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Healthcare, Volume 11, Issue 12 (June-2 2023) – 149 articles

Cover Story (view full-size image): Medical professionals who reflect the diversity of their communities are better equipped to understand patients' social circumstances. International studies reveal an underrepresentation of certain social groups among physicians and medical students. To investigate this issue in Germany, we invited 15,195 physicians in Hamburg and 11,287 medical applicants to participate in an online survey from June to August 2022. Our findings demonstrated a significant underrepresentation of individuals from lower socio-economic backgrounds across all the study subsamples. Furthermore, Turkish and Polish communities were notably underrepresented among physicians in Hamburg and medical applicants and students nationwide. To promote equitable access to medical education, it is crucial to implement strategies that foster greater diversity and inclusion. View this paper
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10 pages, 264 KiB  
Article
Factors Informing the Development of a Clinical Pathway and Patients’ Quality of Life after a Non-Union Fracture of the Lower Limb
by Nontembiso Magida, Hellen Myezwa and Witness Mudzi
Healthcare 2023, 11(12), 1810; https://doi.org/10.3390/healthcare11121810 - 20 Jun 2023
Viewed by 1585
Abstract
Patients with non-union fractures spend extended periods of time in the hospital following poor healing. Patients have to make several follow-up visits for medical and rehabilitation purposes. However, the clinical pathways and quality of life of these patients are unknown. This prospective study [...] Read more.
Patients with non-union fractures spend extended periods of time in the hospital following poor healing. Patients have to make several follow-up visits for medical and rehabilitation purposes. However, the clinical pathways and quality of life of these patients are unknown. This prospective study aimed to identify the clinical pathways (CPs) of 22 patients with lower-limb non-union fractures whilst determining their quality of life. Data were collected from hospital records from admission to discharge, utilizing a CP questionnaire. We used the same questionnaire to track patients’ follow-up frequency, involvement in activities of daily living, and final outcomes at six months. We used the Short Form-36 questionnaire to assess patients’ initial quality of life. The Kruskal–Wallis test compared the quality of life domains across different fracture sites. We examined CPs using medians and inter-quantile ranges. During the six-month follow-up period, 12 patients with lower-limb non-union fractures were readmitted. All of the patients had impairments, limited activity, and participation restrictions. Lower-limb fractures can have a substantial impact on emotional and physical health, and lower-limb non-union fractures may have an even greater effect on the emotional and physical health of patients, necessitating a more holistic approach to patient care. Full article
11 pages, 1628 KiB  
Article
Assessment of Functional Capacity in Patients with Nondialysis-Dependent Chronic Kidney Disease with the Glittre Activities of Daily Living Test
by Mauro Ribeiro Balata, Arthur Sá Ferreira, Ariane da Silva Sousa, Laura Felipe Meinertz, Luciana Milhomem de Sá, Vinicius Guterres Araujo, Jannis Papathanasiou and Agnaldo José Lopes
Healthcare 2023, 11(12), 1809; https://doi.org/10.3390/healthcare11121809 - 20 Jun 2023
Viewed by 1384
Abstract
This study evaluated the functional capacity measured by the Glittre-ADL test (TGlittre) in patients with nondialysis-dependent chronic kidney disease (NDD-CKD) and analyzed the test’s associations with muscle strength, physical activity level (PAL), and quality of life. Methods: Thirty patients with NDD-CKD underwent the [...] Read more.
This study evaluated the functional capacity measured by the Glittre-ADL test (TGlittre) in patients with nondialysis-dependent chronic kidney disease (NDD-CKD) and analyzed the test’s associations with muscle strength, physical activity level (PAL), and quality of life. Methods: Thirty patients with NDD-CKD underwent the following evaluations: the TGlittre; the International Physical Activity Questionnaire (IPAQ); the Short Form-36 (SF-36); and handgrip strength (HGS). The absolute value and percentage of the theoretical TGlittre time were 4.3 (3.3–5.2) min and 143.3 ± 32.7%, respectively. The main difficulties in completing the TGlittre were squatting to perform shelving and manual tasks, which were reported by 20% and 16.7% of participants, respectively. The TGlittre time correlated negatively with HGS (r = −0.513, p = 0.003). The TGlittre time was significantly different between the PALs considered “sedentary”, “irregularly active”, and “active” (p = 0.038). There were no significant correlations between TGlittre time and the SF-36 dimensions. Patients with NDD-CKD had a reduced functional capacity to exercise with difficulties performing squatting and manual tasks. There was a relationship between TGlittre time and both HGS and PAL. Thus, the incorporation of the TGlittre in the evaluation of these patients may improve the risk stratification and individualization of therapeutic care. Full article
(This article belongs to the Special Issue Management of the Patient with Kidney Disease)
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21 pages, 2154 KiB  
Review
Ensemble Learning for Disease Prediction: A Review
by Palak Mahajan, Shahadat Uddin, Farshid Hajati and Mohammad Ali Moni
Healthcare 2023, 11(12), 1808; https://doi.org/10.3390/healthcare11121808 - 20 Jun 2023
Cited by 27 | Viewed by 4676
Abstract
Machine learning models are used to create and enhance various disease prediction frameworks. Ensemble learning is a machine learning technique that combines multiple classifiers to improve performance by making more accurate predictions than a single classifier. Although numerous studies have employed ensemble approaches [...] Read more.
Machine learning models are used to create and enhance various disease prediction frameworks. Ensemble learning is a machine learning technique that combines multiple classifiers to improve performance by making more accurate predictions than a single classifier. Although numerous studies have employed ensemble approaches for disease prediction, there is a lack of thorough assessment of commonly used ensemble approaches against highly researched diseases. Consequently, this study aims to identify significant trends in the performance accuracies of ensemble techniques (i.e., bagging, boosting, stacking, and voting) against five hugely researched diseases (i.e., diabetes, skin disease, kidney disease, liver disease, and heart conditions). Using a well-defined search strategy, we first identified 45 articles from the current literature that applied two or more of the four ensemble approaches to any of these five diseases and were published in 2016–2023. Although stacking has been used the fewest number of times (23) compared with bagging (41) and boosting (37), it showed the most accurate performance the most times (19 out of 23). The voting approach is the second-best ensemble approach, as revealed in this review. Stacking always revealed the most accurate performance in the reviewed articles for skin disease and diabetes. Bagging demonstrated the best performance for kidney disease (five out of six times) and boosting for liver and diabetes (four out of six times). The results show that stacking has demonstrated greater accuracy in disease prediction than the other three candidate algorithms. Our study also demonstrates variability in the perceived performance of different ensemble approaches against frequently used disease datasets. The findings of this work will assist researchers in better understanding current trends and hotspots in disease prediction models that employ ensemble learning, as well as in determining a more suitable ensemble model for predictive disease analytics. This article also discusses variability in the perceived performance of different ensemble approaches against frequently used disease datasets. Full article
(This article belongs to the Special Issue Data Mining and Sentiment Analysis in Healthcare)
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13 pages, 293 KiB  
Article
Infant-Directed Speech to 3-Month-Old Severe Preterm Infants: The Influence of Birth Weight and Maternal Depressive Symptoms
by Alessandra Provera, Erica Neri and Francesca Agostini
Healthcare 2023, 11(12), 1807; https://doi.org/10.3390/healthcare11121807 - 20 Jun 2023
Cited by 1 | Viewed by 1104
Abstract
Severe premature birth (<32 weeks) is a risk factor for the development of maternal perinatal depression, while also affecting dyadic interactions and child outcomes. Although several studies have examined the impacts of prematurity and depression on early interactions, only a few studies have [...] Read more.
