypes as well as the range of factors that contribute to NCI onset and progression. A review of publications related to NCI in PD up to March 2023 was performed using PubMed/Medline. There is an interconnection between the neurocognitive and motor symptoms of the disease, suggesting a common underlying pathophysiology as well as an interconnection between NCI and non-motor symptoms, such as mood disorders, which may contribute to confounding NCI. Motor and non-motor symptom evaluation could be used prognostically for NCI onset and progression in combination with imaging, laboratory, and genetic data. Additionally, the implications of NCI on the social cognition of afflicted patients warrant its prompt management. The etiology of NCI onset and its progression in PD is multifactorial and its effects are equally grave as the motor effects. This review highlights the importance of the prompt identification of subjective cognitive complaints in PD patients and NCI management. Full article

Australian osteopaths engage in multidisciplinary care and referrals with other health professionals, including general practitioners (GPs), for musculoskeletal care. This secondary analysis compared characteristics of Australian osteopaths who refer to, and receive referrals from, GPs with osteopaths who do not refer. The analysis was undertaken to identify pertinent characteristics that could contribute to greater engagement between Australian osteopaths and GPs. Data were from the Australian osteopathy practice-based research network comprising responses from 992 osteopaths (48.1% response rate). Osteopaths completed a practice-based survey exploring their demographic, practice, and clinical management characteristics. Backward logistic regression identified significant characteristics associated with referrals. Osteopaths who reported sending referrals (n = 878, 88.5%) to GPs were more likely than their non-referring colleagues to receive referrals from GPs (aOR = 4.80, 95% CI [2.62–8.82]), send referrals to a podiatrist (aOR = 3.09, 95% CI [1.80–5.28]) and/or treat patients experiencing degenerative spinal complaints (aOR = 1.71, 95% CI [1.01–2.91]). Osteopaths reporting receiving referrals (n = 886, 89.3%) from GPs were more likely than their non-referring colleagues to send referrals to GPs (aOR = 4.62, 95% CI [2.48–8.63]) and use the Medicare EasyClaim system (aOR = 4.66, 95% CI [2.34–9.27]). Most Australian osteopaths who report engaging in referrals with GPs for patient care also refer to other health professionals. Referrals from GPs are likely through the Chronic Disease Management scheme. The clinical conditions resulting in referrals are unknown. Further research could explore the GP–osteopath referral network to strengthen collaborative musculoskeletal care. The outcomes of this study have the potential to inform Australian osteopaths participating in advocacy, public policy and engagement with Australian GPs. Full article

The present study aimed to analyze the current state of the art regarding brand hate with the main intention of identifying possible gaps to be explored in future studies. Brand hate can be described as a set of negative emotions on the part of consumers concerning a certain brand, whose implications involve a reduction in the profitability of companies, as well as of their market shares. From the research carried out in the Scopus and Web of Science databases, 90 publications related to the theme were identified, of which 25 were selected and read in full. The analyzed literature points out that research on the subject has focused almost exclusively on the development of the phenomenon and its consequences from the perspective of consumer behavior. Therefore, the emphasis has been on identifying its direct antecedents, on the effects of its mediators in a set of behaviors such as complaints, negative word of mouth, protests, sponsorship reduction and assignment, brand change, and wishes for revenge, among others. Few studies have been dedicated to understanding the direct effects of brand hate on consumer behavior, its evolution over time in different industries and contexts, who its mediators are, and how the phenomenon is perceived and managed from the perspective of the companies involved in this phenomenon, providing opportunities for future research. Full article

