Healthcare

9 pages, 600 KB

Open AccessProject Report

Transformation of Teamwork and Leadership into Obstetric Safety Culture with Crew Resource Management Programme in a Decade

by Eric Hang-Kwong So, Victor Kai-Lam Cheung, Ching-Wah Ng, Chao-Ngan Chan, Shuk-Wah Wong, Sze-Ki Wong, Martin Ka-Wing Lau and Teresa Wei-Ling Ma

Healthcare 2025, 13(20), 2564; https://doi.org/10.3390/healthcare13202564 (registering DOI) - 11 Oct 2025

Abstract

In parallel with technical training on knowledge and skills of task-specific medical or surgical procedures, wide arrays of soft skills training would contribute to obstetric safety in the contemporary healthcare setting. This article, as a service evaluation, explored the effect of a specialty-based [...] Read more.

In parallel with technical training on knowledge and skills of task-specific medical or surgical procedures, wide arrays of soft skills training would contribute to obstetric safety in the contemporary healthcare setting. This article, as a service evaluation, explored the effect of a specialty-based Crew Resource Management (CRM) training series that transforms the concept of human factors into sustainable measures in fostering clinical safety culture of the Department of Obstetrics and Gynaecology (O&G) in the Queen Elizabeth Hospital. Within the last decade, a tri-phasic programme has been implemented by an inter-professional workgroup which consists of a consultant anaesthesiologist, medical specialists and departmental operations manager from O&G, a nurse simulation specialist, hospital administrators, and a research psychologist. (1) Phase I identified different patterns of attitudinal changes (in assertiveness, communication, leadership, and situational awareness, also known as “ACLS”) between doctors and nurses and between generic and specialty-based sessions for curriculum planning. (2) Phase II evaluated how these specific behaviours changed over 3 months following CRM training tailored for frontline professionals in O&G. (3) Phase III examined the coping style in conflict management and the level of sustainability in self-efficacy over 3 months following specialty-based CRM training. The findings showed the positive impacts of O&G CRM training on healthcare professionals’ increased attitude and behaviour in “ACLS” by 22.7% at a p < 0.05 level, character strengths in conflict management, and non-inferior or sustained level of self-efficacy under tough conditions in the clinical setting up to 3 months after training. As a way forward, incorporating a scenario-based O&G CRM programme into existing skills-based training is expected to change service framework with an innovative approach. In addition, exploring actual clinical outcomes representing a higher level of organisational impacts can be a strategic direction for further studies on the effect of this practical and educational approach on obstetric safety culture. Full article

(This article belongs to the Special Issue Preventive and Management Strategies in Modern Obstetrics)

4 pages, 150 KB

Open AccessCase Report

Venous Thromboembolism Occurrence in the Setting of Nexplanon Insertion with Multiple Risk Factors: A Case Report

by Jennifer Chin and Sarah Taga

Healthcare 2025, 13(20), 2563; https://doi.org/10.3390/healthcare13202563 (registering DOI) - 11 Oct 2025

Abstract

Postpartum patients experience a 60-fold increased risk for venous thromboembolism (VTE). We present a postpartum patient with severe pre-eclampsia, gestational diabetes, and a recent Cesarean delivery, who was diagnosed with a VTE hours after a Nexplanon insertion on venous duplex ultrasound. She was [...] Read more.

Postpartum patients experience a 60-fold increased risk for venous thromboembolism (VTE). We present a postpartum patient with severe pre-eclampsia, gestational diabetes, and a recent Cesarean delivery, who was diagnosed with a VTE hours after a Nexplanon insertion on venous duplex ultrasound. She was started on anticoagulation, had the Nexplanon removed, and recovered well. This case highlights the importance of clinical suspicion for VTE in the postpartum period, presenting a postpartum VTE coinciding with a subdermal implant placement. Full article

26 pages, 434 KB

Open AccessArticle

Workplace Violence, Self-Perceived Resilience and Associations with Turnover Intention Among Emergency Department Nurses: A Cross-Sectional Study

by Anna T. El Riz, Maria Dimitriadou and Maria Karanikola

Healthcare 2025, 13(20), 2562; https://doi.org/10.3390/healthcare13202562 (registering DOI) - 11 Oct 2025

Abstract

Background/Objectives: Workplace violence remains an important vocational psycho-social risk for nurses employed in the emergency department (ED). We investigated the characteristics of workplace violence against ED nurses, and associations with self-assessed resilience, socio-demographic and vocational parameters, including turnover intention. Methods: ED [...] Read more.

