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Volume 13, October-1
 
 

Healthcare, Volume 13, Issue 20 (October-2 2025) – 12 articles

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8 pages, 371 KB  
Article
Effects of Agility Training with a Light-Based System on Balance and Functional Performance in Individuals with Parkinson’s Disease
by Thelma Rut Holmarsdottir, Andri Thor Sigurgeirsson and Atli Agustsson
Healthcare 2025, 13(20), 2559; https://doi.org/10.3390/healthcare13202559 (registering DOI) - 11 Oct 2025
Abstract
Background/Objectives: Impaired balance and general mobility are common complications of Parkinson‘s disease (PD) and are largely caused by bradykinesia and hypokinesia. Although previous studies have shown that patients can increase the speed and amplitude of movement with training, apathy, which is also common [...] Read more.
Background/Objectives: Impaired balance and general mobility are common complications of Parkinson‘s disease (PD) and are largely caused by bradykinesia and hypokinesia. Although previous studies have shown that patients can increase the speed and amplitude of movement with training, apathy, which is also common among people with PD, reduces this prospect. Training with light pods was originally developed for athletes to enhance agility in a way that is motivating. However, this type of training could be ideal for individuals with PD and possibly reduce bradykinesia and its effects. This study used a longitudinal interventional design without a control group to explore the effects of a four-week agility training with light equipment on balance and general mobility in patients with PD, as well as to assess motivational properties. Methods: Seven individuals with PD of the motor subtype “akinetic–rigid” participated in this study. Each participant received training three times per week for four weeks. The training session consisted of five rounds; in each round, participants had to turn off 20 lights. Measurements were performed one and a half weeks before training, at the beginning of the program, and at the end of the program. Balance was assessed with Mini-BESTest, general mobility with Timed Up and Go (TUG), transfer skills with 5× Sit to Stand, walking speed with the 10 m walking test, and the ability to turn on a spot with the 360° Turn Test. Motivational aspects of training were assessed after each training session, with scoring on a scale of 0–10. Results: The training significantly improved overall balance (p < 0.001), especially reactive postural control, sensory orientation, and dynamic gait, while anticipatory balance remained unchanged. Turning ability improved, but mobility, transfer ability, and walking speed did not. Motivation remained consistently high across participants. Conclusions: A four-week light-based agility training program can improve balance and turning ability in people with PD and appears to be motivating. However, no clear effects were found for general mobility, transfer skills, or walking speed. Given the small sample size and absence of a control group, these findings should be interpreted with caution. Full article
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17 pages, 255 KB  
Article
Exploring Pregnant Women’s Perceptions and Experiences of Adiposity Measurements in Routine Antenatal Care: A Qualitative Study
by Susan C. Lennie, Luke Vale, M. Dawn Teare, Raya Vinogradov and Nicola Heslehurst
Healthcare 2025, 13(20), 2558; https://doi.org/10.3390/healthcare13202558 - 10 Oct 2025
Abstract
Background/objectives: Maternal adiposity is a known risk factor for adverse pregnancy outcomes, yet routine antenatal care primarily relies on body mass index (BMI), which has limitations. This study aimed to explore the acceptability of incorporating a broader range of adiposity measurements into early [...] Read more.
