Search Results (37)

One of the central themes of this journal is to ‘re-boot’ the mystical tradition for the contemporary seeker. The author, a practising psychotherapist, undertakes this in the present article by connecting three strands of thought and practice to propose a ‘mystical therapy’. First, there is the Christian mystical tradition as exemplified by the medieval tradition of theologia mystica. Second, the practices and insights of present-day therapy and counselling arising from the pioneering work of Sigmund Freud (1856–1939) and his successors, including recent approaches from practitioners such as James Hillman and Wilfred Bion. Finally, the philosophical reflections of Freud’s Viennese contemporary Ludwig Wittgenstein (1889–1951), especially in regard to das Mystische and the choreography of saying and showing. All three strands are blended together as the author reflects on three decades of work in the area and the possibility of ‘re-booting’ the mystical through these means. Full article

Background/Objective: Drug-related problems (DRPs) are a common, potentially avoidable cause of emergency department (ED) use. In December 2022, our hospital integrated a pharmacist-led intervention into routine ED practice. This intervention comprised medication optimization, adherence counseling, and coordinated hand-off to primary care. We quantified 30- and 90-day reconsultations after discharge and explored factors associated with DRP-related revisits. Methods: A retrospective cohort of adults (≥18 years) who attended a tertiary ED (Barcelona, Spain). We included index DRP visits from 1 December 2022 to 30 June 2024. All received the bundle. Demographic, clinical, and pharmacotherapeutic data were extracted from the Catalan Shared Health Record; an independent committee classified revisits as a DRP or non-DRP. Predictors of 30-day DRP revisits were assessed with multivariable logistic regression. Results: Among 1247 patients (mean age 78.6 ± 16.2 years; 59.2% women; and median nine drugs), 120 (9.6%) reconsulted the ED within 30 days, and 194 (15.5%) within 90 days for any cause. DRP-specific rates were 30.8% (37/120) at 30 days and 26.3% (51/194) at 90 days; 81% and 80% of these revisits, respectively, involved a recurrence of the same DRP. The most frequent index DRPs were constipation (14.2%), gastrointestinal bleeding (9.2%), hypertension (8.3%), seizures (8.3%) and hyponatraemia (6.7%). An age ≥ 80 years independently predicted fewer 30-day DRP revisits (OR 0.32; 95% CI 0.13–0.79); hypertension and cognitive impairment were not significant after adjustment. Conclusions: In this single-arm implementation cohort, overall, 30-day ED reconsultations were 9.6% and about one-third were DRP-related, predominantly recurrences, and chiefly gastrointestinal bleeding and seizures. These descriptive findings should be interpreted cautiously given potential survivorship bias and residual confounding; the apparently lower risk among patients aged ≥ 80 years is hypothesis-generating and may reflect geriatric care pathways and caregiver engagement. Targeted post-discharge monitoring for high-recurrence DRPs may help reduce avoidable ED use, and future evaluations should test this in quasi-experimental or randomized designs. Full article

This paper explores the theoretical foundations and practical applications of the Japanese concept of ikigai in the field of career counselling and study choice, with particular emphasis on its potential implementation in Slovenia’s educational system. Unlike traditional guidance models that primarily focus on the alignment of abilities and interests, ikigai represents a holistic framework integrating values, competencies, social contribution, and economic sustainability. The paper develops a novel conceptual model of ikigai coaching, applicable across three educational phases and structured into five implementation steps. It situates ikigai within broader motivational and existential theories, while also addressing the challenges of intercultural adaptation and risks of oversimplification or commercialisation. Empirical insight is provided through an expert interview with Professor Rutger ThielenTielen (Breda University of Applied Sciences, BUAS), and limitations as well as directions for future research are critically examined. The original contribution of this article lies in its contextualisation of ikigai within the Slovenian educational and cultural framework, where such approaches have not yet been systematically applied or academically evaluated. By integrating theoretical reflection, a structured coaching model, and empirical insight, the paper advances the academic debate on meaning-oriented career counselling and provides a culturally sensitive proposal for enriching guidance practices in Slovenia. Full article