Background/Objectives: Workplace violence remains an important vocational psycho-social risk for nurses employed in the emergency department (ED). We investigated the characteristics of workplace violence against ED nurses, and associations with self-assessed resilience, socio-demographic and vocational parameters, including turnover intention. Methods: ED nurses employed in all public hospitals in the Republic of Cyprus (RC) participated. After obtaining informed consent, data were collected using census sampling (January–June 2024) via the translated 2016 Italian National Survey on Violence towards Emergency Nurses Questionnaire (QuINVIP16) for investigating workplace violence characteristics, and the Connor-Davidson Resilience Scale (CD-RISC-25) for assessing self-perceived resilience. Results: A total of 132 nurses (53.0% response rate) participated. Verbal violence was reported by 70.5% to 92.4% of participants. Long waiting times, overcrowded EDs, and perception of inadequate attention from healthcare professionals were reported as the primary triggers for violence towards participants by patients/visitors. One-third of participants reported that violence-reporting systems were unclear, while 1 out of 4 reported inadequate safety measures against violence. Participants with higher scores of self-perceived resilience were less likely to report turnover intention due to workplace violence (p < 0.001), while those with lower self-perceived resilience reported a significant decrease in work motivation (p = 0.005). Those who experienced decreased work motivation after exposure to a violent episode were more likely to consider a) leaving the profession [OR (95%CI): 79.1(17.7–353.2); p < 0.01], and b) moving to a different work setting [OR (95%CI): 17.0(3.8–76.2); p < 0.01], and actually applying to be transferred to a different work setting [OR (95%CI): 19.6(4.2–91.5); p < 0.01]. Moreover, those who had not attended communication skills training were 4 times more likely to consider leaving the profession following exposure to violence [OR (95%CI): 4.2(1.1–16.2); p = 0.04]. Conclusions: This study is among the few to link workplace violence with both resilience and actual turnover behaviors among emergency nurses, in general and particularly in the post-pandemic era. By showing how personal resilience in the face of violence is shaped by organizational support, such as reporting systems and training, the present findings move beyond individuals-level explanations, and highlight workplace violence as a systematic administrative challenge. This insight represents an important advance in current knowledge, and calls for multifaceted interventions that strengthen both personal and institutional capacity to address violence. Full article

(This article belongs to the Special Issue Enhancing Patient Safety in Critical Care Settings)

18 pages, 492 KB

Open AccessArticle

Nurse-Facilitated Self-Management in Peritoneal Dialysis: A Cross-Sectional Study from Riyadh, Saudi Arabia

by Abdulaziz M. Alodhialah and Shorok Hamed Alahmedi

Healthcare 2025, 13(20), 2561; https://doi.org/10.3390/healthcare13202561 (registering DOI) - 11 Oct 2025

Abstract

Background: Peritoneal dialysis (PD) depends on patients’ self-management abilities, supported by nursing interventions that extend beyond technical skills to include psychosocial and educational domains. Evidence from Saudi Arabia on how these behaviors relate to clinical and quality-of-life outcomes remains limited. Aim: [...] Read more.