Background/objectives: Maternal adiposity is a known risk factor for adverse pregnancy outcomes, yet routine antenatal care primarily relies on body mass index (BMI), which has limitations. This study aimed to explore the acceptability of incorporating a broader range of adiposity measurements into early pregnancy antenatal care, assessing pregnant women’s perceptions to inform implementation strategies. Methods: A qualitative study using semi-structured interviews was conducted with 14 pregnant women purposively sampled to capture variation in BMI, age, and parity. Interviews occurred approximately 4–5 months post-measurement experience. The Theoretical Framework of Acceptability (TFA) guided thematic analysis of transcribed data, with independent coding to ensure rigour. Results: Participants generally viewed the current reliance on BMI as outdated and expressed neutral to positive attitudes toward the use of more detailed adiposity measurements. Most reported little emotional discomfort with the process. However, some reflected likelihood of more body self-consciousness had it been their first pregnancy. Time involved in measurements was not seen as burdensome, however waiting between procedures was a minor inconvenience. Self-assessing body shape was described as difficult. Women emphasised the importance of choice, autonomy, and informed consent, especially in relation to partner involvement, the gender of the anthropometrist, and the nature of the procedures. Clear, advance communication and supportive explanations during appointments were seen as essential to ensuring a positive experience. Conclusions: Expanding adiposity assessments in early pregnancy is acceptable to women if implemented ethically, prioritising consent, privacy, emotional safety, and effective communication. Integration into routine care requires staff training and pre-appointment guidance. Full article
(This article belongs to the Special Issue Focus on Maternal, Pregnancy and Child Health)
17 pages, 601 KB  
Article
Regional Variations in Health Behavior Structures: A Social Determinants of Health Approach
by Seungman Lee, Sungho Yoon and Hanbeom Kim
Healthcare 2025, 13(20), 2557; https://doi.org/10.3390/healthcare13202557 - 10 Oct 2025
Abstract
Background/Objectives: This study analyzes how Health and Fitness Awareness influences quality of life (QOL), mediated by Health Behavior Action and Safety Behavior Practice, within the Social Determinants of Health (SDH) framework. Methods: Accordingly, a multi-group structural equation modeling (SEM) analysis was conducted on [...] Read more.
Background/Objectives: This study analyzes how Health and Fitness Awareness influences quality of life (QOL), mediated by Health Behavior Action and Safety Behavior Practice, within the Social Determinants of Health (SDH) framework. Methods: Accordingly, a multi-group structural equation modeling (SEM) analysis was conducted on the data obtained from 6601 respondents selected from the 2024 National Sports for All Survey, jointly administered by the Ministry of Culture, Sports and Tourism and Korea Sports Promotion Foundation. Nationally representative survey data was collected across metropolitan, mid-sized, and rural areas in South Korea. The analysis further examined whether the structural pathways differed by regional size. Outcome measures included path coefficients and latent mean differences among Health and Fitness Awareness, Health Behavior Action, Safety Behavior Practice, and Improvement in QOL. Results: The analysis revealed that Health and Fitness Awareness significantly influenced both Health Behavior Action and Safety Behavior Practice; these, in turn, had positive effects on Improvement in QOL. Moreover, the structural pathways differed by region: whereas Health Behavior Action played a more significant mediating role in large cities, Safety Behavior Practice was more prominent in mid-sized ones. Conclusions: These findings are expected to provide a theoretical and policy-based foundation for region-specific health promotion strategy development and health equity advancement. Full article
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14 pages, 823 KB  
Article
Preparedness for the Digital Transition in Healthcare: Insights from an Italian Sample of Professionals
by Valentina Elisabetta Di Mattei, Gaia Perego, Francesca Milano, Federica Cugnata, Chiara Brombin, Antonio Catarinella, Francesca Gatti, Lavinia Bellamore Dettori, Jennifer Tuzii and Elena Bottinelli
Healthcare 2025, 13(20), 2556; https://doi.org/10.3390/healthcare13202556 (registering DOI) - 10 Oct 2025
Abstract
Background: The digital transition is reshaping healthcare systems through the adoption of telemedicine and electronic health records (EHRs). While these innovations enhance efficiency and access, their implementation unfolds within overstretched organizational settings characterized by workforce shortages, bureaucratic demands, and heightened psychosocial risks. Burnout, [...] Read more.