With the rapid advancement of generative artificial intelligence (GenAI), its integration into education has gained significant attention. However, the impact of GenAI tools in expressive arts counseling courses (EAsCCs) remains underexplored. Therefore, we examined the effects of integrating GenAI tools, such as text-to-image, into a four-week EAsCC involving 10 college students (2 males and 8 females). Using a mixed-methods approach, the participants in this study engaged in art-based practices to enhance self-awareness, explore life milestones, envision future goals, and develop their action plan. GenAI tools were used to create art-based photos in this study. Qualitative data from reflection journals and quantitative data from a designed questionnaire were analyzed. The results indicated that the course enhanced participants’ self-awareness, confidence, and understanding of expressive arts practice (EAsP). However, the participants encountered challenges with the precision of GenAI tools in generating intended images, highlighting their current limitations. These results underscore the need for the refinement of GenAI technologies to better support creative expression and therapeutic exploration. The results also provide information on the potential and challenges of GenAI in expressive arts education, emphasizing the importance of interdisciplinary collaboration to develop effective and meaningful learning and teaching experiences. Full article

Hemoglobin (Hb) defects, or hemoglobinopathies such as thalassemia and structural Hb variants, are among the most prevalent inherited diseases and are associated with significant mortality and morbidity worldwide. Screening for hemoglobinopathies in the primary care setting plays a critical role in enhancing patient outcomes and advancing population health. It promotes awareness, enables early diagnosis and treatment, supports informed reproductive decisions through genetic counseling, and facilitates access to novel therapies such as genetic modifications. Screening approaches for hemoglobinopathies have evolved to reflect regional prevalence, healthcare infrastructure, and ethical considerations. Varying strategies underscore the necessity of tailoring to local contexts, balancing cost, accuracy, accessibility, and social impact. As global migration reshapes population genetics, flexible and equitable screening frameworks are increasingly essential. This review focuses on practical techniques suitable for the screening of Hb defects in primary care. Recent advances and findings in high-performance liquid chromatography, capillary zone electrophoresis, mass spectrometry, point of care testing, and molecular methodologies are covered. In addition, strategies and approaches in multiple regions in the world are reviewed. Full article

Personality is a fundamental psychological trait that exerts a long-term influence on human behavior patterns and social interactions. Automatic personality recognition (APR) has exhibited increasing importance across various domains, including Human–Robot Interaction (HRI), personalized services, and psychological assessments. In this study, we propose a multimodal personality recognition model that classifies the Big Five personality traits by extracting features from three heterogeneous sources: audio processed using Wav2Vec2, video represented as Skeleton Landmark time series, and text encoded through Bidirectional Encoder Representations from Transformers (BERT) and Doc2Vec embeddings. Each modality is handled through an independent Self-Attention block that highlights salient temporal information, and these representations are then summarized and integrated using a late fusion approach to effectively reflect both the inter-modal complementarity and cross-modal interactions. Compared to traditional recurrent neural network (RNN)-based multimodal models and unimodal classifiers, the proposed model achieves an improvement of up to 12 percent in the F1-score. It also maintains a high prediction accuracy and robustness under limited input conditions. Furthermore, a visualization based on t-distributed Stochastic Neighbor Embedding (t-SNE) demonstrates clear distributional separation across the personality classes, enhancing the interpretability of the model and providing insights into the structural characteristics of its latent representations. To support real-time deployment, a lightweight thread-based processing architecture is implemented, ensuring computational efficiency. By leveraging deep learning-based feature extraction and the Self-Attention mechanism, we present a novel personality recognition framework that balances performance with interpretability. The proposed approach establishes a strong foundation for practical applications in HRI, counseling, education, and other interactive systems that require personalized adaptation. Full article