Background: Peritoneal dialysis (PD) depends on patients’ self-management abilities, supported by nursing interventions that extend beyond technical skills to include psychosocial and educational domains. Evidence from Saudi Arabia on how these behaviors relate to clinical and quality-of-life outcomes remains limited. Aim: To assess self-management behaviors among adult PD patients, examine their associations with clinical and quality-of-life outcomes, and explore the mediating role of emotional well-being, with implications for nursing practice. Methods: A descriptive cross-sectional study was conducted among 158 adult PD patients at King Saud University-affiliated centers in Riyadh. Validated Arabic versions of the Chronic Illness Self-Management Scale and KDQOL-SF were administered. Clinical indicators were extracted from medical records. Data were analyzed using descriptive statistics, t-tests, multivariate linear regression, and mediation analysis. Results: Technical skills achieved the highest self-management scores (mean 3.78 ± 0.62), while emotional coping was lowest (mean 2.71 ± 0.69). Participants with higher self-management had fewer hospitalizations (0.9 ± 0.5 vs. 1.6 ± 0.8, p = 0.01), higher serum albumin (3.60 ± 0.56 vs. 3.44 ± 0.61 g/dL, p = 0.04), and better emotional well-being (60.1 ± 14.9 vs. 55.3 ± 12.4, p = 0.03) than their counterparts. Educational level (β = 0.208, p = 0.001) and emotional well-being (β = 0.197, p = 0.001) were independent predictors of self-management, with partial mediation by emotional well-being (indirect β = 0.062, p = 0.004). Conclusions/Clinical Implications: Optimizing nursing support for PD patients requires moving beyond technical instruction to address health literacy, emotional resilience, and culturally sensitive education. Nurse-led interventions integrating psychosocial support with skill-building may enhance self-management, reduce hospitalizations, and improve quality of life in PD populations. Full article

(This article belongs to the Special Issue Real-Life Advances in Chronic Kidney Disease)

15 pages, 409 KB

Open AccessArticle

Health Literacy and Medication Adherence Among Low-Income Older Adults in the Inner Center of Portugal: A Questionnaire-Based Study

by Carla Perpétuo, Ana I. Plácido, Alexandra Monteiro, Ramona Mateos-Campos, Maria Teresa Herdeiro and Fátima Roque

Healthcare 2025, 13(20), 2560; https://doi.org/10.3390/healthcare13202560 (registering DOI) - 11 Oct 2025

Abstract

Introduction: Health literacy (HL) is a key determinant of health outcomes, particularly among vulnerable populations such as low-income older adults. Limited HL is associated with poor understanding of medication instructions and lower medication adherence, which can compromise therapeutic success. This study aims to [...] Read more.

Introduction: Health literacy (HL) is a key determinant of health outcomes, particularly among vulnerable populations such as low-income older adults. Limited HL is associated with poor understanding of medication instructions and lower medication adherence, which can compromise therapeutic success. This study aims to assess the levels of HL and medication adherence among low-income older adults and to analyse the relationship between HL, medication adherence, and other determinants. Methods: A cross-sectional study was conducted among low-income older adults in Portugal’s Beira and Serra Estrela Region. HL was assessed using the European Health Literacy Survey Questionnaire (HLS-EU-PT), and medication adherence was measured with the Adherence to Treatment Measure (MAT) scale. Descriptive statistics, Spearman correlations, ordinal logistic regression, and linear regression were used to analyse associations between HL, adherence, and sociodemographic and health factors. Results: Of 196 participants, most had problematic or inadequate HL (87.8%). Medication adherence was relatively high (mean = 5.37, SD = 0.54). HL was positively associated with medication adherence (R = 0.260, p < 0.001), education (R = 0.277, p < 0.001), and ability to pay expenses (R = 0.235, p = 0.002) and negatively with age (R = −0.179, p = 0.019), poor health status (R = −0.237, p = 0.002), and difficulty affording medication (R = −0.389, p < 0.001). Completion of the third cycle of primary education predicted higher HL (OR = 1.939, 95% CI: 0.088–3.790, p = 0.040); the ability to pay expenses predicted better adherence (B = 0.101, 95% CI: 0.014–0.187, p = 0.022). Conclusions: Low HL remains a significant barrier among low-income older adults in Portugal, despite generally high medication adherence. Education and financial stability are key determinants to HL and adherence. Interventions should integrate HL promotion with efforts to reduce socioeconomic barriers and support medication management in the vulnerable populations. Full article

(This article belongs to the Special Issue Aging Population and Healthcare Utilization)

► Show Figures

Figure 1

8 pages, 371 KB

Open AccessArticle

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

(This article belongs to the Special Issue Physiotherapy and Occupational Therapy for People with Parkinson’s Disease)