Severe premature birth (<32 weeks) is a risk factor for the development of maternal perinatal depression, while also affecting dyadic interactions and child outcomes. Although several studies have examined the impacts of prematurity and depression on early interactions, only a few studies have investigated the features of maternal verbal input. Furthermore, no study has investigated the relationship between the effect of severity of prematurity according to birth weight and maternal input. This study aimed to explore the effects of the severity of preterm birth and postnatal depression on maternal input during early interactions. The study included 64 mother–infant dyads, classified into three groups: 17 extremely low birth weight (ELBW) preterm infants, 17 very low birth weight (VLBW) preterm infants, and 30 full-term (FT) infants. At 3 months postpartum (corrected age for preterm infants), the dyads participated in a 5-min free interaction session. Maternal input was analyzed using the CHILDES system in terms of lexical and syntactic complexity (i.e., word types, word tokens, mean length of the utterance) and functional features. Maternal postnatal depression (MPD) was assessed using the Edinburgh Postnatal Depression Scale. The results showed that in high-risk conditions (i.e., ELBW preterm birth and maternal postnatal depression), maternal input was characterized by a lower frequency of affect-salient speech and a higher proportion of information-salient speech, specifically as directives and questions, suggesting that mothers in these conditions may experience more difficulty in conveying affective content to their infants. Moreover, the more frequent use of questions may reflect an interactive style characterized by a higher level of intrusiveness. These findings provide preliminary evidence of the impacts of prematurity severity and maternal depression on maternal verbal input, highlighting the importance of assessing both factors in clinical practice. Understanding the mechanisms underlying the impacts of prematurity and depression on early interactions may inform the development of tailored interventions aimed at promoting positive parent–infant interactions and child development. Full article
(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)
16 pages, 1519 KiB  
Article
The Experience of Women Giving Birth after Cesarean Section—A Longitudinal Observational Study
by Dorota Sys, Anna Kajdy, Martyna Niżniowska, Barbara Baranowska, Dorota Raczkiewicz and Urszula Tataj-Puzyna
Healthcare 2023, 11(12), 1806; https://doi.org/10.3390/healthcare11121806 - 20 Jun 2023
Cited by 2 | Viewed by 1712
Abstract
Natural childbirth after a previous cesarean section is a debated issue despite scientific research and international recommendations. This study aimed to examine the experiences of women giving birth after a previous cesarean section, their preferences, and changes in attitudes towards childbirth after labor. [...] Read more.
Natural childbirth after a previous cesarean section is a debated issue despite scientific research and international recommendations. This study aimed to examine the experiences of women giving birth after a previous cesarean section, their preferences, and changes in attitudes towards childbirth after labor. This longitudinal study involved 288 pregnant women who had a previous cesarean section and completed a web-based questionnaire before and after labor, including information about their obstetric history, birth beliefs, and preferred mode of delivery. Among women who preferred a vaginal birth, nearly 80% tried it and 49.78% finished delivery by this mode. Among women declaring a preference for an elective cesarean section, 30% attempted a vaginal birth. Choosing a hospital where staff supported their decision (regardless of the decision) was the most helpful factor in preparing for labor after a cesarean section (63.19%). Women’s birth preferences changed after labor, with women who had a vaginal birth after a cesarean section preferring this mode of delivery in their next pregnancy (89.34%). The mode of birth did not always follow the women’s preferences, with some women who preferred a natural childbirth undergoing an elective cesarean section for medical reasons. A variety of changes were noticeable among women giving birth after a cesarean section, with a large proportion preferring natural birth in their next pregnancy. Hospitals should support women’s birth preferences after a cesarean section (if medically appropriate), providing comprehensive counseling, resources, and emotional support to ensure informed decisions and positive birth experiences. Full article
(This article belongs to the Special Issue Global Changes in Maternity Care)
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20 pages, 1138 KiB  
Review
Smart Devices for Health and Wellness Applied to Tele-Exercise: An Overview of New Trends and Technologies Such as IoT and AI
by Antonio Fabbrizio, Alberto Fucarino, Manuela Cantoia, Andrea De Giorgio, Nuno D. Garrido, Enzo Iuliano, Victor Machado Reis, Martina Sausa, José Vilaça-Alves, Giovanna Zimatore, Carlo Baldari and Filippo Macaluso
Healthcare 2023, 11(12), 1805; https://doi.org/10.3390/healthcare11121805 - 20 Jun 2023
Cited by 9 | Viewed by 5806
Abstract
This descriptive article explores the use of smart devices for health and wellness in the context of telehealth, highlighting rapidly evolving technologies such as the Internet of Things (IoT) and Artificial Intelligence (AI). Key innovations, benefits, challenges, and opportunities related to the adoption [...] Read more.
This descriptive article explores the use of smart devices for health and wellness in the context of telehealth, highlighting rapidly evolving technologies such as the Internet of Things (IoT) and Artificial Intelligence (AI). Key innovations, benefits, challenges, and opportunities related to the adoption of these technologies are outlined. The article provides a descriptive and accessible approach to understanding the evolution and impact of smart devices in the tele-exercise reality. Nowadays, technological advances provide solutions that were unthinkable just a few years ago. The habits of the general population have also changed over the past few years. Hence, there is a need to investigate this issue and draw the attention of the scientific community to this topic by describing the benefits and challenges associated with each topic. If individuals no longer go to exercise, the exercise must go to their homes instead. Full article
(This article belongs to the Topic Role of Exercise in Musculoskeletal Disorders)
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13 pages, 618 KiB  
Article
The Association between Electronic Health Literacy and Oral Health Outcomes among Dental Patients in Saudi Arabia: A Cross-Sectional Study
by Faisal F. Hakeem, Ismail Abdouh, Hatem Hazzaa Hamadallah, Yunus Osama Alarabi, Abdulrahman Saad Almuzaini, Majed Maher Abdullah and Ammar Abdulrahman Altarjami
Healthcare 2023, 11(12), 1804; https://doi.org/10.3390/healthcare11121804 - 20 Jun 2023
Cited by 1 | Viewed by 1659
Abstract
Objective: This cross-sectional study aimed to investigate the association between electronic health (eHealth) literacy and oral health outcomes, including the number of teeth and brushing frequency. Methods: A total of 478 participants were included in the study and assessed for their eHealth literacy [...] Read more.