Introduction: Total knee arthroplasty (TKA) is a treatment for knee pain, but some patients are not satisfied with their outcomes. Utilizing shared decision making (SDM) can lead to better decisions, satisfaction, and fewer regrets. However, healthcare professionals have little knowledge of risk factors for regret. The aim of this study is to evaluate decisional regret using the Decision Regret Scale (DRS) after primary TKA among patients who engaged in SDM. Method: A total of 118 patients who underwent TKA surgery between March 2020 and May 2022 participated in this study, and they were able to reflect on their outcomes. The primary outcome was decisional regret assessed using the DRS, and the secondary outcome was post-operative pain at a three-month follow-up, measured using the Lequesne Index. Result: The study found that 49% of the patients reported no regret, 25% reported mild regret, and 26% reported moderate-to-severe regret. There was a significant correlation between greater levels of decision regret and a higher three-month Lequesne Index. Post-operative pain and post-operative mobility status and the range of motion of the knee joint were also strongly correlated. Conclusion: The study found that more than half of the patients undergoing primary TKAs experienced regret even following SDM counseling. Regret levels were associated with higher post-operative pain and poorer mobility. This underscores the importance of informing patients about potential adverse effects of TKA to manage their expectations and reduce regret in future SDM interviews. Practice implications: This study incorporated patient perspectives through their direct engagement in the SDM process prior to surgery. Patients participated in the design of the SDM framework, which included educational pamphlets and structured interviews to assess their values and preferences. Their involvement ensured that the SDM procedure was tailored to patient-centered outcomes. Furthermore, the follow-up assessments were conducted with patients to evaluate decisional regret and post-operative outcomes, providing valuable insights into the effectiveness of the SDM process. By actively participating in the research through decision making and outcome reflection, the patients contributed to the understanding of factors influencing decisional regret after undergoing TKA. Full article

(1) Background: Structured use of feedback and self-reflection in simulated counselling sessions has a number of benefits, including identification of strategies for improvement, improvement in key skills and adaptability and a patient-centred approach which will help them to succeed as effective healthcare practitioners. The aim of this study was therefore to explore students’ perceptions of self-reflection and feedback in patient counselling simulations and the development of patient counselling skills; (2) Methods: Focus groups explored student perceptions of how the combination of self-reflection, self-assessment and teacher and peer feedback impacted their performance in simulated patient counselling assessments; (3) Results: Four focus groups with 21 pharmacy students were conducted. We identified three main themes and associated subthemes: consistency and continuity (sub-themes learning through repetitive assessment and inconsistent expectations), perceptions of feedback (sub-themes tutor feedback, peer feedback and self-reflection) and real-life practice (sub-themes authenticity of simulation cases, perceptions of empathy and professional development); (4) Conclusions: This study highlights the critical role of integrating consistent, high-quality feedback, peer assessment, and self-reflection in pharmacy education to enhance students’ learning experiences and prepare them for professional practice. As workplace-based assessment becomes more common and expected by accreditation bodies, these insights underscore the need for structured and continuous feedback processes to be integrated into all areas of pharmacy curricula. Full article

The political philosophy of Niccolò Machiavelli has often been reduced to the statement that ‘the end justifies the means’ and understood as an expression of realpolitik as a result of his pragmatic, even ruthless, counsel to would-be princes, or political leaders. However, a more nuanced understanding of Machiavelli’s reflections on human nature in his writings, especially The Prince, reveals that there is a philosophic core within his approach to political success, the acquisition and maintenance of state. But while there is no doubt that Machiavelli openly rejected the idealism of certain ancient and medieval thinkers, whose imagined republics only ever existed in theory, and instead candidly advised princes to seek and wield power, his work reflects not only a profound engagement with the harsh realities of a political landscape dominated by practical necessity but also a project of far-reaching scope. With the concept of “effectual truth” as his guide, Machiavelli proposes radical means to overcome fortuna with virtù and establish the foundations of power in order to bring about that conquest. The fulfillment of his mission and mandate to those who follow his lead represents the Machiavellian enterprise. Full article