Background: The digital transition is reshaping healthcare systems through the adoption of telemedicine and electronic health records (EHRs). While these innovations enhance efficiency and access, their implementation unfolds within overstretched organizational settings characterized by workforce shortages, bureaucratic demands, and heightened psychosocial risks. Burnout, impostor syndrome, and the quality of organizational support have thus become pivotal constructs in understanding healthcare professionals’ digital preparedness. Methods: A cross-sectional online survey was conducted among 111 professionals employed at two San Donato Group facilities in Bologna, Italy. The battery included socio-demographic and occupational data, perceptions of digitalization, and validated instruments: the Maslach Burnout Inventory (MBI), the Clance Impostor Phenomenon Scale (CIPS), and the Work Organization Assessment Questionnaire (WOAQ). Descriptive analyses were complemented by Classification and Regression Trees (CART) to identify predictors of perceived digital preparedness. Results: Most respondents (88%) acknowledged the relevance of digitalization, yet 18% felt unprepared, especially women and administrative staff. Burnout levels were high, with 51% reporting emotional exhaustion, most notably among nurses and female participants. Impostor syndrome affected 43% of the sample, with nurses exhibiting the highest prevalence. CART analysis identified emotional exhaustion, impostor syndrome, and age as principal discriminators of digital preparedness. Conclusions: Our findings highlight the role of emotional exhaustion, impostor syndrome, and age in shaping perceived digital preparedness, underscoring the need for tailored training and supportive practices to ensure a sustainable digital transition. Full article
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12 pages, 345 KB  
Article
Gambling Behaviour, Motivations, and Gender Differences Among Medical Students in Poland: Survey-Based Study
by Dominik Krupka, Jerzy Brzoza, Olgierd Cugier, Maciej Szwajkowski, Jagoda Szwach, Magdalena Raczkowska, Adam Chełmoński and Julia Drewniowska
Healthcare 2025, 13(20), 2555; https://doi.org/10.3390/healthcare13202555 - 10 Oct 2025
Abstract
Background: In psychiatry, gambling is classified as an addiction-related disorder and is characterized by a persistent, problematic pattern of behaviour that leads to significant distress and functional impairment. This study aims to explore the prevalence, underlying motivations, and potential academic impact of gambling [...] Read more.
Background: In psychiatry, gambling is classified as an addiction-related disorder and is characterized by a persistent, problematic pattern of behaviour that leads to significant distress and functional impairment. This study aims to explore the prevalence, underlying motivations, and potential academic impact of gambling behaviours among medical students in Poland. Methods: An anonymous online survey was conducted among students from multiple medical universities across Poland. Participants completed a sociodemographic questionnaire and the South Oaks Gambling Screen (SOGS). Respondents who reported any past or current gambling activity were additionally asked about their motivations and potential academic consequences. Results: The study included 281 participants. Active or past gambling was reported by 55% of respondents, with men significantly more likely to gamble currently. Women were predominantly non-problem gamblers, whereas men more often scored within the “some problems” range on the SOGS. Motivations also differed: women emphasised financial gain, while men cited fun, socializing, and competition. Lottery and scratch cards were most popular overall, though men preferred skill-based and casino activities. Conclusions: Although participants showed relatively low levels of gambling involvement, their risk of developing pathological gambling was comparable to that of the general population. Gender influenced involvement in different gambling patterns. Full article
(This article belongs to the Special Issue Psychological Diagnosis and Treatment of People with Mental Disorders)
18 pages, 597 KB  
Article
Upper Cervical Manipulation and Manual Massage Do Not Modulate Sympatho-Vagal Balance or Blood Pressure in Women: A Randomized, Placebo-Controlled Clinical Trial
by Estêvão Rios Monteiro, Linda S. Pescatello, Gustavo Henrique Garcia, Alexandre Gonçalves de Meirelles, Francine de Oliveira, Rafael Cotta de Souza, Leandro Alberto Calazans Nogueira, Agnaldo José Lopes and Daniel Moreira-Gonçalves
Healthcare 2025, 13(20), 2554; https://doi.org/10.3390/healthcare13202554 - 10 Oct 2025
Abstract
Objectives: To compare the acute effects of upper cervical manipulation (CM) and manual massage (MM) to simulated CM (Sham) and Control conditions (Control) on heart rate variability (HRV) and blood pressure (BP) responses in women with non-elevated BP. Methods: A single-blind, [...] Read more.