Objective: This cross-sectional study aimed to investigate the association between electronic health (eHealth) literacy and oral health outcomes, including the number of teeth and brushing frequency. Methods: A total of 478 participants were included in the study and assessed for their eHealth literacy levels. Demographic variables, including age, gender, income, and education, were collected. The participants’ number of teeth and brushing frequency were also recorded. Multiple regression analyses were performed to examine the relationship between eHealth literacy and oral health outcomes, adjusting for sociodemographic variables. Results: The study sample consisted of both males (66.5%) and females (33.5%), with a mean age of 31.95 years. Among the participants, 16.95% were classified as having inadequate eHealth literacy, 24.06% had problematic eHealth literacy, and the majority (59.00%) demonstrated sufficient eHealth literacy. There was a significant association between eHealth literacy and oral health outcomes. Individuals with problematic eHealth literacy had a higher likelihood of having a greater number of teeth (RR = 1.12, 95% CI: 1.05–1.20, p < 0.001) compared to those with inadequate eHealth literacy. Similarly, individuals with sufficient eHealth literacy showed a higher likelihood of having more teeth (RR = 1.14, 95% CI: 1.07–1.21, p < 0.001) compared to the inadequate eHealth literacy group controlling for age, gender, income, and education. Individuals with problematic eHealth literacy exhibited a tendency towards lower odds of irregular brushing (OR = 0.39, 95% CI: 0.15–1.02, p = 0.054), although this result was marginally significant. In contrast, individuals with sufficient eHealth literacy had significantly lower odds of irregular brushing frequency (OR = 0.24, 95% CI: 0.10–0.62, p = 0.003) compared to the inadequate eHealth literacy group. Conclusion: The findings suggest a positive association between eHealth literacy and oral health outcomes. Improving eHealth literacy may have implications for promoting better oral health behaviors and outcomes. Full article
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25 pages, 1314 KiB  
Article
Shared Decision-Making to Improve Health-Related Outcomes for Adults with Stroke Disease
by Lidia Bajenaru, Alexandru Sorici, Irina Georgiana Mocanu, Adina Magda Florea, Florina Anca Antochi and Athena Cristina Ribigan
Healthcare 2023, 11(12), 1803; https://doi.org/10.3390/healthcare11121803 - 19 Jun 2023
Viewed by 1984
Abstract
Stroke is one of the leading causes of disability and death worldwide, a severe medical condition for which new solutions for prevention, monitoring, and adequate treatment are needed. This paper proposes a SDM framework for the development of innovative and effective solutions based [...] Read more.
Stroke is one of the leading causes of disability and death worldwide, a severe medical condition for which new solutions for prevention, monitoring, and adequate treatment are needed. This paper proposes a SDM framework for the development of innovative and effective solutions based on artificial intelligence in the rehabilitation of stroke patients by empowering patients to make decisions about the use of devices and applications developed in the European project ALAMEDA. To develop a predictive tool for improving disability in stroke patients, key aspects of stroke patient data collection journeys, monitored health parameters, and specific variables covering motor, physical, emotional, cognitive, and sleep status are presented. The proposed SDM model involved the training and consultation of patients, medical staff, carers, and representatives under the name of the Local Community Group. Consultation with LCG members, consists of 11 representative people, physicians, nurses, patients and caregivers, which led to the definition of a methodological framework to investigate the key aspects of monitoring the patient data collection journey for the stroke pilot, and a specific questionnaire to collect stroke patient requirements and preferences. A set of general and specific guidelines specifying the principles by which patients decide to use wearable sensing devices and specific applications resulted from the analysis of the data collected using the questionnaire. The preferences and recommendations collected from LCG members have already been implemented in this stage of ALAMEDA system design and development. Full article
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14 pages, 763 KiB  
Article
Comparison of Sleep Disturbance, Physical Activity, and Health-Related Quality of Life According to Depressive Symptoms in Patients with Metabolic Syndrome: A Secondary Analysis from the Korea National Health and Nutrition Examination Survey Using a Propensity Score Matching Analysis
by Jungmi Yun and Yunji Lee
Healthcare 2023, 11(12), 1802; https://doi.org/10.3390/healthcare11121802 - 19 Jun 2023
Viewed by 1239
Abstract
Metabolic syndrome has become a global epidemic, and the age of its onset is decreasing. However, its prevalence can be reduced by lifestyle modifications. This study examined the differences in sleep disturbance, physical activity, and health-related quality of life associated with depressive symptoms [...] Read more.
Metabolic syndrome has become a global epidemic, and the age of its onset is decreasing. However, its prevalence can be reduced by lifestyle modifications. This study examined the differences in sleep disturbance, physical activity, and health-related quality of life associated with depressive symptoms in patients with metabolic syndrome aged ≥ 40 years. This cross-sectional secondary analysis of data from the 2016 and 2018 Korean National Health and Nutrition Examination Surveys. Of 1404 patients with metabolic syndrome aged ≥ 40 years, depressed and non-depressed patients (103 vs. 103) were matched 1:1 on demographic characteristics using propensity score matching. The outcome variables were then compared between the two groups. We investigated health status, including metabolic syndrome indices, health behaviors, such as sleep disturbances and physical activity, and health-related quality of life. After propensity score matching, health-related quality of life was the only variable that differed significantly between the groups; it was significantly lower in patients with depression (0.77) than in those without depression (0.88) (p = 0.001). Our results suggest that depression with metabolic syndrome is likely to cause a decrease in patients’ quality of life; therefore, development of management systems and programs for early intervention to tackle at-risk groups is necessary. Full article
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9 pages, 243 KiB  
Article
The Effect of Diabetes and Hyperglycemia on Horizontal Guided Bone Regeneration: A Clinical Prospective Analysis
by Paolo De Angelis, Edoardo Rella, Paolo Francesco Manicone, Giuseppe De Rosa, Sofia Gallottini, Margherita Giorgia Liguori, Piero Papi, Viviana Desantis, Pier Carmine Passarelli and Antonio D’Addona
Healthcare 2023, 11(12), 1801; https://doi.org/10.3390/healthcare11121801 - 19 Jun 2023
Cited by 1 | Viewed by 1000
Abstract
Guided bone regeneration (GBR) is a reconstructive procedure for treating atrophic alveolar ridges. This study aims to assess the correlation between different glycemic control levels and clinical findings in patients undergoing horizontal GBR before implant placement. The study population consisted of all patients [...] Read more.
Guided bone regeneration (GBR) is a reconstructive procedure for treating atrophic alveolar ridges. This study aims to assess the correlation between different glycemic control levels and clinical findings in patients undergoing horizontal GBR before implant placement. The study population consisted of all patients requiring horizontal GBR. Patients were divided into three groups based on HbA1c levels: non-diabetic normoglycemic patients (HbA1c < 5.7%), non-diabetic hyperglycaemic patients (HbA1c < 6.5%), and patients with controlled diabetes (HbA1c < 7%). The primary outcomes were the horizontal (mm) and vertical (mm) dimensional changes of the alveolar ridge 6 months after the procedure. The study sample consisted of 54 patients. Sixty-eight implants (95.8%) were classified as “successful,” meaning the possibility of inserting a standard-sized implant following the GBR (diameter ≥ 4 mm). There was a statistically significant difference between the three groups in terms of horizontal gain at 6 months: in particular, there was a statistically significant difference between group 1 and group 2 (p = 0.026) and between group 1 and group 3 (p = 0.030). The present investigation showed that patients with HbA1c levels below 7% could undergo GBR and obtain a statistically significant horizontal bone gain. Full article
(This article belongs to the Special Issue Preventive Oral Health Strategies and Oral Health Status)
16 pages, 311 KiB  
Article
How Do Midwives View Their Professional Autonomy, Now and in Future?
by Joeri Vermeulen, Maaike Fobelets, Valerie Fleming, Ans Luyben, Lara Stas and Ronald Buyl
Healthcare 2023, 11(12), 1800; https://doi.org/10.3390/healthcare11121800 - 19 Jun 2023
Cited by 2 | Viewed by 1552
Abstract
Background: Internationally, midwives’ professional autonomy is being challenged, resulting in their inability to practice to their full scope of practice. This situation contrasts with the increasing international calls for strengthening the midwifery profession. The aim of this study therefore is to explore Belgian [...] Read more.