Background/Objectives: Prenatal physical activity (PA) offers numerous health benefits for both the mother and her child, yet few pregnant women are sufficiently active enough to obtain these benefits. Midwives play an important role in promoting prenatal PA. However, little is known about the content of the information they share with their clients regarding prenatal PA, how they communicate it, and the personal factors that might influence their counseling. In the context of prenatal PA guidance, the aim of this study was to describe the knowledge, attitudes, professional practices, and communication methods used by midwives. Methods: A cross-sectional descriptive study was conducted between February and June 2024 among midwives working in the Province of Quebec. An electronic questionnaire including both closed (quantitative data) and open-ended (qualitative data) questions was developed. Results: Fifty midwives were included in the analysis. Only 28 (56%) reported being aware of the latest Canadian guidelines for PA throughout pregnancy. The recommendations provided varied in terms of content and accuracy but were often conservative (i.e., not focused on increasing PA). Forty-five (90%) mentioned providing information on PA to their pregnant client, and eighty-four (84%) said they used bidirectional communication to share this information. The vast majority (84%) did not consider their counseling to be optimal, primarily due to a lack of training and knowledge. Conclusions: Our finding allowed us to gain a better understanding of current midwifery knowledge, attitudes, and professional practices regarding prenatal PA and to initiate a reflection on how to improve their knowledge, skills, and confidence in guiding their client toward prenatal PA. Full article

The integration of generative AI (GenAI) in school-based mental health services presents new opportunities and challenges. This study focuses on the challenges of using GenAI chatbots as therapeutic tools by exploring secondary school students’ perceptions of such applications. The data were collected from students who had both theoretical and practical experience with GenAI. Based on Grodniewicz and Hohol’s framework highlighting the “Problem of a Confused Therapist”, “Problem of a Non-human Therapist”, and “Problem of a Narrowly Intelligent Therapist”, qualitative data from student reflections were examined using thematic analysis. The findings revealed that while students acknowledged AI’s benefits, such as accessibility and non-judgemental feedback, they expressed significant concerns about a lack of empathy, trust, and adaptability. The implications underscore the need for AI chatbot use to be complemented by in-person counselling, emphasising the importance of human oversight in AI-augmented mental health care. This study contributes to a deeper understanding of how advanced AI can be ethically and effectively incorporated into school mental health frameworks, balancing technological potential with essential human interaction. Full article

Background: It is well established by research that large-scale and indiscriminate prescribing, dispensing, and use of antimicrobials drive antimicrobial resistance (AMR) endangering the health and well-being of people, animals, and the environment. In the context of low- and middle-income countries (LMICs), the prescribing of antimicrobials is often not based on biomedical rationality but involves alternative logic driven by social, cultural, and institutional factors. This paper seeks to develop a “biosocial” perspective, reflecting a unified perspective that treats the biomedical and social conditions as two sides of the same coin. Methods: This analysis is based on an empirical investigation of prescription slips that patients carry to buy drugs from the pharmacy following an outpatient department encounter with the clinician. Data collection involves mixed methods, including the quantitative analysis of the antimicrobials prescribed and a qualitative analysis of the underlying reasons for these prescriptions, as described by doctors, pharmacists, and patients. Data analysis involved triangulating quantitative and qualitative data, to develop a “biosocial” perspective, which can provide implications for the development of antimicrobial stewardship policies, particularly relevant for health institutions in low- and middle-income countries. Results: Our analysis of 1175 prescription slips showed that 98% contained antimicrobials, with 74% being broad-spectrum antimicrobials. Only 9% of cases were advised antimicrobial sensitivity testing (AST) before initiating treatment. Qualitative findings indicated that patients had poor awareness of antimicrobials and pharmacists played a crucial role in counseling. Conclusions: This study highlights that antimicrobial prescriptions in public health settings are influenced by both biomedical and social factors, supporting a biosocial perspective. Although AMS interventions are predominantly biomedical, adhering to clinical standards and best practices, this study underscores the necessity of integrating a biosocial viewpoint by incorporating the experiences of pharmacists and patient groups. Strengthening diagnostic support, patient education, and interprofessional collaboration could improve rational antimicrobial uses in low-resource settings. Full article