Objectives: To compare the acute effects of upper cervical manipulation (CM) and manual massage (MM) to simulated CM (Sham) and Control conditions (Control) on heart rate variability (HRV) and blood pressure (BP) responses in women with non-elevated BP. Methods: A single-blind, four-arm, parallel-group, randomized, crossover, placebo-controlled trial recruited 15 apparently healthy women with non-elevated BP who visited the lab on four occasions with 48 h intervals to ensure adequate washout between interventions. A Latin square randomization approach was employed to assign participants to one of four experimental conditions: (1) Control: Rest without intervention; (2) CM: Bilateral high-velocity, low-amplitude manipulation of the upper cervical spine (C0–C2); (3) MM: A single 120 s session of MM release applied unilaterally to the anterior and posterior thigh, posterior lower leg, and lumbar musculature; or (4) Sham: Mimicking the positioning used in CM without the application of thrust manipulation. In each experiment, HRV, systolic and diastolic BP were measured at rest (Baseline) and every 15 min for 60 min after each intervention. All procedures were performed in the morning to avoid any confounding circadian rhythm effect on HRV and BP. Results: We found significant increases within conditions for RMSSDms (Control: Post-0 (p = 0.032), Post-15 (p = 0.023); Sham: Post-15 (p = 0.014); CM: Post-15 (p = 0.027)); SDNNms (Control: Post-45 (p = 0.037); CM: Post-45 (p = 0.014) and Post-60 (p = 0.019)); PNN50% (CM: Post-0 (p = 0.044), Post-15 (p = 0.044) and Post-45 (p = 0.019)); LF Power (ms2) (CM: Post-60 (p = 0.001)), and LF/HF ratio (MM: Post-60 (p = 0.022). Conclusions: Although no statistically significant between-condition differences were detected, within-condition changes with moderate-to-large effect sizes suggest potential clinical relevance of CM and MM. These preliminary findings emphasize the importance of effect sizes and may indicate greater translational significance in populations with non-elevated cardiovascular risk. Full article
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32 pages, 1428 KB  
Review
Healthcare 5.0-Driven Clinical Intelligence: The Learn-Predict-Monitor-Detect-Correct Framework for Systematic Artificial Intelligence Integration in Critical Care
by Hanene Boussi Rahmouni, Nesrine Ben El Hadj Hassine, Mariem Chouchen, Halil İbrahim Ceylan, Raul Ioan Muntean, Nicola Luigi Bragazzi and Ismail Dergaa
Healthcare 2025, 13(20), 2553; https://doi.org/10.3390/healthcare13202553 - 10 Oct 2025
Abstract
Background: Healthcare 5.0 represents a shift toward intelligent, human-centric care systems. Intensive care units generate vast amounts of data that require real-time decisions, but current decision support systems lack comprehensive frameworks for safe integration of artificial intelligence. Objective: We developed and validated the [...] Read more.
Background: Healthcare 5.0 represents a shift toward intelligent, human-centric care systems. Intensive care units generate vast amounts of data that require real-time decisions, but current decision support systems lack comprehensive frameworks for safe integration of artificial intelligence. Objective: We developed and validated the Learn–Predict–Monitor–Detect–Correct (LPMDC) framework as a methodology for systematic artificial intelligence integration across the critical care workflow. The framework improves predictive analytics, continuous patient monitoring, intelligent alerting, and therapeutic decision support while maintaining essential human clinical oversight. Methods: Framework development employed systematic theoretical modeling integrating Healthcare 5.0 principles, comprehensive literature synthesis covering 2020–2024, clinical workflow analysis across 15 international ICU sites, technology assessment of mature and emerging AI applications, and multi-round expert validation by 24 intensive care physicians and medical informaticists. Each LPMDC phase was designed with specific integration requirements, performance metrics, and safety protocols. Results: LPMDC implementation and aggregated evidence from prior studies demonstrated significant clinical improvements: 30% mortality reduction, 18% ICU length-of-stay decrease (7.5 to 6.1 days), 45% clinician cognitive load reduction, and 85% sepsis bundle compliance improvement. Machine learning algorithms achieved an 80% sensitivity for sepsis prediction three hours before clinical onset, with false-positive rates below 15%. Additional applications demonstrated effectiveness in predicting respiratory failure, preventing cardiovascular crises, and automating ventilator management. Digital twins technology enabled personalized treatment simulations, while the integration of the Internet of Medical Things provided comprehensive patient and environmental surveillance. Implementation challenges were systematically addressed through phased deployment strategies, staff training programs, and regulatory compliance frameworks. Conclusions: The Healthcare 5.0-enabled LPMDC framework provides the first comprehensive theoretical foundation for systematic AI integration in critical care while preserving human oversight and clinical safety. The cyclical five-phase architecture enables processing beyond traditional cognitive limits through continuous feedback loops and system optimization. Clinical validation demonstrates measurable improvements in patient outcomes, operational efficiency, and clinician satisfaction. Future developments incorporating quantum computing, federated learning, and explainable AI technologies offer additional advancement opportunities for next-generation critical care systems. Full article
(This article belongs to the Section Artificial Intelligence in Healthcare)
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21 pages, 5367 KB  
Article
Spinal Cord Injury Epidemiology and Causes: A Worldwide Analysis with 2050 Projections
by Minyoung Kim, Woonyoung Jeong, Suho Jang, Jin Hoon Park, Youngoh Bae and Seung Won Lee
Healthcare 2025, 13(20), 2552; https://doi.org/10.3390/healthcare13202552 - 10 Oct 2025
Abstract
Background/Objectives: The global burden of spinal cord injury (SCI) is increasing due to aging populations and persistent regional disparities, highlighting an urgent need for updated epidemiological data. This study quantifies the global, regional, and national burden of SCI from 1990 to 2021 [...] Read more.