Background: Internationally, midwives’ professional autonomy is being challenged, resulting in their inability to practice to their full scope of practice. This situation contrasts with the increasing international calls for strengthening the midwifery profession. The aim of this study therefore is to explore Belgian midwives’ views on their current and future autonomy. Methods: An online survey among Belgian midwives was performed. Data were collected and analyzed using a quantitative approach, while quotes from respondents were used to contextualize the quantitative data. Results: Three hundred and twelve midwives from different regions and professional settings in Belgium completed the questionnaire. Eighty-five percentage of respondents believe that they are mostly or completely autonomous. Brussels’ midwives feel the most autonomous, while those in Wallonia feel the least. Primary care midwives feel more autonomous than hospital-based midwives. Older midwives and primary care midwives feel less recognized and respected by other professionals in maternity care. The majority of our respondents believe that in future midwives should be able to work more autonomously in constructive collaboration with other professionals. Conclusion: While Belgian midwives generally rated their own professional autonomy as high, a significant majority of respondents desire more autonomy in future. In addition, our respondents want to be recognized and respected by society and other health professionals in maternity care. It is recommended to prioritize efforts in enhancing midwives’ autonomy, while also addressing the need for increased recognition and respect from society and other maternity care professionals. Full article
(This article belongs to the Special Issue New Waves of Sexual and Reproductive Health)
2 pages, 201 KiB  
Correction
Correction: Suppan et al. Impact of Two Resuscitation Sequences on Alveolar Ventilation during the First Minute of Simulated Pediatric Cardiac Arrest: Randomized Cross-Over Trial. Healthcare 2022, 10, 2451
by Laurent Suppan, Laurent Jampen, Johan N. Siebert, Samuel Zünd, Loric Stuby and Florian Ozainne
Healthcare 2023, 11(12), 1799; https://doi.org/10.3390/healthcare11121799 - 19 Jun 2023
Viewed by 521
Abstract
There was an error in the original publication [...] Full article
18 pages, 755 KiB  
Systematic Review
A Mixed-Methods Systematic Review of Group Reflective Practice in Medical Students
by Kelvin C. Y. Leung and Carmelle Peisah
Healthcare 2023, 11(12), 1798; https://doi.org/10.3390/healthcare11121798 - 19 Jun 2023
Cited by 3 | Viewed by 1315
Abstract
Background: Used primarily as a pedagogical evaluation tool for didactic teaching and skill development, reflective practice (RP) for its own merits is poorly understood. This study aimed to systematically review the literature regarding the role of group RP in fostering empathy, wellbeing, and [...] Read more.
Background: Used primarily as a pedagogical evaluation tool for didactic teaching and skill development, reflective practice (RP) for its own merits is poorly understood. This study aimed to systematically review the literature regarding the role of group RP in fostering empathy, wellbeing, and professionalism in medical students. Methods: Electronic searches of empirical studies published between 1 January 2010 and 22 March 2022 from Medline, Embase, and PsychINFO databases were conducted. Empirical studies of any design (qualitative or quantitative) which included RP (1) involving medical students; (2) with a focus on fostering empathy, or professionalism, or personal wellbeing; and (3) provided in a group setting were included. Duplicates, non-English articles, grey literature and articles using RP to examine pedagogy and specific technical skills were excluded. Both authors screened articles independently to derive a final list of included studies, with any discrepancies resolved by discussion, until consensus reached. Articles were rated for methodological quality using the Attree and Milton checklist for qualitative studies; the Oxford Centre for Evidence-Based Medicine criteria, and the Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative studies. Results: Of 314 articles identified, 18 were included: 9 qualitative; 4 quantitative and 5 mixed methodology. Settings included United States (6), United Kingdom (3), Australia (3), France (2), Taiwan (2), Germany (1), and Ireland (1). Themes were (i) professionalism: bridging theoretical paradigms and practice; (ii) halting empathy decline; (iii) wellbeing: shared experience. Additional themes regarding the “successful“ delivery of RP groups in facilitating these outcomes also emerged. Conclusions: This first systematic review of group RP in medical students shows that RP may bring theory to life in clinical dilemmas, while fostering collegiality and mitigating against isolation amongst students, despite the absence of studies directly examining wellbeing. These findings support the value of RP integration focusing on emotive and humanitarian processes into contemporary medical education for medical students. Systematic review registration: PROSPERO CRD42022322496. Full article
(This article belongs to the Special Issue Innovations in Doctors’ Healthcare in Acute Public Hospital Systems)
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14 pages, 822 KiB  
Article
Feasibility of a Home-Based Mirror Therapy Program in Children with Unilateral Spastic Cerebral Palsy
by Anna Ortega-Martínez, Rocío Palomo-Carrión, Carlos Varela-Ferro and Maria Caritat Bagur-Calafat
Healthcare 2023, 11(12), 1797; https://doi.org/10.3390/healthcare11121797 - 19 Jun 2023
Cited by 1 | Viewed by 2051
Abstract
Children with Unilateral Spastic Cerebral Palsy (US CP) have motor and somatosensory impairments that affect one side of their body, impacting upper limb functioning. These impairments contribute negatively to children’s bimanual performance and quality of life. Intensive home-based therapies have been developed and [...] Read more.
Children with Unilateral Spastic Cerebral Palsy (US CP) have motor and somatosensory impairments that affect one side of their body, impacting upper limb functioning. These impairments contribute negatively to children’s bimanual performance and quality of life. Intensive home-based therapies have been developed and have demonstrated their feasibility for children with US CP and their parents, especially when therapies are designed with the proper coaching of families. Mirror Therapy (MT) is being studied to become an approachable intensive and home-based therapy suitable for children with US CP. The aim of this study is to analyze the feasibility of a five-week home-based program of MT for children with US CP that includes coaching by the therapist. Six children aged 8–12 years old performed the therapy for five days per week, 30 min per day. A minimum of 80% of compliance was required. The feasibility included compliance evaluations, total dosage, perceived difficulty of the exercises, and losses of follow-ups. All children completed the therapy and were included in the analysis. The total accomplishment was 86.47 ± 7.67. The perceived difficulty of the exercises ranged from 2.37 to 4.51 out of 10. In conclusion, a home-based program of Mirror Therapy is a safe, cost-efficient, and feasible therapy for children with US CP when the therapist is involved as a coach during the entire program. Full article
(This article belongs to the Special Issue Outcome Measures and Innovative Approaches in Rehabilitation)
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10 pages, 240 KiB  
Article
Validation of the Korean Version of the Cancer Fatigue Scale in Patients with Cancer
by Haneul Lee, Eun Young Park and Ji Hyun Sung
Healthcare 2023, 11(12), 1796; https://doi.org/10.3390/healthcare11121796 - 19 Jun 2023
Cited by 1 | Viewed by 1011
Abstract
Cancer-related fatigue is a highly prevalent and distressing symptom that negatively affects the quality of life of patients in all stages of cancer, including survivors. The Cancer Fatigue Scale (CFS) is a 15-item multidimensional instrument with the potential to enhance comprehension of fatigue. [...] Read more.