► Show Figures

Figure 1

17 pages, 255 KB

Open AccessArticle

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

Open AccessArticle

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

► Show Figures

Figure 1

14 pages, 823 KB

Open AccessArticle

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

► Show Figures

Figure 1

12 pages, 345 KB

Open AccessArticle

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

Open AccessArticle

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

► Show Figures

Figure 1

32 pages, 1428 KB

Open AccessReview

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)

► Show Figures

Figure 1

21 pages, 5367 KB

Open AccessArticle

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)

► Show Figures

Graphical abstract

13 pages, 250 KB

Open AccessArticle

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

Open AccessArticle

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

Open AccessArticle

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

(This article belongs to the Special Issue The Role of Digitalization in Healthcare Within the National Health System: Opportunities and Challenges for a More Efficient System)

► Show Figures

Figure 1

20 pages, 2127 KB

Open AccessSystematic 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)

► Show Figures

Figure 1

12 pages, 237 KB

Open AccessArticle

Moral Distress in Ethical Dilemmas: A Comparative Study of Medical Students and Physicians

by George-Dumitru Constantin, Bogdan Hoinoiu, Ioana Veja, Crisanta-Alina Mazilescu, Teodora Hoinoiu, Ruxandra Elena Luca, Ioana Roxana Munteanu and Roxana Oancea

Healthcare 2025, 13(19), 2547; https://doi.org/10.3390/healthcare13192547 - 9 Oct 2025

Abstract

Background: Ethical dilemmas and the moral distress they generate are central challenges in healthcare practice and professional identity formation. While moral reasoning has been widely studied, comparative evidence on how medical students and practicing physicians approach ethical dilemmas remains scarce in Eastern [...] Read more.

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

(This article belongs to the Special Issue Ethical Dilemmas and Moral Distress in Healthcare)

12 pages, 246 KB

Open AccessArticle

Applying the WHO ICF Framework to Fetal Alcohol Spectrum Disorder (FASD): A Forensic and Clinical Perspective on Disability Assessment and Patient Support

by Davide Ferorelli, Francesco Calò, Gianmarco Sirago, Dania Comparcini, Filippo Gibelli, Francesco Sessa, Marco Carotenuto, Biagio Solarino and Monica Salerno

Healthcare 2025, 13(19), 2546; https://doi.org/10.3390/healthcare13192546 - 9 Oct 2025

Abstract

Background/Objectives: This article aims to investigate the multifaceted effects of alcohol on neurophysiopathological development from gestational stages through adult life and the consequent dynamic-relational challenges in individuals with Fetal Alcohol Spectrum Disorder (FASD). FASD, resulting from prenatal alcohol exposure (PAE), is characterized [...] Read more.

Background/Objectives: This article aims to investigate the multifaceted effects of alcohol on neurophysiopathological development from gestational stages through adult life and the consequent dynamic-relational challenges in individuals with Fetal Alcohol Spectrum Disorder (FASD). FASD, resulting from prenatal alcohol exposure (PAE), is characterized by a range of neurological, cognitive, behavioral, and sometimes physical impairments. This article explores how alcohol and its toxic metabolites cross the placenta, inducing direct cellular toxicity and epigenetic alterations that disrupt critical neurodevelopmental processes such as neurogenesis and brain circuit formation. Clinically, individuals with FASD exhibit diverse deficits in executive functioning, learning, memory, social skills, and sensory-motor abilities, leading to significant lifelong disabilities. A central focus is the application of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) criteria to comprehensively frame these disabilities. The ICF’s biopsychosocial model allows for a multidimensional assessment of impairments in body functions and structures, limitations in activities, and restrictions in participation, while also considering the crucial role of environmental factors. Methods: PubMed and Semantic Scholar databases were searched for relevant papers published in English. Results: This article highlights the utility of the ICF in creating individualized functioning profiles to guide interventions and support services, addressing the limitations of traditional assessment methods. Conclusions: While the ICF framework offers a robust approach for understanding and managing FASD, further research is essential to develop and validate FASD-specific ICF-based assessment tools to enhance support and social participation for affected individuals. Full article

Journal Description

Healthcare

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Further Information

Guidelines

MDPI Initiatives

Follow MDPI