Background/Objectives: The global burden of spinal cord injury (SCI) is increasing due to aging populations and persistent regional disparities, highlighting an urgent need for updated epidemiological data. This study quantifies the global, regional, and national burden of SCI from 1990 to 2021 and projects its prevalence to 2050. Methods: Using data from the Global Burden of Disease (GBD) 2021 study, we estimated age-, sex-, and location-specific prevalence and years lived with disability (YLDs). Projections were developed using sociodemographic modeling, with analyses including Bayesian meta-regression (DisMod-MR 2.1) and Das Gupta decomposition. Results: In 2021, approximately 14.5 million people worldwide were living with SCI, including 7.30 million with neck-level and 7.22 million with below-neck-level injuries. The age-standardized prevalence per 100,000 people was 88 for neck-level SCI and 95 for below-neck-level SCI. Although age-standardized rates declined slightly from 1990 (−0.17% for neck-level and −0.18% for below-neck-level), the absolute burden increased substantially. This increase was particularly prominent in East Asia and low- and middle-income countries. The highest prevalence was observed in men aged 50–64 years. Projections indicate that global SCI cases will exceed 14.5 million by 2050. Conclusions: These findings underscore the growing absolute burden of SCI. Targeted prevention strategies, enhanced rehabilitation services, and equitable healthcare access are crucial to mitigate long-term disability and improve the quality of life for affected populations worldwide. Full article
(This article belongs to the Topic Public Health and Healthcare in the Context of Big Data)
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13 pages, 250 KB  
Article
Job Satisfaction, Quality of Life, and Turnover Intention Among Nurses: A Comparative Study of Pattern-Based and Rotating Shift Schedules
by Yu Jin Jung and Haejin Kim
Healthcare 2025, 13(20), 2551; https://doi.org/10.3390/healthcare13202551 - 10 Oct 2025
Abstract
Background/Objectives: Shift work among nurses is associated with adverse outcomes, such as low job satisfaction, reduced quality of life, and high turnover intention. A pattern-based shift system has recently been introduced to provide more predictable and regular schedules. However, empirical research directly comparing [...] Read more.