Cancer-related fatigue is a highly prevalent and distressing symptom that negatively affects the quality of life of patients in all stages of cancer, including survivors. The Cancer Fatigue Scale (CFS) is a 15-item multidimensional instrument with the potential to enhance comprehension of fatigue. This study aimed to translate the original English version of the CFS into Korean and establish the validity and reliability of the translated version. A cross-sectional descriptive design was used to translate and validate the CFS in Korean. Factor analyses were performed to understand and establish construct and convergent validity with the Brief Fatigue Inventory (BFI), Functional Assessment of Chronic Illness Therapy-Fatigue (FACT-F), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30). The CFS demonstrated good internal consistency (Cronbach’s alpha coefficient for all 15 items = 0.806); the Kaiser–Meyer–Olkin Measure of Sampling Adequacy was found to be 0.897, and Bartlett’s test of sphericity was significant (p < 0.001). Moderate correlations were found between BFI, FACT-F, and EROTC QLQ-C30, indicating moderate validity. However, there were differences in factorial validity between the original scale and the Korean version, demonstrating a need for further testing in a homogenous population of cancer patients. The findings of this validation and reliability study showed that the Korean version of the CFS is a concise, reliable, feasible, and practical tool for evaluating the multidimensional aspects of cancer-related fatigue in patients with cancer. Full article
(This article belongs to the Section Nursing)
16 pages, 2038 KiB  
Review
MIH and Dental Caries in Children: A Systematic Review and Meta-Analysis
by Marta Mazur, Denise Corridore, Artnora Ndokaj, Roman Ardan, Iole Vozza, Sylvie Babajko and Katia Jedeon
Healthcare 2023, 11(12), 1795; https://doi.org/10.3390/healthcare11121795 - 18 Jun 2023
Cited by 8 | Viewed by 1909
Abstract
(1) Background: Molar-incisor hypomineralization (MIH) is a clinical condition affecting permanent teeth in children, with a documented rising trend in the last two decades. The aim of the present study was to analyze and synthesize the available evidence on caries experience (dmft/DMFT) and [...] Read more.
(1) Background: Molar-incisor hypomineralization (MIH) is a clinical condition affecting permanent teeth in children, with a documented rising trend in the last two decades. The aim of the present study was to analyze and synthesize the available evidence on caries experience (dmft/DMFT) and MIH in children. (2) Methods: A systematic review and meta-analysis were conducted according to the PRISMA statement. (3) Results: 59 papers published between 2007 and 2022 were included in the qualitative synthesis and 18 in the meta-analysis. The total sample of subjects was 17,717 (mean: 896), of which 2378 (13.4%) had MIH (mean: 119), with a girl/boy ratio of 1:1. The mean age of the enrolled participants was 8.6 (age range 7–10 years). Meta-analysis showed that MIH has a positive correlation with both dmft (effect size of 0.67, 95% CI [0.15, 1.19]) and DMFT (effect size of 0.56, 95% CI [0.41, 0.72]); (4) Conclusions: Children with MIH should be diagnosed correctly and on time. Treatment and management options for moderate and severe forms of MIH should consider prognosis based on known risk factors, and secondary and tertiary prevention policies should also consider the multifactorial nature of caries etiology. Full article
(This article belongs to the Special Issue Second Edition of Innovative Solutions for Oral Healthcare)
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14 pages, 644 KiB  
Review
What Do We Know about Nociplastic Pain?
by Kacper Bułdyś, Tomasz Górnicki, Dariusz Kałka, Ewa Szuster, Małgorzata Biernikiewicz, Leszek Markuszewski and Małgorzata Sobieszczańska
Healthcare 2023, 11(12), 1794; https://doi.org/10.3390/healthcare11121794 - 17 Jun 2023
Cited by 9 | Viewed by 4350
Abstract
Nociplastic pain is a recently distinguished type of pain, distinct from neuropathic and nociceptive pain, and is well described in the literature. It is often mistaken for central sensitization. Pathophysiology has not been clearly established with regard to alteration of the concentration of [...] Read more.
Nociplastic pain is a recently distinguished type of pain, distinct from neuropathic and nociceptive pain, and is well described in the literature. It is often mistaken for central sensitization. Pathophysiology has not been clearly established with regard to alteration of the concentration of spinal fluid elements, the structure of the white and gray matter of the brain, and psychological aspects. Many different diagnostic tools, i.e., the painDETECT and Douleur Neuropathique 4 questionnaires, have been developed to diagnose neuropathic pain, but they can also be applied for nociplastic pain; however, more standardized instruments are still needed in order to assess its occurrence and clinical presentation. Numerous studies have shown that nociplastic pain is present in many different diseases such as fibromyalgia, complex regional pain syndrome type 1, and irritable bowel syndrome. Current pharmacological and nonpharmacological treatments for nociceptive and neuropathic pain are not entirely suitable for treating nociplastic pain. There is an ongoing effort to establish the most efficient way to manage it. The significance of this field has led to several clinical trials being carried out in a short time. The aim of this narrative review was to discuss the currently available evidence on pathophysiology, associated diseases, treatment possibilities, and clinical trials. It is important that physicians widely discuss and acknowledge this relatively new concept in order to provide optimized pain control for patients. Full article
(This article belongs to the Special Issue New Advances in the Treatment of Chronic Musculoskeletal Pain)
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10 pages, 512 KiB  
Article
Informed Consent in COVID-19-Research: An Ethical Analysis of Clinical Studies Performed during the Pandemic
by Katja Voit, Tobias Skuban-Eiseler, Marcin Orzechowski and Florian Steger
Healthcare 2023, 11(12), 1793; https://doi.org/10.3390/healthcare11121793 - 17 Jun 2023
Cited by 3 | Viewed by 1206
Abstract
Health crises such as the current COVID-19 pandemic pose challenges to the conduct of clinical studies. Aspects of research ethics, such as obtaining informed consent (IC), can be complicated. We are concerned with whether or not the proper IC procedures were followed in [...] Read more.
Health crises such as the current COVID-19 pandemic pose challenges to the conduct of clinical studies. Aspects of research ethics, such as obtaining informed consent (IC), can be complicated. We are concerned with whether or not the proper IC procedures were followed in the context of clinical studies at Ulm University in the years 2020 to 2022. We identified all protocols of clinical studies dealing with COVID-19 that the Research Ethics Committee of Ulm University has reviewed and voted on in the years 2020 to 2022. We then performed a thematic analysis regarding the following aspects: study type, handling of IC, type of patient information, means of communication, applied security precautions, and the approach to participants from vulnerable groups. We identified n = 98 studies that dealt with COVID-19. In n = 25 (25.51%), IC was obtained traditionally in written form, in n = 26 (26.53%) IC was waived, in n = 11 (11.22%) IC was obtained delayed, and in n = 19 (19.39%) IC was obtained by proxy. No study protocol was accepted that waived IC in case IC would have been required in times outside of pandemics. It is possible to obtain IC even in times of severe health crises. In the future, it is necessary to address in greater detail and with legal certainty which alternative methods of obtaining IC are possible and under which circumstances IC can be waived. Full article
(This article belongs to the Section Coronaviruses (CoV) and COVID-19 Pandemic)
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19 pages, 941 KiB  
Review
Effectiveness of Workplace Interventions to Improve Health and Well-Being of Health and Social Service Workers: A Narrative Review of Randomised Controlled Trials
by Rahman Shiri, Risto Nikunlaakso and Jaana Laitinen
Healthcare 2023, 11(12), 1792; https://doi.org/10.3390/healthcare11121792 - 17 Jun 2023
Cited by 5 | Viewed by 5323
Abstract
Health and social service workers face high levels of workload and job stressors, which can affect their health and well-being. Therefore, it is important to evaluate the effectiveness of workplace interventions that aim to improve their mental and physical health outcomes. This review [...] Read more.