Background/Objectives: High levels of emotional intelligence (EI) and resilience in primary care physicians (PCPs) can help them communicate better with patients, build stronger relationships with colleagues, and foster a positive and collaborative workplace. However, studies have indicated that primary care physicians (PCPs) often do not focus enough on developing these skills. Consequently, the purpose of this mixed methods study was to evaluate the effectiveness of an experiential online training (EOT) intervention in enhancing the EI and resilience of PCPs who treat patients with chronic respiratory diseases (CRDs). Methods: A total of 46 PCPs from Greece participated in a 25-hour EOT program, which focused on counseling skills for lifestyle change and breathing techniques for self-regulation. Quantitative data were collected using the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) and the Connor–Davidson Resilience Scale (CD-RISC-25) before, immediately after, and three months post-intervention. Additionally, qualitative data were obtained through written reflections from participants regarding their clinical practice. Results: The results revealed significant improvements in EI and resilience scores immediately after the intervention (ΕΙ: 5.13, SD: 0.65 vs. 5.3, SD: 0.57, p = 0.007; resilience: 76.6, SD: 11.75 vs. 79.83, SD: 10.24, p = 0.029), as well as at the three-month follow-up (ΕΙ: 5.3, SD: 0.57 vs. 5.36, SD: 0.48, p = 0.007; resilience: 79.83, SD: 10.24 vs. 81.03, SD: 7.86, p = 0.029). The thematic analysis of qualitative data identified improvements in five key themes: communication skills, stress management, emotional awareness, resilience, and patient care. Participants reported feeling more confident, empathetic, and effective when interacting with patients, particularly those from diverse backgrounds. The convergence of the quantitative and qualitative findings showed the efficacy of the EOT intervention in enhancing PCPs’ EI, resilience, well-being, and, ultimately, their practice. Full article

Background: Chromosomal numerical and structural alterations are significant causes of various developmental disorders in foetuses. Non-invasive prenatal testing (NIPT) has emerged as an effective screening tool for detecting common aneuploidies, aiding in the identification of individuals who may require further diagnostic work-up. Methods: This retrospective, monocentric observational study evaluates the usage patterns, test choices, turnaround times (TAT), and outcomes of NIPT between 2013 and 2023 on a sample of 2431 pregnant women at a special hospital offering outpatient services and comprehensive gynaecological/obstetric inpatient care. We analysed the trends in NIPT usage, high-risk results, prior screening procedures, as well as factors such as age, gestational age and in vitro fertilisation (IVF) status. NIPT was performed using cell-free foetal DNA (cffDNA) extracted from maternal plasma, followed by library construction, sequencing and result analysis. The sequencing results were aligned with reference genomes, and z-scores were calculated to assess the likelihood of aneuploidy. Statistical significance was set at p < 0.05. Results: The average age of women undergoing NIPT decreased from 36.1 years in 2013 to 33.01 years in 2023 (p = 0.0287), and mean TAT dropped from 12.44 days in 2013 to 7.08 days in 2023 (p = 0.0121), with the most substantial reduction occurring between 2013 and 2019. The study identified a stable rate of women who underwent IVF seeking prenatal testing, with no statistically significant difference between the first half and the second half of the analysed period (p = 0.2659). Among high-risk results, there were 39 chromosomal abnormalities detected, most of them belonging to trisomy 21 (59%). Conclusions: Our findings demonstrate the increasing efficiency and accessibility of NIPT in prenatal care in Croatia, while the significant reduction in TAT and the decreasing age of women undergoing NIPT reflect enhanced operational practices and broader acceptance. Introducing NIPT into the public healthcare system in the Republic of Croatia could improve equitable access to advanced prenatal care and enhance pregnancy outcomes. Future advancements in technology and genetic counselling will further enhance its role, requiring careful attention to ethical and regulatory considerations. Full article

This study was conducted to identify the key elements of transitional care for families with pre-term infants in South Korea. We used an integrative review methodology proposed by Whittemore and Knafle. During the problem identification step, the review question was constructed via the population, intervention, outcome, and timeframe (PIOT) format. During the literature search step, integrative reviews of the published literature from nine electronic databases were undertaken and a total of 14 studies were reviewed that met our inclusion criteria. During the data evaluation step, the quality of the literature was assessed using the Mixed Methods Appraisal Tool (MMAT) developed by Hong et al. We identified three domains and 10 key attributes of transitional care for families of pre-term infants. The parenting empowerment domain included growth and development, developmental promotion, nutrition, safe environment, general parenting, and parent–infant interaction. The emotional support domain included counseling, advocacy, and community network. The social support domain included professional collaboration. Efforts should continue to further develop programs and policies to enhance transitional care for families of pre-term infants that reflect South Korean nursing practices. Full article