Background/Objectives: Shift work among nurses is associated with adverse outcomes, such as low job satisfaction, reduced quality of life, and high turnover intention. A pattern-based shift system has recently been introduced to provide more predictable and regular schedules. However, empirical research directly comparing the pattern-based shift system with traditional rotating shifts is lacking. Therefore, this study compared job satisfaction, quality of life, and turnover intention between nurses working under a pattern-based shift system and those working under a traditional rotating shift system. Methods: In total, 112 nurses (56 on a rotating shift and 56 on a pattern-based shift) were surveyed in this cross-sectional study. Job satisfaction was assessed using the Job Satisfaction Scale for Clinical Nurses, specifically developed for Korean nurses. Quality of life was measured using the Scale for Korean Adults’ Quality of Life. The Turnover Intention Measurement Tool, developed for Korean nurses, was used to evaluate turnover intention. Results: Nurses working under a pattern-based shift system reported significantly higher job satisfaction and quality of life than those in a traditional rotating shift system. No significant difference in turnover intention was observed between the two groups. Conclusions: Pattern-based shift systems were associated with higher job satisfaction and quality of life than traditional rotating shift systems; however, their impact on turnover intention was not significant. These findings highlight the need for comprehensive strategies in scheduling reform, as schedule predictability may improve nurses’ job satisfaction and quality of life but appears insufficient to reduce turnover intention, which is likely shaped by broader organizational and psychosocial factors. Full article
18 pages, 270 KB  
Article
Understanding the Support Needs of Family Caregivers Living with Severe Developmental Disability: An Interpretive Phenomenological Analysis
by Anna McStravick and Rosanna Cousins
Healthcare 2025, 13(20), 2550; https://doi.org/10.3390/healthcare13202550 - 10 Oct 2025
Abstract
Background/Objectives: Living with a disabled family member has extensive implications for the whole family involved in their care, and there is dependency on healthcare support for maintaining quality of life. This qualitative study, conducted in Northern Ireland, investigated the support needs of different [...] Read more.
Background/Objectives: Living with a disabled family member has extensive implications for the whole family involved in their care, and there is dependency on healthcare support for maintaining quality of life. This qualitative study, conducted in Northern Ireland, investigated the support needs of different family members living with a severely impaired individual across the lifespan. A key objective was to identify support needs for intervention. Methods: In-depth semi-structured interviews were conducted to obtain data from eight mothers, fathers, sisters and brothers of a profoundly disabled child or sibling. Data was analyzed using Interpretive Phenomenological Analysis, allowing for the application of double hermeneutic in which the researchers derived meaning from the lived experiences of participants. Results: The analysis yielded five themes in total. Three themes were related to gaps in healthcare systems: Support Needs in Childhood, Support in Transition into Adult Services, and Worry for the Future; and two themes were linked with support needs: Associative Disability in Family Members; and Stigma. All family members had caregiving roles, and these had similarities and differences according to the relationship with the care-receiver. Participants recognized their families were survivors, however maintained a family tragedy rather than positive change outlook. Conclusions: Recommendations derived from the findings to alleviate the stressors of the situation for family members include increasing community support and age-related respite facilities. Additionally, improving and enhancing education of disabilities in schools, and immersing and further integrating individuals with disability into society, will alleviate the alienation, isolation and loneliness experienced by family members. Full article
(This article belongs to the Special Issue Healthcare Practice in Community)
31 pages, 2308 KB  
Article
Digital Transformation of Medical Services in Romania: Does the Healthcare System Meet the Current Needs of Patients?
by Ioana-Marcela Păcuraru, Ancuța Năstac, Andreea Zamfir, Ștefan Sebastian Busnatu, Octavian Andronic and Andrada-Raluca Artamonov
Healthcare 2025, 13(20), 2549; https://doi.org/10.3390/healthcare13202549 - 10 Oct 2025
Abstract
Background: The digitalization of medical services is promoted as a solution for improving access, quality, and efficiency within healthcare systems. In this context, the study investigates the extent to which digitalization in Romania meets the current needs of patients through a convergent [...] Read more.