Health and social service workers face high levels of workload and job stressors, which can affect their health and well-being. Therefore, it is important to evaluate the effectiveness of workplace interventions that aim to improve their mental and physical health outcomes. This review summarizes the findings of randomized controlled trials (RCTs) that examined the impact of different types of workplace interventions on various health indicators among health and social service workers. The review searched the PubMed database from its inception to December 2022 and included RCTs that reported on the effectiveness of organizational-level interventions and qualitative studies that explored barriers and facilitators to participation in such interventions. A total of 108 RCTs were included in the review, covering job burnout (N = 56 RCTs), happiness or job satisfaction (N = 35), sickness absence (N = 18), psychosocial work stressors (N = 14), well-being (N = 13), work ability (N = 12), job performance or work engagement (N = 12), perceived general health (N = 9), and occupational injuries (N = 3). The review found that several workplace interventions were effective in improving work ability, well-being, perceived general health, work performance, and job satisfaction and in reducing psychosocial stressors, burnout, and sickness absence among healthcare workers. However, the effects were generally modest and short-lived. Some of the common barriers to participation in workplace interventions among healthcare workers were inadequate staff, high workload, time pressures, work constraints, lack of manager support, scheduling health programs outside work hours, and lack of motivation. This review suggests that workplace interventions have small short-term positive effects on health and well-being of healthcare workers. Workplace interventions should be implemented as routine programs with free work hours to encourage participation or integrate intervention activities into daily work routines. Full article
(This article belongs to the Section Chronic Care)
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14 pages, 1086 KiB  
Article
Role of Tele-Physical Therapy Training on Glycemic Control, Pulmonary Function, Physical Fitness, and Health-Related Quality of Life in Patients with Type 2 Diabetes Mellitus (T2DM) Following COVID-19 Infection—A Randomized Controlled Trial
by Gopal Nambi, Mshari Alghadier, Arul Vellaiyan, Elturabi Elsayed Ebrahim, Osama R. Aldhafian, Shahul Hameed Pakkir Mohamed, Hani Fahad Ateeq Albalawi, Mohamed Faisal Chevidikunnan, Fayaz Khan, Paramasivan Mani, Ayman K. Saleh and Naif N. Alshahrani
Healthcare 2023, 11(12), 1791; https://doi.org/10.3390/healthcare11121791 - 17 Jun 2023
Cited by 2 | Viewed by 1607
Abstract
The use of tele-rehabilitation (TR) in type 2 diabetes mellitus (T2DM) following COVID-19 infection remains unexplored. Hence, the purpose of this study was to determine the clinical effects of tele-physical therapy (TPT) on T2DM following COVID-19 infection. The eligible participants were randomized into [...] Read more.
The use of tele-rehabilitation (TR) in type 2 diabetes mellitus (T2DM) following COVID-19 infection remains unexplored. Hence, the purpose of this study was to determine the clinical effects of tele-physical therapy (TPT) on T2DM following COVID-19 infection. The eligible participants were randomized into two groups, a tele-physical therapy group (TPG; n = 68) and a control group (CG; n = 68). The TPG received tele-physical therapy for four sessions a week for eight weeks, and the CG received patient education for 10 min. The outcome measures were HbA1c levels, pulmonary function (forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC, maximum voluntary ventilation (MVV), and peak exploratory flow (PEF)), physical fitness, and quality of life (QOL). The difference between the groups in HbA1c levels at 8 weeks was 0.26 (CI 95% 0.02 to 0.49), which shows greater improvement in the tele-physical therapy group than the control group. Similar changes were noted between the two groups after 6 months and at 12 months resulting in 1.02 (CI 95% 0.86 to 1.17). The same effects were found in pulmonary function (FEV1, FVC, FEV1/FVC, MVV, and PEF), physical fitness, and QOL (p = 0.001). The reports of this study show that tele-physical therapy programs may result in improved glycemic control and improve the pulmonary function, physical fitness, and quality of life of T2DM patients following COVID-19 infection. Full article
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13 pages, 6810 KiB  
Article
Computer-Based Intelligent Solutions for the Diagnosis of Gastroesophageal Reflux Disease Phenotypes and Chicago Classification 3.0
by Yunus Doğan and Serhat Bor
Healthcare 2023, 11(12), 1790; https://doi.org/10.3390/healthcare11121790 - 17 Jun 2023
Cited by 1 | Viewed by 1000
Abstract
Gastroesophageal reflux disease (GERD) is a multidisciplinary disease; therefore, when treating GERD, a large amount of data needs to be monitored and managed.The aim of our study was to develop a novel automation and decision support system for GERD, primarily to automatically determine [...] Read more.
Gastroesophageal reflux disease (GERD) is a multidisciplinary disease; therefore, when treating GERD, a large amount of data needs to be monitored and managed.The aim of our study was to develop a novel automation and decision support system for GERD, primarily to automatically determine GERD and its Chicago Classification 3.0 (CC 3.0) phenotypes. However, phenotyping is prone to errors and is not a strategy widely known by physicians, yet it is very important in patient treatment. In our study, the GERD phenotype algorithm was tested on a dataset with 2052 patients and the CC 3.0 algorithm was tested on a dataset with 133 patients. Based on these two algorithms, a system was developed with an artificial intelligence model for distinguishing four phenotypes per patient. When a physician makes a wrong phenotyping decision, the system warns them and provides the correct phenotype. An accuracy of 100% was obtained for both GERD phenotyping and CC 3.0 in these tests. Finally, since the transition to using this developed system in 2017, the annual number of cured patients, around 400 before, has increased to 800. Automatic phenotyping provides convenience in patient care, diagnosis, and treatment management. Thus, the developed system can substantially improve the performance of physicians. Full article
(This article belongs to the Section Artificial Intelligence in Medicine)
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20 pages, 1134 KiB  
Article
Configuration Path Study of Influencing Factors on Health Information-Sharing Behavior among Users of Online Health Communities: Based on SEM and fsQCA Methods
by Minhao Xiang, Tianning Guan, Mengqi Lin, Yujie Xie, Xingyu Luo, Minghua Han and Kun Lv
Healthcare 2023, 11(12), 1789; https://doi.org/10.3390/healthcare11121789 - 17 Jun 2023
Cited by 1 | Viewed by 1361
Abstract
This study examines the determinants that drive the behavior of sharing health information within online health communities. Leveraging the Theory of Planned Behavior, the Technology Acceptance Model, and the “Knowledge-Attitude-Practice” theory, a comprehensive model elucidating the key elements that sway the health information-sharing [...] Read more.
This study examines the determinants that drive the behavior of sharing health information within online health communities. Leveraging the Theory of Planned Behavior, the Technology Acceptance Model, and the “Knowledge-Attitude-Practice” theory, a comprehensive model elucidating the key elements that sway the health information-sharing behavior among users of online health communities is designed. This model is validated through Structural Equation Modeling (SEM) and Fuzzy Set Qualitative Comparative Analysis (fsQCA). Findings derived from the SEM suggest that perceived ease of use, perceived usefulness, perceived trust, and perceived behavioral control exert a significant positive impact on attitudes towards health information sharing, the intention to share health information, and the actual health information-sharing behavior. The fsQCA unfolds two unique configuration path models that lead to the emergence of health information-sharing behavior: one predicated on perceived trust and sharing intention, and the other on perceived usefulness, behavioral control, and sharing attitude. This research provides invaluable insights, fostering a deeper comprehension of the dynamics involved in health information sharing within online communities, thereby directing the design of more effective health platforms to augment user engagement and enable informed health decisions. Full article
(This article belongs to the Special Issue Information Behavior in Online Healthcare)
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18 pages, 927 KiB  
Article
Introducing Computerized Technology to Nurses: A Model Based on Cognitive Instrumental and Social Influence Processes
by Becky Tsarfati and Daniela Cojocaru
Healthcare 2023, 11(12), 1788; https://doi.org/10.3390/healthcare11121788 - 17 Jun 2023
Cited by 1 | Viewed by 2216
Abstract
The use of computerized technologies as an integral part of nursing has become a reality in the health care system. Studies present different approaches that range from accepting technology as a health promoter to an approach that opposes computerization. This study, which examined [...] Read more.