Irritable bowel syndrome (IBS) poses a significant challenge due to its poorly understood pathogenesis, substantial morbidity, and often inadequate treatment outcomes. The role of fecal microbiota transplantation (FMT) in managing IBS symptoms remains inconclusive. This systematic review and meta-analysis aimed to ascertain the effectiveness of FMT in relieving symptoms in IBS patients. A thorough search was executed on PubMed/Medline and Embase databases until 14 June 2023, including all studies on FMT use in IBS patients. We examined the efficiency of FMT in reducing patients’ symptoms overall and in particular subgroups, classified by placebo preparation, FMT preparation, frequency, and route of administration. Among 1015 identified studies, seven met the inclusion criteria for the meta-analysis. The overall symptomatology of FMT-treated IBS patients did not significantly differ from the control group (Odds Ratio (OR) = 0.99, 95% Confidence Interval (CI) 0.39–2.5). Multiple doses of FMT compared with non-FMT placebo, or single-donor FMT therapy compared with autologous FMT placebo also showed no significant benefit (OR = 0.32, 95%CI (0.07–1.32), p = 0.11, and OR = 1.67, 95%CI (0.59–4.67), p = 0.32, respectively). However, a single dose of multiple-donor FMT administered via colonoscopy (lower gastrointestinal (GI) administration) significantly improved patient symptoms compared with autologous FMT placebo (OR = 2.54, 95%CI (1.20–5.37), p = 0.01, and OR = 2.2, 95%CI (1.20–4.03), p = 0.01, respectively). The studies included in the analysis showed a low risk of bias and no publication bias. In conclusion, lower GI administration of a single dose of multiple-donor FMT significantly alleviates patient complaints compared with the autologous FMT used as a placebo. The underlying mechanisms need to be better understood, and further experimental studies are desired to fill the current gaps. Full article

Given the increasing number of citizen complaints about port noise and the lack of relevant studies assessing resident exposure, the effects of port noise are gaining increasing public attention. It is especially significant in ports near residential areas, where excessive noise emissions can seriously impact the urban environment. This paper aimed to investigate the perceptions and attitudes of the population living near the cargo terminals in the Port of Split regarding the impact of port noise in the urban area, focusing on their health and standards of living. The research methodology included a questionnaire distributed in the areas where the residents are most affected by noise. In addition to conventional descriptive survey analysis, the authors used regression analysis and two-way ANOVA with the Tukey post hoc test as a parametric data analysis tool. The survey results showed the harmful effects of port noise on most set parameters, and perceived noise intensity for three different times of the day caused a high level of concern for the urban environment. In addition, the regression analysis results showed a weak and reverse dependency between the distance of the selected residences from the noise sources and the perceived noise intensity. These findings support the validity of the respondents’ perceptions and the credibility of the obtained results. The application of parametric data analysis revealed a lack of formal knowledge of residents about the effects of noise and a strong differentiation between groups based on the variables that determine the level of education of residents and their assessments of the noise intensity of the cargo terminal. However, the subjective impressions and the psycho-physical and emotional states of the residents need also to be included in the validation of the results. The obtained results will facilitate the adoption of noise management policies and implementation of noise abatement programs in the Port of Split. Full article

This paper reviews the literature on perishable food cold-chain management (FCCM) in order to assess its current state, pinpoint its knowledge gaps, and suggest a framework for addressing the issues faced by this industry. This work examines 103 academic articles on the topic of the perishable food supply chain published in various journals between 2001 and 2022. Research publications were selected from two reputed databases—Scopus and Web of Science. The study finds that the current trend in FCCM is toward sustainable FCCM, which offers financial, ecological, and social benefits. However, sustainable FCC practices are more common in wealthy nations but are still lacking in developing countries. High lead times, costs, waste, order returns, complaints, and dissatisfied consumers are the results of a fragmented market and the associated proliferation of chain intermediates. The authors have also developed a conceptual framework based on the findings that illustrates the interconnected nature of the food cold-chain facilities, collaboration among food cold-chain (FCC) stakeholders, concern among FCC stakeholders, economic enhancement, fulfilment of FCC stakeholders’ responsibilities, and overall functioning of the FCC. This study may be helpful to FCC professionals, food regulators, government authorities, and researchers because it gives a concise picture of the state of research in the field. Full article