Background: The digitalization of medical services is promoted as a solution for improving access, quality, and efficiency within healthcare systems. In this context, the study investigates the extent to which digitalization in Romania meets the current needs of patients through a convergent analysis of user perceptions and managerial perspectives. Based on the specialized literature, the research tests two hypotheses: (H1) the implementation of digital technologies significantly contributes to improving the quality of medical services and operational efficiency; (H2) digitalization has a positive impact on patient satisfaction by facilitating access to care and improving communication with medical personnel. Methods: The study adopted methodology is cross-sectional and mixed, including an online mixed-methods questionnaire for patients, distributed between 6 and 14 May 2025, and a qualitative questionnaire with open-ended questions distributed via e-mail to managers from public hospitals through The Administration of Hospitals and Medical Services of Bucharest, between 3 and 24 March 2025. Results: In total, 125 patients and 15 hospital managers participated in the study. Statistical analysis (χ2, ordinal regression) and data triangulation highlight a predominantly positive, yet heterogeneous, patient perception of digitalization, with Hypothesis H1 only partially supported (weak, inconsistent, and in some cases negative associations between technology use and perceived service quality). By contrast, H2 was robustly validated, with patient satisfaction strongly linked to tangible benefits, particularly easier access and online appointment scheduling. However, use remains limited to administrative functions, while advanced technologies such as telemedicine or electronic health records are poorly adopted. From an institutional perspective, hospitals predominantly use IT systems for internal purposes, without real patient access to their own data, no interoperability between medical units, and marginal implementation of telemedicine. This reveals a significant gap between user perception and organizational realities, emphasizing the lack of a patient-oriented digital infrastructure. Conclusions: The results highlight the potential of digitalization to enhance patient experience and service efficiency, while also pointing out structural limitations that hinder the full realization of this potential. Patient satisfaction is strongly associated with tangible benefits, particularly easier access and online scheduling, whereas the effect on perceived quality is weaker and sometimes inconsistent. There are significant disparities in digitalization levels between healthcare providers, perceived by patients as public–private differences, and gaps among public hospitals are also confirmed by managerial data. These findings suggest that a successful digital transformation of the medical system in Romania must address both technological infrastructure gaps and organizational barriers, within a coordinated national strategy that ensures interoperability, patient-centered design, and sustainable implementation. Full article
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20 pages, 2127 KB  
Systematic Review
The Diagnostic Performance of Transvaginal Ultrasound for Posterior Compartment Endometriosis Compared to Laparoscopic and Histopathological Findings: A Systematic Review
by Roxana-Denisa Capraș, Iulia Clara Badea, Mădălina Moldovan, Adriana Ioana Gaia-Oltean, Alexandru-Florin Badea and Teodora Telecan
Healthcare 2025, 13(20), 2548; https://doi.org/10.3390/healthcare13202548 - 10 Oct 2025
Abstract
Background: Deep infiltrating endometriosis (DIE) frequently affects the posterior pelvic compartment, where accurate non-invasive imaging is essential for diagnosis and surgical planning. Aim: This systematic review evaluates the diagnostic performance of transvaginal ultrasound (TVUS) in detecting posterior compartment DIE, specifically rectosigmoid lesions, uterosacral [...] Read more.
Background: Deep infiltrating endometriosis (DIE) frequently affects the posterior pelvic compartment, where accurate non-invasive imaging is essential for diagnosis and surgical planning. Aim: This systematic review evaluates the diagnostic performance of transvaginal ultrasound (TVUS) in detecting posterior compartment DIE, specifically rectosigmoid lesions, uterosacral ligament involvement, and pouch of Douglas obliteration. Material and Methods: A comprehensive literature search of PubMed, Scopus, and Web of Science was performed for studies published between 2015 and 2025. Eligible studies assessed the accuracy of TVUS for posterior compartment DIE using laparoscopy and histology as reference standards. Data on sensitivity, specificity, and overall diagnostic accuracy were extracted or derived. The study’s quality was evaluated using the QUADAS-2 tool. Results: Thirty eligible studies were included. The mean sensitivities and specificities reported in the included studies reached 83.05% and 90.53% for rectosigmoid disease, 78.07% and 90.49% for uterosacral ligament involvement, and 79.58% and 89.75% for pouch of Douglas obliteration, respectively. Adjunctive techniques such as gel sonovaginography, rectal water contrast, or saline instillation into the pouch of Douglas were described, but their use was inconsistent. Marked heterogeneity in patient preparation, scanning protocols, and reporting limited comparability across studies. Despite this, TVUS demonstrated diagnostic performance within a similar range to that reported for MRI in prior systematic reviews, with the advantages of lower cost, accessibility, and integration into routine gynecological practice. Conclusions: TVUS is consistently reported as a reliable and cost-effective imaging modality and, in line with international guidelines, should be considered the first-line option for posterior compartment DIE, though further standardization of scanning and reporting protocols is needed to optimize reproducibility and clinical utility. Full article
(This article belongs to the Special Issue Diagnosis and Therapeutic Advances in Endometriosis)
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