The use of computerized technologies as an integral part of nursing has become a reality in the health care system. Studies present different approaches that range from accepting technology as a health promoter to an approach that opposes computerization. This study, which examined social and instrumental processes that influence nurses’ attitudes toward computer technology, will present a model for the optimal assimilation of computer technology in the nurses’ work environment. The study, which included 224 participants, was designed as a mixed method and included questionnaires and semi-structured interviews of participants. The data were analyzed to understand the factors that influenced nurses’ attitudes toward the use of computer technology. The research findings show that the more clearly nurses understand the positive impact of using technology on the quality of care, the more positive their response to changes in registration and reporting methods. It is not surprising that the research findings found that cognitive instrumental processes and social influence processes have a positive effect on the perceived usefulness of using computer technologies. The unusual finding was the fact that cognitive instrumental processes were the main factor influencing the assimilation of computer technology even though nursing is a social profession. Full article
(This article belongs to the Collection Current Nursing Practice and Education)
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15 pages, 579 KiB  
Review
Influence of Stress and Emotions in the Learning Process: The Example of COVID-19 on University Students: A Narrative Review
by Alfredo Córdova, Alberto Caballero-García, Franchek Drobnic, Enrique Roche and David C. Noriega
Healthcare 2023, 11(12), 1787; https://doi.org/10.3390/healthcare11121787 - 17 Jun 2023
Cited by 1 | Viewed by 2320
Abstract
Emotional instability and stress are the main disturbances that condition the learning process, affecting both teachers and students. The main objective of this review is to analyze the influence of stress and emotions (as part of stress) on the learning environment. Stress is [...] Read more.
Emotional instability and stress are the main disturbances that condition the learning process, affecting both teachers and students. The main objective of this review is to analyze the influence of stress and emotions (as part of stress) on the learning environment. Stress is a physiological mechanism that the organism develops to adapt and survive external and internal challenges. In this context, stress tends to be seen as a negative condition in the learning process when it is chronic. Extreme stress situations, such as the COVID-19 pandemic, can generate anxiety and frustration in students. However, other studies indicate that controlled stress can positively enhance the learning process. On the other hand, the quality and intensity of emotions resulting from stress can influence as well the learning process. Positive emotions are healthy and can promote optimal learning. Emotions lead to sentimental, cognitive, behavioral, and physiological changes, which will have a strong influence on intellectual performance. The activation of coping strategies constitutes a key mechanism for dealing positively with problems and challenges, generating positive emotions essential for the self-regulation of learning. In conclusion, correct management of emotions in stressful situations could promote effective learning through enhanced attention and capacity to solve problems. Full article
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12 pages, 551 KiB  
Article
Utilising the Implementation of Integrated Care to Develop a Pragmatic Framework for the Sustained Uptake of Service Innovations (SUSI)
by Catherine Foley, Julaine Allan, Julia Lappin, Ryan Courtney, Sara Farnbach, Alexandra Henderson and Anthony Shakeshaft
Healthcare 2023, 11(12), 1786; https://doi.org/10.3390/healthcare11121786 - 16 Jun 2023
Cited by 2 | Viewed by 1166
Abstract
The provision of integrated care (IC) across alcohol and other drug (AOD) and mental health (MH) services represents the best practice, yet the consistent delivery of IC in routine practice rarely occurs. Our hypothesis is that there is no practical or feasible systems-change [...] Read more.
The provision of integrated care (IC) across alcohol and other drug (AOD) and mental health (MH) services represents the best practice, yet the consistent delivery of IC in routine practice rarely occurs. Our hypothesis is that there is no practical or feasible systems-change approach to guide staff, researchers, or consumers through the complex transition that is required for the sustained uptake of IC across diverse clinical settings. To address this gap, we combined clinical and consumer expertise with the best available research evidence to develop a framework to drive the uptake of IC. The goal was to develop a process that is both standardised by the best available evidence and can be tailored to the specific characteristics of different health services. The result is the framework for Sustained Uptake of Service Innovation (SUSI), which comprises six core components that are applied in a specified sequence and a range of flexible activities that staff can use to deliver the core components according to their circumstances and preferences. The SUSI is evidence-based and practical, and further testing is currently underway to ensure it is feasible to implement in different AOD and MH services. Full article
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10 pages, 567 KiB  
Review
Reconstructive Options after Oncological Rhinectomy: State of the Art
by Andrea Migliorelli, Rossella Sgarzani, Giovanni Cammaroto, Andrea De Vito, Manlio Gessaroli, Marianna Manuelli, Andrea Ciorba, Chiara Bianchini, Stefano Pelucchi and Giuseppe Meccariello
Healthcare 2023, 11(12), 1785; https://doi.org/10.3390/healthcare11121785 - 16 Jun 2023
Viewed by 1083
Abstract
Background: The nose is a central component of the face, and it is fundamental to an individual’s recognition and attractiveness. The aim of this study is to present a review of the last twenty years literature on reconstructive techniques after oncological rhinectomy. Methods: [...] Read more.
Background: The nose is a central component of the face, and it is fundamental to an individual’s recognition and attractiveness. The aim of this study is to present a review of the last twenty years literature on reconstructive techniques after oncological rhinectomy. Methods: Literature searches were conducted in the databases PubMed, Scopus, Medline and Google Scholar. “Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA)” for scoping review was followed. Results: Seventeen articles regarding total rhinectomy reconstruction were finally identified in the English literature, with a total of 447 cases. The prostheses were the reconstructive choice in 213 (47.7%) patients, followed by local flaps in 172 (38.5%) and free flaps in 62 (13.8%). The forehead flap (FF) and the radial forearm free flap (RFFF) are the most frequently used flaps. Conclusions: This study shows that both prosthetic and surgical reconstruction are very suitable solutions in terms of surgical and aesthetic outcomes for the patient. Full article
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13 pages, 1787 KiB  
Article
Preperitoneal Pelvic Packing versus Angioembolization for Patients with Hemodynamically Unstable Pelvic Fractures with Pelvic Bleeding: A Single-Centered Retrospective Study
by Seong Chan Gong, Ji Eun Park, Sooyeon Kang, Sanghyun An, Myoung Jun Kim, Kwangmin Kim and In Sik Shin
Healthcare 2023, 11(12), 1784; https://doi.org/10.3390/healthcare11121784 - 16 Jun 2023
Cited by 2 | Viewed by 1061
Abstract
The aim of this study was to compare the outcomes of preperitoneal pelvic packing (PPP) and angioembolization (AE) for patients with equivocal vital signs after initial resuscitation. This single-centered retrospective study included information from the database of a regional trauma center from April [...] Read more.
The aim of this study was to compare the outcomes of preperitoneal pelvic packing (PPP) and angioembolization (AE) for patients with equivocal vital signs after initial resuscitation. This single-centered retrospective study included information from the database of a regional trauma center from April 2014 to December 2022 for patients with pelvic fractures with a systolic blood pressure of 80–100 mmHg after initial fluid resuscitation. The patients’ characteristics, outcomes, and details of AE after resuscitative endovascular balloon occlusion of the aorta (REBOA) placed in zone III were collected. The follow-up duration was from hospital admission to discharge. A total of 65 patients were enrolled in this study. Their mean age was 59.2 ± 18.1 years, and 40 were males. We divided the enrolled patients into PPP (n = 43) and AE (n = 22) groups. The median time from emergency department (ED) to procedure and the median duration of ED stay were significantly longer in the AE group than in the PPP group (p ≤ 0.001 for both). The median mechanical ventilation (MV) duration was significantly shorter (p = 0.046) in the AE group. The number of patients with complications, overall mortality, and mortality due to hemorrhage did not differ between the two groups. Three patients (13.6%) were successfully treated with AE after REBOA. AE may be beneficial for patients with hemodynamically unstable pelvic fractures who show equivocal vital signs after initial fluid resuscitation in terms of reducing the MV duration and incidence of infectious complications. Full article
(This article belongs to the Special Issue Acute Care Surgery)
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8 pages, 497 KiB  
Article
Influence of Obesity in Children with Supracondylar Humeral Fractures Requiring Surgical Treatment at a Tertiary Pediatric Trauma Center
by Marko Bašković, Lucija Vucković, Marta Borić Krakar, Arnes Rešić, Nikolina Benco Kordić and Antun Kljenak
Healthcare 2023, 11(12), 1783; https://doi.org/10.3390/healthcare11121783 - 16 Jun 2023
Viewed by 823
Abstract
Background: Almost everywhere in the world, childhood obesity is becoming a serious public health problem with negative effects on both children’s health and society as a whole. The main objective of this study was to determine whether obesity has an effect on the [...] Read more.
Background: Almost everywhere in the world, childhood obesity is becoming a serious public health problem with negative effects on both children’s health and society as a whole. The main objective of this study was to determine whether obesity has an effect on the severity of supracondylar humerus fracture in children, regardless of whether it is a low- or high-energy trauma. Methods: The electronic records of patients treated for the supracondylar fracture of the humerus in the ten-year period from 1 January 2013 to 1 January 2023 were reviewed retrospectively. Results: In the observed period, 618 children, including 365 (59.06%) boys and 253 (40.94%) girls, were hospitalized and treated surgically with the diagnosis of supracondylar fracture. The distributions according to the observed parameters were as follows: age (months) = 88.18 ± 32.64; height (cm) = 123.42 ± 16.83; weight (kg) = 27.18 ± 11.32; body mass index = 17.18 ± 3.06; body mass index-for-age percentile = 57.34 ± 32.11. Overall, 141 (22.82%) fractures were classified as Gartland II, while 477 (77.18%) were classified as Gartland III. A total of 66 (10.68%) fractures were flexion type, while 552 (89.32%) were extension type. The left elbow was affected in 401 (64.89%) children, while the right was affected in 217 (35.11%) children. The main mechanism of injury was a fall at ground level (33.33%). In relation to gender, a statistically significant difference was recorded in body mass index and percentile (p < 0.05). According to Gartland, the proportion of children below and above the 85th percentile in relation to the type of injury was statistically significant (p < 0.05). It was determined that the energy level does not significantly influence the injury’s severity: p(GII) = 0.225; p(GIII) = 0.180. Conclusions: In our study, we found that the proportion of overweight and obese children requiring surgical treatment was higher in Gartland type III injury, so there is no doubt that as a society we must prevent further increases in the prevalence of childhood obesity for this reason as well. Full article
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12 pages, 7184 KiB  
Case Report
Workers with Suspected Diagnosis of Silicosis: A Case Study of Sarcoidosis Versus Siderosis
by Diemen Delgado-García, Patricio Miranda-Astorga, Ashley Delgado-Cano, Juan Gómez-Salgado and Carlos Ruiz-Frutos
Healthcare 2023, 11(12), 1782; https://doi.org/10.3390/healthcare11121782 - 16 Jun 2023
Cited by 1 | Viewed by 2325
Abstract
Silicosis is one of the most important occupational respiratory diseases worldwide, hence the importance of making a correct diagnosis. Diagnosis is commonly based on radiological findings according to the ILO International Classification of Radiographs of Pneumoconioses and occupational exposure. High-resolution computed tomography is [...] Read more.
Silicosis is one of the most important occupational respiratory diseases worldwide, hence the importance of making a correct diagnosis. Diagnosis is commonly based on radiological findings according to the ILO International Classification of Radiographs of Pneumoconioses and occupational exposure. High-resolution computed tomography is indicated for differential diagnosis. This article presents two cases with an initial diagnosis of silicosis that ended up being diagnosed as sarcoidosis and siderosis, respectively. The first case was a 42-year-old male who worked as a crushing operator in an underground copper and molybdenum mine for 22 years. He had a history of exposure to silicon dioxide and was asymptomatic. X-rays did not distinguish silicosis or siderosis, but histological findings (open lung biopsy) allowed for a diagnosis of sarcoidosis. The second case was a 50-year-old male who had worked as a welder in a molybdenum filter plant, an open pit mine since 2013; he spent the previous 20 years as a welder in an underground copper mine, with exposure to silicon dioxide and was symptomatic. The first radiograph showed opacities that were compatible with pulmonary silicosis. A subsequent high-resolution computed tomography and lung biopsy showed a pattern of pulmonary siderosis. Due to the similarities in the radiographs of these three diseases, greater emphasis must be placed on the differential diagnosis, for which a complete occupational and clinical history is important in order to provide clues for the performance of complementary tests to avoid misdiagnosing. Full article
(This article belongs to the Section Environmental Factors and Global Health)
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11 pages, 250 KiB  
Article
Towards the Provision of Palliative Care Services in the Intensive Coronary Care Units: Nurses’ Knowledge, Training Needs, and Related-Barriers
by Baraa Abu-Aziz, Areefa S. M. Alkasseh, Jonathan Bayuo and Hammoda Abu-Odah
Healthcare 2023, 11(12), 1781; https://doi.org/10.3390/healthcare11121781 - 16 Jun 2023
Cited by 1 | Viewed by 1549
Abstract
Despite the notable benefits of palliative care (PC) for patients with chronic diseases, its delivery to people with cardiac problems, particularly in the Middle East region (EMR), remains a critical issue. There is a scarcity of research assessing nursing staff’s needs and knowledge [...] Read more.
Despite the notable benefits of palliative care (PC) for patients with chronic diseases, its delivery to people with cardiac problems, particularly in the Middle East region (EMR), remains a critical issue. There is a scarcity of research assessing nursing staff’s needs and knowledge in providing PC to cardiac patients in the EMR. This study aimed to assess the level of knowledge and needs of PC among nurses towards the provision of PC in intensive coronary care units (ICCUs) in the Gaza Strip, Palestine. It also identified the barriers to the provision of PC services in ICCUs in the Gaza Strip. A hospital-based descriptive quantitative cross-sectional design was adopted to collect data from 85 nurses working in ICCUs at four main hospitals in the Gaza Strip. Knowledge about PC was collected using a developed questionnaire based on the Palliative Care Quiz Nursing Scale (PCQN) and Palliative Care Knowledge Test (PCKT). PC training needs and barriers were assessed using the PC Needs Assessment instrument. Approximately two-thirds of nurses did not receive any PC educational or training programs, which contributed to their lack of PC knowledge. Most nurses would like to enroll in PC training programs, such as family support and communications skills courses. Nurses reported that there was a high demand for PC guidelines and discharge planning for patients with chronic illnesses. Insufficient healthcare professionals’ knowledge about PC and a staff shortage were the main barriers to integrating PC into the Gaza healthcare system. This study suggests incorporating PC into nursing curricula and in-service training, and it covers both basic and advanced PC principles. Intensive coronary care unit nurses need knowledge and training about PC, guidance, and support to provide appropriate care to patients with cardiovascular issues. Full article
(This article belongs to the Special Issue Development and Impact of Palliative and End-of-Life Care Services)
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